Leaders leave patients in PE hospital shell game

A bankrupt hospital that remains open is — in some ways — just as worrisome for patients as if it closed. 

The demise of Dallas-based Steward Healthcare is the latest example of this, and a stark reminder that watchdogs for patients only safeguard their interests up until a certain point. The situation is now a shell game for patients, who might have Steward hospitals open and available to them, but with questionable levels of staffing, safety or timely access to essential services. 

Look to Massachusetts, widely upheld as a leader in the country for high-quality healthcare. This is the state where the first threads that would eventually unwind Steward were pulled, with The Boston Globe publishing investigative reporting in January on conditions within the private equity-backed chain's struggling hospitals. 

"Surgeons buying their own medical instruments. Nurses devising their own mouthwash solution for patients on ventilators. Patients eating crackers after all the sandwiches prepared for the day had run out," the report started. That was just the beginning. 

U.S. Sens. Elizabeth Warren and Ed Markey responded by turning up the pressure for Steward to release financial reports, and Massachusetts Gov. Maura Healey made repeated calls for the operator to sell its nine hospitals in the state and make its exit

Months later, after Steward filed for bankruptcy, disclosed $9 billion in debt and announced intention to sell all of its hospitals. What officials called a charade by Steward is now carrying on as a charade with more participants, as Massachusetts officials tell community members that Steward hospitals remain open and able to provide the care that they were previously providing.

"If you get care at a Steward facility, there is no need to make changes to your medical care," a state resource website reads. "Your appointments, screenings, treatments, and therapies should continue to occur as usual." 

Too often conflicts over hospital access rest on the goal of hospitals remaining open. Lost in this dynamic is concern for patient safety and care quality if struggling hospitals remain operating as-is. The abrupt closure of Steward hospitals would be devastating to the Massachusetts healthcare system, which is already experiencing strained capacity

Quality of care holds equal importance to accessibility, despite the misleading perception created by how leaders have addressed this issue. The matter is too often made into one of closed or open hospitals. Little attention or curiosity is paid to the quality of care patients receive from hospitals in the months before closure announcements or, in the case of Steward, in the months before transitions to new ownership. 

In this scenario, Massachusetts patients find themselves traversing a minefield. Navigating the already complex landscape of hospital choices and healthcare providers is even more daunting when bankrupt hospitals with well-documented quality problems are strewn throughout a city. 

Before Steward's financial problems emerged early this year, the operator's hospitals in Massachusetts already had two- or three-star ratings from CMS. Since The Boston Globe's reporting on surgeons' bring-your-own-devices approach to procedures, homemade mouthwash concoctions and missed patient meals, Massachusetts decided it was wise to pay more attention to the operations of these facilities. The Department of Public Health now monitors all the Steward hospitals to confirm they have the supplies, equipment and staffing necessary to meet state standards. 

Monitoring is a relatively low bar, and can only do so much to ensure high-quality healthcare. Amid state officials' calls for patients to carry on as normal, Massachusetts physicians and health leaders at other hospitals have stepped up to challenge the charade. 

"In spite of these hospitals remaining open, their level of intensity of care is clearly declining," Eduardo Haddad, MD, president of the Lawrence (Mass.) General Hospital Medical Staff, said during a May 15 meeting of the state's Public Health Council. 

Dr. Haddad said Steward's Holy Family Hospital campuses appear to be missing providers in key services such as orthopedics, neurosurgery and, on weekends, dialysis.

"So what we are finding is that [patients] get in, they get evaluated, but then they get transferred out — and appropriately, because you don't want to admit them to a situation where they may not have an essential service," Dr. Haddad said, according to WBUR

Care quality problems at Steward are in line with research and studies on private-equity backed healthcare providers. A study published in JAMA in 2023 comparing hospitalizations from 2009 to 2019 at 51 private equity hospitals and 259 similar hospitals not acquired by private equity found noticeable differences in their patient safety and care quality. 

After a hospital was acquired by private equity, admitted Medicare patients had a 25% increase in hospital-acquired complications, compared with patients admitted before acquisition. Patients also had 27% more falls and 38% more central line-associated bloodstream infections.

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