It is unclear how long inspectors from the North Carolina Department of Health and Human Services will be at Mission Hospital. // Watchdog photo by Starr Sariego

The North Carolina Department of Health and Human Services is conducting an on-site inspection of Mission Hospital this week following complaints about policies, staffing levels, and quality of care filed by nurses over the past two years.

The inspection begins as Mission and HCA Healthcare are facing an investigation from the office of Attorney General Josh Stein, who is running as a Democrat for governor, and growing public criticism from local physicians who say HCA’s for-profit model has “gutted” the hospital since it purchased it in 2019.

“(W)e are currently on-site at Mission Hospital,” DHHS spokesperson Hannah Jones told Asheville Watchdog on Tuesday afternoon. At least some of the inspectors are from the DHHS’ Division of Health Service Regulation, which monitors North Carolina health care facilities to ensure they are adhering to minimum standards of care. “We cannot comment on ongoing DHSR surveys.”

Mission spokesperson Nancy Lindell characterized the visit as routine.

“Surveys from agencies that govern hospital quality and safety occur regularly and are welcome at Mission Hospital as they offer our community continued confidence in the care we provide,” Lindell said. “As always, we are working together with those surveyors to get them the information they request.”

Despite nurses sending multiple complaints to DHHS in 2022 and 2023, no one from the agency had visited the hospital as of August, The Watchdog previously reported. DHHS spokespeople had cited staffing shortages for the agency’s year-long delay of inquiry into the nurses’ concerns.

The Watchdog asked Lindell when the last such DHHS visit happened, what questions inspectors were asking, whether they contacted the hospital before they arrived, how many of them were there and how long the inspection would take. She did not provide answers.

Mission vascular access nurse Mark Klein, who has filed nurse complaints to DHHS since last year, told The Watchdog, “I have spoken with a NCDHHS Nurse Consultant and … multiple NCDHHS personnel are here to investigate the complaints filed by the nurses union’s Professional Practice Committee about quality of care issues at HCA.”

Mission Hospital nurse Mark Klein // Photo provided by Mark Klein

Klein has worked at Mission since 1999 and is a member of the Professional Practice Committee (PPC), a group of unionized nurses at Mission designated to raise nursing concerns with hospital leadership.

The PPC sent complaints in 2022 and 2023 to the DHHS regarding emergency department handoff procedures, issues detailed in an August investigation by Asheville Watchdog, which obtained copies of those complaints.

The complaints focused on a lack of regulation around procedures to hand off patients from the emergency room to other areas of the hospital. Nurses said that because the hospital does not require they make a phone call or have a face-to-face conversation during these handoffs, patients were being put at risk and “disappearing” from the emergency department.

“There is a dangerous practice pattern of bringing unstable patients to medical or stepdown floors or patient decline because of improper transport practices,” according to a PPC complaint sent on May 18, 2022 to DHHS. “We request an onsite investigation into this hazardous situation present here at Mission health.”

Mission told The Watchdog this summer that its electronic handoff method was sufficient but also acknowledged it was looking into nurses’ concerns. Lindell did not immediately respond to questions Tuesday about whether the handoff policy had been changed.

The Watchdog also obtained and published parts of one nurse’s complaint about problems with oncology care at Mission

In that complaint letter, the nurse said there were quality of care issues on Mission’s floor K9, where doctors from Messino Cancer Centers have practice privileges and are supplemented by Mission staff and resources.

Messino recently halted some acute leukemia chemotherapy services at Mission because of “system failures,” noting the hospital had never provided some essential support doctors requested for four years following HCA Healthcare’s purchase of Mission Health system for $1.5 billion in 2019.

“I am concerned about the care patients have received at Mission Health since the acquisition by HCA,” the complaint letter said. “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.”

The PPC has sent monthly recommendations to the hospital chief nursing officer about how patient care can be improved since it formed its union in 2020, registered nurse and PPC member Elle Kruta said.

“Unfortunately, the CNO has not adequately addressed our concerns, resulting in negative patient outcomes,” Kruta said. “Nurses filed complaints, which eventually led to the NCDHHS investigation. Hopefully, going forward, the CNO will listen to bedside nurses and make meaningful changes to protect our patients.”

DHHS’ visit to Mission follows recent scrutiny from the attorney general, whose office declared HCA has violated parts of the purchase agreement it made when it bought Mission.

Stein’s office gave Dogwood Trust, which was created from the proceeds of the sale to ensure that HCA remains in compliance with the purchase agreement, until Dec. 10 to correct the violations or HCA could face a potential lawsuit.

Stein’s office also issued an investigative demand, requesting HCA turn over 41 sets of documents related to oncology and emergency department services. 

An attorney representing HCA sent a Nov. 7 letter to Stein’s office that the request was “legally improper” and that HCA had not violated the purchase agreement.

Stein’s office said it would respond soon, adding to what has turned into a heated exchange of letters this year between hospital administration and the attorney general, who is running for governor.

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 please visit

25 replies on “State inspectors visit Mission Hospital following nurses’ complaints”

    1. Even if they don’t announce, hospitals have a way of knowing when they’re about to be inspected, they’re tipped off. You have to wonder if they are really there because of nurses complaints or all the media attention and scrutiny. They should have been there long ago.

        1. Bob H, I suspect it may be a bit CYA on their part as well. They couldn’t get there to investigate because of their own staffing shortages? Then call in the feds, don’t ignore the nurses cries for help for 2 years while patients are at risk. Inexcusable.

  1. Great news! It’s also a great week to go to Mission since you know things will be different this week.
    I’m proud to say Mark Klein helped me when I was there! He is top notch!
    I can’t say the same for the hospital procedures.

  2. Hmmmm….Reading about past inspections, Mission has plenty of time to staff up and clean up so they look great for the inspectors. Afterwards, things go back to the usual disaster. How about a surprise inspection?

  3. I wish we would stop calling it mission, It is the Hospital Corporation Of America. And the name should have been the first clue of how this sale would affect us all. Shame on those who approved this sale and shame on CMS for not being here to see what the heck is going on. I am talking to you Chuck. Get the feds here!!!

    1. Chuck has never said a peep about this has he? But he calls for a crime summit in Asheville to clean out the homeless criminals, the low hanging fruit. While the white collar corporate criminals invaded our healthcare system unchecked.

  4. Thank you for all that you are doing to make the public aware of the issues in this community that need scrutiny.

  5. I would love to meet with State Inspector…I could give several pages of complaints in regards to the nurses,treatment at my 8day stay. Would love to voice my disgusting stay..

  6. Thanks Watchdog for keeping up with this.
    Good ole Nancy says:
    “As always, we are working together with those surveyors to get them the information they request.”
    (Yeah, right.)
    “DHHS’ Division of Health Service Regulation, which monitors North Carolina health care facilities to ensure they are adhering to minimum standards of care.” (I’d like to know the definition of minimum standards of care.) Sounds like a pretty low bar. Whatever it is, HCA is notches below and I hope the surveyors can see through the smoke and mirrors and “creative” record keeping.

  7. It’s about time that the state is taking action to investigate what has been reported by doctors, nurses and patients. I hope the allegations are proven true and HCA be held accountable to improve patient care

  8. Why the inspector s are there. Ask why Mission sends patients home from hospital at 230am. My mother in was discharged on October 30th Monday and they sent here home at 1:30am arriving at her home at 2:30am she was 98 years old. Stop think this is a disgrace. She is now in heaven and can’t not send her complaint in

    1. Wow I’m finally glad something is being done mission has got away with murder two many times well good to know there’s good folks still out there who gives a care about patients my mom was flew to mission for a sore throat in complaining of a bad cough from Murphy Andrews N.C she wasnt in the hospital one hole day in the took out her voice box like really
      Didn’t ask her didn’t give reason is why they did yeah nobosy could say anything God knows she couldn’t ever again she lasted about a week in they sent her home in a cab with out notifying anyone she died a couple days later so my heart goes out to the families , patients , nurses
      good people don’t give up

  9. Great Job Mark Klein and everyone else thats remaining at Mission to provide care at one of the most compromised hospitals in our very own community.. better put away those coffee mugs and water bottles that provide the vector of contamination…. HCA is nothing but a bully. Chad patrick ceo, would come down on occasion in his down vest, plaid button down to harrass employees. These people/ administrators are small but with large bank accounts that dictate the sub par healthcare provided so that profits remains a priority. Way to HCA… the good of the few at the cost of the many

  10. AC-T has a disturbing report about HCA trying to muzzle doctors even more than they are now. How long must we be held captive to this menace? Thier stranglehold on our community needs to end.

  11. Does anyone know of a facility which has gotten a fine from DHHS which was significant enough to result in systemic change?

    1. No. The fines are paltry even in the worst of circumstances. This hospital is HCA’s 2nd highest money maker in their nearly 200 hospital portfolio. A fine would mean nothing. The only thing that would make a difference is to find that patients are in immediate jeopardy which would threaten their medicare certification and funds. Haywood hospital faced this back in 2006ish and it nearly ended them. The investigation started with a whistle blower doctor.

  12. Bravo to Asheville Watchdog for this tenacious, dare I say bulldog like, reporting. I used the link in one of your articles to file a complaint with the Gibbins Advisors. I have to say I expected nothing, but they emailed me right away, and set up a phone call within days to speak to Ronald Winter, the head guy working on this. They also included a nurse on the call to offer a medical perspective. Mr. Winters sent me the names/emails of two people in the AG’s office and encouraged me to write them about my experience with Mission ER. I know the independent monitor has taken grief in the public meetings about saying they are only there to monitor terms of sale, but they DO care about what’s going on and will follow up if you report issues to them.

    Stay on this Asheville Watchdog!

  13. Dr’s nurses housekeepers dieticians nurse practioners cnas and all the staff makes a hospital plus the supplies one has to work with and the patients that you take care of. SO NOW ONE SHOULD. UNDERSTAND ITS TO THE ADVANTAGE OF THE CORPORATION TO TAKE CARE OF ALL INVOLVÈD OR ELSE THEY WILL LOSE MONEY AND PATIENTS. THATS WHEN IT TURNS SOUTH. ANSWER THEIR NEEDS AND DONOT PATRONIZE THEM……..

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