Steward Health Care’s catastrophic slide from the largest private for-profit hospital system in the nation to a bankrupt and scandal-plagued chain has been well-documented. Last week, we spoke with Hanna Krueger from the Boston Globe’s Spotlight team about the apparent financial misconduct of CEO Ralph de la Torre.
But the fallout isn’t just at the executive level. Extensive reporting from the Spotlight team followed the money, and it led them to the real humans who suffered — and, in some cases, died — as a result of negligence.
Spotlight reporter Jessica Bartlett joined GBH’s All Things Considered host Arun Rath to discuss their findings. What follows is a lightly edited transcript.
Arun Rath: Maybe start with one of the cases you reported on: a death at St. Elizabeth’s Medical Center last October.
Jessica Bartlett: Yeah. So, my coverage of this started back in January when I detailed that a woman — Sungida Rashid, who had given birth at St. Elizabeth’s Medical Center — started bleeding.
When they took her into the operating room, some staff there discovered that they did not have an embolism coil, which is, you know — it’s a typical medical device many hospitals have to stop bleeding. The reason they didn’t have the embolism coil is because the vendor had not been paid and, weeks prior, had repossessed them. So, the woman was transferred to another hospital but didn’t make it.
That was the first discovery that we made — that Steward’s financial flailings, their inability to pay vendors, the precipice of care that they had kind of put the whole state on — had really resulted in patient harm at the front lines.
Our latest report sought to further that, to look across the country at the over 30 hospitals Steward has to really understand: What are the consequences of the corporate decision-making that they made. What did it mean to not have enough staff, supplies or working equipment? And who was harmed?
Rath: And talking [of] the other hospitals, some of the reporting on Carney Hospital in Dorchester, one of the hospitals that just closed — it’s just appalling. It was nicknamed “Carnage.” At what point did Steward Health Care’s dysfunction become an open secret?
Bartlett: I think that the staff have long understood that there [had] not been sufficient investment. I mean, [if] you talk to different staff, they’ll tell you different timelines, but we have documentation going back to 2019 that shows that the corporate parents were very aware of these shortcomings — you know, patients that were struggling in the hospitals because of staffing problems, vendors who weren’t being paid — I mean, the corporate people at the top were really seeing these emails. They were paying attention to these things. They knew about it, and yet they didn’t do much to solve for it in the aggregate.
Now, of course, the pandemic only made all of this worse. I mean, hospitals across the nation were struggling at that point, and this only exacerbated their problems. But even as other health systems began to claw their way out of the pandemic’s clutches, Steward still continued to struggle — I mean, in part because of this history of underinvestment and staffing challenges and turnover, but also because they stopped paying even more bills going into 2021 and 2022.
So, you have this exacerbation of the problem that had really been endemic to the system for, some say, the better part of a decade.
Rath: Your reporting details that federal inspectors found 32 instances of “immediate jeopardy.” Can you explain what immediate jeopardy is and the level of urgency it conveys?
Bartlett: Sure. So, federal investigators will come in sometimes — either random checks, or in response to complaints that come from patients or staff — and review hospitals to see: How are things doing? Are you meeting all of the criteria that qualify you to receive reimbursement from Medicare?
Thirty-two times in the last five years, federal investigators cited Steward with the most stringent designation they could provide, which is immediate jeopardy, which is a designation that means that patients have either died, been injured or have been placed at grave risk.
You might think, “Well, lots of people die in hospitals. Health care is challenging. Things happen.” While that is true, we did an analysis of all of the immediate jeopardy that had been given out over the last five years and discovered that, while only 13% of all the Medicare-certified hospitals had one immediate jeopardy, nearly one-third of Steward hospitals did. That metric alone is startling to show the degree to which Steward’s underinvestment in the system resulted in patient care in the aggregate.
But we also looked at CMS [Center for Medicare and Medicaid Services] quality rankings and CMS patient surveys and found that, across a number of different metrics, Steward was ranked among the bottom.
So, there are sufficient or significant consequences to the underinvestment, time and time again, that you see throughout these different reports.
Rath: Can you tell us a little bit about the reporting process with this? I mean, obviously, there are some things you can find — like the federal inspector on the public record — but I’m thinking about things like the mold outbreak at Glenwood Regional Medical Center that one family found out about from a Globe reporter. How are you finding all of these details?
Bartlett: We went through a number of different databases, not only looking at the federal inspection reports — which are public but kind of challenging to find. Finding those, compiling those and comparing those was a big component of the reporting.
We also looked at medical malpractice lawsuits to find families who had said that their loved ones had suffered. We even looked at Yelp reviews to see if patients had detailed shortcomings. For the Glenwood one, this was [a] federal inspection report that detailed that the mold outbreak at the hospital had resulted in five patients contracting Aspergillus — the mold infection — and four had died.
Federal investigators had cited the hospital not only for not having sufficient cleaning supplies for the cleaning staff but also not [having] enough infection control personnel. A number of other hospitals we’ve spoken to list the dozen or so infectious disease personnel at their hospitals — Glenwood had two. It created a delay in when they responded to these things that other health care executives said would have prompted a more immediate response to find out who these patients were.
We compared it with public death data that we had to track down from the state to see who were the patients that died on this day. Did their medical records match up with the cause of death of having Aspergillus or COVID? And then, also, talking to the families to see [if] their date of admission lined up with what the federal documents said.
One patient’s family was told that their loved one had a lung infection, so that kind of lined up the death there, too. But a lot of it is comparing public information, medical records given from family members and even talking to sources at many of these hospitals to say, “What did you remember from that time? Do you recall patients matching this description that were suffering in this way?”
It was a large undertaking that took us several months, but we’re proud of what we’ve compiled and have been able to document.
Editor’s note: According to the Globe, de la Torre and other Steward executives did not address a detailed list of questions. “The company has no comment,” company spokeswoman Josephine Martin said in an e-mail.
Steward Health Care did not immediately respond to a request for comment from GBH News.
