When do you pull the plug on a hospital?

Today the story made it to prime newspaper real estate — above the fold, banner headline: Carney Called Strain on Caritas.  Archbishop Sean O’Malley and other church officials emailed Caritas Christi Health Care employees last week noting that the $10 million a year subsidy can no longer come out of the coffers of the system or the archdiocese. 

This is news?

For those of you joining us from outside the Boston area, Carney is an in-town nearly-200-bed hospital with a long history — it opened its doors in the 1860’s; before being acquired by Caritas Christi in 1997 it was operated by the Daughters of Charity.  Caritas Christi is the local Catholic health care system in trouble — it tried to sell itself twice in the past year to larger Catholic systems (Ascension Health of St. Louis and Catholic Health Initiatives of Denver) but both deals fell through due to the system’s debt burden (reportedly $275 million).    

The article in today’s paper is just the latest in a string of stories — and a Globe editiorial — offering glimpses of hand-wringing within the archdiocese, in the office of Boston mayor Tom ("Mumbles") Menino, Caritas Christi administration (the post of CEO has been vacant for a couple of years now), legislators and city councilors who don’t want a hospital to close in their district (the City Council president is married to the Caritas Carney Foundation president), and state Attorney General Martha Coakley (she’s hired an out-of-town consultant to work up some options). 

All the players are intimating that they have a plan — including intimations that someone ought to provide financial support for Carney Hospital to continue operating as it always had.  Par for the course.  There is a lot of wishful thinking out there, but some folks get it: Just because there has long been a Carney Hospital doesn’t mean there always ought to be.   

Massachusetts used to have over 100 acute care hospitals.  Mergers and consolidations have reduced this number to below 75.  Virtually all consolidations resulted in rearranging of services across multiple campuses, and most resulted in one campus no longer offering acute care hospital services.  In addition, the former Acute Hospital Conversion Board (a relic of the Former People’s Republic of Massachusetts, which operated toward the end of the last century — part of my portfolio in state government was staffing this board) had a hand in facilitating some long-ago closures.  For example, the Conversion Board arranged for the conversion of the closed Worcester City Hospital to other health care services uses, so that it would not end its days as a boarded-up inner-city shooting gallery.  This is the sort of concern that may be on the minds of the Carney cheerleaders as well.

The current love affair with the free market means the Conversion Board isn’t around anymore, but the mayor, the archbishop, the attorney general, the city council and the legislators are all making noises about support that ought to be forthcoming from somewhere to keep open a facility that clearly cannot operate on its own in the free market.

So, what is to be done?  (I’m not fomenting revolution here, even as a former apparatchick of the former people’s republic — it’s a serious question.)

Today’s newspaper article included the first public mention I’ve seen of the most reasonable outcome that I can imagine:  operating a community health center in the Carney Hospital building.  Everyone loves to bitch and moan about closing a hospital in the city of Boston but, guess what — given the compact layout of our fair city, thousands of hospital beds and all attendant services are just a hop, skip and jump away.  (Check out the map accompanying one of the Boston Globe articles on Carney and reproduced here — it doesn’t even show Mass General or the Longwood Medical Area teaching hospitals). 

Paul Levy, of BIDMC and Running a Hospital fame, has suggested that SEIU buy the hospital and run it (tongue in cheek? Paul says no, but SEIU is seeking to be recognized in his institution these days).

Bottom line, if Carney is running empty and losing money, why prop it up?  A community health center or other health services could be just the ticket.  Duplicative hospital services just cost the system money — money that ultimately could be put to better uses: childhood vaccines and anti-obesity programs, for starters.  Here’s hoping that clearheaded thinking prevails and that we don’t see a ton of money plowed into Carney before the decision is finally made to pull the plug.

— David Harlow