By Michelle Crouch
Co-published with The Charlotte Ledger
Atrium Health would have to add four local elected officials to its board under a North Carolina state Senate bill — one of several proposals this session taking aim at the growing power of large hospital systems.
The bill, SB 961, would also require any meeting of county hospital authority board members to comply with North Carolina open meetings laws, a provision that appears to address concerns that Atrium Health has conducted much of its substantive business behind closed doors.
Atrium operates both as part of Advocate Health, a $39 billion multistate nonprofit hospital giant, and as the Charlotte-Mecklenburg Hospital Authority, a public body. Legislative interest in Atrium has intensified in the wake of its proposed combination with Raleigh-based WakeMed Health & Hospitals, a deal that has drawn scrutiny from state leaders.
Atrium is one of only two county hospital authorities in the state. The other is CarolinaEast, a small system in eastern North Carolina.
Sen. Jim Burgin (R-Angier), who sponsored the bill and co-chairs the Senate Health Care Committee, said he is concerned that hospital authorities enjoy the benefits of a public entity — such as tax exemptions and eminent domain powers — without enough public accountability. It’s an issue previously examined by The Ledger/NC Health News.
“I talked to a number of people about how authorities are set up, and I think one of the problems is: Are they really governing? Who’s on [the board], and are they really taking that position seriously and asking the tough questions?” Burgin said. “I think there needs to be some different people on there — people who represent local government, citizens and everybody — so that it’s not a closed system.”
A second legislative proposal, SB 978, would give the state auditor, attorney general and state treasurer new authority to review and potentially challenge major hospital transactions. It would also add whistleblower protections for healthcare workers, limit hospital noncompete clauses and cap nonprofit hospital CEO pay at 400 times the lowest-paid full-time worker’s compensation.
Atrium did not respond to multiple requests for comment on the bills.
A spokeswoman for the North Carolina Healthcare Association, which represents hospitals, said their group is reviewing both bills. In an email, she said, “Given the significant challenges facing North Carolina hospitals, particularly those serving rural and underserved communities, our hope is that policymakers will support solutions that strengthen hospitals’ ability to care for North Carolinians rather than create additional barriers to delivering that care.”
The measures may face a tough road during this year’s short legislative session, especially since they would need approval by the House of Representatives, which has historically been more aligned with hospital interests. But their introduction is a sign that lawmakers are more willing than before to challenge hospitals.
“Healthcare is one of our most expensive and fastest-growing costs,” Burgin said. “We’ve got to do something about it.”
Questions about closed-door meetings
The Charlotte Ledger/NC Health News has raised questions about whether Atrium meets the spirit of North Carolina’s open meetings laws, as it is required to do as a public entity.
Although the hospital authority’s quarterly board meetings are open to the public by statute, the board does not allow the public to attend committee meetings — where most substantive discussion occurs.
The hospital has long argued that its committee meetings are not “official meetings” that must be open to the public, an interpretation some open government experts dispute.
Amanda Martin, supervising attorney at the Duke University School of Law First Amendment Clinic, said the proposed wording in the bill — requiring “any meeting of the commissioners” to be open — would strengthen the argument that committees composed of commissioners would have to be open to the public.
Burgin said public entities should conduct as much business as possible in the open and use closed sessions only in limited circumstances. He said he was concerned when he heard that Atrium had planned an unusually long four-hour closed session for April 29.
“There were multiple hours of discussion in closed session,” he said. “Closed session is not intended for that. That’s open discussion. It’s very narrow the things that they can do in a closed session.”
A Ledger/NC Health News reporter attended the April 29 meeting in a conference room at The Pearl, Atrium’s new medical innovation district near uptown Charlotte. It began in open session, as required by law, before the public was ushered out for the closed session.
Speakers during the open portion referenced topics to be covered that did not obviously fall under the statutory exceptions cited for closing the meeting. For example, the board chair, Angelique Vincent, told members that the meeting would cover “items you all have raised questions about, or asked for additional information on.” She added, “We have built in time so that we can have a conversation and a dialogue, versus you all just hearing lectures from our speakers.”
Another speaker said, “You’ve heard about all the virtual care. We’re going to talk about that today.”
Atrium has stressed that it is complying with the law.
Standoff on Atrium board nominees
There has also been growing tension in Charlotte over the makeup of Atrium’s board.
Under current law, the only direct authority local government officials have over the hospital authority is that the chair of the Mecklenburg County Board of Commissioners, Mark Jerrell, must approve nominees to its board.
For the most part, chairs of the board have routinely approved Atrium’s nominees. But earlier this year, in a rare rebuke, Jerrell rejected Atrium’s proposed slate, the first such rejection in decades.
Jerrell said at the time he wanted broader representation, particularly voices tied to low-income and underserved communities.
Atrium did not try to find candidates that addressed Jerrell’s concerns but instead opted to continue operating with the existing board members. When asked about that decision, an Atrium lawyer cited a state law that allows board members to remain in office until successors are appointed and qualified.
A proposal to cap CEO pay
Burgin said the hospital CEO compensation cap is aimed at nonprofit hospitals that pay their executives like large private corporations.
“Not-for-profits, I think they’ve got to control it,” Burgin said. “I think when a hospital CEO gets to a certain point, people need to say, ‘Wait a minute, you’re not-for-profit.”
Advocate Health CEO Gene Woods took home $25.8 million in 2024. Advocate’s hourly minimum wage is $18.85/hour, so a bill capping compensation at 400 times that amount could potentially cap Woods’ compensation at about $15.7 million annually — a 39 percent pay cut.
Last week, the intergovernmental committee of the Mecklenburg County Board of Commissioners discussed the hospital authority bill. Although the committee did not take a formal vote, six commissioners said they would support including the bill on the county’s legislative agenda.
“The power here is incredible, and it’s very disturbing,” said commissioner Susan Rodriguez-McDowell. “In my view, this is the most profitable nonprofit, and there are no reins to the power.”
NC Health News reporter Ashley Fredde contributed to this story.
This article is part of a partnership between The Charlotte Ledger and North Carolina Health News to produce original health care reporting. You can support this effort with a tax-deductible donation.
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