MADERA, Calif. — First it was labor and delivery rooms. Then the emergency department. As they inch closer to a new year, residents of rural Madera County are bracing for life without a general hospital.
Faced with bankruptcy, services at Madera Community Hospital and its three rural clinics are set to shut down in the first days of the new year. First responders were already preparing for a deluge of emergencies associated with the looming closure.
Health officials, physicians and nurses from across the San Joaquin Valley packed the meeting room of the Madera County Board of Supervisors this week as board members held a special meeting to discuss how to confront the coming days and weeks.
It was the first time a public meeting was held about the matter since a deal by healthcare company Trinity Health to purchase the hospital was abandoned last week.
“This is a terrible, terrible situation. But I'll tell you, we've worked hard, and I think it's been very good in the coordination that we've had in making sure that patients are being taken care of,” said Dan Lynch, director of the Central California Emergency Medical Services Agency.
The Madera County Sheriff’s Office declared a local state of emergency, something typically reserved for disasters like a wildfire or flooding – both of which are familiar to residents in the county. But the closure of the only acute general hospital for a population of 150,000 presented a potential disaster of its own.
Scramble for services
Wait times for police and ambulance services – as well as commute times for patients having to seek medical care in other places – are expected to become longer. The nearest hospital for residents in Madera is a half hour’s drive south to Fresno.
“The lack of hospital services in Madera County is expected to strain local resources deployed within Madera County, thereby depleting ambulance and response resources such as law enforcement and fire,” the sheriff’s office wrote on Facebook Thursday night.
Declaring a state of emergency opens up the possibility of state and federal help.
Patients at Madera Community Hospital were quickly transferred to other hospitals in the days following the announcement of the closure. Roughly 22 patients were left at the hospital as of Thursday and waiting to be relocated to skilled nursing homes.
An additional five patients in the intensive care unit were moved to facilities as far as Delano and Sacramento.
At the hospital just off Highway 99, nurses conducted routine work late this week while a couple of patients waited to be seen in the dimly lit lobby.
It was quiet, with little to no chatter among employees.
Employees were facing their own challenges. According to some, they were given a 10-day notice of the closure with little to no information on next steps. Many doctors, nurses and other employees attended the meeting on Thursday to voice their concerns.
“Madera will be known as the only county in California that has no hospital, no emergency room, no ICU,” said Dr. Mohammad Ashraf, a cardiologist who’s worked at Madera Community for more than 40 years. “Nobody is going to move here. No [physician] is going to find work.”
Narrow window for solutions
The decision by leaders at the hospital to close down appears to have come as a last resort as they held out hope the hospital would be bought by a larger and much more stable organization.
Madera Community Hospital was losing millions of dollars each month and struggling to keep up with operating costs, according to its leadership. The COVID-19 pandemic only added to the losses as the hospital discontinued some services, staff was lost and healthcare reimbursements were not enough.
Negotiations to sell the hospital to Trinity Health began in October 2021. A separate offer from Community Health Centers, which owns Community Regional Medical Center in downtown Fresno, at the time was not considered since Madera Community Hospital was locked into negotiations with Trinity Health, according to California Senator Anna Caballero.
Local and state officials were looking at a small window of time before the bankruptcy was filed where they could come up with ways to keep some services running – a last ditch effort set off by the sudden closure announcement.
In September, $5 million were secured from the state’s budget to help the hospital keep its doors open. But that money is now in jeopardy under the bankruptcy announcement. It was intended only to help the hospital stay open, not pay off debts, Caballero said.
County officials are considering reallocating unspent funds from the American Rescue Plan, federal money sent to communities for COVID-19 relief, as a measure to help the hospital keep some operations.
More than $14 million that was placed into various projects have not been used, officials said, but the county is reluctant to pull those funds due to prior commitments.
Caballero said Gov. Gavin Newsom is briefed on the situation in Madera County. Although, it was unclear how soon the state could respond in any official way. If the governor declares a state of emergency, there’s a potential for federal aid.
“Madera is the canary in the coal mine,”Sen. Anna Caballero
But for that to happen, state officials are requesting detailed financial statements from the hospital to get a better picture of the losses and any money coming in. Caballero said the hospital’s chief financial officer resigned this week, making it harder to obtain the records needed.
“What management has to do is reorganize their work and figure out what can they keep open, what do they need to close right now and we've asked them to stay open into the new year so that we can continue to look for solutions,” Caballero said.
County supervisors floated the idea of a “super emergency room” that would accommodate certain needs in the region and potentially cost significantly less than running an entire hospital.
Caballero said she has learned the hospital is owed money from insurance companies Anthem Blue Cross and Cal Viva. Securing those payments, and looking at which services the hospital could still afford to offer, were things Caballero said state officials would like to look into as they prepare help.
She added that the estimates of financial loss provided so far – which hospital board members stated is more than $2 million a month– are broad.
Rural communities affected by closures
KVPR reached out to hospital CEO Karen Paolinelli but she has not returned phone calls or emails. However, she hadlong warned of the hospital’s trouble.
According to documents submittedduring the purchase negotiations, around 11 percent of the population in Madera County is uninsured, and half of the patients at the hospital are on Medi-Cal while 30 percent are on Medicare.
A study of hospital closures in rural areas of California shows mortality rates tend to spike after a closure. A 2019 working paper, which has not been peer-reviewed, from the National Bureau of Economic Research, reported an 8.7 percent increase in mortality among patients where a rural hospital is closed. Impacts were far less in urban hospital closures.
The paper stated hospital closures can exacerbate existing health care access among vulnerable residents. Rural closures have also hit patients where a large number of Medi-Cal and Medicaid residents live.
A separate study commissioned by the California Hospital Association this year examining performance data of 79 hospitals in the state revealed hospitals faced financial losses reaching $6 billion without federal aid.
“Madera is the canary in the coal mine,” Caballero said. “We have other community hospitals that are in a very precarious position and we need, as a state, to figure out what the big long term solution is going to be and we’ll be working on that in the new legislative session.”
The holidays have delayed discussions among hospital management and elected officials, Caballero said. And the end-of-year rush is a particular concern as hospitals typically treat patients in emergency visits. But as those services came closer to shutting down, the time to act was also becoming much slimmer.
“The timing could not be worse,” Caballero said.
