End of an error

As Ralph de la Torre yachts (or jets) off into the sunset and Massachusetts tries to pick up the pieces of a health care system he literally sold the ground out from under, it’s time to assess where the state goes from here.

With a typical surgeon’s arrogance, de la Torre absolves himself of any blame for the disaster known as Steward Health Care, even as he says he “amicably separated” from the for-profit chain that’s leaving wreckage here and in other states. Massachusetts, he says, is really at fault:

“Dr. de la Torre urges continued focus on this mission and believes Steward’s financial challenges put a much-needed spotlight on Massachusetts’s ongoing failure to fix its healthcare structure and the inequities in its state system,” read a statement from his spokesperson, Rebecca Kral.”

There is a glimmer of truth in the blame-shifting. Massachusetts has failed in allowing the incursion of private ventures that put profit ahead of patients.

It’s not just for-profit firms like Steward, born with the financial backing of Cerberus Capital Management, the venture capital company that infamously selected the three-headed dog that guards the gates of Hell as its symbol.

Tenet Healthcare, which trades on Wall Street and operates three hospitals in Framingham, Natick and Worcester, is currently under investigation by the state’s Department of Public Health over allegations of dangerous conditions and understaffing.

Mary Sue Howlett, the [Massachusetts Nursing Association’s] associate director of nursing, told the Globe that nurses in the union at Tenet-owned hospitals — Framingham Union, Leonard Morse, and St. Vincent — have submitted 1,005 forms so far this year complaining of unsafe staffing, the bulk of which were filed by nurses at St. Vincent. During the same period, Howlett said, nurses at Steward hospitals in Massachusetts submitted 674 unsafe staffing forms across six Steward hospitals: St. Elizabeth’s, Good Samaritan, Holy Family of Methuen, Holy Family of Haverhill, Morton, and Carney.

Even the not-for-profit system is stressed, with layoffs at Tufts Medicine, Beth Israel Lahey Health, Baystate Health, and employee unrest at the state’s 800-pound health care gorilla, Mass General Brigham.

But those pale in comparison to issues at Tenet — where nurses struck St. Vincent in Worcester for nine months over pay and safety issues — and Steward, where de la Torre’s decision to sell the land and buildings of Massachusetts hospitals to yet another private venture firm, Medical Properties Trust, succeeding in lining his pockets and those of a handful of his team while prompting a corporate bankruptcy filing, the fire sale of six hospitals and the closing of two others.

The fight continues with Governor Maura Healey ordering the eminent domain seizure of Steward flagship St. Elizabeth’s Medical Center, with what might well be considered a low-ball offer of $4.5 million to Apollo Global Management, the latest Wall Street firm to enter the picture.

But here’s where the glimmer of truth in de la Torre’s whine comes into play. Massachusetts has failed, to this day, to impose any level of regulation on the for-profit health care system as it requires from the non-profit sector.

While MGB, BILH, Tufts, Baystate and UMass Memorial all come under the oversight of the attorney general’s public charities division, the for-profits answer to the corporations division of the secretary of state’s office. Instead of being required to file tax returns with the AG, Steward’s filings — when they made them — consisted of the names and locations of corporate offices.

De la Torre took over the reins of the former Caritas Christi system in 2010 with the financial aid of Cerberus, which sold its stake in 2020, netting an $800 million return on its investment.

Metrowest Medical Center, a combination of the Framingham and Natick hospitals, has been for-profit since 1996. Worcester’s St. Vincent went for-profit in 2005. That’s a 28-year period where the commonwealth could have enacted some form of legislation to raise oversight of for-profit health care.

Crickets. Even to this day. With promises from legislative leaders that they will continue to work until January to finish business that under their own rules should have been wrapped up by July 31.

But flouting rules is a common theme here, although de la Torre’s disdain for them is on an entirely different level.

The defiant tone of his blame-shifting is of a piece with his refusal to honor a congressional subpoena to testify about Steward’s downfall. It’s a brazenness on par with Peter Navarro and Steve Bannon in brushing off congressional demands related to the January 6th insurrection.

Actions that landed both men in jail after being convicted of contempt of Congress.

Like Navarro and Bannon, de la Torre could have shown up and pleaded his 5th Amendment rights against self-incrimination. But perhaps he was jetting off to another vacation while his hospital system collapsed.

Give him credit for one thing though: Ralph de la Torre managed to unite Senate Democrats and Republicans in a unanimous vote to ask the Department of Justice to file contempt of Congress charges against him.

Perhaps cooling his heels in prison for up to a year can convince him that perhaps he needs to take some responsibility for his actions.