Prospect safety net hospitals continue to struggle under the legacy of Leonard Green’s past ownership

In CT and PA, the future remains uncertain for Prospect’s financially distressed hospitals and the communities they serve.

Prospect Medical Holdings, a safety net hospital system with 16 hospitals across California, Connecticut, Pennsylvania, and Rhode Island,[1] is facing financial distress at many of its locations less than three years after private equity owner Leonard Green and Partners exited its investment. As Prospect has been attempting to sell its struggling hospitals in Connecticut and Pennsylvania, it has been met with regulatory obstacles and ongoing financial troubles that have held up potential sales.

At Connecticut’s three Prospect hospitals, the situation is especially dire following a ransomware attack in August that has worsened an already troubling financial situation. This development has thrown a wrench in the prospective deal to be acquired by Yale New Haven Health, and hospital leaders and state officials are attempting to negotiate an updated price for the deal, and potentially even state funding, to keep the hospitals open.[2] Hospital leaders and some legislators fear the imminent closure of these three safety net hospitals if a deal does not go through.[3][4]

In Pennsylvania, Prospect’s failed attempt to sell its four Crozer Health hospitals in 2022 has been followed with layoffs and services cuts.[5] In October 2023, the state Attorney General agreed to suspend a lawsuit filed in 2022 related to Prospect’s attempted closure of one of the Pennsylvania hospitals in order to provide a 270-day period for Prospect to sell the Crozer system.[6] It remains to be seen if Prospect will be able to find a willing buyer that can help get the hospitals back on their feet.

In both the Connecticut and Pennsylvania cases, Prospect does not appear to have the ability to operate these hospitals much longer without risk of closures or substantial cuts to jobs and services, and thus selling these hospitals to financially healthy buyers is a critical step forward to protect healthcare services for the impacted communities.

The financial distress of Prospect’s Connecticut and Pennsylvania hospitals, and the risks to communities in losing access to local healthcare services, are the legacy of Leonard Green’s past ownership of the health system, in which the private equity firm and other investors looted safety net hospitals to pay themselves millions in dividends.

How Leonard Green looted Prospect
Over the course of its ten-year ownership, Leonard Green and Prospect’s minority owners took approximately $658 million in fees and dividends from Prospect in part by saddling it with debt and using the proceeds of the loans to pay themselves.[7] They collected this money out of Prospect even as many of its hospitals suffered deteriorating financial conditions and quality concerns – between FY 2015 and FY 2020, Leonard Green continued to profit while the hospital company took a $603 million cumulative comprehensive loss.[8]

Following the dividend recapitalizations, some of the hospitals ran out of cash, forcing the owners to provide a $41 million emergency cash infusion.[9] Later that year the owners collected $44 million to offset the cash infusion.[10] Prospect was eventually able to pay off the existing $1.1 billion in debt it had accrued in part to fund dividends, but only by selling off the bulk of Prospect’s real estate for approximately $1.4 billion to a real estate investment trust (REIT) through a sale-leaseback transaction.[11] The transaction, which included the real estate for Prospect’s CT and PA hospitals,[12] replaced debt with lease liabilities and left Prospect with fewer assets.[13]

Connecticut hospitals on the brink of financial ruin as deal with Yale New Haven Health stalls
At Prospect’s three hospitals in Connecticut, the financial situation is especially grim. The hospitals reportedly owe millions to vendors and contract physicians,[14][15] as well as $1.67 million in back taxes and interest to the state.[16] Prospect reportedly was also missing rent payments to its REIT landlord, Medical Properties Trust, through much of 2023.[17][18] A recent recapitalization transaction in May 2023 that would give MPT a stake in Prospect’s managed care business indicates that Prospect owed at least $68 million to MPT.[19][20]

Yale New Haven Health agreed to purchase the three struggling Prospect hospitals in early October of 2022.[21] The following month, Yale New Haven filed for its certificate of need associated with its intent to acquire Prospect hospitals in Connecticut.[22] The lengthy state review process was still ongoing when Prospect’s hospitals around the country were hit with a ransomware attack in late July 2023.[23]

The ransomware attack was particularly harmful at Prospect’s Connecticut hospitals: Waterbury Hospital, Manchester Memorial Hospital, and Rockville General Hospital. In an October 2023 article, the CT Mirror reported that “the cyberattack was far more debilitating than [Connecticut] hospital officials publicly acknowledged in August.”[24]

The attack, which began on July 31,[25] lasted almost six weeks, and impacted patient care and access to care for people in local communities. According to the CT Mirror, emergency care had to be diverted to other hospitals, including as far away as Massachusetts, for the initial 17 days, about half of scheduled elective procedures had to be cancelled, and the hospitals “at times over the nearly six-week period couldn’t process X-rays or CT scans that are vital for treating potential stroke or heart attack victims.” The state also needed to advance $75 million to the hospitals because they were unable to bill Medicaid while their systems were down. As of early October, the hospitals still needed to use paper checks to pay vendors.[26]

Recent research on the impacts of ransomware attacks on hospitals has demonstrated that not only do such attacks decrease hospital volumes and reduce revenue, but that they “increase in-hospital mortality for patients who are already admitted at the time of attack.”[27]

Axios reported in late August that the Rhysida ransomware gang had claimed responsibility for the attack and claimed to have stolen 500,000 social security numbers, passport and drivers’ license copies, and financial documents, which it was auctioning off on the dark web.[28] The attack exposed at least 24,000 current and former employees’ private information. Some patient data was compromised, but the full extent to which this occurred across the 16-hospital system has not yet been reported.[29][30]

While Prospect is offering two years of credit monitoring and identity protection services to impacted employees in Connecticut,[31] such steps are not enough to guard against potential liabilities from class action lawsuits. Prospect is already facing at least one class action lawsuit related to the ransomware attack.[32]

The ransomware attack had a severe impact on the Connecticut hospitals’ already struggling financial condition, as well as Yale New Haven’s willingness to proceed with the planned acquisition based on the original terms of the deal. Yale is now seeking a lower price for the three hospitals, in addition to $80 million—$16 million per year over 5 years—from the state to update the hospitals’ computer systems and help pay for “recovery efforts” from the cyberattack.[33]

In September, 30 Connecticut legislators and hospital executives met with Governor Ned Lamont to share concerns that if the Yale New Haven deal to acquire Prospect hospitals does not get approved imminently, the hospitals are at risk of major reductions in services or even closure.[34]

State Senator Saud Anwar told the CT Mirror that “ ‘With [Prospect’s] lack of funding and capacity with the cyberattack, their survival may be impacted if the state delays this sale or [approves it] with contingencies that are going to make Yale walk away…The fear we have at this point is if, God forbid, something like that happens … then the deal will fall through and the hospitals will have to close, which would mean thousands of jobs would be lost and hundreds of thousands of people in our state would be without health care.’”[35]

Governor Lamont told the CT Mirror in late October that he “sees no reason for the state to chip in taxpayer funds, but Yale is free to renegotiate the purchase price.”[36] After some hang-ups around the confidentiality of negotiations between the state, Yale, and Prospect, talks have resumed.[37]

Prospect’s failure to sell Crozer Health system in Pennsylvania leads to layoffs, service cuts, and uncertainty
Prospect’s four hospitals in eastern Pennsylvania, under the name of Crozer Health, have also struggled significantly since Leonard Green exited its investment in 2021. In 2022, Prospect/Crozer laid off hundreds of workers,[38] shuttered the maternity ward at Delaware County Memorial Hospital,[39] shuttered the hospice unit at Taylor Hospital,[40] and threatened municipalities with severing paramedic services in just 90 days if they didn’t pay up.[41]

Prospect had a tentative deal in 2022 to sell the Crozer hospitals to ChristianaCare, a nonprofit health system. However, ChristianaCare backed out of the deal in August 2022.[42] Then, in September 2022, Prospect announced it would permanently shut down Delaware County Memorial Health (DCMH), one of hospitals in the Crozer Health system, and transition it to a behavioral health facility. The announcement sparked outrage in the Delaware County community, including by the nonprofit Foundation for Delaware County, which sued Prospect to keep the hospital open on the basis that when it converted Crozer Health from nonprofit to for profit status Prospect committed to keep the hospitals open for at least 10 years.[43]

The office of Pennsylvania Attorney General John Shapiro expressed support for the lawsuit, writing in a statement “Every Pennsylvanian should have access to affordable healthcare. My office will do everything within our power to force Prospect to live up to the commitments they made to Delaware County residents and to protect access to care for all Pennsylvanians.”[44]

However, due to Prospect’s failure to adequately staff the emergency department, the state health department suspended emergency room services and patient admissions at Delaware County Memorial in November of 2022,[45] effectively closing the hospital. Since the closure, area emergency rooms and EMS services have been strained.[46]For a while, the hospital had an onsite nurse and ambulance to transfer patients in need of emergency care to other facilities, but this service was ended in August 2023.

Prospect laid off over two hundred more Crozer employees in early 2023.[47] The Crozer hospitals were also impacted by the ransomware attack in August, resulting in ambulances being diverted to other hospitals in the early days of the attack.[48] Crozer’s systems were reportedly back online by late August.[49]

In October 2023, Prospect and the Foundation for Delaware Country reached a deal to halt their litigation for 270 days in order to provide a window for Prospect to sell the Crozer hospitals.[50] So far, there are no reported potential buyers.

An uncertain future
The dire situations at Connecticut’s and Pennsylvania’s Prospect hospitals are the consequence of private equity pillaging which left them in precarious financial condition. It cannot be overstated how serious the situation is for these hospitals and the communities they serve.

Now, Yale is asking the state of Connecticut to pick up the tab and provide $80 million to support Yale’s acquisition of the three Prospect hospitals located in the state. Because the negotiations over the sale are confidential,[51] it is difficult to know to what extent such an ask is warranted. But Yale New Haven Health holds considerable negotiating power to get a state subsidy based on the consequences if they decide to pull out of the deal.

Hospital executives and some lawmakers believe that if the sale does not go through, these hospitals are at risk for major service cuts and even closures.[52][53] Such a situation could be disastrous, leading to a healthcare crisis for eastern Connecticut and the nearby hospitals that will need to compensate for the cuts and closures despite their limited resources and staffing.

In Pennsylvania, Prospect has another chance to sell its Crozer hospitals. But as the case in Connecticut demonstrates, securing a buyer may be a difficult endeavor given Prospect hospitals’ poor financial state resulting from years of private equity pillaging. These hospitals, which have already cut various services and laid off hundreds of employees, are not out of the woods yet.

Meanwhile, it appears Prospect’s former owner, Leonard Green and Partners, has gotten off scot-free. It already siphoned its millions and made its exit, while patients, workers, and their communities in Pennsylvania and Connecticut are left holding the bag.[54]

[1] “Hospital Locations | Prospect Medical Holdings, Inc.” Accessed October 24, 2023. https://www.pmh.com/locations/hospital-locations/.

[2] Altimari, Dave, and Jenna Carlesso. “Inside the Cyberattack at Prospect Medical Holdings’ CT Hospitals.” CT Mirror, October 1, 2023. http://ctmirror.org/2023/10/01/ct-prospect-medical-holdings-hospitals-cyberattack-yale-sale/.

[3] Altimari, Dave, Jenna Carlesso, and Mark Pazniokas. “Hospital Execs to Lamont, Lawmakers: Seal the Yale-Prospect Deal.” CT Mirror, September 27, 2023. http://ctmirror.org/2023/09/26/hospital-execs-to-lamont-lawmakers-seal-the-yale-prospect-deal/.

[4] Rahman, MD. “Opinion: Care at Manchester Memorial Hospital Must Be Protected.” CT Mirror, October 23, 2023. http://ctmirror.org/2023/10/23/manchester-hospital-prospect-medical-holdings/.

[5] Cooper, Kenny. “Prospect Reaches Deal to Halt Litigation, Opening Window to Sell Crozer Health.” WHYY, October 19, 2023. https://whyy.org/articles/crozer-health-sale-prospect-delaware-county-foundation/.

[6] Pennsylvania Office of Attorney General. “AG Henry Agrees to Suspend Lawsuit Against Prospect Medical Holdings as Company Pursues Sale of CrozerHealth in Delaware County,” October 19, 2023. https://www.attorneygeneral.gov/taking-action/ag-henry-agrees-to-suspend-lawsuit-against-prospect-medical-holdings-as-company-pursues-sale-of-crozerhealth-in-delaware-county/.

[7] O’Grady, Eileen. “UPDATE: Leonard Green-Led Ownership Collected $658 Million in Dividends and Fees from Prospect Medical Holdings despite Challenges, Commitment to Regulators to Forgo Dividends.” Private Equity Stakeholder Project, May 2020. https://pestakeholder.org/wp-content/uploads/2020/05/UPDATE-Leonard-Green-Prospect-Medical-Dividends-PESP-051420.pdf.

[8] “Decision Re: Initial Application of Chamber Inc.; Ivy Holdings Inc.; Ivy Intermediate Holdings, Inc.; Prospect Medical Holdings, Inc.; Prospect East Holdings, Inc.; Prospect East Hospital Advisory Services, LLC; Prospect CharterCARE, LLC; Prospect CharterCARE SJHSRI, LLC; Prospect CharterCARE RWMC, LLC.” State of Rhode Island Office of the Attorney General, June 1, 2021. https://riag.ri.gov/sites/g/files/xkgbur496/files/documents/Prospect_Chamber_Ivy_AG_HCA_Decision.pdf.

[9]Moody’s Investor Service. “Research: Rating Action: Moody’s Downgrades Prospect Medical Holdings, Inc.’s CFR to B3; Outlook Changed to Negative.” March 28, 2019. https://www.moodys.com/research/Moodys-downgrades-Prospect-Medical-Holdings-Incs-CFR-to-B3-outlook–PR_397518.

[10] “Decision Re: Initial Application of Chamber Inc.; Ivy Holdings Inc.; Ivy Intermediate Holdings, Inc.; Prospect Medical Holdings, Inc.; Prospect East Holdings, Inc.; Prospect East Hospital Advisory Services, LLC; Prospect CharterCARE, LLC; Prospect CharterCARE SJHSRI, LLC; Prospect CharterCARE RWMC, LLC.” State of Rhode Island Office of the Attorney General, June 1, 2021. https://riag.ri.gov/sites/g/files/xkgbur496/files/documents/Prospect_Chamber_Ivy_AG_HCA_Decision.pdf.

[11]Moody’s Investor Service. “Moody’s: Prospect Medical’s Sale-Leaseback Improves Liquidity, However Operating Challenges Remain.” July 16, 2019, sec. North America Corporates Ratings & Assessments News. http://www.moodys.com:18000/research/Moodys-Prospect-Medicals-sale-leaseback-improves-liquidity-however-operating-challenges–PR_405116.

[12] “Prospect to Receive $1.55 Billion Investment from Medical Properties Trust, Inc.,” July 15, 2019. https://www.businesswire.com/news/home/20190715005786/en/Prospect-to-Receive-1.55-Billion-Investment-from-Medical-Properties-Trust-Inc.

[13] Pg. 44; “Consolidated Financial Statements for the Years Ended September 30, 2019 and 2018.” Prospect Medical Holdings, December 2019. https://pestakeholder.org/wp-content/uploads/2020/06/PMH-Financial-Statement-2018-2019.pdf.

[14] Carlesso, Jenna, and Dave Altimari. “Yale Health, CT Officials Resume Negotiating Prospect Hospitals Sale.” CT Mirror, October 25, 2023. http://ctmirror.org/2023/10/25/prospect-medical-holdings-yale-health-ct-negotiations/.

[15] Altimari, Dave, and Jenna Carlesso. “Lamont Warned Cyberattack, Debt Put Prospect Hospitals Sale at Risk.” CT Mirror, September 21, 2023. http://ctmirror.org/2023/09/21/ct-prospect-medical-holdings-hospital-yale-health/.

[16] Thomas, Nick. “Yale New Haven Health Target Owes More than $1.6M in Taxes.” Becker’s Hospital Review, August 21, 2023. https://www.beckershospitalreview.com/hospital-transactions-and-valuation/yale-new-haven-health-target-owes-more-than-1-6m-in-taxes.html.

[17] Weil, Jonathan. “Cracks Deepen for America’s Biggest Hospital Landlord: Struggling Tenants, a Bailout on Hold.” WSJ, August 18, 2023, sec. Markets. https://www.wsj.com/business/deals/cracks-deepen-for-americas-biggest-hospital-landlord-struggling-tenants-a-bailout-on-hold-21e3294c.

[18] Biswas, Soma, Laura Cooper, and Jodi Xu Klein. “Hospital Tenants of Medical Properties Trust Hire Advisers for Refinancings – WSJ.” WSJ Pro Bankruptcy, May 12, 2023. https://www.wsj.com/articles/hospital-tenants-of-medical-properties-trust-hire-advisers-for-refinancings-177657d5.

[19] Medical Properties Trust. “Press Release – Medical Properties Trust, Inc. Reports Second Quarter Results,” August 8, 2023. https://medicalpropertiestrust.gcs-web.com/node/15471/pdf.

[20] Weil, Jonathan. “Cracks Deepen for America’s Biggest Hospital Landlord: Struggling Tenants, a Bailout on Hold.” WSJ, August 18, 2023, sec. Markets. https://www.wsj.com/business/deals/cracks-deepen-for-americas-biggest-hospital-landlord-struggling-tenants-a-bailout-on-hold-21e3294c.

[21] YaleNewHavenHealth. “YNHHS Has Signed an Agreement to Acquire Connecticut Health Systems from Prospect Medical Holdings,” October 6, 2022. https://www.ynhhs.org/news/1-ynhhs-has-signed-an-agreement-to-acquire-ct-health-systems-from-prospect-medical-holdings.

[22] Peck, Dave. “ECHN Hospitals Struggle as Leaders Discuss Pending Deal with Yale New Haven Health.” NBC Connecticut, September 28, 2023. https://www.nbcconnecticut.com/news/local/echn-hospitals-struggle-as-leaders-discuss-pending-deal-with-yale-new-haven-health/3113700/.

[23] Altimari, Dave, Jenna Carlesso, and Mark Pazniokas. “Hospital Execs to Lamont, Lawmakers: Seal the Yale-Prospect Deal.” CT Mirror, September 27, 2023. http://ctmirror.org/2023/09/26/hospital-execs-to-lamont-lawmakers-seal-the-yale-prospect-deal/.

[24] Altimari, Dave, and Jenna Carlesso. “Inside the Cyberattack at Prospect Medical Holdings’ CT Hospitals.” CT Mirror, October 1, 2023. http://ctmirror.org/2023/10/01/ct-prospect-medical-holdings-hospitals-cyberattack-yale-sale/.

[25] Altimari, Dave, and Jenna Carlesso. “Prospect Medical Cyberattack Exposed 24,000 Workers’ Private Info.” CT Mirror, October 2, 2023. http://ctmirror.org/2023/10/02/ct-prospect-medical-holdings-hospital-cyberattack-manchester-rockville-waterbury/.

[26] Altimari, Dave, and Jenna Carlesso. “Inside the Cyberattack at Prospect Medical Holdings’ CT Hospitals.” CT Mirror, October 1, 2023. http://ctmirror.org/2023/10/01/ct-prospect-medical-holdings-hospitals-cyberattack-yale-sale/.

[27] McGlave, Claire C., Hannah Neprash, and Sayeh Nikpay. “Hacked to Pieces? The Effects of Ransomware Attacks on Hospitals and Patients.” SSRN Scholarly Paper. Rochester, NY, October 4, 2023. https://doi.org/10.2139/ssrn.4579292.

[28] Sabin, Sam. “A New Ransomware Gang Is Claiming It Hacked a U.S. Hospital System.” Axios, August 24, 2023. https://www.axios.com/2023/08/24/ransomware-stolen-data-prospect-medical-attack.

[29] Altimari, Dave, and Jenna Carlesso. “Prospect Medical Cyberattack Exposed 24,000 Workers’ Private Info.” CT Mirror, October 2, 2023. http://ctmirror.org/2023/10/02/ct-prospect-medical-holdings-hospital-cyberattack-manchester-rockville-waterbury/.

[30] Diaz, Naomi. “Prospect Medical Unsure If Patient Data Was Breached in Attack.” Becker’s Hospital Review, September 11, 2023. https://www.beckershospitalreview.com/cybersecurity/prospect-medical-unsure-if-patient-data-was-breached-in-attack.html.

[31] Altimari, Dave, and Jenna Carlesso. “Prospect Medical Cyberattack Exposed 24,000 Workers’ Private Info.” CT Mirror, October 2, 2023. http://ctmirror.org/2023/10/02/ct-prospect-medical-holdings-hospital-cyberattack-manchester-rockville-waterbury/.

[32] Diaz, Naomi. “Prospect Medical Hit with Lawsuit over Patient Data Breach.” Becker’s Hospital Review, October 19, 2023. https://www.beckershospitalreview.com/cybersecurity/prospect-medical-hit-with-lawsuit-over-patient-data-breach.html.

[33] Carlesso, Jenna, and Dave Altimari. “Yale Health, CT Officials Resume Negotiating Prospect Hospitals Sale.” CT Mirror, October 25, 2023. http://ctmirror.org/2023/10/25/prospect-medical-holdings-yale-health-ct-negotiations/.

[34] Altimari, Dave, Jenna Carlesso, and Mark Pazniokas. “Hospital Execs to Lamont, Lawmakers: Seal the Yale-Prospect Deal.” CT Mirror, September 27, 2023. http://ctmirror.org/2023/09/26/hospital-execs-to-lamont-lawmakers-seal-the-yale-prospect-deal/.

[35] Altimari, Dave, Jenna Carlesso, and Mark Pazniokas. “Hospital Execs to Lamont, Lawmakers: Seal the Yale-Prospect Deal.” CT Mirror, September 27, 2023. http://ctmirror.org/2023/09/26/hospital-execs-to-lamont-lawmakers-seal-the-yale-prospect-deal/.

[36] Carlesso, Jenna, and Dave Altimari. “Yale Health, CT Officials Resume Negotiating Prospect Hospitals Sale.” CT Mirror, October 25, 2023. http://ctmirror.org/2023/10/25/prospect-medical-holdings-yale-health-ct-negotiations/.

[37] Carlesso, Jenna, and Dave Altimari. “Yale Health, CT Officials Resume Negotiating Prospect Hospitals Sale.” CT Mirror, October 25, 2023. http://ctmirror.org/2023/10/25/prospect-medical-holdings-yale-health-ct-negotiations/.

[38] Brubaker, Harold. “Crozer Health Layoffs Went Far Deeper than Initially Reported.” Philadelphia Inquirer, February 8, 2022, sec. Healthcare, business, health. https://www.inquirer.com/business/health/crozer-hospitals-layoffs-prospect-ceo-20220208.html.

[39] Cooper, Kenny. “Delaware County Memorial Hospital Closing Maternity Unit, Leaving 2 in the County.” WHYY, January 7, 2022. https://whyy.org/articles/delaware-county-memorial-hospital-to-close-maternity-unit-just-two-will-remain-in-the-county/.

[40]CBS News. “‘They Don’t Care’: Families Confused, In Pain After Delaware County Hospice Unit Announces Sudden Closure.” February 8, 2022. https://www.cbsnews.com/philadelphia/news/delaware-county-taylor-hospital-hospice-closing/.

[41] Cooper, Kenny. “Crozer Health Threatening to Shutter Paramedic Services for Delco Municipalities.” WHYY, April 15, 2022. https://whyy.org/articles/crozer-health-paramedic-services-delco/.

[42] Cooper, Kenny. “ChristianaCare Backs out of Deal to Buy Crozer Health from Prospect Medical Holdings.” WHYY, August 18, 2022. https://whyy.org/articles/crozer-health-christianacare-sale-scrapped-prospect-medical-holdings/.

[43] WHYY. “Crozer Health, Prospect Sued over Plan to Close Delaware County Memorial Hospital.” Accessed October 24, 2022. https://whyy.org/articles/crozer-health-prospect-lawsuit-delaware-county-memorial-hospital-closure/.

[44] Pennsylvania Office of Attorney General. “AG Shapiro Voices Support for Keeping Delaware County Memorial Hospital Open.” Accessed October 24, 2022. https://www.attorneygeneral.gov/taking-action/ag-shapiro-voices-support-for-keeping-delaware-county-memorial-hospital-open/.

[45] Perez, Walter. “Officials: Delaware County Memorial Emergency Dept. Closed Due to ‘Failure to Adequately Staff.’” 6abc Philadelphia, November 7, 2022, sec. health. https://6abc.com/delaware-county-memorial-hospital-emergency-department-closing-crozer-health-prospect-medical-holdings/12426002/.

[46] Lapook, Jonathan, Michael Kaplan, and Samu. “‘This Really Hit Hard’: Pennsylvania Hospital Shutdown Strains Health Care Delivery, First Responders Say – CBS News.” CBS News, April 24, 2023. https://www.cbsnews.com/news/pennsylvania-hospital-shutdown-strains-health-care-delivery-first-responders-say/.

[47] Cooper. “Crozer Health Lays off 215 People as Part of ‘Operational Restructuring Plan.’” WHYY, March 16, 2023. https://whyy.org/articles/crozer-health-hospitals-layoffs-restructuring/.

[48] Lyngaas, Sean. “Cyberattack Forces Hospitals to Divert Ambulances in Connecticut and Pennsylvania | CNN Politics.” Cnn.Com, August 4, 2023. https://www.cnn.com/2023/08/04/politics/cyberattack-connecticut-pennsylvania-hospitals-ambulances/index.html.

[49] Diaz, Naomi. “Crozer Health Heals Systems after Ransomware Attack,” August 25, 2023. https://www.beckershospitalreview.com/cybersecurity/crozer-health-heals-systems-after-ransomware-attack.html.

[50] Cooper, Kenny. “Prospect Reaches Deal to Halt Litigation, Opening Window to Sell Crozer Health.” WHYY, October 19, 2023. https://whyy.org/articles/crozer-health-sale-prospect-delaware-county-foundation/.

[51] Carlesso, Jenna, and Dave Altimari. “Yale Health, CT Officials Resume Negotiating Prospect Hospitals Sale.” CT Mirror, October 25, 2023. http://ctmirror.org/2023/10/25/prospect-medical-holdings-yale-health-ct-negotiations/.

[52] Altimari, Dave, Jenna Carlesso, and Mark Pazniokas. “Hospital Execs to Lamont, Lawmakers: Seal the Yale-Prospect Deal.” CT Mirror, September 27, 2023. http://ctmirror.org/2023/09/26/hospital-execs-to-lamont-lawmakers-seal-the-yale-prospect-deal/.

[53] Rahman, MD. “Opinion: Care at Manchester Memorial Hospital Must Be Protected.” CT Mirror, October 23, 2023. http://ctmirror.org/2023/10/23/manchester-hospital-prospect-medical-holdings/.

[54] O’Grady, Eileen. “How Private Equity Raided Safety Net Hospitals and Left Communities Holding the Bag.” Private Equity Stakeholder Project, November 2022. https://pestakeholder.org/wp-content/uploads/2022/11/Prospect_Primer_Nov-2022.pdf.