Accusations of understaffing.
Weekend pay bonuses slashed.
A death in the emergency room.
It’s been an exhausting start to 2025 for nurses at Mission Health in Asheville.
Mission Health operates the hospital in Asheville and five smaller, rural hospitals across the North Carolina mountains. The health system has faced extreme scrutiny for decades — even before it was purchased by the largest hospital corporation in the country, HCA Healthcare, in 2019, and its Asheville nurses unionized in 2020.
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Gov. Josh Stein sued the health system in 2023 during his tenure as attorney general.
The medical provider is also the subject of an antitrust lawsuit filed by a number of Western North Carolina cities and counties.
That’s just to name a few strands in the web of litigation that surround the hospital.
Despite all that, the hospital continues to provide care, even as its every move is scrutinized by an independent monitor that ensures the health system remains in compliance with the 2019 purchase agreement between HCA and Mission Health.
Understaffing or neglect?
The hospital’s chief nursing officer is on her way out. One of the hospital’s fiercest critics is attempting to change things from inside the health system’s halls of power. And wildfire smoke and flu season have brought record numbers of people through the doors.
As much as those things may stress employees, executives and patients, they pale in comparison to what happened in February.
That month, a man died in an emergency room bathroom after calling out for help. Nurses say the tragedy was a result of overcrowding in the emergency room and understaffing, and they could not get to him in time.
But the hospital says understaffing wasn’t the issue — it was personnel who neglected to adhere to certain procedures. They’ve fired one employee and are investigating more. Hospital leadership thinks a nurses union — the only one of its kind in the state — is twisting the narrative in order to attract attention and members.
“The February ER incident was a result of hospital protocols not being followed by certain staff members and not the result of staffing levels,” said Katie Czerwinski, a spokeswoman for HCA. “Those are the facts. But (National Nurses United) will likely continue these types of attention-seeking tactics … Every flyer the union releases with a QR code to join shows their true motivation: more dues-paying members.”
But Mission Health nurse Hannah Drummond points out that the death was not an isolated incident.
In 2022 and 2023, Mission Health was placed in “immediate jeopardy” — the most serious citation that the Centers for Medicaid and Medicare can deliver to a hospital — for nine instances of patient harm or avoidable deaths.
“HCA wants to blame individual people rather than taking responsibility for their own systemic failure of putting profits over patients,” Drummond told Carolina Public Press. “That’s why they were in ‘immediate jeopardy’ — because of an unwillingness, not an inability, to safely staff us.”
Paying the price
Complicating matters, Mission Health restructured their Weekender program in March, cutting the hourly bonuses for nurses who work weekends from $40 to $25.
State Sen. Julie Mayfield, D-Buncombe, said the move “makes no sense.” Nashville-based HCA reported a net income of $5.8 billion in 2024 — an increase of 9.9% from 2023.
Cutting an incentive for those working weekends will further strain nurse-to-patient ratios and morale, Drummond worries.
“What’s really important to HCA?” Drummond asked. “Is it actually taking care of their patients or is it lining the pockets of their shareholders?”
But the hospital argues that nurses did not adequately protect themselves against this eventuality in their late 2024 contract negotiations.
“The current union contract,” Czerwinski said, “does not restrict the hospital in adjusting this additional pay rate as needed. While the union initially proposed including the Weekender program in the contract, they later agreed to withdraw that proposal.”
Membership has its privileges
Mayfield heads Reclaim Healthcare WNC, a coalition of physicians, nurses, elected officials, business leaders, clergy and advocates whose mission is to replace HCA Healthcare as owner of Mission Health with a nonprofit hospital system.
And surprisingly, Mayfield is also an HCA shareholder — one with a very specific agenda, and it isn’t profit. Inconspicuously, she and Allen Lalor, who worked as an emergency medicine physician at Mission Health for 27 years, became HCA shareholders in 2023.
“We became HCA shareholders with the intent of submitting shareholder resolutions that would be heard at this year’s shareholder meeting,” Mayfield said. “We’ve been successful in that, though HCA tried to exclude our suggested resolutions.”
That meeting will be held on April 24. Given Mayfield’s view of the company’s practices in Asheville, the other shareholders may be in for a shock.
This article first appeared on Carolina Public Press and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.
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