MPT OF COMMERCE CITY FCER, LLC MPT OF FORT WORTH FCER, LLC, MPTOF SUMMERWOOD FCER, LLC MPT OF FAIRMOUNT ALECTO, LLC MPT OF HOOVER MEDICAL WEST, LLC MPT UK HOLDCO MPT BATH MPT RHM HOHENLOHE MPT RHM BUCHBERG and MPT RHM HEINRICH MANN as Guarantors, MPT OPERATINGPARTNERSHIP, L.P. and MPTFINANCE CORPORATION, as Issuers, MEDICAL PROPERTIES TRUST, INC., as Parent and a Guarantor, theother GUARANTORS named herein, as Guarantors, and WILMINGTON TRUST COMPANY, as Trustee SIXTEENTHSUPPLEMENTAL INDENTURE Dated as of October 3, 2014 To INDENTURE Dated as of April 26, 2011 6.875% Senior Notes due 2021 SIXTEENTH SUPPLEMENTAL INDENTURE

Exhibit 4.19

MPT OF COMMERCE CITY FCER, LLC

MPT OF FORT WORTH FCER, LLC,

MPT OF SUMMERWOOD FCER, LLC

MPT OF FAIRMOUNT – ALECTO, LLC

MPT OF HOOVER – MEDICAL WEST, LLC

MPT UK HOLDCO

MPT BATH

MPT RHM HOHENLOHE

MPT RHM BUCHBERG

and

MPT RHM HEINRICH MANN

as Guarantors,

MPT OPERATING PARTNERSHIP, L.P.

and

MPT FINANCE CORPORATION,

as Issuers,

MEDICAL PROPERTIES TRUST, INC.,

as Parent and a Guarantor,

the other GUARANTORS named herein,

as Guarantors,

and

WILMINGTON TRUST COMPANY,

as Trustee

SIXTEENTH SUPPLEMENTAL INDENTURE

Dated as of October 3, 2014

To

INDENTURE

Dated as of April 26, 2011

6.875% Senior Notes due 2021

SIXTEENTH SUPPLEMENTAL INDENTURE

SIXTEENTH SUPPLEMENTAL INDENTURE (this “Sixteenth Supplemental Indenture”), dated as of October 3, 2014, by and among MPT of Commerce City FCER, LLC, a Delaware limited liability company, MPT of Fort Worth FCER, LLC, a Delaware limited liability company, MPT of Summerwood FCER, LLC, a Delaware limited liability company, MPT of Fairmount – Alecto, LLC, a Delaware limited liability company, MPT of Hoover – Medical West, LLC, a Delaware limited liability company (the “Domestic Guarantors”), and MPT UK Holdco, MPT Bath, MPT RHM Hohenlohe, MPT RHM Buchberg and MPT RHM Heinrich Mann, each a société à responsabilité limitée incorporated and existing under the laws of the Grand Duchy of Luxembourg (the ‘Lux Guarantors” and together with the Domestic Guarantors, the “New Guaranteeing Subsidiaries”), MPT Operating Partnership, L.P., a Delaware limited partnership (“Opco”), MPT Finance Corporation, a Delaware corporation (“Finco” and, together with Opco, the “Issuers”), Medical Properties Trust, Inc., a Maryland corporation (the “Parent”), as Guarantor, each of the other Guarantors (as defined in the Indenture), as Guarantors, and Wilmington Trust Company, a Delaware chartered trust company, as Trustee (the “Trustee”).

WITNESSETH

WHEREAS, the Issuers and the Guarantors have heretofore executed and delivered an Indenture, dated as of April 26, 2011 (the “Base Indenture”), as supplemented by that certain First Supplemental Indenture, dated as of August 10, 2011 (the “First Supplemental Indenture”), by that certain Second Supplemental Indenture, dated as of October 3, 2011 (the “Second Supplemental Indenture”), by that certain Third Supplemental Indenture, dated as of December 2, 2011 (the “Third Supplemental Indenture”), by that certain Fourth Supplemental Indenture, dated as of January 19, 2012 (the “Fourth Supplemental Indenture”), by that certain Fifth Supplemental Indenture dated as of April 9, 2012, (the “Fifth Supplemental Indenture”), by that certain Sixth Supplemental Indenture dated as of June 27, 2012, (the “Sixth Supplemental Indenture”), by that certain Seventh Supplemental Indenture dated as of July 31, 2012 (the “Seventh Supplemental Indenture”), by that certain Eighth Supplemental Indenture dated as of September 28, 2012 (the “Eighth Supplemental Indenture”), by that certain Ninth Supplement Indenture dated as of December 28, 2012 (the “Ninth Supplemental Indenture”), by that certain Tenth Supplement Indenture dated as of June 27, 2013 (the “Tenth Supplemental Indenture”), by that certain Eleventh Supplemental Indenture dated as of August 8, 2013 (the “Eleventh Supplemental Indenture”), by that certain Twelfth Supplemental Indenture dated as of October 30, 2013 (the “Twelfth Supplemental Indenture”), by that certain Thirteenth Supplemental Indenture dated as of December 20, 2013 (the “Thirteenth Supplemental Indenture”), by that certain Fourteenth Supplemental Indenture dated as of March 31, 2014 (the “Fourteenth Supplemental Indenture”) and by that certain Fifteenth Supplemental Indenture dates as of June 30, 2014 (the “Fifteenth Supplemental Indenture”, together with the Base Indenture, the First Supplemental Indenture, the Second Supplemental Indenture, the Third Supplemental Indenture, the Fourth Supplemental Indenture, the Fifth Supplemental Indenture, the Sixth Supplemental Indenture, the Seventh Supplemental Indenture, the Eighth Supplemental Indenture, the Ninth Supplemental Indenture, the Tenth Supplemental Indenture, the Eleventh Supplemental Indenture, the Twelfth Supplemental Indenture, the Thirteenth Supplemental Indenture and the Fourteenth Supplemental Indenture, the “Indenture”), providing for the issuance by the Issuers of the 6.875% Senior Notes due 2021 (the “Notes”);

WHEREAS, pursuant to Section 9.01(a)(4) of the Indenture, the Issuers, the Guarantors and the Trustee may supplement the Indenture without the consent of any Holders in order to add Guarantees with respect to the Notes;

WHEREAS, as of August 6, 2014 and September 30, 2014, the Domestic Guarantors guaranteed the Credit Agreement, and pursuant to Section 4.14(a) of the Indenture, the Domestic Guarantors are required to become Guarantors under the Indenture;

WHEREAS, the Indenture requires that an entity that constitutes a Guarantor shall join the Issuers and the existing Guarantors in executing and delivering to the Trustee a supplemental indenture pursuant to which such entity shall unconditionally Guarantee, on a joint and several basis, the full and prompt payment of the principal of, premium, if any, and interest in respect of the Notes on a senior basis and all other obligations under the Indenture;

WHEREAS, the Lux Guarantors wish to join the Issuers and the existing Guarantors in executing and delivering to the Trustee a supplemental indenture pursuant to which the Lux Guarantors shall unconditionally Guarantee, on a joint and several basis, the full and prompt payment of the principal of, premium, if any, and interest in respect of the Notes on a senior basis and all other obligations under the Indenture; and

WHEREAS, pursuant to Section 9.01 of the Indenture, the Trustee is authorized to execute and deliver this Sixteenth Supplemental Indenture.

NOW, THEREFORE, in consideration of the foregoing and for other good and valuable consideration, the receipt of which is hereby acknowledged, the Issuers, the Guarantors, the Trustee and the New Guaranteeing Subsidiaries mutually covenant and agree for the equal and ratable benefit of the Holders of the Notes as follows:

1. CAPITALIZED TERMS. Capitalized terms used herein without definition shall have the meanings assigned to them in the Indenture. The rules of interpretation set forth in the Indenture shall be applied here as if set forth in full herein.

2. AGREEMENT TO GUARANTEE. The New Guaranteeing Subsidiaries hereby agree to provide unconditional Guarantees effective as of September 30, 2014, on the terms and subject to the conditions set forth in the Indenture including but not limited to Article 10 thereof.

3. MISCELLANEOUS PROVISIONS.

(a) The Trustee makes no undertaking or representation in respect of, and shall not be responsible in any manner whatsoever for and in respect of, the validity or sufficiency of this Sixteenth Supplemental Indenture or the proper authorization or the due execution hereof by the Issuers or for or in respect of the recitals and statements contained herein, all of which recitals and statements are made solely by the Issuers.

(b) Effective as of September 30, 2014, the Indenture shall be supplemented and amended in accordance herewith, and this Sixteenth Supplemental Indenture shall form part of the Indenture for all purposes, and the Holder of every Note heretofore or hereafter authenticated and delivered under the Indenture shall be bound thereby. The Trustee accepts the trusts created

by the Indenture, as amended and supplemented by this Sixteenth Supplemental Indenture, and agrees to perform the same upon the terms and conditions of the Indenture, as amended and supplemented by this Sixteenth Supplemental Indenture.

(c) This Sixteenth Supplemental Indenture shall be deemed to be incorporated in, and made a part of, the Indenture. The Indenture, as amended and supplemented by this Sixteenth Supplemental Indenture, shall be read, taken and construed as one and the same instrument and all the provisions of the Indenture shall remain in full force and effect in accordance with the terms thereof and as amended and supplemented by this Sixteenth Supplemental Indenture.

(d) THIS SIXTEENTH SUPPLEMENTAL INDENTURE SHALL BE GOVERNED BY, AND CONSTRUED IN ACCORDANCE WITH, THE LAWS OF THE STATE OF NEW YORK.

(e) This Sixteenth Supplemental Indenture may be executed in any number of counterparts, each of which so executed shall be deemed to be an original, but all such counterparts shall together constitute but one and the same instrument.

[Signature Pages Follow]

IN WITNESS WHEREOF, the parties hereto have caused this Sixteenth Supplemental Indenture to be duly executed and attested, all as of the date first above written.

SIXTEENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE

SIXTEENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE

SIXTEENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE

SIXTEENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE

SIXTEENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE

SIXTEENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE

SIXTEENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE

SIXTEENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE

SIXTEENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE

SIXTEENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE

SIXTEENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE

SIXTEENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE

SIXTEENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE

SIXTEENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE