Year in review: Health care gets mixed marks in 2023

It might seem that only one story dominated the local wellness landscape in 2023: the frustration some residents have with Mission Hospital and its for-profit owner HCA Healthcare. But a closer look will show that the community faced other struggles and successes with public health.

For example, Buncombe County and the City of Asheville put major resources toward addressing substance use, including the rise of fentanyl and xylazine in the street drug supply. The county debuted a co-responder unit, composed of a Buncombe County sheriff’s officer and a trained mental health counselor, to respond to certain calls. The Mountain Area Health Education Center coordinated with Mission Hospital to initiate medication-assisted treatment for people with substance use disorders upon leaving the emergency room in an effort to address the illness.  

But not all impacts to our local health care landscape originated in our county. Due to a change in North Carolina state law, beginning July 1 women can no longer terminate a pregnancy after 12 weeks of gestation, with few exceptions. And this year also saw North Carolina expand Medicaid eligibility, which will allow thousands of more people locally to obtain health insurance.

Xpress heard from residents from all walks of life — some in health care, many not — about their thoughts on health and wellness in the region in 2023.

Looking back on 2023, do you think Buncombe County and Asheville are on the right path in how they address substance abuse in our community? Why or why not?

“There seems to have been some improvements on that front with more direct, proactive involvement from our first responders. It would be wonderful to see those programs that help people struggling with substance abuse continue to grow in size and scope of services. Treatment, employment and shelter/housing seem to really have a positive impact for the folks that are ready to receive help.” — Billy Doubraski, East West Asheville Neighborhood Association board member

“I believe that Buncombe County has made a start in the treatment of substance use, but I also feel that the stigma of addiction remains so great in this area that the community at large makes it very difficult to put the treatment needed where it is needed and when it is needed. Focusing on reducing stigma may improve outcomes in substance use treatment.” — Sherrie Pace, licensed social worker and addictions specialist  

“Our local governments are fully aware of the challenges presented by substance abuse. There is a mutual commitment to meet this problem head-on, a dedication of resources and a sense of collaboration and shared vision. We didn’t get here overnight, nor will we overcome this menace in short order. Our focus remains on the disease rather than the symptoms, and I believe this is at the forefront of our local leaders’ minds.” — Brad Branham, city attorney, City of Asheville

“More needs to be done to help with mental health and substance abuse as we continue to see many overdoses in our community. Initiatives like the medication-assisted treatment program are a path forward.” — Karis Roberts, executive director, Asheville Brewers Alliance 

“My answer is controversial at this point. With all the junk in drugs these days — causing all sorts of problems, including overdoses and psychosis — I believe getting ‘illicit’ drugs from my doctor and pharmacy would at least give me a measured dosage of what I want to ingest, and my doctor would also be working with me directly, maybe more regularly. Major change of mindset needed for this one.” — Michael Harney, local educator

“Fentanyl use has been incredibly difficult to plan around in child welfare, given the safety considerations and the higher rates of death associated with its use. I think community paramedics have been a bright spot providing education, support and resources to those that are substance affected and unhoused. I also think the more we can use peer support specialists, the greater chance we have to impact change.” — Mick McGuire, program coordinator, Buncombe County Social Services

How, if at all, have the state legislature’s restrictions on abortion impacted your friends’ and family’s reproductive or family planning decisions?

“It is truly wild to me that any government entity has the desire or power to hold an individual’s bodily autonomy hostage. North Carolina’s Senate Bill 20 is detrimental to the livelihood of many and directly impacts anyone who deserves the right to make their own choices about their present-day experiences and their future, myself included.” — Ashanti Ternoir, community member and service provider

“Limiting and criminalizing access to this vital health care is a threat to the lives of those who can become pregnant. I think it is important for us to educate ourselves and take care of one another in community to ensure everyone continues to be able to get the health care they need, regardless of the unjust laws that are being passed to control our bodies.” — Grace Barron-Martinez, activist and Realtor

“Limiting access to full-spectrum reproductive care made it more complicated, delayed and expensive to access health care. Our neighbors are weighing the costs of family planning — housing, transportation and child care — with the reality that they may need to travel to receive medically necessary care. People who can afford it are making difficult and costly decisions to take off work, arrange child care and travel to other states to have their health care needs met while others must self-manage abortions.” — Kim Roney, Asheville City Council member 

What have your experiences with regional health care providers been like in 2023?

“I continue to hear stories from people who are very frustrated with the lack of options and quality of care. We need to have a variety of high-quality health care options across our region in order to ensure that our residents are able to obtain the best quality care at the most affordable price.” — Terri Wells, Buncombe County commissioner

“I’m very privileged in my own access to health care and for not having encountered any major health problems recently. There have been quite a few cracks in my experience with mental health care this year, however, and that’s something that I see reflected in a lot of my loved ones’ experiences as well. There’s a mental health crisis in adolescents and young adults especially, and our health care system doesn’t have the infrastructure to improve it.” — Allie Daum, senior at UNC Asheville 

“I am a veteran and receive most of my health care at the Charles George VA, and it is outstanding. It truly stands out for friendliness, efficiency and compassion. Employees seem to enjoy working there, and the positive vibe is palpable.” — Monica Walsh Blankenship, veteran

“On a personal and professional level, I have found the waitlist for most services to be extensive and overwhelming. Behavioral health care is abundant in this area, and yet it is very difficult to get an appointment and even to get some providers to call you back. The wait for specialty medical care was so extensive in this area that I traveled to South Carolina for an appointment a month earlier than I could get it in the Asheville/Hendersonville area.” — Sherrie Pace

“I have had some of the best experiences with regional health care providers in 2023.” — Michael Harney

“The school system is blessed with outstanding partnerships with a variety of regional health care providers. From support in providing school nurses and athletic trainers to the opening of our first school health center at Clyde A. Erwin Middle School, health care providers have been responsive and proactive in supporting the needs of our students and staff. We look forward to opening our second school health center early in the new year at Enka Middle School.” — Rob Jackson, superintendent, Buncombe County Schools 

“In my limited experience, I think the regional providers have done well. I had a recent experience with the Mission ER, and they provided great care to my loved one. I work routinely with Decedent Affairs at Mission and they have dramatically improved in their communication and support over the last six months. I do think there are significant gaps in mental health care for children and adults, and limited supports and placements for children who need higher levels of supportive care. The wait times for appropriate levels of care and mental health supports are entirely too long.” — Mick McGuire

If you had an emergency, would you go to HCA or elsewhere? Why?

“Faced with a medical emergency, I would avail myself of the closest available care, and if that happened to be HCA, I would seek care there. Two years ago, I was diagnosed with atrial fibrillation and received excellent care from the doctors at Asheville Cardiology Associates, including a successful cardiac ablation performed in the Heart Tower at HCA.” — Terry Roberts, author

“Anywhere else. I recently took [a loved one] to the ER. After six hours waiting, we scrambled to get an urgent care appointment and went there. What HCA has done to Mission is criminal and is a shining example of how basic human rights, such as access to quality health care, can’t be trusted to executives in faraway boardrooms. WNC requires a nonprofit, comprehensive health system that prioritizes people, preventative care and long-term health over profit.” — Ben Williamson, nonprofit administrator 

“Definitely not, unless I had a heart attack. I would go to Pardee or Advent for better quality care and to try and ensure a better outcome for myself.” — Helen Hyatt, activist and South Asheville resident

“Profit-driven health care creates outcomes like we’re seeing at HCA. HCA continues to have many services that other local hospitals nearby do not. What has happened with HCA is an example of a larger systemic problem we’re facing in our country. I’ve been extremely inspired by the organizing of the workers at HCA as they advocate for better working conditions and better care for patients.” — Grace Barron-Martinez

“I’ve gone to the ERs at St. Joseph’s and Mission, but thankfully, not for many years. More recently, however, I’ve read and heard too many horror stories to go to Mission’s ER if I had a choice. If it wasn’t a heart attack or stroke, I’d drive the additional 15 minutes to Advent.” — Jake Quinn, chair, Buncombe County Board of Elections 

“Excluding the confusion with various groups changing their relationship back and forth with Mission, my care has been good. I do feel like a viable alternative to Mission in the area would be good for all. There are great departments at Mission, and some not so great.  But, again, my personal exposure has been limited.” — Monica Walsh Blankenship