News

High court ruling favors AdventHealth over HCA

By JANE WINIK SARTWELL, Published: December 15, 2025

The North Carolina Supreme Court has delivered a key ruling against HCA in the ongoing Certificate of Need battle in Weaverville, according to AdventHealth’s lawyers. The development may mean that AdventHealth can begin construction on a new Asheville-area hospital immediately, despite opposition from HCA. 

Over the years, the state has repeatedly identified a need for more hospital beds in Buncombe County — and each time, it has awarded those beds to Florida-based AdventHealth, which also operates a hospital in nearby Henderson County. 

But Mission Health, operated by the Tennessee-based for-profit HCA, has a near-monopoly on health care in parts of the North Carolina mountains and is fighting to keep AdventHealth out of the Asheville market. Each time the state awards AdventHealth a certificate of need, HCA appeals.

The legal battles have delayed the arrival of expanded health care services in Asheville for years. 

Now, the state Supreme Court has rejected HCA’s appeal of the original 67-bed need awarded to AdventHealth in 2021. (In November 2024, the state OK'd an increase of 26 more beds, for a total of 93). AdventHealth’s lawyers delivered news of the high court's ruling to the hospital system on Friday. 

“That means the case is over and they can start building the hospital,” state Sen. Julie Mayfield, D-Buncombe, told Carolina Public Press.

The court had not yet issued a public announcement of the development prior to publication of this article, but had notified AdventHealth’s legal team, the company confirmed. AdventHealth is still trying to figure out exactly what it means. One complicating factor is that HCA has appealed the 26-bed increase for the Weaverville facility, and that challenge is still active. 

“We’ve been hoping for this answer,” Victoria Dunkle, spokesperson for AdventHealth, told CPP. “I don’t know the specifics of what that means for the next steps and how soon we can take them. We have been working under the understanding that once this last potential was through, we would be getting the CON in hand, and that’s when we can start the actual work on the hospital. But I don’t know when that CON is going to be in hand.”

Mayfield believes that this development removes the final roadblock to hospital construction. Even if the other 26-bed CON is still not available to AdventHealth due to the ongoing appeal process, the company can build the facility to allow for easy expansion. 

To make matters more complicated, a need for an additional 129 beds in Buncombe County was announced this summer. HCA, AdventHealth, UNC Health and Novant Health are all competing for that CON. Whoever it goes to, it will doubtless be appealed. The state, and the public, will hear each hospital’s proposal in a public hearing at 10 a.m. Tuesday, Dec. 16, at Asheville-Buncombe Technical Community College.

HCA spokesperson Nancy Lindell provided a statement to CPP regarding the court’s decision. “While we are disappointed by the Court’s ruling, we remain steadfast in our belief that Mission Hospital can best meet Western North Carolina’s growing need for complex medical and surgical care,” she said. “Mission Hospital accepts thousands of transfers each year from other hospitals that have available beds — including facilities currently seeking approval to expand — because patients need high level medical care only available in Western North Carolina at our hospital.

“Not all acute care beds are the same," the statement continued. "Instead of adding more beds at facilities that are unable to provide the complex medical and surgical care needed, the region would be better served by expanding bed capacity at Mission Hospital. We consider it a privilege to care for our region’s sickest patients but need more beds to do so.”

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Jane Winik Sartwell is a staff reporter for Carolina Public Press, who focuses on coverage of health and business. Jane has a bachelor's degree in photography from Bard College and master's degree in journalism from Columbia University. She is based in Wilmington. Email Jane at jsartwell@carolinapublicpress.org to contact her.