RALEIGH, N.C. — The North Carolina Supreme Court will step into a long-running hospital rivalry in the mountains, a decision that could reset the rules for who gets to challenge the state’s approval of new medical facilities.
The justices agreed on Friday, in their latest list of petitions, to hear two western North Carolina appeals brought by AdventHealth. In both, AdventHealth is fighting certificates of need that state regulators granted to its competitor, Mission Health. State health regulators at DHHS are named in both cases as well. Lower courts sided against AdventHealth each time.
A certificate of need is the state’s permission slip for big health care projects. Under North Carolina law, providers must get approval from the health department before they build or add new facilities, beds or services, or buy certain costly medical equipment. That list covers new hospitals, nursing homes, hospices, home health agencies, dialysis centers and outpatient surgery centers. The idea behind the law is to hold down health costs by blocking needless duplication, and a planning section inside the department’s Division of Health Service Regulation reviews each application.
One of the cases centers on a free-standing emergency department Mission plans in Candler. AdventHealth did not apply for that certificate, and the question it wants answered is what a provider in that position has to prove to overturn an award. To win a challenge, a plaintiff must show both an agency error and what courts call substantial prejudice. The high court spelled out that standard for competitive reviews in an October 2025 ruling but has not done so for reviews where only one provider applies.
The Candler fight has already been through several rounds. Appellate judges found in 2024 that regulators skipped a required public hearing before approving Mission’s plan. Even so, a unanimous Court of Appeals panel ruled in March that AdventHealth had not shown real harm beyond the normal effects of more competition. Judge John Arrowood wrote that its evidence was hypothetical and that lost revenue projections were not enough.
A ruling from the Supreme Court could affect how hospitals and other providers across the state contest one another’s expansion plans. No argument date has been set.
Filed under: Raleigh NC Health News
