Messino Cancer Centers has offices on Brevard Road in West Asheville but also operates at Mission Hospital. // Watchdog photo by Starr Sariego

Messino Cancer Centers will no longer provide chemotherapy for dozens of acute hematology cancer patients at Mission Hospital because of concerns over “ongoing system failures,” which it says were going to ultimately harm patients.

Asheville Watchdog obtained a Sept. 20 letter to Messino doctors and Mission leadership and staff in which Martin Palmeri, head of Messino’s cancer department working at Mission facilities, announced the decision, which will likely force more than 50 patients to seek care outside of Asheville.

“With heavy hearts, the physicians at Messino Cancer Centers cannot with good conscience continue to provide inpatient complex hematology care,” the letter stated.

“The doctors at Messino Cancer Centers have decided to no longer treat complex hematology cancer patients — acute leukemias requiring induction therapy and primary (central nervous system) lymphomas — in the inpatient setting,” the letter said. “For patients currently on treatment, we will complete their course of therapy if the patients prefer to remain at Mission. Otherwise, we will be transferring these patients to academic medical centers for their care.”

The letter noted Atrium Health and Duke Health “are not facing the same struggles that Mission is.”

Atrium and Novant Health have hematology services in Charlotte, roughly two hours from Asheville. Duke Cancer Center is in Durham, nearly three and a half hours away.

While it cited the stresses the COVID-19 pandemic wreaked on the health care world and praised nurses and pharmacy members on the ninth floor of Mission’s K9 oncology floor, — where Messino oncologists provide cancer treatment —  Palmeri’s letter said Messino’s ability to care for patients was negatively affected by “issues that need hospital leadership and resources to succeed.”

Messino has identified and prevented errors “that could have ultimately led to patient harm,” but “problems still persist,” wrote Palmeiri, a Messino Cancer Centers oncologist and president of the North Carolina Oncology Association.

The letter listed several resources and procedures that it said Messino doctors have told Mission for four years are necessary to prevent future errors:

  • 2:1 or 3:1 nurse-to-patient for complicated hematology patients on intensive chemotherapy in areas where they are moving to less intense care 
  • Two chemotherapy trained pharmacists that can support each other and provide medication double checks and consistent weekend coverage
  • Dedicated care management support for oncology patients to reduce inpatient stays and safely transition these patients home
  • Oncology support services — pathology and laboratory — that can provide timely services
  • Management that understands drug and laboratory supply chain management so that patients’ care is not interrupted and their well-being put at risk

The letter said Messino will still provide guidance and direction to Mission hospitals “in hopes of one day being able to resume access to complex hematological care in Western North Carolina. … We will continue to be honest and forthright with the community regarding our capabilities and as soon as we feel this service can be successfully and safely restarted, we will gladly proceed.”

Martin Palmeri // Credit: Messino Cancer Centers

Palmeri declined to comment about Messino’s decision, saying, “As the oncology service line leader that was elected by the oncology community in Western North Carolina, I’m not at liberty to make a public comment at this point.”

He did, however, give a statement regarding Messino’s ongoing services in the area. Messino will still be providing other cancer services at Mission.

“As a representative of Messino Cancer Centers, I can say that we have a robust outpatient oncology service in the outpatient setting,” Palmeri said. “Messino Cancer Centers has the ability to provide advanced cancer care for all cancer types. We have doctors who specialize in hematologic cancers with an expertise in lymphomas, leukemias and multiple myelomas. We are expanding our research portfolio in order to provide cutting-edge therapies. We have strong working relationships and collaborate with our regional academic institutions to further enhance the care of our patients locally.”

A Mission spokeswoman did not answer specific questions about  Messino’s decision.

“The team at Mission Hospital stands ready and willing to care for any patient that comes to us,” Mission spokeswoman Katie Czerwinski said. “If there is anything that needs to be communicated to our patients, we do so directly.”

Concerns raised five months ago

Messino’s decision not to provide acute hematology chemotherapy at Mission comes five months after a National Nurses United union nurse flagged concerns about potential cancer patient harm to the North Carolina Department of Health and Human Services.

“I am concerned about the care patients have received at Mission Health since the acquisition by HCA,” a complaint letter, obtained by The Watchdog, says. “I have explicitly been made aware of patients who received expired chemotherapy and missed doses of chemotherapy. The legacy Mission of old had a nurse-patient ratio of 3-1 on the oncology floor. Now that ratio is 5-1.”

Czerwinski said nurse staffing is based on patient volume and acuity and is revisited every four hours. “Resources are shifted as needed,” she said. “We take concerns brought directly to Mission Hospital leadership by our teammates very seriously and leadership takes all feedback and addresses those concerns directly with our colleagues.”

The complaint letter describes chemotherapy shortages at Mission, an issue nationwide, according to recent reports.

“Regarding the past national methotrexate shortage, Mission Health experienced the same delays in acquiring this drug as the rest of the country’s health systems,” Czerwinski said. “However, there is no longer a supply concern. The Mission team communicates frequently with our providers about critical drug stock, lab and pharmacy updates, equipment downtime, and other relevant updates.”

The complaint letter is heavily redacted to hide information on specific cancer patient incidents, but says they are “snapshots” of what was happening on Mission’s oncology floor.

“No one can quantify the significance of missing these chemo doses and their effect on mortality,” the letter stated. “Please investigate Mission HCA because people are going to die. These patients need not die unnecessarily.”

Though the NCDHHS sent a letter acknowledging the complaint had been filed, it has yet to send investigators to the hospital, according to nurses.

“Conditions have continued to deteriorate under HCA’s profit-motivated management,” said Elle Kruta, a registered nurse and a member of the Professional Practice Committee, a group of unionized nurses at Mission designated to raise nursing concerns with hospital leadership. “This is why union nurses have been speaking out about patient care, safety, as well as safe staffing. Nurses will continue to advocate for our community to ensure that our patients get the kind of care that they truly deserve.”

The Mission Health SECU Cancer Center in Asheville is entirely separate from services Messino Cancer Centers provides elsewhere on the hospital’s campus in central Asheville. // Watchdog photo by Starr Sariego

Mission has emphasized Messino relationship

The Messino Cancer Centers’ shift away from hematology chemotherapy care at Mission comes on the heels of the North Carolina Attorney General’s office sending letters to Greg Lowe, CEO of HCA’s North Carolina Division, earlier this year demanding answers about a potential depletion in oncology services.

In a June 20 letter, the North Carolina Attorney General’s office cited Mission’s sharp reduction in cancer services, consisting of just one physician “where it once had as many as 14.” It warned Mission that it needed to “restaff the medical oncology department immediately” or risk litigation.

In his response to the attorney general, Lowe emphasized that, although Mission was struggling to recruit oncologists, it was working closely with local groups, including Messino.

In May, Mission spokeswoman Nancy Lindell pointed to Messino as a partner, saying that although Mission was down to a single medical oncologist, the hospital “work[s] very closely with other programs in the area such as Messino Cancer Center and GenesisCare Surgery, who continue to operate every day at Mission Hospital.” 

Messino treats patients in Mission’s facilities through practice privileges, and its work there is separate from Mission Health SECU Cancer Center.

Messino broke away from Mission following HCA Healthcare’s $1.5 billion purchase of the nonprofit hospital in 2019 and established an independent practice in January 2020.

Editor’s note: In the initial version of this story, Mission Hospital did not immediately respond to The Watchdog’s questions regarding a chemotherapy shortage. We’ve updated the story after Mission provided comment.

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 To show your support for this vital public service go to

27 replies on “Citing ‘system failures,’ Messino to stop providing acute leukemia chemotherapy at Mission”

  1. Genesis is also being shut down. Operated by private equity. Healthcare should be completely socialized. Even a Medicare for All, single payer system won’t solve these problems. You have to take the profit motive out.

  2. As a spouse of a 21-year cancer survivor (via Greensboro area in 2001), I am ashamed and dismayed that Asheville cannot take care of this particular medical issue with priority and skill and NOTHING seems to be happening to fix the problem. If the “right people” were afflicted, then action would happen, but for now — embarrassing.

  3. The crooked deal that Ron Paulus made with HCA (a deal approved by Josh Stein) has brought nothing but calamity to WNC. HCA is an atrocity, not just in Asheville, but nationwide. They need to be ousted from WNC.

  4. What can we as area residents do to help try and force HCA’s hand to either sell, or upgrade their capabilities to acceptable standards? I don’t think writing to the AG is enough. Is there an article that explores how everyday citizens can try and take some control over their declining standard of healthcare? Any examples from elsewhere?

    1. Probably some good ole fashion protesting. Thousands of people need to be marching outside of that hell hole with big signs. The nurses have tried but no body is listening. One day it will be your loved one, then it will be too late.

  5. I’ve noticed comments about contacting Josh Stein’s office, the NC Attorney General, concerning the issues we as citizens are facing with the poorly run Mission Hospital. This effort will be futile. Chances are good due to many in power, like Stein, who is running for Governor will be “bought and paid for” by HCA….nothing will be done about the decline of the great healthcare facility Mission was at one time.

  6. Thank you for your continued work to bring transparency to this critical situation we are experiencing in cancer/health care in WNC. I am grateful to have an AG willing to put pressure on HCA, but only wish legislation were in place to give him to authority to force a rectification. Mission facilities could certainly support an independent oncology practice, if HCA would step into a facilities only role. Oncologists are well aware of HCA’s shortcomings, and have no desire to work in such a dysfunctional system. However, opening a satellite of a practice such as Messino Cancer Center within Mission walls would provide the autonomy needed to run a successful cancer treatment program. It is devastating to see corporate medicine eating away at our health care system like its own breed of necrotic cancer.

    1. “Anything within Mission’s walls” would open Messino up to liability. They know better. Nobody wants to hitch their wagon to that horse.

    1. Just refer back to 2003, they committed the biggest criminal and civil fraud in the history US health care. They’ve continued since then, business usual without any oversight, because they can.

  7. WHEN, oh WHEN will numerous well-noted “system failures” at Mission be addressed and action taken? Messino’s departure is just the latest. Mission has a problem, WNC healthcare has a problem and HCA IS the problem. HCA’s acquisition of Mission has been and continues to be an unmitigated disaster for healthcare in our area. Where is the political will to fix this?

    1. There doesn’t seem to be any. Our congressman is all worked up about legal pot happening on the rez. Never heard him utter a word about the HCA disaster.


  9. Is there any hope of HCA being punished at all for messing up Mission? Will there be any consequences at all?

    (Also, thanks for continuing to report on this; it’s very important for Asheville and WNC in general)

  10. It is way past time for the state to yank their medicare license. That is the only thing they respond to $$$$$. The state has failed us on every level and people are indeed dying there. This AG letter writing nonsense is ridiculous as is the independent monitor and their oversight of “HCA’s 15 promises,” none of which include quality of care. Another news outlet reported that the advisors are holding public meetings across WNC soon. It’s a dog and pony show, the monitor has no power because the contract was one sided, all for HCA nothing for the people of WNC. Thank Stein and all those that were complicit. And yeah its hurting tourism too, people don’t want to come here in case somethin’ happens and they need medical care. Word is out, just like the crime and homeless issues. Somebody do something.

  11. HCA and for-profit health care is an abomination.

    Remember that it’s just not the Asheville/Mission site. HCA now owns a grouping of WNC rural hospitals which were formerly gobbled up by Mission. Those hospitals were essentially stripped and sold for spare parts and are just triage ERs for HCA in Asheville now. Our entire region is suffering. People ARE dying needlessly.

    A pox upon the houses of each and every hospital board member who thought selling out WNC’s healthcare system to HCA was “convenient” HCA’s dismal record was well known.

    1. Well said PSCC, people have died and continue to die there needlessly as people who could do something do nothing. For HCA, it’s like taking candy from a baby and they’re laughing all the way to the bank.

  12. As a lieukemia patient I agree with most of the comments; however, it a shame we do not an oncologist in our area who is a specialist in treating ONLY lymphoma and lieukemia patients. I go to Charlotte in order to see a doctor specializing in only lymphoma/lieukemia.

  13. Pretty sad when people are going on the nextdoor asheville site to solicit help from within the hospital for their family members whose lives are in peril from the horrible care at Mission. Calling Josh Stein is not going to cut it, obviously. He owes us a REAL explanation of why he did this. He won’t get my vote, for anything, ever.

  14. Why can we not get any help for this joke of a hospital? The AG signed the agreement allowing the sale. He needs to help Asheville instead of spewing empty promises while running for governor. He won’t get my vote. He shouldn’t get any from Asheville.

  15. As a mother of an oncology nurse at Mission, the nurse/patient ratio is unacceptable! The lack of care for the health of patients AND nurses is shameful.

  16. I moved here 23 years ago when the availability of outstanding health care made WNC appear like a wonderland along with all the natural beauty, a charming city that served as an artists’ community, music, good water, great people, great weather, everything. Most of this has gone the way of climate-change ramifications, gentrification, unaffordability for most upon whose backs all this has been built, and now a failing health care system. Why are people being encouraged to move to WNC when it’s rapidly becoming a caricature of its former self?

  17. So the state just gave Mission the go ahead to build a freestanding ER. How can this even be happening?
    The state won’t investigate the dire conditions there, but gives them free reign to add another? This is messed up.

  18. Since HCA has not lived up to the conditions of the purchase agreement, it should be possible to file suit to unwind the deal.

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