The North Carolina Supreme Court has agreed to hear two AdventHealth challenges to certificates of need that state regulators awarded to Asheville-based Mission Health, part of Nashville, Tenn.-based HCA Healthcare.
The court allowed two petitions for discretionary review from Fletcher Hospital, which does business as AdventHealth Hendersonville, according to the court’s Oct. 23 petitions list. The defendant in both cases is the North Carolina Department of Health and Human Services, with Mission as an intervenor. The court had already granted AdventHealth’s motions to stay in both cases on April 13.
The court dismissed a third AdventHealth petition tied to a 2023 North Carolina Court of Appeals case and dismissed the related motion to stay as moot.
In both cases the Supreme Court will hear, lower courts rejected AdventHealth’s arguments, The Carolina Journal reported Oct. 23. One case involves Mission’s CON for a $29 million freestanding emergency department in Candler, near Asheville. AdventHealth has fought the project since 2022 and appealed Mission’s refiled application in 2023.
In 2024, the Court of Appeals found that regulators had failed to follow proper procedures by not holding a public hearing before awarding the Candler CON. However, the court said the error did not necessarily amount to substantial prejudice against AdventHealth. An administrative law judge later ruled against AdventHealth, and a Court of Appeals panel upheld that decision March 4.
AdventHealth did not apply for the Candler CON. It is asking the Supreme Court to define what a challenger must prove to win a dispute over a “noncompetitive” certificate-of-need review. In its 2025 decision in Pinnacle Health Services v. NCDHHS, the court set that standard for competitive reviews. AdventHealth’s attorneys argued in the April petition that competitors’ right to challenge noncompetitive awards is “most often illusory” because their cases are repeatedly dismissed for failing to show substantial prejudice.
A ruling in AdventHealth’s favor could make it easier for competitors to challenge certificate-of-need awards across the state. North Carolina’s CON law also covers ASCs.
The systems have battled over certificates of need in Western North Carolina for years. Mission challenged AdventHealth’s CON for a 67-bed hospital in Weaverville, and the state Supreme Court paused an appellate ruling in that case in 2025. In December 2025, the court ended Mission’s bid to overturn the award.
The NCDHHS said it does not comment on pending litigation.
A spokesperson for Mission Health said the system was “proactive” in addressing rising demand for emergency care by pursuing certificate-of-need approvals for an additional ER in West Asheville in 2022 and 2023.
“Mission greatly respects the administrative and judicial review process and is gratified that both the Administrative Law Judge and the N.C. Court of Appeals has upheld the State’s approval of Mission’s FSER CON applications for West Asheville. We look forward to a final resolution of these cases at the N.C. Supreme Court,” the spokesperson said in a statement shared with Becker’s.
Becker’s has reached out to AdventHealth for comment and will update this story if additional information is received.
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