A patient in Mission Hospital’s emergency room died in the bathroom last week after calling for help but getting no immediate response.

Hospital spokeswoman Nancy Lindell confirmed the incident to Asheville Watchdog on Thursday and said one employee has been fired and more action may be taken in an ongoing investigation. But several ER nurses contend that the department was crowded and understaffed that evening, with no rooms available when the patient arrived.

“The sudden death of a patient is devastating, and we grieve whenever there is a loss of life,” Lindell said. “We realize there are many questions that need to be answered, and we are examining every aspect of this incident. Our investigation indicates that certain staff who had been trained did not follow hospital protocols. We have terminated one individual and have reported to the appropriate agencies. We are working diligently to address any additional issues that are identified during the course of our investigation.”

Lindell would not provide additional details about the incident, including the number of staff and patients in the emergency department at the time.

The unidentified man arrived at Mission by ambulance Feb. 10 for a respiratory complaint or chest pain and went to the emergency department’s internal processing area, according to multiple medical staffers who spoke to Asheville Watchdog on the condition of anonymity because they were not authorized to discuss the matter. 

Typically a patient who arrives in the ER by ambulance is immediately admitted to a room so they can be closely monitored. But no rooms were available, they said. 

An electrocardiogram, or EKG, was ordered for the patient, they said, but he needed to go to the bathroom before the procedure and was taken there by wheelchair. 

“Once they were in the bathroom, they pulled the red cord for assistance,” said an emergency department registered nurse who was working that evening.

When the cord is pulled, an alarm sounds throughout the emergency department and a light flashes.

“Our leadership there at the time had called over our radios multiple times for somebody to please check that bathroom out in the lobby,” the nurse said. “Probably between 12 and 15 minutes it had been going off with no one checking on that patient. And then when they did check on the patient, the patient had arrested,” meaning his heart had stopped beating.

Triage nurse found patient

A nurse who was responsible for triaging patients ultimately entered the bathroom and found the patient, multiple nurses told The Watchdog. She was not supposed to be involved in responding to patient needs in the waiting room.

“After people weren’t answering, she stepped away (from her triage role), which she shouldn’t have been put in that position to step away, in all honesty, because she could have missed something coming through that door,” one nurse said. “But she stepped away and found him.”

Staff tried to revive the patient, but were unsuccessful.

North Carolina Department of Health and Human Services spokesperson Hannah Jones said Division of Health Service Regulation staff “is not on-site at Mission Hospital and cannot comment on possible investigations.” 

The department declined to say whether Mission had informed it of the incident.

Gerald Coyne, managing director of Affiliated Monitors Inc. –  the independent monitor responsible for ensuring HCA Healthcare lives up to the commitments it made when it purchased Mission in 2019 – said he was aware of the incident. 

“We are not conducting an independent investigation of it, because, you know, right now, I think there’s others that hopefully are,” Coyne said.

The nurses told The Watchdog that they thought staffing levels were inadequate that evening and led to the man’s call not being responded to immediately. 

The emergency room was extremely busy, one nurse said, with 25 to 40 patients in the lobby during the busiest part of the night. 

Another nurse said there were patients out the door at one point, many with severe symptoms.

“From what I observed, I would say it’s because of the staffing shortage, based on acuity and volume,” one nurse said. “They’re going to say there’s no staffing issue because of what we’re, quote unquote, fully staffed according to rooms, but we’re not staffed according to the lobby.”

She said nurses were trying their best under challenging circumstances.

“I mean, they’re trying to work up every critical person that comes through that front door who doesn’t have a room, and leadership was aware, because they were calling over the radio that entire time for somebody to go check on that bathroom,” the nurse said. 

Staffing has long been an issue, nurses contend

For years, nurses have contended Mission is not staffing its emergency room adequately, putting patients at risk. 

“This issue dominoes down because they are not properly staffing their floors to take enough patients,” one nurse said. “It trickles down to the ER. These patients are not getting rooms at appropriate times, because we are holding patients that could be taken care of upstairs. But instead of being taken care of up there, the way they’re saving money is by holding them in the emergency department.” 

If patients are in rooms, “they can actually get treatment,” the nurse said. “They would be put on a monitor where we can watch their heart rate, and we can watch their rhythms. They can get breathing treatments, all these things that they cannot get in a lobby, critical medications that they cannot get if they’re not on a monitor because they’re so high risk.” 

The Watchdog asked Lindell, the hospital spokesperson, about the nurses’ contentions about staffing, but she did not respond.

Ashley Bunting, an emergency department nurse and union member, spoke generally about staffing in her department. She was not working the night of the incident.

“We have seen improvements before,” Bunting said. “We have fought this fight before, we have brought up these same issues of hall beds, patients in the waiting room, unsafe staffing. We have seen improvements, obviously not a fix. And to see it backslide to know that, that we have the capability, the hospital has the resources to make improvements, and that, you know, we’re backsliding really, really shows that they’re choosing their profits over their patients, and that I think is the biggest slap in the face of all.”

In December 2023, Mission leaders sent an email to hundreds of medical staff reminding them that they were to respond when alerted to a emergency department patient’s loss of consciousness or “emergent” condition, and to stop to stabilize patients at risk of dying. 

The email was sent amid state and national investigations into safety practices at Mission, including in the emergency department, that ultimately led to a U.S. Centers for Medicare & Medicaid Services finding that patients had been placed in “immediate jeopardy” because of deficiencies in care. Following the finding, CMS issued a 384-page report that detailed the deaths of four people related to issues in the emergency department. 

A Watchdog investigation found those deaths coincided with staffing deficits.

Mission was given 23 days to issue a plan of correction, and the finding was lifted in February 2024 following a visit by federal and  state inspectors.

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 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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(The Center Square) – More than 2,000 households remain in FEMA transitional housing as western North Carolina this weekend begins its 22nd week of recovery from Hurricane Helene.

Another 173 are licensed in the mobile housing units of the agency.

Money and volunteer help has poured in and has at the same time not been enough. Lawmakers on the federal and state levels continue to work on legislation to appropriate more. Interstate 40, a key commerce route between Asheville and Knoxville, Tenn., is scheduled to reopen to two-way traffic a week from Saturday.

In the update provided Thursday by the Office of Emergency Management, $385.7 million has been approved for individual assistance and $9.7 million for FEMA rental assistance funding. The update says 3,529 households are receiving rental assistance.

Disaster unemployment assistance disbursed to date is $21 million.

There have been 6,507 private roadway and bridge projects awarded; 4.4 million cubic yards of debris removed; and 231,813 cubic yards of waterway debris removed.

National Flood Insurance Program payments are $127.1 million.

The storm made landfall as a Category 4 hurricane in Dekle Beach, Fla., on Sept. 26. It dissipated over the mountains of the state and Tennessee, dropping more than 30 inches in some places and over 24 consistently across more.

The storm killed 106 in the state and is estimated to have caused $53 billion in damage.

Lawmakers in Raleigh have appropriated three installments totaling $1.1 billion and are working on the fourth. Early consideration is about $500 million.

Congress sent to the state about $9 billion of the $110 billion package it approved in December.

Part three of three

The man held out a red card he carries in his pocket at all times. One side is in his native Spanish. The other, English, the language of the country he entered illegally nearly 20 years ago. It reads:

“I do not wish to speak with you, answer your questions, or sign or hand you any documents based on my 5th Amendment rights under the United States Constitution.” 

“I do not give you permission to enter my home based on my 4th Amendment rights under the United States Constitution unless you have a warrant to enter, signed by a judge or magistrate with my name on it that you slide under the door.”

“I do not give you permission to search any of my belongings based on my 4th Amendment rights.”

He hopes — and prays — that neither he, nor any of his family or friends, will ever have to present these cards they all carry in the event they are questioned by immigration officials. 

But with the Trump administration vowing to conduct “the largest mass deportation operation in U.S. history,” and threatening Asheville and Buncombe officials if they don’t cooperate, the red card is always at hand while he waits for his green card and long-term legal residency.

“It was terrifying”

“I came here in 2006, 2007,” the man said. “I walked through the desert for four days and four nights to come here. It was terrifying.”

But the prospect of being separated from his family here, and possibly deported, is just as terrifying, he said.

The man works at an industrial enterprise in Buncombe County. He spoke on the condition that neither he nor his employer be identified so that he could speak candidly without fear of reprisals. 

“I’ve been working here for more than 15 years,” the man said. “I have four kids. My wife is from a different country, and she has papers here, but mine haven’t been processed yet. I have a lawyer here to help me get a green card. It’s been three years since I applied, and we haven’t seen anything.” 

The U.S. limits the number of employment-based green cards — officially known as Permanent Resident Cards — issued each year, and the backlog occurs because the demand far exceeds the available supply. At the start of fiscal year 2024, approximately 34.7 million green card applications were pending, according to the Cato Institute. Given the annual cap of about 1.1 million green cards, only about 3 percent of applicants were expected to receive permanent status last year. 

The system for approving or rejecting applications is overburdened. Waits are often measured in years. It’s the same for applications for asylum. In North Carolina at the end of 2023, the most recent data available, there were 24,662 pending asylum applications in the state, and the average wait time for a hearing was more than four and a half years, according to the Transactional Records Access Clearinghouse (TRAC) at Syracuse University.

“I was thinking, if people are here for more than 10 or 15 years, they should get papers, except if they have some kind of criminal record,” the man said. 

“Each company has Latinos working, inside, outside, everywhere,” he said. “We work hard in this country, we do our best, and we don’t do bad things. I pay taxes, I do everything, everything, everything. When we do that, they should give us a solution to get papers.” 

More paid in than paid out

Although some undocumented workers are paid “under the table” for temporary or infrequent jobs, like housekeeping, many others — despite not having legal status — pay federal, state, and local income taxes, as well as Social Security and Medicare taxes, through payroll deductions by their employers.

According to the American Immigration Council, undocumented immigrants in North Carolina paid an estimated $1.8 billion annually in federal, state, and local taxes. The Social Security Administration (SSA) estimates that undocumented immigrants and their employers nationally contribute around $12 billion per year to Social Security through payroll taxes, even though the workers are ineligible to collect Social Security benefits. They also contribute to Medicare through mandatory payroll deductions, but rarely receive benefits.

Undocumented immigrants also contribute billions of dollars in sales taxes through everyday purchases, such as gas, clothing, and groceries, and indirectly pay property taxes, through rent payments, that fund local services like schools and infrastructure.

The government does grant undocumented immigrants a handful of benefits that are deemed necessary to protect life or guarantee safety in dire situations, such as emergency Medicaid, access to treatment in hospital emergency rooms, or access to healthcare and nutrition programs under the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). 

Latinos who risk their lives to come here are not expecting handouts, or the high life, the man said. In his case, he said, he had a nicer home in Mexico than the one he has here, and had attended college. His job in Buncombe requires physical labor every day, in a demanding environment. But his long-term prospects are better in America, he said.

Returning to his native country is not possible, he said. 

“Where my family lives in Mexico, two cartels are fighting,” he said. “They take families out of houses and shoot them. A lot of people die, it’s terrible. I’m worried for my parents. I want to bring my parents here, but I can’t.”

“I don’t do anything bad, and I’m working hard. I love this country, and I want to stay here,” he said.

But he’s scared, he said. “Last night we went to church, and my friends were telling me, ‘You don’t want to go to church because of ICE.’”

Within hours of taking office, President Trump issued an executive order instructing Immigration and Customs Enforcement (ICE) agents to ignore Biden administration restrictions against entering and arresting people in “sensitive” areas, including schools, churches, hospitals and doctor’s offices, daycare centers, funerals, and weddings.

His biggest fear, the man said, is being taken away, separated from his wife and children. 

“If we don’t have papers here, we will always be scared,” he said. “But right now, when Trump’s president, we are more scared.”

“We are hiring them legally”

The man’s employer also spoke on condition of anonymity. 

“Probably 60 percent of our workforce is Hispanic,” the employer said. “All of our employees are run through E-Verify. They have to have two forms of identification. So all of our employees have gone through all the legal proceedings to be qualified as legal employees of this company.”

E-Verify is an internet-based system through which businesses electronically confirm the employment eligibility of their workers. The employee fills out a verification form and that information is matched against U.S. Department of Homeland Security and Social Security Administration databases.  

Undocumented immigrants use stolen or false names and Social Security numbers and forged documents to pass through the E-Verify system. In those cases, it’s unclear whether the worker or employer is exploiting the loophole.

“If their documents look legitimate and feel legitimate, and we question them beyond that, that’s considered discrimination,” the employer told Asheville Watchdog. “We don’t discriminate against our employees. We take their documents and we submit them, and then it’s E-Verify’s job to verify that those are legal documents.”

Once the employee is cleared, “all of their taxes get deducted from their paycheck,” the employer said. “All of that gets reported and deducted for their pay scale and everything. Their tax money goes to the government, just like any other employee’s would.”

Concern about workplace immigration raids in Buncombe is growing among area employers.

“If a police officer or an ICE agent shows up at our door, we’re not going to willingly aid them unless we are required to by the confines of the law,” the employer said. “This is private property, not government property. So if anyone shows up and wants to search our premises, they need a judicial warrant. If they don’t have a judicial warrant, they’re not necessarily welcome to come search our property and ask questions.”

Going after employers

The Trump administration has signaled that it intends to use the Internal Revenue Service and its agents to pursue undocumented immigrants and their employers.

In a Feb. 7 memo to Treasury Secretary Scott Bessent, Department of Homeland Security Secretary Kristi Noem requested the IRS pursue financial audits of businesses suspected of having undocumented workers, and to deputize IRS agents to assist U.S. Immigration and Customs Enforcement with apprehensions, detentions, and removals of individuals who are in the country without authorization.

The deportation of potentially hundreds or thousands of undocumented immigrants who are working in Buncombe County would have far-reaching consequences for local employers, some of whom are themselves undocumented.

In campaign speeches, Trump said he would deport “between 15 and 20 million individuals,” although the number of undocumented immigrants is generally estimated to be 11 million. Trump’s “border czar,” Tom Homan, clarified: “Bottom line is, under Trump he’s still going to prioritize national security threats and criminals. But no one’s off the table. If you’re in the country illegally, it’s not OK. If you’re in the country illegally, you better be looking over your shoulder.”

Doug Brown, chairman of the Buncombe County Republican Party, told The Watchdog via email that because the Trump administration is deporting only criminals, the impact on Buncombe County’s labor force will be minimal. 

“Venezuelan gangs, pedifiles[sic], and criminals are not our workforce,” Brown wrote. “So, if you are working, such as landscaping or washing dishes, as opposed to being a criminal, your gamble to enter the USA illegally is probably a safe gamble.” 

Removing people who entered the United States without authorization “would save us money spent combating the crime, treating the wounded victims, replacing the stolen merchandise, over-burdening our police and sheriff departments — costly consequences of letting millions of people illegally enter our country,” Brown wrote.

Research shows that immigrants — including those who are undocumented — are less likely to commit crimes than U.S.-born residents, according to the American Immigration Council. As of Feb. 9, there were 41,169 ICE immigrant detainees in custody, according to TRAC. More than half, 54.7 percent, had no criminal record, and many more had only minor offenses, including traffic violations.

What are your rights?

Rebecca Sharp, the founder and director of La Esperanza, an outreach program of the Episcopal Church of the Holy Spirit in Mars Hill that serves Latino families in Buncombe, Madison, and Yancey counties, said preparations are already under way to help immigrants deal with the expected increase in enforcement.

“We are preparing by educating them,” Sharp said. “We work with Pisgah Legal to do workshops so they can learn about their rights. You know, what are your rights if someone comes to your door? What are your rights if someone pulls you over? What rights do the police have, and not have, to ask you for immigration papers?”

The U.S. Supreme Court has upheld that certain constitutional rights — excluding the right to vote — extend to everyone living within the U.S., not just natural-born citizens or legalized immigrants. This includes “due process” protections under the Fifth, 10th, and 14th amendments.

ICE enforcement officers typically use administrative removal warrants — signed by agency administrators, not judges or magistrates — to carry out their duties. Unlike a criminal warrant issued by the federal court, a removal warrant for civil violation of immigration laws does not authorize the ICE officer to enter into a home, school, church, or other restricted area to execute the warrant — unless invited to enter.

If refused entry, the ICE agents must obtain a judicial warrant or wait until the subject of the administrative warrant leaves the house or other private area. For many undocumented immigrants, that means every trip to the grocery store, to work, to take children to school — even to go to the doctor — becomes a frightening risk.

“I have heard that there are people that are too scared to leave their houses,” Sharp said. “For the most part, you can’t do that. You have to get food, you have to work, you have to pay the bills, but there are people that are definitely lying low more than in the past.”

La Esperanza also works with Pisgah Legal Services to help immigrants on the typically complex path to long-term lawful immigration status.

Originally called Mujeres Unidas en Fe (women united in faith), the nonprofit organization changed its name to La Esperanza (the hope) as the numbers of volunteers expanded. It now supports dozens of immigrant families in western North Carolina.  

“We’re going to continue to support the community, and that includes people of all legal statuses,” Sharp said. “I’m not going to go up to people and say ‘Hey, by the way, are you undocumented or not?’ That’s not my concern. My focus is saying ‘Okay, you need help. You can’t pay your bills? Let’s get you some help. You have cancer? Let’s get you a doctor.’”

Rumors of ICE activity in western North Carolina — most of them untrue — spread via social media, Sharp said.

“We educate people that social media can overwhelmingly be evil,” Sharp said. “People say ‘Well, I saw on social media that ICE is here. I saw on social media that my neighbor can turn me in.’ So I’m telling people, get off social media. Really look for groups and gatherings with people that you trust.”

Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. John Boyle is a staff reporter and columnist. You can reach him at (828) 337-0941, or via email at jboyle@avlwatchdog.org. Peter H. Lewis is The Watchdog’s executive editor. Email plewis@avlwatchdog.org. Linus Schafer-Goulthorpe is a student reporting intern. The Watchdog’s local 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/.

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