A court case once forced county officials to support indigent care at Madera’s hospital

I began practicing law in 1978. Now retired, I can relate the early history of the Madera Community Hospital vs. the County of Madera. This is relevant given the imminent closure of Madera’s hospital due to financial challenges.

Madera County closed its county hospital in 1971 while Fresno and other counties continued to own and operate county hospitals. Madera Community Hospital opened as a private nonprofit hospital in 1976, and sought financial assistance from the county, which offered some for one year, but then insisted that the expansion of Medi-Cal to certain adults in the early 1970s relieved the county of any further obligation. The 1984 California Court of Appeal case of Madera Community Hospital v. County of Madera, which I briefed and argued, describes what followed:

“Hospital filed its petition primarily to compel County to adopt standards for the medical aid and care of the indigent and poor within Madera County as required by sections 17000 and 17001 of the Welfare and Institutions Code. Legally sufficient standards could, in turn, require reimbursement to Hospital in accordance with such standards for the reasonable value of hospital and medical care previously provided by Hospital to indigent residents of Madera County.

“Hospital … has operated in the County of Madera and is that county’s largest and most fully equipped acute care general hospital providing emergency outpatient, inpatient and nonemergency hospital and medical care to all members of the public. Among the persons obtaining medical care from Hospital are indigent persons and those described as the ‘medically dependent poor,’ persons who have no independent means of paying for the services which they receive.

“Prior to 1971 County met its duty to provide medical aid and care for its indigent residents by the maintenance of a county hospital.

“On October 20, 1980, County adopted resolution No. 80-468, which purports to represent standards adopted for the aid and care of indigent and dependent poor residents of the County of Madera. This resolution contains no reference whatsoever to medical care and services.

“We therefore conclude that Madera County Ordinance No. 353 is inadequate as a matter of law to satisfy the responsibility of County, under Welfare and Institutions Code section 17001, to adopt standards of aid and care for the indigent and medically dependent poor. The … trial court is directed to issue its writ of mandate, compelling the Board of Supervisors of Madera County to adopt standards for the medical care of indigent and dependent poor residents of County. The trial court is further directed to retain jurisdiction of this action following the issuance of its writ to ascertain the legal adequacy of such standards promulgated by County ….”

Madera County officials then adopted standards that were meaningless obfuscation. Biding our time, the hospital kept extensive records that documented the people who refused to sign up for Medi-Cal, but were likely indigent and not just bad debt, and those who were likely indigent but did not qualify for the state program.

This overwhelming evidence was introduced at trial in 1988. The court found the standards grossly deficient and firmly ordered the county to adopt adequate new standards that took Madera Community Hospital, which was in effect the de facto county hospital, into account.

There followed extensive negotiations with the county administrative officer. He noted the difficulties the county faced: does it spend $80,000 for a new fire truck needed for the foothills or for the hospital. I sympathized with how government must determine who gets what from limited resources, but the law is the law.

Ultimately, the hospital and county entered into a contract that, as I recall, provided for certain financial support and the stationing of county personnel at the hospital to sign up people who otherwise would not sign up for Medi-Cal. To my knowledge, this contract worked reasonably well for at least 10 years. In the early 2000s, I represented the hospital again in an unrelated lawsuit brought by a doctor. I recall how clean and well run the hospital appeared to be. That was the last time I represented the hospital.

I count my helping the hospital as one of the highlights of my career. The hospital’s failure brings great sadness.

Daniel O. Jamison is a retired attorney in Fresno.