For over 20 years, I had the privilege of working in the emergency department at Carney Hospital. And I,  like many others, am saddened and worried by the hospital’s imminent closure.  This is not only because old friends are losing their jobs, but also out of an understanding of what the hospital has meant to the community it served.

Carney, like Boston City Hospital before it, has always been an inspiring place to practice, dedicated to the delivery of healthcare to whomever needs it, regardless of resources or demographics. This dedication was not just mouthed as policy. The staff lived it every day. And the hospital’s demise will now leave a gaping hole in the health care system of our state.

Unlike BCH, Carney has always been a private hospital, but it has operated in the spirit of a public institution through its commitment to serving the underprivileged and underserved. It was founded in 1863, a year before BCH, by banker and business executive Andrew Carney and Sister Ann Alexis Shorb, a member of the Daughters of Charity of St. Vincent de Paul. It was the first Catholic hospital in New England. A few years after I began working there, in 1997, it became part of the Caritas Christi Health Care group, which was sponsored by the Archdiocese of Boston.

Caritas then fell on hard financial times, until many believed it could not survive on its own.  In 2010, it sold itself to private equity group Cerberus Capital Management, at which time it became part of the newly formed Steward Healthcare System. Steward and Cerberus, unlike Caritas, are for-profit entities, which made some people nervous about the hospital’s mission and approach to underinsured patients. But whatever you may think of for-profit hospitals, the companies invested heavily in the hospital system. And I can testify that the dedication of the hospital and its staff to their health care mission remained wholly intact after the change in ownership.

Some have blamed Steward and Cerberus for financial missteps that have forced Carney’s closure, and there may be some validity to those accusations — Cerberus reportedly netted $800 million in profit after it sold its stake in Steward in 2020, while Carney hospital has lost money virtually every year under Steward. But to focus on them exclusively is to miss the broader point that many hospitals are struggling financially. In 2022, over half of the nation’s hospitals operated at a loss. In that year alone, the Mass General Brigham system had an operating loss of $432 million.

Hospitals face higher pharmaceutical, supply and administrative costs, a high regulatory burden, and inadequate reimbursement, much of which was exacerbated by the COVID-19 pandemic. As detailed in a March 2024 report by the American Hospital Association, Medicare reimbursement under its main acute-care hospital funding mechanism (IPPS) rose only 5.2% from 2021 to 2023, while cumulative inflation was 12.5%. Medicare and Medicaid underpayments totaled more than $500 billion from 2018 to 2022.  And a McKinsey study revealed that hospitals spent $10 billion in administrative costs in 2019  just to deal with insurers’ prior authorization requirements.

In addition to facing all of those challenges, Carney Hospital has had to manage a patient population that is underinsured, often of limited means, quite ill and medically and socially complicated. Still, it succeeded in delivering a high level of care. The hospital has long excelled in fields that bear the brunt of medical need in many underserved, inner-city areas, like trauma care, social services, infectious disease and substance abuse. And under Steward, it continued to do so. In a given year, over 6,000 patients were transported by ambulance to the hospital, most from Dorchester and Mattapan, and the emergency department saw 30,000 patients. The hospital’s closure will now worsen the scarcity of hospitals in that geographic area.

Most acute care hospitals in eastern Massachusetts sit north of a soft curve that extends  from Boston Children’s Hospital through BMC and B&W-Faulkner out to Framingham. Since the closure of Quincy Medical Center in 2014 and its satellite emergency department in 2020, there have only been two acute care hospitals south of the curve — Carney and Beth Israel Milton — until you reach Good Samaritan and South Shore Hospitals to the east and Milford Regional Medical Center to the west. That’s an area of over 400 square miles.

In light of Carney’s continued financial struggles, its closure has been framed as unavoidable. That may well be the case. Americans understand creative destruction as part and parcel of a healthy economy, with new ventures and structures rising up in the wake of fallen ones — ex ossibus mortuorum. When 130-year-old Boston City Hospital closed in the 1990s, as many of us of a certain age can recall, it was a disruptive and distressing event for the city. But at least the institution was re-imagined as one (Boston Medical Center) that voiced the values and sense of mission of the original. After Charity Hospital in New Orleans  was shuttered in 2005 due to hurricane damage, at least some of its public service responsibilities were assumed by a refurbished University Hospital, which was later integrated into University Medical Center New Orleans, albeit on a different site. And after St. Vincent’s Hospital in Manhattan closed in 2011, part of the campus was renovated and reopened as the Lenox Health Greenwich Village medical center.

But sometimes, when institutions die, nothing rises up from their ashes. When the library of Alexandria was destroyed, many of the literary works, translations, and scientific records of a civilization were simply lost, and society has been poorer for it over the centuries since. This is not to imply that Carney Hospital’s closure is the equivalent of that.  But there is currently no plan in place to reinvent Carney after its demise, so it does mean that the library of health care knowledge in the minds of the nursing and medical providers will be lost to the residents of Dorchester, Mattapan, and surrounding areas, as well as the locally delivered healthcare that this knowledge has underpinned for decades and the commitment of those providers to caring for the underserved.

Sometimes, creative destruction is just destruction.

R.J. Petrella is a physician, scientist and author of the novel “Days of the Giants” (Wide Yard)