At 8:25 a.m. on Sept. 13, 2024, Noe Serrano Hernandez was put under anesthesia for a routine foot surgery at Mission Hospital. Over the next 51 minutes, the 64-year-old’s vital signs would steadily weaken while the nurse anesthetist supervising his care did not intervene until he suffered a heart attack, according to a new lawsuit filed in Buncombe County.
Serrano Hernandez never regained the ability to breathe on his own. A week later his family made the decision to disconnect his life support.
The lawsuit filed this week accuses Mission Hospital, the nurse anesthetist Andrew Hunter, and the supervising anesthesiologist, Dr. Jason Dziak of negligence leading to Serrano Hernandez’s death.
It follows an investigation by the North Carolina Board of Nursing, which found that the care and documentation provided by Hunter, a certified registered nurse anesthetist, was “below the minimum standard of practice,” according to a consent order drafted by the board.
“There was a delay for Mr. Hunter to respond appropriately to Mr. Serrano Hernandez declining during a pretty routine surgery. Because of that he became essentially brain dead,” Paul Dickinson, an attorney for the Serrano Hernandez family, told the Asheville Watchdog. “We’ve talked at length with the family about this. And they want to take some action because they have heard about things at Mission and they want to make sure that things like this don’t happen again.”
Following Serrano Hernandez’s death on Sept. 21, 2024, Mission reported Hunter, who was at the hospital on a short-term contract, to the Board of Nursing. Representatives of Mission Hospital did not respond to the Watchdog’s request for a comment.
The Board of Nursing ultimately found that Hunter had failed to properly document Serrano Hernandez’s care, as well as failing to properly monitor him, react to his declining vital signs or ask for assistance when he needed it.
During the investigation, Hunter said that he was new to the hospital and unfamiliar with the medical charting system. An expert who reviewed the case for the Board of Nursing wrote that while he was “sympathetic” with the fact that Hunter was unfamiliar with the charting system, he found that Hunter failed to properly monitor Serrano Hernandez, especially given his preexisting health conditions, and seek assistance or communicate with the physician in a timely manner.
The Watchdog was unable to reach either Hunter or Dziak for comment. The Board of Nursing issued a reprimand to Hunter and required that he complete three different training modules. As of January 20, Hunter had completed all requirements ordered by the board and his license remains active.
The lawsuit comes as Mission Hospital tries to get back on track following its fourth Immediate Jeopardy finding since 2021. In August, Mission Hospital confirmed that the Centers for Medicare and Medicaid Services found that the facility was back in “substantial compliance” with federal hospital regulations after the agency imposed an unusual period of additional monitoring following the hospital’s most recent Immediate Jeopardy.
Immediate Jeopardy is one of the most severe sanctions that can be handed down by CMS. It warns that a hospital is in danger of losing access to Medicare and Medicaid reimbursements due to threats to patient safety.
Over the past several years, Mission Hospital has struggled with an exodus of nursing staff, leaving the hospital more reliant on nurses on short-term contracts, known as “travellers” or “travel nurses.” Studies and experts have connected an increased use of travellers to worse healthcare outcomes for patients largely due to their unfamiliarity with a hospital’s procedures.
On average, travel nurses represent 3 to 4 percent of a hospital’s total nursing staff, according to a 2023 study published in Healthcare Management Review. But records reviewed by the Watchdog found that in December 2025 travellers made up close to a quarter of the total nursing staff at Mission.
An investigation by the Watchdog found that the death of 88-year-old Lucero Sierra, which was cited in the most recent Immediate Jeopardy, came after a travel nurse responsible for her care did not take action when tests showed Sierra urgently needed a blood transfusion.
What happened?
Serrano Hernandez suffered from a range of health issues, including type 2 diabetes, hypertension, peripheral arterial disease, a chronic infection of the bones in his left foot and end-stage renal disease, meaning that he could not survive without dialysis. Despite this, he was still able to walk and managed his conditions with dialysis three times a week.
On Sept. 13, 2024, Serrano Hernandez was scheduled to receive a routine outpatient surgery at Mission Hospital to remove and biopsy the infected bone from his left foot. The procedure called for a local nerve block in his left foot and for Serrano Hernandez to be placed under “monitored anesthesia care,” according to the lawsuit.
The fact that Serrano Hernandez had serious pre-existing health conditions meant that he was a high-risk anesthesia patient, according to the Board of Nursing’s expert’s findings.
During the operation, Hunter was providing anesthesia services under the supervision of Dziak, an MD anesthesiologist. According to the Board of Nursing, Hunter was the only anesthesia provider in the operating room during the procedure.
At 8:25 a.m., Serrano Hernandez was placed under anesthesia. According to court records and the Board of Nursing’s investigation, he was given Fentanyl, a powerful opiate, and Versed, a sedative. At 8:37 a.m. Serrano Hernandez was given Propofol, which is commonly used to induce general anesthesia. He was also given a drug to reduce his fluid secretions and another to prevent dangerously low blood pressure, which can occur during surgeries.
At that time, there was no change reported in Serrano Hernandez’s vital signs and the levels of carbon dioxide in his blood were within his normal range, according to the lawsuit.
During the procedure, Serrano Hernandez was not intubated. Instead, he received oxygen though a less invasive device known as a nasal cannula that feeds in oxygen through the nose, instead of requiring a tube be inserted down a patient’s throat.
But beginning at 8:40 a.m., Serrano Hernandez’s vital signs began to display a worrying decline. His heart rate slowed to 30 beats per minute and his blood pressure fell to a level “inadequate for his underlying physiological status,” according to the board of nursing. Over the next 35 minutes, Serrano Hernandez’s breathing slowed to zero.
In their settlement order, the Board of Nursing found that there were no documented interventions for Serrano Hernandez’s collapsing rate of breathing or his slowing heart rate. The infusion of Propofol was not stopped until 9:05 a.m., according to the lawsuit.
Witnesses present in the operating room told the board of nursing that Hunter “never voiced any concerns regarding the patient until the conclusion of the surgical procedure.”
Documentation showed that at 9:08 a.m., Narcan, which counteracts the effects of opiates, was documented as administered by IV. This was followed by infusions of Epinephrine at 9:10 a.m. and 9:13.
At 9:14 a.m., Hunter texted Dziak to come to the operating room. Serrano Hernandez was not breathing and the oxygen levels in his blood had fallen to dangerously low levels. At 9:16 a.m. he went into cardiac arrest.
Staff were able to restore a pulse. Serrano Hernandez was intubated and transferred to the ICU. He was found to have suffered a brain injury from the lack of oxygen. He remained in a coma and dependent on a ventilator to breathe until a week later on Sept. 21, when his family decided to disconnect his ventilator.
Speaking to the Watchdog, Valentina Mejia, one of the attorneys for the Serrano Hernandez family argued that the evidence showed that there was “failure to rescue.”
“There were a lot of delays: They failed to intubate, they coded him too late, they didn’t give him air. That’s one of the first things that they’re supposed to do when vitals get the way they were,” Mejia said.
Serrano Hernandez’s death was an “immeasurable loss” to his wife and daughter, wrote the family’s attorneys in their lawsuit.
“The lawsuit’s not bringing back a family member, but they [Mission] have a real incentive to do something when they see such an egregious error and to make sure that steps are taken so that somebody else doesn’t lose a family member,” Dickinson said.
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Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. Ted Clifford is The Watchdog’s investigative reporter focusing on healthcare. He can be reached at tclifford@avlwatchdog.org. The Watchdog’s local reporting is made possible by donations from the community. To show your support for this vital public service go to avlwatchdog.org/support-our-publication/.
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