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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