Friday's announcement that the bankrupt Steward Health Care plans to close Carney Hospital in Dorchester and Nashoba Valley Medical Center in Ayer after failing to secure buyers for the hospitals was met with frustration from public officials and calls from lawmakers for Gov. Maura Healey and Attorney General Andrea Campbell to strictly enforce the state's laws around hospital shutdowns.

Steward said those two of the eight Massachusetts hospital facilities it has been trying to sell since declaring bankruptcy on May 6 attracted no bids that could be approved in bankruptcy court and will close in roughly one month. But the company's timeline for closing the hospitals appears at odds with state laws and regulations that lay out a detailed timeline of steps hospital operators must take before closing. And overshadowed by the closure announcement Friday was word that all of Steward's other hospitals do have buyers lined up, which will contribute further to a substantial reshaping of the health care landscape in eastern Massachusetts.

"Over the past several months, Steward Health Care has been actively working to sell or transition all its Massachusetts hospitals and we are in active final negotiations to sell six of them. Despite the extensive sale process, which involved close coordination with lenders and regulators, there were no qualified bids for two hospitals, Carney Hospital and Nashoba Valley Medical Center, and, unfortunately, they will be closing on or around August 31, 2024," the company said Friday morning. "This is a challenging and unfortunate situation, and the effect it will have on our patients, our employees, and the communities we serve is regrettable. We will do all we can to ensure a smooth transition for those affected while continuing to provide quality care to the patients we will continue to serve."

Health and Human Services Secretary Kate Walsh told the News Service the administration is "very sorry that Steward announced that two hospitals are closed today, but not surprised."

Gov. Maura Healey said this week that all of Steward's Massachusetts hospitals up for sale received at least one bid, but Walsh clarified Friday that the bids for Nashoba and Carney were not "deemed acceptable to Steward or their creditors" in bankruptcy proceedings.

Patients have been leaving Steward facilities during the system's public-facing crisis, and Department of Public Health Commissioner Robbie Goldstein said the departures have been especially sharp.

In June, an average of 13 of the Carney's 83 medical beds were filled and an average of 11 of Nashoba Valley's 46 beds were filled, the governor's office said.

"Those are 50 percent drops from where they were six months ago," Goldstein said in an interview alongside Walsh.

The independent monitor keeping an eye on patient care at Steward hospitals during the bankruptcy process reported this week that services at the hospitals here could be improved in some areas, but she found no "material issues impacting patient care" that put patients at risk.

Healey, who has said her goal was to protect jobs and access to care at all of Steward's eight hospital facilities in Massachusetts, said Friday morning: "This is not over." But she gave no indication of any action she could or might take to prevent the hospitals from closing.

"It’s regrettable that Ralph de la Torre and Steward’s greed and mismanagement are resulting in the closures of Carney and Nashoba Valley hospitals. These hospitals have long served their communities – their closures are about more than the loss of beds, doctors, and nurses. We want to assure the people of Massachusetts that we have prepared diligently for this moment and will take all available steps to help facilitate a smooth transition for impacted patients and employees," the governor said, referring to the company's CEO.

Steward took bids on its seven hospitals (eight campuses) operating in Massachusetts: Good Samaritan Medical Center in Brockton, Morton Hospital in Taunton, St. Anne's Hospital in Fall River, St. Elizabeth's Hospital in Brighton, Carney Hospital in Dorchester, Holy Family Hospital with campuses in Methuen and Haverhill, and Nashoba Valley Medical Center in Ayer. Norwood Hospital, which was closed for renovations, was not included in the sale process.

Healey added, "For the remaining hospitals, we know that Steward received several bids to not only maintain but improve five of their hospitals in three key regions. It is time for Steward and their real estate partners to finally put the communities they serve over their own selfish greed. They need to finalize these deals that are in their best interest and the best interest of patients and workers."

A sales hearing is scheduled for the hospitals in U.S. Bankruptcy Court on July 31, at which time more information on the prospective buyers and their bids should be made public.

Hospital Closure Requirements

The attorney general's office said Friday that the Department of Public Health has oversight responsibility for hospital closures and did not address questions about whether Campbell -- one of the few public officials who did not weigh in Friday with a statement on the Steward closures -- would be involved in enforcing the state's laws and regulation around hospital closures.

State law and regulations require any provider planning to close an essential service to notify DPH at least 120 days in advance and then provide a formal notice 90 days before the planned closure.

But it was unclear Friday how Steward's announcement that the Dorchester and Ayer hospitals would close around the end of August comports with the state's requirements.

When the News Service asked how Steward could claim it would shutter two hospitals in about 35 days, Goldstein replied, "I think the operative word there is 'claim.' "

"We have yet to receive a formal notification of closure from Steward at the department, and we have yet to receive their closure plan," Goldstein said. "Until we have that, we won't know exactly what they are proposing that they want to do and therefore what we might say to them in response to that initial closure plan."

While Goldstein said just before 4 p.m. the department had not received any official closure notice, Steward said earlier in the day it had already "notified and are closely coordinating with the appropriate state and federal agencies on the closure process."

Healey's office said Friday that Carney Hospital and Nashoba Valley Medical Center "will proceed through an orderly and regulated closure," with the next step being the bankruptcy judge considering approval of Steward's motion to close. Steward is required to send a notice of closure to DPH, which "will then facilitate a transition for impacted patients and employees," the governor's office said.

The company said Friday that it will "work closely with our Carney and Nashoba patients to help them find the best possible care alternative and with our valued employees and health care professionals to assist with this very difficult transition."

There is a litany of checkpoints along the way. DPH must publish a notice of a public hearing on the closure at least 81 days out and hold the hearing at least 60 days before the closure would take effect.

Within 15 days of that public hearing, DPH is to provide the hospital with a determination as to whether the service provided by the hospital is necessary for preserving access and health status within the hospital’s service area. If DPH deems the service necessary, the hospital is required to submit a plan to DPH for assuring access within 15 days, and the two sides can go back and forth a bit until there are 10 days remaining until the closure, according to the Division of Health Care Facility Licensure and Certification at DPH.

However, even if regulators find the service is crucial to maintaining care, they cannot legally require a hospital to keep a service open to the public. DPH can only call for a provider to submit a plan outlining what patients will do after a closure and conduct post-closure monitoring, not block any service from shutting down.

Goldstein said it's not unprecedented for facilities to close in fewer than 120 days despite the statutory and regulatory requirements.

"The reality of our authorities at the department is we don't have a lot to enforce if someone is to violate the 120-day closure process," he said. "One of our enforcement mechanisms is that we take away their license. Steward is giving us their license for these facilities, so that enforcement mechanism isn't going to work for us."

"But again, we don't yet have their closure plan. We do think that we're going to be able to work with them on the closure plan to make sure that patient safety is preserved," Goldstein added.

The attorney general was more direct about the Steward situation in a court filing earlier this month.

"To be clear, Steward, as the licensed operator, must comply with all regulatory requirements, including funding, staffing and transitioning through closure or a change in owner/operator," Campbell wrote. She added, "Steward’s obligation to ensure a smooth transition is not only imposed on Steward by Massachusetts health care regulations, but it is also an obligation on Steward as a chapter 11 debtor."

Sen. Jamie Eldridge, whose district includes Nashoba Valley Medical Center, called the facility a "treasured community hospital" and was among a group of lawmakers who urged Healey and Campbell to do everything in their power to prevent the closures and, at the least, enforce the state's 120-day notice requirement.

"I'm heartbroken to hear from town of Ayer that @Steward will be closing Nashoba Valley Medical Center," Eldridge said on X Friday morning. "I'm asking @MassGovernor @MassAGO to continue to work to stop any hospital from closing, create transition plan & enforce the 120-day closure law."

Sen. Nick Collins, whose district includes the Carney, told the News Service that the state "should not allow an for expedited closure of Carney Hospital."

"That would play into the hands of MPT and their strategy to sell the assets at an inflated value and fly away with a windfall. We need to do everything we can to keep Carney Hospital open so that a qualified bidder can come in after bringing the inflated value down to earth," Collins said.

House Ways and Means Chairman Aaron Michlewitz, who represents Boston's North End, said Friday that news of the two Steward hospital closures was "not completely surprising, based off some of the challenges that were being faced."

"But it leaves a lot of uncertainty, a lot of concern, and we think it speaks even more so to why we have to get this health care bill passed that we've been working on. Because certainly want to avoid any circumstances like this going forward here in Massachusetts. And passing this bill is one step at doing that," he said. "But I still think -- still jarring to hear, even though no one should have been completely shocked by the thing, just to see the headline and everything, that was still pretty jarring."

Michlewitz, among the most powerful lawmakers on Beacon Hill, suggested Friday that the House is not thinking about any kind of Steward bailout legislation as its time for formal sessions winds down next week.

"I don't think it's something that we are considering at this moment. We've done a lot for the hospital community through ARPA and through other means the last couple years, obviously, through this turbulent time. This is a different circumstance," he said. "And I think we feel this is something that needs to be worked out on its own, without financial incentive from the Legislature."

Walsh suggested the facilities up for sale will soon be "run by respected systems who know what they're doing" and cautioned against reacting with too heavy a hand.

"We're being very careful not to write laws in response to one situation, or [the Legislature is] being very careful not to write laws in response to one situation," she said. "[We're] making sure that we have what we need. Remember, these hospitals will be run by respected systems who know what they're doing and have a commitment to the regions that we're serving and to the people there."

Asked if the administration was weighing any Hail Mary action to keep Carney Hospital and Nashoba Valley Medical Center open, Walsh replied, "I'm often moved to prayer in this process, but I'm not sure it's going to work on this one."

Adding To Hospital Capacity Crunch

Acknowledging the ripple effects Steward's closures could have on the health care landscape, Healey also announced Friday a new online dashboard that allows people in need of care to find nearby hospitals, understand the services available at each location, and view monthly updates on patient volumes and bed availability. The closure of two hospitals will come at a time of significant strain for health care facilities of all shapes and sizes, and as hospitals all over the state struggle to keep up with the demand.

"The loss of these hospitals will not only impact these patients and communities, but will also compromise the care for patients served by other hospitals in the region, hospitals that are already overwhelmed and will now be forced to absorb those patients abandoned as a result of these closures," the Mass. Nurses Association said in a statement Friday.

For Carney patients, the closest alternative is likely Beth Israel Deaconess's Milton campus, which is about two miles southwest. Google Maps suggests a trip from Carney to Beth Israel Deaconess Milton would take 10 minutes driving or 10 to 15 minutes on the route 240 bus.

Nashoba Valley Medical Center stands in a less densely populated area, and the distances are longer to other acute care hospitals.

The closest neighbors to NVMC are likely the UMass Memorial HealthAlliance campuses in Fitchburg, Clinton or Leominster (each about 15 miles away), Emerson Hospital in Concord (17 miles), or Lowell General Hospital (16 miles).

Goldstein and Walsh said the state for months has been working with other hospitals to help them absorb Steward patients, plus monitoring conditions in their geographic areas.

The nurses union said its members and other health professionals "have held the line throughout this crisis" and added its voice to the calls for the state and federal governments to keep the hospitals running "because no community is expendable and closure is not an viable or acceptable option."

"In the interim, we call on the state to enforce its law forbidding hospital closures with less than 120 days’ notice to allow the state time to find a means of preserving these hospitals for the care of these vulnerable communities," the MNA said.

Filaine Deronnette, vice president at-large of the 1199SEIU union that represents about 80,000 health care workers in the Bay State, reacted to Friday's announcement and said "the future of care in Massachusetts is at risk."

"Steward Health Care's decision to close Carney Hospital and Nashoba Valley Medical Center is devastating, which will create hospital deserts and exacerbate health inequities in the communities they serve. Patients across Massachusetts will now ultimately pay the price of Steward’s mismanagement if care is pushed miles away and ER capacities reach crisis level," Deronnette said.

Alison Kuznitz and Sam Doran contributed reporting.