The state’s top health agency is working to gather more information regarding the death of a Mission Hospital patient in an emergency department bathroom after staff did not quickly respond to his call for help.

The North Carolina Department of Health and Human Services and the U.S. Centers for Medicare & Medicaid Services (CMS) would not provide Asheville Watchdog specific information about any potential investigations but said it is consulting with CMS about the Feb. 10 death.

“First, it is critical that every person in North Carolina can get the care they need from providers and local hospitals,” NCDHHS spokesperson Summer Tonizzo said Wednesday. “One of our priorities is making sure every North Carolinian can access the care they need at the right time and in the right place. 

“We are aware of the tragic death that occurred in the ED last week at Mission Hospital and while we can’t comment on possible investigations, we are working to ensure patient safety. All complaints we receive are confidential and are being reviewed by NCDHHS. The team is working to gather more information to determine next steps in consultation with CMS.”

A CMS spokesperson said the agency does not comment on ongoing or potential investigations.

Mission Health spokesperson Nancy Lindell did not answer questions about whether any investigators had visited the hospital and if leadership had made changes in staffing or training following the death. “We don’t have anything further for you,” she said.

On the evening of Feb. 10, a patient arrived by ambulance at the emergency department with a respiratory complaint or chest pain and was sent to an internal processing area. 

Medical staff ordered an electrocardiogram, or EKG, for the man, but before the procedure, he needed to go to the bathroom. While inside, he pulled a call bell, but no one responded for 12-15 minutes, multiple nurses said, until a triage nurse checked the bathroom and found him dead. The Watchdog was the first to report the death on Feb. 20.

Following death, hospital fires one employee

Lindell told The Watchdog that day that Mission was investigating the incident and had fired one employee. 

“Our investigation indicates that certain staff who had been trained did not follow hospital protocols,” Lindell said at the time. “We have terminated one individual and have reported to the appropriate agencies.”

Nurses told The Watchdog that they thought staffing levels were inadequate that evening and led to the man’s call not receiving an immediate response.

NCDHHS and CMS have previously investigated the hospital, focusing primarily on the emergency department. After a late 2023 investigation, they determined that 18 people were harmed, four of whom died, because of violations of federal standards of care in the emergency department.

In February 2024, CMS placed Mission in immediate jeopardy, the most severe sanction a hospital can face, threatening suspension of federal funding unless the violations were fixed. Investigators found Mission in federal compliance 23 days later and lifted the sanction.

Several emergency department nurses who spoke to The Watchdog said conditions had improved shortly after the immediate jeopardy finding. The hospital hired more staff and worked with nurses to develop emergency department management strategies, among other improvements.

But conditions declined when Mission went back to pre-2024 procedures, contracts for traveler nurses expired, nurses quit and staffing in the emergency department grew sparse again.

Nurses said they are often overwhelmed by crowded nights in the emergency department and not enough staff to immediately work with patients.

Even after the Feb. 10 death, the department is strained, according to nurses The Watchdog spoke to Wednesday.

“I was there last night,” said Alyssa Aradia, an ER nurse, discussing her Tuesday night shift. “We had 130 in the department when I got there. We never got below 95. So that’s a lot of patients. We had patients in the waiting room that were already admitted, just waiting for beds. They never even made it to an ED room. We had high acuity patients in the express pods [contained parts of the waiting area]. 

“The express pods turned into holding pods, and nurses had to come down from step-down units or wherever to watch them while we did stuff out of the waiting room. Some people were waiting 9, 10, 11 hours in the waiting room for a bed upstairs that were already admitted by the time I left.”

Ashley Bunting, an ER nurse who worked all day Wednesday, said there were 70 patients in the emergency department when she started at 7 a.m. and about 140 patients at max. Patients were lining the halls, Bunting said, adding that it felt like the most intense day since Tropical Storm Helene. 

Bunting said it has been mostly “radio silence” from administration following the death. 

Training on call bell response

Aradia said that since the death, nurses were required to complete call bell response training and now there is an “increased demand for nurses to be responsive on the radio.” 

She explained this means that even if she was preparing a blood pressure medicine “to make sure somebody stays alive, and somebody wants a blanket, and I don’t answer on the radio about the fact that I heard them say that they want a blanket, I can get written up for it.”

Bunting said she saw nurses drilling for how to respond to call bells like the one the patient rang.

Nurses are demanding HCA Healthcare, Mission’s owner, staff the hospital better. For years they have contended that inadequate staffing could lead to harm and death. 

“A patient may have recently died at Mission Hospital due to dangerously low staffing levels,” a National Nurses United flyer obtained by The Watchdog reads. “Nurses have been warning for months that this could happen if HCA refused to take immediate action to ensure safe staffing.”

Union nurses plan to hold a public demonstration March 6 at the hospital campus. According to the flyer, their demands include improved contracts, break relief, more staff, no more hallway beds, and additional pay for picking up extra shifts.

They also are supporting the efforts of Reclaim Healthcare WNC, a coalition of elected officials, doctors, advocates, clergy, and health care workers seeking to replace HCA with a nonprofit owner. 

In response to the Feb. 10 death, the group has scheduled a news conference Friday morning during which it will “call for Mission to increase staffing levels at the hospital and provide more information about recent deaths at the hospital,” according to a news release it issued earlier this week.

Many nurses feel as though nothing has changed, despite regulatory action and community outcry.

“It just somehow feels even worse, not better,” Aradia said. 

Bunting echoed her concern.

“It feels very much like our cries for help are going unanswered,” Bunting said.
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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