ASHEVILLE, N.C. (828newsNOW) — A North Carolina judge has cleared the way for the state’s lawsuit against HCA Healthcare over Mission Hospital to move to trial, handing Attorney General Jeff Jackson a significant legal victory in a case that alleges the company failed to uphold promises it made when it acquired Asheville’s Mission Health system.
North Carolina Business Court Judge Julianna Earp largely denied HCA’s motion for summary judgment, ruling that the state’s claims over emergency and cancer care services at Mission Hospital should proceed to trial.
“HCA threw every argument against the wall to try to get this case thrown out, but they didn’t stick,” Jackson said in a statement. “I’m grateful the judge saw through them. We’re going to trial, and I will keep fighting to defend emergency and cancer care in western North Carolina.”
The lawsuit stems from HCA’s 2019 purchase of Mission Health. As part of that acquisition, then-Attorney General Josh Stein negotiated an agreement requiring HCA to continue providing emergency and trauma services and oncology services at Mission Hospital through at least 2029.
The state alleges HCA failed to meet those commitments after receiving hundreds of complaints from patients and community members. According to the governor’s office, the North Carolina Department of Justice received more than 500 complaints following the acquisition, many involving concerns about emergency, trauma and cancer care.
Gov. Josh Stein, who filed the lawsuit while serving as attorney general, welcomed Tuesday’s ruling.
“HCA made commitments to the people of western North Carolina about critical health care services they’d continue to perform,” Stein said in a statement. “When HCA failed to live up to its promises, I took it to court. Access to quality health care can be the difference between life and death. I’m pleased that the Department of Justice now has the chance to hold this for-profit hospital accountable.”
Judge Earp agreed with the state’s interpretation that the purchase agreement requires HCA “to take all steps necessary to actually provide” emergency and cancer services at Mission Hospital.
The judge also denied HCA’s request to dismiss claims alleging the company failed to adequately staff Mission Hospital’s emergency department, resulting in unsafe nurse-to-patient ratios that affected patient care.
In another key ruling, Earp refused to exclude testimony from Dr. Kia Parsi, executive director of the Texas A&M Rural and Community Health Institute. According to the court, Parsi concluded Mission’s emergency department staffing levels were too low to provide adequate care.
The case comes as Mission Hospital continues to face heightened scrutiny from state and federal regulators.
Since HCA acquired Mission in 2019, the Centers for Medicare & Medicaid Services has cited the hospital with four “immediate jeopardy” findings, including one issued in January 2026. An immediate jeopardy designation is the agency’s most serious deficiency level and indicates conditions that place patients at risk of serious injury, impairment or death.
Tuesday’s ruling does not determine whether HCA violated the purchase agreement but allows all of the state’s claims to be decided at trial.
HCA has denied the allegations and has maintained that it has met its obligations under the purchase agreement. A trial date has not yet been announced.
