A Hospital Scandal That Properly Reflects our Warped New Health-Care Reality

(Permanent Musical Accompaniment to This Post)

Being our semi-regular weekly survey of what’s going down in the several states where, as we know, the real work of governmentin’ gets done and where the festival was over and the boys were all planning for a fall.

We begin this week right here in the Commonwealth (God save it!) where the TheBoston Globe’s Spotlight team—star of stage, screen, and FOIA requests—dropped a huge bomb that rattled the walls almost everywhere in the state government. Ground zero was Steward Health Care, one of the country’s largest for-profit hospital chains, for-profit hospitals being yet another sign of how fcked-in-the-haid our health-care system is. But one thing for-profit companies excel at is greasing the skids for themselves. It begins with a death.

On Sept. 13, 2023, a triage nurse in the Brockton hospital’s overwhelmed emergency department received a plea for help from a patient in the registration line. Suffering from acute chest pain and shortness of breath, 37-year-old Jennifer Knight believed she was having a heart attack. But 10 hours into her nonstop shift, with too few nurses to handle a surge of patients, the nurse sent Knight back to the line, without evaluating her or checking her vital signs, according to investigators. Knight collapsed just 20 minutes later and died.

The nurse got fired, unfairly, it seems. The nurses union raised hell. The governor’s office reached out to the CEO of Steward to rehire her, not because her firing was facially unjust but because her husband works in public health for Governor Maura Healey, which smacks of old Massachusetts politics.

The call — which circumvented any official appeal process — occurred at a time when Steward was careening toward bankruptcy, and seeking millions in bailout money from the Healey administration. Within days, Zachos was back on the job. ... The direct ask of [Steward Health Care CEO Ralph] de la Torre, and his rapid response, is one of the most telling examples of the often-accommodating relationship that long persisted between Steward executives and state regulators. While de la Torre and other Steward executives have faced withering scrutiny for their alleged mismanagement and plundering of one of the nation’s largest private, for-profit hospital chains, the Globe Spotlight Team has found they benefited from insufficient scrutiny from elected officials and regulators until the company foundered and it was too late.

Time and again, Massachusetts health regulators acquiesced to Steward’s demands even as Steward flouted state laws. Handed a loose rein, Steward’s executives rode the hospital chain right into bankruptcy.

Among the Spotlight Team’s findings:

A top state health official directed a subordinate in 2015 to remove information about serious patient care problems at Steward from a public presentation.

Then-Attorney General Healey’s office, which had substantial sway over health care companies, reworked a 2015 report about Steward to downplay its perilous financial condition — to the surprise of one of the report’s lead authors.

State health officials ignored repeated pleas from Steward nurses, including Zachos, to force significant improvements at besieged hospital units, where patients languished, and in some cases died, after receiving inadequate care.

At the same time, they did little as Steward eliminated critical-care beds to focus on more profitable services, closed key medical units without legally required notice, and kept its growing financial problems from public view. Steward repeatedly claimed that its finances were proprietary, and thus exempt from the disclosures required of every other hospital system.

At pivotal moments, Steward executives pushed employees and their families to donate generously to key players on Beacon Hill and beyond, filling the campaign coffers of their would-be regulators. All told, executives and their spouses gave at least $2.4 million to federal and state candidates — largely in states targeted for hospital expansion, according to a Spotlight review of campaign finance databases.

Some of the elected officials now most vocal about Steward’s implosion collectively took in hundreds of thousands in campaign dollars from its executives and employees.
Maura Healey is among them. This summer, Healey slammed de la Torre for fleecing hospitals, calling his actions “really reprehensible and unforgivable,” and suggesting he had fooled the state. “He basically stole millions out of Steward on the backs of workers and patients,” she said. “Our administration is working night and day to protect jobs, protect patients, and pick up the pieces of the situation that Ralph de la Torre has put us in.” ...

... Just months after she became attorney general in 2015, Healey’s office said Steward had fulfilled its obligations under a state oversight agreement in place since the company’s founding. Yet, the chain’s financial projections portended grave problems. As governor, Healey’s administration was briefed in the summer of 2023 about Steward’s likely collapse, records show. There’s no evidence the administration took significant action in response to the warning, the Spotlight Team found.

Looked at from one angle, the scandal can be seen as a perfect fractal of the world the carefully manufactured conservative majority on the Supreme Court has wrought. There’s the deforming effect of money on politics (Citizens United). There’s the deregulatory fervor (Loper Bright). And there’s the endlessly vulnerable place in which John Roberts left the Affordable Care Act. And, clearly, no place is safe.

We move along to Texas, where Attorney General Ken Paxton has decided that the enforcement mechanisms of the Fugitive Slave Act have pharmaceutical uses as well. From the AP:

Texas Attorney General Ken Paxton filed the lawsuit on Thursday in Collin County, and it was announced Friday. Such prescriptions, made online and over the phone, are a key reason that the number of abortions has increased across the U.S. even since state bans started taking effect. Most abortions in the U.S. involve pills rather than procedures. Mary Ruth Ziegler, a law professor at the University of California, Davis, School of Law, said a challenge to shield laws, which blue states started adopting in 2023, has been anticipated. And it could have a chilling effect on prescriptions. “Will doctors be more afraid to mail pills into Texas, even if they might be protected by shield laws because they don’t know if they’re protected by shield laws?” Ziegler said in an interview Friday.

I note that conservatives regularly bleat that we don’t all live in New York or California. I further note that we don’t all live in Collin County, Texas, either. I think it would be great if one of those liberal billionaires would outfit a squadron of airplanes to fly over the length and breadth of Texas, dropping abortion pills by the thousands. Ken Paxton undoubtedly would have anti-aircraft batteries at the border by the weekend.

Meanwhile, in Kansas, the cult has well established itself at the local level. From KCUR:

A new conservative majority on the Derby Board of Educationvoted down a proposed contract with Houghton Mifflin Harcourtfor the high school curriculum, which would have cost about $400,000. The curriculum was recommended by Derby High School teachers, who reviewed six social studies programs over the past year. Some board members voiced concerns about anti-racism statementson the publisher’s website, as well as the company’s statements about diversity, equity and inclusion. They also said parts of a textbook and online materials do not fairly reflect Trump’s first presidency.

“My biggest concern … involved what I would define as bias of omission,” board member Cathy Boote said. Boote listed several examples of material she said did not accurately reflect Trump’s actions during his presidency, including his stance on Cuba, trade deals with China, relationships with allies and the Jan. 6 Capitol riot. “Then there was the ‘Muslim ban,’ ” Boote said, making air quotes with her fingers. “With no mention of the fact it wasn’t aimed at all Muslim countries, just those that have no ability to vet. Safety was the top priority, but they leave it sit there, with no explanation, to make you think he was xenophobic.”

Well, we can’t have our children learning that, can we?

And we conclude, as is our custom, in the great state of Oklahoma, whence Blog Official Gas Fire BBQ Chef Friedman of the Plains brings us the tale of how to sort children without really trying. From Oklahoma Watch:

Children would have to show proof of U.S. citizenship or legal immigration status to enroll in a public school under new rules proposed by the Oklahoma Department of Education, a practice that could run afoul of federal law and deter children who are undocumented or from mixed-status families from attending school. The agency’s proposal states that students without documentation would not be prohibited from enrolling. Supreme Court precedent requires public schools to enroll children living within their districts, whether they are in the country legally or not.

But federal law also bars schools from asking about a student’s citizenship or immigration status to confirm they live in the district as it can have a chilling effect on student enrollment, according to guidance to the U.S. Department of Justice and U.S. Department of Education. Neither can schools discourage students from enrolling if they don’t have a birth certificate or if they have a foreign birth certificate.

Ah, but these rules did not reckon with Ryan Walters, the Oklahoma education superintendent commissioner and a regular here in our semi-regular weekly survey.

In August, Superintendent of Public Instruction Ryan Walters announced a plan to ask school administrators to calculate the cost of illegal immigration in their districts. Several district leaders said publicly they would refuse a directive to ask students about their immigration status. Last week, the department told Oklahoma Watch the only public record related to that effort is Walters’ Oct. 29 letter to Vice President Kamala Harris demanding nearly $475 million to reimburse Oklahoma for the cost of illegal immigration on the state’s schools. Dan Isett, a spokesman for the department, said guidance to districts is in process.

I used to think they’d run out of people like Walters sooner or later, but they seem to have a limitless supply.

This is your democracy, America. Cherish it.