The HCA-owned Chippenham Hospital in Richmond, Va., hid information from regulators that showed as many as 90 trauma unit employees lacked required education and training credentials, a lawsuit by a former burn center manager alleges.
Had Virginia Department of Health officials learned about the education gaps, they could have yanked the hospital's Level 1 trauma center designation and jeopardized the fledgling burn unit, the lawsuit alleged.
Rebecca Mitchell was a former director of clinical operations for Burn and Reconstructive Centers of America, which manages a large burn center in Augusta and several other burn centers across the country. Her lawsuit adds another twist in the turmoil surrounding BRCA after the sudden death in 2020 of its longtime director, Fred Mullins.
The lawsuit also comes amid an ongoing national debate over fees some hospital trauma wards charge, markups that health researchers have found especially prevalent at for-profit hospital chains such as HCA, the nation's largest.
HCA disagreed with the claims in the lawsuit and is "defending it aggressively," said Pryor Green, an HCA strategic communications executive in Richmond. "Our focus, as always, is on our patients and ensuring they are able to continue to receive world-class care in our Level 1 Burn Center."
Officials with the Virginia Department of Health also declined to comment.
Asked by The Post and Courier about the case, Mitchell said the experience left her feeling "like a pawn in a much larger game that HCA and BRCA were playing."
The lawsuit’s allegations highlight the increasing role of trauma units as hospital profit centers. A growing number of hospitals across the country have sought “Level 1” status for their trauma units, a designation that means the units can handle severe injuries at any time of the day.
“Once you become a Level 1 trauma center, you’re a magnet,” said Ge Bai, a health finance expert with Johns Hopkins University who has studied trauma center growth and billing practices.
Patients are more likely to seek treatment at Level 1 units because the designation “means you are really good at taking care of these patients,” Bai said. This, in turn, means more revenue for the hospitals, especially when it comes to “activation fees.”
Some hospitals automatically charge these fees when patients arrive in a trauma center. Hospitals contend the fees are necessary because it's costly to maintain a state of readiness. But investigations by Kaiser Health News and The Tampa Bay Times have found HCA hospitals sometimes sock patients and insurers with fees in the tens of thousands of dollars. Trauma patients “are an important revenue source for hospitals,” Bai said.
Rebecca Mitchell. Provided
Mitchell’s lawsuit touches on these high stakes.
Mitchell had begun her career as an intensive care unit nurse and later as a burn specialist in the Joseph M. Still Burn Center in Augusta. She eventually became director of clinical operations for BRCA.
But in 2020, Mullins, the Augusta burn center’s director, died suddenly, and the organization was thrown into chaos as physicians said they discovered issues with its business practices. One burn center after another left the BRCA network, taking millions of dollars in revenue with them. Most of the burn units ended up with HCA, which now touts that it has the “largest burn and reconstructive surgery network in the nation,” a claim BRCA had made a few years before.
In her lawsuit, Mitchell claimed that HCA was using the turmoil in Augusta as part of a larger power play to take over BRCA.
Chippenham Hospital in Richmond, Va. File/Julia Rendleman for Kaiser Health News/Provided
Amid this uncertainty, Mitchell was assigned to help start a new burn unit in Chippenham Hospital, a large HCA-owned hospital in Richmond. The process seemed to proceed well enough until 2022, when Mitchell discovered discrepancies in HCA’s trauma unit, her lawsuit stated.
Trauma staff often work in burn units, and an HCA employee told her that the hospital had failed to include the names of some 90 trauma nurses in a survey required by the Virginia Department of Health, her lawsuit said. Mitchell dug into their records and found many nurses lacked required training and education credentials for the hospital’s Level 1 trauma designation, her lawsuit said.
“Based on her review of records, Mrs. Mitchell concluded HCA was not 100 percent compliant with Virginia's education requirements, contrary to HCA's apparent representation to Virginia regulators,” the lawsuit alleged.
When she brought this to the attention of HCA and her supervisors at Burn and Reconstructive Centers of America, she was locked out of her computer and eventually fired, her lawsuit alleged.
Mitchell told The Post and Courier that both HCA and BRCA knew the financial stakes were significant.
"Without the proper certification, HCA could lose a lot of revenue from its trauma and burn center at Chippenham," she said. "And BRCA would lose this business, plus other locations as well because of the partnership it had with HCA."
Mitchell said that she felt betrayed by both organizations. "And I was totally devastated to think that the work I love doing in burn and wound care was being taken from me," she said, adding that because of HCA's reach in her industry, "I may never be able to do what I love again."
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