Buncombe commissioners urge HCA CEO to meet with WNC leaders on Mission Hospital concerns

Buncombe County commissioners escalated their pressure on HCA Healthcare on Tuesday, May 5, by unanimously approving a resolution urging CEO Sam Hazen to come to Western North Carolina and answer for Mission Hospital’s operations.

The board’s demand puts a sharper public spotlight on a fight that has grown since HCA bought Mission Health System in 2019 for $1.5 billion. Commissioner Drew Ball said Mission Health had lost community trust and needed to answer questions and be accountable to the people the hospital serves.

The resolution ties that request to a string of failures local leaders have already put on the record. Commissioners cited four Immediate Jeopardy findings since the purchase, along with employee concerns about patient care and staffing. Mission was also placed in Immediate Jeopardy in 2024 after a federal review found nine incidents between April 2022 and November 2023, and federal regulators gave the hospital 23 days to correct the problems before later accepting its corrective plan.

The county’s push also lands against a long record of outside scrutiny. The North Carolina Attorney General sued HCA in December 2023, accusing the company of breaching the 2019 purchase agreement and failing to provide quality, consistent emergency services and cancer care. In July 2024, Dogwood Health Trust said an independent monitor found HCA in potential noncompliance in areas tied to emergency and trauma services, oncology services, Medicare and Medicaid enrollment in good standing, and uninsured and charity-care policies.

Those concerns have continued even as state officials approved more growth. On April 2, 2026, the North Carolina Department of Health and Human Services approved Mission’s request for 95 additional acute-care beds at its Asheville campus, a decision that frustrated commissioners given the hospital’s recent safety history and unresolved staffing questions.

The county has also been fighting over the effect Mission’s emergency department has had on local taxpayers and EMS crews. Buncombe County has sought $3 million in damages over ambulance transport delays and higher EMS costs, saying crews were forced to wait with patients while Mission’s emergency room handled backlogs. In that litigation, Mission’s emergency department wait time was cited as averaging 236 minutes, compared with a national average of 161 minutes and a state average of 175 minutes.

If HCA refuses Hazen’s visit, Buncombe County’s leverage is limited but real: it can keep the issue in the public record, maintain pressure through elected officials and community advocates, and continue pursuing its own legal claims. What it cannot do is force HCA to change course, which is why commissioners are making the demand in public now.