‘I just want the hospital to stay open.’ Residents have few options as Madera Community closes

What should have been downtime in the week between Christmas and New Year’s turned into a flurry of work for Madera County as the board of supervisors began addressing the closure of the county’s sole hospital.

Madera Community Hospital’s emergency department shut down at noon Friday.

The rest of the hospital will close Jan. 3 and is expected to declare bankruptcy that day. Its associated medical clinics — including Family Health Services Madera/Specialty Clinic in Madera, Family Health Services in Mendota and the Chowchilla Medical Center — will close Jan. 10.

The board of supervisors held a special meeting Thursday that ran nearly four hours to talk through the impacts of the closure, propose possible next steps and hear from the public.

State of emergency declared

Madera County Sheriff Tyson J. Pogue declared a state of emergency later Thursday, but during the meeting made it clear that was his intention before the end of the day. He said the hospital’s closure will have widespread effects across all of the county’s law enforcement, health and emergency services departments.

“By proclaiming a local state of emergency, we are formally requesting help from state and federal officials,” he wrote in a news release Thursday night. “This proclamation will request needed resources to support our efforts to continue providing the same high level of service and safety to our citizens in Madera County.”

Among the major concerns is reallocation of resources and manpower, as emergency services and ambulances begin transporting county patients to hospitals outside the county and to Fresno or Merced.

“Firefighters now waiting on EMS, can’t fight fires,” Central California EMS director Dan Lynch told the board of supervisors during the meeting. “Which takes them out of the firefighter business.”

In the long term, the sheriff’s office expects to see a decrease in the reporting of domestic violence and sex crimes, as nurses are mandated reporters and many crimes only get picked up during hospital service.

The sheriff’s coroner division said it expects mortality rates to increase countywide, as fewer residents will be able or willing to seek immediate care. The morgue will also begin to face capacity issues. The hospital closure will “effectively double the numbers of bodies” coming in.

The hospital also serviced the county’s jail system, and the sheriff’s office said it will be requesting the creation of a transportation unit specifically to move sick inmates between its facilities and other area hospitals. That unit would have five deputies and 10 corrections officers and operate at a cost of $1.8 million annually, though some of that cost could mitigated by contracting with other agencies.

Who (or what) is to blame?

While the closure (and eventual bankruptcy) of Madera Community seemed to have come quickly, the 106-bed, not-for-profit hospital has been struggling for several years — operating at a loss of $2.5 million a month, according to Deidre da Silva, chairperson of the hospital’s board of trustees.

The shortfall is due, in part, to the high number of traveling nurses assigned to the hospital during the COVID-19 pandemic, and the hospital’s MediCal reimbursements, which de Silva said are some of the lowest in the state, and often don’t cover the cost of care.

“It’s not a working business model,” she said.

Madera Community Hospital was the first in the region to report a coronavirus patient in March 2020 and the first to offer monoclonal treatment. Board of trustees vice chair Stell Manfredi called the confluence of events during and immediately following COVID “nothing but a spiraling vortex.”

Manfredi said the hospital’s finances were what ultimately stalled a deal with Trinity Health, which had been poised to buy the hospital before it backed out last week.

In a statement to The Bee, Trinity Health said the decision was based on additional conditions of the deal imposed by California Attorney General Rob Bonta, but didn’t specify what those conditions were.

Many residents at Thursday’s meeting questioned why the deal fell apart, with at least a few positing it had something to do with the state’s guidelines on offering reproductive services (abortions).

It did not.

Manfredi likened the whole situation to a game of chicken between the Attorney General and Trinity Health “with Madera County Hospital in the middle.”

Super ER, Madera Hospital District possible solutions?

Several possible solutions were floated during the meeting, including the creation of a so-called “Super ER” that would offer limited services, or starting a hospital district, similar to one in Tulare County, which similarly lost its Tulare Regional Medical Center in 2017.

Madera County’s administrative officer, Jay Varney, said reopening the hospital would cost more than $50 million in the first year and anywhere from $30 million to $35 million the following year. Most agree that needs to happen, but he added: “We’re talking reality now, which is how do we pay for it?”

The board will consider reallocating some of the money the county was allocated in the 2021 American Rescue Plan Act and work with the state and federal government for other funding options.

Varney said that what’s happening now with Madera Community will certainly be looked at by other rural hospitals struggling to stay afloat following the pandemic.

“We are first, but we will definitely not be the last,” Varney said.

‘I just want the hospital to stay open’

Despite questions about the hospital’s management and the failure to finalize a deal with Trinity Health, those who spoke during the public comment period Thursday rallied behind keeping the hospital up and running.

Nena Falcon was one of more than a dozen community members who spoke during the meeting.

A labor and delivery nurse at Madera Community, she said she worries that those in need of serious medial attention will no longer be able to get it in time.

“When I say, ‘minutes mean lives,’ I mean it,” she said.

“Minutes mean lives. They’re not going to make it to Fresno or Merced.”

Dissecting the hospital’s failure and looking for blame can be saved for another time, Falcon said .

“I don’t care what happened. I don’t care about the finances of this hospital. What we care about is the patients. What we care about are our families. And they are getting sucker-punched,” she said.

“I just want the hospital to stay open.”