ASHEVILLE, N.C. (WLOS) — A lawsuit against HCA Healthcare over emergency and cancer care at Mission Health will proceed after recent court rulings, Attorney General Jeff Jackson’s Office said in a July 28 news release.

Jackson’s office said North Carolina Business Court Judge Julianna Earp ruled in favor of several of the attorney general’s arguments and denied most of HCA’s motion for summary judgment. The judge issued a 55-page order granting in part and denying in part motions filed by both the attorney general and HCA, allowing key portions of the case to proceed.

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“HCA threw every argument against the wall to try to get this case thrown out, but they didn’t stick,” AG Jackson said in a written 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, initially filed in 2023 by then-Attorney General Josh Stein, accuses HCA Healthcare of failing to provide the emergency and cancer care it committed to when the for-profit company purchased Mission Health System in 2019. Among the allegations is that oncology and other services have been reduced in violation of the sale agreement.

People familiar with the case believe a trial could begin as early as next year unless the parties settle.

Jackson’s office said Judge Earp rejected HCA’s request to avoid trial and agreed that the 2019 purchase agreement “requires HCA to take all steps necessary to actually provide” emergency and cancer services at Mission Hospital.

State Sen. Julie Mayfield, who has closely followed the case and spoken out repeatedly about chronic understaffing and patient care issues, said the ruling allows Jackson a path forward.

“I think it’s going to be a challenge for either party to win this,” Mayfield said. “But I think what the AG would say is this was a good ruling for them.”

The order also includes testimony from former Mission CEO Ron Paulus, who said preserving Mission’s services was central to negotiations over the hospital’s sale.

“All discussions with Mission Board were based on Mission continuing as we know it for at least 10 years. This was an essential aspect of even beginning discussions with HCA. I would never have gotten the Mission Board to move otherwise,” Paulus is quoted as saying.

HCA argues the Asset Purchase Agreement does not require it to maintain the same quality or quantity of services that existed at the time of the acquisition. According to court filings, the company contends the contract language stating it “shall not discontinue” services means only that it cannot completely eliminate a service line.

Community advocates disagree.

“This hospital continues to give poor care to patients because of the horrific nurse-to-patient ratios,” said Karen Sanders, a registered nurse and patient advocate with Reclaim Healthcare WNC.

Sanders has been a nurse for 50 years and says she worked at Mission when the hospital had a stellar medical care reputation.

Mayfield said concerns extend beyond oncology.

“What we have seen, not just in oncology and the ER, which the suit talks about, we have seen a diminution in service on a number of service lines,” she said.

The judge’s ruling comes the same week the court-appointed independent monitor issued a report expressing concerns about what he described as a degradation of services that may not comply with the purchase agreement. The report has been sent to the attorney general. Mission Hospital remains operating under its most recent corrective action plan submitted to Federal regulators.

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Since HCA Healthcare purchased Mission Health System in 2019, the Centers for Medicare & Medicaid Services has placed Mission Hospital in “immediate jeopardy” multiple times, most recently in January 2026.

In March 2026, Mission Health CEO and President Greg Lowe announced that CMS had removed the latest “immediate jeopardy” status following a survey and approval of the hospital’s Enhanced Plan of Correction.

A new statement from Mission Health reads: “We are confident in our compliance with the terms of the APA. As always, our foremost focus is providing high-quality care to the Western North Carolina communities we are proud to serve, and we remain committed to meeting the healthcare needs of our region.”