At a Carney Hospital “stakeholders” meeting last Friday morning (Aug. 16), speakers from the state Department of Public Health and the city’s Public Health Commission indicated that the process by which Steward Health Care is disposing of its hospitals was “changing rapidly.” Because of this, I will focus on observations of the process by which the state and city have engaged in the Carney’s status. I also offer recommendations for how the state and city should approach preserving essential Carney services.

Massachusetts health care officials have acted like the crisis with the Steward hospitals began with the declaration of bankruptcy by Steward this spring. In fact, the crisis had been developing for several years, especially since the hospital properties were sold to Alabama-based Medical Properties Trust (MPT) in 2016. On Feb 14, 2022, a Wall Street Journal article on MPT (“How a Small Alabama Company Fueled Private Equity’s Push into Hospitals”) indicated that Steward had paid $1.2 billion in rent and mortgage interest between 2016 and 2022, and lost $800 million between 2017 and 2020. At that point, the Mass Executive Office of Health and Human Services (EOHHS) could – and should – have started a process to determine how to ensure the preservation of health care services at the Steward hospitals, which disproportionately serve high need communities.

Instead, concern about Steward’s finances turned into crisis when Steward declared bankruptcy on May 6 of this year, 2024, and it became known that the company owed at least $1 billion and as much as $10 billion to creditors. But EOHHS waited for additional information from the federal judge in Houston. A May 7 WBUR radio story (“The 3rd-largest Mass. hospital system is in bankruptcy. Here’s what you need to know”) suggested that some hospitals could wind up in other hospital systems and other hospitals could wind up closed.

EOHHS could have determined which of the hospitals’ services were essential to ensure health in their communities and started to engage with the likely bidders for the hospitals to determine how essential services were going to be continued, but apparently they did not. When hospital advocates suggested that the state declare a public health emergency and use eminent domain to seize hospital properties, we were told that all issues were in the hands of the bankruptcy judge. EOHHS even allowed him to ignore a Massachusetts law requiring 120 days’ notice when essential health services are to be terminated when he authorized the closure of the Carney and Ayer Hospitals on July 31.

Instead, we were told by EOHHS Secretary Kate Walsh that “the market has spoken.”  Perhaps if we had a single payer system with all providers receiving the same reimbursement for the same service, and competition for patients based on quality, she could reasonably make that statement. But we do not have, nor have we ever had, a genuine market in health care.

Secretary Walsh should certainly know about how contrived the market is from her tenure as CEO of Boston Medical Center. In the 1990s two hospitals – Boston City Hospital and University Hospital – were determined by the market to be unnecessary. But thanks to community action, courageous officials, and a special legislative deal, Boston Medical Center was created via a 1996 merger of the two hospitals. Critically, the reimbursement rate for services at BMC is higher due to the legislative deal that created the center. Other hospitals receive more or less reimbursement for services based on the types of insurances their patients have, based on where the patients work, and based on whether the hospital is based in higher or lower income communities. It has never been, nor is it now, a true fair market.

The market also allows for purchases of hospital systems, including non-profit hospitals, by equity firms. The market doesn’t care about the health of populations, especially in vulnerable communities in our state; it cares about money. The market rewards extremely expensive hospital systems and is allowing multi-billion-dollar expansions of them so they can compete for wealthy foreigners, while low income and working class Massachusetts communities that need caring, affordable institutions in convenient locations are losing their affordable, nearby community hospitals.

Shutting down health care resources in low income communities should not be justified by citing the health care market. It should be determined by what communities need to ensure a healthy population, but EOHHS has apparently decided that a bankruptcy judge makes the decisions for the Dorchester/Mattapan/Hyde Park/Quincy communities regarding access to emergency care and hospital psychiatric treatment.

We were also told that the Commonwealth just didn’t have the money, despite $8 billion in the rainy day fund. Then, last Friday afternoon, we found out that what we were told was untrue, when the governor authorized the seizing of St. Elizabeth Hospital by eminent domain and allowed EOHHS to operate the hospital until a deal is struck with Boston Medical Center to take it over.

So eminent domain, and actions to save critical health services on the western side of the city are okay for a hospital that will be part of BMC, but not for the Carney Hospital?  Those 31,000 people who visited the Carney emergency room from Dorchester, Mattapan and Hyde Park last year will just have to make other arrangements in cases of emergency; 60,000 annual patient visits to Carney ambulatory services will have to find a new medical home, and the patients in the much-needed 70 psychiatric beds will be sent somewhere else. This rushed shuttering of services is to be completed by Aug. 31 in a system with overwhelmed emergency rooms, few slots for primary care services, and a chaotic hospital psychiatric system. Has anyone calculated the price of transferring 31,000 emergency room visits to higher-cost downtown hospitals?

I recommend the following next steps:

1) Seize Carney Hospital by eminent domain and work out an arrangement for BMC to take over the Carney emergency room, as it does at the East Boston Neighborhood Health Center, or entice Beth Israel Lahey to expand Milton Hospital’s emergency room operations to jointly run them with a second site at Carney.

2) Create a network of community health centers to open an urgent care center in the Carney Ambulatory Care Center that will operate seven days a week.

 3) Turn over the 70 psychiatric beds to the Department of Mental Health with the goal to move the beds to a competent private operator.

4) Establish a commission to look at alternative uses for the rest of the Carney property, which could include a surgical center and other clinical and low acuity operations, using the laboratory, x-ray, and other imaging services currently on site.

5) Pass legislation that gets Massachusetts back into effective health planning that reflects our state’s values and ensures that we have a health care system that meets the needs of every part of our Commonwealth.

Over the past few weeks, we’ve heard stories from Carney patients whose lives were saved by having a convenient emergency room in the southern tier of metro Boston. The message was very clear: People will die if we fail to preserve essential community services at the Carney.