Ascension Saint Thomas Hospital Midtown and Saint Thomas West in Nashville, Tenn., could lose their Medicare provider agreements effective Sept. 18 after the health system failed to submit an acceptable safety plan following an Aug. 14 medication error, according to a Sept. 8 News Channel 5 Nashville report.
CMS notified Ascension Saint Thomas CEO Shubhada Jagasia, MD, in a recent letter that the hospitals’ provider agreement “may be terminated” on that date, according to the outlet. Because Midtown operates as a satellite facility of Saint Thomas West under CMS’s system, both hospitals are at risk even though the error occurred only at Midtown.
The immediate jeopardy citations stem from an Aug. 14 incident in which four patients undergoing elective joint-replacement surgery were injected in the spine with potassium phosphate instead of the intended anesthetic, mepivacaine, after syringes were mislabeled the day before. All four patients required transfer to a higher level of care, and one briefly went into cardiac arrest. At the time state inspectors concluded their on-site review Aug. 21, one patient was being kept alive on ECMO, and three others were dealing with serious nerve damage in their lower bodies — including paralysis and numbness starting around the midsection. A state survey found three conditions of participation in immediate jeopardy, citing failures in pharmacy and surgery services and what inspectors called “a culture of overall noncompliance” among hospital leadership.
Ascension has since submitted three separate safety plans, all of which state and federal regulators deemed unacceptable for lacking sufficient detail on corrective steps — even as the health system publicly announced new safety protocols the same week. The health system had previously outlined several corrective measures, including isolating high-alert medications in distinctly marked storage, adding a mandatory hard stop requiring independent verification for spinal-medication scan alerts, and requiring dual pharmacist verification for spinal-medication workflows.
In a Sept. 9 statement, Ascension said both hospitals “will remain open and operational” and that their emergency departments, operating rooms, outpatient clinics, transfer centers and procedural areas continue delivering care. The health system said it reported the error and has “implemented rigorous clinical safeguards and updated protocols across our pharmacy and surgical services,” and said it is “refining our corrective action plans in full coordination with these agencies to ensure every requirement is met.” The health system characterized its exchanges with regulators as “ongoing, structured collaboration,” saying administrative notifications and review cycles are standard components of the oversight process following a significant event.
CMS, in a statement to Becker’s, said it does not speculate about potential future enforcement actions and that termination is “generally a last resort after applicable opportunities to correct deficiencies have been exhausted.” The agency said submission of a corrective action plan alone does not establish compliance — a facility must demonstrate the conditions creating the immediate jeopardy have been removed. CMS said it will continue monitoring the hospitals’ compliance and evaluating their corrective actions, and will take additional action as necessary to ensure patient safety.
The Tennessee Department of Health, which conducts surveys on CMS’ behalf through the state Health Facilities Commission, said its investigation remains ongoing. The Tennessee Bureau of Investigations has also opened an inquiry into the medication error, though no criminal charges have been filed.
Losing Medicare certification has proved fatal for hospitals before. Chicago-based Weiss Memorial Hospital closed in August 2025 the the day prior to CMS’s termination of its Medicare agreement took effect, after federal officials found it out of compliance on emergency services, nursing services and physical environment standards. At the time, roughly 55% of Weiss Memorial’s patients were on Medicare and about 30% were on Medicaid — leaving too small a base of fully paying patients to sustain the hospital.
A year earlier, Modesto, Calif.-based Stanislaus Surgical Hospital suspended operations and laid off all 160 employees after CMS terminated its provider agreement over noncompliance with pharmaceutical services and infection-control standards, despite months of efforts by the hospital to work with federal regulators toward an acceptable corrective plan.
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