The new Sweetwater Hospital Association Patient Tower Expansion is a 4 story addition to Sweetwater Hospital in Monroe County, Tennessee. The 26,500 square foot building will include a new Intensive Care Unit with 7 beds and 4 step-down rooms, 10 med surg beds, and a new Gastroenterology office with 15 examination rooms. The existing conditions provided several design challenges that needed to be overcome. The site is in downtown Sweetwater on a small sloping portion of the existing hospital campus. Due to the sloping site, the basement level, which will provide space for future expansion, required the use of retaining walls on all sides up to 16 feet tall. The restricted floor to floor levels of the existing building created the need to use a specialty structural system and creative mechanical and electrical systems.