ASHEVILLE, N.C. (828newsNOW) — State health regulators on Tuesday heard hours of often emotional testimony as four hospital systems made competing cases to add acute-care beds in Buncombe County, a decision that could reshape health care access across Western North Carolina.

The public hearing, held in Asheville as part of North Carolina’s Certificate of Need review process, drew elected officials, health care leaders, first responders and patients from across the region. At issue is how up to 129 additional acute-care beds should be approved and which system should receive them.

The applicants include Mission Hospital, AdventHealth, Novant Health and UNC Health West Medical Center, each proposing different locations, scales and visions for meeting the region’s growing health care needs.

UNC Health West Medical Center proposes building a new 129-bed hospital in Asheville, a $711.1 million project projected to open in 2031. UNC officials said the hospital would be the only acute-care facility in southern Buncombe County and would restore nonprofit, in-state hospital care to a community that has increasingly traveled elsewhere for services.

Novant Health Asheville Medical Center is seeking approval for a 34-bed community hospital in Arden, a $322.2 million project expected to open in 2030. Novant representatives said the smaller footprint is intentional, aimed at expanding capacity while increasing patient choice and competition without concentrating all new beds in a single facility.

AdventHealth Asheville is requesting approval to add 129 beds to its already approved hospital in Weaverville, expanding the project to 222 beds. The $253.7 million hospital is slated to open in 2030 and would serve northern Buncombe County and surrounding rural areas.

Mission Hospital, Buncombe County’s only tertiary-care hospital and Level I trauma center, is seeking to add 129 beds at its Asheville campus, bringing its total to 862 beds. The $198.5 million expansion would be completed by 2031.

Mission argues capacity crisis

Mission leaders said the most urgent need is immediate expansion at the region’s only tertiary-care center, which serves patients from an 18-county area.

Chief Operating Officer Melina Arrowood told regulators that Mission’s bed occupancy regularly exceeds 90 percent, well above the state threshold used to determine need, and that the hospital has already declined more than 1,500 patient transfers this year because no beds were available.

Mission accepted nearly 12,000 high-acuity transfers in 2025, Arrowood said, while other hospitals in the region reported licensed but underutilized beds that lack the specialized staffing and services Mission provides.

Dr. William Schillinglaw, Mission’s medical director for trauma and critical care, emphasized the hospital’s role as WNC’s only American College of Surgeons-verified Level I trauma center, a designation reflecting the highest standard of trauma care.

Mission officials also cited the hospital’s response during Tropical Storm Helene, when it treated more than 600 emergency patients in the first 24 hours and operated for weeks without municipal water.

Supporters echoed those concerns. Alex Glover, chair of the Blue Ridge Regional Hospital board, said smaller hospitals increasingly depend on Mission for complex care and warned that continued strain could jeopardize access to lifesaving services across the region.

Calls for competition and alternatives

Other speakers argued that WNC needs alternatives to Mission Hospital, particularly since its acquisition by for-profit operator HCA Healthcare.

Asheville City Council member Bo Hess said workforce shortages, long wait times and limited options have left patients frustrated. Retired oncologist Dr. Michael Messino said inpatient cancer and leukemia care has declined locally, forcing patients to travel long distances.

Several speakers criticized HCA’s staffing levels, transport delays and regulatory findings, urging regulators to award beds to nonprofit systems instead.

UNC Health supporters stress nonprofit model

Supporters of UNC Health emphasized its nonprofit mission, in-state governance and track record at Pardee Hospital in Henderson County.

William Lapsley, chair of the Henderson County Board of Commissioners and former Pardee Hospital board chair, said UNC Health has a 15-year record of clinical excellence and patient satisfaction and is prepared to expand access in Buncombe County.

Former Asheville Mayor and former UNC Health board chair Charlie Owen said UNC Health Pardee is the only hospital in WNC with a five-star CMS rating and an “A” patient safety grade, calling it evidence of quality care already being delivered.

Several speakers said a new UNC Health hospital would restore nonprofit community-based care to Asheville and reduce the need for residents to seek treatment outside the region.

Novant Health highlights patient choice

Novant Health supporters focused on coordination of care, patient experience and access to specialty services.

Asheville resident Wendy Blankenship described weeks of anxiety after an abnormal mammogram and said a Novant physician stepped in to arrange follow-up care even though she was not his patient.

Cancer survivor Sharon Glickman said Novant Health’s integrated oncology care in Winston-Salem was life-changing and said Asheville residents deserve the same support close to home.

Fairview resident Guy Badgett said he traveled to Atlanta for cardiac care after facing months-long waits locally, arguing that additional providers would give patients meaningful options.

AdventHealth emphasizes rural access

Much of the testimony supporting AdventHealth came from rural officials, EMS leaders and first responders, who said a hospital in Weaverville would dramatically improve access for northern Buncombe County and neighboring counties such as Madison and Yancey.

DeLaina Lewkowicz, a WNC native, said Tropical Storm Helene exposed the danger of relying on a single tertiary hospital. She noted that AdventHealth’s Weaverville facility would operate on a separate water system and electrical grid from downtown Asheville.

AdventHealth Chief Medical Officer Dr. Byron Dixon said expanding the Weaverville hospital would allow AdventHealth to develop another high-acuity facility capable of handling trauma, cardiac, stroke, neonatal and cancer care.

“Another community hospital won’t solve that bottleneck,” Dixon said. “Community hospitals still rely on Mission because it is the only option.”

Mark Snelson, director of Madison Medic EMS, said approval of AdventHealth’s beds would be a “game changer” for Madison County, which has no hospital.

“We serve 22,000 people across 455 square miles with just three ambulances,” Snelson said. “A trip to Mission or out of state can take our trucks out of service for two to three hours.”

Yancey County Sheriff Shane Hilliard and EMS Director Kristy Bryant said shorter transport times and real alternatives could save lives, particularly in emergencies involving children or trauma patients.

Decision ahead

State officials said testimony from applicants and the public will be reviewed as regulators determine how to approve additional beds. A final decision is expected in the coming months.

For many speakers, the hearing was about more than numbers or projects.

“This isn’t about competition,” Bryant told regulators. “It’s about access — and doing what’s right for the people who live here.”