ASHEVILLE, N.C. (828newsNOW) — North Carolina Attorney General Jeff Jackson cleared a major legal hurdle Tuesday in the state’s lawsuit against HCA Healthcare, with a judge allowing claims over Mission Hospital’s emergency and cancer services to move forward to trial.

North Carolina Business Court Judge Julianna Earp largely denied HCA’s motion for summary judgment, ruling that the state’s claims should proceed and rejecting several arguments the hospital operator made to dismiss the case.

“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 centers on HCA’s 2019 purchase of Mission Health System. The attorney general alleges HCA failed to uphold commitments it made in the purchase agreement to maintain emergency, trauma and oncology services at Mission Hospital through at least 2029.

Judge Earp agreed with the state’s interpretation that the purchase agreement requires HCA “to take all steps necessary to actually provide” those services, according to the attorney general’s office.

The judge also rejected 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 and diminished patient care.

In another key ruling, Earp denied HCA’s effort to exclude testimony from Dr. Kia Parsi, executive director of the Texas A&M Rural and Community Health Institute and an emergency medicine expert. According to the court, Parsi concluded Mission’s emergency department staffing levels were too low to provide adequate patient care.

The case has drawn significant attention in Western North Carolina amid ongoing concerns about conditions at Mission Hospital.

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 harm, impairment or death.

The attorney general’s lawsuit seeks to hold HCA accountable for what the state says are failures to meet its contractual obligations under the Mission acquisition agreement. Tuesday’s ruling does not decide whether HCA violated the agreement but allows those claims to be decided at trial.

HCA has denied the allegations and has argued it has met its obligations under the purchase agreement. A trial date has not yet been announced.