The Scottish Government has taken control of a health board amid concerns about its leadership, out-of-hours services and unscheduled care.
NHS Forth Valley was put on stage four of the health service's National Performance Framework for Governance, Leadership and Culture, which means the Government has direct formal oversight.
Health Secretary Humza Yousaf said there were "continuing concerns about the ability of the leadership to effectively respond to issues when raised".
He added: "We have been engaging with NHS Forth Valley for some time on a range of performance-related issues, including concerns around GP out-of-hours services and unscheduled care. The common barrier to improvement in these areas is governance, leadership and culture."
Earlier this year NHS Forth Valley, which has just one hospital with A&E facilities, just under half of patients were either admitted, transferred or discharged within the target time.
Inspectors from Healthcare Improvement Scotland (HIS) reported a raft of serious concerns at Forth Valley Royal Hospital in Larbert this June, including a fifth bed being added to some four-bed bays and treatment rooms which were used as nonstandard care areas for in-patients.
And in July last year doctors and nurses at the hospital said patient safety had been put at risk by a toxic culture of mismanagement and bullying.
Wednesday's decision to move it to stage four comes after an unannounced visit by the watchdog, which is set to publish a report in the coming weeks detailing its findings of its latest inspection.
The Scottish Government said it will now oversee the development and delivery of the boards improvement plan to address the concerns raised in out of hours and unscheduled care.
Jackie Baillie, Scottish Labour's health spokeswoman, repeated her calls for Yousaf to resign and said the "crisis" at the health board was "symbolic of the wider crisis in the NHS.
"The SNP's incompetence continues to put lives at risk and they failed to act six months ago when serious concerns were raised by HIS," she said.
"Humza Yousaf has proven time and time again that he is completely out of his depth and unable to deal with the many challenges facing our NHS. It is high time that Nicola Sturgeon restores faith in our NHS and sacks her failing Health Secretary."
Sandesh Gulhane, the Scottish Conservatives' health spokesman, said the trust being put into special measures "should have come last year when the allegations of toxic bullying emerged".
"We need a root-and-branch investigation to eradicate this culture and hold to account the people responsible," he said.
"The fact that NHS Forth Valley is underperforming so badly is a reflection on Humza Yousaf's inadequate leadership of Scotland's NHS, rather than over-stretched, dedicated frontline staff."
An NHS Forth Valley spokesman said: "We welcome the additional support being provided and are committed to working closely with the Scottish Government to deliver any changes or improvements recommended by the Assurance Board."
To sign up to the Daily Record Politics newsletter, click here.
