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Mission Health monitors issue mixed reviews

Although many praised Mission Health for remaining open and delivering care during Hurricane Helene, questions remain about nursing staffing levels, cancer treatment and emergency care. [CAROLINA PUBLIC PRESS]

By Jane Winik Sartwell, Carolina Public Press, Published: July 12, 2025

Asheville-based Mission Health has seen several busy months so far in 2025, with some important wins after facing significant adversity in 2024. Even so, pushback from community leaders, employees and judges continues.

While even some of the critics of its flagship Mission Hospital in Asheville commend the hospital’s efforts after the devastation of Hurricane Helene, nurses there remain outraged about what they consider chronic, and dangerous, short staffing.

The hospital — which is operated by HCA, the largest hospital corporation in the country and parent company of the Mission Health group in Western North Carolina — received a seal of approval from the North Carolina Department of Health and Human Services, but lawsuits against the hospital system are still in the pipeline, including from multiple governments.

HCA won the right to build a standalone emergency room in West Asheville, but has so far not been successful in efforts to block competitor AdventHealth from constructing a hospital in Weaverville, in northern Buncombe County, which would break HCA’s health care monopoly in much of the region.

Meanwhile, the independent monitor responsible for ensuring Mission Health complies with the 2019 purchase agreement of the previously nonprofit health care group is preparing to release its 2024 assessment — and it doesn’t look good for Mission Health.

DHHS seal of approval

In response to 35 complaints made to DHHS about improper patient care and management at Mission Hospital, the agency conducted a three-day survey of the hospital in May.

The result could not have been better for the hospital.

DHHS found “no deficiencies,” meaning that despite the complaints — one of which may have related to a patient dying in a hospital bathroom — the hospital is in compliance with the agency’s standards.

State Sen. Julie Mayfield, D-Buncombe, takes responsibility for sending quite a few of those complaints to DHHS.

“Most of the cases I send to DHHS strike me as very serious and indicative of systemic failures at the hospital,” Mayfield told Carolina Public Press.

“I am concerned that the baseline regulations that hospitals are held to are just that: baseline. They don’t get at providing great care. They’re the floor of what hospitals have to comply with.”

DHHS sent the results of its survey to the federal Centers for Medicaid and Medicare, which will use the information to determine whether the hospital is in compliance with the Emergency Medical Treatment and Labor Act. EMTALA requires hospitals to provide emergency care to everyone, regardless of their ability to pay.

This outcome of the DHHS survey is significant, considering what happened when the agency turned its gaze on the hospital in 2023.

That survey landed the hospital in Immediate Jeopardy, the most serious citation that the Centers for Medicaid and Medicare can deliver to a hospital.

This time, though, no such warnings were issued.

“We are deeply grateful to our dedicated staff for their professionalism, resilience, and focus throughout this challenging process,” hospital spokesperson Nancy Lindell told CPP. “The results of this survey again reaffirmed the strength of our team and our shared commitment to excellence.”

But some in the community worry that complaints of bad care at the hospital will continue to pile up, despite this pat on the back from regulatory groups.

“We know that reportable incidents are continuing to happen,” Aaron Sarver, spokesperson for Reclaim Healthcare WNC, told CPP.

Reclaim Healthcare is a coalition, led by Sen. Mayfield, of physicians, nurses, elected officials, business leaders, clergy and advocates whose mission is to replace HCA Healthcare as owner of Mission Health with a nonprofit hospital system.

“Each week community members report negative experiences at Mission to us,” Sarver said. “(We) vet those claims and pass them on to state and federal regulators, the AG’s office, and the Independent Monitor. We also frequently hear directly from staff at Mission about unacceptable conditions and patient stories, and we send those to the same entities.”

Many of those complaints from staff come from nurses at Mission, who are part of the only hospital union in the state.

Cardiac nurse Kerri Wilson calls the DHHS findings “disappointing.”

“We’ve been screaming from the mountaintops: ‘This is what’s wrong. This is why these things happen,’” Wilson told CPP. “And yet, when the agencies come in and look at things, they’re able to scapegoat it somehow, and not hold the hospital responsible for the negligent situations they put us in. And we still see those scenarios happening daily.”

Mission Health nursing issues

 

For Wilson, three major issues are front of mind this summer: safe staffing ratios, nurse retention and recruitment and health care coverage.

Wilson is concerned that because of the staffing shortages of the hospital, nurses will be turned down for vacation time this summer. Nurses in the ICU, she told CPP, are taking care of three or more patients each. According to her, ICU nurses should never have more than two patients.

The hospital is changing staffing grids to further burden nurses in surgical units, Wilson said. Because of this and other issues, more and more Mission nurses are quitting their jobs.

“When you have a corporation like HCA that continually puts profits over patients, it causes moral distress,” Wilson said. “When something happens to a patient that you know wouldn’t have happened if you had the resources you asked for, that causes moral injury. Those injuries cause nurses to want to leave the bedside.

“They’re not doing anything for retention. There is no retention at all, and our recruitment is not able to keep up with the number of nurses leaving.”

To solve its nurse retention issues, HCA is bringing in more and more travel nurses to Mission. One quarter of the nurses at Mission are now travellers, according to Mayfield. Travel nurses work temporary assignments at various health care facilities, used by hospital systems to address staffing shortages or high patient volume. They tend to float to different units through the hospital.

Travel nurses are not part of the nurse union at Mission, and Wilson says their presence weakens the voice of the permanent nurses at Mission.

Mayfield thinks their presence gives the hospital a less personal, less local, feel.

“For older residents, you want to feel some confidence that these people know something about you and who you are, what your life is like,” Mayfield said. “That those travel nurses will not just strikes me as sad.”

Additionally, the hospital and MAHEC, the health organization where many nurses seek primary care, have changed their relationship. Mission Health Partners will no longer cover their employees to seek primary care at MAHEC.

This is because MAHEC left Mission Health, not the other way around, Lindell said.

Either way, the impact is felt by nurses trying to use insurance for their health care. There aren’t many other primary care outfits in the Asheville area taking new patients, according to Wilson.

CON update

The state continues to find a need for more and more hospital beds in Buncombe County, and each time, has awarded those beds to the Florida-based AdventHealth over HCA. AdventHealth currently operates one of two hospitals in adjacent Henderson County.

Like clockwork, HCA appeals these decisions, delaying the construction of what is now slated to be the second-largest hospital in the mountains.

First, the state awarded Advent 67 beds in Buncombe County. HCA appealed. Then, the state awarded Advent 26 more beds, and once again, HCA appealed. Just recently, the NC Court of Appeals ruled against HCA in this appeal. This week, Advent made a public bid for another 129 beds, bringing the total number of beds to 222.

“HCA will very likely use every measure at their disposal to delay and limit competition,” Sarver of Reclaim Healthcare WNC wrote. “HCA’s functional monopoly is to their benefit and bottom line, though it is to the detriment of WNC residents.”

HCA is currently one of the largest providers of hospital care in the mountains, especially in the region’s largest county Buncombe, and the multiple rural counties where HCA operates the only hospital or where no hospitals are located and HCA’s are the closest option.

That near monopoly in the region appears to be one that the corporation would like to hold onto. It’s an issue Gov. Josh Stein was outspoken about during his time as attorney general.

In other, related news, Mission Hospital’s Certificate of Need application for an ER in West Asheville was approved by the administrative law judge.

Lindell says this decision “allow(s) for improved access to emergency care closer to home for those residents and visitors.”
Mission Health lawsuit updates

Mission Health is a group of six hospitals and related medical facilities in Western North Carolina, the biggest of which is in Asheville. The other five hospitals are in small towns in nearby mountain counties.

The City of Brevard, Buncombe County, the City of Asheville and Madison County filed an antitrust lawsuit against HCA in 2022, alleging that HCA is purposefully stifling competition and driving up health care costs in the region. In this case, court-ordered mediation is complete and the parties are still engaging in discovery, meaning exchanging documents and deposing witnesses, according to Kassi Day, spokesperson for Buncombe County.

That isn’t Buncombe County’s only lawsuit against HCA.

Another, filed in 2024, seeks more than $3 million in taxpayer damages. Because of HCA’s understaffing at Mission’s emergency department, the county claims, the county’s EMS costs increased. The damages lawsuit is also in discovery.

Tennessee-based HCA, which stands for Hospital Corporation of America, bought Mission Health from its previous nonprofit owner in 2019 for $1.5 billion.

For-profit HCA’s acquisition of previously nonprofit Mission Health resulted in the creation of the Dogwood Health Trust, to hold the $1.5 billion HCA paid to the new nonprofit foundation, for use in philanthropic endeavors in Western North Carolina.

Dogwood was also tasked with hiring an independent monitoring company to assess whether HCA is abiding by the purchase terms it agreed to back in 2019.

In addition to Stein’s distaste for HCA’s alleged monopoly, he too has an ongoing lawsuit against the company. His suit relates to a loss of quality cancer and emergency care at Mission Health, which would be considered a breach of HCA’s purchase agreement.

The new attorney general, Jeff Jackson, inherited this suit, but his office had no updates to share on the litigation.

Independent Monitor assessment

Last year, Dogwood and the independent monitoring company, Affiliated Monitors, found that HCA was, in fact, not in compliance with this purchase agreement for calendar year 2023.

That was due to two issues.

The question of whether HCA has continued the cancer and emergency care it promised to maintain is still under litigation, so Dogwood cannot judge whether the hospital has or hasn’t made good on its promise.

Also, given the Immediate Jeopardy citation, the hospital could not be considered in good standing with CMS.

Both of these issues were still active for at least some of 2024. Mission did not resolve its Immediate Jeopardy status until early 2025. The Stein litigation continues today.

The only resolved issue from 2023 relates to the hospital’s charity care policy.

Because of that, it is likely that Dogwood will once again find the hospital not in compliance with the 2019 purchase agreement for calendar year 2024, at least in CPP’s analysis.

But 2024 was a complicated year.

“You can’t fairly look at 2024 without recognizing the catastrophe of Hurricane Helene,” Affiliated Monitors project manager Jerry Coyne told CPP. “The stress that was put on the hospital network was unprecedented. The system, and the staff, responded very admirably. There is a very positive story to be told about the way the hospital network worked to stay open and deliver services. Although we will cover some of that in our report, it’s not really part of the Asset Purchase Agreement. But you can’t really talk about the year without acknowledging that.”

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