Caritas Christi Health Care CEO Ralph de la Torre surprised a Coalition to Strengthen the Carney meeting last week when he strode in and told the audience that Carney would not close or change its service mix in any major way. Instead, he said, it will embark on a major fundraising, recruitment and reinvestment effort to reestablish its image as a competitive healthcare provider.

"We have decided that Carney will stay as an acute care facility," said de la Torre to loud applause last Thursday night at the Sheet Metal Workers Hall on Adams Street. "That decision really comes from the work the people in this room have done. This community has made this possible."

The long-awaited Wellspring Report, carried out by the healthcare consulting firm Wellspring Partners, was released the same evening and outlined four options for the Carney - Revitalization, Conversion to a psychiatric hospital, change of ownership and closure - but looked far deeper into the revitalization option, possibly at the behest of a steering committee composed of Carney staff and board members that oversaw its work.

"I asked the Cardinal Sean O'Malley: 'Does it really matter what the report says?'" said de la Torre Thursday night, indicating the Archdiocese of Boston leader's devotion to the hospital. "He says: 'Not really.'"

But, de la Torre said, the task of rebuilding the Carney will not be easy. For capital improvements the hospital and its supporters will have to raise $20 to $30 million over five years, recruit a number of primary care doctors and hard-to-attract specialists, and expand services, including adding 16 psychiatric beds at the hospital. One crucial element, according to de la Torre, will be keeping and possibly expanding upon government sources of funding such as the $4 million the hospital received from the state's Essential Providers Fund last year and the year before.

"Last year we got $4 million and I'll tell you right now, some of the legislators did not want to give that money to the Carney. The response was 'Let's close the door on them,'" said state Rep. Marty Walsh at the meeting, also describing a meeting between the entire Dorchester and Mattapan state legislative delegation and state secretary of Health and Human Services Judy Ann Bigby. "We all said to her in no uncertain terms, there is no other option than giving Carney the money."

The state money, de la Torre hopes, would go directly toward deferred maintenance and needed improvements in the hospital, but that assumes the hospital finances would profitable. The balance of the needed $20 to $30 million would likely be raised from a combination of philanthropy and other state or federal sources, he said. "It's actually not a lot of money in terms of what hospitals spend on capital."

The Wellspring Report details the Carney's loss of market share from 2004 to 2006 to competitors in a market where hospital admissions have shrunk by two percent in the same time period. In 2004, Carney took 8.2 percent of the market. That shrunk to 7.5 percent by 2006. Boston Medical Center - affiliated with Quincy Hospital, and Partners Health System - affiliated with Faulkner Hospital, together dominated the Carney's service area.

The report also confirmed many of the points made by local health center leaders and elected officials who have been fighting the potential closure of Carney. If it were closed, said the report, it would cost $6.8 to $20 million more per year to care for Carney patients at surrounding hospitals, which echoes local voices who label Carney a "low-cost" hospital. The study also states the inability of surrounding hospitals to absorb the Carney's emergency room and psychiatric care beds.

One potential bottom-line booster, listed as a long-shot candidate in the report, is the expansion of a hospital within the hospital at Carney, 25 Long Term Acute Care (LTAC) beds leased by New England Sinai Hospital. If expanded, the report contends it could reduce a potential cash gap in the Carney's budget by $10.5 million.

LTAC beds are for patient stays over 25 days, and hospitals within hospitals have proven to be lower cost ways to serve these patients. But concerns over potential abuses of the system have been raised in the U.S. Congress, and a three-year moratorium has been in effect since this time last year. Although there is a need for LTAC in the neighborhood, according to the report, any expansion of the beds at the Carney would need a federal exemption or the lifting of the moratorium.

Other suggestions from the report include adding 16 psychiatric beds and developing new services in wound care and radiation oncology. The only way to improve market share, it indicated, was to develop new services and new ways to get patient referrals.

De la Torre said the hospital has all but ruled out getting more referrals from local health centers as a strategy, though Carney does get significant numbers from Harbor Health Services, the Dorchester House and others. Instead, the hospital will focus on expanding its own network of primary care doctors, the Carney Medical Group as well as hiring new specialists such as surgeons, more gastroenterologists, and urologists.

"Initially we can fill some voids with doctors from other hospitals," said de la Torre.

"I think the answer that holds the most hope for them is the expansion of the physician group and specialists," agrees Harbor Health Services president and CEO Dan Driscoll. "Gastroenterologists for instance… generate funds for the hospital as well as for themselves.

"I thought it was a well-done and well-balanced report," he added. "It doesn't pull any punches on what it takes to get there."

In addition to expanding, the hospital also needs to get the word out on its current strengths, said de la Torre, like a sterling reputation for strong customer service evinced by a few impromptu testimonials given at last Thursday's meeting.

"Part of the plan is not only to improve facilities but also to improve our brand, really get it out there just how good we're doing so that patients want to come here," said de la Torre in a phone interview.

To a question about 50 people who recently lost their jobs in a round of layoffs at the hospital, de la Torre responded: "Those were tough times. Unfortunately that was part of the reality, I know that Dr. O'Leary agonized over that." As to more layoffs in the works, de la Torre said, "the rumor's not true."

Community activists are now set to continue their advocacy for the hospital.

"Our work is not over," said City Council President Maureen Feeney in a prepared statement. "We will continue to advocate for both private and public resources to help strengthen the future of Carney Hospital."