Appendix B presents extensive first-person accounts from patients, nurses, travel nurses, physicians, and clinic managers describing severe ER dysfunction, staffing shortages, extensive boarding, unsafe nurse-to-patient ratios, workflow breakdowns, and declines in charity care after HCA’s 2019 acquisition of Mission Health. Examples include patients waiting 15+ hours without physician evaluation; nurses reporting routine 5:1 or worse ratios, requests to take 6 patients, and ER holds with dozens of admitted patients (one report: 39 held in ER). Charity care shifts described include upfront payment demands, higher out-of-pocket requirements (e.g., $100–$1,300), longer processing delays (up to six months), and narrowed practical access despite stated higher eligibility thresholds.

Questions this document answers

5:1 (with reports of being asked to accept 6:1)

39 patients

210/116

A little more than 15 hours

Up to six months

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