Turning patients into profit: How Steward embodies the risk of private equity's push in healthcare.

The rise and fall of Steward Health Care tracks a surge in private equity into all sectors of U.S. healthcare in the wake of the 2010 Affordable Care Act. The annual value of private equity health care deals roughly tripled over the 2010s, reaching $120 billion by 2019, according to experts. Today, private equity firms own around 460 US hospitals, about 8 percent of all private hospitals and 22 percent of all for-profit hospitals, according to the nonprofit Private Equity Stakeholder Project. At its peak, Steward, with more than 30 hospitals, was a significant slice of that pie. Private equity deals are often pitched as the last chance to save struggling hospitals. Sometimes they do. In other cases, hospital systems have been stripped of assets and neglected while executives and investors reap huge payouts. Today, Steward is under scrutiny in several ways, including bankruptcy court, where the carcass of the company — $9 billion in debt — is being picked over. And in federal district court, where prosecutors are digging into allegations of financial mismanagement that hastened the company’s collapse. In Massachusetts, taxpayers are bracing for a $700 million bill to rescue several Steward hospitals, from the same government that permitted this to happen. A Steward spokeswoman said the company declined to comment. Early this year, the Globe Spotlight Team set out to examine what went wrong in this once-promising, Boston-born hospital chain. What’s emerged is a cautionary tale about letting a wannabe billionaire, a titan of private equity, and a real estate investment trust become stewards of a public necessity like healthcare. It is about how they took a business dedicated to serving patients, and by their own account, turned it into a business for finance and investing. And it is about how everyone, so far, has gotten away with it.