Widespread opposition to closure of Boston-area municipal hospital

On the night of December 2, hundreds of people filled the auditorium of Quincy High School near Boston, Massachusetts for a public hearing about the closure of the Quincy Medical Center. The closure was announced on November 6 by the for-profit Steward Health Care Systems, in violation of the Asset Purchase Agreement it signed when buying the hospital in 2011.

The Quincy Medical Center was founded in 1890 and run by the city until 1999, when it was incorporated separately but retained its non-profit status. In 2011, it filed for bankruptcy in federal court; Steward, an affiliate of the predatory Cerberus Capital Management, bought the hospital for a bargain price while the bankruptcy proceeding was still pending.

Quincy is a working class city of 90,000 to 100,000, just southeast of Boston. While Steward is seeking to cut medical services in the city, its population is growing and as many as 4,000 new housing units are being discussed.

A year earlier, in November 2010, Steward had bought six hospitals—in Dorchester, Brockton, Methuen, Norwood, Brighton and Fall River—from the Catholic Church’s Caritas Christi network.

In 2011, Steward paid only $38 million for Quincy Medical Center, plus a commitment to invest at least $34 million in capital expenditures and some smaller amounts starting five years after the purchase. In return, it committed to keep the hospital, including its 22 inpatient geriatric psychiatric beds, open for at least six and a half years and to provide the Massachusetts Department of Public Health (DPH) at least six months of written notice before closing the hospital.

By announcing on November 6 of this year that it would be closing Quincy Medical Center on December 31, Steward broke all of these agreements. At the December 2 public hearing, its management promised instead to provide emergency, urgent, and veterans services outside of the hospital setting. Several speakers opposed this proposal by likening it to getting surgery in a strip mall. City Council members complained that Steward had not consulted them about the closure plan, and Quincy’s Director of Veterans’ Affairs had been given conflicting information about a new location for veterans’ services.

Steward management complained of having put $100 million into lobby renovations, improved accessibility, and electronic records systems. However, they made no mention of how much they stand to gain from selling the hospital building and grounds.

They sought to blame the closure on declining inpatient stays at the Center, arguing that other hospitals within a 15-minute drive could pick up the slack. Nonetheless, Quincy Medical Center sees at least 30,000 emergency room visits per year. The South Shore Medical Center receives about 86,000, and speakers expressed concern that it will be overloaded.

Representatives from the state Department of Public health sat at the front of the hall but remained silent for the more than three-hour meeting, even when asked pointed questions by attendees. The Massachusetts attorney general’s office, which approved the sale to Steward in 2011 and has made only mild protests about the closure, did not send anyone to the meeting. In the press, there has been talk about postponing the closure date until February 4.

Attorney General Martha Coakley, a Democrat who lost the gubernatorial election this year, issued a statement on September 7, 2011, approving the sale to Steward. The statement recognized that under non-profit law “public charities, which hold their assets in charitable trust for the benefit of the public, cannot sell their assets and operations to a for-profit entity simply because they may operate better or more effectively with private equity.” Later in the statement, it was revealed that only two proposals were received, both from for-profit entities.

Documents from that period also show the attorney general’s capitulation on serious issues, including reducing the closure notice period from 18 to six months and excusing the fact that the Quincy Medical Center board had not taken written minutes when preparing for bankruptcy.

Many of the Medical Center’s revenue problems before the bankruptcy were caused by competition from large hospital mergers, such as Partners Healthcare, and the loss of state and federal funding it had received as a disproportionate share hospital before Massachusetts passed its health insurance mandate in 2006.

According to the American Hospital Directory, 2,600 inpatient stays at Quincy Medical Center were paid for by Medicare in the year ending September 30, 2013.

The first two hours of the December 2 hearing were taken up by statements from state and city politicians, hospital administrators, consultants, hucksters from Steward and union executives. Nonetheless, patients, workers and hospital employees stayed long enough to make statements that received sustained applause.

One speaker pointed out that fewer than 300 of the more than 900 jobs on Steward’s web site are full-time, permanent positions. Steward’s promises to find other jobs for those being put out of work were thus rendered hollow.

He stated he was “very disappointed that the attorney general who ratified this agreement doesn’t have the decency to be here tonight,” receiving applause from the hall but silence from the DPH representatives.

A retired nurse pointed out that Steward was Coakley’s biggest campaign contributor in this year’s gubernatorial election. Applause filled the hall again when she said that “the problem [is] poor management.”

Quincy Medical Center nurses represented by the Massachusetts Nurses Association/National Nurses United have been working without a raise for the past seven years.

Quincy Mayor Thomas Koch and state legislators who opened the comment period feigned indignation at Steward, only to conclude their statements with resignation to the closure plans. Nonetheless, city councilors complained that Steward hadn’t consulted them at all, and one received standing applause for stating that “Steward … has failed.”

Speakers from the unions showed no shame at the hearing. SEIU Local 1199 has been meeting with Steward for more than a year and bargaining for a year over employee benefits. The union had formed a “confidential task force” with Steward, who thanked them for their “collaborative approach.” The local’s web site contains no statement on the closure.

While Teamsters Local 25 does not represent Quincy Medical Center workers, its president/principal officer, Sean M. O’Brien, made some garbled comments which managed to praise Steward’s “commitments” and “integrity.” His concern was to try to continue medical coverage for local members who live in Quincy.

An official of the Massachusetts Nurses Association boasted of “working hard” with Steward and asked only for a “definitive” closure date.