KINGSPORT, Tenn. — Jerry Qualls had a coronary heart assault in 2022 and was rushed by ambulance to Holston Valley Medical Heart, the place he was hospitalized for per week and stored alive by a ventilator and blood pump, based on his medical information.
His spouse, Katherine Qualls, mentioned his medical doctors provided little hope. In an interview and a written criticism to the Tennessee authorities, she mentioned medical doctors at Holston Valley advised her that her husband wouldn’t qualify for a coronary heart transplant and shouldn’t be anticipated to get well.
Defiant, she insisted he be transferred hours away to a hospital in Nashville. Inside days of leaving Holston Valley, Jerry Qualls was awake and sitting upright, his spouse mentioned, and he in the end obtained a lifesaving coronary heart transplant.
“What number of households don’t know tips on how to get a switch and their liked one dies?” Katherine Qualls wrote in her criticism to the state. “My husband would have been lifeless inside a couple of days if I didn’t get him out after I did.”
Holston Valley Medical Heart is a flagship of Ballad Well being, a 20-hospital system in northeastern Tennessee and southwestern Virginia that’s the solely choice for hospital care in a big swath of Appalachia. Ballad shaped six years in the past when lawmakers in each states, in an effort to forestall hospital closures, waived federal antitrust legal guidelines so two rival well being methods may merge. The merger created the biggest state-sanctioned hospital monopoly within the nation.
Since then, Ballad has largely stored these hospitals open. However the monopoly has additionally fallen wanting about three-fourths of the quality-of-care targets set by the states during the last three fiscal years, together with failing to fulfill state benchmarks on infections, mortality, emergency room velocity, and affected person satisfaction, based on annual studies from the Tennessee Division of Well being and Ballad itself.
Some native residents have turn into cautious, afraid, or unwilling to hunt care at Ballad hospitals and should drive over an hour to succeed in different choices, based on written complaints to the Tennessee authorities and state lawmakers, public listening to testimony, and KFF Well being Information interviews performed over the previous 12 months with sufferers, members of the family, native leaders, and a few officers who as soon as publicly supported the monopoly, together with a former authorities marketing consultant and one state lawmaker. A lot of those that submitted complaints or have been interviewed allege that paper-thin staffing at Ballad hospitals and ERs is the foundation explanation for the monopoly’s quality-of-care woes.
In a two-hour interview vigorously defending the corporate, Ballad Well being CEO Alan Levine mentioned the hospitals are quickly recovering from a quality-of-care droop brought on by covid-19 and a subsequent rise in nursing turnover and employees shortages. These points affected hospitals nationwide, Levine mentioned, and weren’t associated to the Ballad merger or the monopoly it created.
Levine declined to debate particular complaints from sufferers. However he mentioned that every of the complaints referenced on this article took problem with medical selections made by medical doctors in Ballad hospitals — not “any coverage or apply at Ballad.”
“I can perceive if the sufferers, if the spouse, was upset in regards to the medical selections they made if it turned out to be incorrect,” Levine mentioned. “However that has nothing to do with the merger, OK? That’s a totally completely different problem, and it occurs in hospitals all around the nation.”
Within the interview with KFF Well being Information and within the days that adopted, Levine flexed appreciable connections to officers within the Tennessee authorities. As Levine spoke in a boardroom at Ballad’s hilltop headquarters, he was flanked by three native mayors who voiced help for the hospitals and mentioned complaints got here from a vocal minority of their constituents. Days later, Levine received two Tennessee state company administrators and a former state well being commissioner to supply emails or textual content messages supporting statements he made in the course of the interview.
Logan Grant, govt director of the Tennessee Well being Amenities Fee, which processes complaints towards hospitals for the state, mentioned in a press release prompted by Levine that Ballad hospitals are “not an outlier by way of substantiated survey findings.”
Joe Grandy, the mayor of Tennessee’s Washington County, the place Ballad is headquartered, mentioned most residents take into account the standard of care within the space “about pretty much as good because it will get.”
Brenda Getaz actually doesn’t.
Getaz, 76, who spent three a long time as a hospital official specializing in high quality requirements earlier than retiring to Washington County, mentioned she plans to maneuver to Atlanta if state governments don’t take motion to repair Ballad within the coming 12 months. Getaz mentioned native medical professionals she trusts have urged her to maneuver away so she doesn’t must depend on Ballad for care.
“I’m frightened to be taken to a Ballad facility,” she mentioned.
Glimpses of Authorities Concern
The Tennessee Division of Well being, which has probably the most direct oversight over Ballad Well being, over the previous 12 months has declined a number of interview requests to debate the hospital monopoly. Division emails reviewed by KFF Well being Information, a few of which have been obtained by way of public report requests, supply glimpses of concern contained in the company.
Emails present the well being division has tried to carry Ballad extra accountable for its high quality of care in closed-door negotiations and is investigating Holston Valley’s therapy of a latest coronary heart affected person after receiving detailed complaints from his household. In a 2023 e mail, Tennessee Well being Commissioner Ralph Alvarado reacted to a information story about low job satisfaction amongst Ballad nurses by writing: “Ouch. … What are they doing to handle this?”
In one other e mail from the identical 12 months, Alvarado praised a casual report submitted at a public listening to that concluded Ballad’s monopoly had brought on extra hurt than good. The report was written by Wally Hankwitz, a retired well being care govt who as soon as led a doctor administration firm in Kingsport. The report levied pages of criticism towards Ballad’s “sub-par” efficiency and known as for the monopoly to finish.
“THIS communication from the COPA listening to is especially good,” the well being commissioner wrote to a few of his employees. “Completely based mostly on information. I’d virtually like to listen to Ballad’s response to this.”
When requested to reply to the Hankwitz report, Levine mentioned it was “filled with errors” and that “no credible establishment would take note of it.”
Regardless of issues, Tennessee and Virginia have annually decided that the advantages of the Ballad monopoly outweigh any unfavourable impacts, issuing stamps of approval that enable the monopoly to proceed. This has occurred, not less than partly, as a result of each states grade Ballad towards scoring rubrics that don’t prioritize high quality of care.
Larry Fitzgerald, a retired Tennessee marketing consultant who monitored the monopoly for the state for greater than 5 years and all the time gave Ballad excessive marks, mentioned in an interview that his arms have been tied by the state’s lenient grading system, which allowed Ballad to succeed on paper even when it failed to fulfill the state’s quality-of-care targets.
Fitzgerald mentioned he’s unconvinced that the state-sanctioned monopoly had prevented any hospital closures and mentioned the merger had “in all probability not” benefited native residents total.
When requested the place he would get medical consideration if he lived in northeastern Tennessee or southwestern Virginia, Fitzgerald instantly responded, “I’m not going to a Ballad hospital.”
In his interview, Levine alleged Fitzgerald had “mainly defrauded the state” by not elevating these criticisms of Ballad in his public studies on the monopoly and mentioned it was “irresponsible” and “obscene” to specific his issues about high quality of care after retiring.
‘Horror Tales’ From Ballad Sufferers
Tennessee Home member Bud Hulsey, a Republican from Kingsport, wrote in a 2023 letter to the state well being division that he “was an avid supporter of the merger” that created Ballad however since then had turn into “involved” and “saddened” by the state of the native hospitals.
In a latest interview, Hulsey mentioned that whereas his household has obtained wonderful care from Ballad, his constituents have advised him “horror tales” for years.
“I had folks name me from the ready room after they’ve sat there for 12 or 14 hours,” Hulsey mentioned. “The scales have much more complaints on them than accolades.”
Others have soured on the monopoly, too. Joe Macione, who for years was on the board of Wellmont Well being System, one of many rival firms that turned Ballad, as soon as publicly advocated for the merger.
In an interview, Macione mentioned state leaders ought to have admitted years in the past that the monopoly was a mistake.
“It has not labored,” mentioned Macione, 87. “All my household is aware of that, if I’ve the time, I wish to go to a extremely graded hospital, both in Asheville or Knoxville.”
Ballad Well being was created in 2018 after Tennessee and Virginia officers waived federal anti-monopoly legal guidelines and authorised the nation’s greatest hospital merger, based mostly on what’s known as a Certificates of Public Benefit, or COPA, settlement. Ballad is now the one choice for hospital look after a lot of the roughly 1.1 million folks in a 29-county area on the nexus of Tennessee, Virginia, Kentucky, and North Carolina.
Within the years since, there have been a number of indicators of discontent with and inside Ballad hospitals. In 2019, protesters gathered day by day for eight months exterior Holston Valley to oppose the closure of the neonatal intensive care unit and the downgrading of a trauma middle. (Ballad has mentioned the NICU closure was essential and benefited sufferers, and a research revealed this 12 months mentioned the trauma adjustments saved lives.)
In 2020, Bristol Regional Medical Heart CEO Greg Neal resigned after it was found he made the preliminary incision in a coronary heart surgical procedure regardless of not being a physician, based on Tennessee state information. (Levine mentioned in his interview that the resignation reveals Ballad is holding staff accountable.)
In 2022, 14 cardiologists signed a letter warning of “extreme limitations” within the Bristol Regional cardiac catheterization lab that have been affecting affected person security and delaying procedures for weeks or months. (Ballad mentioned in a letter to the Tennessee authorities that it labored with the cardiologists, who it mentioned have been partly accountable, to make the lab extra environment friendly.)
In 2023, Ballad Well being was ranked final amongst 200 giant well being care organizations in an evaluation of nurse satisfaction revealed by an MIT enterprise journal. (Levine dismissed this evaluation as unscientific.) This 12 months, the Federal Commerce Fee cited Ballad as a cautionary story whereas opposing an analogous hospital merger into consideration in Indiana, and a longtime Kingsport physician took a parting shot at Ballad in his obituary. (Ballad declined to touch upon both subject.)
And in August, the widow of a Tennessee sheriff filed a lawsuit alleging that Ballad brought on her husband’s dying and deliberately understaffed hospitals “to save cash.” Brenda Tester, the spouse of Johnson County Sheriff Eddie Tester, alleged in that lawsuit that Ballad put her husband on blood thinners after which gave him an pointless liver biopsy, inflicting “life ending inner blood loss” that led to “his cardiac arrest and in the end his sudden dying.”
Ballad has but to reply to the Tester lawsuit in court docket. Levine mentioned in his interview that the medical doctors who handled the sheriff weren’t employed by Ballad however merely contracted to work in its hospitals.
A few of Ballad’s most decided critics are members of the family of Anton Maki Jr., a former Holston Valley physician who returned to the hospital as a affected person in February. The household has filed complaints with a number of Tennessee companies and the federal authorities and supplied emails to KFF Well being Information exhibiting that Tennessee is investigating Maki’s case.
In an interview and in these complaints, Maki’s members of the family allege Holston Valley gave Maki improper therapy, regardless that his signs and lab checks made it apparent that he was having a severe coronary heart assault that required pressing consideration.
The improper care did “everlasting harm” to Maki’s coronary heart, the household’s complaints allege. That harm required him to have a everlasting mechanical coronary heart pump surgically implanted at a non-Ballad hospital, mentioned one in every of his daughters, Alexandra Maki, who’s a surgeon in Kentucky. She mentioned her father died after a fall three months later whereas nonetheless in a weakened state.
Alexandra Maki mentioned that her father had been alarmed by the Ballad monopoly for years however that she didn’t totally respect his warnings till she witnessed his care at Holston Valley firsthand.
“I filed these complaints as a result of it’s my obligation as a physician to report what I noticed,” Alexandra Maki mentioned. “That was not care. It’s a facade of a hospital. It’s a well-oiled dying machine.”
KFF Well being Information reporter Samantha Liss contributed to this text.
KFF Well being Information is a nationwide newsroom that produces in-depth journalism about well being points and is among the core working packages at KFF—an impartial supply of well being coverage analysis, polling, and journalism. Study extra about KFF.
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This text first appeared on KFF Well being Information and is republished right here below a Inventive Commons license.
