Mission Hospital's Repeat Federal Safety Citations Raise Oversight Questions

A 72-year-old man arrived at Mission Hospital on July 23, 2025, with chest pains and shortness of breath. Three days later, a patient care technician found him on the floor of his room, disconnected from both his oxygen device and the telemetry equipment used by off-site technicians to monitor his vital signs. He died. That incident, one of several that triggered Mission's fourth Immediate Jeopardy designation in less than five years, captures a pattern that state and federal regulators say poses a systemic risk to the Buncombe County residents who depend on western North Carolina's only Level 1 Trauma Center.

CMS lifted the fourth Immediate Jeopardy designation on March 4, when Mission CEO Greg Lowe announced the removal in a memo to hospital staff. CMS confirmed the removal following a survey that ended Feb. 13, after approving the hospital's Enhanced Plan of Correction on Jan. 29. The reprieve is partial. A Feb. 27 CMS letter confirmed that Mission remains out of compliance with multiple Medicare Conditions of Participation, including requirements related to patients' rights, nursing services and infection prevention and control. The hospital must return to substantial compliance by July 29 or risk losing its Medicare provider agreement.

State records show CMS cited Mission for 20 deficiencies in the nine years before HCA's 2019 acquisition. Under HCA's management, that figure climbed to 38 deficiencies, producing four formal Immediate Jeopardy declarations. Each designation documents specific harm: in 2024, an NCDHHS inspection found 18 patients were harmed between 2022 and 2023, four of whom died, through violations connected to the hospital's emergency and oncology services. A separate case that year involved a patient who died in the emergency department bathroom in February after calling for help for 29 minutes before staff responded. In 2021, regulators found the hospital failed to properly care for a patient who had a history of drug use and was found dying on the floor of her room.

State Sen. Julie Mayfield, a Democrat representing Buncombe County, has called the cycle a "merry-go-round" of enforcement. "I will also note that pre-sale Mission did not struggle with the range and depth of problems that HCA has," Mayfield said. "I suggest that this is a direct result of HCA prioritizing process, speed, and profit over the most important priority: centering patient care."

Two pieces of proposed legislation now aim to give regulators stronger tools. U.S. Rep. Chuck Edwards, the Republican representing NC-11, testified before the House Appropriations Committee that he plans to introduce the Healthcare Accountability Act, which he dubbed "the HCA, Mission Act." The bill would give CMS the power to impose monetary fines, require state monitoring, and appoint temporary management at noncompliant facilities. Mayfield said she also plans to introduce state legislation that conditions the award of new hospital beds on remaining in compliance with CMS regulations, and that she already has Republican colleagues in support.

Currently, when a hospital has jeopardized patient safety, CMS's lone regulatory tool is a finding of Immediate Jeopardy, which requires a hospital to submit a plan of correction within 23 days or risk the agency stopping Medicare or Medicaid reimbursements. Terminating Mission's agreement outright is not a viable option: the resulting loss of Medicare and Medicaid funding would be disastrous for the hospital, which is financially dependent on that funding, and Mission remains the only Level 1 Trauma Center in western North Carolina.

Patients who have concerns about care at Mission can file complaints with the North Carolina Department of Health and Human Services, the state agency that conducts CMS inspections, or submit complaints directly through CMS. Medical records can be requested through Mission's health information management department. The July 29 compliance deadline marks the next formal reckoning, one that CMS, state legislators, and community advocates will be watching closely.