The decisions by Steward Health Care and the federal bankruptcy judge in Texas to close the Carney Hospital would seem to spell the end of this hospital, which was created in South Boston in 1863 by a bequest from Andrew Carney. In 1953, the hospital moved into Dorchester’s Lower Mills neighborhood and expanded operations to serve the huge population of Catholics in the southeast tier of Boston and nearby communities.

How the hospital got to this point of closure is the result of some poor decisions made by the hospital and by those with authority over its administration over the past fifty years along with demographic and health system changes that affected these decisions. It is also the result of the failure of our state’s leadership to have a comprehensive plan in place to support optimal health for the residents of Massachusetts.

But none of these things should dictate that the hospital should close. It has had difficult times over several decades, but it has persevered. A hospital for Dorchester and its neighboring communities is an essential part of what should be an overall health care system for Massachusetts. But such an entity does not exist. We need one, and the Carney Hospital needs to be a key part of it.

The lack of a comprehensive plan for health care in our Commonwealth affects the health and well-being of our communities, especially the low-income neighborhoods that are part of the Carney’s service area. Allowing the destruction of a key health component in such a large section of metropolitan Boston should not be contemplated unless we have such a comprehensive plan in place. Unfortunately, Massachusetts leadership has allowed a type of laissez faire medical marketplace to dictate how health care is delivered, resulting in a chaotic, fragmented, and hugely costly system. Billions of dollars are allowed to be spent to create unnecessary luxury wings at hospitals with the goal of attracting wealthy foreign patients while convenient and lower cost community hospitals are allowed to close. Eliminating the Carney Hospital from the mix of services will just make that chaotic and costly system worse.

My experience with the Carney Hospital dates to a visit to the emergency room when I first arrived in Boston in 1972. The Carney was a bustling hospital operated by the Catholic Daughters of Charity with 424 licensed beds for its 10,000 yearly admissions It had a busy emergency room, a training program for physicians, a robust brain neurosurgery department, and a large 60+ bed psychiatric unit for adults, adolescents, and seniors. It also had a heliport built on the roof to assist in covering emergencies from the South Shore.

Dramatic demographic shifts in the Boston area during the 1960s and 1970s resulted in a population crash in the city, which lost 250,000 residents between 1950 and 1975. Much of that loss was in the Dorchester/Mattapan area, including a large part of the Catholic population of Dorchester, which constituted a major part of the Carney’s patient population.

An internal report by Carney leadership in 1974 indicated that the hospital needed to be engaged in the Black community as a way to stem the losses in its patient census that were occurring because longtime White Irish Catholics were moving to the South Shore in droves and being replaced with African Americans with no experience using Carney.

The hospital’s medical providers’ interest was to continue to serve the insured White population emigrating to the towns south of Boston, but Carney leadership decided to try to both keep their traditional patients and look at the incoming population of African Americans as a source of new patients. A department was created in the Carney to coordinate hospital ambulatory care and community outreach into the changing neighborhoods.

Led by Dr. John Coldiron and Sr. Kathleen Natwin of the Daughters of Charity, the Carney supported the development of community health facilities, including the Dorchester House, Little House, and the Bowdoin Street, Mattapan, Neponset, Roslindale, and Codman Square health centers, which helped fill the vacuum of health care in their communities from the loss of private physicians.

That is how I got involved with the Carney. After the closing of the Codman Square branch library, the Codman Square Civic Association was looking for a new use for the building. A meeting was held in December of 1974 to discuss the idea of putting a health center into the library building, during which I was chosen to chair a Codman Square Health Committee with that goal, which was supported by the hospital.

Dr. Coldiron and Sr. Kathleen were light years ahead in thinking about the future of the Carney, and, in fact, prescient about the future of health care, but their ideas were ultimately rejected by Carney Hospital leadership. Just as the health committee was preparing documents, with Carney help, to go before the health planning councils and committees necessary to create a health center, I received a call from Sr. Margaret Tuley, president of the Carney, telling me that the doctors on staff there had voted against the Carney expending any more effort in starting health centers in Dorchester. She said that she was sorry; the Carney could no longer help Codman Square.

The health committee continued to work, and eventually secured the support of Mayor Kevin H. White in 1978 to allow the library building to be used as a health center. Following the mayor’s decision, the Carney re-approached us. I got a call from Sr. Kathleen Natwin, who said that since the health center in Codman Square was now going to happen, the Carney wanted to help us get it started. They provided initial staffing and allowed the center to use the hospital for payroll services and supplies.

I was chosen as the executive director of the health center and included in management meetings of the Carney, as were the directors of the aforementioned health centers. Most patients of the centers were sent to the Carney for specialty care and admissions, and our boards were invited to annual dinners.

Carney Hospital continued to experience strong divided opinions between the forward -thinking leaders (Coldiron, Natwin) who saw health centers as the new way to connect to the Dorchester community, keep the hospital vital, and deal with the reality of Dorchester’s demographic shifts, and the medical staff, many of whom saw the newer non-white residents of Dorchester as a source of poor reimbursement for care.

Then it all crashed and burned. In 1987/88, the Carney changed its direction, and ended its relationships with five of the seven health centers. As for Codman Square, I was contacted by the Carney president’s office in 1988 and informed that the hospital no longer wanted a relationship with us; that it was closing off its main administrative support (payroll and supplies); and that we should look for another hospital to work with.

In 1988, I approached Boston City Hospital’s (BCH) Commissioner Judith Kurland and asked for a relationship between that hospital and Codman. Over the next few years, all Codman physicians and nearly all patients became part of the BCH (now Boston Medical Center) system. The other health centers also developed relationships with other hospitals. The end result was the movement of thousands of Carney patients to other hospital systems.

Every couple of years, there would be some effort to save the Carney, which I would join, though the patient census continued to shrink. Around 1993, discussions started between leaders of Massachusetts General Hospital and Carney president Jack Logue about the Carney becoming part of Mass General. These talks were put on hold when Partners Healthcare was created in 1995, and Boston’s Cardinal Bernard Law ended any chance of this development coming to life in 1997 by requiring the Carney to join Caritas Christi, the archdiocese’s hospital group, which resulted in the Daughters of Charity giving up the hospital.

Caritas Christi produced a 2006 analysis of conditions at the Carney that looked at both the cost of closing the hospital and what could be done to make it profitable. The analysis indicated that the hospital’s financial health depended on about $5 million in state support per year. It calculated that the cost of closing the hospital would be in excess of $50 million, due mostly to unfunded liabilities and loans, severance and unemployment costs. To increase revenue, the analysis suggested adding long-term acute care services, additional oncology programs, and MRI capacity, closing unprofitable services like psychiatry, and merging some services with other Caritas hospitals. Caritas later looked at the having the entire system become part of Ascension Health in 2008.

But the Carney continued slipping toward obscurity, shrinking from over 400 beds in the 1980s to 160 licensed beds and occupancy under 100 patients per day on average, half from the Carney psychiatry unit. The facility was old and needed substantial capital investment. The mainstay Irish Catholic population had developed relationships with suburban hospitals and Dorchester residents had developed relationships with the downtown hospitals through their health center affiliations. Patients for non-psych units tended to be Vietnamese, Haitian, and older white residents. Most of the health centers became part of payment systems that cemented their relationships with Boston Medical Center or Beth Israel. The centers suggested that the Carney transform its residency program to create a family medicine residency as a way to rebuild relationships with them, but that didn’t happen.

In 2010, Caritas Christi was purchased by Cerberus Capital Management, creating for-profit Steward Healthcare, with plans for more than $400 million in new capital. With Caritas Christi and the archdiocese in financial trouble, the new deal and the money was seen as a way to preserve the hospitals and it received the support of hospital unions, which saw their pensions funded, and of elected officials, who saw it as way out of a crisis. All the regulatory agencies of government approved it. And I joined the latest task force to help figure out what to do about the Carney. I was later offered the opportunity to try to restore the hospital as its president, but my tenure was short. During my time there, the Carney was offered to Boston Medical Center for free, but the hospital refused the offer, despite its need for psychiatric beds.

The Carney Hospital is the victim of many poor decisions and its fate could be characterized as “death by a thousand cuts,” with perhaps a few stabs wounds along the way. While the Carney has been allowed to atrophy, this does not mean that it is not needed. There are more than 200,000 Massachusetts residents within a few miles of the hospital.

Emergency rooms elsewhere are already chaotic and overwrought, and our highways have continuous traffic that would jeopardize the lives of people in need of emergency care if the Carney ER is not an option. Just this week, I had dinner with a Dorchester friend who believes her life was saved by virtue of having the Carney emergency room close to home. She got a bacterial infection with a 20-30 percent fatality rate that quickly overwhelmed her. Being seen quickly at the Carney ER prevented further damage from the infection.

Beyond emergency room access, the loss of the Carney’s 60+ psychiatric beds will be disastrous for our state’s overburdened behavioral health system. The Carney is also a teaching hospital with many residents and fellows in training to become physicians.

It is absurd to allow the flawed medical marketplace to determine health care needs. But that is what our state leadership is saying. Gov. Healey and Health and Human Services Secretary Kate Walsh need to re-think their view that a decision by a judge in Houston to close the Carney is acceptable for Massachusetts’ health care system. They also need to re-think the notion that the “market” is the best way to have and sustain a comprehensive health care system that meets the needs of all Massachusetts residents, let alone the people in neighborhoods with among the poorest health outcomes in the Commonwealth. Is anyone thinking about what happens the next time there’s a pandemic?

The governor needs to act before Carney operations cease from lack of patients and staff. She can declare a public health emergency, which will allow the Commissioner of Public Health to take actions, including taking over the hospital. It is important that this happen quickly, so that essential services, such as the emergency room and the psychiatric units, can continue operations.

Only then can discussions begin on how to constitute a system of comprehensive services for the more than 200,000 people in this area of metro Boston, which happens to produce the worst health outcomes in Massachusetts. This could include assembling a coalition of health centers that could create a system to use the hospital for lower acuity services, or engaging hospital systems to take responsibility for essential services at the Carney in collaboration with the health centers.

The cost of such an intervention will be far less than forcing the thousands of residents in this section of Massachusetts to have only the high-cost options of downtown hospitals. Failure to act quickly is medical malpractice on these needy communities.