Federal lawmakers are threatening to hold Steward Health Care CEO Ralph de la Torre in contempt of Congress over his refusal to appear at a Senate committee hearing next week, as the health care crisis caused by the company's bankruptcy continues to unravel.

Sen. Ed Markey, who chairs the Health, Education, Labor, and Pensions (HELP) Subcommittee on Primary Health, and Retirement Security with Sen. Bernie Sanders of Vermont, subpoenaed de la Torre to testify before the committee at the Capitol building on Sept. 12 about the system's bankruptcy.

The committee voted on a bipartisan basis to hold the hearing, Markey said at a press conference in Boston on Thursday, where he said they would take another vote next week to hold the Steward CEO in contempt of Congress if he fails to attend despite the subpoena.

"When I voted on July 25 to issue the first subpoena from the Senate Health Committee since 1981, it was not a request for Ralph de la Torre to answer for what he's done, it was a demand that he answer for what he has done. It was a demand that 15 of my bipartisan colleagues joined," Markey said.

A letter to Sanders from de la Torre's lawyers on Wednesday said it would have been inappropriate for de la Torre to attend.

"Dr. de la Torre declined the Committee’s invitation to participate at this hearing because it would be inappropriate for him to testify on matters related to Steward’s bankruptcy while those proceedings remain live and ongoing in U.S. Bankruptcy Court," the letter signed by Alexander Merton of Quinn Emanuel Trial Lawyers said. "Rather than afford the time necessary to administer Steward’s reorganization case, however, on July 24, 2024, the Committee issued the Subpoena now seeking to compel Dr. de la Torre’s testimony."

Sen. Elizabeth Warren, who was also at Thursday's briefing, said that de la Torre could be arrested by federal marshals for refusing to comply with a federal subpoena to testify.

"A congressional subpoena is exceedingly rare. But it is a legal order. Not an invitation -- an order," Warren said. "Yesterday we learned through his lawyer that Ralph de la Torre is saying he will refuse to obey a lawfully issued subpoena. Ralph de la Torre is one more rich guy who thinks the rules don't apply to him."

De la Torre's lawyers laid out additional reasons why the CEO does not plan to speak before the congressional panel: On Aug. 28, Steward prohibited de la Torre from speaking on its behalf regarding bankruptcy-related issues; the "unfettered administration of Steward's bankruptcy proceedings" is the best way to ensure continuous care for communities who rely on their hospitals; and that the Senate committee continues to "cast aspersions" on de la Torre.

"Unfortunately, while Dr. de la Torre has continued to fight for Steward hospitals and the patients and communities they serve, members of this Committee continue to cast aspersions on Dr. de la Torre and appear determined to turn the hearing into a pseudo-criminal proceeding in which they use the time, not to gather facts, but to convict Dr. de la Torre in the eyes of public opinion," Merton wrote.

Though the Sept. 12 committee hearing is not a criminal case, Markey and Warren did not shy away from bold language about what they called de la Torre's "criminally exploitative" operations of Steward Health Care.

"Contempt means that if he continues to refuse to appear before the committee, we will not stop until he answers for what he has done or is put behind bars," Markey said.

Warren referenced a Boston Globe Spotlight piece published earlier this week about the CEO's "secret financial dealings."

The article alleges that de la Torre dipped into Steward's bank accounts -- as hospitals were struggling and medical equipment was being repossessed due to outstanding debts to vendors -- to finance his luxurious lifestyle.

"Now, Ralph de la Torre's lawyer says that Mr. de la Torre can't talk because the hearing will be turned into a 'pseudo-criminal proceeding.' Based on the facts gathered in yesterday's spotlight report in The Boston Globe, it is entirely possible that Mr. de la Torre's looting of Steward may have involved significant criminal activity, but that is not an excuse for ignoring a subpoena," Warren said.

She argued that if de la Torre worried that his answers could put him at risk of going to jail, he could plead the Fifth Amendment, "right out in the public for everyone to see."

The story of Steward Health Care's financial crisis has been unfolding for months, coming to somewhat of a turning point this week when a bankruptcy judge authorized the sale of six of the system's eight Massachusetts hospitals to new buyers.

For those hospitals, which have spent years under Steward and the last several months with hovering uncertainty of whether the hospitals would close altogether, their attention is now turning to rebuilding trust among health care staff and patients, said the Massachusetts Nurses Association's Ellen MacInnis.

The News Service reported earlier Thursday that the state has committed at least $417 million to aid those six hospitals over three years as they transition to new owners -- in addition to $72 million the state already paid to keep them open this summer.

The Executive Office of Health and Human Services said Thursday morning that the $417 million package will support the Holy Family Hospital facilities in Haverhill and Methuen (being bought by Lawrence General Hospital), Saint Anne’s Hospital in Fall River and Morton Hospital in Taunton (being bought by Lifespan) and Good Samaritan Medical Center in Brockton (being bought by Boston Medical Center).

BMC is also buying the operations of St. Elizabeth's Medical Center in Brighton and the state plans to seize that property by eminent domain. HHS said information on financial aid for St. Elizabeth's will be made available at a later time, meaning the aid package's bottom line is nearly certain to grow.

And there was another milestone this week for the communities whose Steward hospitals were not bought. Patients in Dorchester, Ayer, and the other cities and towns surrounding Nashoba Valley Medical Center and Carney Hospital are looking for new places to receive care, and employees at those facilities are job searching, after both hospitals shuttered their doors last weekend.

Congresswoman Lori Trahan, who represents the Middlesex area that Nashoba Valley serves, said she is worried about it now becoming a "health care desert."

Asked if she believed the state could do more for Nashoba Valley, like take the land by eminent domain as they did for St. Elizabeth's in Brighton, Trahan said she is working with state officials to find ways to reopen the hospital.

"There wasn't a qualified bid during the bankruptcy proceedings to keep Nashoba Valley, so eminent domain was not an option," she said. "I can tell you, I am on daily phone calls with the governor, the secretary, and our state and local leaders as well as providers and nurses, physicians groups. And we are exhausting all options in terms of trying to get those proposals, certainly, but things change between when bankruptcy proceedings end and kind of going forward. We need to make sure as we reopen services that they are services that can be sustained. So, that is what we're exploring now. But I'm quite optimistic."

With the sale of six community hospitals, those at Thursday's briefing said it was time to begin thinking about accountability.

"As we start to see the Chapter 11 bankruptcy proceedings come to a conclusion, with good news yesterday that six hospitals were in fact sold, or authorized to be sold to new operators, our time and attention now focuses on accountability," said Tim Foley, executive vice president of health care union 1199 SEIU, who then called for "justice for these communities, for these workers, for these patients."