Written by Jack Evans, Asheville Watchdog.
Mission Hospital has been designated as Western North Carolina’s first Level I trauma center — a significant accolade for a hospital that, according to state and federal regulators, recently put patients’ lives at risk and still has ongoing deficiencies that could lead to it losing Medicare and Medicaid funding.
Bestowed by the American College of Surgeons, the designation, announced by Mission and first reported by WLOS-TV, is the highest a healthcare facility can receive for caring for severely injured patients. Representatives from the College, as well as the North Carolina Department of Health and Human Services, visited the hospital in late September to determine whether it qualified for an upgrade from the Level II designation it’s held since 1995.
Their visit was scheduled for Sept. 25 and 26, according to a July letter from NCDHHS; Mission’s Wednesday news release said it took place in September but did not give specific dates.
The scheduled days overlapped with an NCDHHS investigation into several incidents at Mission, including two in which patients died. At the state’s recommendation, the U.S. Centers for Medicare & Medicaid Services issued a sanction of immediate jeopardy three weeks later, meaning the hospital’s practices posed an imminent threat to patients’ lives and safety. As Asheville Watchdog previously reported, a follow-up survey led to the immediate jeopardy being lifted but found that the hospital still has systemic issues that put it out of compliance with Medicare rules. It faces termination of its Medicare agreement if it doesn’t fix them by Jan. 15.
The immediate jeopardy finding, one of the most severe citations a hospital can receive, was Mission’s second in two years and its third since HCA Healthcare bought it in 2019.
The American College of Surgeons did not immediately respond to a request for comment Thursday. NCDHHS was unable to make a spokesperson available to comment before this story’s publication.
Trauma care is a subset of emergency care: It treats patients who are typically admitted into a hospital through its emergency department, but who require more specialized and extensive treatment than a typical ER can provide. According to a news release from Mission — which erroneously describes the hospital’s location as “Asheville, Tenn.” — the Level I verification “recognizes Mission Hospital’s capability to provide care for every aspect of injury, supported by around-the-clock surgical specialists, advanced technologies and coordinated partnerships with emergency services across the region.”
But Mission’s emergency services have often been central to the hospital’s troubles and deficiencies. In early 2024, CMS placed Mission in immediate jeopardy due to problems in the emergency and oncology departments that endangered 14 patients and led to four deaths. In February, a patient died in an emergency department bathroom after calling for help for 29 minutes with no response; investigators found that Mission violated federal emergency care regulations but, because the hospital initiated “corrective action” before regulators arrived, it avoided sanctions.
Emergency services were involved in multiple cases that led to October’s immediate jeopardy sanction, including that of a patient who died after equipment monitoring their blood oxygen levels failed during transport from the emergency department to another unit. (It was one of several cases in which state surveyors found problems stemming from technological errors.) In a follow-up investigation, the surveyors listed emergency services as one of four categories in which Mission has ongoing deficiencies and compliance issues.
Advocates, county had voiced concerns about Mission’s bid
Mission’s bid for the Level I designation, which The Watchdog was the first to report this summer, faced backlash from local healthcare advocates and from Buncombe County commissioners, who in a letter to NCDHHS detailed their concerns about the quality and cost of care at Mission.
“At present, it appears that Mission Hospital has not demonstrated the staffing stability, operational reliability, or patient safety culture required for Level I trauma designation,” Board of Commissioners Chairperson Amanda Edwards wrote in the August letter. “Our purpose is not to oppose or endorse, but to ensure that OEMS [Office of Emergency Management Services] has all pertinent information to make a well-informed decision.”
It was not immediately clear whether NCDHHS accounted for the county’s concerns. The letter, drafted by County Commissioner Drew Ball, was sent after a deadline for the county to give its input. Ball said in an August commission meeting that the state agency told him it would consider the letter despite its lateness; the agency told The Watchdog at the time that it was still contemplating how to treat the missive.
Neither Ball nor Edwards immediately responded to requests for comment Thursday.
Mission was previously the only Level II trauma center in the region, according to the North Carolina Office of Emergency Services. According to outlines from the National Institutes of Health’s National Library of Medicine, that means it provided 24-hour access to general surgeons, doctors in several specialties, specialty surgery options, ongoing trauma education and quality monitoring and improvement programs.
As a Level I trauma center, Mission will have to commit to teaching and research in trauma management care for patients who have used multiple drugs. It will also be required to provide mental health screening for patients with traumatic injuries and handle a minimum of 1,200 trauma cases a year — or at least 240 involving extreme trauma injuries — and at least 200 trauma patients under the age of 15.
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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 [email protected]. The Watchdog’s reporting is made possible by donations from the community. To show your support for this vital public service go to avlwatchdog.org/support-our-publication/.