This story was originally published in the Asheville Watchdog.
The U.S. Centers for Medicare & Medicaid Services has placed Asheville’s Mission Hospital in immediate jeopardy, the third time since 2019 that the hospital has faced the harshest sanction that can be levied against a healthcare facility.
Mission CEO Greg Lowe announced the sanction in a letter emailed to hospital staff Friday and obtained Tuesday by Asheville Watchdog. He wrote that CMS had accepted a North Carolina Department of Health and Human Services recommendation that the HCA Healthcare-owned hospital be placed in immediate jeopardy, meaning it risks losing its Medicare and Medicaid funding.
When reached for comment, Mission spokesperson Nancy Lindell deferred to her previous statement made Friday about NCDHHS’ recommendation of immediate jeopardy.
The sanction follows an on-site NCDHHS inspection last month on behalf of CMS. In its recommendation to CMS, the state agency cited incidents on July 26, Aug. 19, and Sept. 4.
The July 26 incident aligns with one in which a cardiac patient died after becoming disconnected from telemetry equipment, which off-site technicians use to monitor patients’ vital signs, for at least an hour. The Watchdog first reported news of the death last month.
The other incidents concerned safety issues during patient transport and improper infection prevention precautions, according to an NCDHHS letter sent to Lowe on Oct. 10.
“CMS has taken appropriate action to hold HCA accountable,” said Aaron Sarver, a spokesperson for Reclaim Healthcare WNC, a coalition of healthcare workers and elected officials calling on HCA to improve conditions at Mission or give up ownership.
“Unfortunately, this is not the first-time that Immediate Jeopardy has been invoked against them due to staffing that continues to put patients in danger of serious injury, harm, impairment, or death,” Sarver said. “Step one is to restore staffing at Mission to safe levels. The core issue is that nurses, techs and support staff are overburdened and cannot reasonably provide quality care to all the patients they are responsible for.”
The immediate jeopardy citation gives Mission 23 days – until Nov. 9 – to issue a plan of correction acceptable to CMS or face a catastrophic loss of funding. In his letter, Lowe said the hospital had proactively given a plan to CMS “because we believe it is clear that we have addressed the issues raised.”
Striking a defiant tone, Lowe criticized unspecified “misinformation that has been circulating online and in the press” and what he described as an “unusual” investigation that he implied was connected to “outside pressure.”
He cited the length of the investigation — surveyors were on site for two weeks in September — and an outcome in which he said “more than two-thirds of the complaints they were sent to investigate were determined to be baseless.” (The Watchdog has not independently confirmed this detail; in its letter to Lowe, NCDHHS noted one incident, on Sept. 18, in which Mission took corrective action that prevented it from rising to the level of an immediate jeopardy recommendation.)
“I have a tremendous amount of respect for the surveyors and they were simply doing the jobs required of them,” Lowe wrote. “However, it is unfortunate that there seemed to be outside pressure on these surveyors to find a problem.”
Lowe says inspectors deviated from ‘normal protocols’The hospital had already taken corrective actions, which it shared with investigators, Lowe said, and which the hospital hoped NCDHHS would take into account.
“That has occurred in previous surveys by NCDHHS,” he wrote, “and it is my sincere hope that outside pressure in the area is not the reason they chose to deviate from their normal protocols.”
Mission was placed in immediate jeopardy in 2024 after an NCDHHS inspection revealed 18 patients were harmed between 2022-2023, four of whom died, all as a result of violations of federal standards of care related to the hospital’s emergency and oncology services. The sanction was lifted after Mission provided its plan of correction.
In 2021, Mission faced another immediate jeopardy sanction after a female patient was found dying on the floor of her hospital room on March 1, her IV disconnected, and saline flush syringes in her bed. NCDHHS inspectors found that “the hospital failed to maintain a safe environment for a medical/surgical patient with a history of substance abuse and prevent patient access to unsecured flushes, failed to follow a physician order for liquid pain medication, and failed to communicate and escalate patient care concerns for safety.”
In early 2024, CMS also investigated an Emergency Medical Treatment and Labor Act violation at Mission after a patient died in an emergency department bathroom in February after calling for help for 29 minutes before staff responded. That investigation determined that Mission violated its responsibility to provide emergency services. But by the time CMS investigated, it determined that Mission had taken sufficient steps to remedy the problems that led to the death and the hospital avoided an immediate jeopardy finding.
Two other hospitals acquired by HCA in the region have been placed in immediate jeopardy since the 2019 sale – Blue Ridge Regional Hospital in Spruce Pine in 2023 and Mission Hospital McDowell in Marion in 2021.
“The pattern we now can see clearly since HCA purchased Mission in 2019, is after being sanctioned by regulators, HCA surges resources to the hospital for a period of time to have an IJ lifted,” Sarver said. “Then, they return to a baseline of unsafe staffing levels. That can be fixed tomorrow by bringing in more staff, but it must be a permanent fix.”
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Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. Keith Campbell is the managing editor of Asheville Watchdog. You can reach him via email at kcampbell@avlwatchdog.org. Jack Evans is an investigative reporter who previously worked at the Tampa Bay Times. You can reach him via email at jevans@avlwatchdog.org. Andrew R. Jones is a Watchdog investigative reporter. The Watchdog’s reporting is made possible by donations from the community. To show your support for this vital public service go to avlwatchdog.org/support-our-publication/.
