Protecting people when healthcare institutions fail.
The Steward collapse exposed a second crisis: what happens when the financial structure meant to protect patients and clinicians from malpractice claims can no longer reliably do its job?
Understand the issueRead the reportingSteward's bankruptcy disrupted hospitals and communities. Its malpractice insurance structure created a separate, continuing problem for claimants and clinicians.
A captive is an insurance company owned by the organization whose risks it insures. Captives are common risk-management tools, but governance, capitalization, liquidity and domicile matter.
The central policy question is simple: how should money reserved for patient claims and provider protection be safeguarded when a health system encounters financial distress?
Steward did not collapse overnight. This chronology combines investigative journalism with state records, federal proceedings, bankruptcy reporting, and Massachusetts health-care coverage. Boston Globe Spotlight remains an important source, but it is deliberately not the sole source. Each entry identifies where readers can examine the underlying reporting or public record.
No single newsroom or government agency tells the whole story. The timeline cross-references investigative reporting with Massachusetts records, federal congressional proceedings, bankruptcy coverage, and local health-care journalism. Claims about disputed conduct are attributed to the source making them.
JournalismState / primary recordFederal record
The crisis developed over more than a decade. Financing decisions, regulatory oversight, hospital operations, staffing and supplies, bankruptcy, and malpractice coverage are related but distinct issues. The timeline is intended to let readers examine those events before considering the proposed policy response.
This timeline distinguishes reporting, government allegations, official actions, and adjudicated outcomes. Links are provided so readers can examine the underlying sources. Inclusion of a source does not imply that the source endorses this coalition or its policy proposals.
The Boston Globe reported that TRACO listed 517 pending or settled-but-unpaid malpractice claims as of August 2024.
The Globe reported TRACO listed approximately $3.5 million in cash at that time.
The Globe reported Steward's lawyers estimated remaining malpractice claims could cost as much as $200 million to resolve.
A successful malpractice claim has limited practical value if the responsible coverage lacks accessible assets to pay a settlement or judgment.
When expected institutional coverage is disputed or insufficient, clinicians may face uncertainty about defense costs, tail exposure and personal liability.
The Steward experience raises questions about reserve requirements, related-party transactions, captive governance, transparency and where malpractice assets may be domiciled.
This is broader than one company. Captives are widely used in health care. The policy challenge is to preserve their legitimate risk-management benefits while protecting the assets intended for claims.
This framework responds to the unresolved fallout from Steward while identifying broader vulnerabilities in Massachusetts health care. Its central principle is that patients and individual health care professionals should not be left bearing the consequences of institutional and financial failures they did not create and could not control.
Requested immediate state action. Establish a Steward-specific process building on M.G.L. c. 231, §60B, with substantial representation from licensed health care providers and appropriate representation of the professions involved in the care. The process should consider whether a claim presents a legitimate question of liability, whether each person named had an actual role in the alleged harm, and whether systemic failures such as understaffing, resource limitations, institutional decisions, or inaccessible malpractice coverage contributed. Where evidence supports institutional or executive responsibility, that responsibility should be examined rather than shifted automatically to individual clinicians.
Requested immediate state action. PROTECT proposes that Steward Medical Group and other relevant Steward business entities be addressed in litigation arising from Steward operations, rather than allowing institutional conduct to disappear from consideration while individual clinicians remain exposed. Any mechanism should operate consistently with bankruptcy-court orders, procedural rules, and applicable state and federal law.
Modeled on Massachusetts' 2020 COVID emergency legislation. Massachusetts should examine whether the extraordinary conditions surrounding the Steward collapse warrant targeted liability protections for good-faith care delivered amid severe institutional disruption, resource loss, staffing pressure, and other conditions outside individual clinicians' control. The proposal draws on the Commonwealth's 2020 response, when emergency legislation provided qualified civil-liability protections for certain health care services affected by COVID-19 emergency conditions.
Requested immediate state action. Create a mechanism to address reported unpaid Steward-related settlements and judgments while preserving the Commonwealth's ability to pursue recovery from Steward, TRACO, insurers, executives, affiliates, or other legally responsible parties. PROTECT also proposes a consolidated malpractice mechanism with fair pricing for affected providers to reduce duplicative individual costs and coordinate resources. This should operate in tandem with the proposed Steward-specific review process.
Former Steward clinicians who believed they had employer-provided malpractice protection may now face substantial costs for tail or replacement coverage. PROTECT calls for review by the Attorney General and Division of Insurance of pricing and market conduct, with refunds or penalties where authorized by existing law and supported by the evidence.
Continue investigation of conduct surrounding Steward's collapse and pursue appropriate civil, criminal, or regulatory remedies where supported by the evidence. PROTECT also calls for meaningful public transparency, to the extent permitted by law, concerning investigative and charging decisions.
Examine whether assets securing Massachusetts malpractice liabilities should be required to remain domestically accessible, adequately capitalized, transparent, and subject to stronger regulatory oversight. Review captive governance, reserve adequacy, reinsurance, related-party transactions, and mechanisms that ensure promised protection remains reachable when a health system restructures, closes, or enters bankruptcy.
Reconsider the $100,000 limitation in M.G.L. c. 231, §85K for qualifying nonprofit health care organizations. PROTECT proposes that institutional responsibility should be appropriately shared when evidence shows hospital-level decisions involving staffing, budgets, equipment, coverage, or other system-level conditions contributed to patient harm.
Examine circumstances in which executives and governing bodies may be held accountable for knowing or reckless decisions that improperly extract assets, undermine financial safeguards, compromise staffing or resources, or contribute to an institution's inability to meet patient-care obligations. Corporate structure should not automatically insulate individuals from responsibility for their own legally actionable conduct.
Modernize Massachusetts PA law to reduce unnecessary supervisory requirements, align liability more closely with clinicians actually involved in a patient's care, and preserve access when health systems close, restructure, or lose physicians. PROTECT supports consideration of H.2371/S.1502 and related reforms to the statutory supervision framework in M.G.L. c. 112, §9E.
Providers should be able to raise good-faith concerns about staffing, resources, patient safety, systemic failures, and health care quality with policymakers and regulators without professional retaliation. Massachusetts should examine stronger remedies and penalties for retaliation while preserving legitimate investigation of underlying facts and excluding knowingly false statements or concealment of evidence from protection.
Where is the malpractice risk actually held? This directory maps Massachusetts hospital systems and hospitals to publicly identifiable captive insurers, risk-retention arrangements, or other professional-liability structures. This directory includes only organizations for which a captive or comparable professional-liability vehicle and its domicile can be supported by a public source. Systems without sufficiently verifiable public captive data are omitted rather than listed speculatively.
Search by hospital or health system name to see the publicly documented malpractice insurance vehicle and domicile.
| Hospital / Health System | Malpractice / Liability Vehicle | Domicile | What the public record shows | Source |
|---|---|---|---|---|
| Steward Health Care Includes former Massachusetts Steward hospitals | TRACO International Group, Ltd. | Panama Legacy Steward structure | Public reporting identifies TRACO as Steward's malpractice captive and documents its relocation to Panama. The Steward bankruptcy created continuing disputes over legacy malpractice obligations. | Globe Spotlight → |
| UMass Memorial Health UMass Memorial Medical Center; HealthAlliance-Clinton; Marlborough and affiliated entities | Commonwealth Professional Assurance Company, Ltd. | Grand Cayman, Cayman Islands Publicly documented | Massachusetts Health Policy Commission organizational materials identify the company as a Grand Cayman corporation with UMass Memorial Health Care as sole shareholder. | MA HPC → |
| Baystate Health Includes Baystate Medical Center, Baystate Franklin Medical Center, Baystate Noble Hospital, Baystate Wing Hospital and affiliated entities | Baystate Health Insurance Company, Ltd. (BHIC) | Cayman Islands Publicly documented | Baystate Health's audited financial statements identify BHIC as a captive insurer organized and licensed in the Cayman Islands that provides professional liability and other coverage to Baystate corporate members and employees, and offers malpractice insurance to qualifying medical staff and certain non-employed physicians. | Baystate audited financials → |
| Boston Medical Center BMC / Boston University Medical Group-related professional liability | Boston Medical Center Insurance Company, Ltd. (BMCIC) | Cayman Islands Publicly documented | A Massachusetts Division of Insurance examination identifies BMCIC as a Cayman Islands captive providing professional and general liability insurance to BMC and its Faculty Practice Foundation affiliate. | MA DOI → |
| Trinity Health / Trinity Health of New England Includes Mercy Medical Center and other Trinity ministries | Trinity Assurance, Ltd. (TAL) | Cayman Islands Publicly documented | Trinity Health financial statements identify TAL as its wholly owned captive providing coverage under the system's centralized professional and general liability program. Cayman regulatory records identify Trinity Assurance, Ltd. as a Cayman licensee. | Trinity Health → |
| CRICO subscriber organizations Includes Mass General Brigham, Beth Israel Lahey Health, Boston Children's, Dana-Farber, Cambridge Health Alliance, Atrius and other Harvard medical community subscribers | CRICO (A Reciprocal Risk Retention Group) | Vermont, USA Publicly documented | CRICO states that its reciprocal RRG was established in Vermont in 2023 to provide medical professional liability and other liability coverage to Harvard Medical School-affiliated subscribers. Its subscriber list identifies the covered organizations. | CRICO subscribers → |
Methodology: Hospital/system identification is cross-checked against Massachusetts DPH/MassGIS and Health Policy Commission materials. Captive entries are added only when a government record, audited financial statement, court record, regulator, or other sufficiently reliable source identifies the vehicle. Captive structures can change, and a system may use multiple layers of self-insurance, captive insurance, risk-retention groups, commercial excess coverage, or reinsurance. This directory should therefore be read as a public-record research project rather than an insurance-coverage opinion.
Massachusetts DPH/MassGIS hospital dataset → Massachusetts HPC system/ACO reference →
The lessons of Steward extend beyond Massachusetts. PROTECT supports examining federal reforms that protect clinical independence, strengthen accountability, and reduce the risk that financial structures interfere with patient care.
Introduced in Congress in September 2026, the proposal targets corporate ownership and control arrangements in physician practices, including structures that lawmakers say can allow private-equity firms, insurers, and other for-profit entities to exercise control through management organizations or nominal physician ownership.
PROTECT's Massachusetts proposals focus on malpractice coverage, institutional accountability, workforce protection, and access to care. Federal corporate-practice reform addresses a related question: who ultimately controls clinical organizations and the decisions that affect patients and healthcare professionals?
Federal proposals and the nine Massachusetts recommendations are presented separately because they operate under different laws and would require action by different levels of government.
The Senate Finance Committee announcement describes the bill's restrictions on corporate control of physician practices and identifies supporting organizations.
Read the announcement →The sponsors' release describes the policy rationale and organizations that publicly supported the proposal.
Read the release →The sponsors list healthcare and consumer organizations supporting the legislation. Inclusion here reflects support for that federal proposal and does not imply membership in PROTECT.
See supporting organizations →Stay informed about the Steward malpractice crisis, legislative developments, PROTECT policy proposals, new research, coalition activity, and additions to the Massachusetts captive-insurance directory.
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Sign up for PROTECT updatesSignup information is collected through the PROTECT Google Form. Responses can be linked to a Google Sheet from the Form's Responses tab.
Independent reporting is essential to understanding both Steward's collapse and the continuing malpractice issue. Links below go to the original publishers; some may require subscriptions.
The Globe Spotlight Team's collection of investigations into Steward's finances, operations, oversight and collapse.
Read the Spotlight investigation →Spotlight's November 2024 investigation examined TRACO's assets, Steward-related transactions, its move to Panama and the implications for claimants and clinicians.
Read the investigation →A December 2024 follow-up reported on TRACO's bankruptcy-court effort to recover money it said Steward owed.
Read the article →Reporting on state and federal findings involving Good Samaritan Medical Center's emergency department.
Read the article →Reporting on unpaid vendors and the operational consequences of Steward's financial problems.
Read the article →Future additions can include bankruptcy filings, Massachusetts regulatory materials, legislative documents and court filings so readers can review primary evidence alongside news coverage.
Article descriptions are summaries, not reproductions. All article copyrights remain with their respective publishers.
A musical reflection on the Steward crisis and its aftermath.
This effort is intended to bring together health care professionals, professional associations, patient advocates, community organizations, and other partners committed to protecting patients and providers. Organization names and logos can be added here as groups formally join or endorse the effort.
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PROTECT stands for Patients and Providers for Reform, Oversight, Transparency, Equity, and Clinical Trust.
PROTECT is a coalition of patients, healthcare professionals, advocates, and organizations working to strengthen accountability, protect access to care, and ensure that patients and individual healthcare professionals are not left bearing the consequences when healthcare institutions fail.
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