This story was originally published in the Asheville Watchdog.
Mission Hospital has received state approval to add 95 more acute-care beds to its main facility in Buncombe County despite being under investigation by state and federal healthcare agencies for repeated safety violations linked to multiple patient deaths in recent years.
In making the Certificate of Need award on March 27, the North Carolina Department of Health and Human Services Division of Health Service Regulation rejected competing proposals by AdventHealth Asheville and UNC Health West Medical Center each to add 129 beds to facilities they plan to build in Buncombe County.
Novant Health Asheville Medical Center and Novant Health, meanwhile, received approval to develop a new, 34-bed hospital in Arden.
Under North Carolina law, healthcare providers are required to obtain a certificate of need from the Department of Health and Human Services before developing or offering a “new institutional health service.” The 2025 State Medical Facilities Plan identified a need for a maximum of 129 additional acute care hospital beds to serve the residents of Buncombe, Graham, Madison and Yancey counties.
Mission, which is owned by Nashville-based HCA Healthcare, had applied to develop all 129 beds. The “findings” letter from NCDHHS did not say why the state decided to award it fewer beds.
The rulings, obtained this week by Asheville Watchdog, concluded that Mission Hospital “was determined to be a more effective alternative” to AdventHealth and UNC Health for receiving the new beds because of its “scope of services.” Mission is the only Level 1 Trauma Center in western North Carolina, meaning it is equipped to handle the most complex and critical injuries 24 hours a day.
“I was shocked, and then puzzled, why the state would award [Mission] 95 more beds when they can’t seem to safely manage the beds that they have,” said state Sen. Julie Mayfield, D-Buncombe. “It simply makes no sense.”
The federal Centers for Medicare and Medicaid Services (CMS) has repeatedly sanctioned Mission Health for endangering patients since HCA Healthcare acquired it in 2019. The most recent Immediate Jeopardy citation, imposed in late January, was officially lifted February 9, but Mission is still out of compliance with some federal standards of care. The hospital has until July 29 to address those or it will again risk being denied reimbursement from Medicaid and Medicare.
Immediate jeopardy – the most serious warning CMS can issue for violations of health and safety regulations that endanger patients – indicates that a hospital is in noncompliance with one or more conditions for receiving payment from the federal Medicaid and Medicare programs.
Mission Hospital has been placed in Immediate Jeopardy at least four times since the Nashville-based HCA Healthcare bought the nonprofit Mission Health system in 2019.
NCDHHS gave AdventHealth and UNC Health West until April 27 to appeal.
“Based on the recent health care access and quality concerns in our region, we do not believe the decision is in the best interest of our community and will have profound impacts,” AdventHealth spokesperson Victoria Dunkle told The Watchdog. “We are currently evaluating appeal options that honor the community’s needs and voice. Phase one of AdventHealth Weaverville is currently under construction. Additional phases of inpatient beds are vital to the vision of offering advanced trauma and tertiary care to our community closer to home.”
The Watchdog reached out to UNC Health West to ask about a possible appeal but did not hear back before deadline. HCA-Mission did not respond to a request for comment. NCDHHS had not responded to Watchdog questions by deadline.
Barring an appeal, the state’s ruling means Mission Hospital will expand to 828 beds from the current 733. Its original application to state health regulators in November proposed a $198.5 million expansion scheduled for completion in 2031.
AdventHealth previously received approval to build a new 93-bed hospital in Weaverville. The proposal rejected by NCDHHS last week would have allowed AdventHealth to expand it to 222 beds.
Mayfield, who is also chair of Reclaim NC Healthcare, a nonprofit group formed in 2023 “to advocate for the restoration of quality healthcare in WNC,” said she planned to introduce new legislation in the state Assembly “that conditions the award of new beds on remaining in compliance with CMS regulations. And I already have Republican colleagues who are supportive of that as well.”
U.S. Rep. Chuck Edwards, R-NC11, testified last month to the House Appropriations Committee that he planned to introduce federal legislation that would allow CMS to place more penalties on hospitals that receive immediate jeopardy citations. His proposed “Healthcare Accountability Act (HCA)” would, if adopted, allow CMS to impose fines and take temporary control of management of noncompliant facilities.
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Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. Peter H. Lewis is executive editor and a former New York Times senior writer, editor and columnist. Email plewis@avlwatchdog.org. The Watchdog’s local 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/.