In rural California, a hospital with millions in equipment sits empty and closed
This story is one of three in a series from KVPR's latest coverage of the closure of Madera Community Hospital. For past coverage, click here.
MADERA, Calif. – Just off Highway 99 in Madera, the county’s only general hospital sits dark and quiet in a vast, empty parking lot.
The signage is stripped off the front of the building. It reveals a scar where the name “Madera Community Hospital” hung for just over 50 years.
At the entrance to the emergency room, hospital CEO Karen Paolinelli leads the way inside.
“So this is our waiting room as you can see,” she says, pointing to a dark room lined with rows of empty chairs.
Paolinelli turns, and points to a nearby entrance. “This is our triage area. These are our triage rooms here and there, so our nurses come [and] get the patient,” she says.
But there are no nurses coming – and no patients to serve. Computer monitors are powered down. Hospital beds are frozen in time.
Every footstep echoes in the silence.
“I’ve worked here for 35 years and I’ve never seen this ER empty,” Paolinelli says.
Paolinelli says about a hundred patients a day used to come to the ER — patients who’ve now had to seek services elsewhere since the department closed in late December.
The closures trickled in and left a hospital in the middle of California’s agricultural heartland – where many face chronic health conditions – to sit empty.
Services such as labor and delivery shut down Dec. 28, followed by the ER two days later. All other outpatient services and surgery closed by Jan. 3. The rural clinics followed.
On a recent visit to the hospital which has sat empty for nearly two months, Paolinelli unlocks the door to a brand new area for radiology services. It has x-ray rooms and a brand new CT scanner, which is similar to an MRI machine. Doctors use it to diagnose diseases, as well as determine treatment options.
Just two days before it was ready for use, the hospital closed down.
This was the only general hospital CT scanner in Madera County – where the closest acute care hospital is now 20 miles away in Fresno.
“We just need to open up our doors and start up the operations again,” Paolinelli said.
Facing the losses
Finding a solution hasn’t been easy. Hospital Board of Trustees Chair Deidre da Silva joined Paolinelli on the recent tour. It was the first time KVPR went inside the hospital and heard from the CEO since the closures. Da Silva said the priority is finding a financial partner who can restart operations. A second option is to bring back healthcare services themselves.
“But in order for that to happen, we need a large cash infusion. We're continuing to make contacts with the state, [with] the county, with the city and then we're going to also try to go for private donations — [to] see if we can maybe get it open in a limited capacity,” Da Silva said.
I’ve worked here for 35 years and I’ve never seen this ER empty.Karen Paolinelli, Madera Community Hospital CEO
The final option for Madera Community Hospital is bankruptcy and liquidation. But that’s a last resort and one that hospital leaders are holding off as long as possible since first announcing that direction in December.
Paolinelli said the hospital is running out of time.
“If we can't quickly do something and the state can't step in and help us get this hospital back open, it might be impossible to open if we can't find a partner,” she said.
The hospital has a fully operational facility and many assets, nearly 40 acres of property as well as equipment. But right now, without any services, it's costing roughly $900,000 a month just to maintain the hospital’s skeleton operations, like cleaning, security and accounting.
“If there’s any chance of reopening this facility, we have to maintain it,” Paolinelli said.
According to the American Hospital Directory, Madera Community Hospital reported an $11.5 million loss from its last full year of operations in fiscal year 2021-2022. Paolinelli said the pandemic destroyed the hospital’s bottom line.
She cited low Medi-Cal insurance repayments and a severe shortage of nursing staff that forced the hospital to pay for traveling nurses who charged a premium.
“We almost doubled how many patients we had in our hospital and for a small rural community to be able to quickly get enough staff to take care of all those patients, it's impossible because there was a nursing shortage before the pandemic,” Paolinelli said.
‘We’re gonna see these halls full again’
Da Silva said the drawn-out affiliation process with Trinity Health forced the hospital to maintain a full slate of services to stay in compliance with hospital standards during negotiations. But those were services the hospital could not afford.
“During the pandemic, [Paolinelli] would be told, ‘You don't worry. Just keep testing, vaccinating, intubating, saving lives. You're going to be reimbursed. Don't worry money's coming, help is coming. It's on the way,’ Well, it didn't happen,” Da Silva said.
Adding to the tight timeline, $5 million in funding secured through the state budget last year by state Senator Anna Caballero and Assembly Member Frank Bigelow was not expected to come until the new year.
Paolinelli said immediate access to those funds could have given her another six weeks to reorganize and keep some services open. But the failed purchase agreement with Trinity Health gave no time to find other funding sources.
“Everybody thought that the deal was going to go through,” Da Silva said. “We were pretty confident that this deal with the AG, he was going to come back with conditions that Trinity would agree with and we'd all be happy and we'd march onto the new year with a new partner. I think it came as a shock for us as well,” she said.
Walking through the intensive care unit, Paolinelli recalls how full it was during the pandemic. The 10-bed ICU was forced to accommodate as many as 30 beds for COVID patients. Madera Community Hospital, in fact, was the first hospital in the Central Valley to treat a COVID patient three years ago.
It's just so sad to see that a hospital that was so needed during the pandemic was allowed to close post-pandemic.Karen Paolinelli, Madera Community Hospital CEO
“It's just so sad to see that a hospital that was so needed during the pandemic was allowed to close post-pandemic,” Paolinelli said.
The hospital’s tight knit community of medical providers was like a family and the day they had to close, Paolinelli said it was one of the hardest conversations she’s ever had.
“How do you tell your employees you're closing your doors and they don’t have a job,” she said in tears with the emptiness of the hospital around her. “It's very difficult. It was awful.”
But she has not given up hopes of reopening, and neither has Da Silva. Though, they say every day Madera Community Hospital stays closed, the harder it will be to reopen.
“We're not giving up, we're gonna get there. We're gonna get this place back open and we're gonna see these halls full again,” Da Silva said.