A robust Senate Republican is demanding solutions from a private-equity backed hospital in southeast Iowa amid revelations {that a} male nurse practitioner on the facility sexually assaulted 9 feminine sufferers there in 2021 and 2022.

The power, Ottumwa Regional Well being Heart, is a part of Lifepoint Well being Inc., a hospital system headquartered in Brentwood, Tennessee, and owned by Apollo World Administration, the large private-equity agency in New York co-founded by Leon Black.

The incidents on the Ottumwa facility got here to gentle late final 12 months after the overdose loss of life within the hospital of Devin Caraccio, 27, an authorized nurse practitioner who was a contract worker on the hospital, in keeping with its spokeswoman. After he died on the job in October, the Ottumwa police accessed his cellphone, discovering picture and video proof that he had assaulted the sufferers, in keeping with a police division investigator, Jeremy Tosh. 

The police division mentioned in an announcement in December that “It’s suspected that all the victims had been asleep, or in a state of unconsciousness when the assaults happened.” Two of the victims haven’t but been recognized; two had been beneath 18, Tosh mentioned in an interview final week.

Eight-term Sen. Chuck Grassley of Iowa despatched a letter this month to the hospital, Lifepoint Well being and Apollo’s chief government, Marc Rowan. In it, he requested whether or not monetary practices had lowered cash for affected person care and will have facilitated the sexual assault.

One in all Grassley’s questions was whether or not Apollo contractually shields itself from legal responsibility for actions that happen at hospitals it invests in, operates or manages. He additionally requested Apollo to element its “experience concerning rural or non-urban hospitals.”

A spokeswoman for Apollo mentioned: “Our funds are traders in Lifepoint and we’re responding to the questions from Senator Grassley’s workplace.”

Along with Ottumwa Regional, Lifepoint has greater than 60 acute care hospitals in 17 states, together with Arizona, Kentucky, Tennessee and Virginia. The power in Ottumwa, a city of 25,000, is one among many rural hospitals owned by Lifepoint; it’s the solely hospital within the 432-square-mile county of Wapello. 

Rural hospitals have skilled appreciable monetary strain in recent times, alleviated considerably by authorities reduction funds disbursed in the course of the pandemic. In keeping with analysis from the KFF, a nonprofit group previously generally known as the Kaiser Household Basis, median working margins at rural hospitals earlier than the pandemic had been 1.5%, versus 5.2% for nonrural services.

In an announcement, Cara Clouse, a spokeswoman for Ottumwa Regional Well being Heart, mentioned the ability is dedicated to the protection and well-being of its sufferers.

“The heinous acts of this former contractor clearly violate our insurance policies and values, and our hearts are with all these affected by his misconduct,” she mentioned. “Ottumwa Regional continues to cooperate with legislation enforcement, and now we have adopted various reforms to additional strengthen our controls and safety to safeguard these we serve and stop rogue unhealthy actors.”

A Lifepoint spokeswoman mentioned that the corporate “is deeply disturbed by the horrible acts dedicated by a contractor at Ottumwa Regional Well being Heart,” and that the corporate is implementing “new insurance policies and reforms to assist guarantee sufferers and their households are protected.”

Over the previous decade, private-equity corporations like Apollo have spent a whole bunch of billions of {dollars} shopping for up well being care companies, together with nursing houses, hospital staffing corporations and doctor practices. To finance these purchases, private-equity homeowners usually burden the businesses they purchase with debt, then slash the businesses’ prices to extend earnings and enchantment to potential patrons down the street.  

Within the enterprise of well being care, the drive for income can run counter to the purpose of serving to sufferers, critics say. 

Caraccio’s assaults on sufferers elevate “critical questions with respect as to if these hospitals have the proper assets or if they’re being loaded with overwhelming quantities of debt to the purpose the place they’re pressured to shift cash away from affected person care,” Grassley wrote in his letter. It additionally went to the CEO of Lifepoint Well being; the chief government of Warburg Pincus, one other private-equity agency that owned Ottumwa Regional Well being Heart earlier than Apollo purchased it; and the CEO of Medical Properties Belief, an actual property funding firm that had carried out a monetary transaction involving the ability. 

Apollo purchased the Ottumwa facility in 2015 from Warburg Pincus, and it turned a part of RegionalCare Hospital Companions. A flurry of transactions adopted: The following 12 months, Apollo merged RegionalCare with Capella, one other well being care firm, and in 2018 Apollo merged these operations with Lifepoint Well being. 

Then, in 2019, Medical Properties Belief purchased the true property beneath 10 Lifepoint hospitals, together with Ottumwa Regional, leasing them again to the services. Personal-equity corporations usually conduct such transactions, producing money for themselves and their companions from the sale of actual property underlying the services, however usually saddling the hospitals with elevated prices in rents. 

The sale and leaseback of the true property in Ottumwa doesn’t seem to have added to the ability’s rental prices, in keeping with an individual briefed on the transaction.

Nonetheless, such transactions are a priority to Grassley. “The fixed promoting and reselling of hospital belongings by non-public fairness, non-public capital, actual property funding trusts (REITs), and different associated entities raises questions with respect as to if these monetary maneuvers have negatively impacted the assets and thereby the care our nation’s rural hospitals present to their sufferers,” he famous in his letter.

The Lifepoint spokeswoman mentioned: “The actions of this one disturbed particular person don’t replicate who we’re, our core values, or how we function any hospital and on no account could be linked to Ottumwa Regional’s monetary standing. Lifepoint is happy with the substantial investments now we have made since turning into part of the Ottumwa neighborhood in 2018, together with the greater than $31 million in facility and expertise updates and for doctor recruitment and retention.”

A spokesman for Grassley mentioned the investigation by his workplace is ongoing. The recipients of his letter had been requested to reply by Friday, March 31. The spokeswoman for the hospital declined to touch upon the letter.