When a regional healthcare anchor changes how it operates, the consequences can extend far beyond individual departments. The loss of physicians, specialized staff and supporting services can weaken an entire
healthcare system— and ultimately affect where patients can be treated, how quickly they receive care and how far they must travel to get it.
That concern is particularly significant in Western North Carolina, where Mission Hospital in Asheville serves as the region’s principal hospital for highly specialized care. Mission is the hub of a healthcare network whose spokes include smaller hospitals and medical facilities throughout the region. When a rural hospital has a patient who needs a specialist or service it cannot provide, the traditional solution is to stabilize the patient and transfer or refer that patient to Mission.
That system works only if the hub has the specialists and services needed to receive those patients.
Following HCA Healthcare’s 2019 acquisition of the formerly nonprofit Mission Health system, documented physician departures, reductions in specialty services and repeated federal patient-safety concerns raise a larger question: Can Mission continue to function as the regional center for highly specialized care if the personnel and services required for that role continue to erode?
The issue is not simply how many doctors Mission employs. At a hospital like Mission, specialists are part of the infrastructure. A hospital may have beds, operating rooms and sophisticated equipment, but if it cannot reliably provide the specialists needed to use those resources, there is a critical difference between having a service on paper and actually being able to provide it to a patient when needed.
Consider neurology. Mission reportedly had seven full- or part-time neurologists as recently as the end of 2023. By the end of 2024, that number was reportedly down to two.
That is more than a staffing problem. Neurologists are needed not only for scheduled appointments but also for inpatient care, intensive-care patients and emergency stroke treatment. They also participate in telestroke services that support hospitals throughout the region. Plans for overnight coverage relying on remote telemedicine and limited temporary physicians illustrate how a service can technically remain available while providing something substantially different from having a full complement of specialists immediately available.
Urology has experienced a similar contraction, with the available specialist pool reportedly falling dramatically. Medical oncology has also suffered substantial attrition. That is particularly consequential because complicated cancer care depends on many parts of the hospital working together: oncologists, nurses, pharmacists, laboratory personnel, blood-transfusion services, infusion services and intensive-care support.
For patients with complex blood cancers, those connections can be especially important.
This issue is no longer simply a matter of newspaper accounts or physician complaints. In July 2026, the North Carolina Business Court addressed allegations concerning complex hematology services and initial chemotherapy treatments in the Attorney General’s lawsuit against HCA. The court ruled that HCA’s obligation under the 2019 Asset Purchase Agreement to maintain the “provision” of covered services means actually supplying or making those services available to patients—not simply maintaining the physical facilities while relying on others to deliver the care.
That distinction should matter to every resident of Western North Carolina.
Why? Because geography magnifies the consequences when a regional specialty center loses capacity. A patient in a rural community who needs a specialist may traditionally have been stabilized at a local hospital and then transferred to Asheville. But if Mission does not have sufficient specialty capacity, the next destination may be a hospital much farther away.
For a patient, that can mean hours of additional travel, an ambulance or air transfer, a family facing a long drive, or a prolonged hospital stay while another facility is found that can provide the necessary care.
The same principle applies after the immediate medical crisis has passed.
Rehabilitation is an important part of the healthcare system because patients who are medically stable often still need rehabilitation before they can safely return home. Acute-care hospitals, in turn, need appropriate post-hospital services to move those patients out of hospital beds and make those beds available for people who need acute treatment.
The independent monitor overseeing HCA’s compliance has identified the discontinuation of industrial rehabilitation at CarePartners as a potential violation. The larger point is simple: a healthcare system is only as strong as the connections between its parts.
Physician departures, federal patient-safety findings, state litigation and independent monitoring represent separate lines of evidence pointing toward a broader concern—not simply isolated staffing problems.
Neurology supports emergency and stroke care. Cancer care depends on pharmacy, nursing, laboratory and blood-transfusion capabilities as well as physicians. Urology supports emergency and inpatient care. Rehabilitation helps patients leave acute-care hospitals safely.
When several of these components weaken at the same time, the consequences no longer belong to individual departments. They become regional.
For Western North Carolina, this makes the issue much larger than an internal corporate-management dispute. It is a question of regional healthcare infrastructure and whether the operational and financial priorities of a healthcare system can coexist with the staffing and supporting services required of a regional center for highly specialized care.
The question, therefore, is unavoidable: Can Mission continue to fulfill its role as Western North Carolina’s principal center for highly specialized care if the physicians, supporting services and clinical programs necessary to perform that role continue to erode?
The answer matters not only to Mission’s patients, but to everyone who depends on the region’s healthcare system.
Jim Tebay is an Asheville resident and a retired organizational consultant.
This article originally appeared on Asheville Citizen Times: Opinion: HCA’s fractured continuum of care and the human cost
