[Senate Hearing 118-472]
[From the U.S. Government Publishing Office]
S. Hrg. 118-472
EXAMINING THE BANKRUPTCY OF
STEWARD HEALTH CARE: HOW
MANAGEMENT DECISIONS HAVE
IMPACTED PATIENT CARE
=======================================================================
HEARING
OF THE
COMMITTEE ON HEALTH, EDUCATION,
LABOR, AND PENSIONS
UNITED STATES SENATE
ONE HUNDRED EIGHTEENTH CONGRESS
SECOND SESSION
ON
EXAMINING THE BANKRUPTCY OF STEWARD HEALTH CARE, FOCUSING ON HOW
MANAGEMENT DECISIONS HAVE IMPACTED PATIENT CARE
__________
SEPTEMBER 12, 2024
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Printed for the use of the Committee on Health, Education, Labor, and
Pensions
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
57-254 PDF WASHINGTON : 2025
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BERNIE SANDERS (I), Vermont, Chairman
PATTY MURRAY, Washington BILL CASSIDY, M.D., Louisiana,
ROBERT P. CASEY, JR., Pennsylvania Ranking Member
TAMMY BALDWIN, Wisconsin RAND PAUL, Kentucky
CHRISTOPHER S. MURPHY, Connecticut SUSAN M. COLLINS, Maine
TIM KAINE, Virginia LISA MURKOWSKI, Alaska
MAGGIE HASSAN, New Hampshire MIKE BRAUN, Indiana
TINA SMITH, Minnesota ROGER MARSHALL, M.D., Kansas
BEN RAY LUJAN, New Mexico MITT ROMNEY, Utah
JOHN HICKENLOOPER, Colorado TOMMY TUBERVILLE, Alabama
ED MARKEY, Massachusetts MARKWAYNE MULLIN, Oklahoma
TED BUDD, North Carolina
Warren Gunnels, Majority Staff Director
Bill Dauster, Majority Deputy Staff Director
Amanda Lincoln, Minority Staff Director
Danielle Janowski, Minority Deputy Staff Director
C O N T E N T S
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STATEMENTS
THURSDAY, SEPTEMBER 12, 2024
Page
Committee Members
Sanders, Hon. Bernie, Chairman, Committee on Health, Education,
Labor, and Pensions, Opening statement......................... 1
Cassidy, Hon. Bill, Ranking Member, U.S. Senator from the State
of Louisiana, Opening statement................................ 4
Witnesses--Panel I
de la Torre, Ralph, Dr., Chief Executive Officer, Steward Health
Care System, Dallas, TX........................................ 5
Witnesses--Panel II
MacInnis, Ellen, R.N., Nurse at St. Elizabeth's Medical Center,
Boston, MA..................................................... 6
Prepared statement........................................... 8
Summary statement............................................ 10
Sprague, Audra, R.N., Former Nurse at Nashoba Valley Medical
Center, Lunenburg, MA.......................................... 10
Prepared statement........................................... 13
Summary statement............................................ 14
Albritton Mitchell, Staci, Mayor, West Monroe, LA................ 15
Prepared statement........................................... 16
Echols, Hon. Michael Charles, Representative, Louisiana House of
Representatives, Monroe, LA.................................... 17
Prepared statement........................................... 19
ADDITIONAL MATERIAL
Statements, articles, publications, letters, etc.
Sanders, Hon. Bernie:
Statement from Senator Casey................................. 35
Letter from a Physician associated with Sharon Regional...... 35
Letter from Dr. Garrow Primary Health Network................ 36
Letter from the City Manager of Sharon, PA................... 37
Cassidy, Hon. Bill:
Letter from Alexander J. Merton, Quinn Emanuel............... 38
Letter to Alexander J. Merton, Quinn Emanuel, from the HELP
Committee.................................................. 39
EXAMINING THE BANKRUPTCY OF
STEWARD HEALTH CARE: HOW
MANAGEMENT DECISIONS HAVE
IMPACTED PATIENT CARE
----------
Thursday, September 12, 2024
U.S. Senate,
Committee on Health, Education, Labor, and Pensions,
Washington, DC.
The Committee met, pursuant to notice, at 10:01 a.m., in
room 562, Dirksen Senate Office Building, Hon. Bernard Sanders,
Chairman of the Committee, presiding.
Present: Senators Sanders [presiding], Casey, Baldwin,
Murphy, Kaine, Hassan, Hickenlooper, Markey, Cassidy, Collins,
Braun, Romney, and Budd.
OPENING STATEMENT OF SENATOR SANDERS
The Chair. The Committee on Health, Education, Labor, and
Pensions will come to order. It's very significant here in
America today, we have a healthcare system, which in my view
going to say the healthcare system is broken, but it's
currently not the only thing that's broken. We have a
healthcare system that is broken, dysfunctional, and cruel. Too
often it is a system that is designed not to make patients
well, but to make healthcare executives and stockholders
extraordinarily wealthy.
There cannot be a clearer example of that than private
equity billionaires on Wall Street who are making billions by
purchasing hospitals throughout our Country, stripping all of
their assets, and loading them up with debt that these
hospitals could never pay back. Perhaps more than anyone else
in America, Ralph de la Torre, the CEO of Steward Healthcare,
is the poster child for this outrageous type of corporate greed
that is permeating our for-profit healthcare system.
Working in partnership with a private equity firm,
Cerberus, Dr. de la Torre became obscenely wealthy by loading
up hospitals from Massachusetts to Arizona with billions of
dollars in debt and selling the land underneath these hospitals
to real estate executives at Medical Properties Trust who
charged unsustainably high rents. As a result of Dr. de la
Torre's elaborate financial scheme, Steward Healthcare and the
more than 30 hospitals it owns in eight states, declared
bankruptcy with some $9 billion in debt.
But let's be clear, Steward's severe financial problems did
not happen overnight. They have been going on for more than a
decade. It has been estimated that at least 15 patients at
hospitals owned by Steward died as a result of a lack of
medical equipment or staffing shortages, and that at least 2000
other patients were put in serious risk according to Federal
regulators. Since 2019, Federal inspectors have cited Steward-
owned hospitals over 30 times for putting patients in
``immediate jeopardy'' meaning the patients died, were put at
grave risk, or were injured.
In 2014, Steward shut down the Quincy Medical Center,
Massachusetts, with the exception of its emergency room, which
it shut down 6 years later. Today, Quincy is the largest city
in Massachusetts without an emergency room. In 2018, Steward
shut down the Northside Regional Medical Center in Youngstown,
Ohio, closing the only labor and delivery unit in that city for
pregnant women and their babies, and laying off 468 healthcare
workers in the process.
Last year, Steward shut down the Texas Vista Medical
Center, the main healthcare option for San Antonio's south side
after it missed over $650,000 in payments to medical suppliers
leaving the hospital with a severe shortage of respiratory
masks among many other things. Last month, state regulators
required Steward to shut down St. Luke's Behavioral Center in
Phoenix, Arizona after they found that it had been without air
conditioning in Phoenix, as temperatures soared past 100
degrees, putting more than 70 patients at risk of heat
exposure.
Steward has also shut down pediatric wards in
Massachusetts, Louisiana, closed neonatal units in Florida and
Texas, and eliminated maternity services at a hospital in
Florida. We know that Steward has gone bankrupt. We know that
several of its hospitals have already been forced to close
their doors because they ran out of money.
But the question that is interesting to me is, in the midst
of all of that, how is the main person behind all of these
efforts, Dr. de la Torre, how's he doing financially? While
hospitals shut down, while patients go without care, while
healthcare workers lose their jobs, how has Dr. de la Torre
been doing in terms of his own financial well-being? And the
answer is that he has been doing phenomenally well.
While Steward was busy shutting down hospitals, the
companies he owned received $250 million in compensation over a
4-year period. Let me repeat. He personally received hundreds
of millions of dollars, some of which, remember, hospitals shut
down, patients without care, workers being laid off, and some
of that money he used to purchase this $40 million yacht.
While Steward Hospitals were severely understaffed,
patients were not getting the care they desperately needed, Dr.
de la Torre was able to afford this $15 million custom made
luxury fishing boat. $15 million fishing boat while patients
were dying. While Steward-owned hospitals cannot afford to pay
for life saving medical supplies, it had enough money to
purchase a $62 million private jet, and incredibly, a $33
million backup jet that Dr. de la Torre and his family used for
non-business trips throughout the world.
While Steward's hospitals were laying off hundreds of
workers, de la Torre made a $10 million charitable contribution
to an exclusive prep school in Dallas that was fully paid for
by Steward Healthcare, not his own personal funds. How many of
Steward's hospitals could have been prevented from closing
down? How many lives could have been saved? How many healthcare
workers would still have their jobs today if Dr. de la Torre
spent $160 million on high quality healthcare at the hospitals
he managed, instead of a yacht, two private jets, a luxury
fishing boat, and a huge contribution to a wealthy prep school.
Today, we will be hearing from nurses in Massachusetts and
from public officials in Louisiana who have firsthand knowledge
of the harm Steward has caused the patients, the healthcare
workers, and the communities in which they live. I look forward
to hearing from these panelists very soon. As the Chairman of
this Committee, I look forward to working with Ranking Member
Cassidy, and I want to thank him and his staff for their
cooperation on this effort.
Senator Markey, I want to thank Senator Markey for his
leadership. He is from Massachusetts. They have been very hard
hit by Steward. And I hope that we will be working together
every Senator, Democrat and Republican, to hold Dr. de la Torre
accountable for his financial mismanagement and his greed.
But let me conclude by saying this. Dr. de la Torre did not
act alone. Who else besides de la Torre benefited financially
as a result of Steward's bankruptcy? Cerberus, the private
equity firm he partnered with, made an estimated $800 million
profit from its investments in Steward Healthcare. From 2017
through 2021, the CEO of Medical Properties Trust received
about 70 million in bonuses, stock, awards, and salary. How
much of that compensation came as a result of its financial
arrangements with Steward?
The collapse of Steward Healthcare is just one extreme
example of the damaging role in my view, that private equity is
having on our healthcare system. Private equity firms have
bought, bought up hundreds of hospitals, thousands of nursing
homes, and tens of thousands of medical practices, saddling
them up with unsustainable debt and stripping their assets to
make huge profits for their executives and their investors.
Study after study has shown that on average, when a private
equity firm takes over a hospital, a nursing home, or another
medical provider, the price of healthcare goes up, the quality
goes down, and healthcare workers are asked to do much more
with fewer and fewer staff. The issue of private equity and
healthcare is an issue this Committee must look into. We cannot
allow wealthy private equity executives to treat our healthcare
system as their own personal piggy bank.
Healthcare in America, in my view, must be a human right
for every man, woman, and child in this country, and not simply
an opportunity for billionaire investors to make huge profits.
Senator Cassidy, I want to thank you for your hard work on
this, and you are recognized for an opening statement.
OPENING STATEMENT OF SENATOR CASSIDY
Senator Cassidy. Thank you, Senator Sanders.
For months this Committee has engaged in a bipartisan
investigation into the bankruptcy of the Steward Healthcare and
the impact on the delivery of its care at its hospitals. And I
would add therefore, on the impact of the healthcare of the
patients those hospitals served. It was quickly evident that
breaking down the management decisions of Chief Executive
Officer Dr. Ralph de la Torre is essential to understand
Steward's financial problems.
Steward's bankruptcy has nationwide implications impacting
more than 30 hospitals across eight states, including Glenwood
Regional Medical Center in West Monroe, Louisiana. According to
a report from the Centers for Medicare and Medicaid Services, a
physician at Glenwood told a Louisiana State Inspector, ``the
hospital was performing Third World medicine.''
Because of management decisions resulting in limited
resources at Glenwood, the state had to force the hospital to
operate at one-third capacity. One patient died waiting for a
transfer to another hospital, because Glenwood lacked resources
to treat. Glenwood is also the largest employer in West Monroe
and West Ouachita Parish, at one point employing 9 percent of
the community.
Now, hospitals like Glenwood are essential to the both
physical and financial health of the communities they serve. We
need to keep this from happening again. That means we need
answers, and it seems the principle to give that answer is Dr.
Ralph de la Torre, and this is what our bipartisan work has
been about; answers for our constituents, answers to inform
legislative solutions.
Unfortunately, Dr. de la Torre has refused to testify
voluntarily. As a result, the Committee issued a subpoena in
July. Up until September the 4th, Dr. de la Torre's lawyers
indicated he intended to comply with the subpoena and to
testify. However, 8 days before the hearing, Dr. de la Torre
informed the Committee that he would not comply with the
subpoena. We responded to Dr. de la Torre explaining why his
objections to the Committee's subpoena have no merit and
directed him to comply.
Now a witness cannot disregard and evade a duly authorized
subpoena. Therefore, today the Chairman and I will be asking
the Committee to report a resolution to authorize civil
enforcement and criminal contempt proceedings against Dr. de la
Torre, requiring compliance with the subpoena. I thank the
Chairman for working with me on this critically important
issue. I believe our actions today are a testament to what
bipartisanship can accomplish on behalf of Americans, on behalf
of patients. Thank you.
The Chair. Thank you, Senator Cassidy. And again, I want to
thank you and your staff for their bipartisan efforts. As
Senator Cassidy mentioned, our first witness is Dr. de la
Torre, but as I think everybody can see, Dr. de la Torre is not
here. He was subpoenaed to testify at 10 a.m. this morning. On
September 4th, 2024, counsel for Dr. de la Torre sent a letter
to the Committee, objecting to the compelled testimony and
declining to comply with the subpoena. The next day, the
Committee overruled these objections in their entirety and
informed his attorneys that we expected to see Dr. de la Torre
today.
Dr. de la Torre is not present in the room at this time, so
I now call up our second panel of witnesses. Panel, if you
would come to the dais, we would appreciate it.
[Pause.]
The Chair. All right. Let me thank all of our witnesses. We
have four excellent witnesses from Massachusetts, Louisiana,
and we thank them all for being here. Senator Markey has played
a very important role in driving this investigation and has had
a huge impact on communities throughout Massachusetts. So
Senator Markey, I'd appreciate it very much if you can
introduce our first two witnesses.
Senator Markey. Thank you, Mr. Chairman, very much, and
thanks to you and Ranking Member Cassidy for your leadership on
this issue.
Again, I continue to be grateful for partnering with the
Subcommittee hearing that we had in April up in Boston to hold
Steward Health accountable. Greed thrives in the dark, and
these witnesses are bringing this story into the light.
Our first witness is Ms. Ellen MacInnis. Thank you for
being here today. Ms. MacInnis serves on the Massachusetts
Nurses Association Board of Directors. She has worked as a
nurse for 35 years, including over 25 years at St. Elizabeth's
Medical Center, a Steward-owned hospital. Ms. MacInnis worked
in the coronary care unit, in the medical intensive care unit,
and for 20 years in the emergency department. So we thank you
Ms. MacInnis for your testimony. And we very much appreciate
your leadership on this issue right from the very beginning.
The Chair. Let's introduce the other witness as well, and
then we'll introduce all the witnesses and then we'll hear the
testimony.
Senator Markey. The next witness is Mrs. Audra Sprague.
Thank you for being here. Mrs. Sprague served as the co-chair
of the Massachusetts Nurses Association at the Nashoba Valley
Medical Center since 2015. She has also served as a member of
the Massachusetts Board of Registration in nursing since 2021.
Mrs. Sprague worked at the Nashoba Valley Medical Center in the
emergency department for 17 years. She, alongside almost 500
healthcare workers and administrators, lost their jobs late
last month when the bankruptcy court approved Nashoba Valley's
closure due to Dr. de la Torre's financial mismanagement of
Steward.
We thank you for being here. We thank all the hardworking
healthcare workers like you and Ms. MacInnis who are fighting
for patients, not just in Massachusetts, but all across our
Country. You continued to save lives even as the resources were
being drained out of your hospital. Thank you.
The Chair. Senator Cassidy, do you want to introduce the
panelists from Louisiana?
Senator Cassidy. Please. Although they're not sitting in
that order, I'm going to ask Mayor Mitchell to go first. So
I'll introduce her first. Staci Mitchell is the mayor of West
Monroe, Louisiana, has held this role since 2018. Mayor
Mitchell has served her community for many years previously as
an alderman for West Monroe and owning a successful business
for 20 years. She also serves as a board member of Glenwood,
and her role on that board gives us insight into the day-to-day
operations of Glenwood and their challenges.
She holds a Bachelor's of Science in Agricultural Economics
from Louisiana State University. And Mayor Mitchell, thank you
for being here. And by the way, I trust West Monroe is doing
well with the hurricane?
Ms. Mitchell. Yes.
Senator Cassidy. Next, I will introduce State
Representative Michael Echols. And Michael is a state
representative first elected in 2019, representing District 14,
which includes Monroe and Ouachita Parish. Representative
Echols serves on a number of important committees, including
the Health and Welfare Committee, where he has spent
significant time investigating Glenwood Regional Medical Center
and their mismanagement. And he'll bring to this table the
insights learned from the Louisiana Legislative Sessions. He
holds a Bachelor of Science in Accounting from the University
of Louisiana, Monroe, and a MBA from the University of
Louisiana, Monroe.
Thank you both for being here.
The Chair. Thank you, Senator Cassidy.
Ms. MacInnis, the floor is yours, and thank you very much
for being with us today.
STATEMENT OF ELLEN MACINNIS, R.N., NURSE AT ST. ELIZABETH'S
MEDICAL CENTER, BOSTON, MA
Ms. MacInnis. Thank you, Senator.
The Chair. Just make sure the mic is on and talk into it
and hold it close to your mouth for that, please. A little bit
closer.
Ms. MacInnis. Okay. Thank you, Senator. Thank you. Thank
you, Senator Sanders, and Members of this Committee. My name's
Ellen MacInnis. I'm a nurse at St. Elizabeth's Medical Center
in Boston. I've been there 26 years. For the first 12 years I
worked at St. Elizabeth's, we were operated by the Archdiocese
of Boston, and then Cerberus Capital came along, Steward came
along, and it's been downhill since then.
We have 2,800 Massachusetts Nurses Association nurses and
healthcare professionals working at Steward Hospitals. I'm
proud and honored to be representing them today. We hope that
we can provide a unique perspective on this issue, because we
are the front-line providers, we provide more than 90 percent
of the care delivered at Steward Hospitals.
The corporatization and commodification of healthcare is
the guiding ethos of Steward. It's the one and only priority,
and it has led to horrific suffering and harm to our patients,
the people who take care of our patients, and our communities.
The immediate and most debilitating impact of the ownership of
Steward was the Steward's tendency to understaff units whenever
and wherever they can. I spent 20 years working in the
emergency department at St. Elizabeth's, and I can tell you we
always struggled to have enough staff, enough equipment, enough
supplies to keep our patients safe.
Probably one of the biggest impacts is after a patient is
admitted to the hospital, they end up sitting in the emergency
department for hours to sometimes a couple of days, because the
units where they should be admitted and safely cared for are
not staffed. This chronic understaffing has resulted in
preventable harm and even death. The Boston Globe just ran a
front-page expose, highlighting some of the tragic consequences
at Steward Hospitals. This included two patients at Holy Family
Hospital in Methuen who died in the emergency department
because they weren't immediately assessed and they weren't
monitored, and that relates directly to severe understaffing of
that department.
At Good Samaritan, two patients died after spending hours
in a significantly understaffed emergency department. One 81-
year-old gentleman came in for chemotherapy for his pancreatic
cancer, and by the time staff got to him, he was dead. There
were 95 patients in that emergency department on that shift,
and only 11 nurses. It is absurd to think that 11 nurses can
care for that number of patients. Another Steward hospital,
sadly enough, a 28-year-old gentleman came in. He was in an
acute mental health crisis. He was placed in restraints for his
own safety, and there was nobody available to closely monitor
him, which is what statute provides for. And when he went into
distress, nobody was there to rescue him and he's dead.
All of these were preventable. We also have seen Steward
fail to provide the supplies and the equipment that we need.
Either the supplies don't come through the front door because
we're on a credit hold and nobody will bring them to us. Also,
our equipment it's not properly maintained. We have IV pumps
and computers with battery lives of seven to 10 seconds,
because the maintenance just hasn't been done.
During my time in the emergency department, I worked
nights, there were nights that we didn't have any Similac or
Pedialyte or even diapers. I can think of two separate
occasions where staff went out in the middle of the night to a
24-hour store to get those supplies. Also, we frequently didn't
have food kitchens locked up. And I personally have given my
dinner, my meals to patients, and staff has chipped in and sent
out and had food brought in for patients.
Sadly enough, sometimes babies die, newborn babies die, and
the practice is to place the baby's remains in a bereavement
box and take it to the morgue. Steward didn't pay the vendor,
and there weren't any bereavement boxes and nurses were forced
to put babies' remains in cardboard shipping boxes. These
nurses put their own money together and went to Amazon and
bought the bereavement boxes.
Gosh, there's so much more to say. Probably the most tragic
and what finally blew the lid off all this, was the death of a
39-year-old woman who came to the hospital, had an absolutely
normal childbirth, was bleeding. She may have been saved by a
device known as an embolism coil. There weren't any in the
hospital. There hadn't been any in the hospital for weeks. They
had been repossessed by the vendor. She died.
Steward has also caused the closure of Quincy Medical
Center. I grew up in Quincy. This was very close, very close to
my heart. And now Nashoba and Carney Hospital. Carney Hospital
sees more than 30,000 patients a year. Boston AMS takes 6,000
patients a year to Carney Hospital. Where are they going to go?
We don't have the capacity in Boston for this. I know we have a
lot of hospitals, we also have a lot of patients.
Just to be clear, we need not to let this happen again. And
thank you for coming together, and it's my sincerest hope that
you can put an end to this. Thank you.
[The prepared statement of Ms. MacInnis follows.]
prepared statement of ellen macinnis
Thank you, Senator Sanders and to the other Members of this
Committee for the invitation to testify today.
My name is Ellen MacInnis, a former Steward nurse at St.
Elizabeth's Medical Center in Boston, and a member of the Massachusetts
Nurses Association Board of Directors. I have the honor and privilege
of representing more than 25,000 RNs and health professionals working
in facilities across the Commonwealth from Cape Cod to the Berkshires.
This includes more than 2,800 RNs and health professionals working in
eight of the nine Steward owned hospitals in Massachusetts. In coming
here today I hope to provide a unique perspective on the issue, as we
are the frontline providers who deliver 90 percent of the clinical care
patients receive at these facilities. We also can provide a unique
historical perspective as our members have worked at nearly every
facility owned or operated by for-profit entities--be they private
equity firms, or traditional for-profit providers accountable to
shareholders on Wall Street since these firms first entered our state
back in the 1990's.
As a nurse who has given decades of service at St. Elizabeth's
Medical Center, I had worked at the facility when for years it was a
not for profit facility run by the Archdiocese of Boston, and for the
last 14 years following the purchase of our hospital by Cerberus
Capital Management, and soon to be named Steward Healthcare.
From the perspective of nurses and health professionals on the
front lines of the Steward system the impact on our patients and our
communities was the same--the corporatization and commodification of
health care which is the guiding ethos of Steward and other such
providers has left a trail of broken promises made to these communities
and the state agencies responsible for the regulation of these
providers, and more importantly, to the degradation of patient care
leading to an unprecedented level of suffering for the patients and
families who depend on us for their health and safety.
The immediate and most debilitating aspect of ownership by Steward
for those of us charged with providing care to patients was the chronic
lack of staff needed to deliver appropriate timely care to our
patients. Having spent 20 years working a busy, urban emergency
department, I can tell you we were always struggling to provide life-
saving emergency care in a department that was often overwhelmed with
patients, with patients boarding in hallways going without care,
including critically ill patients waiting to be admitted to our
intensive care units, but these patients couldn't be moved to those
units due to the lack of needed staff. Every day was a constant
struggle to convince Steward to add the staff we needed to meet the
needs of patients and every day, little or nothing was done to address
our concerns. And it was the patients who suffered the consequences, in
delays in receiving needed medications and treatments, in care left
undone, with patient suffering preventable falls and in too many cases,
severe harm and even deaths.
The Boston Globe just ran a frontpage expose highlighting some of
the tragic consequences of these staffing shortages at Steward
Hospitals. This included two patients at Steward owned Holy Family
Hospital in Methuen Mass who died in the hospital's emergency
department, one a 38 year-old and another 81 year-old male who both
died from being undiagnosed and going without proper monitoring in the
ED due to the lack of staff on hand to provide that monitoring and
assessment.
At Steward Good Samaritan Hospital in Brockton, two other patients
died after spending hours in an emergency department significantly
understaffed. In one instance, a patient admitted for chemo therapy for
pancreatic cancer died alone on a stretcher in a hallway, after
spending hours waiting to be seen at a time when the ED was staffed
with just 11 nurses caring for 95 patients. No ED nurse should be
expected to or can safely care for eight or nine patients at a time,
but at this hospital, and other Steward hospitals, this was a regular
occurrence.
At another Steward Hospital, a patient experiencing an acute mental
health crisis who was placed in restraints, who was supposed to be
receiving one to one monitoring to ensure his safety, ended up dying
because the hospital was unable to provide that level of monitoring due
to the lack of staff.
These were not isolated instances, and I emphasize, all of them
were totally preventable.
The other common issue for Steward which severely compromised
staff's ability to provide the care our patients deserve was the lack
of supplies and equipment needed for the care of patients. This ran the
gambit from the lack of basic necessities to life saving equipment.
During my time in the emergency department, there were many nights
when we didn't have baby formula on hand for a mother or clean onesies
for an infant who had soiled themselves while coming to us for care. Or
often at night, there were no food stuffs to feed a hungry diabetic or
patients who were waiting for hours to be seen, forcing us to send one
of our colleagues out to purchase these basic necessities.
We had nurses going from floor to floor searching for needed
medical supplies, such as IV tubing, bandages, linens, you name it, all
of it not available because the vendors who supplied those materials
hadn't been paid by Steward for months, and were now placed on vendor
hold waiting for that overdue payment.
A more egregious and appalling example at my hospital was the
failure of Steward to ensure a supply of bereavement boxes, which are
the cases used to carry the remains of deceased newborns to the morgue.
Instead, staff were expected to transport these remains in banker's and
shipping boxes. To compensate for this indignity it was left to our own
nurses to go on line and purchase appropriate containers on Amazon.
The most tragic example, also reported in the Boston Globe, was the
tragic and preventable death of a 39 year-old mother simply because the
embolism coil that would have saved her life had been repossessed by
another unpaid vender.
In addition to the lack of supplies, we watched Steward totally
neglect the infrastructure of our facilities, allowing equipment to go
unrepaired, and to see once proud institutions deteriorate before our
eyes. At one of our facilities, a suicidal patient leaped to his death
from a window that was supposed to be locked shut, but was pried open
because of its being in severe disrepair.
At my hospital, several floors went 36 hours without electricity
due to faulty wiring and electrical issues, forcing nurses to run long
extension chords to be able to run monitors and other equipment needed
to monitor and treat patients.
Let us be clear, none of this is acceptable on any level at any
time. All of it was preventable. Those responsible for this needless
suffering deserve to be held accountable for both their actions, and
their inaction, which is why we are here speaking to you today, in the
hope that you will find a way to hold Steward and Ralph de la Torre
accountable for what they have done to our patients and our
communities. And beyond that, we hope you can use this process and your
power to prevent such harm from being caused by other providers who
choose to place their desire for profit margins over their mission of
caring for the most vulnerable among us.
Finally, we think it is important to point out that it is not just
Steward, private equity or other types of for-profit providers that
need to be held accountable. Our state and Federal agencies that are
charged with regulating and ensuring the safety of our health care
providers and facilities must also be held accountable for doing their
part in protecting the public. We want to make clear that our nurses
and our association went to great lengths over a period of years to
document and report the behavior, practices and outcomes at our
facilities to all levels of state and Federal Government, and it wasn't
until the bankruptcy filing was announced that there was any real or
meaningful effort to address our concerns about Steward. We would also
point out that while Steward is definitely a bad player in the health
care market, they are by no means alone.
It is our hope that this crisis can serve as a wake up call to all
levels of government and to the public that the danger to our public
health from the influence of the profit motive into health care is
significant and that we all must do our part to change the system to
protect our most valuable resource--the health and well being of all
who live in this great nation.
______
[summary statement of ellen macinnis]
My name is Ellen MacInnis, a 26-year nurse at Steward St.
Elizabeth's Medical Center in Boston, and a member of the Massachusetts
Nurses Association Board of Directors. I have the honor and privilege
of representing more than 2,800 RNs and health professionals working in
eight of the nine Steward owned hospitals in Massachusetts.
My testimony will provide a unique perspective on the issue, as we
are the frontline providers who deliver 90 percent of the clinical care
patients receive at these facilities.
From the perspective of nurses and health professionals on the
front lines of the Steward system the impact on our patients and our
communities was the same--the corporatization and commodification of
health care which is the guiding ethos of Steward and other such
providers has left a trail of broken promises made to these communities
and the state agencies responsible for the regulation of these
providers, and more importantly, to the degradation of patient care
leading to an unprecedented level of suffering for the patients and
families who depend on us for their health and safety.
The testimony details how Steward's failure to provide appropriate
staffing at their facilities led to a host of patient injuries,
including a number of preventable patient deaths at five different
facilities.
It will highlight the impact on patient care of Steward's failure
to pay its vendors, resulting in nurses and other staff being unable to
find basic supplies, as well as lifesaving equipment, in two cases,
leading to patient deaths.
Finally, it will call for accountability for Steward and its
executives for the harm they have caused for the hundreds of thousands
of patients and communities it had a mission to serve, while also
calling for future accountability for all health care providers who
place a priority of profits over the delivery of patient care.
______
The Chair. Thank you very much.
Ms. Sprague.
By the way, if you need more than 5 minutes, that's fine.
Take seven, 8 minutes if that's what you guys need.
STATEMENT OF AUDRA SPRAGUE, R.N., FORMER NURSE AT NASHOBA
VALLEY MEDICAL CENTER, LUNENBURG, MA
Ms. Sprague. Thank you. Thank you, Senator Sanders, and the
Members of this Committee for bringing this to the forefront.
My name is Audra Sprague. I'm a registered nurse. I worked at
Nashoba Valley Medical Center for 17 years.
Steward Healthcare systematically extracted every possible
dollar that they could get out of our hospital until it led to
its closure 12 days ago on August 31st, 2024. Since Steward's
ownership, I have witnessed personally myself some firsthand
devastating effects of the company's practices of reducing
overhead to financially benefit their stakeholders and their
CEO, with no regards for the patients and the impact on the
patients and their care and the family and our staff.
Under Steward, essential resources began to dwindle repairs
that once would've been done immediately, were put off and
delayed, sometimes they weren't addressed at all. For example,
if you have a critically ill patient, you need IV access as
quickly as you can to give them fluids and medications. And if
you can't get it within a very reasonable small amount of time,
you use what's a mechanical drill called an IO to go through
the bone, into the bone marrow. But it's mechanically powered,
so it goes faster, and less trauma and pain for the patient.
Our drill battery died and it's a closed system, so the
vendor hadn't been paid. We couldn't get one from that vendor,
so they had to source it from another place. We ended up
getting this subpar--it was like a Fisher Price toy. It felt
like it was this mechanical, like you had to hand pump it to
get this big bore needle to go through the bone into a patient.
Technically it worked, but it was ridiculously poor quality.
And it's just a perfect example of Steward only cared about the
money and didn't care about what was happening to the patients.
As beds broke, they weren't repaired. So, when our census
would increase, we would have to rent beds for a long time.
Then all of a sudden, we couldn't even rent the beds because we
were on credit holds. So, we were forced to transfer patients
to other facilities because we didn't have the physical bed for
them to lay down in an actual hospital bed.
Our hospital is licensed for 57 medical beds, plus 20
geriatric psychiatric beds. Of the 57 medical beds, by the time
we closed, we probably had around 18 to 20 working beds. So,
working under these conditions became overwhelming for
everybody, nurses, doctors, anybody in the hospital at every
different level. Due to the chronic understaffing and lack of
supplies, it became our burden to try and make up for the
financial, like strain that we were under. So, we would keep
that same level of care for the patient whenever we could by
hiding the chaos that was going on outside and hiding all of
the things that had to be done to get the care for that
patient. And it was exhausting.
It's already a very demanding job, and they made it almost
impossible to do. On July 5th, 2023, I had to bring my then 18-
year-old son into the ER at Nashoba. I knew he would be cared
for well, I trusted every single person in there. But Steward
had made it so there was such low staffing and didn't care
about the constant pleas for, we needed more staffing on
overnights. He was diagnosed with new onset type 1 diabetes and
was in diabetic ketoacidosis, which is a life-threatening
complication of type 1 diabetes. He was admitted as an ICU
patient into the hospital.
But there was no ICU beds. There was beds, there just
wasn't nurses because they hadn't staffed it. So, he had to
stay in the ER that entire night. That night, there were two
nurses staffed in the ER, despite us constantly saying we
needed more, and there were 18 patients in the ER that night.
So, no way in the world could two nurses, no matter how fast
they were, how hard they worked, no matter what, could care for
18 patients.
In the state of Massachusetts, if you're an ICU patient,
you should have one-to-one nursing, at times one-to-two, but at
a minimum, it should be one-to-one on an insulin drip. The
nurses there could not meet all the needs. They couldn't get to
all the patients. So, I myself had to take care of my own
child, titrating the drip, making sure that he was getting what
he needs on the critical and emergent needs that he had being
in diabetic ketoacidosis.
The lack of overnight staffing in that ER has been ongoing.
It was a known patient safety issue. Despite our local
administration, our local hospital, CEO, CNO, acknowledging it
and wanting to support it and wanting to fill it, corporate no
matter what, they would just say no. In our negotiations that
had just ended a few months before on the new contract, we
wanted a third nurse on nights. We asked for it over and over,
and the corporate negotiators were like, ``Nope, you don't need
it, you can't have it,'' despite everybody saying it was
needed?
But to ensure that my son received the critical time
sensitive care he needed, I had to be his nurse that night and
not his mother. And he deserved to have both. He deserved to
have a one-on-one nurse and a mother there to support him. And
I wasn't able to do that because I had to focus on his nursing
care and make sure that he was Okay.
Steward's abrupt closure of Nashoba with barely 30 days'
notice has left our region without critical healthcare
services. Our transport times for ambulances have doubled or
tripled, our local EMS systems are in no way going to able to
consistently meet these needs, and there was no time to
buildup. They just said, ``Nope, we're closing. 30 days, that's
it.'' And we have no public transportation. There's not even
Ride or, Lyft, Uber, anything near us. Maybe every now and then
you can get one.
But the closure has resulted in longer waiting times for
emergency care, for essential screening tests at other
hospitals like mammograms, colonoscopies, all of those things
now, other hospitals are going to have to add all of our
patients that were getting those services at Nashoba into these
hospitals, that they were already overwhelmed, especially in
the emergency departments at the two closest hospitals to us.
Moreover, Nashoba's closure has left the primary care
physicians that are still in place, with no place to send them
for diagnostic testing like X-rays, CTs, ultrasounds, MRIs.
They have to go drive a half hour to get, any of those
services, if they can get in for them.
It's just, Steward has a pathological lack of concern for
anyone but themselves. They do whatever is good for them. They
repeatedly misrepresented or outright falsified information to
the state regulators intending to downplay the impact of the
closure. For instance, DPH inquired about the closure plan,
what the transportation options would be in our area after the
closure so patients could get back and forth to appointments.
In the response to DPH's question, Steward cited, a company
called Here to There Transport, and said that they are
providing 24/7 transportation. The way it was worded was
completely meant to imply that this was going to solve the
situation. Here to There Transport is one woman named Joanne.
[Laughter.]
Ms. Sprague. She is lovely, like, don't get me wrong, but
she used to provide us with vouchers for patients that would
need a cab ride home or some sort of transportation home, but
she mainly does airport transport, so she needs to sleep. And
she's not 24/7. She's one person. And then she even stopped
doing that because Steward wouldn't pay them. So, she would
provide the transport--and so it's definitely not a solution
for our entire community's, healthcare needs.
They portrayed us as a failing hospital with declining
census to justify closure in the state. But the narrative
conceals that the corporative executives have systematically
deprived our hospital of essential resources for years,
including not giving us consistent gastroenterology, general
surgery, urologists, anesthesiologists. And as a result,
Nashoba was forced to transfer our patients for care that we
could no longer provide.
The Steward's greed has put lives at risks and their action
is going to kill people. And it's left a complete hole in our
community that despite the warnings and pleas, nothing's been
done to stop them. They have unchecked greed across the board.
And it's not just a business failure, it's a human tragedy
waiting to happen in our region. Thank you.
[The prepared statement of Ms. Sprague follows.]
prepared statement of audra sprague
My name is Audra Sprague, and I was a registered nurse in the ER at
Nashoba Valley Medical Center for 17 years. Steward Health Care
systematically extracted every possible dollar from our facility,
leading directly to its closure 12 days ago on August 31, 2024. Nashoba
Valley Medical Center was vital to the health of residents in our
region.
Since Steward took ownership, I've witnessed and experienced
firsthand the devastating effects of the company's practices of
reducing overhead to financially benefit the stakeholders. Under
Steward, essential resources began to dwindle. Repairs that once would
have been immediate were significantly delayed, if addressed at all.
For example, when we were unable to gain IV access quickly on a
critically ill patient, best practice is to use a mechanically powered
drill that inserts a needle into bone marrow, allowing us to administer
medications and fluids. When the battery died on our drill, Steward
failed to pay the vendor, leaving us without a functioning drill. They
eventually replaced it with a subpar hand-pump manual drill, which was
technically compliant but woefully inadequate for the needs of
critically ill patients.
As beds broke, they were not repaired. When the census increased,
we would rent beds, until the vendors put us on ``credit hold'' because
bills were not paid. We were forced to transfer patients to other
hospitals for care because we didn't have a physical bed to put them
in. Our hospital was licensed for 57 medical beds, but at the time of
our closure, we had approximately 18 working medical beds.
Working under these conditions was overwhelming. Basic nursing
tasks were challenging due to chronic understaffing and lack of
supplies. The nurses and doctors shouldered the burden of maintaining
the standard of patient care. We became very adept at doing more with
less, but it made an already demanding job nearly impossible.
On July 5, 2023, I brought my then 18-year-old son to the ER at
Nashoba. He was diagnosed with new-onset Type 1 diabetes and was in
diabetic ketoacidosis, which is a life-threatening complication. He was
admitted as an ICU patient, but due to a lack of staffing in the ICU,
my son was forced to stay in the ER as an ICU boarder. That night,
there were 18 patients in the ER. In Massachusetts, an ICU patient on
an insulin drip, by law, should have 1:1 nursing care. His nurse in the
ER had 8 other patients to care for. I had to provide his care myself,
as the two ER nurses could not possibly meet the critical and emergent
needs of all 18 patients. The lack of overnight nursing staff in the ER
was an ongoing patient safety issue. Despite local administration's
support for more nursing staff on the overnight shift, repeated
requests were dismissed during contract negotiations by Steward's
corporate executives. To ensure my son received the critical, time-
sensitive care he needed, I had to act as his nurse that night instead
of his mother. He deserved to have his mother and a 1:1 nurse.
Steward's abrupt closure of Nashoba, with barely 30 days notice, has
left our region without critical healthcare services.
Transport times have doubled or tripled one way. Our local EMS
systems will not be able to consistently meet the demand, which is made
worse by the lack of public transportation. The closure has resulted in
longer wait times for emergency care and essential screening tests,
such as mammograms and colonoscopies, at hospitals farther away.
Moreover, with Nashoba's closure, local primary care physicians and
specialists have lost the ability to obtain diagnostic services like
MRIs, CTs, ultrasounds, and simple X-rays. Steward has shown a
pathological lack of concern for anyone but themselves.
Steward repeatedly misrepresented or outright falsified information
to state regulators, intending to downplay the closure's impact. For
instance, when the DPH inquired about transportation options for
residents after the hospital's closure, Steward cited a company called
``Here to There'' Transport LLC that supposedly provides 24/7
transportation. This was presented as if it solved the problem of no
public transportation or ride-sharing services in the region. In
reality, ``Here to There'' transport is one woman named Joanne who
primarily provides airport transfers--not the solution to our
community's healthcare access issues.
Steward portrayed Nashoba as a failing hospital with a declining
patient census to justify the closure to the state. However, this
narrative conceals the fact that Steward's corporate executives
systematically deprived the hospital of essential resources for years,
including specialty physicians such as gastroenterologists, general
surgeons, urologists, and anesthesiologists. As a result, Nashoba was
forced to transfer patients to other hospitals, such as St.
Elizabeth's, for care that could no longer be provided locally. What
appeared to be a hospital in decline was, in fact, the result of
Steward's calculated neglect.
The closure was not because the hospital was failing; it was
Steward's failure to support it. Steward's greed is putting lives at
risk, and their actions--or lack thereof--will kill people. They have
systematically dismantled healthcare in our community, leaving us
without the resources to save lives in critical moments. Despite
repeated warnings and desperate pleas from healthcare professionals, no
one has stepped in to stop them. Steward's unchecked greed has created
a healthcare crisis, and if nothing is done, people will die as a
result. This is not just a business failure--it's a human tragedy
waiting to happen.
______
[summary statement of audra sprague]
My name is Audra Sprague, I am a registered nurse with 17 years of
service at Nashoba Valley Medical Center, I will give testimony
regarding what it was like to work in a Steward-owned hospital and the
impact the hospital's closure had on our community. My testimony will
attribute the closure to the mismanagement and profit-driven strategies
of Steward Health Care, which acquired the hospital in 2011. Under
Steward's ownership, the hospital's resources were systematically
drained.
Steward's cost-cutting measures limited staff's ability to provide
care. Essential equipment was neglected or replaced with inadequate
substitutes. Maintenance and repairs were postponed, resulting in
insufficient medical facilities and increased pressure on the staff.
This deterioration was compounded by chronic understaffing, which made
basic tasks increasingly difficult and placed a heavy burden on staff.
My testimony will discuss a time when my 18-year-old son was
admitted to the emergency department with a life-threatening condition
but was forced to remain there due to a lack of available ICU beds. As
a result, I had to provide care for my son due to inadequate staffing,
instead of being able to provide him support as his mother.
The hospital's closure has had severe repercussions for the
surrounding community. Patients now face extended transport times to
receive care at distant hospitals, straining local EMS systems and
further burdening already overwhelmed healthcare facilities. The loss
of Nashoba Valley Medical Center also means that local primary care
physicians and specialists have lost a crucial resource for diagnostic
services.
My testimony will explain how Steward Health Care provided
misleading information to state officials, downplaying the impact of
the hospital's closure. The company's portrayal of Nashoba as a failing
hospital with a declining patient census was misleading; in reality,
the hospital's struggles were a result of Steward's deliberate neglect.
Steward Health Care's pursuit of profit over patient welfare led to
the hospital's closure and created a healthcare crisis. The repeated
and constant profit driven decisions continue to have life-threatening
consequences for my community, creating a grave situation in many
communities around the country, all led by corporate greed.
______
The Chair. Thank you very much, Ms. Sprague.
Representative Echols. Oh, I'm sorry. Ms. Mitchell.
STATEMENT OF MAYOR STACI ALBRITTON MITCHELL, WEST MONROE, LA
Ms. Mitchell. Good morning, Chairman Sanders, Senator
Cassidy, and the other Members of the HELP Committee. My name
is Staci Albritton Mitchell. I'm the mayor of the city of West
Monroe, Louisiana, and as Dr. Cassidy mentioned, I'm also a
member of the Community Advisory Board for Glenwood Hospital.
And I never expected to be here before in my life, testifying
before Congress, but what my community has experienced over the
last year, I think is worth your attention.
I appreciate this opportunity to testify on the impacts the
Steward Health System has had on our city, West Monroe, as well
as the northeast Louisiana region. The city of West Monroe is
located in northeast Louisiana. We're home to about 13,000
residents, but our eight-parish region has almost 300,000
residents. West Monroe is the home of Glenwood Regional Medical
Center, it is managed by Steward Healthcare. It serves as one
of the primary health access points, not only for West Monroe,
Ouachita Parish, the eight other parishes I mentioned, as well
as it takes transfers from 26 rural hospitals.
During Steward's management, access to emergency care
became greatly diminished and at times unavailable. This
created a strain on the other healthcare facilities in our
region. And when Glenwood was put into immediate jeopardy
status in December 2023, patients seeking emergency room
services had to be diverted to other facilities 10 to 20
minutes away on the other side of the Ouachita River from West
Monroe. And there are reports of these individuals waiting
hours upon hours and sometimes days to receive services.
Even with the Glenwood ER open, there kind of became a lack
of overall confidence in the care that was provided at
Glenwood. And some residents chose to seek services in
hospitals even further away, creating, more stress on an
already stressful situation and of course, more expense for,
kind of an impoverished region. But this also overwhelmed the
other hospitals.
While patient care is the priority, Glenwood is also an
important economic driver. It is the largest employer in the
city of West Monroe and West Ouachita Parish. And before
Steward's reductions, there were over 1200 employees at
Glenwood, and today there are approximately 750. I can't
overstate to you what a closure of Glenwood would do to these
employees and their families.
Those who work maintenance and janitorial and clerical type
jobs will be affected the most. There's a shortage, of these
jobs in our region, and the medical professionals would likely
have to go somewhere else. They would have to relocate to find
employment, which would also worsen the shortage of
professionals and specialists that we have in our area. In
addition to the effects on the direct employees, Steward has
either not paid or they have delayed paying local vendors.
Last November, I was contacted by a local landscaper asking
if there was anything that I could do to assist in getting
paid. He had been, providing the services but had not been paid
in several, several months. I said, ``Send it over. Let me see
what I can do if I can help.'' When I got the invoice, I was
surprised it was for $72,000. And for a small business with a
family and dependents and employees, that's a lot of money and
could put them out of business.
Now I want to be clear that the caring employees of
Glenwood, they have held that hospital together during
challenging times. Their dedication, their commitment to their
patients and to our community, is to be commended. And this
situation, though, it continues to cause mental and physical
stress on them because they don't know if they're going to have
a job tomorrow or not, or what conditions they're going to have
to work under.
In West Monroe, we welcome outside investment. We know that
good healthcare is a must for a region to prosper and Steward's
management has had a negative effect on our efforts to attract
business residents and industry. It is imperative that when
individuals or companies invest in critical infrastructure,
such as healthcare, that they do so in a responsible manner,
and they have their patients and the well-being of all in mind.
And in Steward's case, there was a failure to uphold this
responsibility. And you can see the ramifications easy in West
Monroe and in these other communities that have Steward-managed
hospitals.
I thank you for the opportunity to be here. I also hope
that you will be able to do, something will come of this,
because I want to ensure that nothing like this happens to
another community. Thank you.
[The prepared statement of Ms. Mitchell follows.]
prepared statement of staci albritton mitchell
Good morning, Chairman Sanders, Ranking Member Cassidy, and Members
of the Senate Health, Education, Labor, and Pensions Committee.
My name is Staci Albritton Mitchell, and I am the Mayor of the city
of West Monroe, Louisiana. While I never expected to testify before
Congress in my lifetime, I feel that what my community has experienced
over the last year is worth your attention. I appreciate the
opportunity to be here today to testify on the impacts the Steward
Health System has had on the City and the greater region.
For background, the city of West Monroe is located in northeast
Louisiana and has a population of 13,000. This region is home to almost
300,000 residents. West Monroe is the home of Glenwood Regional Medical
Center, which is managed by Steward and serves as the primary health
access point for the residents of West Monroe, as well as Ouachita
parish and 8 other surrounding Parishes. Glenwood accepts transfers
from 26 rural hospitals in Northeast Louisiana. Glenwood was originally
established in the 1960's. It was purchased by Steward Health in 2017
and has been under Steward's management since then.
I mentioned before that Glenwood is a primary access point for
almost 300,000 people, many of whom have been put at risk in the last
year because of Steward's management. During Steward's management of
Glenwood access to crucial emergency care became greatly diminished and
at times unavailable, creating a strain on other healthcare facilities
in the region. When Glenwood was put into ``Immediate Jeopardy'' status
in December 2023 patients seeking emergency room services had to be
diverted to facilities located across the river, up to 10 to 20 minutes
further, such as Saint Francis Medical Center or Ochsner Hospital,
quickly leading to severe overcrowding at these other facilities. There
are reports of individuals having to wait hours and even days to
receive services.
Further, even with the ER open, these self-inflicted service
reductions led some people to a lack of overall trust in the community
for the care provided by Glenwood. Some Northeast Louisiana residents
are choosing to seek services further away, enduring increased travel
and expenses in a rural, impoverished region, which further stresses
other hospitals.
While patient care is the priority, Glenwood is also an important
economic driver. Glenwood is the largest employer in the city of West
Monroe and West Ouachita Parish. Before Steward's service reductions
there were over 1200 employees at Glenwood. Today there are
approximately 750 employees.
I can't overstate what a closure of Glenwood would do to these
employees and their families. Those who work maintenance, janitorial
and clerical type jobs will be affected the most because of the lack of
those types of jobs in the region. The medical professionals would
likely need to relocate to find new employment, which would worsen an
already dire shortage of these professionals in the area.
In addition to the effects on its direct employees, Steward has
either not paid or delayed paying local vendors. As an example, last
November I was contacted by a local landscaping company asking for
assistance dealing with Steward on an unpaid invoice. The business
owner was contracted with Steward to provide landscaping services and
had been faithfully fulfilling his duties under the contract. Steward,
on the other hand, failed for several months to provide any payment for
these services. I was provided the unfulfilled invoice for $72,000.
While the invoice was eventually paid, a rural small business with
employees and dependent families can be forced to shut down for an
unpaid invoice of that size.
I want to be clear that the caring employees of Glenwood have held
the hospital together under extremely challenging conditions. Glenwood
employees should be commended for their dedication to their patients
and our community. This situation continues to cause mental, emotional
and physical stress on these employees not knowing if they are going to
have a job tomorrow.
West Monroe welcomes and encourages outside investment into our
community. Accessibility to good health care is imperative for a region
to prosper. Steward's management of Glenwood is having a negative
effect on our efforts to attract new business, industry and residents
to our region.
It is imperative that when individuals or companies invest in
critical infrastructure, such as health systems, that they do so in a
responsible manner with the health and well-being of all who are
dependent on services in mind. In Steward's case, there was a failure
to uphold this responsibility, and the various ramifications of that
failure are easily seen within West Monroe and the other communities
across the Nation that were impacted by Steward hospitals. I want to
ensure that other communities don't have to go through this.
Again, I appreciate the opportunity to participate in today's
hearing and am happy to answer any questions you may have.
______
The Chair. Mayor Mitchell, thank you very much.
Representative Echols.
STATEMENT OF REP. MICHAEL CHARLES ECHOLS, LOUISIANA HOUSE OF
REPRESENTATIVES, MONROE, LA
Mr. Echols. Thank you, Senator Sanders, Senator Cassidy,
and panel. Today is a very important step in holding those
accountable in this healthcare delivery system that continue to
rob from all of us across America. Only you at the Federal
level can make this happen. I'm going to highlight some of the
hearing that we had in Baton Rouge.
After a year and a half of hearing from local physicians,
nurses, and other providers that there was a problem, we
started to see service lines being cut for delivery in
Northeast Louisiana from intensive services, urologic care, all
the way down to basic MRI diagnostics. Physicians called me
highly alarmed that they were unable to deliver quality care,
which they're used to being able to give by having the
resources.
After about 6 months of hearing many of these stories, as a
legislator, I felt inclined on the Health and Welfare
Committee, that we needed to have a hearing and have a broader
discussion with the local management, which are essentially
Steward hired executives that they brought in. On April the
9th, I had a hearing. Now this is after the facility had been
placed in medical jeopardy numerous times, numerous
conversations with our Louisiana Department of Health, at the
time, Stephen Russo was the legal counsel there working as
executive counsel in conjunction with all the other leadership
at LDH. We summoned the interim president and CEO Jon Turton to
a committee meeting along with community members, much like
you've done from across America today.
In that hearing we heard impact from other regional
hospitals on how they had to pick up the load when Steward and
Glenwood were unable to keep up with the patient volume, they
cut their numbers by two-thirds. They testified to the fact
that it was tens of millions of dollars in additional costs
that they were not able to recoup. They even did service lines
for Glenwood. St. Francis Hospital, one of the regional
hospitals, which up until the day of the hearing had not been
paid for MRI services that they were helping out this other
regional hospital.
LDH testified that they didn't have supplies on hand. And
when they came in and put them under medical jeopardy all the
way down to basic $1, $2 supplies, things that you need for
surgical care, were not on hand and patients there ended up
getting hurt because of that. Several members of staff told me
about infections that happened with patients and patients dying
because of the lack of those supplies.
All this led up to this hearing where when we deposed Mr.
Turton, the interim CEO, he admitted on the record that Steward
was solely responsible for not providing the financial
resources that they needed to provide adequate care to that
hospital. He also, on the record, noted that because of their
mismanagement, they killed and maimed patients. When that
interim leader, the Steward hired executive, admits that on the
record, we have a substantial problem.
When I hear my colleagues from across America here to talk
about these deficiencies in the healthcare system, it is
glowingly clear to me that the executives of Steward Health
Group are healthcare terrorists. They are killing our patients,
they're killing our communities, and they need to be held
accountable.
I think the problem is broader. Senator Sanders, you
mentioned at the beginning of the hearing that there are other
organizations involved. Medical Properties Trust coupled with
Steward, have facilitated a Ponzi like scheme, that to me, has
to be held accountable as well. Funneling billions of dollars
through private equity into these healthcare delivery systems
are creating criminal enterprises.
I'm hopeful that this Committee, after this subpoena of the
CEO, who no-showed, can hold him accountable, put him in jail,
because that's where he deserves to be for stealing this money
from all of our communities. Glenwood and its employees and the
people on the ground are terrific people. They've done
everything in their power to make sure that the patients get
everything they can, but their hands have been just completely
tied.
This has created a massive imbalance in our healthcare
delivery system in northeast Louisiana. We're trying to keep
the pieces together, but I do want to make sure, and after this
panel is over, that organizations like Medical Properties Trust
cannot continue to fund other bad actors who are going to come
right after Steward, because this isn't the only game in town.
They've got people they've worked with for decades that
they'll fund. They'll come in and have the same mismanagement.
So, I'm hopeful that this Committee, whether through new laws
or through some form of oversight, can make sure that imbalance
gets rebalanced, and we put logic and reason back in the
healthcare delivery system.
Thank you for your time and attention. I'd be happy to
answer any questions.
[The prepared statement of Mr. Echols follows.]
prepared statement of michael echols
Thank you for the opportunity to allow me to testify before your
esteem Committee. The issue with Steward Health Group and Glenwood
Regional Medical Center has created an imbalance in Northeast Louisiana
and the healthcare delivery system. I have over the last year and a
half seen the dramatic impact to patient care as well as the imbalance
in the delivery system for rural hospitals because of Stewards
negligence and malfeasance. After visiting with local physicians and
patients it was alerted to me that there were major problems at
Glenwood Hospital. The physicians had deep concerns about the lack of
supplies, leadership issues, and other bad decisions that were being
made by executives of Stuart health group who manage Glenwood Regional
Medical Center and how it was impacting their ability to care for
patients. Soon after these anomalies started being presented by
physicians, Glenwood Regional Medical Center started to eliminate
service lines such as labor and delivery, urologic care, major
diagnostics such as MRI as well as other specialist services because of
this mismanagement.
As a legislator I was inclined to have a hearing to discuss many of
these issues in a public forum to allow individuals to express their
concerns both the public as well as providers in the medical community.
Prior to having a public hearing I was able to meet with Louisiana
Department Of Health representatives such as Stephen Russo, who at the
time was the Executive Counsel of LDH. There were numerous
communications with them who in turn communicated with the Glenwood
leadership team as well as Stuart exec at the time. You could easily
determine that something was wrong after several months of back-and-
forth and reading national publications about Stewards mismanagement
and other markets. It was abundantly clear that there was a problem at
Glenwood with many of the service lines being shut down, quality issues
being reported other hospitals reporting issues with Glenwood.
After several months and transition of state administration for the
department of health who took over soon after the January 2024
inauguration it was apartment Gelenwood and Stewart had transitioned
from a series of small problems to major problems being placed on
jeopardy status with the state and having their Medicare and Medicaid
licensures in jeopardy at the Federal level. There were numerous
accounts patient care was being compromised due to material shortages,
no specialist care due to physicians was being paid and reports of
patients being hurt or even dying because of not getting the care that
they deserved or needed.
Due to all these reports of Stewart's negligence and gross
malfeasance some weeks later I was able to establish a commission
committee to meet and report from the community on April 9 of 2024 at
the Louisiana legislature the Subcommittee of Health and Welfare was
able to meet and receive testimony from community members.
Nurse practitioners, nurses, doctors regional hospital executives
from St. Francis members from the LDH or the department of health
executive team all presented what the impact was of Stuart
mismanagement corporate malfeasances and noninvestment in the property
in Northeast Louisiana.
That hearing was revealing and that the president or CEO of
Glenwood Jo Turton arrived and testified on behalf of Glenwood and
Stuart in the audience, Mr. Puddy a southeast regional vice president
of Steward was present as a legal council, but refused to testify. He
was to come to the table but again he was scared and did not come to
the table. Mr. Turton and his testimony validated that Steward was
negligent as well as liable for not providing supplies, not paying
vendors, not having a fiscal management and killing or maiming patients
to which he admitted all these things on the record.
This testimony alone which can be found online is reason to hold
Steward liable and corporately negligent for killing and/or maiming
patients in Northeast Louisiana due to the fact that Steward and the
greedy team of executives who stole money through whatever means
possible in conjunction with Medical Properties Trust unjustly enriched
themselves versus reinvesting back in provider pay vendor payments, and
patient care.
All these things have created a massive imbalance in Northeast
Louisiana healthcare delivery market. I hope that this Senate panel
will be willing to hold these executives these corporate raiders who
work between Medical Properties Trust as a quasi Ponzi scheme to
acquire hospitals, distribute short term profits from over valuations
and hold assets in a REIT thus separating ownership from operators in
order to rape the healthcare delivery system and pillage the assets
while holding them hostage through funny bankruptcy laws and a real
estate investment trust that has no accountability to the community to
hold an asset hostage. Steward and Medical Properties Trust has done
this in numerous communities, asked for political bail outs and
continue their Ponzi like scheme. These schemes persist and I'm hopeful
the SEC will investigate MPT further along with the symbiotic
relaitonship of the CEO of Steward and MPT. These two have scheduled to
loot hundreds of millions of dollars through financial relationships
while leaving patients to die on the table waiting to care.
I'm here today to answer any questions to reflect on the hearing
that was held on April 9, 2024 in Baton Rouge. Thank you for your time.
______
The Chair. Thank you very much, Representative, and thank
you for your work in being here today.
Senator Cassidy, what comes to my mind above and beyond the
discussion we're having, Massachusetts is supposedly one of the
progressive states, Louisiana, one of the conservative states,
and we're hearing the same story, aren't we? We're hearing
about decent, hardworking healthcare workers trying to maintain
a rotten system based on outrageous greed. We're hearing
communities being impacted whether Louisiana or Massachusetts,
and we're seeing that all over the country.
I want to pick up on a point that every one of you made,
and that is the spillover impact that the collapse of a
healthcare facility has on other facilities in the region. In
Vermont, Massachusetts, Louisiana, we're all stressed in
healthcare. If a system closes down, if a hospital closes down,
it's not like, ``Hey, no problem. Other people will pick it
up.'' So maybe just go right down the list. Mayor, do you want
to start off? In your community, what is the impact on other
facilities?
Ms. Mitchell. Well, definitely the other two facilities in
Ouachita Parish are overwhelmed. The ERs are full. The beds are
full. So not only are the patients having to wait, but the
employees that work there are stressed. They're overwhelmed.
The Chair. Say a word on that. And maybe somebody else, all
of you mentioned this in one way or another. You have decent
people. I'm always amazed. I have to tell you, I have had
nurses in tears in my office, not worrying about their wages,
but broken hearted that they cannot provide the quality of care
they have been trained and want to do. And what I'm hearing
from all four of you is you have great workers, stressed out,
overwhelmed. Who wants to talk about the impact of what Steward
has done on the employees of the various facilities? Anyone
want to jump in?
Ms. Sprague.
Ms. Sprague. Hi. Thank you.
The Chair. Talk a little bit closer to the mic.
Ms. Sprague. Yes. The impact for the healthcare workers,
nurses, doctors, everybody, is you go there and you become
for--I can speak as a nurse--you want to take care of people,
you want to help people. Nobody's working this hard in this
situation for any other reason. And when you have--in the
emergency department where I worked--you have sick critical
patients and not enough physical people to take care of them
all, you have to go to the most emergent situation.
Which means that there's some poor little elderly woman in
her bed that's in pain, that's not getting her pain medication
or, incontinent and needs to be cleaned up. And in the back of
your head, that needs to be done, but you can't physically get
there and there's not a physical time to do it. And that those
are the things that keep you up at night that you worry, you're
like, ``Oh my God, that poor woman.'' And it wasn't that you
didn't want to, you just physically could not get to it because
of the life-threatening things or the urgent things you have to
prioritize.
It was everywhere at every level. Everybody was trying to
make up for what Steward wasn't putting in and wasn't
investing. We had to invest with our own work.
The Chair. I'm hearing that there has been enormous
emotional toll on people who see suffering, who want to address
it and are unable to do so.
Ms. Sprague. Yes. Yes.
The Chair. Not to mention, one of you mentioned people
actually taking money out of their own pockets to buy
necessities. Ms. MacInnis, did you want to add to that or?
Ms. MacInnis. Thank you, Senator Sanders. I have spent the
past 12 years since we realized--it took us a little bit of
time to realize what a bad player Steward was--and I've spent
countless hours sitting across the table from Steward at least
twice a month at staffing and labor management meetings and
saying, ``This is unsafe. This is untenable. We can't do
this.''
We represent hundreds of nurses who just sometimes struggle
to come into work, to put one foot in front of another. It
ruins you. A lot of people who used to work full time, 36 hours
a week, cut down their hours. Now when people are that
stressed, they just, they cut down their hours and they just
don't feel like they can do it anymore. It's the moral injury
that occurs when you're unable to do the one and only thing you
want to do. And that's to keep patients safe and to take care
of the best care that you can of a patient of all my patients.
But for the greed of Steward in the way they deliberately,
and it almost feels malicious, deprive me of my colleagues, my
support system, my supplies, my equipment. I'm just worn out.
The Chair. Thank you.
Senator Cassidy.
Senator Cassidy. I would defer to Senator Romney.
Senator Romney. Thank you, Mr. Chairman, and Ranking Member
Cassidy. Appreciate the testimony we've heard and your
willingness to bring this to our attention in a very clear and
convincing way. Obviously, the events that took place under Mr.
de la Torre's management at Glenwood and other facilities
across the country, including by the way, five hospitals in
Utah, was reprehensible and never should have happened.
Steward was operating in my state from 2017 to 2023. They
understaffed healthcare facilities. They didn't pay for
required medical equipment. They failed to meet minimum
operating standards. They refused to pay a number of vendors to
the tune of about $40 million to vendors in my state, and most
importantly, they endangered lives. And it's hard to calculate
precisely how many lives have been seriously affected or worse
as a result of their mismanagement.
Clearly this kind of unusual setting warrants careful and
thorough Federal review. HHS at the Federal level is
responsible for conducting oversight to combat waste, fraud,
and abuse. It appears that all three were involved at Steward.
And I appreciate Chairman Sanders and Ranking Member Cassidy
for bringing the issue before our Committee, but I regret we
don't have someone here from the Administration either this
Administration or the prior Administration to talk about, Okay,
what should HHS be doing? How can we oversee, particularly in
the case of hospitals in rural areas, that this doesn't happen?
And, is there something that needs to be done at the Federal
level to make sure that levels of care are being provided? Is
there something done at the state level?
Now, I'll turn to you Representative, which is, what is,
what happens at the state level? Is there some state oversight
where state regulators lack in this regard? I don't know, to
what degree the Federal regulators should have been taking more
aggressive action or whether they had the authorities necessary
to do that. But from your perspective, is there something that
the state can do or should do or did not do that would've
prevented either the tragedies in your state or perhaps in
other states like mine that had been so gravely affected as
well?
Mr. Echols. At the time--and thank you for the question,
Senator--the undersecretary, the secretary of LDH started
investigating in November 2023, which led us up to the hearing
in spring of 2024. They do have, through the medical jeopardy
process the ability to suspend or terminate the license for the
facility. And that's the path we were headed down with this
particular situation.
Some states are more aggressive than others. I mean, when
you look at shutting down a hospital and potentially hurting
more people because of that, this is how both private equity
and these facilities get away with these schemes, because they
put your facility in jeopardy, they shut them down, your
community has nothing. So, they suffer even more. So, then they
can come to politicians like you and me and ask for additional
bailout money and other lifelines, which to me is part of the
broader crime.
To answer your question, yes, there are pathways for our
departments of health to hold them accountable, but the
question is, is the pain worth more than the punishment?
Senator Romney. Do you believe that additional Federal
oversight is important or necessary in this regard?
Mr. Echols. I think more broadly, when you look at how
these schemes are funded, they come through--and Senator
Sanders mentioned Medical Properties Trust--when they're
fueling this private equity movement to be able to fund these
schemes, then yes, there's Federal oversight. And it starts
with the SEC. I'm shocked that a real estate investment trust
can have such large ownership of a company like Steward. That's
not how REITs function. Federal laws should prohibit those
things.
There's a broader conversation on how you fund it. And then
there's, maybe a less broad conversation around specifically
with the Department of Health and Hospitals on regulatory
environments that disallowed these types of operations to
exist.
Senator Romney. Great, thank you.
Mr. Chairman.
The Chair. Thank you.
Senator Markey.
Senator Markey. Thank you, Mr. Chairman, very much. Behind
me are pictures from the patients who died at Steward Hospitals
in Massachusetts when Steward directed millions, tens of
millions, hundreds of millions of dollars away from paying
their bills and into the pockets of corporate executives. Ralph
de La Torre, Cerberus, Medical Properties Trust were just
sucking out tens, hundreds of millions of dollars for their own
benefit and leaving these hospitals without the resources which
they need.
Dirty ICUs, patients are bleeding out, they're dying in the
hallway. Sunita, Theresa, Gilberto, David, Patsy, Michael, they
were amongst the patients that our nurses were just referring
to. And God knows how many others, whose names we don't even
know. We know that more than 2000 patients were endangered by
Steward Healthcare according to The Boston Globe Spotlight
team. They were grandparents, parents, children, aunts, uncles,
nephews, nieces, friends, community members.
But for those corporations, private equity, those profits
came first, meaning the patients came last and ultimately just
left it to the nurses to try to deal with this situation as it
unfolded. And this was a situation where every patient meant
something special to the families and to the nurses as they
tried to help.
Ms. MacInnis, you saw the faces of these patients. Can you
talk about----
Ms. MacInnis. Yes, I saw----
Senator Markey. Can you talk about these people and their
families and what the impact on them was?
Ms. MacInnis. Patients die and patients become less well
sometimes when they empty the--when they enter the hospital,
and it's inevitable and that's life. When a patient becomes
less well or they die because the resources that they need were
unavailable, that's greed. And when I think back over the years
of the patients I was unable to care for in the emergency
department, because one of the cardinal rules at Steward is you
can never decline a transfer.
You might not have a bed in the hospital. You might have a
28-bed emergency department with five nurses and 35 patients.
And when you get that call that a critically ill patient is
coming, and you say, ``I can't. I can't possibly prepare for or
care for that patient.'' The nursing supervisor says, ``Well,
I'm not allowed to say no, so neither are you.'' And then you
get that patient, and it's a gut punch to know that you won't
be able to do for that patient what you know that patient
needs.
Time and time again my organization--I personally, I've
been to Beacon Hill. I've talked with people from DPH, EOHHS.
We've reported power outages and other failures. They closed
the ICU at--Steward closed the ICU mid-COVID at Nashoba Valley.
And when the MNA reported them for closing it, the DPH called
corporate and corporate said, ``Oh, no, no, no, no, no. RIC was
open. Not to worry.'' Even though it was dark in there, and
there were no patients, and there were wires hanging out of the
wall from where the equipment had been removed.
When the MNA called DPH and said, ``Well, what did you
find?'' They said, ``No, it's open. Steward said, it's open.''
So, then pictures were sent to DPH and said, this is clearly a
closed unit. And DPH did nothing. DPH is a toothless tiger, and
that's why we need this to be fixed at the Federal level. Every
single entity that was closed in Massachusetts by Steward was
deemed an essential service. And DPH said, ``No, no, no, no,
no, no, it's essential. You can't close that.'' And then they
closed it anyway, and there were no ramifications. Nothing
happens.
Senator Markey. What would you have done with the $800
million that Cerberus took out of the system? What would you
have done with the $40 million that Ralph de la Torre used to
buy his own private yacht? What could you have done with those
revenues?
Ms. MacInnis. We could have had beds that work. I mean, I
work on the 10th floor of a building. There is supposed to be
six elevators. One of them is working, a single elevator is
working. They gave us these sleds, so we're supposed to do a
lateral transfer, if there's a fire in the building, you go to
the next building. And they gave us these sleds to drag
patients who can't walk.
I'm 65 years old. Do you think for 1 minute I can haul a
patient on a flight of stairs on a sled? This is lunacy. Six
elevators and only one of the--and even that one works most of
the time. So yes, if we had that money, we'd have a facility
that's clean and where things function. We'd have beds for
patients, we'd have stretchers, we'd have food, diapers----
Ms. Sprague. Staff.
Ms. MacInnis. Staff. All roads lead to staffing. If we had
enough staff, we could make do with missing some other things.
But for every person you take away from the bedside, you
increase the risk to the patient who's left without care.
Senator Markey. Thank you for being here today. You are
brave. And Dr. de la Torre is a coward.
Ms. MacInnis. Absolutely.
Senator Markey. He would not come here to allow you to
confront him with the reality of what he has left as his legacy
at these hospitals.
Ms. MacInnis. Thank you.
The Chair. Senator Markey, thank you.
Senator Cassidy.
Senator Cassidy. I'll defer to Senator Braun.
Senator Braun. Thank you, Mr. Chairman, and Senator
Cassidy. This is just another egregious example of a broken
healthcare system, when you can have a story like this. I just
spent time with someone yesterday, and this was on an ERISA
plan. I think the claim was about 4.2 million that the company
had to end up paying the provider 875,000 bucks. And then the
insurance companies and another middleman in it got nearly $3
million. And the owner ERISA plan had to end up paying that
bill, didn't have enough transparency to actually make a
decision that would've prevented it in the first place. And,
who was suing the provider that only got 875,000 bucks and the
insurance company's other middleman got over 3 million.
That should never be happening in a system. I fought it my
entire career as someone wanting to offer great health
insurance, took it on back 16 years ago. Proudest thing that I
did was created healthcare consumers out of my employees.
Didn't think that was reasonable to have your bill, your health
insurance go up 5 to 10 percent each year and be told you're
lucky. This is part of a broken healthcare system that even
doctors and nurses and independent pharmacists don't want to
get into anymore because it's been taken over.
When private equity gets into emergency rooms and gets into
something, that's because it's easy cash-flow. That's Okay if
you want to do it on something that isn't critical, if the
marketplace allows it. Here, it ends up in a story like this.
It ends up to where we're paying twice as much as most other
countries are for healthcare. And in many cases we have poorer
results. I give you that description of another aspect of the
system that I just described. Look at how many resources are
being wasted. And then you look at this egregious example,
something's got to give.
Senator Sanders and I have put out a template based upon
competition and transparency, getting rid of the barriers to
entry. It would be a far bigger reform of a broken industry
than what government has attempted to do in the past. And I
think it ought to put the industry on notice, from insurance
companies to hospitals, to the whole gamut. The only ones not
liking the system or the practitioners that live within it and
they're not happy about how it's evolved, is we have to do
something to fix it from the ground up, or we're going to hear
more of these tragic stories.
I got a question here. I'm going to ask it let me get to it
here. It'll be for Mayor Mitchell. Told you about the bill
we've got that's going to create strong transparency. It's
going to engender competition. It's going to try to chip away
at this story and others, and there's so many of them that make
you sick. I'm wondering if greater transparency would've been
helpful in the fiscal condition of Glenwood Regional. If there
was more information for people to see out there, do you think
it would've made it an easier navigation in terms of what you
had to go through?
Ms. Mitchell. Yes, I think so. And thank you for the
question. Even now, as a board member, I mean, we didn't know
it. It was always presented that Glenwood was profitable. It
was actually one of the most profitable hospitals in the
Steward system. We didn't even know. And there were rumors kind
of in town, maybe the summer, late summer of 2023, about some
local vendors not being paid or being slow to be paid.
But it really was not until September and October when it,
the realization of the seriousness of the issue came about. And
then all of a sudden, I mean, we were in immediate jeopardy in
December. And at that point there was, not a whole lot that
could be done on the local end of it.
I've been mayor 6 years. This is by far the No. 1 topic
that I get calls, comments, texts, people I don't know stop me
in the grocery store asking, ``Please do something about
this.'' And it just all came to head kind of just all of a
sudden. So, transparency would definitely, I think, help the
situation.
Senator Braun. I think until healthcare consumers who have
atrophied within a broken system that many times are fearful
that their own insurance plan is going to be there for them
after they get the bill four to 5 months later, it's all got to
change.
Ms. Mitchell. Agreed.
Senator Braun. If it's not involved with an engaged skin-
in-the-game consumer and a system that if they want to call
themselves free enterprise has to start responding. Otherwise,
you're going to see this egregious issue, many others like I
described. And then yes, a system that could still be repaired
will have to be run like every other country does it. Industry
wake up. Thank you.
Ms. Mitchell. Thank you.
The Chair. Thank you very much.
Senator Hassan.
Senator Hassan. Thank you, Mr. Chairman, and Ranking Member
Cassidy for holding this hearing. Before we begin, it's
absolutely unacceptable that Dr. de la Torre has defied a
subpoena from this Committee and isn't at today's hearing. The
American people deserve to hear answers directly from him on
the horrific mismanagement of Steward Healthcare.
Ms. Sprague and to all the witnesses, thank you for being
here. To our nurses in particular, thank you for what you have
done throughout your professional careers. Nurses keep our
healthcare system going and they save patients every day and
they comfort patients every day. And we are very, very grateful
to you.
Ms. Sprague, I want to discuss your experience at Nashoba
Valley Medical Center, which is located in Massachusetts just
about 10 miles from the New Hampshire border. And Southern New
Hampshire Medical Center in Nashua about 18 miles away, is
likely to be one of the healthcare facilities that now has to
absorb the impact of the closing at Nashoba Valley.
When Nashoba Valley Medical Center announced abruptly at
the end of July, that it would be closing in August, leaving
just a month for patients and staff to prepare for this massive
change in their community, I am curious about what patients and
staff at Nashoba were told in the weeks leading up to that
closure.
Ms. Sprague. From Steward Corporate, very little. We got
the WARN notice that was sent to the MNA that wasn't sent
directly to each of the employees because they don't have to if
you're a part of the union. So that's how the notification came
of the closure to begin with. That was on July 26th. On August
2nd, so 5 days later we got--well, five business days, so a
full week later--we got the first email from corporate Octavia
Diaz that said, pretty much, ``I'm sorry. Like, we tried, but
we're going to close anyways. It's not our fault. Nobody bid.''
Which everything was done in complete secrecy.
They kept saying no viable bids. But nobody knows what that
means or what that entails. And they just closed. We had a town
hall meeting, which is like a--we did it by phone with our CEO,
but even they weren't given a ton of information from
corporate. And that's it. We never had another interaction from
corporate to all of the employees, like that was sent to us.
Everything's closed now.
Some of the doctors have left, like the specialists, the
endocrinologists have left. I know about it because I work in
the hospital and I know like what's going on as being part of
one of the co-chairs of the union. But I have never gotten a
letter from the hospital saying that there's no longer a
diabetes and endocrine center. So a lot of people don't know.
I know that there's nothing in check for them and how they
got here, I don't understand because if I don't do my job,
there is a very strict system that will pluck me out of
practice to keep patients safe. So how private equity comes in
and just can do all of this to all of these people with no
systems in place, it's crazy to me.
Senator Hassan. Right. Because patients are going to have
to travel farther----
Ms. Sprague. Much farther.
Senator Hassan [continuing]. To receive care in our region.
It puts a massive strain on nearby hospitals and local EMS,
including as I pointed out in my state. Can you speak just
briefly--I want to ask you two things. Talk to me about the
impact that you have seen or you're hearing from your
colleagues in the nursing profession on other hospitals in the
region as they have to work to absorb hundreds of patients from
Nashoba. And then also, I understand that you all tried to push
back and protest the closing. And I'm curious about how Steward
responded to that.
Ms. Sprague. Steward had no response to it at all. We never
heard anything from them. They just went on with their day. And
because they don't think that they care at all. It was of no
consequence to them of what they were doing to every employee
and every person that gets care at our facility, how it was at
every level going to affect them. And people had no
transportation, no way to get there. They had no knowledge of
it. And I guess there's some helpline that's set up for, I
don't know, a few hours a day, but I'm sure it's wholly
inadequate if Steward is in charge of setting it up, and they
just had no help and no time, because they wanted to get it
done in 30 days, because then it's less debt, less money that
they have to spend to keep this hospital open.
There was no time to increase the staffing. For all the
EMS, all the towns, most of them have one or two, ambulances
aren't staffed. Now their transport times are double, triple to
get someplace where they're out of service much longer. Meaning
that there's not another ambulance crew available for the
people in that town. And most of them are also the
firefighters. So now you don't have firefighters in town for
that. And the other hospitals around are having to absorb the
patients.
Then as the employees who have lost our jobs, now we have
to go work in that setting where they're overwhelmed because
how far can we go when we're not going to drive hours and hours
to go where these hospitals aren't affected. So now I have to
go work in an emergency department if I want to stay an ER
nurse, which I do, that's more overwhelmed than it was before.
And so, it's just so multi-layered, and it's things you don't
even think of. You're like, ``Oh my gosh.'' Even a month later,
I'm like, ``I didn't even think of that.''
They don't care that nobody in our area, 16 communities
that are serviced, they have literally nowhere to go and it
will cost lives. And they know the state and they know it's
wrong, and they know that Steward lied about everything always.
And they still got to just do whatever they wanted. I don't
understand it.
Senator Hassan. Well, thank you. I'm over time. I want to
just comment to Ms. MacInnis. I had a question about how things
have changed at St. Elizabeth's, and you've already answered
that multiple times. But Mr. Chairman, as somebody with family
in the Boston area, I just want to say that St. Elizabeth used
to have a reputation as being a wonderful, wonderful hospital,
especially for moms and babies. And to hear your stories shakes
me to my core. And I thank you for being willing to share it. I
thank all of the panelists for being able to, as Senator Markey
pointed out, be brave enough to be here today when the person
who should be here today is not. Thank you.
Ms. MacInnis. Thank you, Senator.
The Chair. Thank you, Senator Hassan.
Senator Cassidy.
Senator Cassidy. Hey, Mayor Mitchell and Representative
Echols, I want to enter into a conversation with you.
Mayor Mitchell, you were on the community board. Did they
ever show you financials?
Ms. Mitchell. Financials were passed out each month. I'm
not an expert in healthcare finance, but they were passed out
every month. And it did show that the hospital was profitable.
Senator Cassidy. Now was it profitable on a margin? Was it
profitable like, ``Oh my gosh, you got some operating capital
here?''
Ms. Mitchell. It was, I think, more marginal.
Senator Cassidy. Now I'm struck, and this may be for Mr.
Echols, but we are hearing that they never went on divert in
Massachusetts, that they would accept a patient for transfer
even if they didn't have a bed.
Ms. MacInnis. That's correct. Yes.
Senator Cassidy. But it took our health and hospitals to
make them limit their--now I'm a physician. I know that's
because you didn't have staffing. If you don't have staffing,
but you're still taking patients, then you're putting the
patient in danger. I'm just going to say that.
Did they ever discuss why they would not limit their number
of beds without the state making them do so? Because presumably
staffing had become an issue and that's why the state limited
it.
Ms. Mitchell. When I first called LDH, which would've been
probably late October, December, or November, telling them we
need help, I was told it was a private industry, private
business, free enterprise, and until certain types of
complaints were made, that there really wasn't a lot that could
be done. An extremely helpless situation knowing that, things
were not great in the hospital. And it took, I think, a
different type of complaint. I think a patient or maybe a
physician made a complaint to LDH and it took that to get LDH
to send surveyors to Glenwood to assess the situation.
Senator Cassidy. The specific complaint was about staffing
ratios, regarding the paucity of equipment? Tell me.
Ms. Mitchell. I think it was more about the lack of
supplies.
Senator Cassidy. Lack of supplies. Now Representative
Echols, one of the things I'm interested in, is a lease
arrangement between Medical Properties Trust and the hospital.
And I think you've reviewed some legal proceedings which have
taken that, which would otherwise be proprietary and has now
become public. Were there market rates being paid for the
lease, or were there above market rates? Can you give us a
sense, because I'm trying to--where is the hole in the bottom
of the bucket? They're making money even on the margin, and yet
there's some hole where the money's dripping out.
Mr. Echols. I think it all starts at the top. So, as I
understand it and was reported by the Department of Health,
that the lease between Steward and Medical Properties Trust was
equivalent to $10 million a year. So, a property like Glenwood,
$10 million a new year is an enormous amount of money.
Senator Cassidy. Is that market rate or is that above
market rate?
Mr. Echols. It's above market rate.
Senator Cassidy. Do you have any sense, is it marginally
above, 10x above? Are you seeing what I'm saying?
Mr. Echols. I think it's at least 2x.
Senator Cassidy. 2x.
Mr. Echols. That's on the high end. $5 million a year would
be a high lease for that type of property with a deferred
maintenance and other issues. Steward, which is of course
responsible when a REIT owns an asset, the lessor, whoever's
leasing the building, would typically be in charge of making
improvements to physical plant. They have to keep that for
their SEC rules.
In this case, they should have been investing back in the
hospital. There's tens of millions of dollars of deferred
maintenance in that facility.
Senator Cassidy. Let me stop you for a second, because in
our investigation, it looks like MPT has for Steward in
general, has through forbearance of loans or just cash,
returned about $200 million to the system. I'm trying to be
impartial here. I'm trying to figure out what's actually going
on. So, you could argue that they were putting the money back
in the system to try and float the boat. But Mayor Mitchell,
was there any--could you see from the community board, or
Representative Echols from your investigation, that any of this
money was put back into that deferred maintenance et cetera?
Ms. Mitchell. No. You could walk in the medical mall or the
hospital now, and there'll be buckets--especially with the rain
that's come through the last couple of days--there'll be
buckets in the hallway catching water because of the leaks. I
was in the medical mall last week and you had to walk around,
things like that to get to the facility where I needed to get a
test.
Mr. Echols. Steward executives required employees, PTs,
doctors, nurses to go around and cleanup the hospital,
physically cleanup, sweep, mop to try to prepare for this next
round of liquidation, I guess, as they're bringing in suitors
to try to take over this lease.
Senator Cassidy. Let me stop you because I just have
seconds left.
The Chair. You got time.
Senator Cassidy. I keep on hearing corporate, corporate,
corporate. Am I gathering that local decision-making, that you
couldn't say, ``By the way that we need another coil to
embolize a bleeding adenoma in the liver.'' You had to go to
corporate to get them to pay for that. So, Mayor Mitchell,
again, you're on the Community Advisory Board, is our
impression correct that local decisions had to be made
corporately?
Ms. Mitchell. Yes. And so many of the different departments
got moved out of the hospital. So it was even harder to get a
decision or to get a response or to get anything done.
Senator Cassidy. What was the means of communication? Was
it a kind of formal discussion, listen, here's our to-do list
and here's our needs list, or was it more ad hoc?
Ms. Mitchell. It was really more ad hoc. I mean, the
community advisory board, I mean, we were not in the day-to-day
operations, obviously we're not in those decisions. It was more
of a here's what's going on in the hospital type situation.
Senator Cassidy. Well, I'm going to--the Chairman has
generously allowed me to go a little bit over. But before I
end, I want to thank the nurses. I used to work in a hospital,
which was publicly run and always at the end of the fiscal
year, we didn't have money for things, but it was the committed
staff that made it work. And I just like my heart's beating
with yours on everything you've done.
Thank y'all. Thank y'all.
The Chair. Thank you, Senator Cassidy.
Senator Hickenlooper.
Senator Hickenlooper. Thank you, Mr. Chairman. First do no
harm. That's connected to the Hippocratic Oath. And Dr. de la
Torre went to medical school, became a doctor. I mean, it
raises the question, how can he be Okay with the business
decisions he made and how can he stand behind them? Thousands
of workers laid off because of Dr. de la Torre's shoddy
business practices and mismanagement of Steward Health's
hospitals and closures.
Four hospitals in Massachusetts alone laying off 2,500
employees. And at a time when we're so worried about healthcare
employees, we're somewhere in the vicinity as many as 6.5
million could leave the profession by 2026, by the end of 2026.
And we have in the best, most of optimistic pipeline, a couple
million to replace them. And I think that gross mismanagement
is not only impacting current workers lives, but it's also
affecting future potential workers, young people that would
have considered going into this.
Ms. MacInnis and Ms. Sprague, how do we go about battling
back? How do we re-institute the efforts to inspire high school
students who might be interested in science or open to medicine
to get them to go into healthcare even in what appears to be
such an unstable environment, and within Massachusetts
obviously, it's going to be a distraction and a deterrent for
young people to get into healthcare.
Ms. MacInnis. I'd like to respond, if I may. We need
legislation. We need safe patient staffing legislation. We need
safe patient handling legislation. So, the equipment is always
available to move patients around. And we need safe environment
legislation that would make it a crime to harm a medical
worker. I worked 20 years in the ER, I have lost count of the
number of times I've been assaulted.
Ms. Sprague. Absolutely.
Ms. MacInnis. We just don't have access to lifting
equipment. And any time a nurse takes care of more than four
patients on a med surg unit, the odds of one of those patients
dying increases by 7 percent. We cannot keep doing this. Five
and six and seven patients, you cannot give good care. All the
scientific evidence is four patients is doable. As long as we
are bringing new nurses into this environment and OTs and PTs,
and we're making them care for too many patients, they're going
to turn around and they're going to leave.
Nobody's going to stay and work in this environment. The
Commonwealth in Massachusetts, we have 20,001 nurses now than
we did at the beginning of COVID. Just to be clear, there is no
nursing shortage in the Commonwealth in Massachusetts. There is
a shortage of nurses who want to work in unsafe situations.
Ms. Sprague. I agree 100 percent with what she's saying.
And, to have healthcare in hospitals be for-profit means that
nurses aren't a billable service. So, if you're trying to make
a profit, the same amount of work has to be done at the end of
the day, whether there's one nurse to do it or 10 nurses to do
it. So, there's no incentive for a for-profit company that's
looking to get every dime out of the hospital and all the
services, to add more nurses. They don't care how your day is.
They're not there to actually help patients. They're there to
make money.
Until it's not for profit and it's actually for the
patients, then they will put more nurses on because it's not,
wherever the funding comes from to help the hospital so that
they can provide the correct amount of staff. Because no for-
profit company is going to do it out of their own pockets,
obviously because they want the profits for them. It's just
they've lost sight of what it's for. We're not a company that's
putting handles on buckets, like, it's people and it matters.
It's their lives, it's your family, my family.
Any of the people that are actually owning these companies,
they'll never be in that situation, because they're going to go
to the VIP section. They're going to be, ``Oh, this is the CEO
of whatever, blah, blah, blah.'' They're going to be taken to
the best room. They're going to be taken quickly out of--so
they'll never know what it's really like where the rest of the
people that are there in their hospitals are the ones suffering
from their choices.
Senator Hickenlooper. I'm out of time, but it's compelling.
I mean, obviously something's got to give.
The Chair. Well, thank you for your questioning, Senator
Hickenlooper. And I think the issue that you raised is, if
you're a young person interested in going into healthcare, do
you want to walk into a disaster like that at a time when we
desperately need young people to do it. It's a very important
point.
The other point that I would pick up on is what Senator
Braun made a moment ago, that in the midst of everything that
we are talking about today, please don't forget, we are
spending twice as much as what other countries spend per capita
over $13,000 for every man, woman, and child in America. And
this is what we are getting.
Senator Murphy.
Senator Murphy. Thank you very much, Mr. Chairman. Thank
you all for being here. This is a very important hearing. It's
important because, well, we are focused on this particular
company and this set of horror stories. What is happening in
your hospitals is happening all across the country. I wish this
were not true, but there are hundreds of Ralph de la Torres who
are making a disgusting fortune off of withholding healthcare
from people in need.
I just want to tell you a quick story about what's going on
in Connecticut. In 2016, a company called Prospect Medical
Holdings that is owned by a private equity company, Leonard
Green and Partners bought three hospitals in Connecticut, three
small hospitals, Manchester Hospital, Waterbury Hospital,
Rockville Hospital. You know exactly what happened.
Immediately, they started stripping services out of these
hospitals. Same story you're telling. All of a sudden, supplies
started running short. All of a sudden, specialists couldn't be
found because they were cutting them off of the rolls. The
elevators stopped working in these hospitals just like they did
in your hospitals.
By 2018, these hospitals were in trouble. Everybody knew
it. Prospect was looking for a new buyer to just flip the
hospitals to make more money. In that year, in 2018, Leonard
Green took $658 million in fees and dividends. As these three
hospitals in Connecticut were essentially dying in front of our
eyes, patient quality was being compromised.
John Danhakl is the managing partner of Leonard Green.
There's a lot of various reports about how much he's worth, but
likely in the neighborhood of a billion dollars. I mean, how
have we let American capitalism get so off the rails? So,
unmoored from the common good that anybody thinks it's Okay to
make a billion dollars off of degrading healthcare for poor
people in Waterbury, Connecticut. A, how do you live with
yourself? But B, why do we accept that as a country?
This is just a choice to decide to commoditize our
healthcare system, in Connecticut, in Louisiana, in
Massachusetts, in every state across this country. And we have
enough data at this point to know quality is worse, often way
worse when these private equity companies come in. And not just
in hospitals, in nursing homes, the death rate in nursing homes
owned by private equity companies is 10 percent higher than in
those not owned by private equity firms. So, there's no
mysteries of what's going on here.
Ms. MacInnis, I wanted to just ask you a simple question.
You've talked about this before, but I mean, let's acknowledge
that every hospital has to make money, right? You have to make
money in order to operate. So, nobody begrudges a hospital for
making decisions that allow it to make more money than it puts
out.
The question is this, are you making money for the purpose
of providing good healthcare, or are you making money for the
purpose of making the owners filthy rich? And every decision
that happens in a hospital is different, if you are making
money to provide good healthcare versus making money to make
the owners filthy rich. You were there before and after.
Ms. MacInnis. Yes, I was.
Senator Murphy. Just in the remaining minute, tell us a
little bit about what it was like on the ground floor before
this company comes in, right? And then after the company comes
in. Can you feel it as an employee, the difference in the value
system of the owners?
Ms. MacInnis. Yes. It's noticeably different. I used to
work on an interim coronary care unit, and we gave the best
care. We took care of some of the sickest patients outside the
ICU, and we gave the best care. We had a one to three, a one to
four ratio. I never, ever, ever, in the two and a half years
that I worked on the floor, we never had a code. And that's
because we were able to rescue our patients. We had enough
eyes, enough hands, good assessments, good monitoring, enough
nurses around, frankly, because----
Senator Murphy. Because the focus was providing good care.
Ms. MacInnis. Because the focus was--yes. And when things
got tight, what Caritas Christi did is they let go assistant
nurse managers, and then they let go other people. The very
last thing that they did, and they actually never did, was get
rid of staff nurses, get rid of bedside nurses. They kept us
well staffed, and we took the best care of our patients. I was
so proud to work at St. Elizabeth's.
After just Steward took over, it's just axe and axe and
just taking away everything, violating agreements that they
made with us, they laid off all the nursing assistants on our
maternity floors. Imagine running a maternity floor with no--
well, I can tell you as a nurse, it's an absurd prospect. They
lay off our educators. Now they're cutting right where--for
patient facing staff.
Whereas Caritas Christi absolutely prioritized that to the
point where they stopped funding our retirement plan. They took
away a lot of other things before they took anything away from
our patients.
Senator Murphy. Because the purpose is making as much money
to make the owners filthy rich. Right? And it's just when there
is a fundamental difference in the purpose, there's a
fundamental difference in what happens inside that hospital.
And that's just the reality.
Ms. MacInnis. Yes.
Senator Murphy. Thank you.
Ms. MacInnis. Absolutely.
The Chair. Thank you, Senator Murphy.
Senator Cassidy, did you want to--I think we have come to
the end. Did you want to have unanimous consent or?
Senator Cassidy. Yes, thank you. I ask unanimous consent to
enter into the record the letter we received from Dr. de la
Torre, and the Committee's response to that letter.
The Chair. Without objection.
[The following information can be found on page 38 in
Additional Material:]
The Chair. Let me very sincerely thank all four of our
witnesses. Thank you for what you have done for your hospitals
and your communities. And thank you for telling the American
people what has been going on with Steward Healthcare. And I'll
pledge to you, and I think I speak for Senator Cassidy as well,
we are going to pursue this. This is not the last discussion of
this. And if Dr. de la Torre thinks that he is comfortable by
not being here today, Dr. de la Torre, if you're watching,
you're wrong. This will be pursued.
With that, let me thank everybody for participating. I once
again note that Dr. Ralph de la Torre, CEO of Steward
Healthcare did not comply with the HELP Committee's subpoena
and attend the hearing today. I ask unanimous consent to enter
into the record a statement from Senator Casey, from
stakeholders in support of the Committee investigating this
matter.
[The following information can be found on page 35 in
Additional Material:]
The Chair. For any Senators who wish to ask additional
questions, questions for the record will be due in 10 business
days, September 26th by 5 p.m.
This Committee stands adjourned.
ADDITIONAL MATERIAL
statement for the record of senator robert p. casey, jr.
Chair Sanders, Ranking Member Cassidy, thank you for convening this
important hearing to discuss the bankruptcy of Steward Health Care and
the impact of these bankruptcy proceedings on local communities. I am
disappointed that Dr. de la Torre defied the subpoena this Committee
authorized and has chosen not to appear today. I hope that the
Committee will be able to hear from him soon.
I would like to highlight the experience of a community in
Pennsylvania, the town of Sharon, which is in Mercer County. Sharon has
experienced many struggles in recent years, but the local community has
been working hard to revitalize the town and promote economic growth in
the region. Key to those efforts has been the Sharon Regional Medical
Center, which is one of the largest employers in the county. Sharon
Regional Medical Center is owned by Steward Health Care, the only
hospital that Steward still owns in Pennsylvania. And now, this
hospital is at risk of closing due to the bankruptcy. Closing Sharon
Regional Medical Center would have devastating consequences on the
local community.
The Sharon community's experience highlights the precarity of too
many of our community hospitals, institutions that are pillars of their
communities, supporting jobs and providing local, life-saving medical
care. It calls into serious question the role of private equity and
complex corporate ownership structures that are increasingly wading
into the health care sector, placing profit above people. Many smaller
community hospitals and rural hospitals continue to face financial
burdens exacerbated by the pandemic and cannot survive when those
burdens are compounded by corporate greed.
To illustrate how important it is that we keep community hospitals
in the hands of their communities and with their doors open, I am
including three letters from members of the local community about the
importance of Sharon Regional Medical Center, which are illustrative of
how vital the hospital is to the local community.
Several of their thoughts stood out to me. One physician in the
community wrote, ``Instead of a growing, robust medical community, we
find ourselves having to send our patients further and further for
specialty care, or our patients must wait for months to be seen
locally.'' The head of the local federally Qualified Health Center
network said, ``Community hospitals play a crucial role in coordinating
care and ensuring continuity for patients with complex health needs.
The loss of this resource would disrupt established care plans,
complicating the management of chronic diseases and increasing the risk
of adverse health outcomes.'' And the Sharon City Manager wrote, ``The
city of Sharon has finally reached a turning point in a robust
revitalization movement. The effect of the loss of the City's medical
system and one of the county's largest employers would stall and set
back that movement which has been of vital importance to the future
growth of the city, valley, county, and region.''
As you can see, the impact of a hospital closing can be devastating
to the community. I am grateful that the Committee on Health,
Education, Labor, and Pensions is taking a serious look at how we ended
up facing this situation, and thinking about what we can do to support
community hospitals remaining in the hands of their community members
and serving the community.
______
Dear Senator Casey:
I am a primary care doctor employed by Steward Medical Group, now
Stewardship Health, though, like the other primary care clinics in the
Steward system, we have now been acquired by Rural Healthcare Group (a
Tennessee-based firm owned by Kinderhook Industries, LLC--another for-
profit, private investment firm). I became a primary care doctor
because the health of my neighbors and community is important to me. I
have practiced medicine in Western PA for over 20 years now, and I love
the area and the people of rural Pennsylvania.
Sharon Regional not only provides health care for the people of
Mercer county and surrounding regions, but it is the largest employer
in Mercer county, with approximately 1800 employees. As a primary care
physician, I do not work directly for the hospital, but I feel more
than comfortable sending my patients there for inpatient care when they
are ill, and to specialists who utilize the hospital for procedures and
surgeries.
During Steward's tenure, I have seen the closure of our regional
cancer center and our maternity ward and OB/GYN services. These were
``business decisions'' that were justified, we were told, by
underutilization; this does sound legitimate, given the closures of
these kinds of medical services all over rural Pennsylvania. However,
the lack of services did not stop there; increasingly, we noticed
surgeries and cardiac procedures getting canceled due to lack of
supplies because vendors weren't getting paid. In our own clinic, we
and our staff took up janitorial work for the same reasons--emptying
garbage cans, mopping floors, and cleaning toilets because the
contracted janitorial service had not been paid. Most concerning was
when some of our specialists, with whom we had forged trusting bonds,
left because they were unable to perform the procedures they were
trained to do due to lack of surgical supplies. Instead of a growing,
robust medical community, we find ourselves having to send our patients
further and further for specialty care, or our patients must wait for
months to be seen locally. Now, we worry daily about the future of
Sharon Regional Hospital, which is the hospital that we, as Steward
employees, must also utilize for our own health care. As a primary care
group, we don't know if we will have any specialists left locally to
refer our patients to if the hospital should close. And as for future
doctors and nurses who may have wanted to train and settle down and
work here? Well, due to the bankruptcy, the nursing school--which has
been in existence here for over 150 years, had to close, and the Family
Practice residency program at Trumbull--the other Steward hospital in
the PA/Ohio area--is in jeopardy. There is no other hospital in our
area that would be able to absorb the patient load that would be left
in the wake of a closure of Sharon Regional; and, as mentioned before,
our community would be further devastated by the loss of jobs.
I will say that the health care workers and support staff at our
hospital and clinics are the most dedicated, compassionate, hard-
working, and professional group of people I have had the pleasure to
work with. It has been disturbing and devastating to read about the
downfall of Steward and the behind-the-scenes financial manipulations
that brought us to this point. Health care is not just a business to
us; it is a calling to care for our fellow human beings. It is sacred
work. A hospital is not some ``asset'' to be bought and sold--it is one
of the cornerstones of a community, providing aide and comfort to
everyone when most vulnerable. There should NEVER be an instance when
corporate interests outweigh the health care needs of our communities.
I took an oath to lead my life and practice my art in uprightness
and honor. I know I speak for my physician colleagues, as well as my
nursing and support staff, when I say that I wish those to whom we had
entrusted the health and lives of our patients, our community, and
ourselves had chosen to lead us in a similarly honorable way. Instead,
we feel let down, taken advantage of, and used like so many pawns on a
chessboard in a game that enriched the few at the top, and left our
communities devastated.
Thank you for your time.
______
Honorable Members of the Senate:
Thank you for the opportunity to address this critical issue on
behalf of Primary Health Network, the largest community health center
in Pennsylvania and one of the largest in the Nation. The potential
closure of a community hospital, like Sharon Regional Health System,
would have profound and far-reaching impacts on our health center and
the communities we serve. Here's a summary of the repercussions we
would face:
1. Loss of Specialty Care Providers and Delayed Referrals: The
closure of a community hospital would result in the immediate
loss of specialty care providers who are crucial to our
healthcare system. Their departure would greatly reduce access
to specialized medical services and lead to increased delays in
referrals. Patients would face longer wait times for necessary
care, potentially causing conditions to progress and
complicating treatment. This strain on our already limited
resources would force patients to travel long distances for
care, or, in some cases, forgo it entirely.
2. Increased Pain and Suffering: The lack of a nearby community
hospital means longer travel times and greater logistical
challenges for accessing emergency and routine care. This can
exacerbate health conditions, particularly for those with
chronic illnesses, the elderly, and individuals with limited
mobility, leading to increased pain and suffering.
3. Economic Impact on the Community: The closure would have
significant economic repercussions, including job losses and
decreased local economic activity. Community hospitals are
major employers and economic contributors, and their closure
would ripple through the local economy, impacting jobs and
economic stability.
4. Psychological and Social Effects: The stress and anxiety
caused by inadequate access to healthcare can profoundly affect
the mental health of our community. Patients may experience
increased psychological distress due to the uncertainty and
difficulty in obtaining care, impacting their overall quality
of life.
5. Disruption of Continuity of Care: Community hospitals play a
crucial role in coordinating care and ensuring continuity for
patients with complex health needs. The loss of this resource
would disrupt established care plans, complicating the
management of chronic diseases and increasing the risk of
adverse health outcomes.
In summary, the closure of a community hospital would have
devastating consequences, including the loss of essential specialty
care providers, delays in specialty care, increased pain and suffering,
economic decline, and significant psychological and social impacts.
We urge you to carefully consider these repercussions and work
toward solutions that preserve and enhance the availability of
essential healthcare services in our communities.
Thank you for your attention to this important matter.
Sincerely,
Dr. George Garrow,
Chief Executive Officer,
Primary Health Network.
______
Robert G. Fiscus City Manager,
Sharon, PA,
September 9, 2024.
RE: Potential Closure of Sharon Regional Medical Center, located in
Sharon--Mercer County, PA
Dear Senator Casey:
With the potential closure of Sharon Regional Medical Center
(SRMC), located in Sharon, PA, this letter is to address the concerns
pertaining to the extremely negative impact this situation could have
on the Shenango Valley, the heart of the most populated area of Mercer
County, and surrounding areas. The city of Sharon has finally reached a
turning point in a robust revitalization movement. The effect of the
loss of the City's medical system and one of the county's largest
employers would stall and set back that movement which has been of
vital importance to the future growth of the city, valley, county, and
region.
The negative impact of the potential loss of SRMC in summary:
Loss of Essential Local Healthcare: The absence of a
full-service healthcare provider will necessitate that Shenango
Valley/Mercer County residents in need of essential and/or
specialized medical care would now need to travel an hour and a
half to Erie, Pittsburgh or out of state into Ohio.
Countywide Job Loss: SRMC is considered one of the
largest, if not the largest, employers in Mercer County and, if
closed, the loss of jobs would devastate the city, county, and
region. The unemployment rate would rise, impacting workforce
opportunities which, in turn, would push residents to leave the
county to pursue medical-related jobs elsewhere. Losing SRMC
also has the potential to negatively impact the housing market
with those unemployed or underemployed at risk for home
foreclosure.
Emergency Medical Response Impact: Local private
ambulance services' out-of-service time will increase as the
usual local EMS transport time will increase significantly,
further damaging an already fragile emergency medical system.
Mercer County is already stressed with ambulance shortages, and
the additional out-of-service times will inevitably lead to
more instances of not having local ambulances available.
Additional drive time may also increase the cost of EMS
transport to Mercer County residents.
Behavioral Health Impact: SRMC is the only local
inpatient behavioral health provider in Mercer County. In its
absence, patients will be displaced to UPMC Western Psychiatric
in Pittsburgh or Penn Highlands in Dubois. Besides
transportation challenges for patients and their family
members, this will send money provided by the Mercer County
Behavioral Health Commission out of Mercer County to those
providers, further damaging the local/regional economy.
Local Financial Impact: The City of Sharon would
potentially lose (at minimum) 5 percent of the City's annual
operating budget which comes from revenue directly related to
SRMC, and the indirect economic damage would negatively impact
the City's already challenging budget constraints. The
necessary budget cuts would equate to a reduction of city
services and reduced personnel complements, which could equate
to less police officers, firefighters, and public works
employees, among others.
Municipal Impact: The absence of a local healthcare
provider would create an additional burden on our municipal
police and fire departments with increased demand related to
longer service times for out-of-town emergency medical and
behavioral health transport. In addition, this increased demand
would come at a time when deep emergency service reductions
would be necessary to avoid municipal bankruptcy.
Per the points above, this situation has the very real potential to
negatively impact our city, community, and county for years to come.
Thank you for your attention to this important matter and
advocation for a positive resolution.
Sincerely,
Robert Fiscus,
Sharon City Manager.
______
Quinn Emanuel, Trial Lawyers,
Washington, DC,
September 18, 2024.
Hon. Bernie Sanders, Chairman,
U.S. Committee on Health, Education, Labor, and Pensions,
Washington, DC.
Re: Senate HELP Committee Subpoena to Dr. Ralph de la Torre.
Dear Senator Sanders:
We write to follow-up on our September 4, 2024 letter (``Letter'')
to the Senate Health, Education, Labor, and Pensions Committee (the
``Committee'') and the Committee's recent announcement that it intends
to vote this week on two contempt resolutions regarding the July 25,
2024 subpoena issued to Dr. de la Torre, in his capacity as Chairman
and Chief Executive Officer of Steward Health Care System LLC
(``Steward''), for testimony at the Committee's September 12, 2024
hearing titled ``Examining the Bankruptcy of Steward Health Care: How
Management Decisions Have Impacted Patient Care'' (the ``Hearing'').
As we underscored in our Letter, Dr. de la Torre lacks the authority to
speak on behalf of Steward with respect to the ongoing bankruptcy
proceedings and he is prohibited by a Federal court order from doing
so. Despite these valid objections, however, the Committee moved
forward with the Hearing without meaningfully considering the issues
that Dr. de la Torre raised and without attempting to reschedule the
Hearing. What is more, the Committee's disregard for Dr. de la Torre's
request to reschedule the Hearing in light of these legal restrictions
substantiated our concern that the true purpose of the Hearing was not
to gather facts within the Committee's constitutional and congressional
remit, but instead a pseudo-criminal proceeding with the goal of
convicting Dr. de la Torre in a court of public opinion.Our
concerns that the Hearing would be used to ambush Dr. de la Torre in a
pseudo-criminal proceeding were on full display last week, with the
Committee soliciting testimony from witnesses calling Dr. de la Torre
and Steward executives ``health care terrorists'' and advocating for
Dr. de la Torre's imprisonment, all while the Committee refused to even
acknowledge or aid the bankruptcy settlement that would ensure
continuity of services in all but two Steward hospitals across the
Nation.
Dr. de la Torre cannot be permitted to provide sworn testimony at
this time, given that the Hearing was seemingly designed as a vehicle
to violate Dr. de la Torre's constitutional rights, including his Fifth
Amendment rights. The U.S. Constitution affords Dr. de la Torre
inalienable rights against being compelled by the government to provide
sworn testimony that is specifically (yet baselessly) sought to frame
Dr. de la Torre as a criminal scapegoat for the systemic failures in
Massachusetts' health care system. Accordingly, on the advice of
counsel, Dr. de la Torre invokes his procedural and substantive rights
under the Fifth Amendment of the U.S. Constitution, including the
privilege to refrain from testifying at the Committee's Hearing. See
Quinn v. United States, 349 U.S. 155, 161 (1955). (``Still further
limitations on [Congress's] power to investigate are found in the
specific individual guarantees of the Bill of Rights, such as the Fifth
Amendment's privilege. . . '').
If the Committee had any concern for the hospitals affected by
Steward's bankruptcy proceedings it would, consistent with Dr. de la
Torre's request to postpone the hearing for a more appropriate time,
permit the bankruptcy resolution to move forward and focus its actions
on tackling legitimate questions in the best interests of Steward
patients, hospitals, and communities.
Sincerely,
Alexander J. Merton
______
U.S. Senate,
Committee on Health, Education, Labor, and
Pensions,
Washington, DC,
September 25, 2024.
Alexander J. Merton, Partner,
Quinn Emanuel,
Washington, DC.
Dear Mr. Merton:
We write in response to your letter of September 18, 2024. As
explained in our letter of September 5, 2024, your client, Dr. Ralph de
la Torre, had a legal duty to attend the hearing of the U.S. Senate
Committee on Health, Education, Labor, and Pensions on September 12,
2024, as commanded by the duly authorized Committee testimonial
subpoena issued to him on July 25, 2024, for which you accepted service
on his behalf and indicated his availability.
As further explained in our September 5, 2024, letter, had Dr. de
la Torre appeared to testify, he would have had a full opportunity to
assert his Fifth Amendment right against self-incrimination in response
to questions posed to him by Members of the Committee that implicated
that right. Having elected not to appear, Dr. de la Torre willfully
placed himself in default of the Committee's subpoena. Your effort to
assert the Fifth Amendment, on your client's behalf, after the fact,
and generally rather than in response to specific questions, is
untimely and inadequate and does not cure your client's default.
In response to Dr. de la Torre's failure to appear, the Committee
convened an executive session on September 19, 2024, and voted to
report two resolutions to the Senate for further consideration. The
first directs Senate Legal Counsel to bring a civil action to enforce
the Committee's subpoena and the second authorizes the President of the
Senate to certify a Committee report regarding the refusal of Dr. Ralph
de la Torre to appear and testify before the Committee to the U.S.
Attorney for the District of Columbia for criminal prosecution. Both
resolutions were agreed to and favorably reported by the Committee.
Sincerely,
Hon. Bernard Sanders,
Chairman.
Hon. Bill Cassidy, M.D.,
Ranking Member,
U.S. Senate Committee on Health,
Education, Labor, and Pensions.
______
[Whereupon, at 11:40 a.m., the hearing was adjourned.]
[all]