Over the last few months, Dallas-based Steward Health Care has been subject to increased scrutiny regarding the health system's troubled finances and the status of its more than 30 hospitals across eight states.
Backlash against Steward appears to be far from over as lawmakers, health leaders and community members continue to demand answers for how things got to this point, and Becker's has been closely following the health system's struggles.
Here are 71 things to know about Steward:
1. Medical Properties Trust, the largest hospital landlord in the U.S., revealed Jan. 4 that Steward had fallen approximately $50 million behind on year-end rent. MPT's current cash basis portfolio with Steward is $3.5 billion.
2. Somerville, Mass.-based Mass General Brigham withdrew its physicians from Steward's Holy Family Hospital campuses in Haverhill and Methuen, Mass., in late January due to practice environment concerns that did not meet their patient safety care standards. The physicians returned to the two Steward hospital campuses on Feb. 9 after surgical items were replenished and conversations were held regarding staffing and supplies.
3. Steward's Port Arthur-based Medical Center of Southeast Texas closed its Beaumont campus on Feb. 2, including its emergency department and all hospital-related services, due to the campus being underutilized, a spokesperson for Steward told Becker's.
4. Steward shared that it was throwing a financial safety net around its nine Massachusetts hospitals in early February, with no plans to close its hospitals in the state.
5. While Steward hospitals continued to struggle financially, were unable to pay vendors, and lacked proper medical supplies, attention turned to Steward CEO Ralph de la Torre, MD, and his two yachts, valued at a combined $55 million.
6. Steward's Miami-based North Shore Medical Center shuttered its neonatal intensive care unit and behavioral health unit Feb. 9 and closed its obstetrics unit Feb. 14, weeks earlier than its initial March 10 planned closure. The hospital, which has more than 700 employees in addition to over 400 medical staff, laid off around 152 people represented by 1199SEIU. A spokesperson for the union told Becker's that number could be larger, as their members did not represent all hospital employees.
7. Three different Utah lawsuits are seeking a combined $40 million in damages from Steward after investors claimed the health system took funding from its five hospitals in the state to pay acquired bills across other states. In Florida, the health system is also facing several lawsuits pertaining to its eight hospitals there.
8. Steward issued a "six-point action plan" Feb. 23. The plan included a $150 million cash infusion from the health system's current lenders, new labor agreements, the immediate sale of non-essential assets, working with an advisory firm for restructuring, and compliance with Massachusetts lawmakers to develop a "go forward" plan. The plan was met with backlash from Massachusetts Gov. Maura Healey.
9. As New Bedford, Mass.-based Southcoast Health expressed interest in buying Steward's Fall River, Mass.-based Saint Anne's Hospital in early March, Steward shared plans that it is looking to transfer the ownership of all nine of its Massachusetts hospitals.
10. U.S. Sen. Ed Markey invited Dr. de la Torre to testify at an April 3 field hearing in Boston regarding unanswered questions over the health system's troubled finances, but Dr. de la Torre did not show. The hearing also addressed for-profit companies' impact on healthcare access.
11. Steward's Texarkana, Texas-based Wadley Regional Medical Center denied rumors that the facility is closing its doors on March 19. The denial comes as construction on the hospital's $227 million replacement facility has been paused since February.
12. Steward's West Monroe, La.-based Glenwood Regional Medical Center closed its inpatient rehabilitation unit March 20.
13. Steward closed its Stoughton, Mass.-based New England Sinai Hospital on April 2. The 182-bed rehabilitation hospital had been open since 1927. Steward shared plans to close the hospital in early December due to "chronic low reimbursement rates" for Medicare and Medicaid service.
14. Kenney and Sams, a Boston law firm, filed a lawsuit against Steward March 25 and claimed that the health system owes it $605,306 for legal services rendered for more than six years, including interest and additional damages.
15. Steward shared plans to sell its physician group to UnitedHealth Group's subsidiary Optum on March 26. Sen. Elizabeth Warren expressed concern over the sale not benefiting patients, healthcare workers, or guaranteeing the survival of Steward's facilities. The group has 1,700 physicians, according to Steward's website.
16. Dr. de la Torre exchanged written responses with The Boston Globe in March through his lawyer and a company spokesperson. He detailed how it "has been the most stressful time in my life, but more importantly, I know that it has been even more stressful for the communities we serve." Dr. de la Torre also shared with the Globe that when Cerberus Capital Management, the private equity firm that founded Steward, wanted in 2020 to enter the health system into bankruptcy due to increased financial pressure from the COVID-19 pandemic, Steward's entire leadership team, including Dr. de la Torre, threatened to resign.
17. Ms. Warren and Mr. Markey released an April 2 statement that accused Cerberus of profiting around $800 million from Steward and looting the health system when it exited in 2020. The statement came after Cerberus shared a Feb. 26 response letter to Massachusetts lawmakers' request for more information regarding Steward's financial struggles.
18. Medical Properties Trust offloaded five Steward-operated Utah hospitals in April for around $1.1 billion in cash proceeds. The hospitals were leased to Englewood, Colo.-based Catholic Health Initiatives Colorado, part of Chicago-based CommonSpirit Health.
19. Ms. Healey's administration began holding a series of regional meetings with hospitals and community health centers on April to discuss Steward's ongoing financial difficulties at its Massachusetts hospitals. The meeting participants included the Massachusetts Department of Public Health, the Massachusetts Health and Hospital Association, and the Massachusetts League of Community Health Centers.
20. Hematology oncology services were temporarily paused at Steward's Brockton, Mass.-based Good Samaritan Medical Center in mid-April after its provider left. The outpatient services were provided by an independent physician practice and not run by the hospital.
21. Rallies were held outside of Steward Massachusetts hospitals ahead of the health system's April 30 loan agreement deadline out of concern that the facilities could be negatively affected. The loan agreement was part of Steward's "six-point action plan" from late February (mentioned above in number eight).
22. Massachusetts health department officials launched an incident command system to protect care access and to reduce any potential disruption of services at Steward's state hospitals. The command system aims to support coordination between hospitals, labor groups, state agencies, community health centers, and other stakeholders.
23. Steward filed for Chapter 11 bankruptcy on May 6 to keep operations running at its existing hospitals and clinics. The health system shared in a May 6 news release that it would receive an initial $75 million from Medical Properties Trust through plans to finalize terms of debtor-in-possession financing, and could be eligible for an additional $225 million from its landlord. Medical Properties Trust shared that it expects Steward to use the $75 million to maintain patient care while it "accelerates the re-tenanting of hospitals to new operators." However, the landlord did not share plans to provide any additional funding to the health system.
24. During a May 7 court hearing in Houston, Steward attorney Ray Schrock told U.S. Bankruptcy Judge Chris Lopez that the health system had placed its 31 U.S. hospitals up for purchase to help offload its $9 billion debt after it filed for bankruptcy, Reuters first reported May 7. Mr. Schrock said that Steward is hoping to keep its hospitals open and to finalize the sale of its facilities by the end of the summer.
25. A "processing error" with Bank of America led to Steward delaying payment on May 9 to their employees. The delay was not system wide.
26. Medical Properties Trust yet again saw losses due to Steward in their first quarter of 2021, ended March 31. The company saw a net loss of around $693 million in impairments mostly due to non-real estate adjustments related to Steward.
27. Arizona Attorney General Kris Mayes launched an investigation into Steward regarding what led the health system to file for bankruptcy. The health system has four hospitals in Arizona: Florence (Ariz.) Hospital, Mountain Vista Medical Center in Mesa, Ariz., St. Luke's Behavioral Health Center in Phoenix, and Tempe (Ariz.) St. Luke's Hospital.
28. Steward proposed an initial bidding timeline for its 31-hospitals and Stewardship Health to be sold in May 15 court documents filed in the U.S. Bankruptcy Court for the Southern District of Texas.
29. The auction timeline was rejected by The Justice Department in a May 28 bankruptcy court filing. The filing detailed how the debtor-in-possession financial deal between Medical Properties Trust and Steward interferes with the health system's "obligation to comply with the United States' antitrust review" of the Stewardship Health, Optum deal and should not be approved.
30. U.S. Bankruptcy Court Judge Chris Lopes approved Steward's sale dates for Stewardship Health and its 31-hospitals. The sales would be conducted in two rounds. The first round, which comprises Stewardship Health and all of Steward's hospitals except the Florida facilities and some Texas hospitals, has a June 24 bid deadline and a July 11 first sale hearing. The second round, which comprises Steward's Florida hospitals and four Texas facilities, has an Aug. 12 bid deadline and an Aug. 22 sale hearing.
31. Providence, R.I.-based Lifespan shared that it's keeping a watchful eye on Steward's scheduled asset sales and bankruptcy hearing. While Lifespan CFO Peter Markell did not confirm that the health system would be taking on any of Steward's Massachusetts hospitals, he did say that Lifespan would have to make sure any potential purchases worked from a "business and financial perspective."
32. Steward secured a $225 million loan commitment from a group of lenders to help keep its hospitals and Stewardship Health operational ahead of auction, according to a June 10 Steward news release. The lenders were WhiteHawk Finance, Owl Creek Investments, OneIM, MidOcean, and Brigade Capital Management. Mr. Lopez approved the funding on June 14.
33. A group of U.S. lawmakers wrote a letter to the U.S. Department of Labor Acting Secretary Julie Su on June 17 and requested that the department support Steward's 30,000 employees and its retirees as the health system deals with ongoing bankruptcy proceedings.
34. The auction date for Stewardship Health and the health system's "first-round hospitals" in Arizona and Massachusetts and St. Joseph Medical Center in Houston was delayed three weeks. "The extension gives everyone involved time to develop robust bids," a spokesperson for Steward said in a June 20 statement shared with Becker's.
35. Steward's Glenwood Regional Medical Center laid off 23 employees, including some leadership roles to adjust to a change in business conditions.
36. Optum backed out of plans to acquire Stewardship Health in Late June.
37. The FDA ordered North Shore Medical Center to pause its mammogram services after it failed to meet clinical image quality standards by the American College of Radiology. The potentially inaccurate screenings occurred from March 14, 2022 to March 14, 2024.
38. Steward made six payments at just under $1.6 million this year to London-based Audere International, a commercial intelligence, investigations and security company. Steward had previously paid upward of $7 million over a more than six-year period to the company to conduct surveillance and disinformation operations against both critics and a former Steward employee.
39. Steward was hit with a criminal investigation by federal prosecutors at the U.S. Attorney's office in Boston. The investigation includes allegations of fraud and violations of the Foreign Corrupt Practices Act. "Steward Health Care can confirm it is aware of and cooperating with an investigation by the U.S. Department of Justice," a spokesperson for Steward said in a July 12 statement shared with Becker's. "As a matter of policy, Steward will have no further comment on this investigation as it remains ongoing."
40. July 12 bankruptcy court documents obtained by Becker's revealed that Dr. de la Torre made a gross salary of $3,766,461 from May 8, 2023, to April 11, 2024. The documents also revealed that 14 other Steward executives received at least $1 million in overall compensation just 12 months prior to the health system filing for bankruptcy.
41. Steward accepted bids in late July for Hope, Ark.-based Pafford Health Systems to purchase Wadley Regional Medical Center in Hope, Ark., and AHS South to purchase Regional Medical Center in West Monroe, La. The health system also rejected nonviable bids and canceled the auction and sale hearing for three of its hospitals: Trumbull Regional Medical Center in Warren, Ohio, Hillside Rehabilitation Hospital in Howland, Ohio, and Sharon (Penn.) Regional Medical Center.
42. Patient care ombudsman Suzanne Koenig conducted an inspection of several Steward hospitals in Massachusetts, Ohio, Pennsylvania and the Miami area from May 22 to July 22. The report found that while there was some room for patient care improvement, there were no material issues impacting patient care that would require immediate attention from bankruptcy court.
43. In a 20-1 favorable vote, the Senate Health, Education, Labor and Pensions Committee voted July 25 to subpoena Dr. de la Torre and investigate the bankrupt for-profit health system. On Sept. 4, Dr. de la Torre declined to participate in the upcoming Sept. 12 hearing.
44. Ms. Healey's administration shared that it will dedicate $30 million to Steward to keep its hospitals in the state operating through the end of august.
45. Steward shared plans July 26 to close two of its Massachusetts hospitals — Dorchester, Mass.-based Carney Hospital and Ayer, Mass.-based Nashoba Valley Medical Center — by Aug. 31. U.S. Bankruptcy Court Judge Christopher Lopez approved the closures during a July 31 hearing; however, Massachusetts Secretary of Health and Human Services Kate Walsh said the health system must present a "responsible closure plan" that follows the state's 120-day closure process for the two hospitals. The system also shared that 1,243 employees would be laid off as part of the closures. The hospitals are now closed.
46. Warren (Ohio) City Hospital, the name of a collaborative group of business and community leaders, shared plans to acquire Steward's Warren, Ohio-based Trumbull Regional Medical Center.
47. The Boston City Council voted Aug. 7 to approve a resolution that calls on the city's Public Health Commission to declare a public health emergency due to the planned closure of Steward's Carney Hospital.
48. As news surfaced about Steward closing two of its Massachusetts hospitals and conducting layoffs, Dr. de la Torre faced backlash for traveling to France for the Olympics.
49. In early August, Steward's Sharon (Pa.) Regional Medical Center shared plans to close its 125-year-old nursing school after the current class of students graduates in May 2025.
50. Nashville, Tenn.-based Rural Healthcare Group, part of private equity firm Kinderhook Industries, entered into a definitive agreement with Steward to take on Stewardship Health for $245 million in cash. Mr. Lopez approved the sale during an Aug. 15 bankruptcy hearing and Steward completed the sale Oct. 31.
51. Steward and Orlando (Fla.) Health entered into a binding asset purchase agreement for Steward's northern Florida assets for $439.42 million in cash in mid-August. Steward designated Orlando Health as the successful bidder for the assets Aug. 28 and Mr. Lopez approved the sale Sept. 10. Orlando Health took over the hospitals Oct. 24.
52. Steward's St. Luke's Behavioral Health Center, a 127-bed facility in Phoenix, was ordered to halt operations by state officials Aug. 14 after temperatures inside the facility reached 99 degrees Fahrenheit. The hospital was forced to furlough workers following the halt Aug. 26, affecting more than 200 employees and filed a WARN notice for 255 employees on Oct. 1. Mr. Lopez approved Santa Fe Springs, Calif.-based College Health Enterprises, a healthcare management company, as interim manager for the hospital during an Oct. 22 hearing. In early December, the hospital received permission from the Arizona Department of Health Services to reopen in a limited capacity.
53. Ms. Healey's administration said Aug. 16 that deals "in principle" had been reached for four Steward hospitals to be taken over by new operators. On Sept. 4, Mr. Lopez approved the sale of six Massachusetts Steward hospitals to three different health systems. The approval includes the sale of Brockton-based Good Samaritan Hospital and St. Elizabeth's Medical Center to Boston Medical Center for $140 million. Providence, R.I.-based Lifespan will take on Taunton, Mass.-based Morton Hospital and Fall River, Mass.-based St. Anne's Hospital for $175 million and Lawrence (Mass.) General Hospital will purchase Holy Family Hospital in Methuen (Mass.) and Holy Family Hospital in Haverhill (Mass.) for $28 million. The three health system's officially took over operations of the hospitals on Oct.1, which saved more than 13,000 jobs, according to a news release shared with Becker's.
54. Steward filed a lawsuit Aug. 19 against Medical Properties Trust, claiming that the efforts to sell its remaining hospitals to new operators have been disrupted by "parties who have refused to follow the clear ground rules." In an emergency motion, Medical Properties Trust argued that the global bidding procedures do not give Steward the green light to sell its landlord's property.
55. New York City-based Apollo Global Management, an alternative investment manager, rejected the $4.5 million proposal from Massachusetts to take over Steward's St. Elizabeth's Medical Center, citing that the proposal "significantly undervalues the real property underlying St. Elizabeth's" in an Aug. 20 letter. The state took over the hospital through eminent domain on Sept. 27 to transfer it to Boston Medical Center.
56. Steward shared plans to close Trumbull Regional Medical Center and Hillside Rehabilitation Hospital, both in Warren, Ohio, on or around Sept. 20 after the facilities failed to attract qualified buyers. The closures will result in 944 employee layoffs.
57. Pennsylvania Attorney General Michelle Henry shared in an Aug. 22 bankruptcy court notice, obtained by Becker's, that Steward required $1.5 million from the state by Aug. 23 or the health system will submit a closure notice for Sharon (Pa.) Regional Medical Center. During an Aug. 22 bankruptcy court hearing, Mr. Lopez approved a relief process letting Steward to exercise its business judgment on what to do with the status of its hospitals. He also approved a deadline of Aug. 30 for the state to come up with funding with no extension. On Sept. 10, the state shared that it will provide $4.5 million over a three-month period to the hospital to keep it from closing. It also shared that Meadville (Pa.) Medical Center submitted a letter of intent to acquire Sharon Regional on Aug. 16. Steward then requested the funding from the state increase to $3 million per month in early December. Pennsylvania has until Dec. 9 at 11:59 p.m. ET to secure the funding or Steward will start the closure process for the 163-bed hospital.
58. Warren (Ohio) City Hospital, a collaborative organization of business and community leaders, shared that it has raised enough money to acquire Steward's Trumbull Regional Medical Center. Warren City Hospital is now working to raise funding to keep the facility operational, which the group estimates could cost around $9 million per month for the first 60-90 days.
59. Becker's compiled a list regarding the current status of each of Steward's 31 hospitals that we will continue to update regularly. Link here.
60. Christus Health Ark-La-Tex, part of Irving, Texas-based Christus Health, entered into a binding asset purchase agreement for Steward's Texarkana, Texas-based Wadley Regional Medical Center on Sept. 3 and completed the purchase of the hospital Nov. 1. Christus also shared Sept. 18 that it is taking over the shuttered Medical Center of Southeast Texas in Beaumont and plans to reopen the facility "in the coming months."
61. Mr. Lopez authorized an interim settlement agreement for Steward to transition 15 of its hospitals across Arizona, Florida, Louisiana, Ohio and Texas to Medical Properties Trust or an applical designated operator during a Sept. 11 hearing.
62. Dr. de la Torre did not show up to the Sept. 12 HELP committee hearing that he was subpoenaed to attend. The committee voted Sept. 19 to forward two resolutions regarding contempt charges against Dr. de la Torre to the full Senate. The full Senate voted unanimously to hold Dr. de la Torre in criminal contempt on Sept. 25.
63. Steward received approval Sept. 12 from Mr. Lopez to sell Wadley Regional Medical Center at Hope to Pafford Health Systems for $200,000.
64. Mr. Lopez approved the sale of three Arizona Steward hospitals, Florence Hospital, Mountain Vista Medical Center and Tempe St. Luke's Hospital to Scottsdale, Ariz.-based HonorHealth during an Oct. 3 court hearing. He also approved the sale of Steward's Mesa Emergency Center and multiple outpatient physician practices to HonorHealth. Mr. Lopez named HonorHealth interim manager of the assets on Sept. 11.
65. Steward filed an Oct. 7 notice of closure for its already nonoperational Norwood (Mass.) Hospital and four satellite facilities. The four Steward-affiliated facilities — a facility specializing in performance therapy, an infusion clinic, a pharmacy and a facility offering radiology services — received bankruptcy court approval to close Nov. 5.
66. Mr. Lopez approved the sale of Steward's Odessa (Texas) Regional Medical Center and Big Spring, Texas-based Scenic Mountain Medical Center to Brentwood, Tenn.-based Quorum Health during an Oct. 11 hearing. Quorum became interim manager of the hospitals Sept. 11 and was made permanent manager Sept. 17.
67. Flint, Mich.-based Insight Health Systems received bankruptcy court approval Oct. 16 to purchase Hillside Rehabilitation Hospital and Trumbull Regional Medical Center and has since shared plans to lay off an undisclosed amount of employees. Insight received approval to officially take over the two hospitals Nov. 4.
68. Mr. Lopez approved the sale of seven Steward hospitals, five in Florida and two in Texas, to Healthcare Systems of America, an affiliate of Glendale, Calif.-based American Healthcare Systems during an Oct. 25 court hearing.
69. Steward closed the sale of Stewardship Health to Rural Healthcare Group, on Oct. 31. The physician group was rebranded as Revere Medical. Joseph Weinstein, MD, who previously served as chief medical officer at Steward, now serves as CMO for Revere Medical. Andrew Herman, who served as CFO of Steward Health Care Network and later held the same role for the Stewardship division, now serves as chief growth officer for Revere Medical.
70. Federal officials detained Dr. de la Torre the week of Nov. 18 to execute a search warrant and seize his phone as part of an ongoing investigation. They also recently seized the phone of Armin Ernst, head of Steward's international operations.
71. Steward filed a Dec. 16 notice in bankruptcy court to close Sharon Regional Medical Center after Meadville Medical Center withdrew its proposed purchase of the hospital. The notice aims to close the 163-bed hospital on Jan. 6.