HCA-owned Mission Hospital in Asheville has received four “immediate jeopardy” warnings from the federal Center for Medicaid & Medicaid Services in the past five years. This warning, the most serious from CMS, means that a medical service provider has caused, or is likely to cause, harm or impairment to recipients of care.
Mission Hospital is an anomaly.
It is also the only Level I trauma center in Western North Carolina, serving 18 counties in Western North Carolina. It’s also the only hospital in the state with a nurse’s union, which formed in 2020, a year after the Nashville-based for-profit healthcare company HCA purchased the Mission Health group, which also includes additional hospitals in surrounding mountain counties. Before the sale, Mission operated as a nonprofit.
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The hospital’s “merry-go-round” of enforcement, which Carolina Public Press has previously reported on, has no clear end in sight, as closing the hospital off to Medicaid and Medicare patients would leave a wide number of North Carolinians in the region without adequate access to care.
Still, physicians, nurses, and community stakeholders are growing weary of the issues leading to the Immediate Jeopardy warnings at Mission. Reports of understaffing, 10 preventable deaths in the past 18 months, and a lack of security are merely a handful of grievances from the hospital.
A nurse’s perspective
Kerri Wilson is a nurse at Mission Hospital. She said she can remember a time when “everyone” wanted to work at the hospital. Now, she’s wary of her loved ones receiving care in the hospital where she works. When her father received care at Mission, either her or a family member stayed watching him around the clock.
“We did not leave because we were not comfortable, we didn’t feel like he would be safe,” she said. “It’s really terrifying to sometimes have that inside knowledge of the dangers that happen behind the scenes that don’t always reach the patient.”
Wilson, who was born and raised in Asheville, has been working in the medical cardiology step-down unit at Mission Hospital for the past 10 years. She’s a member of the nurses’ union, too. Mission is the go-to hospital for cardiac traumas in the region, which is one of the reasons why she has stayed at the hospital since HCA’s purchase.
According to a 2024 study by Wake Forest law professor Mark Hall, Mission Health’s profits went up after trimming staff. But short staffing has been a repeated issue for the hospital.
Safety, especially in the labor and delivery unit, is an issue, according to Wilson. Union nurses have been working to get metal detectors in, but she said they are still seeing knives brought in, as the hospital does not have a weapons detection system. The Nurse’s Union conducted protests outside Mission about this issue earlier this year.
Facing Immediate Jeopardy
In October 2025, Mission was again placed under Immediate Jeopardy status. The NC Department of Health and Human Services and CMS letter lifted this after approving HCA’s plans to rectify the problems. Mission’s most recent Immediate Jeopardy finding from January was lifted in February when CMS accepted a plan from HCA, according to company spokesperson Nancy Lindell.
But last month, the Asheville Watchdog reported that a patient who was on an involuntary commitment order died by suicide in the psychiatric department. The Immediate Jeopardy finding from October cited preventable patient death and detailed patient care issues.
Wilson is a member of the union’s professional practice committee, which is a group of nurses who report recommendations and concerns to the hospital’s Chief Nursing Officer. These reports, along with others done by other groups and government officials, can all link to past Immediate Jeopardy warnings. The hospital has been under enhanced monitoring since January, when it received its latest warning.
“We are basically told to do more education, and they ignore the real problems, which are the short staffing,” she said.
Forty percent of the nurses at Mission right now are travel nurses, Wilson said. She explained that the hospital needs more veteran nurses to acclimate new nurses. Mission has dealt with extensive staffing issues in the past, and recently publicized a plan to hire 90 nurses in 90 days, which they succeeded.
Aaron Sarver is a spokesperson for Reclaim Healthcare WNC, a nonprofit coalition of physicians, nurses and community members looking to hold HCA accountable and improve staffing and care at Mission Hospital. The group has advocated for transparency from the company when it comes to staffing numbers and profits.
“How many nurses left during that time period?” he said. “What’s the overall staffing picture, which is much more important, right? If you hire 100 nurses in 90 days, but lose 50, you know.”
Community responses
On June 16, NC Sen. Julie Mayfield, D-Buncombe, and Reclaim Healthcare WNC conducted an event to honor nurses at Mission in Asheville. Molly Zenker, a union nurse whom Mission let go in 2024, which she says was for being “outspoken,” appeared at the event. Zenker currently works at Pardee Hospital in Henderson County but is pursuing reinstatement at Mission Health.
“It was funny,” Mayfield said. “People laughed, people cried, you know. All of our honorees got standing ovations.”
Some nurses who were being honored were not present because they were in arbitration with Mission at the time of the event.
“We hope to start telling some of these patients’ stories that come to us that are tragic and terrible and very sad, but right now we just send them to the agencies, and the public does not hear about them,” Mayfield said.
She has been vocal about issues at Mission Health and said that regularly she hears about issues at the Mission from patients actively seeking care at the hospital, to nurses and physicians.
The Patient’s Union, a national patient advocacy group, also announced that it will be conducting a gathering called “Grieving the State of Mission Hospital” in Asheville next on Monday, June 29. The event has been promoted on social media platforms throughout the area as a community vigil.
A path forward
Last week, UNC Health applied for more beds in downtown Asheville, appealing a decision from DHHS to award those 95 beds to Mission Health. Those beds include ones that Mission Health was recently awarded over a new AdventHealth hospital in Weaverville. DHHS awarded the beds to mission despite not plans to increase staff to care for those beds in Mission’s Certificate of Need application.
In April, Mayfield proposed to HCA investors to examine negative impacts of the hospital’s 2019 sale of Mission. Though the proposal failed, garnering only 12% of the shareholder vote, she read the proposal to CEO Sam Hazen at the annual shareholders’ meeting. She said she plans on raising it again next year.
Mayfield also proposed a new bill, Senate Bill 978, which is currently in the North Carolina General Assembly, aimed at increasing the safeguards for hospital whistleblowers in the state. There was language around transparency that other legislators cut before the bill went to the Senate.
HCA spokesperson Nancy Lindell said in an email statement to Carolina Public Press that Mission has put a number of plans in place to improve care, though she did not specify.
Currently, Mission Hospital’s regulatory future is uncertain, but groups like Reclaim Healthcare WNC and the Nurses’ Union are still pursuing ways to increase the dialogue between the communities that rely on Mission and HCA.
“I would love to see HCA held accountable for the destruction that they’ve caused in our community, and see them have to hold to some of their promises from when they purchased us about actually upholding the care that Mission was providing before,” Kerri Wilson said.
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