私募股权接管了一家医院。随后将其关闭。

嘿，我是瑞恩。还有杰斯。

Hey. It's Ryan. And Jess.

在进入今天的节目之前，我们有个激动人心的消息要宣布。

Before we get into today's show, we have something exciting to announce.

我们将于10月7日周二在纽约市格拉梅西剧院举办首场现场演出。哇哦。我们希望大家都能到场。

We are hosting our first ever live show in New York City. Woo. We'll be at the Gramercy Theater on Tuesday, October 7, and we want you to be there.

届时会有特别嘉宾，我保证这将是个充满活力的夜晚，我们会畅谈金钱、商业和权力话题。演出后我和杰斯还会留下来与大家交流见面。一定会非常精彩。

We'll have special guests, and I can promise you it'll be a fun night full of lively conversations about money, business, and power. And Jess and I will hang out after the show to mingle and meet people. It's gonna be a great time.

门票将于本周五9月5日上午10点（东部时间）在bit.ly/journallive2five开售。节目备注里可以找到链接。

Tickets go on sale this Friday, September 5 at 10AM eastern at bit.ly/journallive2five. You can find the link in our show notes.

再次提醒，10月7日周二我们在纽约格拉梅西剧院等你，门票本周五9月5日开售。

Again, we'll be at the Gramercy Theater in New York City on Tuesday, October 7, and tickets go on sale this Friday, September 5.

访问bit.ly/journallive25购票。期待见到大家。宾夕法尼亚州的切斯特市是该州最古老的城市，坐落在特拉华河畔，距费城约半小时车程。多年来当地社区一直面临社会经济问题。

Go to bit.ly/journallive25 to get your tickets. We hope to see you there. The city of Chester, Pennsylvania is the oldest city in the state. It's nestled on the Delaware River, about half an hour from Philadelphia. And for years, the community there has struggled with socioeconomic issues.

半数人口处于或低于贫困线。惊人的是约38%的人享有医疗补助。

Half the population lives at or below the poverty line. An incredible number, I think 38% or so of people are on Medicaid.

这是肖恩·惠勒，当地非营利组织VSMC急救医疗服务中心的负责人。

That's Shane Wheeler, who runs VSMC Emergency Medical Services, a nonprofit in the area.

那里的疾病发病率高得离谱。在医疗保健方面，那真是个非常非常糟糕的地方。

The disease rate there is insane, you know. It's just it's a rough it's a really, really bad place with regards to health care.

五月情况进一步恶化，当地最后一家医院关闭。这次倒闭引发了一系列事件，使得切斯特居民更难获得医疗服务。

Things got even worse in May, when the last local hospital shut its doors. The closure set off a series of events that made it even harder for Chester residents to get access to health care.

他们不仅失去了医院，还失去了医生。整个预防医疗体系崩溃了。他们失去了初级保健医生、哮喘专科医生。他们曾深深依赖的医疗系统彻底垮塌了。

They lost their hospital, but they also lost their doctors. There's a total class of preventative care. They've lost their primary care physicians, their asthma doctors. They were really invested in the health system that collapsed.

切斯特的医疗危机是多年困局的最近发展。一家私募股权公司收购了一系列经营困难的当地医院，试图使其盈利。这是私募股权公司在全国范围内采用的策略，却导致医院及其服务的社区既缺乏关键医疗服务，又深陷债务泥潭。私募投资者正从社区医院抽走数百万美元资金。

The health care crisis in Chester is the latest development in a years long saga. A private equity firm had bought up a string of struggling local hospitals in an effort to make them profitable. It's a strategy that private equity firms have employed across the country. And it's one that's left hospitals and the communities they serve short of crucial medical services and deep in debt. Private equity investors are siphoning millions of dollars away from community hospitals.

去年这家私募支持的医疗网络申请破产时，彻底摧毁了医疗服务提供者和患者。而对切斯特市而言，影响堪称巨大。欢迎收听《华尔街日报》节目，我是杰西卡·门多萨，今天是9月4日星期四。

When the private equity backed network filed for bankruptcy last year, it devastated providers and patients. And for Chester City, the impact has been monumental. Welcome to The Journal, our show about money, business, and power. I'm Jessica Mendoza. It's Thursday, September 4.

本期节目将探讨：私募股权在医疗领域的暴利冒险，及其对一个社区造成的严重后果。宾夕法尼亚州切斯特医疗危机的导火索要追溯到2016年，当时当地医院被Prospect Medical Holdings公司收购。

Coming up on the show, private equity's lucrative venture into health care and the dire consequences for one community. The events that led to the health care crisis in Chester, Pennsylvania began in 2016. That year, the local hospital was acquired by a company called Prospect Medical Holdings.

Prospect Medical是由洛杉矶私募股权公司Leonard Green and Partners整合的连锁医院体系，共16家医院。

Prospect Medical is a chain of hospitals, 16 hospitals that was put together by Leonard Green and Partners private equity firm in Los Angeles.

这是我们负责破产报道的同事索玛·比斯瓦斯。她表示像Leonard Green这样的私募公司试图通过提高运营效率来增加医院盈利。

That's our colleague Soma Biswas, who covers bankruptcies. She says that private equity firms like Leonard Green try to get the hospitals running more efficiently and make them more profitable.

私募股权的典型做法是：发现某些地区经营不善的非营利医院后，承诺进行投资收购。随后他们通过债务市场融资收购更多医院，将其串联成Prospect Medical这个连锁体系。

What private equity did here, and it's pretty typical, is that they saw the opportunity to buy some hospitals in certain areas. These were nonprofit hospitals that were not doing well. And they promised to make investments, and then what they do, which is also typical of private equity, is they went and they borrowed money in the debt markets to buy more hospitals, and they strung them together into this chain. And that became Prospect Medical.

通过将所有医院纳入同一控股公司，Leonard Green开始为投资者提取分红。2012至2018年间，其股东通过Prospect旗下医院获得6.54亿美元分红及股权出售收益。但这些资金从未反哺医院本身。后来两党国会委员会发现，这些医院非但未能如承诺般扭亏为盈，反而濒临破产。

With all the hospitals under one holding company, Leonard Green was able to start taking dividends for investors. And those dividends paid out. Between 2012 and 2018, Leonard Green shareholders made $654,000,000 in dividends and share sales from hospitals under Prospect Medical. But none of that money was making it to the hospitals themselves. A bipartisan congressional committee would later find that far from the turnaround the firm promised, the hospitals were practically insolvent.

在切斯特医院，索玛采访的护士表示基本维护都成问题。因霉菌感染，部分设施一度关闭，医院还停付部分耗材和服务费用，导致患者护理难以为继。为维持运营，Prospect最终出售了医院所在土地。

At the hospital in Chester, Soma talked to nurses who said basic upkeep had become a challenge. At one point, parts of the facility were shut down because of a mold infestation, and the hospital stopped paying for some supplies and service providers. That made it hard to keep up with patient care. To make ends meet, Prospect sold the land the hospital was built on.

他们的做法是与一家上市房地产公司达成协议。这类交易在许多不同类型的公司中相当常见，房地产公司会介入买下你的建筑，以及你所有设施所在的土地。

What they did is they reached a deal with a publicly traded real estate company. And these are fairly common for a lot of different kinds of companies where the real estate company comes in and they buy your building, all the land that your facilities sit on.

2019年达成的这笔房地产交易，为Prospect提供了急需的现金。但这也意味着像切斯特这样的医院突然需要每年向新地主支付数百万美元的租金，且这些租约被锁定超过十年。与此同时，赚取数百万后，Leonard Green决定退出。2021年，这家私募股权公司出售了其在Prospect Medical Holdings的控股权。

The real estate deal, took which place in 2019, gave Prospect the cash it desperately needed. But the deal meant that hospitals like the one in Chester were suddenly on the hook for millions of dollars in annual rent payments to the new landowners. And they were locked into those leases for more than a decade. Meanwhile, having made millions, Leonard Green decided to move on. In 2021, the private equity firm sold its controlling stake in Prospect Medical Holdings.

Leonard Green会辩称——他们也确实这么说过——在新冠疫情爆发前一切都很顺利。疫情导致医院基本无法进行手术，只能接收急诊患者。所有非紧急手术都被暂停，这正是他们陷入财务困境的原因。

What Leonard Green will say is that, and they've said this, that everything was great until the COVID-nineteen pandemic hit and the pandemic meant that basically, you know, hospitals couldn't have surgeries. They could only take patients that were in emergency situations. So, like, all of the elective stuff was shut down, and that that was the reason why they got into financial distress.

Leonard Green的代表还表示，他们对Prospect的收购拯救了原本可能关闭的医院。随后五年间，Prospect持续挣扎。根据法庭记录，其拖欠账单和养老金缴款。2024年，宾夕法尼亚州总检察长就州内医院条件对Prospect提起诉讼，公司对这些指控提出异议。

Representatives for Leonard Green also said that their buyout of Prospect helped save hospitals that otherwise would have closed. Over the next five years, Prospect continued to struggle. It fell behind on bills and pension contributions, according to court records. In 2024, the Pennsylvania attorney general sued Prospect over conditions at its hospitals in the state. The company has disputed the allegations.

临近年底时，Prospect财务状况恶化到切斯特的医院无力支付租金。今年一月，Prospect申请了第11章破产保护。

Near the end of the year, Prospect's finances were so bad, the hospital in Chester couldn't make its rent payment. And this past January, Prospect filed for chapter 11 bankruptcy.

包括本案在内的所有破产程序，目标都是设法偿还所有债权人。企业申请破产时通常资不抵债，常规做法是寻找买家。但他们花了数周时间寻找却一无所获。

The goal of any bankruptcy, including this one, is to figure out a way to pay all the creditors. You know, when a company files for bankruptcy, typically, they don't have enough money to pay all of their bills. Typically, companies look to find buyers. They spent weeks looking for buyers, and they couldn't find anyone.

由于没有买家，无人能偿还Prospect的债务（包括欠税），这对切斯特市所在郡县造成巨大压力——当地不得不通过增税来填补损失。

Without a buyer, there was no one to pay Prospect's debts, including back taxes. And that was a big problem for the county where Chester City is located, which had to raise taxes to cover the loss.

Prospect Medical Holdings欠该郡及部分学区2000万美元税款，这些是累积多年的滞纳税款。因此该郡和某特定学区不得不对所有房产所有者增税，波及房产业主和商业主。其中某学区税率增幅尤为显著。

Prospect Medical Holdings, they owe the county and some of the school districts in the county $20,000,000, and and these are back taxes that they haven't paid for a couple of years. So as a result, the county and one particular school district had to raise taxes on all property owners. So that means homeowners, business owners. It was it was particularly sharp increase for one of the school districts districts in the county.

简言之，后果由社区承担。后续发展是：Prospect破产导致切斯特医院于五月关闭，最大冲击落在本地医疗体系——周边急诊科难以应对激增病患，同时多家关联诊所停业。

In other words, the community was left holding the bag. That's next. Prospect's bankruptcy led to the closing of Chester's Hospital in May, and the biggest impact of the shutdown was on the local health system. Nearby emergency departments struggled to accommodate the new influx of patients. At the same time, many affiliated doctors' offices shut their doors.

患者发现常规预约需等待超一年。这正是Shane Wheeler介入的契机——这位运营非营利急救服务机构VSMC的负责人被问及：'你是如何开始为切斯特市社区提供服务的？'

Patients found themselves having to wait over a year for routine appointments. That's where Shane Wheeler comes in. He's the guy who runs VSMC, the nonprofit emergency medical service. How did you end up servicing the community in Chester City?

我常跟人说，我们压根没料到会接手切斯特市的项目，对吧？要知道，它离我们在费城的运营点有点远。但当时Prospect Holdings破产留下了这个空缺。

I always tell people I did not have Chester City on our bingo card, right? And, you know, it's a little bit out of the way from our Philadelphia operation. But there was this gap with Prospect Holdings bankruptcy.

嗯。

Mhmm.

他们需要有人接手，而我们想提供帮助——这就是我们出现在那里的原因。

And they needed they needed to care, and we wanted to that's why we're there.

但工作很艰难。一个大问题是肖恩团队接到的很多呼叫并非紧急情况。他们反而要处理割伤擦伤、咳嗽感冒这类问题。肖恩说，有时团队还要应对患者要求续处方药的情况。

But the work is tough. One big issue is that a lot of the calls Shane's team gets aren't for emergencies. Instead, they're getting called in to respond to things like cuts and scrapes, coughs and colds. Sometimes, Shane says, his team responds to patients trying to get their prescriptions refilled.

在切斯特市这类高度依赖医院急诊室的社区，居民通常会在急诊室获得预防性护理。但现在医院没了急诊室，这些问题开始浮现。比如有人会说'我血压有问题'，或者'我约不到医生，要等一年'——真的就是字面上的一年。

In most communities similar to Chester City where there's a high dependency on a hospital ER, they would get their preventative care at the emergency room. Well, without the emergency room in the hospital there, we're now starting to feel some of this stuff. So, I'm having problems with my blood pressure, you know, or I can't get a doctor's appointment for a year. Wow. Right, literally.

'我吃药的方法对吗？'这类本该与家庭医生进行的对话，现在他们都想和我们的急救员及护理人员讨论。

Am I taking my medication correctly, you know? Yeah. These kind of conversations that they should be having with their primary care physician, they're now trying to have that conversation with our emergency medical technicians and paramedics.

这根本不是肖恩团队的本职工作。VSMC是紧急医疗服务机构，员工训练有素应对突发医疗危机，然后将患者送至急诊室接受进一步治疗。

And that's not really what Shane's team is supposed to be doing. VSMC is an emergency medical service, which means the staff is trained to respond to immediate medical crises and then take patients to an ER for further care.

我们不是医生，对吧？我们不具备家庭医学的专业训练，也不擅长初级保健医师、医师助理和执业护士的工作。我们的职责是止血、心脏复苏、为患者提供呼吸支持这类急救操作。

We're not physicians, right? And we're not necessarily trained in a space of being experts in family medicine or what primary care physicians and PAs and nurse practitioners do, right? We stop the bleeding, start the heart again, we we breathe for the patient kind of things. Right?

这些非紧急呼叫还导致团队被占用，难以快速响应真正的紧急情况。而且团队只有转运患者到医院才能获得收入，非紧急呼叫意味着没有报酬。

All these non emergency calls also means the team gets tied up, and it makes it harder to respond quickly to actual emergencies. And because the team only makes money when they transport patients to a hospital, non emergency calls mean they don't get paid.

超过45%的出诊最终没有转运患者，这意味着无偿服务——因为我们不转运就得不到补偿，极少数保险会支付现场治疗费用。医疗补助和医疗保险只支付基础出车费，再按里程计费，而不是按临床服务计费。所以如果不转运患者，我们就得不到报酬。

Over forty five percent of our responses are resulting in no transports, which means it's uncompensated care because we don't transport the patients and very few insurances will pay for treatment in place. Medicaid and Medicare pay a base rate, which is the load fee, and then they pay a per mile rate as opposed to bill for, like, clinical services. So if we don't load the patient and transport them, we don't get compensated.

肖恩的团队正被迫填补医院关闭留下的空缺。但切斯特还面临其他压力。随着数千名前医院员工失业，整个社区争抢医疗服务，州政府决定介入干预。

Shane's team is having to fill gaps that the hospital closure left behind. But there are other strains on Chester too. With thousands of former hospital employees out of work and the whole community scrambling for health services, the state has decided to step in.

我对这个社区深感忧虑。我对那些遭受私募股权伤害的农村社区深感忧虑。我们将继续竭尽所能解决这个问题。

I'm deeply concerned about this community. I'm deeply concerned about the rural communities that have suffered at the hands of private equity. We're gonna continue to do everything in our power to address it.

夏皮罗州长已大力推动通过一项法律，旨在加大私募股权公司收购医院及其他医疗机构难度，并可能加强监管。因此当私募股权公司试图收购医院系统或特定类型医疗企业时，司法部长需考量其对社区和患者护理的影响，而非仅关注财务收益。

Governor Shapiro had made a big effort to pass a law that would make it harder for private equity firms to buy hospitals and other kinds of health care facilities and and perhaps just have more scrutiny. So, when a private equity firm comes in and wants to buy a hospital system or certain other types of health care businesses, you know, it'll require the attorney general to take into account the impact on the community and patient care, not just look at the dollars and cents.

宾夕法尼亚州正试图为切斯特及州内其他社区制定长期解决方案。在此之前，肖恩表示他和团队将努力维持运转。你们需要什么来维持服务？是否担心未来无法继续提供现有服务？这会令你们不堪重负吗？

Pennsylvania is trying to come up with a long term solution for Chester and other communities in the state. Until then, Shane says he and his team will try to keep things afloat. What do you need to keep this going? Are you in any way worried that you won't be able to continue to provide the services that you provide? Is this gonna stretch you too thin?

是的，我们很担忧。每个人都很担忧。我认为员工们很担忧，社区也很担忧，对吧？他们刚被医疗系统辜负了。

Yeah, we're worried. Everybody's worried. I think our staff is worried. I think the community is worried, right? They were just let down by a health system, right?

而且，难以想象的事情发生了。所以我们确实很担忧。不过我们与社区关系良好，我有信心能维持运营。但要知道，很多因素正在威胁这一点。

And, you know, the unthinkable happened. So yeah, we're worried. I think that we have a really great relationship with the community, and I'm confident that we're going to be able to sustain the operation. But, you know, there's a lot of things on the that are threatening that.

今天是9月4日星期四，节目到此结束。《华尔街日报》播客由Spotify与华尔街日报联合制作。本期节目额外报道由亚历山大·格拉德斯通完成。感谢收听，明天见。

That's all for today, Thursday, September 4. The Journal is a coproduction of Spotify and The Wall Street Journal. Additional reporting in this episode by Alexander Gladstone. Thanks for listening. See you tomorrow.