IN JANUARY 2024, Gov. Maura Healey’s administration launched the Advancing Health Equity in Massachusetts initiative to address health disparities across the Commonwealth.

Ten geographic areas encompassing 30 communities were targeted after being found to have the greatest health inequities in relation to the two leading causes of premature death in Massachusetts. Dorchester and Ayer were among those communities.

Six months later, the administration said it could not stop their local hospitals from closing.

The news came not long after the announcement of Steward Health Care’s bankruptcy – a financial mismanagement scandal that led to the widely covered demise of one of the country’s largest for-profit hospital chains. Steward operated eight hospitals in Massachusetts, and in the summer of 2024, its executives made deals with the state to sell the facilities. But the crisis renewed calls to end private equity ownership of health care.

The Healey administration helped five of Steward’s hospitals transition to new operators, but Nashoba Valley Medical Center – located in the rural North-Central town of Ayer – and Carney Hospital – located in Dorchester, Boston’s largest neighborhood – were left to close, leaving many to question why the state couldn’t have done more. (Steward’s eighth facility, Norwood Hospital, has been closed since it flooded in 2020.)

Just over one year later, those regions are grappling with strained EMS services, diminished access to care, and trust that has been broken. Local leaders, hospital staff, and residents say they are a testament to the devastation that lingers after communities lose their critical infrastructure.

“If you talk to most people out here, they feel abandoned, let down, hurt,” Ayer Town Manager Robert Pontbriand said. “There was a failure of leadership and commitment to this region, and people are hurting on all levels. They have very long memories.”

A 2024 Boston Globe investigation detailed an “often-accommodating relationship that long persisted between Steward executives and state regulators.” For years, state officials did not discipline the hospital chain for its regulatory violations, scrutinize its insistent expansion plans and cost-cutting efforts, or respond as it headed toward financial ruin.

Healey has since touted that her administration “saved” five of Steward’s hospitals, while also claiming that Carney and Nashoba Valley – where 71 and 65 percent of patient revenue came from Medicaid and Medicare, respectively – were out of their hands. She attributed the closures to the “greed and mismanagement” of Steward’s leaders and financial partners, arguing that the state lacked the authority to prevent it. Steward claimed there weren’t any qualified bids for the two hospitals as there were for the other five.

The administration committed some $835 million to the nonprofit buyers of the other Steward hospitals over three years – $72 million in subsidies to keep the hospitals open during the bankruptcy, $66 million for the eminent domain taking of St. Elizabeth’s Medical Center, and $697 million in ongoing operator support – which helped them meet their bids. The total cost to the state is expected to be $360 million after recoupment and federal reimbursement, according to the Executive Office of Health and Human Services.

The state provided supplemental payments through MassHealth and advanced some of the Medicaid program funds the hospitals would have received anyway. But, it is unclear if federal Medicaid cuts will impact the reimbursements anticipated by the administration.

Steward had neglected investment and upgrades in its facilities for years, adding to the challenge of finding new hospital networks to purchase them. But there were bids for both Carney and Nashoba Valley, and without an explanation of why those deals fell through, the public has been left to speculate.

State Sen. Jamie Eldridge, who represents the Middlesex and Worcester district encompassing Ayer, claims he spoke with executives at St. Joseph’s Hospital, owned by Covenant Health and based in New Hampshire, who were interested in acquiring Nashoba Valley last year and had been in talks with the Office of Health and Human Services. Eldridge says the state didn’t offer enough support to make that purchase viable for St. Joseph’s.

Covenant Health and St. Joseph’s did not respond to a request for comment.

Additionally, it was reported that UMass Memorial Health had been in talks with the state and submitted an offer for Nashoba Valley, but the property owner and private equity giant, New York City-based Apollo Global Management, declined it. “I think the question goes back to – what was the financial offer from the state to make that deal happen?” Eldridge said. “We still don’t really know.”

UMass Memorial and Apollo declined to comment on the purchase offer.

The Globe reported in August 2024 that Insight Health Systems, a physician-owned system operating hospitals for low-income residents in Michigan and Illinois, made bids for all of Steward’s hospitals in Massachusetts, including Carney and Nashoba Valley, which Steward rejected as not qualified. Insight declined to comment.

Residents, hospital staff, and other state and local leaders from the Nashoba Valley and Dorchester regions recognize Steward as the culprit in the death of their hospitals, but also say they feel betrayed by the Healey administration. Pontbriand noted signs posted throughout the town of Ayer that read, “No hospital 2024, no Healey 2026.”

“There’s a great deal of anger, mostly directed at the Healey-Driscoll administration, but I would say at legislators too,” Eldridge said. “Until a hospital comes back, I think it’s going to be really hard to repair that damage and lack of faith in government.”

Steward determined whether the bids were qualified. But the Healey administration still has not answered a litany of questions from both CommonWealth Beacon and other news organizations about what they could have reasonably done to prevent the potential deals from falling through, and it remains unclear whether the state could have attracted and convinced potential, qualified buyers to place bids on Carney and Nashoba Valley by offering funding upfront.

The administration has appeared invested in the deals of the other five hospitals, particularly through its seizure of St. Elizabeth’s Medical Center in Brighton by eminent domain, which kept the hospital open after Apollo rejected the state’s low-ball offer of $4.5 million. The administration took control of the property and transitioned its operations to Boston Medical Center. Apollo sued, and the state ultimately agreed to pay $66 million for the property in a settlement, according to HHS.

“We know how difficult the loss of Nashoba Valley Medical Center and Carney Hospital were to their communities,” a spokesperson from the Executive Office of Health and Human Services said in a statement. “Over the last year we have continued to monitor and assess the communities’ access to health care services.”

In 2024, the city of Boston’s tax records listed Carney Hospital’s assessed property value at $76 million, though the market-rate value was likely much higher. Nashoba Valley was assessed at just over $17 million. The two facilities together employed nearly 1,250 people and saw around 23,000 patients in their emergency departments in 2023.

“You have all these hospitals in crisis. We just wanted the same consideration as others,” Pontbriand said, adding that it seemed the decision not to save the hospital had already been made. As the North-Central region continues to grow, he says the need for services will rise.

“A wound still healing”

Dozens of former nurses, doctors, secretaries, and emergency room staff from Nashoba Valley Medical Center gathered in the parking lot of the shuttered, abandoned building on August 31, exactly one year after the hospital closed. They dubbed it their first annual employee picnic.

There were lighthearted moments, like their yankee swap of old memorabilia from the hospital – parking lot signs, a wall phone, old magazines. They spent the evening catching up on each other’s new jobs and trading old stories from their time at the hospital until it got dark.

But it was hard to forget why they were there.

“It was very bittersweet to see how much our lives have changed in one year,” said former Nashoba Valley nurse Audra Sprague, who worked at the hospital for 17 years. “Something you put so much work into, and you think is so solid, can be taken away in an instant.”

After the 60-year-old hospital closed its doors last year, Ayer Fire Chief Tim Johnston said many in the largely working class, rural community still had hope that the doomed hospital could reopen. But after a year of driving by an empty building, he says the outlook is more dismal.

“We’re a year out, and I guess we realize that the hospital is not coming back,” he said.

In the last year, his small emergency response team has frequently had to call for mutual aid and backup, often when they receive additional calls while all their immediate staff are already out on duty. He said 70 percent of their patients used to go to NVMD. But because Ayer ambulances are being driven further distances to surrounding hospitals, responders are away from the station for extended periods of time.

“You’re taken out of your service area, and what used to be a 40-minute turnaround is anywhere from an hour or two at best,” he said. “It’s been certainly challenging for a small town, because we just don’t come up with additional labor and manpower.”

Speaking at an April budget hearing, then-Health and Human Services Secretary Kate Walsh said the 77-bed facility was an “empty community hospital that people just weren’t using.”

The decision that it was a non-essential hospital – by who? Spreadsheets?

Ayer Town Manager Robert Pontbriand

In its 2024 closure documents, Steward reported average daily census counts that made Nashoba Valley’s patient volume appear low. Steward had been pulling services and staff for months before the hospital closure, according to Sprague, which forced them to transfer more patients and contributed to seemingly low census numbers.

But many decried that the daily census measure only counted patients who were admitted to the hospital and did not include outpatient surgeries or emergency room patients who were transferred or not admitted (both of which were reported separately), nor did it include those who only received medical imaging services at the hospital.

Sprague pointed to Steward’s closure documents filed in bankruptcy court estimating that the number of patients at Nashoba Valley was 31 as of July 15, 2024. Emergency room staff, according to Sprague, determined that 42 patients were seen in the ER alone that day, along with hospital data showing that 37 patients were treated in hospital units other than the emergency department.

“The decision that it was a non-essential hospital – by who? Spreadsheets?” Pontbriand said.

Most of Ayer’s EMS transports and patients now go to UMass Memorial Health’s Leominster campus or Emerson Hospital in Concord, which are approximately 15 and 17 miles away from Nashoba Valley Medical Center. Travel times can be much longer for patients coming from their homes outside of Ayer. For those living in Pepperell, who used to be seen at Nashoba Valley, travelling to Leominster or Emerson is approximately a 20-mile, 40-minute drive.

What started as cracks before the hospital closed soon became deep fissures, Pontbriand said.

Given the traffic on Route 2, ambulance response times can be much longer. Leominster Hospital was already strained before the closure, with emergency departments in the UMass system hitting unprecedented levels in 2024. Dr. Eric Dickson, president and CEO of UMass Memorial, told Spectrum News last year before the closure that the state’s average daily census had reached 860 while the system only had 750 beds.

“If someone had a serious medical emergency, you might not have the ability to save that person’s life if you’re driving a half an hour or 40 minutes to Emerson Hospital in Concord, or to Leominster Hospital, or to Worcester,” Eldridge said.

Sprague, an ER nurse who now works at UMass Memorial’s Clinton Hospital about 15 miles from Nashoba Valley, estimates they are at critical capacity nearly 75 percent of the time. She recently worked four hours past the end of her shift. After being over capacity all day, she said she didn’t feel comfortable leaving two nurses and one doctor with 10 patients in the waiting room and 16 in ER beds.

Emerson’s emergency room visits spiked 24 percent in July compared to July 2024, according to data from DPH. At Clinton, visits were up nearly 11 percent.

Code Help – a surge plan that every hospital in the state is required to have to address emergency room crowding – has become the norm, according to both Sprague and Leominster emergency room secretary Shelly Roy, who said it has gotten worse since the closure.

“Every other day we’re in a Code Help,” Roy said. “They don’t really amount to much except words.”

Roy, who previously worked as the ER secretary at Nashoba Valley, said she often sees 15 to 20 patients in their waiting room in Leominster. In one night, the emergency department received 32 ambulance deliveries. She said it was the worst she has seen.

The influx of patients means people are waiting longer to receive treatment or diagnoses, according to Roy, who said their CAT scan services were recently backed up nearly six hours.

“Now something that should take a couple of hours or even half an hour to diagnose is taking a lot longer because of all the wait times and people that are in the ER,” she said. “It’s a very big deal when people’s lives are lost because they’re not diagnosed fast enough.”

The average length of stay at Health Alliance’s emergency departments was just over six hours as of March, according to a Massachusetts Center for Health Information and Analysis database. Roy said she often sees patients waiting six to eight hours.

Prior to the closure, the region’s median ambulance transport times were mostly aligned with those of the rest of the state. Post closure, that time increased from 12 to 17 minutes for emergency calls, according to a Nashoba Valley Health Planning Working Group report published in March.

There used to be a primary and a backup ambulance in Ayer – both of which have now become primary vehicles. With the addition of a medic truck, Johnston said they don’t have enough staff to operate all three at once. In one weekend in August, the team of four transported patients to a total of seven different hospitals in the region.

“They’ve lost a big piece of what gave them comfort – having a hospital in their area,” Johnston said. “Now … they’re never sure where we’re going to take them.”

The added strain has put wear and tear on the vehicles, but most of all, EMS staff are overwhelmed because of staffing shortages that existed even before the closure.

“EMTs, paramedics – they’re getting tired,” Pontbriand said. “This small regional hospital served 17 rural communities of the Nashoba Valley. It filled a key gap.”

Regional leaders estimated it would cost $9.6 million to sustain their emergency response systems over the next 2 years, according to a formal request sent to Healey’s office in December 2024 and signed by 13 fire chiefs, 11 town and city managers, and the state legislative delegation representing the Nashoba Valley region. The Legislature ultimately provided a $5 million earmark for the communities affected by Nashoba Valley’s closure in the supplemental budget signed by the governor this summer. That funding was part of a $10 million allocation to support EMS statewide.

Those communities have yet to see that funding, and how it will be distributed among the Nashoba Valley region hasn’t been announced. In 2024, DPH also provided $2 million in capital grants for EMS providers throughout the Nashoba Valley region that was split among eight towns.

While helpful, Pontbriand says it doesn’t replace the loss of a hospital.

“We knew that the stress on the emergency response system out here was going to be considerable on two levels, both in terms of response time, but also cost,” Pontbriand said. “The towns out here are not rich towns.”

Nashoba Valley was also one of the area’s largest employers, and nearly 500 jobs were lost.

At Leominster Hospital, Johnston said they often encounter other ambulances from local towns like Shirley and Groton that would have previously gone to Nashoba Valley.

“They just don’t have a bed ready for all the patients, so we end up going up against the wall and waiting for them to get a bed available. Sometimes this can be extended periods of time, so more than 15 or 20 minutes,” he said. “It could be peak periods when we get there, and there’s six or seven ambulances.”

The region has already been hit hard by other hospital closures. Fitchburg’s Burbank Hospital, dating back to 1890, closed in 1997. UMass Memorial closed its pediatric unit at Leominster Hospital in 2018 and its maternity unit in 2023. And Community Healthlink, an affiliate of UMass Memorial, is set to shut down another program in October that provides mental health services for adults in Fitchburg after recently closing two primary care programs – one in Leominster in September 2024 and another in Worcester in March.

After the closure, it took Sprague months to find an available endocrinologist to treat her son with Type 1 diabetes. Her parents, age 84, lost access to their endocrinologist, neurologist, and orthopedist.

I’m worried about what’s going to happen. I’m getting further and further from my health care. How much energy, time, and money do I want to spend in order to get what I need?

Jane McInerny, a 69-year-old Dorchester resident

Rural communities like Ayer with fewer surrounding facilities are likely to be worse off when hospitals close, according to Jose Figueroa, associate professor of health policy at Harvard’s School of Public Health.

“It tends to worsen your underlying chronic diseases if you delay access to care, whether the delay is because you have to switch to a new doctor or travel longer,” Figueroa said. “It impairs your ability to ensure you’re on the right medications. It impairs your ability to get testing that might dictate whether your treatment regimen should be changed.”

The consequences of switching or delaying care are much worse for older adults who are more likely to suffer from chronic underlying conditions, functional limitations, and cognitive impairment, he added. Research suggests that older adults are more likely to struggle finding new providers and are more likely to have been in a long-standing relationship with one doctor. A lack of continuous, trusted care is a cause for concern, as delays can result in a need to be hospitalized for treatment, Figueroa said.

More than half of older Americans now get their Medicare coverage through an insurance company’s Medicare Advantage plan, which often have restrictions on where a patient can receive care that is covered.

“If there’s a hospital that was within network of your current plan and then it closes, not only do you have to figure out who’s the nearest provider that can take care of your problem, but are they within network?” Figueroa said.

“The market has spoken.”

Jane McInerny, a 69-year-old retiree with multiple sclerosis, received nearly all her primary and specialty care at Carney Hospital. She moved to Dorchester in 2019 and lives just a few blocks from the hospital in the Harmon Apartments, a community for adults living with physical disabilities. McInerny, who uses a wheelchair, used to be able to get herself to her appointments in a matter of minutes.

“When I moved here, I felt comfortable with the quality of medical care provided at the Carney, and I said, ‘If I’m in this community and there’s this accessibility, this is where I want to be,’” she said in an interview. “Gov. Healey’s lack of action is really disheartening for me.”

Since the closure, she’s had to find new providers, including a primary care physician, physical therapist, podiatrist, ophthalmologist, and occupational therapist. The closest community health center to Carney, Codman Square, was too busy for her to get in for appointments, reporting nearly a five-month wait time for new primary care patients, according to a Dorchester working group analysis released in April.

Getting set up with an ophthalmologist took McInerny almost a year.

She relies on transportation provided by her health insurance to get to her medical appointments, which are now scattered across Beth Israel Deaconess Milton Hospital, Brigham and Women’s Faulkner Hospital, the Nielsen Eye Clinic in Quincy, Braintree Rehabilitation Hospital, Beth Israel Deaconess Medical Center, and a private office.

“I’m worried about what’s going to happen. I’m getting further and further from my health care,” McInerny said. “How much energy, time, and money do I want to spend in order to get what I need?”

McInerny estimates that instead of seeing certain providers every three to four months, she may start going every six or 12. Now, she must schedule her transportation ahead of time.

While facing a different set of challenges than the rural Nashoba Valley region, Dorchester residents, political leaders, activists, and health care providers fought as fiercely to prevent the closure of Carney Hospital, which has served the community since it was founded in 1863.

Lew Finfer, a community organizer and longtime Dorchester resident, was a former patient at Carney along with his family members. For nearly 40 years he lived two blocks from the hospital. He says passing by it now feels like a “gaping hole.”

“They had this hearing and people got to testify, but it felt halfhearted, because it was done and it wasn’t going to change anything,” Finfer said of the closure last year. “It makes people feel powerless that something like this just gets closed. It leaves them with a bad taste in their mouth.”

He had hoped the state would encourage Boston Medical Center to bid on Carney by offering supplemental funding the administration spent to keep the other hospitals open.

“The state let us down, but people also feel that BMC let Dorchester down too,” he said.

Longtime community activist and former Carney Hospital CEO Bill Walczak pointed to the state’s seizure of St. Elizabeth’s through eminent domain and questioned why the same couldn’t be done for Carney, even if there were no “qualified” bidders.

“The fair way to approach it would have been for the Commonwealth to make the same kind of deal that they made with St. Elizabeth’s of taking over responsibility for Carney Hospital,” he said.

Walczak served as president of the hospital for a brief 14 months from 2010 to 2011. He left after introducing a plan to increase the number of primary care providers, add a maternity unit, and develop a new department of family medicine that was rejected by Steward.

Carney had around 30,000 annual emergency department visits before it closed. Since then, Boston EMS has seen a 20 percent increase in transport times, according to the working group analysis. The number of EMS runs from the Carney region to surrounding hospitals also increased following the closure date.

Boston Medical Center is nearby, but its emergency department is already the busiest in New England and the 11^th busiest in the country. The average length of stay in its emergency department was nearly six hours as of March.

Milton Hospital is just two miles from Carney, but its website has posted a long-term alert: “Due to an increased demand in emergency services, wait times may be longer than usual.” In February, Milton saw a 16 percent increase in emergency department visits compared to the year prior, according to the working group report.

At Codman Square Health Center, urgent care volume increased 12 percent following the closure of Carney. At DotHouse Health, volume increased 10 percent.

Dorchester residents already have some of the lowest life expectancy rates in Boston. But as the state moved forward with the sales of the other five Steward hospitals, Kate Walsh, the former Massachusetts HHS secretary, told reporters “the market has spoken” to explain the closures.

Just a few weeks later, shortly before Carney closed its doors for good, the Department of Public Health declared that the hospital was an “essential service necessary for preserving access and health status within the hospital’s service area.”  What happens when the market fails to deliver in regions where vast health inequities already exist? Walczak said government intervention is needed in low-income communities that don’t have the payer mix for hospitals to break even and stay open.

“Somehow the secretary of health and human services was able to get away with saying ‘the market has spoken’ about a hospital in a community with some of the worst health outcomes in the Commonwealth,” Walczak said. “The notion that somehow our health care system should abide by the wishes of the marketplace, which is determined by finances and profits, was obscene.”

Walczak pushed back on the idea that patients in Dorchester, many of whom don’t own cars, can access hospitals downtown.

“Most of the time, it’s almost impossible to get downtown in any reasonable time period,” he said. “When you’re coming from Lower Mills in Dorchester, it would take you a half an hour to 45 minutes to get into a downtown hospital.”

Carney was also a vital source of 50 in-patient psychiatric beds serving patients with mental health and substance use disorder needs. An ongoing shortage of mental health professionals and a lack of available, specialized inpatient beds means 39 percent of behavioral health-related ER visits in Massachusetts lasted more than 12 hours before discharge or admission between January 2024 and May 2024, up from 31 percent in 2020, according to a 2025 Health Policy Commission report.

Looking ahead

UMass Memorial is moving ahead with $42 million plans to build a new freestanding emergency facility in Groton – just four miles from Ayer – that is expected to open in 2027. DPH approved the system’s proposal in July. But reports of UMass Memorial’s financial stress have left local leaders like Pontbriand cautiously optimistic.

At the groundbreaking ceremony for the facility in September, Healey again laid into Steward’s former CEO, Ralph de la Torre, adding that Steward’s “betrayal” would not be “the end of the story.”

“Today, we recommit to healthcare in this region and across our state,” Healey said to the crowd. “There’s nothing more precious than making sure we have access to care in the most vulnerable moments.”

In a statement, UMass Memorial spokeswoman Shelly Hazlett said reopening Nashoba Valley’s emergency room was the hospital’s “first choice,” but a deal with Apollo couldn’t be reached in a timely manner.

“The timeline related to building this satellite emergency facility is comparable to what it would have been to acquire and upgrade the former Nashoba facility,” Hazlett said. “By building a facility from the ground up, we can optimize the design to enhance patient flow, support modern technologies, and improve operational efficiency.”

The facility is expected to offer imaging, lab services, observation beds, and a helipad for transfers in addition to surgical and other emergency services. It will not have inpatient beds.

A similar stopgap has yet to come to fruition in Dorchester.

HYM Investment Group, a company led by Thomas O’Brien, former director of the Boston Redevelopment Authority, recently signed a contract with Apollo to begin formulating a redevelopment plan for the site, the Dorchester Reporter reported this month.

HYM will partner with the local advocacy group My City at Peace (MyCAP) to create a plan for the property. The new site will likely include a health care component along with housing and open space, according to O’Brien, although no specific plans have been introduced. Neither he nor MyCAP responded to interview requests.

“We recognize the important role the Carney Hospital has played in the Dorchester community,” O’Brien said in a statement. “Together, HYM and MyCAP welcome conversations with all who care about the site’s future and look forward to presenting a plan that includes a healthcare component and reflects the needs of Dorchester.”

Boston Mayor Michelle Wu has repeatedly said her administration will block any redevelopment efforts that do not include a health care component. Her office did not answer questions about the new contract for the site, which is currently zoned for multifamily residential use.

For the local leaders, health care workers, and residents that fought for their hospitals, but were left behind, one question remains: Why?

“I think part of the community is still looking for that lifeline to come back,” Johnston said. “When is the state going to come swooping in and save us? We don’t have an answer for that.”