Private-equity backed Steward Health Care, owner of Sebastian River Medical Center, has been taken over by a group of its physicians led by the company's CEO, Dr. Ralph de la Torre, making it the largest physician-owned healthcare system in the country.

Ten percent of the system would still be owned by Medical Properties Trust, a real estate investment trust that owns the system’s 35 hospital campuses and leases them back to Steward.

“This is a transformational moment for the healthcare industry, with new realities in a COVID-19 world that must be addressed with an equally transformational, patient-first approach,” de la Torre said in a statement.

“The COVID-19 global pandemic has exposed serious deficiencies in the world’s healthcare systems, with a disproportionate impact on underserved communities and populations. We believe that future healthcare management must completely integrate long-term clinical needs with investments.”

What that will mean for the future of Sebastian River Medical Center remains unclear. The COVID-19 pandemic has taken a toll on the financial health of hospitals across the country, including both Sebastian River and its larger competitor Cleveland Clinic Indian River.

In March, non-emergency procedures were stopped at hospitals and imaging labs across the country – though some systems, including Steward Health, argued it was between physician and patient whether to postpone a procedure.

Even that pushing of the emergency order envelope didn’t keep Steward from furloughing staff.

In early May, Steward announced its three Florida hospitals would resume elective surgeries “previously delayed by the coronavirus pandemic.”

Monday, Steward did not respond to questions about the timeline for completion of its new patient tower and operating suites that were supposed to open in February, well before the pandemic reached Indian River County.

Cleveland Clinic Indian River’s chief medical officer, Dr. David Peter, said his hospital had “fully complied” with the government directive on elective procedures, but had not had to lay off any employees.

 “We never stopped doing emergency procedures or the things that we need to do to take care of the community,” Peter said.

Resuming non-emergency surgical procedures has been a slow process, he added. “We have been very purposeful in reopening, starting first with elective procedures where we knew patients would be in the hospital a very short period of time – less than 24 hours.

“Once we had gotten those launched in a successful way, we began to open all of our surgical practices. At this time, we’re fully open. Our operating rooms are doing very well. In a few instances, our volumes are higher than they typically were. We are certainly back to where we would like to be with procedures, with a few exceptions.” 

Both local hospitals are concerned that people are still wary of coming to the emergency department, where volumes are still depressed. 

“Even in Indian River County, where the number of COVID-19 patients is low compared to many counties in Florida, and in the United States, people are avoiding going to the hospital,” said Ravi Masih, MD, medical director of emergency services at Sebastian River. “This is an extremely alarming trend.”

“We started seeing that pretty much across the country,” said the  Cleveland Clinic’s Peter. “I don’t have a full explanation, but ER volumes are staying down. We don’t have any studies to prove this, but we do believe that we have patients who stayed home longer and who have gotten sicker and then presented much later. And that combination – of delay, worsening and then presentation – is harder to take care of. One of the things we want to do is encourage patients if they’re ill at home, if they need care, to seek care in a timely fashion. They’re more likely to have a better outcome.”

Masih also urged patients not to delay treatment.

“Be assured that at Sebastian River Medical Center, we are taking every precaution to limit patient exposure to COVID-19,” said Masih. “Patients are not waiting in the emergency room.  When a patient presents, they are immediately evaluated and taken to the appropriate section of the emergency treatment area. 

“Patients that present with non-respiratory symptoms are escorted to a section of the emergency room designated a ‘clean’ or non-respiratory unit,” Masih said. “At present, about 20 percent of the emergency treatment area is dedicated to respiratory patients and 80 percent is dedicated to general emergencies."

Peter said with the exception of low volumes continuing in the emergency department, the hospital has returned to its full vitality, with projects like improvements to the maternity wing still underway and the low-key opening in March of the new stroke center, which now offers interventional neurology.

“We’re active, we’re vibrant, we’re building,” Peter said. “We do see this as a challenge but we’re also looking to the future to what we can build here in Indian River County.”