There are 182 hospitals in the US and the UK, including St. David's, operated by HCA Healthcare, the largest hospital network in the country. HCA is extremely profitable-earning $5.6 billion in revenue last year-and its stock is a favorite on Wall Street.

Competitors closely imitate HCA's methods as an industry pioneer. However, some of HCA's doctors and staff believe that the company's earnings come at the expense of its patients and staff. They claim that patients suffered injury as a result of significant understaffing and inadequate facility investment.

HCA's Doctors and Nurses Speak Up

According to some doctors and nurses who have worked in HCA's facilities, fresh criticisms are now being raised at the company's palliative and end-of-life care for patients.

They claim that HCA administrators put pressure on employees to convince the families of sick patients to request such care. The effort can benefit HCA in two ways, according to the doctors and nurses, despite the risk to patients of discontinuing life-saving therapies.

This is supported by an internal hospital document. In addition to helping HCA free up a hospital bed more quickly, it lowers in-hospital death rates, a quality indicator that is widely observed. This could result in more insurance payments from a new patient.

Interviews were conducted with six nurses and 27 doctors who work at 16 HCA facilities across seven states. All claimed that in an effort to improve performance indicators, respective HCA hospitals promoted palliative and end-of-life care. These medical specialists' opinions are supported by internal HCA hospital documents and texts between hospital staff members that were released to NBC News.

One doctor at a corporate hospital reported what he perceives to be a sharp drop in referrals at the facility two weeks after NBC News began questioning HCA about its hospice referrals.

Read also: Death And Dreams: Vibrant Dreams Give Comfort To The Dying

The Reason Behind Hospice Care Transfers

Transfers to hospice care lower the inpatient mortality rate in a hospital, even though few patients are probably aware of this.The reason is that every patient death increases the hospital's inpatient mortality statistics. Even if the patient remains in the same hospital and dies there, the death won't be included in the facility's inpatient mortality rate because the patient was formally released from the hospital after being transferred to hospice care.

(Photo : by Danielle Del Valle/Getty Images for SEIU)
NASHVILLE, TENNESSEE - APRIL 19: Hospital workers from California, Florida, Texas, Kansas and other states rallied in front of hospital giant HCA Healthcare headquarters, to demand the company invests in safe staffing levels and patient care on April 19, 2023 in Nashville, Tennessee.

The shift toward palliative and then end-of-life care has another advantage: shorter patient stays, according to an HCA hospital brochure.Patients receiving end-of-life care often don't live long, thus the practice enables HCA to swap out any patients whose insurance may be costing the institution money because it has expired with those who bring in new cash.

In recent years, the industry-wide practice of giving palliative care to seriously sick patients has gained popularity as a way to treat their symptoms, as well as to comfort and manage their pain, and to assist their families.

Related article: Healthcare Spending to Rise 6 Percent By 2023