Steward Health Care

Steward Health Care was a large private for-profit health system headquartered in Dallas, Texas. It utilizes an integrated care model to deliver healthcare across its hospitals and primary care locations, as well as through its managed care and health insurance services. At the start of 2024, Steward operated 33 hospitals and employed 33,000 people in the United States, however that number has decreased significantly due to the company's May 2024 bankruptcy filing. Steward's international ventures include Steward Colombia, which operates four hospitals, and Steward Middle East, which operates in Saudi Arabia and the United Arab Emirates.

At its height, Steward was the largest private hospital system in the US, with 37 hospitals consisting of almost 8,000 inpatient beds, over 25 urgent care centers, 42 skilled nursing facilities, and a large physician network, in total employing about 42,000 people across the United States and Malta.

Steward began in 2010 in Massachusetts, when private equity firm Cerberus Capital Management acquired the failing non-profit Caritas Christi Health Care system. This move was led by Caritas CEO Ralph de la Torre, MD, a former cardiac surgeon who became founder and CEO of the new system, a position from which he resigned on October 1, 2024. Steward mainly operates in the United States, with locations across the country. Since 2016, Steward has fueled its national expansion with debt-driven mergers and acquisitions, largely financed through sale-leaseback deals with its principal landlord, Medical Properties Trust (MPT), in which Steward purchases hospitals and immediately sells the real estate to MPT in order to recoup costs, pay investors, and fuel further expansion, in turn entering into triple-net lease agreements with MPT to be paid by the hospitals.

Cerberus, having made a profit of about $800 million over 10 years, made its exit in 2020 by giving its shares in Steward to a group of Steward physicians led by de la Torre in exchange for a convertible bond worth $350 million. Steward is owned by said physicians (90%) and MPT (10%). While Steward says that selling and leasing their hospital properties (a practice they call "asset light") allows them to prioritize patient care, experts have described it as a contributing factor to the system's later financial difficulties and resulting patient care and safety concerns. Following months of reported financial issues and billions in unpaid bills, Steward filed for Chapter 11 bankruptcy on May 6, 2024.

Internationally, Steward is known for its role at the center of a major corruption scandal in Malta, the result of a nullified public–private partnership to run and improve several of the island nation's public hospitals which has led to criminal charges against multiple former Maltese government officials. In May 2024, Maltese authorities recommended charges against Ralph de la Torre and multiple other Steward executives in relation to accusations of bribery, misappropriation, and money laundering. Separately, Steward International has opened two hospitals in Colombia and performs consulting work in the Middle East with a plan to build a hospital in Saudi Arabia.