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The only general hospital serving rural Madera County will close, CEO announces

The City of Madera water tower is seen in the distance.
Cresencio Rodriguez-Delgado
The City of Madera water tower is seen in the distance.

Dec. 28, 2022, Update: Madera Community Hospital is speeding up closure of some of its services ahead of the new year. In an announcement posted to the hospital’s website, leaders announced all labor and delivery services were immediately ending Wednesday, Dec. 28. The emergency department will shut down on Friday, Dec. 30. The hospital’s message stated all other services would stop on Jan. 3, as originally planned.

Original story:

MADERA, Calif. – The only general hospital in rural Madera County is scheduled to close early next year, in a move that is expected to trigger negative effects on residents relying on its medical care.

The CEO of Madera Community Hospital Karen Paolinelli announced in a press release on Friday that all operations at its emergency room, obstetrics, outpatient and surgery departments will close on Jan. 3, 2023. Three rural clinics operated by the hospital will close on Jan. 10.

Paolinelli announced all remaining patients at the hospital in the City of Madera will be transferred to other facilities by Jan. 17.

A special meeting by the Madera County Board of Supervisors is scheduled for Dec. 29 to discuss the closure and any possible ways the county could respond.

The sudden announcement came after a year-long effort by hospital leadership to find solutions to its struggling finances. Officials from the Fresno County Department of Public Health said on Friday they were prepared to offer assistance to Madera County residents as the hospital moved toward closing.

“Our hearts are broken by this news, but we are committed to ensuring that our community and region have access to quality medical care,” Dr. Rais Vohra, Fresno County Interim Health Officer, stated. “We are here to support all of our medical partners and help them navigate this transition.”

Paolinelli said the closure stems from financial strain caused by the pandemic.

In April, she told KVPR closing the hospital was a real possibility unless the state figured out ways to help struggling hospitals. That same month, a study commissioned by the California Hospital Associationexamining performance data of 79 hospitals in the state revealed hospitals faced financial losses reaching $6 billion; after pandemic relief from the federal government was factored in, total losses lowered to nearly $4 billion.

Madera Community Hospital averages around 30,000 emergency visits per year, according to information submitted during the purchase negotiations and provided online by the hospital.At its clinics, around 50,000 people were seen on average. The number of patients at the hospital and clinics had been declining in recent years.

Failed purchase

Earlier this month, California Attorney General Rob Bonta conditionally approved the sale of Madera Community Hospital to Trinity Health. But the deal fell through.

The CEO of Saint Agnes Medical Center in Fresno, which is also owned by Trinity Health and would’ve operated the Madera hospital, said some of the conditions for the sale set by Bonta were to blame for canceling the plans. It was unclear to which conditions she referred.

Bonta said he was disappointed with Trinity Health’s decision to not go through with the sale. He had announced conditions that Trinity Health should meet, such as maintaining services in good faith for five years and providing a range of healthcare services. In the original agreement, Trinity Health had also committed to millions in hospital upgrades.

“The minimal conditions we set on the sale would have kept the hospital’s services affordable and accessible, and prioritized people’s health and safety,” Bonta said in response to the healthcare company’s decision. “These baseline conditions would merely require Trinity to use its best efforts to act in good faith and keep the hospital open for patients who relied on it for critical and lifesaving services. Instead, Trinity refused to meet even these minimal conditions and chose to callously walk away. Madera County’s residents deserve better."

California law requires the attorney general to oversee and approve the sale or transferof a healthcare facility owned by a nonprofit.

The sale exploration to Trinity Health had a practical foundation since Trinity’s Saint Agnes Hospital was the closest distance to Madera County and the second-most utilized hospital for emergency visits by Madera County residents after Madera Community Hospital.

Residents of Fresno and Madera counties also face similar rates of asthma, diabetes and cancer.

Hospital's financial struggles

According to documents submitted for review during the purchase negotiations and posted to Madera Community Health’s website, the hospital generated little revenue compared to Saint Agnes in the three-year period before the COVID-19 pandemic, showing the hospital’s struggle to keep up with costs.

In total between 2016 and 2020, operating expenses exceeded revenue by $5.7 million. And costs worsened as the pandemic set in. Madera Community Hospital was one of the first hospitals in the San Joaquin Valley to receive a COVID-19-positive patient in 2020.

Largely rural, Madera County has a population just under 160,000 and stretches from the Valley eastward to the Sierra Nevada. Nearly 60 percent of the population is Hispanic. About 22 percent of the population lives below the federal poverty level.

According to the documents submitted during the purchase negotiations, around 11 percent of the population is uninsured, and half of the patients at the hospital are on Medi-Cal while 30 percent are on Medicare.

The documents stated patients in the county who rely on Medi-Cal insurance and the rural clinics were expected to be affected most due to the lack of physicians who accept the insurance and because there is a lack of affordable medical services. But overall transportation to nearby hospitals, most likely in Fresno, was also expected to be a burden on residents.

“If closure or reduction of essential services occurs, the entire population of residents will experience negative health outcomes because of the loss of access to hospital and emergency services with no nearby alternatives,” the document stated.

The hospital recently celebrated its 50th anniversary and a message from the CEO stated the hospital system was one of the largest employers in the county.

An online petition to save the hospital had quickly circulated online after news of the closure.

Cresencio Rodriguez-Delgado is KVPR's News Director. Prior to joining the station's news department in 2022, he was a reporter for PBS NewsHour and The Fresno Bee.
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