From Staff Reports 

ASHEVILLE, N.C. — AdventHealth and UNC Health on April 23 filed separate appeals of the North Carolina Department of Health and Human Services’ approval for Asheville-based Mission Hospital to add 95 acute care beds, costing an estimated $798 million, arguing against the March 27 decision. 

The appeal sets up “a likely legal battle over the future of Western North Carolina healthcare services,” the Asheville Citizen Times reported on April 29.

The appeals stem from concerns over Mission’s severe “immediate heopardy” safety citations, staff turnover since its 2019 nonprofit-to-for-profit conversion, and a push for greater regional competition.

Key details regarding the appeals include:

• Contention: The appeals argue against the expansion of Mission Hospital (owned by HCA Healthcare), which has faced recent federal patient safety sanctions.

• Process: The case will be reviewed by an administrative law judge, who has 270 days to issue a decision.

• Previous litigation: The healthcare market in Buncombe County has seen multiple legal challenges over Certificates of Need for new hospital beds.

• The competitors: Both AdventHealth and UNC Health submitted proposals to increase their presence in the region but were passed over in this, the latest in a series of heated Certificate of Need battles.

• The scandal factor: Mission Hospital has been under severe scrutiny following multiple “Immediate Jeopardy” citations from the Centers for Medicare and Medicaid Services, yet state regulators deemed their expansion plans valid, a decision sparking intense local frustration.

• The legal fight: The appeals, filed by Advent and UNC, move the dispute to an administrative law judge, potentially delaying the expansion for months or years.

• The broader war: This appeal is a counter-move to a long, contentious rivalry. In 2022, Mission appealed the approval of an AdventHealth hospital in Weaverville, and now Advent and UNC are challenging Mission’s growth, arguing the decision violates the intent of community-focused care and that Mission’s safety record should have disqualified them. 

The appeals, filed in the Office of Administrative Hearings, also challenge the approval of a 34-bed hospital for Novant Health.

The appellants argue that the state “erroneously determined” the need for more beds at Mission, according to Becker’s Hospital Review and Asheville Watchdog.

Both systems claimed that the state’s approval of the expansion was incorrect, prompting further legal challenges regarding hospital capacity in the Buncombe County region.