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Nurses at Mission Hospital in Asheville, North Carolina, are hopeful that the health system will begin taking accountability as it faces another round of sanctions from state and federal health agencies. Last week, the North Carolina Department of Health and Human Service (NCDHHS) recommended Mission Hospital be put in immediate jeopardy for practices that resulted in an unsafe environment for patients. Why It Matters Since HCA Healthcare bought the health system in 2019, this is the third time Mission Health has recommended for immediate jeopardy. In a 2021 incident, Asheville Watchdog reported, a female patient was found dying on the floor of her hospital room. The second recommendation for jeopardy came only last year, after an NCDHHS inspection found that 18 patients were harmed between 2022 and 2023, resulting in four deaths. Kerri Wilson is a registered nurse working on a medical cardiology step-down unit at Mission. She’s worked there since 2016 and has seen the ways things at the hospital have changed since HCA Healthcare purchased Mission Health in 2019. “This is the hospital and town I was born in, I grew up in, and I love it, but I'm glad to see that they're being held accountable,” she told Newsweek in an interview Monday. “We know that HCA has the resources to invest in our community, in our hospital, and make it the best. We could be one of the best in the country, just like we were being recognized before they purchased us. We could be even better with all the resources they have, if they would listen to nurses and the community and put that money where it needs to be, in patient care.” What To Know Mission Hospital faces immediate jeopardy after a recent investigation from NCDHHS found that several hospital practices resulted in an unsafe environment for patients. According to the Centers for Medicate and Medicaid Services (CMS), immediate jeopardy is the most serious deficiency type for a hospital and carries the most serious sanctions. This occurs when noncompliance by providers, suppliers or laboratories has placed the health and safety of recipients in its care at risk for serious injury, serious harm, serious impairment or death. On October 10, NCDHHS sent a letter to Memorial Mission Hospital CEO Greg Lowe, informing him that a survey conducted in September resulted in an immediate jeopardy declaration on September 25, 2025. According to the letter, obtained by Asheville Watchdog, NCDHHD said the hospital staff failed to provide a safe environment for patients by “failing to have systems in place and followed to promptly correct and mitigate risks related to patient misidentification, to follow established telemetry escalation pathways and ensure systems in place and functioning for continuous monitoring of a patient during transport.” The letter said nursing staff failed to respond to and assess a telemetry patient with emergent needs, ensure safe and appropriate transport and continuous pulse oximetry monitoring for a patient during transport, and to prevent and control infections by not accurately implementing and communicating infection-prevention precautions. NCDHHD's investigation cited incidents from July 26, August 19 and September 4. A September 18 incident related to “infection prevention practices” was later determined to be abated. In a statement to a local ABC affiliate WLOS News 13, HCA Healthcare's Mission Health said it is disappointed with NCDHHS's recommendation. "While we respect the surveyors’ role, the state regulators have not articulated what insufficiencies exist today, given the extensive corrective action plans we have implemented and provided to them," the statement said. "Because of that, we proactively shared our plans with CMS. We believe we have addressed the issues and welcome an expedited follow-up survey. We remain confident in the ability of our team to provide compassionate, high-quality care and are committed to continuous improvement in patient safety and clinical excellence. We will continue to work cooperatively with DHHS and CMS to resolve this issue, while keeping our main focus on the community we serve." On September 30, the nurses at Mission recently held a rally to sound the alarm on the hospital’s staffing and safety issues that have long been an issue at the hospital. Wilson said nurses have been raising concerns to hospital leadership, but those concerns “fell on deaf ears.” “They don't want to hear it." she said. "They act like we're just complaining about things and we're trying to warn them of the dangerous system. As a way of kind of escalating, we went to the streets, we took it to the community and to the public to say 'these are the things we're warning management about, and they just won't listen.'” According to National Nurses United, the largest nursing union in the country, the hospital employed 1,692 bedside nurses in March 2024, a number that falls well short of the roughly 2,200 nurses needed to safely staff the hospital. By August 2025, the number of bedside nurses dropped to 1,523. The union said these staffing levels were “alarmingly close” to staffing levels that led Mission Hospital into its previous immediate jeopardy designation. Nurses are also concerned that HCA is not taking seriously the demands to improve working conditions at Mission. National Nurses United said HCA eliminated an important meal and rest break program for nurses, “despite management previously touting increases in patient satisfaction on the hospital units with the program.” Wilson said the hospital kept the 2021 immediate jeopardy sanction “very secretive” which led to a rally and the eventual unionizing later that year. “Our nurses chose to join in so that we would be able to speak out and be protected, because we saw the dangerous things that were happening and we wanted to be able to stop it.” she said. Back in July, Wilson said the staff asked the hospital for an emergency meeting with leadership after an incident that led to a patient death, to discuss what the hospital can do to prevent future events. These included many of the same recommendations nurses had been suggesting for the last few years, Wilson said. That request was denied. With a third immediate jeopardy decision looming over the hospital, Wilson said leadership is trying to put a Band-Aid over the deep-rooted systematic problems that led them to this position in the first place. She said they are adding education action plans that “put more tasks on the already overburdened staff.” But Wilson and the other nurses at Mission are hoping this time will be different. “What we hope to see is that there actually be some action and then put the resources into getting staff into the hospital so that we can fix the broken system,” she said. "We want to actually address the problem to prevent things from like this happening in the future. We hope to fix the system [to] stop these events from happening, not get them out of immediate jeopardy and go right back to the broken system.” What Happens Next NCDHHS forwarded its recommendation and the corresponding information to the CMS regional office in Atlanta. CMS will make the determination of compliance or noncompliance and will notify Lowe of their finding and whether any action needs to be taken. Wilson said staff will continue to communicate any incidents to NCDHHS and all the other regulatory agencies “to help keep pressure on the hospital to do the right thing.” The staffing situation for every team member at Mission needs to be fixed, she said. And she is calling on HCA to use its vast resources to improve conditions and care for everyone. “Every single role is being pushed to the max and we need more of everyone to provide the care that our patients actually need,” Wilson said. “And until HCA leadership is willing to do that, our patients are going to suffer. We want them to know that we're not going to be quiet. We will be on the streets. We will be working with regulatory agencies. We will be doing everything we can.” Newsweek reached out to NCDHHS and Mission Health/HCA Healthcare for comment. 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