“There’s some dislocation that happened,” acknowledged Kate Walsh, the state secretary of health and human services, “but we protected a lot of jobs” at the surviving Steward hospitals. Going forward, she said, “we’ve got the right providers in the right places” to serve patients. The hospital buyers, who will receive hundreds of millions of dollars in transition aid from the Healey administration over the next three years, will be working to integrate the former Steward hospitals and their employees into their systems while upgrading infrastructure, from parking lots to emergency rooms, in dire need of repairs. “We know and anticipate significant challenges,” said Dr. Abha Agrawal, president and chief executive of Lawrence General Hospital, which is buying Holy Family Hospital with campuses in Methuen and Haverhill. “Steward simply didn’t invest in these facilities.” But there will also be the opportunity to create healthy regional health systems — in the Merrimack Valley and other parts of the state — with the mission to deliver care in low-income and working-class areas. “Creating this integrated safety net system, we want to focus on high quality, equitable, locally accessible, convenient care,” Agrawal said. In other deals waiting to take effect, Boston Medical Center is purchasing St. Elizabeth’s in Brighton and Good Samaritan Medical Center in Brockton, while Lifespan Health System of Providence is buying St. Anne’s Hospital in Fall River and Morton Hospital in Taunton. The buyers will face some pressing issues. They’ll need to assure the planned sale this fall to a private equity firm of Steward’s doctors network , which includes primary care physicians, won’t affect patient referrals to specialists such as cardiologists and oncologists. And they’ll have to replace employees, from surgical technicians to maintenance engineers, who took new jobs as Steward’s finances deteriorated. Hospital workers who stayed will have to adjust, too. “This has been massively disruptive for the employees,” said Julie Pinkham, executive director of the Massachusetts Nurses Association, which is in talks with the buyers about contract provisions and health insurance. Pinkham, a member of a panel that advises the state’s Health Policy Commission, last week told fellow advisory council members that hospital employees “held firm and worked through this entire crazy [Steward] situation” and should be rewarded for their loyalty. Other health care systems across Eastern Massachusetts, meanwhile, will be struggling to fill the gaping holes in hospital coverage left by Steward. The for-profit hospital chain, which uprooted its Boston base and moved to Dallas in 2018, shuttered Carney Hospital in Dorchester and Nashoba Valley Medical Center in the north central Massachusetts town of Ayer on Aug. 31, insisting it could find no qualified buyers. Those aren’t the only hospital closures that are part of Steward’s legacy. The company shut Quincy Medical Center in 2014, and New England Sinai Hospital, a rehab center in Stoughton, last March. It promised to reopen Norwood Hospital, evacuated after a flash flood in 2020, but walked away from the 215-bed community hospital this year, turning over a reconstruction project to an investment firm that owns the property and is working to find a new operator. The ripple effects of Steward’s collapse are already being felt well beyond the communities served by its hospitals, as patients crowd into overburdened emergency rooms far from their homes and employees scramble for jobs at other systems grappling with their own stresses. “This has also had impact on every other health care system and hospital,” Steve Walsh, president of the Massachusetts Health & Hospital Association, told the advisory council. “When the Steward problem is ‘solved,’ it is only the tip of all the other [health care] challenges that we face throughout the Commonwealth.” State officials, who ponied up $72 million in emergency funds to help the Steward hospitals meet their payroll this summer, have pushed parties involved in the hospital sales — along with regulators reviewing the deals — to complete these complex transactions by the end of September. The state Department of Public Health last week approved licenses for the new owners. The office of state Attorney General Andrea Joy Campbell quickly completed its review of the transactions. And the Health Policy Commission said Friday it had concluded its own review. A potential snag emerged last week as Steward’s lenders and Apollo Global Management, a firm that controls its Massachusetts hospital real estate, continued to haggle over how to divide proceeds from the sales. In bankruptcy court filings last week, Lifespan and Lawrence General said the dispute threatened to derail the sales by preventing them from acquiring the land and buildings of the hospitals they’re buying. Judge Christopher Lopez scheduled a Sunday hearing at the US Bankruptcy Court in Houston in a bid to resolve the differences and clear the way for the Massachusetts sales to close on Monday. Even when the six hospitals change hands, community leaders in Dorchester and Central Massachusetts will continue to press state leaders to find ways to reopen the Carney and Nashoba facilities as emergency rooms, behavioral health units, or urgent care centers. Last week, state officials said they were creating two working groups focused on stabilizing health care in communities that were served by the shuttered hospitals. The groups will study the impacts of the closures and design what officials call “road maps” that tap other regional players to help meet the needs of former Steward patients. Steward was created in 2010 to operate the former Caritas Christi chain of hospitals, with its founder, de la Torre, promising he could pioneer a new and sustainable model for community health care. The company and its founder are now leaving Massachusetts in disgrace, accused of loading their hospitals with debt while extracting huge personal payouts. A workable model for community hospitals is more important than ever. Yet many other health systems across the state, even nonprofits running big-city and small local hospitals, face their own financial problems. Tufts Medical Center in Boston has eliminated hundreds of jobs over the past two years as it continues to lose money and struggles with soaring labor costs. Springfield-based Baystate Health, the largest hospital system in Western Massachusetts, announced a leadership shakeup last week as it tries to reverse its own financial losses. While some of the issues plaguing the state’s hospitals surfaced even before the rise and fall of Steward and will persist in the coming years, there’s little doubt that the Steward calamity aggravated them. Alan Sager, a professor of health policy and management at Boston University’s School of Public Health and longtime critic of the state’s health system, said many of its problems stem from a lack of state planning over decades, leaving critical decisions up to private players. “State government allowed these [Steward] hospitals to be bought and plundered,” he said. “And the Commonwealth continues to fly blind without any real knowledge of which hospitals are needed with what services and what capacity for volume in different locations.” Administration officials, however, say they’re devoting more resources than in the past to monitoring hospitals and their coverage areas, tracking where patients get care and how long they’re waiting. It’s part of a transition they say will make the system less dependent on acute care hospitals. “We’re spending hours every day thinking through the future of health care in Eastern Massachusetts,” said Robbie Goldstein, the state’s commissioner of public health.
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