Senate bill on Mission Hospital loses transparency oversight provisions

A Senate bill meant to respond to Mission Hospital’s troubles lost the part that would have forced more public scrutiny of hospital deals, leaving Western North Carolina with fewer tools to check what happens when care changes hands. The surviving measure still protects whistleblowers, limits non-compete clauses and caps nonprofit hospital CEO pay, but it no longer carries the broader transparency oversight that Sen. Julie Mayfield said was needed after HCA bought Mission Health in 2019 for $1.5 billion.

The stripped language mattered because Mission Hospital is not just another corporate asset in Asheville. It is the largest hospital in the region and a critical provider of surgical, maternal and trauma care, which means its failures ripple far beyond Buncombe County. Mayfield said the bill’s remaining protections were shaped by what happened after HCA took over the formerly nonprofit system, including reports that employees were fired after speaking to state and federal surveyors or indicating they would share care-improvement recommendations publicly.

Sen. Jim Burgin, the bill’s sponsor, said he did not want the measure to interfere with the developing Atrium Health and WakeMed merger in the Triangle. He also acknowledged that a pre-merger review law would have produced more discussion and more public information about hospital deals. That is exactly the kind of oversight Mission critics have been asking for, as patient safety complaints and service cuts have mounted in Asheville.

The urgency comes from Mission’s regulatory record. Mayfield said the hospital has received four Immediate Jeopardy citations from the Centers for Medicare and Medicaid Services in five years. In October, inspectors found preventable patient death, unsafe patient transport, patient misidentification and harmful infection protocol. CMS later removed one Immediate Jeopardy designation, but it required Mission to hire Bryant Healthcare Consultants and file monthly progress reports by July 26.

Those findings have fed a wider backlash across Western North Carolina. Reclaim Healthcare WNC launched in July 2024 with physicians, nurses, elected officials, clergy, business leaders and advocates calling for HCA to sell Mission Health and return it to nonprofit ownership. The coalition includes Mayfield, Brevard Mayor Maureen Copelof and Highlands Mayor Patrick Taylor.

The state and its watchdogs have also kept pressure on HCA. North Carolina Attorney General Josh Stein sued the company in 2023, accusing it of allowing emergency, trauma and cancer care to deteriorate. Dogwood Health Trust said in 2025 that HCA was potentially out of compliance on emergency and oncology services, Medicare and Medicaid standing, and uninsured and charity care policies. Two issues were later corrected, but the emergency and oncology concern remained open, leaving Buncombe County still waiting for the kind of oversight that can actually stop the next failure before patients pay for it.