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The New Hampshire Attorney General’s Office gave its blessing Monday to the takeover of Manchester’s Catholic Medical Center by for-profit HCA Healthcare, Inc.

Attorney General John Formella announced his office reached an agreement with HCA and CMC to make sure the new ownership will continue CMC’s mission to provide healthcare and serve the community. 

“This settlement represents a thoughtful approach that both addresses the insurmountable financial challenges CMC is facing and ensures that the healthcare needs of New Hampshire residents continue to be met,” Formella said.

The deal has been in the works for years as CMC sought financial salvation. The nonprofit hospital has been losing up to $3 million a year. The Attorney General’s Office review was the last step in finalizing the deal with HCA.

“CMC’s decision to sell the hospital is largely the result of financial distress that has brought CMC to the brink of bankruptcy,” Formella reported in his role as the state’s Director of Charitable Trusts. “On top of large losses over the last several years, CMC has projected losses of $41.5 million for its 2024 fiscal year, and its debt totals around $160 million. In April 2024, CMC laid off 142 employees attempting to reduce its losses, but providers and patients continue to leave the hospital, reducing revenues at a greater rate than any reduction in expenses.”

The purchase, which the report notes is “not an affiliation or partnership,” will provide financial stability the hospital has long sought.

In a statement, the Diocese of Manchester said maintaining the hospital’s Catholic identity “was essential to the CMC Board of Trustees and Bishop Peter Libasci in deciding a future course of action for the hospital. CMC was created in a close relationship with the Diocese of Manchester including that the Bishop of Manchester approves certain activities of the hospital and the assets of CMC transfer to the Diocese upon the sale of CMC. Going forward, these assets will be held and used exclusively by a foundation that will continue the legacy of CMC’s commitment to provide Catholic health care in the community.”

As part of the deal, HCA first got Vatican approval to take over CMC by signing an agreement to operate within the Catholic Church’s ethical standards for medical care.  

Formella’s agreement with HCA will see that the key funding is in place for hospital expansion and as well as continuing charity care for the Manchester community. 

“As part of HCA Healthcare, CMC and our new colleagues will have access to much-needed resources that will pave the way for financial stability and continued growth. We are committed to making significant capital investments and enhancing key service lines that will benefit not only Manchester patients but patients across New Hampshire with expanded choice and ensure they have the highest-quality care available close to home,”  said Dr. William Lunn, president of HCA Healthcare’s Capital Division.

HCA will contribute $2 million over the next three years to local community health initiatives like Healthcare for the Homeless and Poisson Dental Clinic. 

“With HCA Healthcare, CMC’s legacy of excellence will not only endure but flourish — expanding access to care, enhancing services, and remaining deeply rooted in our Catholic mission,” Alex Walker, president and CEO of CMC said.

Mayor Jay Ruais called Monday’s announcement a pivotal moment for the city.

“CMC’s partnership with HCA Healthcare ensures immediate access to the financial and operational resources necessary to sustain its more than 130-year legacy of providing high-quality Catholic healthcare to our region,” Ruais said. “I am pleased that vital and beloved community programs, such as Healthcare for the Homeless and Poisson Dental, will also continue to serve our community for years to come.”

HCA is a Tennessee-based for-profit company that operates 180 hospitals throughout the U.S., including three in New Hampshire. Critics oppose HCA’s acquisition of CMC, pointing to its actions at Frisbee Memorial Hospital, where the company shut down the labor and delivery department after promising to keep it open. 

HCA’s proposed deal with CMC was hounded last year by nurses from HCA’s North Carolina Mission Hospital in Asheville who said HCA operated in an unsafe manner that put their lives and the lives of patients at risk. The nurses came to New Hampshire to stage protests, publish newspaper ads, and talk to the media, all in an effort to stop the sale.

“The community needs to know what happened to our hospital, because the same thing will happen to their hospital,” Kelly Coward, a nurse and union representative at Mission Hospital in Asheville, told NHPR last year.

Those nurses, all members of the National Nurse United union, stopped their protest a day before the Oct. 23 attorney general’s public hearing at CMC. The union kept silent through the fall and had no statement Monday about the deal’s approval. 

On Oct. 22, National Nurse United announced it had reached a contract deal with HCA for 17 hospitals in 6 states, including the Mission Hospital in Asheville. 

Former state Sen. Lou D’Allesandro, who represented Manchester for decades, backs the HCA deal.

“CMC must be saved, and we must make sure that all contingencies are met,” D’Allesandro told NHJournal Monday. “I am a strong supporter and will continue to work on behalf of all the citizens of Manchester to have quality medical care continue to be provided.”

Bishop Libasci says he’s pleased with the result.

“We may look forward now to a strong, vigorous, Catholic hospital on Manchester’s West Side and Catholic healthcare throughout the state of New Hampshire,” Libasci said.

EDITOR’S NOTE: An earlier version of this article erroneously reported that the Diocese of Manchester owns CMC. NHJournal regrets the error.

At Wedensday’s public hearing on the proposed sale of Catholic Medical Center to HCA Healthcare, speaker after speaker made one fact clear: CMC needs help, and it can’t continue serving the community without it.

“CMC is in a very weak financial position,” said independent consultant Tyler Brannen. He was brought in by the New Hampshire Attorney General’s Office to analyze the proposed deal.

“It’s been operating at a loss for years. They can’t continue to operate at these losses indefinitely.”

Mary Ann Dempsey, Director of Public Trusts at the New Hampshire Department of Justice.

The state’s Director of Charitable Trusts, Mary Ann Dempsey, opened the public hearing and represented the state Department of Justice.

“Our review of the transaction will take into consideration expert analysis such Mr. Brannen, as well as input from the two parties, from community stakeholders, and from the public,” Dempsey pledged before an audience of some 300 people at Manchester Memorial High School.

One attendee was retiring state Sen. Lou D’Allesandro (D-Manchester). He told NHJournal moving ahead with the sale is the right thing to do.

“We need CMC, we need a vibrant CMC. We need a financially secure CMC. This is one way to make it happen. And I think that’s very, very significant,” D’Allesandro said. “All the services that have been provided must continue to be provided, there can’t be any deviation, we need that commitment.

“But this is a deal that’s got to happen.”

A non-profit controlled by the Roman Catholic Diocese of Manchester, CMC loses millions of dollars a year operating one of Manchester’s only two hospitals. CMC leaders have been looking for a fix for years without success, according to Tim Riley, chair of CMC’s board of trustees. A proposed merger with the Dartmouth-Hitchcock Health system fell apart in 2022 after years of work on the deal.

“That left CMC in a vulnerable position,” Riley said.

Tennessee-based HCA, a for-profit company that operates 180 hospitals throughout the U.S., including three in New Hampshire, says it’s ready to step in. Dr. William Lunn, president of HCA’s Capital Division, said the deal to join would end up with a stronger CMC, buoyed by investment and resources from the parent company.

Several speakers noted the proceeds from the sale would go to a charitable foundation controlled by the Diocese to further CMC’s charitable goals. Riley and Lunn said HCA will also respect CMC’s Catholic identity, and the hospital will still adhere to Catholic ethical standards for medical care.

“First and foremost, we required a partner that would maintain and embrace our Catholic identity,” Riley said. “This means following the ethical and religious directives for Catholic healthcare. It was important that our Catholic identity was not suddenly tolerated but fully embraced.

“HCA is a partner who is committed to our Catholic legacy and identity,” Riley added.

Critics of HCA say they fear the company will put its profit margins over public service. They point to the company’s takeover of Frisbie Memorial Hospital, where HCA shut down the labor and delivery department after promising to keep it open. 

And while the sale makes sense out of necessity, Brannen said there are likely going to be cost increases for patients and a possible loss of local control. Added to those concerns is the strength of the language in the contract when it comes to charitable care.

HCA is also the target of a lawsuit brought by North Carolina Attorney General Josh Stein accusing the company of failing to provide the care it promised when it bought the Mission Health System. Lunn said many problems at the Mission hospital have been corrected, and noted that Stein filed the lawsuit while he was seeking election to become North Carolina’s next governor. 

Manchester Mayor Jay Ruais spoke at the public meeting, praising HCA’s commitment to investing in the west

Manchester Mayor Jay Ruais.

side of his city beyond just the hospital itself.

“I’m thrilled to hear about the investment that you’re making, not only to the infrastructure in the hospital, but the infrastructure that you’re looking to create within our community as well. And I know that you would want the city to be a partner in that process,” Ruais said.

Alex Walker, CMC’s CEO, announced Wednesday that Dartmouth-Hitchcock will no longer provide labor and delivery at CMC. He also addressed concerns that the deal might push the hospital out of the business.

“We deliver about 1,000 babies a year. We have been delivering babies at Catholic Medical Center for the last 50 years. We’ve been delivering babies in the city of Manchester for the last 130 years,” Walker said. “So you need to hear from me on behalf of our Board of Trustees and the bishop: Labor and delivery services are a vital part of Catholic Medical Center. It is, in a lot of ways, our essence and what we’re all about.”

The public hearing is part of the New Hampshire Attorney General’s Office review process for the proposed sale. Mary Ann Dempsey, Director of Charitable Trusts, will continue to accept public comments about the proposed sale until Nov. 1. Those comments can be emailed to [email protected].