Editor’s Note: As 2024 comes to a close, Asheville Watchdog staffers take you back and inside their most memorable stories and news events of the year.

I was driving down I-26 on Jan. 11 when I got the call.

The U.S. Centers for Medicare & Medicaid Services had a document I’d been hunting for months, and I would possess it within minutes.

The caller, a CMS employee, told me he had a letter from the North Carolina Department of Health and Human Services informing CMS of its investigation of Mission Hospital and its recommendation that the hospital be placed in immediate jeopardy, the most severe sanction it could face.

State and federal investigators had descended on the hospital in November and December 2023, interviewing nurses, doctors and administrators about the quality of care being provided to patients. 

I knew the investigations were happening, but I didn’t know how severe their findings would be. I certainly didn’t expect a finding of immediate jeopardy, which CMS defines this way:

“Immediate Jeopardy (IJ) represents a situation in which entity noncompliance has placed the health and safety of recipients in its care at risk for serious injury, serious harm, serious impairment or death.” 

Unless a hospital fixes the conditions that brought about the immediate jeopardy, it faces the loss of its Medicare and Medicaid funding, which can jeopardize its financial viability. As we have reported, the majority of patients in western North Carolina are on Medicare or Medicaid, or are uninsured.

I called my editors and we started an all-hands-on-deck session of calling sources, writing and editing. 

Within a few hours of my receiving the call from CMS, we published our story, making Asheville Watchdog the first media outlet to break this major news.  

“We have taken those results seriously, and there are no excuses for our patients receiving anything other than exceptional care,” Mission Health spokesperson Nancy Lindell said in the story. “This is not the standard of care we expect, nor that our patients deserve, and we will work diligently to improve.”

On Feb. 1, CMS made it official with its own letter to HCA North Carolina Division President Greg Lowe.  The letter stated that the hospital had 23 days to issue a “plan of correction,” which would need to spell out how it planned to fix the conditions that brought about immediate jeopardy. 

On Feb. 15, a scathing 384-page report from CMS detailing what caused the failures was released. Again, The Watchdog was the first to report the findings: 18 people had been harmed, including four who died between 2022 and 2023, all because of violations of federal standards of care. I described the report this way in my story: 

It spotlights not only patient deaths and long delays in care but also a lack of available rooms, a lack of governing bodies “responsible for the conduct of the hospital,” and multiple leadership failures.

Following a Feb. 23 visit to Mission by state and federal inspectors, the immediate jeopardy finding was lifted. But a coalition of prominent physicians and patient advocates blasted Mission’s plan of correction, writing a letter to NCDHHS Chief Deputy Secretary Mark Benton in which they demanded to know why the plan didn’t require the hiring of more staff.

Mission’s challenges weren’t over. It still risked losing federal funding if it didn’t address issues in key areas: governing body, patient’s rights, quality assessment and performance improvement programs, nursing services, laboratory services and emergency services. The hospital was ultimately found to be in compliance in late May.

The Watchdog’s reporting on immediate jeopardy was just one component of our coverage of Mission Hospital in 2024. Throughout the year, we investigated numerous angles about the largest hospital in western North Carolina. Many of our stories have been grim and tough to report.

A wave of departures

Nurses and doctors have left the hospital, seeking more promising job opportunities. The Watchdog has investigated the departure of neurologists, urologists, cancer medication doctors, pharmacists, hospitalists, registered nurses and others. We’ve spoken to patients, chaplains, administrators and union leaders.

I’ve spoken with many health care workers who say they feel hamstrung by their circumstances. They say they’re unable to leave because they’ve established roots here yet at the same time don’t want to stay because they are burned out or are forced to make compromises, many related to staffing issues at the hospital.

In July, a broad coalition of physicians, patient advocates, clergy and Democratic state Sen. Julie Mayfield launched Reclaim Healthcare WNC. The initiative calls for HCA to relinquish Mission so it can become a nonprofit hospital, as it was before the Nashville company bought Mission Health in 2019 for $1.5 billion.  

Our reporting shows that nurses and doctors are working hard through the tumult to give the best care possible to our community. They worked through enormous challenges following Tropical Storm Helene, with HCA supplying a high level of support.

Some still feel as if the company will continue to cut where it can. 

Some of the last stories I wrote in 2024 revealed Mission’s plan to close the region’s only long term acute care hospital, Asheville Specialty Hospital, and to raze the St. Joseph’s Hospital campus, whose origins date back more than a century and which has been expensive for Mission to maintain.

About a year ago, I wrote a year-in-review piece about my investigation into the hospital’s emergency room procedures, which nurses said had endangered patients. The story included this statement about Mission:

Not everything is clear, but after two years of reporting, I believe that whatever is happening there, it’s seismic.

I didn’t realize how accurate that statement would be.

Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. Andrew R. Jones is a Watchdog investigative reporter. Email arjones@avlwatchdog.org. The Watchdog’s local reporting during this crisis is made possible by donations from the community. To show your support for this vital public service go to avlwatchdog.org/support-our-publication/.

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