Mass Attorney General Calls for St. Elizabeth's to Become Community Hospital

Massachusetts Attorney General Martha Coakley released a report yesterday making series of recommendations related to governance, management, and organization to help the Caritas Christi Health Care System (CCHCS) to "address the challenges it faces and achieve stability." The Attorney General's study was done by an outside group, the Health Strategies & Solutions, Inc. (HSS).

The Caritas system as a whole has been plagued by financial problems, including a very low operating margin of 0.8% (compared with 3% for a "healthy" non-profit) and continued losses in the Caritas Physician Network (expected to be $15 million in 2008, down from $30 million in 2007). It has been without a permanent replacement for its chief executive officer for nearly two years.

St. Elizabeth's Medical Center in Brighton Center is part of the Caritas system, and operates as a teaching hospital affiliated with Tufts Medical School. The Boston Globe noted that St. Elizabeth's "is among the worst-performing hospitals in the Boston area, according to statistics compiled by the state Division of Health Care Finance and Policy."

The Attorney General's report makes a series of recommendations that, if fully implemented, could change the nature of the services provided by St. Elizabeth's. Some of the report's recommendations, from the Attorney General's press release and the viewgraphs accompanying it, are:

• Diocesan leadership should relinquish control over strategic, operational, and financial matters to the independent Board of Governors. Diocesan leadership should retain influence only over matters of religious direction.
• St. Elizabeth’s Medical Center in Brighton should continue its realignment as a community teaching hospital, with a concentration on two or three major service lines:
• CCHCS leadership perceives one opportunity to be in the area of cardiovascular services.
• Caritas St. Elizabeth’s should focus on its core service area, for the most part competing with local hospitals for patients.
• HS&S understands that CCHCS has initiated a process to develop a contemporary strategic plan for Caritas St. Elizabeth’s.
  
• The previous CCHCS administration developed a “System Forward” strategy which identified Caritas St. Elizabeth’s as the tertiary/quaternary referral center hub of CCHCS. Current CCHCS management understands that this is not a practical strategy.
• Caritas St. Elizabeth’s has insufficient resources and capabilities to compete successfully for a wide range of tertiary care services in the highly competitive Greater Boston marketplace.
• Caritas St. Elizabeth’s should function as a community teaching hospital, with continued emphasis (and development of advanced capabilities) in two to three major service lines where it can be competitive.
• CCHCS has initiated a process to develop a contemporary strategic plan for Caritas St. Elizabeth’s.
• Financial losses resulting from employment of or contractual arrangements with physicians should be addressed as a top priority.
  
• Failure to successfully address these issues in a timely manner will result in deterioration of CCHCS’ competitive and financial positions.
  

According to the HHS presentation, having St. Elizabeth's operate as a tertiary care services facility appears not to have worked because: (1) St. Elizabeth's is "not clinically prepared or capable" of being a tertiary center; and (2) doctors from other hospitals in the system were not making referrals to St. Elizabeth's due both to the geographical distance between Caritas hospitals.

The Archdiocese of Boston owns the Caritas system. It has been looking to sell it for several years, but has limited the search to buyers who would maintain the religious foundation of the system. One buyer, Ascension Health of St. Louis, backed out of an agreement to purchase the system after disclosure that the physicians group had overstated its revenue by $10 million. A subsequent sale attempt to Catholic Health Initiatives of Denver also fell through.

The recommendation for the Archdiocese to relinquish governing control over the system is the top priority, according to a letter written by the Attorney General:

The most compelling priority confronting Caritas is the need for the Archdiocese of Boston to relinquish direct and indirect control over strategic, operational, and financial matters of Caritas while retaining influence only over matters of religious direction. Operating a hospital system is an extraordinarily complicated business, a recognition that has led virtually all religious organizations throughout the nation to transfer control to lay boards while in most cases maintaining a commitment to the religious principles upon which the systems were founded. Indeed, last year, the Archdiocese approached three different national organizations about potentially assuming control of Caritas -- all are lay organizations that adhere to and promote the religious principles of the Catholic faith.

It is in the best interests of Caritas that the Archdiocese transfer total control of the business of the system to an independent Board of Governors, which should have the sole authority to choose Board members and the chief executive, and to run Caritas in the manner it deems appropriate with no outside influence except on matters of religious direction.

Governance has been a recent problem for the Caritas system. Its chief executive officer, Dr. Robert Haddad, stepped down in 2006 due to allegations of sexual harassment. Caritas has been unable to fill that position ever since, resulting in a lack of top leadership during a time of challenging finances and competition.

St. Elizabeth's is currently undergoing a major construction project to expand and modernize its emergency department with a new building at the intersection of Washington Street and Cambridge Street. A new access road, which would start from near the intersection of Washington Street and Monastery Road, appears to be on hold since it was disclosed last summer that the archeological excavation would be required at the site. The access road also would pass close to St. Gabriel's Monastery, which is classified as a Local Landmark and is on the State Register of Historic Places.

Here's a link to the Boston Globe story about the Attorney General's Report in Friday's paper.

It's Official: In Boston, St. Patrick's Day Will Be Celebrated On St. Patrick's Day

As most people know, the Roman Catholic Church's celebration of St. Patrick occurs annually on March 17.

This year the lunar calendar has resulted in an early Easter on March 23, which causes St. Patrick's Day to fall on Holy Monday -- the second day of Holy Week. (March 22nd is the earliest possible date for Easter.)

Irish bishops decided in 2007 to move the feast day of St. Patrick in 2008 to be earlier, on Saturday, March 15, to avoid the conflict. They didn't want to postpone St. Patrick's Day to April 1st, because it would create a scheduling mess with the civil celebrations.

Seán Cardinal O'Malley, Archbishop of Boston, notes, however, that Saturday, March 15 now conflicts with the official church calendar schedule for celebration of St. Joseph. (Did the Irish bishops realize this conflict?) Cardinal O'Malley doesn't want to bump the feast of St. Patrick a day earlier because March 14 is a Friday during Lent -- which is a traditional day of fasting (although now it is observed by not eating meat).

So Cardinal O'Malley has chosen instead to strike out a different path within the Archdiocese of Boston by celebrating the liturgical Mass for St. Patrick on March 17th, i.e., on St. Patrick's Day itself. That day also happens to fall on Evacuation Day, a civil holiday here.

There we have it: this year, St. Patrick's Day will be celebrated as a religious day on St. Patrick's Day -- here in the Archdiocese of Boston, but not in Ireland or in many other dioceses that follow the Irish bishops' lead.

Fortunately, this big mess won't happen again any time soon:

This marks the first time the date has been changed since 1940. The next conflict with Holy Week is not expected until 2160.

The construction mess over at St. Elizabeth's Medical Center has caused their annual Easter Egg Hunt to be moved over to the (former) St. John's Seminary land for the second straight year. But this year, it will occur a week early -- on Saturday, March 15th, the date of the entire church's St. Joseph's Day as well as the Irish bishops' St. Patrick's Day.

Next week: How I Learned to Stop Worrying and Start Leaping by Loving the Gregorian Calendar.

Tree Removal Hearing for St. Elizabeth's: Friday, 8/24, at 10 am

From the A-B TAB community notes listing:

Tree removal hearing

The Boston Parks and Recreation Department will be hosting a public hearing to discuss the removal of seven public shade trees at St. Elizabeth’s Hospital in Brighton on Friday, August 24, at 10 a.m. The hearing will be held in the Conference Room of the Boston Parks and Recreation Department located at 1010 Massachusetts Avenue, 3rd floor, Roxbury.

The hearing will discuss an application for seven tree removals on Cambridge St. due to the interference with the expansion of St. Elizabeth’s Hospital. The trees to be removed are thornless honey locusts and have a combined diameter at breast height of 27.5”.

The public hearing will be held by the City of Boston Tree Warden (or designee), who may accept or deny the application. If you have any questions or comments regarding this hearing, please contact the Boston Parks and Recreation Department at (617) 635-4505 or by submitting written comments to: Boston Parks and Recreation Department, Attn: Cambridge St. Tree Hearing, 1010 Massachusetts Avenue 3rd Floor, Boston, MA 02118 no later than Friday, August 17, 2007. A decision regarding the tree removals will be made within two weeks of the hearing.

For further information, please contact Greg Mosman of the Boston Parks and Recreation Department at (617) 635-7275.

St. Elizabeth's Medical Center's New Access Road Temporarily On Hold

St. Elizabeth's Medical Center recently received approval from its BRA institutional task force, the BRA Board, and the Zoning Board for their Institutional Master Plan and its Large Project, a new Emergency Room building at the corner of Cambridge Street and Washington Street.

An element of that project is the construction of a new access road to the ER which would run from the intersection of Washington Street and Monastery Road, alongside the historical landmark St. Gabriel's Monastery, and through a grove of trees.

Rumors were floating around Brighton in the last weeks that St. Elizabeth's had run into a snag: despite ground-breaking on the ER site itself, the access road has appeared delayed. The Boston Herald reports on some details of that delay: the office of the Secretary of the Commonwealth, and the Massachusetts Historical Commission, are requiring St. Elizabeth's to conduct "an excavation... because of its proximity to a historic monastery and cemetery and what were once a Colonial-era farm and a Native American campsite."

No human bones have been found in the work to date. State officials are reviewing the archeological findings.

The A-B TAB reprinted the story. Unfortunately, they are running a photo of the ER location (with the caption "Work on the proposed site of an access road..."), not the actual access road several hundred yards away. Oops.

Sale of Caritas Christi Hospitals Cancelled: What About St. E.'s New ER?

Friday's Boston Globe reported Friday that the sale of the Catholic hospital chain Caritas Christi is now formally cancelled. This confirms the month-long suspicion following last month's notice that the physician's group at St. Elizabeth's Medical Center, which is the flagship hospital in the chain, overstated its revenue by $10 million.

The obvious question, however, wasn't even posed by the Boston Globe: What does this mean for St. Elizabeth's plans to build a brand-new, state-of-the-art Emergency Room building at the corner of Washington Street and Cambridge Street?

The chain has $275 million in debt, declining patient volume, and, according to the Globe, St. E.'s "is among the worst-performing hospitals in the Boston area, according to statistics compiled by the state Division of Health Care Finance and Policy."

The BRA Board approved their master plan in April, ceremonial ground-breaking took place recently, and site preparation has been underway. A comment on a previous post noted that the statue of Mary was moved a few days ago. The hillside location for the ER looks awful as of today -- "denuded," as one woman told me, "like a plucked-bare mound of Venus":



My guess is that the ER construction will go forward regardless. (St. E.'s did not respond to a request for comment on the impact.) It sounds like St. E.'s could continue to spend the chain deeper into debt with the hope of building advanced facilities that will attract more physician referrals, and hence, revenue. Let's hope they don't spend the chain into bankruptcy first.

St. Elizabeth's Starting Site Preparation for New Emergency Room

No sickening smack yet, but it's probably just around the corner: St. Elizabeth's Medical Center has conducted their formal, photo-op ground-breaking for the site of their new Emergency Room. No excavation yet while they still do site preparation. Fences have been seen blocking off access to the hillside site.

Few in the neighborhood doubted the need for St. Elizabeth's to update their aging ER facility.

The project's associated loss of open space (and trees), however, didn't please everyone:

“I realize that the hillside will disappear and I accept that,” [said Charlie Vasiliades], “but I don’t feel that St. E’s offered enough in return to compensate for the loss of that green space.”

Vasiliades wanted the hospital to grant a permanent easement on the land behind the campus abutting the future new access road, in order to prevent any future development there.

Thneeds 1, Brown Bar-ba-loots 0.

A Sickening Smack: St. Elizabeth's Medical Center Tree Chopping Project

The day is fast arriving when St. Elizabeth's Medical Center will chop down more than a dozen trees on their property to make way for a (temporary) access road.



There have been orange stakes with red flags the last few weeks scattered throughout both the site of the new emergency room and the new access road.

The access road land has been classified under Article 51 of the zoning code as a Conservation Protection Subdistrict overlay (as well as another overlay of the institutional master plan area); obviously, conservation holds little sway when the institution rammed this road through the Article 80 institutional master plan process.

Such a lovely sight for the moment:

And at that very moment, we heard a loud whack!
From outside in the fields came a sickening smack
of an axe on a tree. Then we heard the tree fall.

BUT...
business is business!
And business must grow
regardless of crummies in tummies, you know.

I hope we can someday bring back the Brown Bar-ba-loots, Swomee Swans, and Humming-Fish.

(The Lorax, Copyright 1971 by Dr. Seuss Enterprises, L.P.)

Easter Egg Hunt: Saturday April 7th

St. Elizabeth's Medical Center is hosting the annual Easter Egg Hunt this Saturday, April 7th (rain, snow, sleet, freezing rain, fog, or shine).

The location this year will be the Archdiocese's Chancery at 2121 Commonwealth Avenue in Brighton. (The usual location is about to become a construction site.)

The festivities kick off with a toddler hunt at 9:30 am (under three years old).

The all-out egg hunt for children age three and over begins at 10:00 am.

Here's a picture of the mayhem from last year: