Asheville’s Mission Hospital is facing Immediate Jeopardy — the most serious citation that regulators can deliver to a hospital — for the second year in a row.
When the North Carolina Department of Health and Human Services visited Mission in September, surveyors witnessed a series of disturbing incidents. The agency let Mission Health CEO Greg Lowe know in a letter that “hospital staff failed to provide a safe environment for patients.”
DHHS found that:
- Nursing staff failed to respond to and assess a telemetry patient with emergent needs (resulting in death)
- Failed to ensure safe and appropriate transport and continuous pulse oximetry monitoring for a patient during transport
- Failed to prevent and control infections by not accurately implementing and communicating infection prevention precautions
The agency also found issues with patient misidentification at Mission. The incidents described by DHHS occurred on Sept. 18, Sept. 4, Aug. 19, and July 26.
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Based on the disastrous visit and other reported incidents, the agency has recommended that CMS places the hospital in Immediate Jeopardy. That puts Mission at risk of losing its Medicare and Medicaid funding.
State Sen. Julie Mayfield, D-Buncombe, calls the Immediate Jeopardy recommendation “unfortunate but not surprising.”
“They still have not made the permanent changes they need to make to increase staffing and ensure that patients can get the care they need,” Mayfield told Carolina Public Press. “It’s really pretty simple: it’s all about staffing, it’s always been about staffing.”
This is the third time Mission has been threatened with Immediate Jeopardy since Tennessee-based, for-profit HCA Healthcare purchased the formerly nonprofit Mission Health hospital system in 2019. Mission Hospital in Asheville is the flagship hospital of the Mission Health group, which is the primary health care provider for several Western North Carolina counties.
DHHS has sent its Immediate Jeopardy recommendation to the federal Centers for Medicare and Medicaid Services office in Atlanta, also known as CMS. That agency now has to decide whether to officially issue a citation. If it does, Mission has 23 days to issue a plan of correction — or else lose critical funding.
Last year, the hospital’s plan of correction placated CMS, even after four instances of preventable patient death.
Mission still faced consequences. Because it had failed to remain in “good standing” with CMS all year, HCA was found to have violated its purchase agreement of the hospital. That is likely to happen again this year, even if a plan of correction is issued, approved and acted upon after the second straight Immediate Jeopardy finding.
“Their plan will never be enough because they are not interested in tackling the root problems,” Mayfield said. “There are two root problems. The first one is staffing. The second is the culture.”
It remains to be seen whether CMS will accept the plan that Mission issues this time around.
In addition to the Immediate Jeopardy finding, Mission Health is fighting a lawsuit from Attorney General Jeff Jackson accusing it of diminished emergency and oncology care. These allegations would potentially violate the terms of HCA’s acquisition of Mission Health.
Mission Health spokesperson Nancy Lindell provided CPP with a statement Oct. 20 reacting to the news: “Mission Health is disappointed with the (DHHS) decision to recommend CMS place our hospital in Immediate Jeopardy. While we respect the surveyors’ role, the state regulators have not articulated what insufficiencies exist today given the extensive corrective action plans we have implemented and provided to them. Because of that we proactively shared our plans with CMS. We believe we have addressed the issues and welcome an expedited follow-up survey.
“We remain confident in the ability of our team to provide compassionate, high-quality care and are committed to continuous improvement in patient safety and clinical excellence. We will continue to work cooperatively with DHHS and CMS to resolve this issue, while keeping our main focus on the community we serve.”
Editor’s note: This article original posted on Oct. 19, 2025, but was updated on Oct. 20 based on additional information that became available.
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