"It needed to be done," is what some are saying after nearly 5 percent of Caritas Carney Hospital's workforce lost their jobs last Thursday. For the people who work there, the logic was little comfort.

"It was probably the worst day in my 18 years being here in terms of the pall it cast in the hospital," said former chief of staff Dr. David Lustbader, who also sits on the board of trustees for Carney. "But I've worked a long time with Dr. [Daniel] O'Leary and there wasn't any option going forward."

According to Lustbader, the cuts will save between $3 and $3.5 million and came not only because of the Carney's recent financial struggles and changes in disbursement rates due to Massachusetts health care reform, but also because the state's distressed hospital fund - which gave the Carney $4 million in 2006 and again in 2007 - might not be granted so generously in the future.

"Each year we get aid they tell us it is unlikely to continue," said Lustbader. "The distressed hospital money has gotten less and less every year. I think we're trying to demonstrate to everyone that were doing everything we can to balance this budget."

"That is part of the decisions being considered in the Ways and Means Committee right now," said Joe Eisenberg, the committee's chief of staff. "As of yet those recommendations are not yet released."

The state's health care budget, which is approved by the federal government, is under pressure to balance the needs of ailing hospitals, managed care providers, as well as support the groundbreaking healthcare reforms the state has passed. The eyes of state-level lawmakers across the country are on the mandatory health insurance plan in Massachusetts, waiting to see if the Commonwealth can pull it off financially.

The Carney cuts represented 40 full-time-equivalent jobs, which put 50 people out of work with severance pay on Thursday. An additional 15 already vacant positions were eliminated. Only 2.5 full-time nursing jobs were cut, all already vacant. The rest of the mix included managers, assistants to doctors and administrators, staff from the dietary department, and non-professional staff, according to Carney spokesperson Margaret Carr.

A company called Applied Management Systems has been reviewing every position in the hospital for the last three months, Carr said, and comparing staffing levels to national benchmarks. Some of the changes related to shifts in patient volumes.

"Inpatient volumes have increased in certain areas," Carr said. "Surgical volume has decreased. The fiscally responsible thing is what we did [Thursday]. It was extremely painful for everyone involved."

At least some of the slack will be picked up by nurses, according to Jane Connelly, chair of the Massachusetts Nursing Association.

"It's shocking what floor nurses are doing, to me. They are overworked, they don't take lunch, they don't take breaks, they just work," Connelly said.

The Coalition for Strengthening the Carney, a group of Dorchester health center leaders, elected officials and other interested parties has met for the past two Fridays, with the nurses in attendance. Director of Harbor Health Services Dan Driscoll said the group has yet to discuss the layoffs, but is beginning to lay plans for wider community meetings to discuss the Carney's predicament and support its preservation.

"My view is it's a shame it came to this, but the hospital is working very hard to keep its head above water," Driscoll said of the layoffs. "Medicare payments have not kept pace with costs and the Carney has a large number of patients on those kinds of payments. Other hospitals have transferred the costs to other areas, but the Carney doesn't have many patients with those other insurances so they're really really getting a squeeze."

As the Reporter went to press, the Boston Globe reported that Caritas Christi Healthcare, the Catholic hospital chain that owns the Carney, will hire a new CEO, Ralph De la Torre, who is currently chief of cardiac surgery at Beth Israel Deaconess Medical Center (BIDMC).

In his "Running a Hospital" blog, CEO of BIDMC Paul Levy congratulated De la Torre and said he looked forward to "a growing relationship between our two organizations." BIDMC and Caritas Good Samaritan Hospital announced a new physician and cardiac care partnership last month. Milton Hospital, a competitor of the Carney, signed an affiliation agreement with BIDMC in 2005.