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96-550: Steward Health Care is a large private for-profit health system headquartered in Dallas, Texas . It utilizes an integrated care model to deliver healthcare across its hospitals and primary care locations, as well as through its managed care and health insurance services. At the start of 2024, Steward operated 33 hospitals and employed 33,000 people in the United States , however that number has decreased significantly due to

192-757: A mortgage with Apollo Global Management . The year 2023 saw Steward begin to downsize. Following a failed attempt in 2021 to sell its Utah hospitals to HCA Healthcare , abandoned after the Federal Trade Commission filed an antitrust lawsuit, Steward successfully sold its statewide operation to CommonSpirit Health . This deal included "five hospitals, over 35 medical group clinics, imaging and urgent care centers, and other outpatient ventures." Steward also closed Texas Vista Medical Center, citing low reimbursement rates and 25 percent of patients not paying their bills ( CBS News also reported that Texas Vista owed more than $ 650,000 to various vendors), and announced

288-448: A "tremendous edge." The conversation led to a formal proposition for Cerberus to purchase Caritas and convert the system to for-profit. Prior to finalization, the transaction required approval from the state Attorney General—mandated by state law for any changes in tax status from non-profit to for-profit. AG Coakley approved the deal with four main stipulations, requiring that Cerberus: Cerberus agreed to these stipulations, which brought

384-406: A 16 percent increase in admissions and a 21 percent increase in outpatient visits in 2015, and new hospital president Walter J. Ramos said the hospital was expecting to break even by the end of the year following several years of losses. The year 2015 ended in a milestone for Steward, as they saw their first-ever profitable year, attributed to a significant drop in expenses. It also marked the end of

480-511: A 90 percent controlling stake in the company by buying out Cerberus' ownership. The group of physicians was able to do this after borrowing $ 335 million from Medical Properties Trust, which retained 10 percent of the company. Over the course of its ownership, Cerberus made a profit of $ 800 million. The next year, MPT entered into a joint venture with Australian firm Macquarie Infrastructure Partners , selling 50% interest in its ownership of Steward's Massachusetts real estate to Macquarie and taking out

576-527: A debt of $ 32 million to the federal government in "reimbursements for insurance overpayments". During proceedings, the company stated it would be putting all 31 of its hospitals up for sale, with auctions scheduled for the summer. On July 1, the Organized Crime and Corruption Reporting Project published a report, verified by The Boston Globe , revealing that Steward had spent millions since 2018 on surveillance campaigns targeting several parties critical of

672-520: A financial analyst and his family, collecting sensitive information on a former executive (allegedly to retaliate if said person leaked damaging information about Steward), and the alleged forgery of bank statements in order to create the perception that a Maltese politician accepted a bribe to grant a passport to a sanctioned Russian national. While the use of private intelligence agencies is neither uncommon for corporations to engage in, nor necessarily illegal, one expert stated, "even if legal, it’s weird for

768-541: A hospital system to be spending resources on this." Steward and the involved agencies denied any illegal activity and for the most part declined to respond or comment on specifics, citing confidentiality. On July 11, CBS News reported that according to anonymous sources, federal prosecutors with the United States Attorney's Office for the District of Massachusetts were investigating Steward for fraud and violations of

864-511: A hospital. Connecting with the Archdiocese through Jack Connors, a mutual acquaintance, de la Torre met with the Caritas board of directors and was chosen to be their new CEO. Spending his first year at Caritas restructuring the system, de la Torre saw the system turn from a loss of $ 20 million in 2008 to an income of $ 31 million in 2009, even amid the aftermath of the recent financial crisis . Despite

960-517: A large physician network, in total employing about 42,000 people across the United States and Malta. Steward began in 2010 in Massachusetts, when private equity firm Cerberus Capital Management acquired the failing non-profit Caritas Christi Health Care system. This move was led by Caritas CEO Ralph de la Torre , MD, a former cardiac surgeon who became founder and CEO of the new system,

1056-655: A largely affluent and insured clientele whilst avoiding unprofitable care areas. Critics thus claim, for example, that for-profit hospitals specialize in such highly lucrative fields as medical rehabilitation , elective/plastic surgery, and cardiology while avoiding provision of loss-making services such as emergency medicine which in turn caters mainly to the indigent. Analogously, critics of for-profit HMOs argue that such firms disproportionately insure healthy people, while simultaneously eschewing chronically ill patients, who must then by default be cared for disproportionately by public insurance schemes and non-profit providers—thus

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1152-488: A mandated hearing in bankruptcy court. On July 25, the United States Senate Committee on Health, Education, Labor and Pensions voted 16–4 to subpoena Ralph de la Torre for testimony before the committee on September 12, following multiple declined invitations to voluntarily testify in previous months. According to The Hill , this marked the committee's first ever subpoena to compel testimony. Further,

1248-489: A massive national expansion. The deal became final in September 2017, and would mark the acceleration of the company's strategy of funding further expansions by selling purchased facilities' real estate to MPT. This strategy has widely been labeled as a significant factor in the system's later financial difficulties. Studies noted that while a large portion of the proceeds from the sales went toward expansion and investor dividends,

1344-451: A million dollars lobbying against such laws. The coat of arms of the archdiocese, shown in the information box to the right at the top of this article, has a blue shield with a gold cross and a gold "trimount" over a silver and blue "Barry-wavy" at the base of the shield. The "trimount" of three coupreaux represents the City of Boston, the original name of which was Trimountaine in reference to

1440-400: A new campus 5 miles north of the current location. On February 5, construction firm Robins & Morton sent a memo to subcontractors stating they had "requested evidence of [Steward] having made financial arrangements that will allow them to fulfill their payment obligations under the contract." Having not received proper evidence of financing, the firm ordered subcontractors to halt all work on

1536-541: A part of predecessor Caritas Christi, was one of Steward's first hospitals, and having been founded in 1863 was the oldest hospital Steward operated. In September, a deal was announced and tentatively approved by bankruptcy court settling related litigation between Steward and MPT. As part of this deal, Steward agreed to relinquish control of certain of its remaining unsold hospitals to interim operators secured by MPT in exchange for MPT releasing all claims against Steward for overdue and long-term future lease obligations. MPT in

1632-417: A plan to collect what Steward owed. The end result was an action plan designed, according to MPT, to "strengthen Steward’s liquidity and restore its balance sheet, optimize MPT’s ability to recover unpaid rent, and ultimately reduce MPT’s exposure to Steward." Steward agreed to pursue the sale of some hospital operations and to divest from non-core operations, in exchange for receiving a bridge loan from MPT in

1728-405: A position from which he resigned on October 1, 2024. Steward mainly operates in the United States, with locations across the country. Since 2016, Steward has fueled its national expansion with debt-driven mergers and acquisitions , largely financed through sale-leaseback deals with its principal landlord , Medical Properties Trust (MPT), in which Steward purchases hospitals and immediately sells

1824-521: A press release identified these operators as Healthcare Systems of America (for facilities in Southeast Florida, East Texas, and Louisiana), HonorHealth (Arizona), Quorum Health (West Texas), and Insight Health (Ohio). These operators, starting September 11, would be "the beneficiaries of operating revenue and have responsibility for the expenses of the hospitals each will manage" until Steward reaches purchase agreements with new permanent operators. Of

1920-427: A real estate company. Our focus is on running hospitals and taking care of our patients." Thirteen properties were ultimately sold to Healthcare Trust of America, a real estate investment trust , the next year for $ 100 million. The triple-net lease entered into by Steward would see doctors and hospitals pay rent for the buildings while still being responsible for property insurance , taxes , and maintenance . Despite

2016-511: A report from an outside agency to review Caritas' finances and make recommendations for its future. This report, published in March 2008, made several recommendations, including that the Archdiocese cede control of the system to an independent board of directors , retaining control only over religious matters. According to Coakley, the complexity of operating a hospital system had, at that point in time, led "virtually all religious organizations throughout

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2112-442: A sexual abuse scandal which touched off investigations of Catholic Church sexual abuse cases throughout the United States. Richard G. Henning has served as archbishop since October 31, 2024. The Archdiocese of Boston encompasses Essex County , Middlesex County, Norfolk County , and Suffolk County in Massachusetts. It includes most of Plymouth County except for the towns of Marion , Mattapoisett, and Wareham . As of 2018,

2208-666: A so-called "dumping" of undesirable patients. For-profit hospitals have also been criticised by elements of the Canadian medical establishment as providing inferior care at higher cost. See this commentary in the Canadian Medical Association Journal and this editorial in The New England Journal of Medicine . For-profit hospitals in India have recently come under increasing media scrutiny. In an article by

2304-492: A state known for non-profit healthcare, Steward was a controversial company from the beginning. De la Torre was regarded by many early on as an ambitious and highly influential figure in healthcare, having goals of building the company on a national level. He stood out as one of the few people willing to invest millions into the system's troubled hospitals, which mostly serve low-income populations who would struggle to access healthcare without them. However, three years later, Steward

2400-522: A whole remains in question amid its bankruptcy filing in May. Prior to the filing, Massachusetts lawmakers all but committed to ruling out a bailout , stating that the system had already received $ 54 million in previous years in the form of COVID-19 relief aid. Also contributing to lawmakers' stance on the issue was Steward's repeated refusal to provide financial reports to the state, a requirement of all hospitals under state law and one which Steward has been battling

2496-723: Is a Latin Church ecclesiastical territory, or archdiocese, of the Catholic Church in eastern Massachusetts in the United States. Its mother church is the Cathedral of the Holy Cross in Boston. The archdiocese is the fourth largest in the United States. It was formed in 1808, branching off from the Diocese of Baltimore and growing rapidly during the 19th century. Starting in 2002 the archdiocese faced

2592-454: Is also said that, in the free market, hospitals have an incentive to do better due to competition. Non-advocates argue that for-profit hospitals promote the medical-industrial complex and can lessen physician-patient interactions. Detractors, however, claim that the relative success of for-profit medical providers arises from their positioning themselves in the medical marketplace in such a manner as to offer mainly profitable care services for

2688-503: Is also the leading provider of rehabilitation services. For profit Psychiatric Solutions was the largest provider of psychiatric services in the nation, until they were bought out by Universal Health Services in 2010. A conceptually related institution is the for-profit HMO , which now comprises the predominant means of delivering medical services in the United States . Advocates of such institutions claim they are able to provide better care at lower cost due to higher efficiency. It

2784-474: Is confident we have adequate supplies for our physicians, providers, and health care professionals to continue providing high-quality care to our patients." In its ensuing investigation, the Massachusetts Department of Health found that the hospital had little control over what vendors were paid and when: During its investigation, DPH became aware from St. Elizabeth's president that the non-payment of

2880-688: Is known for its role at the center of a major corruption scandal in Malta , the result of a nullified public–private partnership to run and improve several of the island nation's public hospitals which has led to criminal charges against multiple former Maltese government officials. In May 2024, Maltese authorities recommended charges against Ralph de la Torre and multiple other Steward executives in relation to accusations of bribery, misappropriation, and money laundering. Separately, Steward International has opened two hospitals in Colombia and performs consulting work in

2976-458: Is nothing I can do to stop the closure of the two hospitals." It was later revealed that Massachusetts, as part of a tentative agreement with Steward, would advance $ 30 million in Medicaid payments owed to Steward toward funding hospital operations in the state. $ 11 million would be paid on August 1, and the remaining $ 19 million in mid-August. Stipulations in the agreement were expected to require that

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3072-500: Is owned by said physicians (90%) and MPT (10%). While Steward says that selling and leasing their hospital properties (a practice they call "asset light") allows them to prioritize patient care, experts have described it as a contributing factor to the system's later financial difficulties and resulting patient care and safety concerns. Following months of reported financial issues and billions in unpaid bills, Steward filed for Chapter 11 bankruptcy on May 6, 2024. Internationally, Steward

3168-466: The Huffington Post , they spoke about the problems with "corporate hospitals" and senior surgeons being told to sell surgeries to their patients even if they weren't needed. In one instance, a doctor was told he would be sacked if he didn't have enough patients to operate on. Archdiocese of Boston The Metropolitan Archdiocese of Boston ( Latin : Archidiœcesis Metropolitae Bostoniensis )

3264-778: The Affordable Care Act (ACA). Firms saw the potential for increased profits given both the expected increase in demand for hospital services by newly insured patients and the ACA's switch from fee-for-service (in which providers are paid per individual service) to capitated and bundled payment models (in which providers are paid a flat fee, often per patient, regardless of care provided). These new models aimed to rectify fee-for-service's unintended incentivization for providers to perform or recommend procedures or services which may not have been medically necessary in order to increase income. Intended to control costs and increase quality of care,

3360-556: The American Revolutionary War drove a change in popular attitudes in the colonies. The Constitution of the Commonwealth of Massachusetts , written by John Adams and ratified in 1780, established religious freedom in the new state. With the Massachusetts constitution being the first state constitution in the United States, its framework of government became a model for the constitutions of other states and, eventually, for

3456-418: The Diocese of Worcester . The Archdiocese of Boston is divided into five pastoral regions, each headed by an episcopal vicar . Brookline Cambridge Somerville Winthrop E. Norfolk Co. As of 2018, the archdiocese had 112 schools with approximately 34,000 students in pre-kindergarten through high school. In 1993 the archdiocese had 53,569 students in 195 archdiocesan parochial schools. Boston had

3552-898: The Foreign Corrupt Practices Act . Following bid deadlines, Steward revealed in a court filing that they would be cancelling auctions on three hospitals in Ohio and Pennsylvania after they received no qualified bids. The plan for the facilities—Sharon Regional Medical Center, Hillside Rehabilitation Hospital, and Trumbull Regional Medical Center—was not immediately known. Bloomberg on July 22 reported that Steward had found buyers for at least two hospitals: Wadley Regional Medical Center in Hope, Arkansas and Glenwood Regional Medical Center in West Monroe, Louisiana would be purchased by Pafford Health Systems and American Healthcare Systems respectively, pending

3648-478: The real estate to MPT in order to recoup costs, pay investors , and fuel further expansion, in turn entering into triple-net lease agreements with MPT to be paid by the hospitals. Cerberus, having made a profit of about $ 800 million over 10 years, made its exit in 2020 by giving its shares in Steward to a group of Steward physicians led by de la Torre in exchange for a convertible bond worth $ 350 million. Steward

3744-525: The 2011 agreement to keep Quincy Medical Center open, Steward announced in November 2014 that the hospital would close by the end of the year. Steward cited operating losses mostly attributed to a surplus in patient beds in the region, coupled with patients being referred more often to nearby South Shore Hospital in Weymouth and Beth Israel Deaconess Medical Center's Milton campus . The next month, Steward and

3840-626: The 2018 deal amid continued allegations of fraud and lack of progress in hospital renovations and construction, ultimately returning control of the hospitals to the government. In May 2024, concurrent with the company's U.S. financial struggles, Maltese investigators announced that they would be recommending charges against thirty-four individuals associated with VGH, Steward, and Swiss firm Accutor, including Steward CEO de la Torre. The charges included criminal conspiracy , trading-in-influence , misappropriation of public funds , fraud , money laundering , and bribery of local officials. The office of

3936-627: The 2024 closure of New England Sinai Hospital , reporting operating losses of $ 22 million. In January 2024, an investigation by The Boston Globe revealed that Steward was facing significant financial difficulties, creating fears of possible hospital closures. Part of this stemmed from a press release from Medical Properties Trust announcing that Steward owed MPT $ 50 million in unpaid rent on their properties, in addition to owing several contractors and vendors for unpaid services and equipment. MPT, after multiple months of partial rent payments from Steward, brought on financial and legal firms to come up with

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4032-459: The Archdiocese of Boston surfaced in later years as well. This included alleged abuse at Saint John's Seminary and Arlington Catholic High School . The Archdiocese of Boston lobbies against laws intended to help survivors of abuse, such as a proposed 2023 law to remove the statute of limitations on child sexual abuse lawsuits. From 2011 and 2019 the Catholic church in Massachusetts spent over half

4128-501: The Attorney General of Malta confirmed that the thirty-four individuals would face charges as recommended by investigators. The charges stem from allegations that Steward and VGH conspired with Maltese Prime Minister Joseph Muscat , his chief of staff Keith Schembri , and Minister of Tourism Konrad Mizzi , who were already charged, in order to secure the government contract and attain political influence in later renegotiations of

4224-416: The Attorney General's 5-year monitoring period, allowing Steward to become more flexible with spending, use of debt, and facility operations. In September 2016, Steward and Cerberus entered a $ 1.25 billion deal with real estate investment trust Medical Properties Trust , in which MPT would purchase all of Steward's hospital properties for $ 1.2 billion and pay an additional $ 50 million for a 5 percent stake in

4320-458: The Massachusetts governor's office announced that deals had been finalized to transfer five hospitals to new operators. Lawrence General Hospital is expected to take over Holy Family Hospital's two campuses in Methuen and Haverhill, and Lifespan Health System of Rhode Island will enter the state for the first time to take over Morton Hospital and Saint Anne's Hospital. Further, the office stated that

4416-517: The Middle East with a plan to build a hospital in Saudi Arabia. Steward Health Care was founded in 2010, when Caritas Christi Health Care was sold to New York private equity firm Cerberus Capital Management , with Caritas CEO and former Beth Israel Deaconess Medical Center heart surgeon Ralph de la Torre continuing as CEO of the new company. Caritas Christi Health Care, founded in 1985 under

4512-401: The agreement as intended to support “political and government activities and interactions.” Investigators said that after leaving office, Muscat and Mizzi became paid consultants of Accutor, with Schembri also appearing to benefit indirectly. Two Accutor directors later resigned from the company, reporting that they became aware of an arrangement apparently concealed by company executives in which

4608-415: The agreement, by their own discretion or by sale, closure, or transfer of the hospitals, Steward must remove all "symbols of Catholic identity," return all religious items to the Archdiocese, and make a $ 25 million donation to a Massachusetts charity designated by the Archdiocese. This agreement would not apply to any future facilities acquired outside of the original Caritas organization. Being an outlier in

4704-969: The amount of $ 60 million and MPT writing off portions of Steward's unpaid rent. Of the agreement, MPT said "There can be no assurance that Steward will successfully execute its plans or that the Company will recover all of its deferred rent and loans outstanding to Steward." In February, U.S. House Representative Stephen Lynch said after a meeting with Steward that the health care system was looking to sell four of its nine Massachusetts hospitals "as soon as possible," including St. Elizabeth's Medical Center in Brighton, Holy Family Hospital's two campuses in Haverhill and Methuen, Nashoba Valley Medical Center in Ayer, and Norwood Hospital, whose reconstruction would also be halted. The repossession by vendors of medical equipment for unpaid bills

4800-616: The archdiocese had 284 parishes with 617 diocesan priests and 275 permanent deacons. In 2018, the archdiocese estimated that more than 1.9 million Catholics lived within its territory. New England's first settlers were Congregationalists and, in Rhode Island, Baptists . Many of them left England because they were disappointed in the lack of reforms in the Church of England . These dissenters followed Martin Luther and John Calvin in rejecting

4896-427: The arrangement in any way been a donation towards genuine political purposes connected to Malta it would not have been necessary to send the payments offshore to Switzerland." On June 17, 2024, The Boston Globe published an investigative report into Steward Malta. Their investigation included an interview with Joseph Muscat, the day before he was formally charged, who placed blame on Steward for failing to deliver on

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4992-576: The cable television network CatholicTV . From 1964 to 1966, it owned and operated a broadcast television station under the call letters WIHS-TV . The Archdiocese of Boston is also metropolitan see for the Ecclesiastical province of Boston. This means that the archbishop of Boston is the metropolitan for the province. The suffragan dioceses in the province are the Diocese of Burlington , Diocese of Fall River , Diocese of Manchester , Diocese of Portland , Diocese of Springfield in Massachusetts , and

5088-466: The coils was in part due to the hospital's lack of control over its funds and authorization to make payments to its vendors. [...] According to the president, the hospital's corporate office determined which vendors to pay and made the payments (or not). Unpaid bills also led to work stoppages in multiple construction projects. In Texarkana, Texas , construction started in 2021 on a $ 227 million project to replace Steward's Wadley Regional Medical Center with

5184-473: The company demonstrate an ability to begin paying its debts by April 30, the end of their forbearance period. While Steward in February said that it has a plan to come out of the forbearance period as a sustainable company, economic experts, specifically ones who have studied Steward for years, expressed doubt that the system would be able to achieve this given the amount of debt and further predicted that bankruptcy

5280-587: The company's May 2024 bankruptcy filing. Steward's international ventures include Steward Colombia , which operates four hospitals, and Steward Middle East , which operates in Saudi Arabia and the United Arab Emirates . At its height, Steward was the largest private hospital system in the US, with 37 hospitals consisting of almost 8,000 inpatient beds, over 25 urgent care centers, 42 skilled nursing facilities, and

5376-462: The company. In return, Steward would lease the properties back from MPT. This influx of money would allow Steward to pay back the entirety of Cerberus' initial 2010 investment while the firm would remain a majority owner, in addition to allowing the company to pay back all of its $ 400 million in debt. Steward and Cerberus were further able to provide hundreds of millions of dollars in dividends to investors from this sale, including to de la Torre, and fund

5472-425: The company. Leaked correspondence between Steward executives and employees and multiple private intelligence agencies showed that as the company missed payments on operational necessities at its hospitals such as staffing, medical equipment, and repairs, executives directed the prioritization of on-time and early payments to these agencies as "existential work." This work included one agency following and photographing

5568-498: The contract with the Maltese government. VGH and Steward were alleged to have bribed the officials via a slush fund of €1 million laundered through Accutor, a Swiss consulting firm. Steward, Muscat, Schembri, and Mizzi denied the accusations. Steward publicly claims that it hired Accutor "as a business management consultant," and Steward President Armin Ernst in a 2019 internal e-mail described

5664-519: The deal and the source of the funding were not immediately disclosed, however later reporting indicated that the system refinanced its debt with a $ 600 million loan in 2023 and received a bridge loan of $ 150 million in January, the two loans coming from a group of asset management firms including Sound Point Capital Management, Oaktree Capital Management , WhiteHawk Capital Partners, Owl Creek Asset Management, MidOcean Partners , and Brigade Capital . Terms of

5760-475: The deal, MPT said "[f]rom our initial underwriting of these properties, MPT has strongly believed in the mission critical nature of these hospitals as well as their cash flow potential under the right management. [...] By replacing Steward, we are better positioned to protect the critical function of these facilities for the benefit of their communities and the value of our real estate for the benefit of our shareholders." Steward's future in individual locales and as

5856-417: The end of 2017, Steward announced an upcoming international expansion which was finalized in February 2018, in which they took over Vitals Global Healthcare of Malta , creating Steward Health Care International. Vitals, an embattled Maltese healthcare company, was the center of a controversial 2015 public-private partnership in which it entered a concession agreement with the government to operate three of

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5952-531: The federal constitution. In 1788, the Abbé de la Poterie, a former French naval chaplain serving in Boston, celebrated the city's first public mass in a converted Huguenot chapel at 24 School Street in Boston, which he named Holy Cross Church. Two refugees from the French Revolution ministering to Boston's Catholic population at the turn of the century, Reverends Francis Anthony Matignon and John Cheverus , raised

6048-739: The first bishop of Boston. The exponential growth of the Catholic Church in New England through the nineteenth century led the Vatican to create new dioceses out of the Diocese of Boston and later the Archdiocese of Boston. In the 1920s, Cardinal William O'Connell moved the chancery from offices near Holy Cross Cathedral in the South End to 127 Lake Street in the Brighton neighborhood of Boston. "Lake Street"

6144-474: The funds to build a larger building, the Church of the Holy Cross. These buildings no longer exist, but they were the foundation of the Catholic Church in Massachusetts. Pope Pius VII erected the Diocese of Boston on April 8, 1808, taking all of New England from the Diocese of Baltimore . The new diocese consisted of the states of Connecticut , Massachusetts (including present-day Maine ), New Hampshire, Rhode Island , and Vermont. The pope named Cheverus as

6240-464: The governor of Massachusetts shared that Steward had received bids on all of its hospitals in that state. Despite this, Steward said in a statement on July 26 that two of these hospitals, Carney Hospital in Dorchester and Nashoba Valley Medical Center in Ayer would close on August 31, having received no "qualified" bids. The closures were approved by bankruptcy court in an emergency hearing on July 31. In

6336-461: The hospitals themselves received little from the sales and were left responsible for lease payments with built-in escalator clauses which saw rent payments increase annually. In correspondence with The Boston Globe in 2024, de la Torre and Cerberus both distanced themselves from responsibility for the deals with MPT, each pointing to the other as the driving force behind the deals. 2017 saw Steward finally expand beyond Massachusetts' borders, with

6432-545: The hospitals, and accusations that VGH was siphoning money out of the country, parties agreed to a deal that would see Steward purchase VGH for just €1, while the Maltese government would pay VGH €50 million to accept the deal. The transfer of the concession to Steward did not sate the public's concerns and triggered the organization of a medical workers' strike by the Medical Association of Malta . Steward's presence remained unpopular until 2023 when Maltese courts annulled

6528-413: The island nation's hospitals for thirty years. The agreement with Vitals was widely controversial especially among physicians, who raised concerns both about the government relinquishing control of the public healthcare system and about VGH's lack of experience in the healthcare sector. In 2018, amid allegations of collusion between VGH and government officials, lack of progress in the rehabilitation of

6624-507: The largest private for-profit hospital operator in the United States at the time. 2017 also saw Steward expand internationally with their takeover of a multi-billion-dollar contract to operate and renovate struggling hospitals in Malta. In February 2018, Steward announced that its top management would move to Dallas, Texas from Boston. In June 2020, Cerberus exited the picture when Steward physicians, led by Steward founder del la Torre, acquired

6720-469: The loan required that Steward present by April 30 a plan to begin paying its debts and emerge as a sustainable company. In late March 2024, Steward announced a preliminary agreement made to sell its physician network Stewardship Health to Optum , a subsidiary of UnitedHealth Group and already the largest employer of physicians in the United States. Optum pulled out of the agreement in June. Though their reasoning

6816-490: The nation to transfer control to lay boards." With the Archdiocese's agreement, an independent board was created. Still, Caritas did not have a CEO—its previous CEO had resigned in 2006 amid allegations of misconduct. And so the new board began searching for a new leader for the system. That year, cardiac surgeon Ralph de la Torre, who just the previous year founded and became CEO of Beth Israel Deaconess Medical Center's Cardiovascular Institute, began seeking opportunities to lead

6912-463: The new payment models further provided private equity firms and other investment groups with opportunities to maximize returns through strategies such as cutting costs and taking on more patients. De la Torre sought one of these firms as a potential investor, and in 2009 met with Robert Nardelli , an executive at Cerberus and former CEO of Chrysler and Home Depot . Nardelli was impressed with de la Torre's energy and expertise, describing him as having

7008-422: The overall cost of the deal to $ 895 million. In addition, Steward entered into a binding contract with the Archdiocese, named the "Stewardship Agreement," requiring that Steward employ a Vice President for Mission and maintain at each hospital an ethics committee in order to ensure the Caritas hospitals maintained Catholic identity. The agreement stipulated that in the event that Steward or the Archdiocese terminate

7104-577: The ownership of the Archdiocese of Boston , was a non-profit healthcare system comprising six Eastern Massachusetts hospitals as well as a number of non-acute healthcare facilities across southern New England . Rife with financial difficulties for years, the Archdiocese had been in the process of trying to sell the health system, most recently to Catholic health system Ascension in a bid that fell through in mid-2007. Following these failed attempts, Massachusetts Attorney General Martha Coakley commissioned

7200-630: The proceedings. In its press release, Steward stated it was finalizing terms of a $ 75 million in new debtor-in-possession financing from MPT, with the possibility for $ 225 million more if it meets certain unspecified conditions set by MPT. The company's filing revealed approximately $ 9 billion in liabilities , including $ 6.6 billion in long-term rent obligations, $ 1.2 billion in loans, almost $ 1 billion in unpaid bills to vendors, and $ 290 million in unpaid wages and benefits to its employees. In listing its obligations to non-insiders, filings revealed twenty creditors who were owed in excess of $ 10 million, including

7296-622: The properties with hospital buyers. On August 13, Kinderhook Industries announced that its subsidiary, Rural Healthcare Group, would acquire Stewardship Health. While the parties didn't disclose the cost of the transaction, court filings indicated that the tentative price would be $ 245 million. On the 14th, Steward and Orlando Health entered into an agreement designating the latter as a stalking horse bidder for Steward's Northern Florida hospitals, including Rockledge Regional Medical Center, Melbourne Regional Medical Center, Sebastian River Medical Center, and its local physicians group. On August 16,

7392-480: The property in Brighton. At the beginning of the 21st century the archdiocese was shaken by accusations of sexual abuse by clergy that culminated in the resignation of its archbishop, Cardinal Bernard Francis Law , on December 13, 2002. In September 2003, the archdiocese settled over 500 abuse-related claims for $ 85 million. Victims received an average of $ 92,000 each and the perpetrators included 140 priests and two others. Additional sex abuse allegations within

7488-491: The provided money be used solely on hospital operations, prohibiting use on rent, debt, or executive compensation, and that the funds were contingent on milestones based on ensuring an orderly transition of hospitals to new operators and orderly closure of those without buyers. Following the nullification of their Massachusetts lease, MPT and Macquarie Infrastructure Partners turned over the properties to Apollo Global Management, leaving Apollo to handle potential leases or sales of

7584-481: The purchase in February of eight hospitals from Tennessee -based Community Health Systems across Ohio , Pennsylvania and Florida , and the later acquisition in May of Tennessee-based Iasis Healthcare , which added 18 hospitals in Utah , Arizona , Texas , Louisiana , Arkansas , Colorado , Florida and Nevada . The latter deal brought Steward's network up to 36 hospitals with estimated revenues of $ 8 billion, making it

7680-401: The requirements of the concession. Muscat claimed that, at the time the deal was transferred to Steward, they seemed like an "obvious choice" given Boston's reputation for healthcare. For-profit hospital In the United States, the three largest such firms are Hospital Corporation of America , Tenet , and Encompass Health . Encompass Health, as the third-largest U.S. national chain,

7776-582: The same hearing, the court also approved a request by Steward to nullify its master lease with MPT, which bound the Massachusetts hospitals to $ 100 million lease payments until 2040 – allowing new operators the opportunity to negotiate new lease terms. It was not immediately clear how Steward's timeline would meet regulatory requirements, as Massachusetts law requires 120 days' notice to the Department of Public Health prior to closure of essential hospital services – however, Governor Maura Healy later stated that "there

7872-476: The selling of indulgences , the celebration of a Latin Mass , the doctrine of transubstantiation , and papal authority. As these dissenters set up colonies in New England, they enacted legal restrictions on Catholics, including bans on Catholic worship. Massachusetts made it a crime, with a potential life sentence, for a Catholic priest to reside in the colony. The political necessity of gaining Catholic support for

7968-430: The short-term success, de la Torre believed Caritas' long-term prospects depended on a significant cash infusion—particularly to preserve jobs and fund the system's pension plan, which was uninsured and had been frozen due to lack of contributions by Caritas. Coinciding with de la Torre's revamp of Caritas, 2009 saw private equity firms begin to show increased interest in healthcare investments in anticipation of passage of

8064-576: The site. Similarly in Norwood, Massachusetts , construction to replace Norwood Hospital, which was fully evacuated and subsequently demolished due to damage from flooding caused by an intense 2020 rainstorm, was stopped due to nonpayment. On February 2, 2024, Steward announced to employees that they had agreed to a "significant financial transaction" that would allow their Massachusetts hospitals to continue operations while they continued to explore options for selling some facilities to other operators. The terms of

8160-436: The state Department of Public Health reached a deal to keep the hospital's emergency department open until the end of 2015. The emergency room ultimately stayed open until November 2020, almost five years longer than planned. Operations at Steward's Carney Hospital in Dorchester appeared to benefit from Quincy Medical Center's closure, seeing 125 QMC employees transfer to Carney, including several physicians. Steward reported

8256-566: The state over for years—which was cited as a reason they were provided significantly less American Rescue Plan Act money in the third round of this aid. Medical Properties Trust, in a February Securities and Exchange Commission report, reported operating losses of $ 664 million for the fourth quarter of 2023, specifically noting $ 772 million in "write-offs and impairments" which they attributed primarily to Steward. Further, MPT deferred collection of full rent payments until June. In addition, conditions of Steward's January 2024 bridge loan required that

8352-514: The state will take Saint Elizabeth's Medical Center by eminent domain for eventual transfer to Boston Medical Center , which would also purchase Good Samaritan Medical Center. Apollo was expected to challenge the eminent domain seizure, citing a property value assessment of more than $ 200 million. The first two permanent closures to result from Steward's bankruptcy occurred on August 31, when Carney Hospital and Nashoba Valley Medical Center, both of Massachusetts, shut down. Carney Hospital, originally

8448-576: The state. On May 5, 2024, The Wall Street Journal reported that Steward Health Care was expected to file for Chapter 11 bankruptcy protection within the coming days, blaming rising costs, insufficient revenue and cash crunches as part of the decision. Steward's bankruptcy is set to be one of the largest hospital bankruptcies in U.S. history, and the largest one in decades. The next day, Steward announced that it had indeed filed voluntarily for Chapter 11 bankruptcy protection. The company stressed that its hospitals and medical offices would remain open during

8544-440: The three government officials were to receive €18 million as partners in the hospital deal. Current Accutor officials denied the accusations. The Times of Malta reported in May 2024 that investigators "concluded that the chances Muscat, Schembri and Mizzi happened to all then go on to independently form relationships with Accutor is considered so negligible that the possibility is excluded," and that they further "observed that had

8640-625: The three hills on which the city's original settlement stood. The cross, fleurettée , honors the Cathedral of the Holy Cross while also serving as a reminder that the first bishop of Boston and other early ecclesiastics were natives of France. The "Barry-wavy" is a symbol of the sea, alluding to Boston's role as a major seaport whose first non-indigenous settlers came from across the sea. The diocesan newspaper The Pilot has been published in Boston since 1829. The archdiocese's Catholic Television Center , founded in 1955, produces programs and operates

8736-475: The type of sale-leaseback deals that would partially define its long-running business model when it put 11 of its medical office buildings up for sale with the intent of leasing the properties for continued use. Consistent with earlier deals with the state, Steward reported that all proceeds would go to hospital operations. Steward justified the sale by claiming that being a landlord to its own physicians created compliance issues, as well as stating that "we’re not

8832-435: Was a metonym for the bishop and the office of the archdiocese. In June 2004, the archdiocese sold the archbishop's residence and the chancery and surrounding lands in Brighton to Boston College , in part to defray costs associated with numerous cases of sexual abuse by clergy of the archdiocese. The archdiocesan offices of the archdiocese moved to Braintree . The archdiocesan seminary, Saint John's Seminary , remains on

8928-498: Was likely. While the proposed sale of its physician network would be expected to provide a significant windfall, it was not expected that a sale would be approved in a short enough timeframe to avoid bankruptcy. Known disposition of individual hospitals are: Steward Health Care International is Steward's arm for its operations outside of the United States. Its headquarters are located in the Salamanca district of Madrid , Spain . At

9024-550: Was linked to the death of a new mother at Saint Elizabeth's Medical Center in Brighton, Massachusetts, who in October 2023 suffered a liver bleed which staff were unable to treat due to the lack of equipment. She was then transferred to another hospital, where she later died. Steward, regarding the incident at St. Elizabeth's, said in part that "understanding that the demand for supplies and staff can fluctuate at any given moment due to changing and unpredictable volumes of patients, Steward

9120-561: Was not immediately clear, the proposed deal had been the subject of legislators' calls for thorough regulatory review. On May 3, 2024, with no word from Steward regarding whether it met its April 30 forbearance deadline, the Massachusetts Executive Office of Health and Human Services (EOHHS) announced the activation of the Incident Command System to prepare for anticipated disruptions in health care access across

9216-666: Was reported to be continuing to lose money and multiple attempts to expand outside of Massachusetts had failed. While Steward would eventually achieve its goal of expanding to other states, the first several years focused on in-state growth. In September 2011, AG Coakley approved Steward's acquisition of Morton Hospital in Taunton and Quincy Medical Center , both of which were previously non-profit facilities at risk of closing due to financial struggles. The deal required, among other commitments, that both facilities stay open for at least 10 years. In November 2011, Steward took its first step into

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