Message from William Hathaway and Anthony Spensieri

March 23, 2020

Dear Colleagues:

This has been an exceptional week locally and nationally as we face a rapidly changing clinical scenario the likes of which most of us had never imagined. We now have presumptive positive patients in our community and health system. We want to express our deep and personal thanks for all of your efforts as we prepared for the arrival of COVID-19. Your teamwork is amazing. As we now make the shift from preparation to care our collaboration as a team will carry us through this challenging time. While none of us can predict what will happen, we know that we will face this together. We know our community is grateful for our talented, committed and compassionate providers and staff and appreciates that you all are on the front line of this pandemic continuing to provide the very best care to our patients every day.

We want to thank you for your patience with our communications as we continue to work through the myriad and ever changing recommendations. We will work to make information available to you in a timely manner. Never hesitate to reach out to us for questions or concerns.

With deepest respect in these extraordinary times,

William R Hathaway M.D., CMO NC Division, HCA Healthcare

Anthony M. Spensieri, MD CMO Mission Hospital


Personal Protective Equipment

As we monitor PPE shortages around the country and globe, we want you to know that our current supplies are adequate at this time. We are gravely concerned about future shortages.

Making sure we follow our usual practices will help prevent spread and ensure adequate protection for our staff as well as conserve our limited resources:

·         Not coming to work ill

·         Practicing diligent hand hygiene and respiratory etiquette

·         Clean all surfaces, including cell phones, stethoscopes, keyboards, mice (or it is mouses?), and Dictaphones with alcohol wipes

·         Follow PPE guidance and appropriate isolation processes

See this table for general guidance and the link which follows for practice setting information.

We are implementing plans for re-use and extended use of N95 respirators. The CDC guidelines on how and where this can occur can be found here. (Guidance for Extended Use and Limited Reuse of N95 Respirators.) We are also beginning PPE Reprocessing as a proactive strategy. Please see HCA/CSG COVID19 Resources Site for details.  COVID-19 Guidance for Practices & Clinics

COVID Testing

We are currently using commercial labs for our testing and are actively exploring a number of ways to bring testing in house. Our turnaround times are unacceptably long, often approaching 4 days or more. This is related to over whelming volume for the laboratories providing testing. Please be aware that hundreds of tests are pending across our community some of which will undoubtedly return positive.

Currently community testing is limited because of limited tests and PPE . We are advocating minimal testing in the outpatient setting in an effort to preserve both testing and PPE resources for those patients who become ill. New guidance from the state does not recommend widespread testing at this point. They continue to recommend NOT testing people who are asymptomatic and NOT testing people visiting a healthcare facility solely to get tested.

If people only have mild illness that does not prompt them to seek care they should be advised to remain at home until they have met the NCDHHS Guidance for Discontinuation of Home Isolation.

Non-Essential Surgeries

All Mission Health hospitals and facilities are following the CMS Guidance for the determination of which procedures will be performed for the foreseeable future. We are actively developing processes to implement this guidance and additional communication will be forthcoming. Please remember that our goal is to preserve resources for future needs while not unintentionally creating additional morbidity for the patients whose procedures are being delayed. This initiative will also decrease the likelihood of community transmission.

I thank you in advance for your cooperation.

Ambulatory Care

We want to make you aware that many insurers are liberalizing virtual health and telephonic healthcare rules to facilitate increased use of video and telephone care to enable care for patients in their home or provided by physicians who may need to be isolated or quarantined yet are still able to work. As we are able to compile resources to help your practice learn more about these changes we will share. Planning for these changes now may be very helpful as we experience increases in cases of COVID19 in our community.


Additional References

NCDHHS Coronavirus Disease 2019 (COVID-19) Response in North Carolina

CDC COVID-19 Information for Healthcare Professionals

HCA/CSG COVID19 Resources Site

HCA/COVID-19 Guidance for Practices & Clinics

Mission and Me/COVID-19



William R. Hathaway, MD FACC

Chief Medical Officer

HCA Healthcare | North Carolina Division

12 Ardmore Street, Asheville, NC 28803

P 828.213.1215  |  Connect With Us