Something just doesn’t add up about the Jamestown Regional Medical Center situation. That’s unfortunate, because regardless of whether the ultimate picture is rosy or bleak, the hospital’s employees, patients, local government officials and the community as a whole deserve to know the truth.

On Thursday, the Rennova-owned Jamestown hospital was reportedly on the brink of a closure, then was told it would remain open.

The Cookeville Herald-Citizen, quoting state Rep. John Mark Windle, D-Livingston, was first to report that the Centers for Medicare & Medicaid Services (CMS) had given the hospital until nightfall to voluntarily close or be forced to close by CMS. No reason was given, but Windle told the newspaper that the Internal Revenue Service had placed a lien on the hospital for unpaid taxes.

Later in the day, the Herald-Citizen was also the first to report that the hospital would remain open. Quoting Fentress County Mayor Jimmy Johnson, the newspaper reported that the hospital had paid its taxes, forwarded a copy of the check to CMS, and would be allowed to remain open on a day-to-day basis.

There’s so much about this explanation that just doesn’t make sense.

1.) First, since when is CMS in the business of closing hospitals? The Centers for Medicare & Medicaid Services is a licensing agency. It can — and does — terminate licensure numbers for various reasons. When that happens, the hospital stops receiving federal payments for treating patients that are covered by Medicare and Medicaid. Especially in a rural community, that would effectively force the hospital to close. But CMS does not force closures outright. As the Independent Herald reported Thursday evening, we could find no recent example of CMS giving a hospital an ultimatum to close its doors.

2.) Even when CMS terminates a Medicare provider number, they don’t drop that bomb the day-of. According to the agency’s published protocol, a 15-day notice is required to be given. No such notice has been given to any Tennessee hospital since CMS said on November 21, 2018 that it was going to terminate Vanderbilt University Medical Center’s Medicare license. The agency rescinded that notice on December 7, 2018. Even in cases where a hospital’s emergency department is found by CMS to be deficient in such a way that causes immediate concern for patients’ safety, a 23-day notice is given that allows the hospital time to correct the deficiencies. If, after that period of time, the agency decides to follow through with terminating the hospital’s Medicare license, a public notice is required at least two days in advance.

3.) Since when does CMS take action against a hospital for failing to pay its taxes? When CMS does terminate a hospital’s participation in the Medicare program, it’s for issues related to patient health or safety — not taxes. Unpaid taxes fall under the jurisdiction of the IRS. In 2016, when Pioneer Health Services was nearing bankruptcy, the IRS placed a $500,000 tax lien on Scott County Hospital for unpaid taxes. The CMS did not terminate Pioneer’s Medicare license, and it certainly didn’t give the hospital an ultimatum to close.

4.) Even if CMS did take action against Jamestown Regional Medical Center for unpaid taxes, why would it stipulate that the hospital is allowed to be open “day-to-day” once those taxes were paid? If the taxes were paid in full, the issue has been settled and there would be no reason for a federal agency to place a “day-to-day” stipulation on the hospital.

A request for clarification from CMS’s regional office in Atlanta was not immediately answered.

Multiple people — all of them speaking on condition of anonymity — told the Independent Herald on Thursday that a surreptitious effort of sorts had been undertaken by some staff members of the Jamestown hospital who are disgruntled with Rennova’s corporate leadership to undermine the facility. As a result of complaints, those sources said, state inspectors had visited the hospital on behalf of CMS on multiple occasions in recent months.

The Independent Herald has also learned that CMS inspectors have twice visited Big South Fork Medical Center in Oneida — another Rennova-owned facility — in recent months: an initial visit and a follow-up. Those visits reportedly did not find deficiencies at the local hospital.

So far, Rennova’s corporate executives have been mum on the situation unfolding in Jamestown. However, multiple people inside Big South Fork Medical Center have said they do not think the Jamestown situation is a reflection of operations at the Oneida facility, nor will the ultimate outcome at Jamestown Regional impact BSFMC. 

In the meantime, the explanation provided on Thursday — that CMS was set to force a closure of Jamestown Regional due to unpaid taxes before ultimately allowing the hospital to remain open on a “day-to-day” basis — still doesn’t add up. From that vague explanation to detailed — albeit anonymous — accounts of a lack of community support for the hospital in Jamestown to Windle’s brow-raising rebuke of Rennova founder Seamus Lagan as an “Irish gangster” that was quickly condemned by some as unprofessional, there were no winners in Thursday’s episode.

And all that remains are unanswered questions.