Unnerved by bankruptcy, doctors and patients are leaving Steward hospitals

As Steward Health Care goes through bankruptcy proceedings, many doctors and patients are reluctant to associate with its seven operating hospitals in Massachusetts, according to health care leaders and people who work in the facilities.

Doctors have been leaving since the for-profit company filed for Chapter 11 bankruptcy last month, according to some Steward employees who are concerned about the hospitals' ability to maintain services. Patients at one cancer clinic already had to seek alternatives after a doctor's departure caused care to be suspended.

At the same time, state officials and hospital leaders said some patients are avoiding Steward facilities over concerns about the company's financial troubles. The dynamic could further erode the hospitals' finances and repel potential buyers. The drain on staff and patients may also strain the state's health care system.

Standing outside St. Elizabeth's Medical Center in Brighton, nurse Ellen MacInnis said nursing shifts there are adequately staffed, but it's a different story for doctors. MacInnis, who has worked at the hospital for more than two decades, said almost half of its emergency department physicians have left since Steward's financial problems became public six months ago. While she said there appear to be enough doctors for now, MacInnis expects more departures this summer.

"Physicians are leaving, and Steward is probably going to have to do a hard search and probably pay a lot of money for replacements," MacInnis said.

Hospital officials acknowledged that hiring and retaining doctors has been challenging but said there are no gaps affecting care.

"I could not be more proud of the medical staff at St. E’s and the care they are providing our patients," St. Elizabeth's President Paul Smith wrote in an emailed statement. "The collective commitment of our staff, to our patients and each other, will always be my enduring memory from this time in my professional life."

Dr. Paula Muto, a general and vascular surgeon in North Andover affiliated with another Steward facility, Holy Family Hospital in Methuen, said there have been frequent farewell parties for doctors leaving the hospital following Steward's bankruptcy.

"You say, 'Oh, there's another one gone,'" Muto said. "Sometimes it's people retiring early, sometimes it's people just going to another community. As the head of the [operating room] said, 'We're a family being torn apart.'"

Steward, which started in Massachusetts with the purchase of a Catholic hospital chain, grew to become the nation's largest private, for-profit hospital network, headquartered in Texas. The company announced in January that financial problems jeopardized its operations. Since that time, state officials have monitored Steward hospitals and pledged to preserve health care and jobs.

Bankruptcy court documents suggest Steward's debts and financial obligations could reach $10 billion. All of the company's hospitals across eight states and its physicians group are up for sale as it works to restructure.

MacInnis said operations at St. Elizabeth's have improved since state monitors started their daily visits, but still there are issues. Chief among them, she said, is vendors who say they're worried they won't get paid. She said an entire floor of the hospital — about 30 beds — was closed because the hospital couldn't secure a vendor to repair the beds, and just one of six elevators to the hospital's top floors works.

"We have to stop having the conversation about what we’re going to do if these hospitals close; we need to start talking about what we’re going to do to keep them open," MacInnis said.

Steward Health Care did not respond to requests for comment for this story. Smith, from St. Elizabeth's, said the hospital has engaged "multiple vendors" to fix beds, and the "recent challenges with elevator repairs have largely been resolved."

"St. Elizabeth’s Medical Center remains an essential hospital that is providing quality services to patients," Smith said.

To try and minimize the fallout from Steward's bankruptcy and keep the hospitals operating during the legal proceedings, state officials have set up a command center and said they are closely watching the facilities.

Speaking at a recent meeting of the state's Public Health Council, Massachusetts Health Commissioner Dr. Robbie Goldstein acknowledged that some doctors are departing. He said "regional captains" keep an eye on each Steward hospital and confer about how other medical centers are impacted.

He also said patient numbers are falling at Steward hospitals, although he did not provide specific numbers.

"It is very clear from the data that there are decreasing volumes at the Steward facilities," Goldstein said. "It seems really to be a factor of patient choice, of individuals making the decision to go to a different facility."

Goldstein stressed that patients can continue seeking care at Steward hospitals.

Patients leaving Steward are, in some cases, arriving at the doors of other medical centers, increasing the workload for hospitals that are already busy.

"The reality is that many individuals who have the means to go elsewhere — often those with higher incomes and commercial insurance — are choosing to do so," said Massachusetts Hospital Association President and Chief Executive Officer Steve Walsh in an emailed statement. "It is yet another stark reminder of how fragile the commonwealth’s healthcare system is at this moment, particularly for the state’s poorest and most historically marginalized communities."

A lack of supplies and services can also mean nearby hospitals are caring for Steward patients. At Lawrence General Hospital, providers are treating more patients who used to receive care at Holy Family. Lawrence General's medical staff president, Dr. Eduardo Haddad, told state officials that Holy Family no longer offers services such as orthopedics and neurosurgery. At a meeting of the state's Health Policy Council this month, he said he hopes to learn soon who will take over Steward's facilities.

"The ground keeps on moving independent of us," Haddad said. "And the issue to me is that the best outcome here is a quick resolution for a change in operator so that we can acquire trust again."

South Shore Hospital in Weymouth also experienced an influx of patients caused not only by Steward's troubled finances, but by the ongoing closure of Brockton Hospital after a fire in February of last year. While Brockton may come back online later this year, another hospital in the region, Steward-operated Norwood Hospital, closed because of flooding in 2020 and never reopened.

South Shore Hospital officials said after more than a year of patient increases, they now run the third busiest hospital emergency department in the state. They estimated the emergency room staff sees 365 patients a day, and the hospital is operating at about 130% of its capacity. To accommodate the extra patients, South Shore has had to reduce the length of patient stays, double up patients in some rooms, allow more patients to be treated at home and add beds in hallways.

"The patient experience, I would say, is what has been most impacted," said Dr. Jason Tracy, chief medical officer at South Shore. "Our community is very understanding, but getting care in a hallway is not what many of us would want for our health care."

South Shore President and Chief Executive Officer Dr. Allen Smith said he's hired interim and temporary staff members. The hospital also hired more physicians — some from Steward — and Smith said he's "had inquiries" from other Steward doctors looking for a change of employment.

One of the biggest challenges, Smith said, is not knowing how the bankruptcy process will play out. While Smith is proud of how his workers have handled the increased patient load, he said there's a lot of anxiety about how the state's health care system will emerge after the loss of Steward, its third largest hospital operator.

"The worst emotion is just this sense of uncertainty of when things are going to start getting better," Smith said. "They will get better at some point, but the fact that we can't say to anyone — whether it's a patient or family member or staff — 'this is when things are going to start getting better,' that's the hardest part right now."

Steward is preparing to auction off its Massachusetts medical centers next month, several weeks later than initially planned. The company has not specified a reason for the change in timeline or what will happen to hospitals that don't receive bids.

Complicating the process is the fact that Steward's landlord, Medical Properties Trust, charges rental fees to Steward to operate the hospitals. Bankruptcy experts said it's unclear how those lease arrangements would be handled if another hospital operator takes over. They also said it remains possible that some of the hospitals will ultimately close.

"We have to stop having the conversation about what we’re going to do if these hospitals close; we need to start talking about what we’re going to do to keep them open."

Ellen MacInnis

Workers at Holy Family Hospital in Methuen said they're concerned about how a potential new owner would regain the trust of patients and health care professionals. Sue Bolier, who has been a nurse and hospital administrator for decades, said Holy Family is a critical part of the community. She recalled how it used to be known as the place where actor Michael J. Fox once went for neurosurgery. But now, she worries the hospital's reputation has been damaged by the publicity around Steward's financial problems.

"Holy Family had such a great name," said Bolier, who is a part-time hospital employee. "Of all the hospitals I've worked at, [Holy Family] has the most caring group of people."

Bolier praised the nursing staff in particular for working hard to provide care despite the bankruptcy.

Muto, the surgeon, said since Steward declared bankruptcy, supply shortages have eased at Holy Family. But she remains concerned about the hospital's future. Muto traveled to Washington, D.C. earlier this month with a group of doctors carrying message for lawmakers. She told them the health care industry as a whole has become too focused on profits, and lawmakers should improve oversight of companies like Steward.