Steps to correct immediate jeopardy at Mission have 'backslid,' nurses say

Regulators determined HCA Mission Hospital in Asheville, N.C., was no longer in immediate jeopardy Feb. 23, but some nurses at the hospital claim measures in place when surveyors were present have not been consistent. 

The hospital's plan of correction to address serious deficiencies it was cited for in January centered around policies related to emergency department care. Among the changes laid out in the plan are ensuring patients are triaged and assigned a nurse within 10 minutes of ED arrival, having lab orders collected within 30 minutes and implementing enhanced communication procedures. Officials at Mission have previously said they began bringing in more staff to work in the ED when they received initial findings from the state health department in January. 

While the standard for nurse staffing is now higher in the ED, it's not consistently met, Hannah Drummond, BSN, RN, an emergency department nurse at Mission Hospital and union member, told the Carolina Public Press in a March 14 report. Ms. Drummond said because of this, patients arriving by ambulance are not moved into the emergency room as quickly as they could be, which keeps ambulances in limbo. 

Ms. Drummond said a number of steps have "already blackslid" since regulators visited the week of Feb. 20, such as no longer having phlebotomists support nurses in the ED. 

"The hospital is attempting to scapegoat staff, acting as if the nurses or other staff members are the issue as to why they're out of compliance in these areas — when we the nurses' union know that it's actually due to a lack of resources," she told the news outlet. 

Once the immediate jeopardy status was lifted, CMS notified the hospital it has until June 5 to come back into full compliance and avoid losing federal funding. 

"We are especially appreciative of the countless members of our teams from numerous departments who came together over the past several months to help explore and develop ways that we could provide more expedited and better care in the Emergency Department," a spokesperson for the hospital told the Carolina Public Press. "The results of their collective efforts have been noticed by patients, families, and EMS — in addition to the surveyors."

Late last year, the state health department conducted inspections at the hospital on behalf of CMS and recommended it be placed in immediate jeopardy, noting nine deficiencies related to incidents that occurred between April 2022 and November 2023. Changes laid out in the hospital's correction plan were all related to deficiencies CMS had identified in its report on what led to the immediate jeopardy sanction, including long wait times, delays in lab work and other issues that allegedly led to the deaths of four patients, The Asheville Watchdog previously reported. 

A group of physicians, nurses and patient advocates have criticized the hospital's plan of correction because it did not make specific mention of increasing staff. In a letter to Mark Benton, chief deputy secretary for health at the North Carolina Department of Health and Human Services, the group called the plan "insufficient' and urged regulators to request staffing information from the hospital and assign a third party to monitor its execution of the correction plan. 

Becker's has reached out to HCA Mission and will update the report if more information becomes available. 

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