The news that Archbishop Sean O'Malley will replace the head of the church's Caritas Christi Health care system is stunning. Caritas, which owns and operates two important Dorchester facilities, Carney Hospital in Lower Mills and St. Mary's Women's and Infants center in Uphams Corner, has been headed ably for 18 years by Dr. Michael Collins. The dismissal of Dr. Collins suggests the archdiocese has plans to change directions, and that possibility alone is worrisome.

Full disclosure: Michael Collins and I are cousins, and when he brought Carney into the Caritas system in 1977, I let him know that our neighborhood has a vital stake in ensuring the continued prosperity of the hospital. The Carney is a life-sustaining institution in Dorchester, and I assured him that he would hear from me if Caritas ever withdrew its commitment to maintaining this community hospital. The staff, headed by president Joyce Murphy, has made the health care needs of the many diverse communities of Dorchester and Mattapan the Carney's first priority.

Carney annually heads the list of uncompensated care in the state, and House Speaker and Carney neighbor Tom Finneran has been a tireless advocate for state funds to ease the bad debt problem the Carney faces.

But there's the danger that the new fiscal restraints facing the Catholic church might impact the decisions made by the efficiency consultants now making decisions for Caritas. They should know that if they make any decisions detrimental to these two Dorchester facilities, they will have a fight on their hands - and it will begin here. - Ed Forry

Dorchester and Mattapan residents are fortunate to be served by one of the finest network of health centers in the Commonwealth. Beginning in 1965, with this country's first federally funded health center on Columbia Point, these community-based centers have delivered. They offer high quality health care, a family doctor and a medical "home" to low and moderate income residents. With the success of this first facility, Boston's teaching hospitals quickly supported the concept, opening 30 health centers within ten years.

But all of them were committed to bringing respectful, quality, user-friendly care to people in the communities where they lived and worked.

With strong backing from these hospitals, they quickly filled a void with a unique community-based health system, ensuring primary care in the neighborhoods, and through their hospital partners a continuum of in-hospital care when needed.

According to a report by the Massachusetts League of Community Health Centers, "Based on a recent study by the health center-based HMO, Neighborhood Health Plan (NHP), patients served by community health centers had less hospital admissions, hospital stays and emergency room visits than did NHP patients who received their health care from hospital-based primary care sites."

In the current debate about health care costs, the Mass League states, "We are very willing participants in any and all initiatives that lead to more health access and greater efficiencies in the health system. However, we are reasonable about how that should happen and what it would realistically take to get there: continued partnerships with hospitals and other community-based providers; payments from the state that meet health center costs in providing care to Medicaid and uninsured patients; resources to expand our technological and physical plant capacity.

"Study after study suggests that $ 1.00 invested in CHC based primary care returns $ 3.00 in savings to the health care system."

After 40 years of community service, these health centers play an important role in today's labyrinthine health care system. In many ways, they are the first line of defense for people in need of health care.

- Ed Forry