Introduction:
Ransomware attacks on hospitals have surged in recent years, forcing executives into gut-wrenching decisions under crisis conditions[1][2]. With patients’ lives potentially on the line, some hospitals decide to pay hackers hoping for a quick resolution. In fact, healthcare organizations are more likely to pay ransoms than those in other sectors – 61% of health providers hit by ransomware admitted to paying, compared to 46% across industries[3]. But despite the desperation and the hefty sums exchanged, paying the ransom rarely equates to “problem solved.” Time and again, real-world cases show that even after a hospital gives in to extortion demands, the aftermath continues to wreak havoc on operations, data integrity, patient care, reputation, and regulatory standing. The true business risk far exceeds the ransom amount. This article explores why the damage from ransomware doesn’t end when the Bitcoin is sent, drawing on global case studies that illustrate the lingering fallout of attacks – even when the ransom is paid.
A hospital administrator faces a ransomware demand screen. Even after paying a ransom, many hospitals find their systems crippled and critical data compromised, underscoring that a ransom payment is not a quick fix.
It’s tempting to view a ransom payment as the fast track to restoring hospital IT systems. Unfortunately, there’s no honor among thieves – and no guarantee of recovery once criminals have been paid. Cybersecurity experts emphasize that handing over money often doesn’t get you what you expect. As Crane Hassold, a former FBI analyst, notes, “Even if you pay the ransom, it is not a guarantee that you’re going to get data back… There have been so many examples of someone paying a ransom and then not actually receiving a decryption key, or receiving a decryption key and it just not working”[4]. In other words, hospitals may pay tens or hundreds of thousands of dollars and still be left with scrambled systems.
Real cases bear this out. In 2016, Kansas Heart Hospital learned the hard way that payment doesn’t ensure resolution. The hospital paid an initial ransom to restore its files, only for the attackers to demand a second ransom immediately afterward instead of providing a full decryption[5]. At that point the hospital refused to pay more, recognizing the shakedown would continue, and resorted to rebuilding systems from backups[6]. Similarly, Change Healthcare – a major health IT firm – disclosed in 2024 that it paid an astronomical $22 million ransom to the BlackCat group and “did not get its data back” in return[7]. In fact, after payment the hackers still threatened to leak patient data on the dark web, and some stolen records were published despite the payoff[8]. These examples underscore that a paid ransom is a gamble, not a cure. A 2021 global survey found only 8% of organizations that paid a ransom got back all their data, while 29% recovered no more than half[9]. As one cybersecurity report bluntly concluded, “when it comes to ransomware, it doesn’t pay to pay”[10]. Paying may even invite follow-up extortion: criminals know a hospital willing to pay once might pay again. The bottom line is that a ransom payment offers false hope and, in many cases, no meaningful shortcut to restoration[11].
Even in the best-case scenario – where attackers honor the payment and hand over decryption keys – hospitals often face prolonged operational turmoil. It is not like flipping a switch to go back to normal. Restoring hundreds of servers and thousands of workstations from encrypted state is a slow, painstaking process that can take days or weeks[12]. During that time, critical hospital functions remain impaired. For example, DCH Health System in Alabama paid a ransom to Ryuk ransomware attackers in 2019, yet its three hospitals were paralyzed for 10 days before normal operations resumed[13]. For over a week, DCH’s staff diverted new patients to other facilities, turned away ambulances, and fell back to pen-and-paper documentation while IT systems remained locked[14][15]. Paying the attackers did not spare DCH from effectively a week and a half of downtime and chaos.
Other hospitals have endured similar ordeals. In Japan, Osaka General Medical Center suffered a massive ransomware attack on October 31, 2022 that crippled its electronic medical records and scheduling systems. The public hospital could not treat outpatients, had to cancel surgeries, and ran on paper charts for inpatient care[16][17]. It took over two months for Osaka General to fully resume normal operations[18] – indicating that even with decryption efforts, the recovery was agonizingly slow. In a U.S. example, Scripps Health in California (hit by ransomware in 2021) remained disrupted for four full weeks, with digital systems down and ambulances diverted, despite working to decrypt and restore systems as fast as possible[19]. These timelines reveal a harsh truth: Paying a ransom seldom leads to immediate restoration of healthcare IT. Instead, hospitals often slog through long periods of reduced functionality while rebuilding their networks, whether they obtain a decryption key or have to rely on backups. Every day of downtime means canceled appointments, delayed procedures, diverted emergencies, and a mounting backlog of care. As one analysis noted, it is “not necessarily the case” that paying shortens disruptions – many hospitals that paid still faced multi-week outages[20][21]. Executives must realize that the operational disruption is likely to continue well beyond any ransom payment, and this prolonged interruption carries its own massive costs.
Modern ransomware attacks don’t just lock up data – they also steal it. This means a hospital hit by ransomware is effectively facing two crises: encrypted systems and a data breach. Paying the ransom might (in theory) address the encryption by obtaining a decryption key, but it does nothing to rewind the data theft. Attackers often copy sensitive patient records and threaten to leak them publicly if not paid (a tactic known as double extortion). Disturbingly, paying to decrypt files does not guarantee hackers will keep stolen data secret. Often they leak it anyway or extort the victim further. In the 2023 Change Healthcare breach mentioned earlier, after receiving the $22 million ransom, the perpetrators still attempted additional extortion and dumped patient information on the dark web[8]. Another hospital, Sturdy Memorial in Massachusetts, paid a ransom in 2021 specifically in exchange for a promise that the attackers would “destroy” the stolen data – essentially buying the criminals’ word[22]. Yet even in announcing that payment, Sturdy had to acknowledge tens of thousands of patients’ records were compromised and report the breach to regulators[23][24]. The integrity and confidentiality of patient data cannot simply be bought back; once data is in criminal hands, the damage is done.
This raises serious issues of trust and safety. Medical records might be tampered with or incomplete after an attack, even if decrypted. There is also no way to verify that criminals erased their copies of the data. As cybersecurity expert Lee Kim warns, a gang could take the ransom and still only return partial access until more money is paid[25]. Or they might demand another payout later, threatening to leak data they retained. Truly, “there’s no honor among thieves”[26]. Hospitals that pay ransoms remain at criminals’ mercy regarding any exfiltrated data. For instance, Lehigh Valley Health Network (Pennsylvania) refused to pay a ransom to the BlackCat group in 2023; the hackers then leaked nude medical images of cancer patients to punish the hospital[27]. But even organizations that do pay cannot be sure such leaks won’t occur – extortionists may publish or sell the data regardless, or come back months later with new demands. In short, a ransom payment cannot undo a data breach. The hospital still faces all the fallout of exposing patient records: mandatory breach notifications, potential identity theft risks for patients, credit monitoring costs, and the erosion of trust in the institution’s ability to safeguard information.
Perhaps the most compelling reason that paying doesn’t fix the real problem is that the real problem is patient safety, not just locked computers. A decryption key does not instantly put cancelled surgeries back on the schedule or magically triage the waiting room full of patients who were turned away during the outage. Even after paying, hospitals often remain in disaster mode, and patients feel the impact. During the Scripps Health attack, for example, stroke and heart attack patients had to be rerouted to other hospitals, potentially losing crucial treatment time[28][19]. In another case, the 2019 ransomware attack on Springhill Medical Center (Alabama) coincided with a childbirth complication – the hospital’s systems were down, clinicians lacked access to fetal monitor readings, and tragically the infant died. The mother’s lawsuit alleges the ransomware-induced outages led directly to the baby’s death by impairing the care team’s situational awareness[29]. This is an extreme example, but it underscores the life-and-death stakes. Likewise, in Germany, a woman in Düsseldorf died in 2020 when a ransomware attack on the city’s University Hospital forced her emergency treatment to be delayed and rerouted to a farther hospital[30]. These cases make clear that paying the ransom doesn’t rewind the clock on patient harm that occurs during the attack. Every minute of system downtime in a hospital can have medical consequences.
It’s no wonder that a 2023 survey found 45% of health IT professionals reported ransomware caused increased complications in medical procedures – up from 36% the year before[31]. Surgeries get postponed, lab results are delayed, ambulances are diverted, and clinicians are forced to work without vital electronic systems. The chaos does not immediately subside just because a ransom is paid. For days or weeks, doctors and nurses must rely on paper charts, “work blind” without historical data, and implement fallback processes. In the Osaka General Hospital incident, staff described the first week as “very crowded and chaotic,” with confusion among clinicians and patients alike[32][33]. It took significant time and improvisation to restore even basic services. This ongoing disruption to patient care is the real cost that hospital leaders must focus on. While executives might hope that paying ransom will rapidly restore clinical operations, the reality is that patient care will be disrupted for the duration of the recovery period, and some impacts – like adverse outcomes or deferred treatments – can never be undone. In essence, the primary risk from ransomware is to patient safety and continuity of care, which a decryption key alone cannot guarantee.
Beyond the immediate operational crisis, ransomware leaves lingering scars on a hospital’s reputation and invites scrutiny from regulators and the public. A ransom payment may be made quietly, but the incident itself almost always becomes public knowledge, whether through breach notification laws, media coverage, or data leaks on the internet. Hospitals then face the arduous task of rebuilding trust with their community. Patients lose confidence in a hospital that has allowed their data to be kidnapped or leaked, and they may fear for their privacy or even their safety in that facility[34]. This reputational damage can result in patients choosing competitors for care. For healthcare executives, a tarnished reputation is a long-term business risk – brand damage can impact everything from elective procedure volumes to donor support for non-profits. Paying the ransom does nothing to mitigate this; in fact, some might argue it encourages criminals to target the hospital again (painting a target on the back of an institution known to pay).
Regulators, for their part, are increasingly unforgiving about ransomware incidents. In the United States, any breach of protected health information (which ransomware attacks almost invariably cause) triggers obligations under HIPAA and state laws. The U.S. Department of Health and Human Services now views ransomware attacks as presumed data breaches, meaning hospitals must notify affected patients and may face investigations or fines. Lawsuits are another inevitable consequence. In 2023, a large Oklahoma health system settled a class action for $30 million after a ransomware-related data breach exposed patient records[35]. In Ireland, the national Health Service Executive (HSE) is dealing with over 600 legal claims from patients after a 2021 ransomware attack crippled the country’s health system[36][37]. Years later, the HSE is offering compensation payments to tens of thousands of affected individuals, a process expected to cost over €100 million[38][39]. This illustrates that the financial fallout of an attack can far exceed the ransom demand, once regulatory penalties, legal settlements, and remediation costs are tallied.
Executives must also consider potential regulatory changes on the horizon. Governments are contemplating stricter rules on ransom payments. For instance, U.S. authorities (and some EU officials) have discussed banning organizations from paying ransoms to dampen the ransomware epidemic[40][41]. While healthcare might get carve-outs for extreme scenarios, any such policy would increase the scrutiny on hospitals that pay. Even absent a ban, paying a ransom to certain sanctioned cyber gangs could violate sanctions law – funding groups tied to hostile nations is not only ethically fraught but could bring government penalties[42]. And regardless of legality, paying criminals signals to the public and regulators that the hospital may not have had adequate prevention and recovery plans, which can prompt tough questions from boards and lawmakers. In short, the decision to pay (or not pay) does not shield a hospital from regulatory and public fallout. A paid ransom will not erase the breach from regulators’ ledgers, nor will it undo the required notifications and potential fines. The primary way to fix the problem is by preventing it and responding effectively, not by funding the attackers. As one expert aptly put it, “Recovering from a ransomware attack can take years and is about so much more than just decrypting and restoring data – whole systems need to be rebuilt… and there is operational downtime and customer impact to consider”[43]. Hospitals must invest in resilience before an attack, because after one, there is no easy way out.
Ransomware is a uniquely damaging threat to hospitals because it strikes at the core of their mission: delivering timely, safe patient care. When every minute counts for a stroke or trauma patient, having critical systems held hostage is devastating. It’s understandable that under such duress, hospital leaders might view paying the ransom as the lesser of two evils – a way to potentially speed up recovery and protect patients. But as we’ve seen through global case studies, paying the ransom is at best a band-aid on a gaping wound, and at worst it pours salt in that wound. The primary business risk in a ransomware attack is not the ransom amount; it is the total impact on operations, patients, and the hospital’s future. Downtime, data loss, and reputational damage will continue to hemorrhage value long after the ransom is paid.
Healthcare executives should approach ransomware as a when, not if, scenario and focus on robust incident response and continuity plans. This means investing in secure backups, network segmentation, regular drills, and cyber defenses to minimize disruptions if an attack occurs. Many health systems now publicly state they will not pay ransoms, aligning their strategy accordingly[44][45]. The reason is clear: even a “successful” ransom payment still leaves the hospital in an operational code blue – scrambling to restore systems, reassuring patients, and repairing its image. Rather than banking on cybercriminals’ mercy, leaders are wiser to bank on resilience. In the final calculus, preventing ransomware and being prepared to recover quickly without paying is the only sure way to protect both patient safety and the bottom line. Paying the ransom may feel like an urgent transfusion for a hospital in crisis, but it won’t cure the underlying condition. In cybersecurity medicine, an ounce of prevention is worth far more than a pound of cure – especially when the “cure” comes from criminals who caused the harm in the first place. Hospitals that prioritize cyber resilience will weather the storm far better than those who hope to buy their way out of trouble. The evidence is overwhelming: paying the ransom doesn’t fix the problem – bolstering your defenses and response capabilities does.
Sources: Recent case studies and cybersecurity reports have been cited throughout this article to provide factual support and real-world examples of ransomware impacts on hospitals. Key references include industry analyses, news on specific hospital attacks across the U.S., Europe, and Asia, expert commentary, and surveys on ransomware outcomes[31][11][13][9][7][30], among others, underscoring the global and persistent nature of this threat. All evidence points to the same conclusion: The true cost of a ransomware attack far exceeds any ransom, and paying that ransom often fails to mitigate the most damaging consequences.
[1] [3] [4] [11] [12] [25] [26] [27] [28] [31] [42] [44] [45] Paying the ransom: Hospitals face hard choices in cyberattacks | Special Report | Chief Healthcare Executive
[2] [19] [29] [30] Why Are Ransomware Attacks Targeting Health Care Providers? | Tufts Now
https://now.tufts.edu/2024/04/09/why-are-ransomware-attacks-targeting-health-care-providers
[5] [6] Kansas Heart Hospital Ransomware Attack: Ransom Paid, Second Demand Issued
[7] [8] Change Healthcare discloses USD 22M ransomware payment | IBM
https://www.ibm.com/think/news/change-healthcare-22-million-ransomware-payment
[9] [10] [43] Only 8% of businesses that paid a ransom got all of their data back - Help Net Security
https://www.helpnetsecurity.com/2021/04/28/ransom-paid/
[13] [14] [15] Alabama Hospital chain paid ransom to resume operations after ransomware attack
https://securityaffairs.com/92450/cyber-crime/alabama-hospital-ransomware.html
[16] [17] [18] [32] [33] After crippling ransomware attack, Osaka hospital embraces cyber safety, smoother workflows - Source Asia
[20] [21] [40] [41] Trends in Ransomware Attacks on US Hospitals, Clinics, and Other Health Care Delivery Organizations, 2016-2021 - PMC
https://pmc.ncbi.nlm.nih.gov/articles/PMC9856685/
[22] [23] [24] Hospital Pays Ransom in Exchange for Promised Data Destruction
[34] Hospitals need unified strategy vs ransomware | Healthcare Asia Magazine
[35] $30M settlement reached in data breach affecting 2.4M patients
[36] [37] HSE offering €750 compensation to cyberattack victims - RTE
https://www.rte.ie/news/ireland/2025/1209/1548056-hse-cyberattack-compensation/
[38] [39] Four years later, Irish health service offers €750 to victims of ransomware attack
