By Jack Evans
The death of a patient in a bathroom at Mission Hospital earlier this month reflects a return to poor staffing conditions, especially in the hospital’s emergency department, similar to those that precipitated federal sanctions last year, healthcare advocates said at a news conference Friday.
Understaffing has led to “at least one other preventable death,” said state Sen. Julie Mayfield, D-Buncombe, a leader of Reclaim HealthCare WNC. The group, a coalition of doctors and nurses, patient advocates, public officials, clergy and others has, since forming last summer, advocated for HCA Healthcare to relinquish ownership of the Mission Hospital network to a nonprofit. Those who spoke Friday reiterated that call to action.
Mayfield said the patient died in late January. She could not provide other details, she said, but added that regulators have been notified.
Reclaim has decried what it describes as a “divestment in staff, resources, and services” precipitating a decline in the hospital’s quality of care. Last year, the U.S. Centers for Medicare & Medicaid Services placed the hospital under immediate jeopardy — a sanction that can result in the loss of Medicare and Medicaid funding — alongside a scathing report about its violations of federal standards that left four patients dead and victimized dozens of others. That action followed Asheville Watchdog reporting about emergency room procedures that nurses said were endangering patients.
Though the federal agency ultimately approved the hospital’s correction plan, allowing it to avoid financial catastrophe, physicians and patient advocates blasted the plan for not including the hiring of more staff.
Staffing at Mission did improve following the immediate jeopardy notice, nurses said Friday at the news conference. For a time, the emergency department’s waiting room was regularly empty and beds were available, recalled Ashley Bunting, a Mission nurse. Pay incentives returned. Nurses got lunch breaks for the first time since HCA bought the hospital in 2019.
But in recent months, she and another nurse, Molly Zenger, said, Mission has allowed patient-to-staff ratios to reach dangerously high levels. Bunting described shifts beginning several nurses short of hospital guidelines, long lines of people waiting to be admitted to the emergency room and patients being treated on stretchers in hallways. The hospital currently employs about three-quarters of the nurses it needs to be fully staffed, Zenger said.
“I have worked some of the hardest shifts of my career this week,” Bunting said. “I’m tired, and I’m angry.”
Tom Kelly, the chief of the Riceville Fire Department, said ambulances sometimes wait in the hospital parking lot for as long as 45 minutes before patients can be admitted — some of whom begged paramedics to take them to any hospital but Mission.
Mission spokesperson Nancy Lindell said the hospital had been adding staff, including a number of contract nurses, to deal with “historically high numbers of patients with respiratory and flu-like illnesses” in the ER.
“The claims made at today’s press event regarding overall staffing levels are incorrect,” Lindell said. “We continue to prioritize our hiring and recruitment efforts – adding more than 240 members to our team in January and holding more than 36 recruitment events over the last two months.”
The Watchdog first reported last week on the death of the emergency room patient, a man who arrived via ambulance at the hospital Feb. 10 for a respiratory complaint or chest pain. No rooms were available, and while waiting for an electrocardiogram, the patient was taken by wheelchair to the bathroom, multiple medical staffers told The Watchdog. While there, he pulled a cord for assistance, causing an alarm and flashing lights throughout the emergency department.
But there was no immediate response to the call, staff said. One nurse estimated it took between 12 and 15 minutes before anyone checked on the patient. By the time a triage nurse did, his heart had stopped beating. Staff were unable to revive him. Nurses attributed the slow response to understaffing.
Lindell said last week that Mission had determined that protocols had not been followed and had fired one employee. The North Carolina Department of Health and Human Services said Wednesday that it’s gathering more information about the death and consulting with CMS.
“As stated previously and despite what has been insinuated, the February ER incident referenced in this press conference was a result of hospital protocols not being followed by certain staff members and not the result of staffing levels,” Lindell said. “The investigation of the January incident referenced in this press conference confirmed that there were no delays that impacted the outcome.”
“The investigation of the January incident referenced in this press conference confirmed that there were no delays that impacted the outcome,” Lindell said.
Nurses told The Watchdog earlier this week that the incident is emblematic of a decline in conditions at Mission: Though care improved as the hospital added staff following the immediate jeopardy finding last year, it has declined amid the hospital’s return to pre-2024 procedures, expiring contracts for traveler nurses and dwindling staff. Nurses said they are often overwhelmed by crowded nights in the emergency department. The nurses union plans to hold a demonstration at Mission on March 6.
The recent decline has been particularly frustrating, Mayfield said, given the improvements the hospital made in the wake of the immediate jeopardy finding and its “heroic” performance in the wake of Tropical Storm Helene.
Reclaim has spoken to nonprofit hospital systems that are interested in buying Mission, Mayfield said. But even if HCA could be persuaded to sell, the price tag would likely be a huge hurdle: Between Medicaid expansion and Mission’s increased profitability thanks to staff cuts, she said, Mission is worth far more than the $1.5 billion HCA paid for it.
Meanwhile, Mission leadership has been absent, the Reclaim advocates said. Kelly said quarterly meetings that hospital executives once had with public officials were nixed after hospital brass became “uncomfortable” with officials’ questions. Mayfield said she would welcome a chance to talk to hospital leadership through a forum other than the press. When nurses brought their concerns to a staff meeting, Bunting said, they were told to come up with their own solutions.
“HCA has completely ignored our warnings,” she said. “We have spoken out, we have called for action, and they have chosen to do nothing.”
Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. Jack Evans is an investigative reporter who previously worked at the Tampa Bay Times. You can reach him via email at jevans@avlwatchdog.org.
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