The closing of the Carney Hospital on Aug. 27, 2024, by Steward Health Care produced a gaping hole in the health care system for Dorchester and Mattapan, two communities with great healthcare needs and poor healthcare outcomes. 

The Department of Public Health, which approved the closing (in fact, it sped it up), issued a statement during the same month it allowed the move, saying that “the Hospital is in fact an essential service necessary for preserving access and health status within the Hospital’s service area.” It was a jarring, but unfortunately familiar juxtaposition to residents of the low-income neighborhoods.

The Carney’s fate, going from a busy 424-bed hospital known for brain surgery to closure in a 50-year decline, tells a story about the healthcare system, urban change, and poor decisions made by those charged with managing the facility.  It also points to what needs to happen for the sake of community health in this largest, most diverse section of Boston.  

I’ve had a more than 50-year involvement with the Carney Hospital, as a patient, as a founder of the Codman Square Health Center, which was established with the help of the Carney, and as a president of the hospital. It’s a story I have lived.

Boston’s population decline after World War II hit the Dorchester and Mattapan communities hard.  The exodus of working and middle-class residents to the suburbs left the city with more housing than needed and a remaining population with lower incomes. It was also a period when western Dorchester and Mattapan saw a large increase in African American residents, mainly from southern states.  

A large part of the traditional Carney population – working-class, insured Catholics – headed to the southern suburbs but continued to use the Carney, a Catholic hospital owned by the Daughters of Charity, for hospital services.  When primary care physicians followed their patients out of town, they left behind new residents with few options for care, except for hospital emergency rooms. In the 1960s and 70s, community health centers replaced private physicians and served lower-income urban residents.  

The Carney administration supported the development of many of the health centers, and had a policy that medical specialists, who were mostly private physicians, would see all patients from the health centers. But as the number of health center patients grew, the specialists became reluctant to care for them, as they were more likely to be uninsured or on Medicaid insurance, which was considered to be a poor payer.  

Race was also a factor.  Some Carney physicians actually created a map to get to the Carney from the southern suburbs that reduced the time that they would need to spend on Dorchester roadways.

As the traditional Carney population started aging out, and their children found their hospital care south of the city, the private physicians revolted.  The medical staff in 1988 voted to stop seeing most health center patients, thereby abandoning much of the hospital service area. I received a call from the Carney’s CFO that they would no longer support Codman and gave us 90 days to find another hospital partner. 

Five of the seven Carney-affiliated health centers developed relationships with other hospitals:  Bowdoin Street and Little House went with Beth Israel, and Dorchester House, Roslindale, Mattapan, and Codman Square with Boston City Hospital. Only Neponset maintained its primary relationship with Carney.  

As the hospital abandoned the major part of its service area, the health centers severed Carney as their hospital partner. Carney bed occupancy shrank, and Carney administration set up task forces to try to come up with solutions.  I served on every one of those task forces.  

In the early 1990s, a deal was struck for Massachusetts General Hospital to take over the Carney, in the same way that Brigham and Women’s Hospital took over the Faulkner in Jamaica Plain, but the arrangement was later shot down by Cardinal Bernard Law, the leader of the Boston Catholic Archdiocese, who insisted that Carney join an affiliated network of Catholic hospitals called Caritas Cristi. As a result, the Daughters of Charity departed the Carney.

During this period, another shift was the move away from healthcare planning to allowing the market to determine healthcare patterns and services.  This movement resulted in more well-insured patients moving their care to wealthier, high cost teaching hospitals, leaving community hospitals with more low-income patients in lower payment insurance plans. 

Amidst all this, the Carney Hospital lost money, and the Caritas Cristi system faltered while the archdiocese from 2002 on was dealing with financial settlements from the priest sexual abuse scandal.  When Dr. Ralph de la Torre, then CEO of Caritas Cristi, presented an option to the archdiocese to have the Catholic hospitals turned into for-profit hospitals backed by the Cerberus equity firm while maintaining their Catholic identities, the archdiocese jumped at it and Caritas Cristi became Steward Health Care.

In 2010, I was approached by the new Steward Health Care and offered the job of president of the hospital.  At the time, the occupied beds hovered around 100 per night, and the leadership of Steward decided that they wanted to rebuild relationships with the health centers and the Dorchester community. 

Though I didn’t apply for the job, I saw it as an opportunity to rebuild a community hospital around the needs of the Dorchester/Mattapan community and create a family medicine residency and a joint family/psychiatric residency to build primary care capacity in Dorchester.  I even presented the idea of the health centers taking control of the hospital as a new global health care payment system called Accountable Care Organizations (ACO) was emerging.  

I didn’t last long enough as president to pursue these ideas, but in my time at Carney, Ralph de la Torre told me that he had offered the hospital to Boston Medical Center gratis.  Kate Walsh, then the president of BMC, acknowledged that to me but said that renovating the Carney was cost prohibitive. I noted that the hospital had 50 psychiatric beds, which was essential to have in the emerging ACO system, and BMC had none, but she indicated that Dr. de la Torre’s proposal was not going to happen.

The hospital continued to decline and closed with the bankruptcy of Steward in August 2024. Our state government supported the transfer of most of the former Steward hospitals to other systems at a cost of more than a half billion dollars to the Commonwealth and prevailed on UMass Memorial Health to re-create an emergency facility to replace the services formerly offered at Nashoba Valley Medical Center, the only other Steward hospital that closed. 

I urged the Commonwealth to do for the Dorchester/Mattapan community what it did for Allston/Brighton, which was to take the similarly sized St. Elizabeth’s Hospital property by eminent domain, which ultimately cost the Commonwealth $65 million.  I also suggested ways to preserve the Carney emergency room, which treated over 30,000 patients per year, and the psychiatric beds. Kate Walsh, by then the state’s Secretary of Health and Human Services (EOHHS), refused to intervene.

For the past 20 months, Dorchester and Mattapan residents have been waiting to see what will happen with the Carney Hospital property, following promises by Mayor Wu that the land would only be used for healthcare purposes. That wait may soon be over, as HYM Investment Group, in partnership with My City at Peace, has been working on a plan for the 12-acre property with Apollo Global Management, the owner of the property following Steward’s bankruptcy. 

The plan calls for a 350,000-square-foot medical facility, alongside a 150,000 square-foot facility that could be part of the UMass Boston Nursing School, and several hundred housing units, including senior placements.

The medical facility would contain an emergency room, high tech radiology, and potentially other medical services, but, as of now, no desperately needed psychiatric beds are planned. There will be no inpatient medical/surgical beds, but data at the closing of the Carney casts doubt on the need for them. 

Here are some thoughts and questions as we move toward a redevelopment plan:

• Tom O’Brien of HYM and Rev. Jeff Brown of My City at Peace have done an excellent job of engaging the community and determining healthcare options, but Apollo owns the property.   To have this plan work, O’Brien and Brown need to be permanently at the table.  Does their agreement contain this requirement?

• The Commonwealth owes the Dorchester community a rational healthcare plan and system. Will EOHHS agree to become a partner in this project and recreate the lost psychiatric beds?

• How will the new medical facility integrate with the rest of Dorchester/Mattapan’s healthcare system, i.e., the health centers?  

• Will patients of the health centers be able to use the new medical facility, i.e., will the new facility accept the insurances that health center patients have, and accept referrals from the health centers?

• The plan for the medical facility mentions primary care as a possible service, which could be damaging to the health centers if it provides options to better paying private insurance customers.  Will the new medical facility instead support the expansion of primary care in the health centers, rather than compete against the centers? 

• Land was taken from Dorchester Park to expand parking for the Carney Hospital.  Will the plan use this land as restored green space, rather than buildable space?

Many mistakes by state government, archdiocesan leadership, and hospital management led us to where we are today.  Let’s get it right this time.