This story was originally published in The Asheville Watchdog
A Mission Hospital patient under an involuntary commitment order died by suicide inside the psychiatric unit in the early morning hours of May 21, Asheville Watchdog has confirmed.
The patient, whom The Watchdog is not naming at this time, was brought to the hospital by law enforcement, according to four people familiar with the incident.
“The agency is aware of the reported patient suicide at Mission Hospital and takes this matter very seriously,” a spokesperson for the U.S. Centers for Medicare & Medicaid Services (CMS) said.
CMS has repeatedly sanctioned Mission Hospital since HCA Healthcare acquired it in 2019, determining that at least nine patient deaths were connected to lapses in care. Since January, the hospital has been under “enhanced monitoring” by CMS. On Tuesday, surveyors for the agency were reported to be at Mission Hospital.
Mission Hospital representatives did not respond to questions from Asheville Watchdog.
The death occurred in the emergency department’s “Red Pod,” a specialized unit that serves psychiatric patients, according to several sources.
“Red Pod” secure facilityMission Hospital’s Emergency Department is a common first stop for psychiatric patients placed under involuntary commitment, a legal process where an individual can be detained because they are a danger to themselves or others due to mental illness or substance use. Once there, providers evaluate and attempt to stabilize patients before they are sent to a treatment facility, discharged, or taken back into custody.
In certain cases, individuals on an involuntary hold are supposed to be accompanied by a “sitter” who monitors them. It is unclear if the individual was accompanied at the time of their death.
Following the death, hospital management circulated an updated policy to staff entitled “Enhanced Patient Safety Measures for Involuntary Committed (IVC) Patients.”
Among the new requirements is that patients under an involuntary commitment receive a “one-to-one sitter effective immediately.”
The sitter is required to remain with the patient until a nurse completes a “Columbia Suicide Severity Rating Scale” — a commonly used test to determine a patient’s likelihood of committing suicide — and a risk assesment performed by a doctor.
Staff are now being instructed to alert the emergency department’s nurse coordinator if a sitter is not present and an evaluation has not been completed, or if staff see “concerning items in the patient’s room.”
Repeated sanctions for Mission HospitalThe latest death comes amid ongoing struggles for Asheville’s flagship hospital, the only Level 1 trauma center in western North Carolina.
It comes just four months after Mission Hospital’s most recent Immediate Jeopardy warning. The sanction, the most serious that can be handed down by federal regulators, warns that a hospital could lose access to Medicare and Medicaid reimbursements if violations are not corrected.
Neither the hospital nor state and federal investigators are required to announce the sanctions to the public. The Watchdog has confirmed that HCA-owned Mission has received at least four such warnings since 2021. The Immediate Jeopardies collectively cited nine deaths linked to deficiencies in patient care.
Among them was a cardiac patient who died after being disconnected from a monitoring system for over an hour. Another was an 88-year-old woman who went 13 hours without a needed blood transfusion.
But other deaths, including an incident where a patient died after his calls for help inside of an emergency department bathroom went unanswered for 29 minutes, were not cited by federal investigators as part of an Immediate Jeopardy report.
While Mission took steps to successfully lift the Immediate Jeopardy by the end of February, CMS took the unusual step of placing the hospital under additional monitoring. Due to what the agency has characterized as “systemic and repeated quality concerns,” Mission hospital was also required to submit and adhere to an enhanced plan of correction by July 29.
[Editor’s note: If you or someone you know are having thoughts of suicide, call or text 988 to reach the 988 Suicide and Crisis Lifeline. In addition, Crisis Text Line is a texting service for emotional crisis support. To speak with a trained listener, text HELLO to 741741. It is free, available 24/7, and confidential.]
