‘Robbing Peter to Pay Paul’: Inside Steward’s Crumbling Massachusetts Hospitals

In the dying days of Steward Health Care’s Massachusetts hospital chain, staff said they grew so frustrated with supply shortages and unpaid bills that employees at one facility put up a punching ball in the lobby featuring former CEO Ralph de la Torre’s face.

Since the Dallas-based healthcare provider declared bankruptcy in May, it has emerged that De la Torre and other executives paid themselves lavish dividends, flew in private jets, and spent tens of millions of dollars on fishing boats and yachts while their hospitals struggled to obtain basic supplies. 

Sales have been approved for six of the company’s eight Massachusetts hospitals, saving them from closure. But Steward said it failed to find qualifying bidders for the Nashoba Valley Medical Center in Ayer or Carney Hospital in Dorchester, leading both to close on August 31. 

Jennifer Watson, who worked as an emergency department nurse at Nashoba Valley for 16 years, accused Steward of “robbing Peter to pay Paul” in its final years in charge, leaving the hospital scrambling to find badly needed equipment.

“There were times where we didn’t have the right kinds of tubing for our pumps, like IV tubing for our pumps, so we had to use something different,” Watson said of the facility an hour’s drive from Boston. “They just stopped paying certain bills.”

At times, she said, a lack of the correct medications forced staff to use substitutes. When medicine was available, it might not be in the correct dosage — meaning staff had to combine smaller doses, or open up vials with a larger dose and waste the remainder.

Doctors often had to pay for supplies on their personal credit cards and then struggled to get reimbursed, she said. 

“So many things were broken and they were never repairing them,” Watson said “When you say that the emergency room can only have eight bottles of water for the day? How do you think that’s okay? I’m sorry, my patient needs water.” 

At one point, Watson said, Steward even stopped paying the company that emptied the bins where confidential patient information was supposed to be shredded and stored. The bins overflowed, forcing staff to stuff the papers into cardboard boxes until senior employees came to take them away in heavy-duty disposal bags. 

Outside, meanwhile, the lawns grew wild as landscaping bills went unpaid. At one point, the manager brought in her husband and their personal lawn mowers to cut the grass themselves, Watson said.

Staff were asked to tighten belts, too. “They were nickeling and diming us about lunch time,” she said. “They wanted us to not get paid for 30 minutes of the day, even though we never got a lunch break.” 

In a statement, a spokesperson for Ralph de la Torre said he “did everything in his power to help Steward Health Care overcome numerous industry headwinds and challenges, including personally purchasing necessary equipment and supplies … and personally guaranteeing loans for the company with his assets.” 

“Dr. de la Torre has also been a tireless advocate for the improvement of reimbursement rates for the underprivileged patient population served by Steward’s hospitals,” the statement added.

“The state of Massachusetts has had the opportunity to fix its failed healthcare system, but the same problems still exist. Dr. de la Torre and many others have been trying to not only shed light on the inequities in the state system for years, but fix them.”

The statement said that “Carney and Nashoba … are not the only hospitals that have struggled under the state's failed system.”

“Steward has been singled out, but the reality is, the state’s entire healthcare system is in disarray and the state government has not done enough to fix these existential, industry-wide challenges.” 

Strife Over Unpaid Bills

Internal Steward emails show unpaid vendor bills were a cause for concern by January 2019, when Douglas Costa, chief operating officer of Steward Health Care Network, complained of “an incredible amount of vendor invoices and employee expense reports outstanding” and vendors discontinuing service. 

“I won’t even get into how much I’m floating on my personal credit card at this point in time," he wrote.

In one internal email from April 2020, a Steward executive named five vendors that hadn’t been paid.

“I think we need to be getting them something because they probably won’t supply us with materials for surgeries if we aren’t paying anything,” the executive wrote.

Around this time, Steward executives bought out Cerberus, the private equity company which once owned it. 

De la Torre and other Steward shareholders received a roughly $111 million dividend from Steward funds in January 2021. Later that year, de la Torre bought a $40 million yacht, having previously bought a $15 million fishing boat. Steward had also become infamous for owning lavish private planes while its system crumbled. 

In a Senate hearing into Steward — which de la Torre did not attend — Ellen MacInnis, a nurse at St. Elizabeth’s Medical Center in Boston, said things went “downhill” once Steward took over the facility from the Archdiocese of Boston in 2010. (That year, Steward bought the Massachusetts hospitals of Caritas Christi Health Care, a Catholic non-profit hospital chain).

“The corporatization and commodification of healthcare is the guiding ethos of Steward,” she said. MacInnis said this led to “horrific suffering and harm to our patients, the people who take care of our patients, and our communities.” 

At one stage, she said, Steward hadn’t paid a vendor for the bereavement boxes used to transport the remains of newborn babies who had died. In their place, she said, nurses used cardboard boxes they had bought themselves on Amazon. 

‘He Stops Paying Bills’

While Watson and her co-workers were struggling at Nashoba Valley, things were equally dire at Carney Hospital in Dorchester, just outside Boston, by 2021.

In June that year, a patient in mental distress, who had been left unmonitored, died of cardiac arrest during an understaffed night shift, the Globe reported. Months earlier, a staffing company Steward allegedly owned $40 million had pulled nurses from Steward facilities.

By September 2023, the Globe reported, an internal email showed a Carney emergency room nurse coming to work and seeing that four nurses would be expected to manage 25 patients. She called it “seriously dangerous.”

Dan Martin, a radiology expert who worked at Carney Hospital for 33 years, said de la Torre had made “great promises” about new investments when Steward took over the Caritas chain in 2010 — but after a year or two, everything suddenly stopped.

“He stops paying bills,” Martin said. “You’d try to order supplies and different vendors would say, ‘No, you’re on credit hold for 90 days.’ Equipment would break down, we couldn’t get people to really fix it.” 

Elevators would stop working, stranding patients, he said: “There was one point in time that there were no elevators that could accommodate a stretcher, so we couldn’t get a patient from the emergency room up to get a CAT scan done.” 

By the time Carney Hospital closed, only two of its 11 elevators were working, Martin said.

Supplies ran so short that they sometimes had to ask surgeons to bring them from other hospitals where they also worked, he added. 

“What doctor wants to work at a hospital where he can’t do a surgery because he can’t get the supplies?”  

The stories about de la Torre’s personal spending infuriated the staff, Martin said. He shared a photo of a punching ball made out to look like de la Torre in striped prison garb, which he said was placed in Carney’s lobby a few days before it closed. Security quickly seized it.

By last fall, he said, the hospital had hit a new low in terms of shortages. 

“I would order a supply, it wouldn’t come in. I would go down to the head of purchasing. And he would maybe say ‘I’m on credit hold.’ So then I would have to go to try to find another manufacturer to get a product that was similar that we weren’t on credit hold with. And then we would find out they were on credit hold,” Martin said.   

In the hospital’s last days, patients facing addiction and mental illness tried to get into the emergency room, apparently unaware the hospital was closing. 

Both Martin and Watson said they expected the closure of the two hospitals to have devastating consequences for their areas. 

“In this area … the 17 communities that Nashoba serves? There is no other hospital,” Watson said. “People are gonna die.” 

Khadija Sharife (OCCRP) and the Boston Globe contributed reporting.