HCA Healthcare Corp. | REPORT ON HEALTHCARE CONSEQUENCES at HCA Healthcare Corp.

Status
Filed
AGM date
Previous AGM date
Proposal number
4
Resolution details
Company ticker
HCA
Lead filer
Individual
Resolution ask
Report on or disclose
ESG theme
  • Social
ESG sub-theme
  • Public health
Type of vote
Shareholder proposal
Filer type
Shareholder
Company sector
Health Care
Company HQ country
United States
Resolved clause
HCA Healthcare, Inc. (“HCA”) shareholders request that its Board of Directors publish a report within one year of the upcoming annual meeting (at reasonable expense and omitting proprietary and personally protected information) describing the healthcare consequences and impacts its hospital acquisitions in the last decade have had on impacted communities. The report should include information on (i) the number of physician departures post-acquisition; (ii) a comparison of pre- and post-acquisition patient satisfaction ratings; (iii) a comparison of the number of staff per occupied beds pre- and post-acquisition; and (iv) an assessment of the impacted community’s perception of HCA and response to the acquisition.
Supporting statement
Studies illustrate that hospital acquisitions can have a significant impact on the patients served by such hospitals, especially in rural areas with lower incomes and high poverty rates.1 HCA’s latest Form 10-K states that “a component of [HCA’s] business strategy is acquiring hospitals and other health care businesses.”2 HCA has spent significant resources acquiring hospitals, and shareholders are interested in understanding the healthcare and community consequences of these acquisitions in the communities surrounding these hospitals. HCA’s acquisition of Mission Health (“Mission”) in 2019 illustrates the harmful impact such acquisitions can have on surrounding communities. Since 2019, well over 200 physicians3 have left Mission. In addition, almost immediately, HCA allegedly raised prices by 10%, started charging patients surprise fees4 and reduced the number of staff per occupied bed at the flagship Mission Hospital from 6 full time equivalents pre-sale to 3.7 (average across North Carolina is 5.1).5 Patient satisfaction ratings declined precipitously from 4’s and 5’s pre-sale to 1 in 2025,6 and there were significant staff reductions and/or departures in nursing staff and services such as chaplaincy, pharmacy, rehabilitation, sterile processing, laboratory, and environmental services.7 Since 2019, Mission has been cited five times for Immediate Jeopardy (IJ) due to multiple patient deaths and two Emergency Medical Treatment and Labor Act (EMTALA) violations and referred for a third EMTALA violation.8 Nursing shortages correlate with at least one IJ citation.9 Prior to HCA’s acquisition, Mission was the only health system designated as one of the nation’s Top 15 Health Systems in six of seven years by IBM/Watson Health (2012-2015; 2017-2018). Since 2019, Mission has experienced a steep decline in the quality of care and patient experience,10 repeated regulatory censure, a lawsuit from the North Carolina Attorney General,11 and community opposition.12 There is robust evidence that hospital acquisitions can cause an array of problems, including higher prices, worse health outcomes, shutdowns and reduced access.13 Shareholders should know the healthcare, legal, reputational, and employee impacts of HCA’s acquisitions, both to understand whether HCA contributes to our country’s healthcare crisis and to assess how HCA manages risks associated with its acquisitions. For these reasons, I urge you to vote FOR this proposal. 1 https://www.advisory.com/daily-briefing/2024/04/29/hospital-mergers 2 https://d18rn0p25nwr6d.cloudfront.net/CIK-0000860730/b8ab85b0-3a86-4f3b-b91b-71dcb3124683.pdf 3 https://avlwatchdog.org/how-many-doctors-have-left-mission-hca-wont-say/ 4 https://www.economicliberties.us/our-work/the-harms-of-hospital-mergers-and-how-to-stop-them/#_ftnref3 5 https://hlp.law.wfu.edu/wp-content/uploads/sites/11/2024/08/HCA-Mission-Changes-in-Patient-Care-Following-HCAs-Purchase-working-draft-WFU.pdf; https://avlwatchdog.org/hca-arrived-with-plans-to-cut-800-staff-as-soon-as-it-bought-mission-new-court-filings-in-antitrust-case-show/ 6 https://www.medicare.gov/care-compare/details/hospital/340002/view-all?city=Candler&state=NC&zipcode=28715 7 https://hlp.law.wfu.edu/wp-content/uploads/sites/11/2024/08/HCA-Mission-Changes-in-Patient-Care-Following-HCAs-Purchase-working-draft-WFU.pdf; https://avlwatchdog.org/former-mission-chaplain-the-moral-injury-that-is-happening-there-daily-is-staggering/ 8 https://avlwatchdog.org/mission-hospital-placed-in-immediate-jeopardy-sanction-is-third-since-sale-to-hca/; https://drive.google.com/file/d/1hwFf7PaZJrVumKyCcntZ57vu807uL8_Z/view?usp=drive_link 9 https://www.asheville.com/news/2024/05/asheville-watchdog-deadly-failures-in-care-at-hca-mission-coincided-with-hundreds-of-vacant-nurse-positions/ 10 https://www.statnews.com/2023/11/30/hca-mission-hospital-cost-cutting-appalachia/ 11 https://avlwatchdog.org/hca-was-in-potential-non-compliance-with-mission-agreement-in-3-areas-in-2024-independent-monitor-report-states/ 12 https://reclaimhealthcarewnc.org/ 13 https://www.economicliberties.us/our-work/the-harms-of-hospital-mergers-and-how-to-stop-them/#_ftnref3

DISCLAIMER: By including a shareholder resolution or management proposal in this database, neither the PRI nor the sponsor of the resolution or proposal is seeking authority to act as proxy for any shareholder; shareholders should vote their proxies in accordance with their own policies and requirements.

Any voting recommendations set forth in the descriptions of the resolutions and management proposals included in this database are made by the sponsors of those resolutions and proposals, and do not represent the views of the PRI.

Information on the shareholder resolutions, management proposals and votes in this database have been obtained from sources that are believed to be reliable, but the PRI does not represent that it is accurate, complete, or up-to-date, including information relating to resolutions and management proposals, other signatories’ vote pre-declarations (including voting rationales), or the current status of a resolution or proposal. You should consult companies’ proxy statements for complete information on all matters to be voted on at a meeting.