MADERA, Calif. — On a rain-soaked Monday afternoon, Family Health Services clinic in Madera was in its final operating hours.
Some parked cars were the only visible sign of activity in the vast empty space left by the closure of next-door Madera Community Hospital, which operated the clinic.
The hospital filed for bankruptcy and closed its doors on Jan. 3 but left its clinics to run until Jan. 10. While the bankruptcy filing is expected to be completed by next week, the closure of three clinics and a hospital in a single month in the county have left many questions.
Sandra Bonds, a Madera resident and patient had just left her final appointment at the clinic on a recent day. She stood under the hospital’s awning, waiting to catch the bus.
“I use the clinic and the hospital, so it’s really going to be missed,” she said. “I don't know what we're gonna do, especially if you have an emergency when there's no emergency room, and now no clinic.”
Clinics in Madera, Chowchilla and Mendota all closed their doors this week. Roughly 6,500 patients were served by Madera Community Hospital's clinics in Madera and Chowchilla, according to estimates provided by Camarena Health, a federally-qualified health center that remains as a source of medical care in the county.
Camarena Health operates 18 health centers across Madera County that provide urgent care, dental, vision and behavioral health services. It’s unclear so far how many patients the clinic network absorbed since the closure of Madera Community Hospital and its clinics.
“We have been working to transition those patients and to give them a medical home,” CEO Paulo Soares said.
Legislators race to save hospital services
In late December 2022, Trinity Health, one of the largest not-for-profit Catholic health care systems in the country, backed out of a deal to purchase Madera Community Hospital.
The closure of the county’s general hospital in the final days of last year triggered a scramble by officials looking for ways to save the services. Two days after the hospital closed on Jan. 3, Assemblymember Esmeralda Soria and Senator Anna Caballero, whose districts include Madera County, delivered a joint letter to Trinity Health requesting it renegotiate provisions in an existing agreement with Madera Community Hospital. The provisions were related to $15 million owed to Trinity Health.
The bankruptcy filing by Madera Community Hospital allows for the distribution and pay off of debts, including the $15 million debt to Trinity Health. Trinity Health operates more than 80 hospitals across the country, including Saint Agnes Medical Center in Fresno.
I don't know what we're gonna do, especially if you have an emergency when there's no emergency room, and now no clinic.Sandra Bonds, Madera County resident
Officials with Saint Agnes, which would have acquired the hospital, cited conditions of the sale set by Attorney General Rob Bonta as a reason for Trinity Health pulling back. Any sale or transfer of a nonprofit health care facility must be approved by the Attorney General, according to state law.
In an interview this week with KVPR, Soria said she and Caballero have been in discussions with Madera Community Hospital’s CEO Karen Paolinelli to explore short-term and long-term solutions.
“I asked her for a plan of action as to what can we do, even when they go into bankruptcy, in terms of trying to reopen. That way they keep their license current,” Soria said.
Keeping the hospital’s license active gives the hospital authority to operate an acute care facility. Soria said she’s working on securing a group willing to operate with the current license.
Soria said she’s also spoken to Gov. Gavin Newsom. When asked what the Governor’s response to her was, Soria said the governor told her he’d work to “figure something out.”
Congressman Jim Costa, whose district no longer encompasses Madera County, has also been looking to federal officials for solutions. He and Congressman-Elect John Duarte issued a joint letter last week, asking the federal government to declare a local health emergency in Madera County.
The letter was addressed to Health and Human Services Secretary Xavier Bacerra and the administrator of Centers for Medicare and Medicaid Services. The letter states that an emergency declaration gives the Department of Health and Human Services authority to intervene by providing medical services from select medical corps groups. Another possible intervention is to award grants to help deal with a surge of patients at surrounding hospitals.
Costa was involved with negotiations pertaining to Madera Community Hospital for the past 18 months. After the deal with Trinity Health fell through, he issued a statement saying “It disappoints me greatly that Trinity Health decided to walk away from its affiliation agreement with Madera Community Hospital.”
Local clinic steps up
Camarena Health, meanwhile, has petitioned the federal government’s Health Resources and Services Administration to update its scope of services to include specialty services such as cardiology, or gastroenterology – all of which used to be available through the hospital. The HRSA is reviewing the application.
“As soon as we get an approval to include those services in our scope, our plan is to immediately begin offering services,” Soares said.
Following the hospital’s closure, Camarena Health expanded hours and staffing at two urgent care clinics in Madera, but has since readjusted to normal hours with added clinicians on site. Soares, the CEO, said patient volume has been manageable so far.
“It's great that we already have them in place because it does offer for those non-emergent situations, something that is nearby and accessible after hours,” Soares said.
The urgent care centers are open seven days a week, but Camarena Health has not decided to provide 24-hour service. Soares said the centers don’t offer the same emergency room services as a hospital and due to low patient volume, he could not justify the cost to keep the centers open around the clock.
The California Department of Public Health designates Madera County as a rural, medically underserved area. The agency reports that a number of issues in the county – including poverty, geography, poor transportation and high rates of unemployment – produce barriers to healthcare.
Soria, the assemblymember, said the issues affecting Madera County residents through this time are about equity in healthcare.
“We can't have equity when a hospital in our community is closing down and when we don't make a recognition that there may be a way to do things differently in the Valley,” she said.
