Many hospitals around the Mid-State have smoke free campuses.
Often, this means smokers end up on city sidewalks, and their cigarette butts find their way into the street or nearby grassy areas.
The Nashville Clean Water Project told Nashville's News 2 the cigarette butts aren't just eyesores, they are toxins that end up in local streams and rivers.
On Patterson Street, across from Centennial Medical Center, the litter is clearly noticeable on the ground.
Cigarette butts are everywhere including on the road, in the grass, lying in storm drains, even right under the don't litter sign.
"This whole area is like a municipal ash tray," said Mark Thien with the Nashville Clean Water Project, "These city streets are not designed to be ash trays, plain and simple. It's wrong."
Since Centennial Medical Center is a smoke free hospital campus, employees, patients and visitors have to find another place to light up.
For hundreds, that place is right across the street, next to a park.
"That's what people need to understand," said Thien, "When you put anything on the street, in the grass and it ends up in the gutter, and it rains, it goes directly into the rivers and streams in Middle Tennessee."
Toxins in cigarettes can kill fish if they mistake the butts for food.
Birds that may use them for nesting material can also be exposed to harsh chemicals.
"It does frustrate me," said F.J. Campbell, Chief Medical Officer with Centennial Medical Center, "If people choose to smoke a cigarette, they can also make the choice of disposing of it appropriately."
Campbell told Nashville's News 2 crews used to sporadically come out to Patterson Street to clean up litter, but due to the sheer volume of butts, in recent weeks they have started asking crews to clean up every day."
"There are trillions of cigarette butts that are put into the water ways world wide every year," said Thien, "And Nashville is doing a very good job, apparently, of contributing to that."
Centennial said they do not provide receptacles for smokers, because the property across the street doesn't belong to them and they don't want to encourage smoking, but they said they do encourage people to pick up after themselves.