Takeaways from the Williamson Health Sale to Ascension

The clock is ticking on Williamson Health’s potential sale to Ascension — a process that has been marred by Ascension Saint Thomas's recent local medication error that left several patients seriously injured.

On Wednesday, the Williamson County Commission voted to move forward with the letter of intent process for the sale valued at as much as $900 million. By the end of 120 days (with the option of two 30-day extensions), the county-owned hospital system must opt in or out of the sale, with approval from the commission and the Williamson Health Board of Trustees. 

A local error has cast a shadow on the process. 

On Aug. 14, a few weeks after the Williamson Health Board of Trustees agreed to sell the hospital, several patients were given the wrong medication at the local Ascension location, Ascension Saint Thomas. According to a state report, one patient was put on life support, and three more experienced “significant lower-extremity neurologic impairment, including paralysis.”

Because of this, Ascension Saint Thomas Midtown and West locations were served a termination notice from the Centers for Medicare and Medicaid Services. The hospital has until Sept. 18 to rectify its violations, and if the Medicare contract is terminated, Medicare would stop paying for new patients, too. A Medicare termination could affect Medicaid reimbursements as well. 

County commissioners expressed concern about rushing the timeline. 

Williamson Health officially announced in July 2025 that it was considering a sale, and claimed preparation for that announcement had begun months prior as part of the hospital’s strategic planning process.

In a letter to the public, the community-owned hospital cited “mounting pressures" — including staffing shortages, an increase in operating costs and inadequate reimbursements from insurance companies including Medicare and Medicaid, among other concerns.

In July 2026, following an RFP process, the hospital announced that Ascension was the top prospect. Throughout the process, the Williamson County Commission has evaluated aspects of the sale during its public property meetings. 

While constituents have poured out concerned emails about the sale following the local Ascension medication error. 

“Any insinuation of a hasty process is a flawed argument,” said District 9 commissioner Matt Williams. “We started over two years ago strategically considering this as a potential pathway. Over a year ago, as disclosed publicly. The RFP results and the recommendations from the board have been in front of you for two months now. Let's not pretend like we had a dozen bidders with competing offers that were all very similar to each other. We had two. We also don't have any revocation. The longer we drag this out, at any point these systems can withdraw their proposal.”  

Commissioners seek to answer questions in the LOI process. 

A few questions were raised at the latest Williamson County Commission meeting. Will Ascension give full access to hospital records? While it wasn’t explicitly stated in the letter of intent, Ascension is expected to be cooperative, explained Jesse Neil, a partner at legal firm Foley & Lardner representing the Williamson County Commission. 

Another outstanding question centers on Neil and his attorney fees. Ascension has not agreed to pay the fees, which include $900 an hour rates for his work evaluating the process. 

In addition, earlier this year, the Tennessee General Assembly passed a law that would allow the county to use the proceeds from the sale for more uses outside of the typical healthcare-focused trust fund. Commissioners on Wednesday raised questions about if that funding could apply to the county’s $1.1 billion in general government debt.  

The sale has seen support from medical professionals. 

The Williamson Heath Board of Trustees unanimously agreed to sell the hospital system in July. The latest commission meeting opened with a number of medical professionals, including Williamson Health employees and leadership, expressing support for moving forward with the deal. Many of them had worked for both organizations and cited parallels in culture.

“Over the next few months, all parties will be engaged in a thorough and comprehensive due diligence process that will allow our two organizations to share important information needed to negotiate transactions details related to employee compensation and benefits, clinical operations and outcomes, patient safety and quality initiatives, plans for growing and elevating Williamson Health, as well as how Ascension Saint Thomas intends to help us continue our mission of caring for the community we love so much and have proudly served for 68 years,” said Board of Trustees Chairman Bo Butler.