Earlier this year, a Maltese magistrate concluded a four-year investigation into the matter and recommended that Ernst and de la Torre be charged with money laundering, criminal association, and corruption of public officials, including the nation’s former prime minister, Joseph Muscat, the Globe reports.
Meanwhile, new allegations of domestic dealings continue to come to light. In a separate investigative story Monday, the Globe reported that Steward executives used Steward-owned malpractice insurer TRACO “like a piggy bank.” The Panama-based TRACO was supposed to work like an independent insurer for the hospital chain; Steward would pay TRACO malpractice insurance premiums on behalf of its doctors and the pooled money would be used to litigate and pay out claims. But, instead of paying premiums, Steward gave TRACO IOUs. By the end of 2023, TRACO’s accounting records showed $99 million in outstanding loans, most owed by Steward, and $176 million in “accounts receivable,” also mostly owed by Steward.
With Steward now in bankruptcy, insurance coverage for health care providers is now in question, as are payouts to patients who were harmed by Steward’s care. The Globe noted the case of Yasmany Sosa, whose 35-year-old wife, Yanisey Rodriguez, died a preventable death after giving birth at Steward North Shore Medical Center in Florida in September 2022. Steward agreed to a $4 million settlement with Sosa in March, but the money hasn’t appeared, leaving Sosa in limbo and struggling.
“They killed my wife, that’s for starters. Second of all, they destroyed my family,” Sosa told the Globe through a translator. “This has all become a bunch of loopholes, legal strategies. This really is very difficult for me… I’ve already lost everything.”
The western North Carolina plant that makes 60 percent of the country’s intravenous fluid supply has restarted its highest-producing manufacturing line after being ravaged by flooding brought by Hurricane Helene last month.
While it’s an encouraging sign of recovery as hospitals nationwide struggle with shortages of fluids, supply is still likely to remain tight for the coming weeks.
IV fluid maker Baxter Inc, which runs the Marion plant inundated by Helene, said Thursday that the restarted production line could produce, at peak, 25 percent of the plant’s total production and about 50 percent of the plant’s production of one-liter IV solutions, the product most commonly used by hospitals and clinics.
“Recovery progress at our North Cove site continues to be very encouraging,” Baxter CEO and President José Almeida said. “In a matter of weeks, our team has advanced from the depths of Hurricane Helene’s impact to restarting our highest-throughput manufacturing line. This is a pivotal milestone, but more hard work remains as we work to return the plant to full production.”
Overall, Baxter said it is ahead of its previously projected timeline for getting the massive plant back up and running. Previously, the company said it had aimed to produce 90–100 percent of some products by the end of the year. Still, the initial batches now under production are expected to start shipping in late November at the earliest.
One of the many challenges to restoring the facility was the lack of access to the site; Helene had damaged an access bridge. In its latest announcement, Baxter said that a temporary bridge—built with support from North Carolina’s Department of Transportation and the federal Administration of Strategic Preparedness and Response (ASPR)—has allowed the transport of more than 885 truckloads of existing inventory out of the plant since Helene. A second temporary bridge, expected to be completed in early November, will enable further access of traffic and equipment to the site.
Hurricane Helene’s catastrophic damage and flooding to the Southeastern states may affect the country’s medical supply chain.
Hospitals nationwide are bracing for a possible shortage of essential intravenous fluids after the cataclysmic storm inundated a vital manufacturing plant in North Carolina.
The plant is Baxter International’s North Cove manufacturing facility in Marion, which is about 35 miles northeast of Asheville. Helene unleashed unprecedented amounts of rain throughout the western part of the state, killing dozens and ravaging numerous communities, homes, and other structures, including the plant.
The North Cove plant produces 60 percent of the country’s supply of IV solutions, typically producing 1.5 million bags per day, according to the American Hospital Association. The dozens of sterile solutions Baxter makes at the facility are used for everything from intravenous rehydration and drug delivery to peritoneal dialysis used to treat kidney failure.
“Our hearts and thoughts are with all those affected by Hurricane Helene,” Baxter CEO José Almeida said in a statement on September 29. “The safety of our employees, their families, and the communities in which we operate remains our utmost concern, and we are committed to helping ensure reliable supply of products to patients. Remediation efforts are already underway, and we will spare no resource—human or financial—to resume production and help ensure patients and providers have the products they need.”
Critical supply
On October 2, Mass General Brigham, Massachusetts’ largest hospital and health care system, warned employees via email of a “serious and immediate IV fluid shortage,” according to the Boston Globe.
Enlarge/ The name placard for Dr. Ralph de la Torre, founder and chief executive officer of Steward Health Care System, in front of an empty seat during a Senate Health, Education, Labor, and Pensions Committee hearing in Washington, DC, on Thursday, September 12, 2024.
Lawyers for Ralph de la Torre—the Harvard University-trained cardiac surgeon who took over the Steward Health Care System in 2020—told senators in a letter last week that he was unable to testify at the hearing. Despite previously agreeing to the hearing, de la Torre and his lawyers argued that a federal court order stemming from Steward’s bankruptcy case, filed in May, prevented him from discussing anything amid reorganization and settlement efforts.
But that argument was found to be without merit by the Senate committee that issued the subpoena in July—the Senate Committee on Health, Education, Labor, and Pensions (HELP), chaired by Bernie Sanders (I-Vt.). In comments to the Associated Press Wednesday, Sanders said there were plenty of topics he could have safely discussed.
“Tell me about your yacht”
“He has decided not to show up because he doesn’t want to explain to the American people how horrific his greed has become,” Sanders said. “Tell me about your yacht. Tell me about your fishing boat. I want to hear your justification for that. Tell that to the community where staff was laid off while you made $250 million.”
On Thursday, lawmakers prepared a seat for de la Torre at the hearing, but it stayed empty.
In a statement to ABC News Thursday, Steward defended de la Torre’s absence. “The Committee continues to ignore the fact that there is an ongoing settlement effort underway with all interested parties that paves the way to keep all of Steward’s remaining hospitals open and preserve jobs,” the statement said. “Dr. de la Torre will not do anything that could jeopardize this effort.”
Lawmakers, meanwhile, have moved forward with plans to pursue civil and criminal contempt of Congress charges. “A witness cannot disregard and evade a duly authorized subpoena,” ranking member Bill Cassidy (R-La.) said at today’s hearing. “Therefore, today, the chair and I will be asking the committee to report a resolution to authorize civil enforcement and criminal contempt proceedings against Dr. de la Torre requiring compliance with the subpoena.” The committee has scheduled a session on Thursday, September 19, to adopt the two resolutions.
While the star witness was AWOL, the hearing moved on, offering stunning and horrifying testimony from two Massachusetts nurses and Louisiana state leaders who experienced the conditions at Steward’s hospitals, which number over 30 across eight states. The most heart-wrenching testimony came from Ellen MacInnis, a nurse at St. Elizabeth’s Medical Center in Boston, which was taken over by Steward.
Enlarge/ Miami Beach, Fire Rescue ambulance at Mt. Sinai Medical Center hospital. ]
Since 2021, federal law has required hospitals to publicly post their prices, allowing Americans to easily anticipate costs and shop around for affordable care—as they would for any other marketed service or product. But hospitals have mostly failed miserably at complying with the law.
A 2023 KFF analysis on compliance found that the pricing information hospitals provided is “messy, inconsistent, and confusing, making it challenging, if not impossible, for patients or researchers to use them for their intended purpose.” A February 2024 report from the nonprofit organization Patient Rights Advocate found that only 35 percent of 2,000 US hospitals surveyed were in full compliance with the 2021 rule.
But even if hospitals dramatically improved their price transparency, it likely wouldn’t help when patients need emergency trauma care. After an unexpected, major injury, people are sent to the closest hospital and aren’t likely to be shopping around for the best price from the back of an ambulance. If they did, though, they might also need to be treated for shock.
According to a study published Wednesday in JAMA Surgery, hospitals around the country charge wildly different prices for trauma care. Prices for the same care can be up to 16-fold different between hospitals, and cash prices are sometimes significantly cheaper than the negotiated prices that insurance companies pay.
“The findings illustrate substantial, and often irrational, variations” in trauma pricing, according to the study authors—a group of researchers at Johns Hopkins and the University of California, San Francisco. They suggest that “price variations cannot be explained by trauma severity alone.”
For the study, they obtained data on “trauma activation fees” (TAFs) from hospitals across the US. TAFS were created in 2002 to be standardized billing codes that would help recuperate readiness costs for trauma care. Those overhead costs are what hospitals pay to maintain readiness to provide emergency trauma care around the clock, including having operating rooms constantly ready, as well as sufficient staffing, equipment, and supplies, like blood products. TAFS are billed with four codes corresponding to trauma response levels (I through IV), which are based on standardized criterion of injury severity. These fees are in addition to billing for a patient’s actual medical care.
Wide variation
The researchers pulled TAF data from a platform that aggregates hospital-disclosed pricing data called Torquise Health. From there, they obtained 3,093 unique TAF observations across 761 unique hospitals in 49 states. They broke out TAF fees by different types of trauma response levels as well as types of prices: list prices, cash prices often paid by the uninsured, and negotiated prices paid to insurers.
The prices varied dramatically for each trauma level and pricing type. For instance, for the most severe trauma response level (level I), the median TAF list price was $6,607, while the median negotiated price was $3,431, and the median cash price was $2,663. For the list prices, the span between the 10th percentile prices and the 90th percentile prices went from a low of $1,650 up to 11 times more than that: $18,500. Looking across the percentiles for the negotiated prices, costs ranged from $900 to 11,661, 13 times more. And the cash prices ranged from $660 to $8,190, 12 times more.
The largest spread was seen in the cash prices for trauma response level II TAFs. There, the median cash price was $2,630, but the span between the 10th and 90th percentiles was $768 to $12,140, which is 16 times more.
In all the data, cash prices were often lower than the negotiated prices. This is good for uninsured patients who may be offered cash prices, but it’s not great for the insured. “One could argue that insured patients who are already paying insurance premiums should not pay more than cash prices,” the authors wrote.
Overall, the pricing and lack of transparency is a problem that requires intervention, the authors conclude. “The unexpected and pressing nature of trauma means patients are sent to the closest appropriate hospital and unable to compare prices as they do with nonemergency and shoppable medical services,” the authors wrote. Moreover, the people who will suffer the most from these wide-swinging prices are the uninsured and most financially vulnerable patients, they add.
![Miami Beach, Fire Rescue ambulance at Mt. Sinai Medical Center hospital. ]](https://cdn.arstechnica.net/wp-content/uploads/2024/04/GettyImages-1189385839-800x533.jpeg)
