As Massachusetts officials give go ahead to seek care at Steward Hospitals, doctor gives his side

MAY 15, 2024…..As state officials continue to encourage people to seek care at Steward Health Care’s eight hospitals in Massachusetts despite the company’s bankruptcy, a doctor from a neighboring hospital said the messaging doesn’t tell the whole story of what is actually happening on the ground.

Since Steward filed for bankruptcy in Texas last week, Gov. Maura Healey and others have sought to make clear that the legal proceeding does not necessarily mean that anything has changed for patients, urging people to keep their appointments at Steward facilities and encouraging residents to seek emergency care at Steward hospitals without reservation.

Public Health Commissioner Robbie Goldstein told the Public Health Council on Wednesday that the state’s “consistent message to patients in the community has been and continues to be that all Steward hospitals in Massachusetts remain open, patients should keep up with their health care needs, maintain their appointments, screenings and tests.”

But the chief of medical affairs at Lawrence General Hospital, which is near to Steward’s Holy Family Hospital in Methuen and Haverhill Hospital in Haverhill, told the council that underneath the state’s rhetoric “is a reality, which is that in spite of these hospitals remaining open, their level of intensity of care is clearly declining.”

“And that’s a message that is not really advertised, but it is real. For the ones that are next door to them, we can see that vital support services — not just having emergency room physicians and nurses, but you need to have orthopedics, neurosurgery, you need to have all of these other things to be able to care for these patients. So what we are finding is that they get in, they get evaluated, but then they get transferred out. And appropriately, because you don’t want to admit them to a situation where they may not have an essential service,” Dr. Eduardo Haddad, a council member, said. “I think it’s important for the state to be aware of this and not, you know, understand that they are functioning at a full level of care, because the likelihood is that this is going to continue to decline.”

Haddad’s comments sparked a conversation about the capacity crunch that has long stressed Massachusetts hospitals, and the fears that Steward closures — or significant degradation of available services — could put other hospitals under even greater pressure.

Goldstein said DPH monitors have been closely watching for staffing, capacity or other issues at Steward’s hospitals, and said that team includes five regional “captains” who have been in touch with Steward hospitals as well as other nearby hospitals or community health centers “so that we can understand those changes in care and access that you’re describing, Dr. Haddad.”

“What we have learned from those conversations is that, at this moment, while there may be shifts in individuals that are providing care at one facility or another, the hospitals are still able to provide the care that they were previously providing,” the commissioner said. “And I think it’s really important for us to have that message out there because we don’t want people with chest pain driving past the Holy Family campus to go someplace else. And we certainly don’t want a pregnant person who is in active labor to drive past Good Samaritan Hospital, and to try to drive to South Shore Hospital or something else in the region.”

The commissioner said DPH has conversations with Steward monitors multiple times a day so that “we can guarantee ourselves that that care can continue to be delivered in these facilities and, therefore, we can say the statement that people should go to the hospitals to get care.”

Goldstein hinted at one way the Steward situation could change if people stop seeking care at its hospitals: patient-sourced revenue would drop and the maximum of $300 million in “debtor-in-possession” financing Steward received from its landlord to keep its hospitals open during the bankruptcy case would dry up sooner.

“The question that is outstanding for many of us is just that … knowledge that $300 million is a set dollar amount, and hospitals can be expensive to operate. And if clinical volume decreases and the hospital’s clinical revenue will decrease, and therefore the $300 million will go faster. The bankruptcy process provides us transparency, and will allow us to understand how quickly those dollars are being spent, how those dollars are being spent, and help us think through a plan of what happens at the end,” the commissioner said.

Goldstein also told Haddad that the incident command structure the state established two weeks ago to monitor the Steward situation is working “to understand what shifts are happening and could happen” as the company’s bankruptcy plays out in the coming weeks and months.

“There are timelines that are defined by the bankruptcy court and by the process that Steward is in. Those timelines will inform a lot of our work. We anticipate that things will march along a particular calendar and we want to be prepared. Just as we were prepared with our incident command structure and ready to go for bankruptcy, we want to be prepared for whatever transition might happen, whether that be for a particular service line or an entire hospital,” the commissioner said.

A lawyer for Steward told U.S. Bankruptcy Court last week that the company faces a June 25 deadline to auction its hospitals in Massachusetts and other states except for Florida under the terms of the loan it got from its landlord. But he also said that timeline is “not feasible.” The court is scheduled to hold a hearing on initial motions in the case on June 3 and a meeting of Steward’s creditors on July 23; those are the only two dates set in the proceeding as of Wednesday.

Dr. Edward Bernstein, an emergency medicine professor at the Boston University School of Medicine, on Wednesday reiterated his contention that the Steward predicament is but one part of a broader capacity crisis at Bay State hospitals. Bernstein has repeatedly called on the council to think about emergency department boarding and ED waiting times as it also weighs the future of the Steward system.

“We still have this serious capacity problem where people are operating at over 95 percent occupancy rates, when 85 percent” is used as the standard for safe occupancy, he said Wednesday. “So I don’t see how we can play the piano with just one hand, just pay attention to Steward without having the other hand on the overall thing that’s been going on for quite a time, the crowding of our health care system and especially the impact on emergency care.”

Goldstein agreed with Bernstein that “these two are hand in glove.”

“There’s no way to separate capacity and Steward, it is the reality of where we are in Massachusetts right now,” the commissioner said. “And so our incident command is set up to address long-standing capacity concerns and then the acute piece of it, which is happening right now with Steward.”