BOSTON (State House News Service) — Girding for potential hospital closures, state public health officials are looking to safeguard training opportunities for medical students assigned to facilities owned by financially distressed Steward Health Care.
The Department of Public Health is also particularly worried about the uncertain future for nursing students amid the state's severe workforce shortage, DPH Commissioner Robbie Goldstein said Wednesday. Medical students, including from Boston University's medical school, are learning in all parts of the Steward system, Goldstein said.
"There are nursing students in almost every one of the Steward facilities, so we're working to catalog all of these, to identify the number of students in each of the facilities, and to think about eventual placement should a facility no longer need to take students of any kind," Goldstein said during a virtual Public Health Council meeting Wednesday morning. "It's a big issue. I would say in particular, it's a huge issue in nursing because there are very limited nursing placements across the state."
Goldstein's concerns surfaced in response to a question from PHC member Dr. Michele David, chief of clinical quality and patient safety at MIT Health. David noted that Steward also serves as an academic training center, and that the system's financial instability could jeopardize workforce training.
A DPH spokesperson said there are 189 active "limited licensees" -- including residents, fellows and interns -- training at Steward facilities.
At St. Elizabeth's Medical Center in Brighton, that includes 12 interns, 117 residents and 33 fellows. At Carney Hospital in Dorchester, there are four interns and 23 residents, the DPH spokesperson said.
The spokesperson said the Board of Registration in Nursing doesn't track where nurses are employed and that the body does not have jurisdiction over student nurses.
Students at Boston University's Chobanian & Avedisian School of Medicine are slated to continue their clinical rotations at St. Elizabeth's and other Steward-affiliated hospitals, spokesperson Maria Ober said.
Physician assistant and medical students at St. Elizabeth's are being trained in specialties such as internal medicine, neurology, OBGYN, pediatric, psychiatry and surgery. Ober said they are supervised by physicians with BU faculty appointments.
"We are very focused on supporting our students and have developed a detailed reassignment plan, if necessary," Ober said in a statement.
Read More: Mass. Gov. Calls On Steward Health Care To Transfer Hospitals, Produce Docs
Frustrated by Steward's financial mismanagement and failure to disclose audited financial statements, Gov. Maura Healey has said it's time for the company to exit the commonwealth's health care system. Without disclosing specifics, Goldstein said Wednesday the state is prepared to take necessary action against Steward.
Steward did not respond to a request for comment Wednesday about students at its hospitals and any potential plans to maintain training opportunities. The company last Friday signaled its facilities have garnered "strong" interest from multiple prospective buyers.
"Steward Health Care is working with state officials and others to transition ownership of the Massachusetts hospitals in a way that everyone agrees is best for patients, our employees, and the Commonwealth," a Steward spokesperson said last week.
Goldstein did not offer estimates of how many nursing students could be impacted should Steward, which owns nine hospital locations in Massachusetts, end up shuttering some of its facilities as the for-profit-company deals with major financial issues.
"This is very much on my mind and on the mind of people who are thinking through the possibilities and the planning around Steward," he said.
DPH surveyors are monitoring Steward's eight open facilities as the state keeps a close eye on patient safety, as well staffing and supply levels. Goldstein again declined to predict the future of the company.
"Now I don't want to speculate on the eventualities of Steward because there are so many permutations of what could happen," the commissioner said. "But I think we all need to be committed and consistent with our values and what our goals are for the state, which is to make sure that people have access to care in their community, and that we are providing care to the most vulnerable, and thinking about the inequities that exist and how we can address those."
Steward serves a high volume of low-income or Medicaid patients, a demographic that company executives said contributed to multi-million-dollar losses for its Stoughton hospital, which is slated to close this spring.
PHC member Dr. Eduardo Haddad, chief of medical affairs at Lawrence General Hospital, warned that Steward may close other hospitals that serve some of the most vulnerable residents but aren't turning a profit.
"We are in the midst of all this here in Lawrence, and we feel the pain of all this," Haddad said. "My concern would be that they would attempt to close all the hospitals that have poor margins and then keep the ones that are in better locations open. And that would be, I think, a very bad result for the community."
Goldstein said DPH is pursuing regional planning efforts, analyzing data and communicating with local partners as the state navigates the ongoing uncertainty.
"This is a situation where every day, we need to reevaluate where we are -- and that is what we're doing -- to make sure that we are not surprised by anything," he said. "And should any action need to happen, we the department will be ready to take that action, the State House will be ready to take that action, the Executive Office of Health and Human Services will be ready to take that action. And I think importantly, our communities will be ready to take any action that's necessary."
Written by Alison Kuznitz/SHNS.
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