Private, nonprofit Madera Community Hospital has closed. Photographed Thursday, Dec. 29, 2022 in Madera. Credit: Eric Paul Zamora / Fresno Bee

What's at stake?

After Madera County’s only general acute-care hospital shut its doors earlier this month, local leaders are starting to plan for a long-term solution.

Nearly a month after Madera County’s only general acute-care hospital announced its closure, uncertainty looms as local elected officials scramble to find a solution to support the hundreds of thousands of Maderans who are left without care.

Madera City Council members voted Wednesday in favor of a resolution to support Madera County’s emergency declaration following the closure of the Madera Community Hospital earlier this month. They also voted to support a joint city-county exploration of possible solutions, such as setting up a taxpayer-funded independent health care district for a community hospital.

“There is no clear path and there’s no clear answer at this point,” Madera City Manager Arnoldo Rodriguez said during a presentation to Madera City Council on Wednesday evening.

The hospital announced its closure in late December after Fresno’s Saint Agnes Medical Center and its parent company, Trinity Health, backed out of a deal to buy the struggling hospital. The hospital ended its emergency services on Dec. 30 and its other services on Jan. 3, leaving around 150,000 Madera County residents and beyond without access to local care and around 700 employees out of work.

“I wish I could sit here before the council and the community and tell you that we have it all figured out,” Rodriguez said, “but this is a very complicated issue with a lot of moving parts.”

The closure triggered Madera County as well as Fresno County to declare states of emergency – a move they hoped will prompt assistance from state and federal officials.

Councilmembers said that while the closure was a serious threat to an already vulnerable community, they wouldn’t allocate taxpayer funds to help reopen Madera Community Hospital.

The hospital was expected to file for Chapter 11 bankruptcy earlier this week, but there’s no official confirmation yet.

Madera County officials estimate that reopening the hospital would cost more than $50 million in the first year and anywhere from $30 million to $35 million the following year.

“If we do allocate one penny,” Councilmember Cecelia Gallegos said, “I think it’s to create something bigger and better for our community and for our citizens that we can manage and have an oversight (of) to make sure that we’re taking care of everyone here.”

Madera City, County leaders plan to look at a health care district

The Madera County Board of Supervisors is considering hiring a consultant to help explore possible next steps, such as establishing a health care district or community facilities district – an idea that Madera City Councilmembers also expressed interest in during their meeting.

According to the state Legislative Analyst’s Office, a nonpartisan government agency, a health care district is a type of special local government district that is legally separate from a county or city.

A health care district is governed by a locally elected five-member board of directors and is authorized to build and operate hospitals and other health care facilities in underserved areas, according to the LAO.

These districts can operate hospitals, healthcare clinics and ambulance services and can collect revenue through property taxes, special taxes, service charges, debt financing and other sources.

A health care district can be formed when a majority of the registered voters in the proposed district area vote in favor of its formation, according to the Association of California Healthcare Districts, which represents dozens of California’s 70 health care districts.

While the idea is still exploratory in nature, some councilmembers said they were open to it.

“If the district hospital is the solution, then I think we move on that,” Councilmember Jose Rodriguez said during Wednesday’s council meeting. “But at the end of the day, we allow the residents to decide whether they want this or not.”

Central Valley representatives turn to state, feds for help

Local Central Valley representatives are in touch with state leaders regarding the hospital’s closure – but there’s no word yet on if and how the state will get involved.

Elisa Rivera, a spokesperson for state Sen. Anna Caballero, told The Bee/Fresnoland on Jan. 13 that Caballero has been working with the distressed hospital for the past 18 months.

“The senator has been really, really involved in trying to find a solution,” Rivera said.

Most recently, Caballero joined former Assemblymember Frank Bigelow in securing $5 million in state funding to help MCH remain open, although the hospital had waited until after the state budget cycle had already ended to seek help from her office.

In addition to sending a letter of support to the attorney general’s office in support of MCH’s affiliation with Trinity Health, Caballero also worked with the governor’s office to request that local health plans expedite payment for services their patients received at MCH, according to Rivera.

Over the past few weeks, Caballero has been in conversation with Gov. Gavin Newsom’s office on potential next steps and an update is forthcoming, Rivera said.

New Assemblymember Esmeralda Soria, D-Fresno, who represents the 27th District that includes Madera, has also been in touch with state leaders, said Roy Sianez, Soria’s chief of staff.

In a Jan. 18 statement to The Bee/Fresnoland, Sianez stated that over the past several weeks, Soria has met with various state officials including the Governor’s Office, the California Department of Finance, the California Health and Human Services Agency and the office of the Attorney General “to discuss options to continue to meet the healthcare needs of Madera County residents and surrounding cities.”

Local congressmen are turning to the federal government for support.

On Jan. 5, Reps. Jim Costa, a Democrat from Fresno who represents California’s 21st Congressional District and John Duarte, a Republican representing California’s 13th Congressional District, penned a letter to the U.S. Department of Health and Human Services urging the agency to issue a Public Health Emergency as well as enlist the support of U.S. Public Health Service Commissioned Corps and the Medical Reserve Corps, given the hospital closure, “tripledemic,” and overcapacity at other medical centers in the region.

“The San Joaquin Valley is already medically underserved,” the letter says. “We are now asking the brave frontline workers who are stretched thin and burnt out to stretch themselves just a little farther.”

Costa’s office had also “urged” the hospital to apply for Federal Emergency Management Agency (FEMA) funding for COVID relief sometime prior to August 2022, according to a Madera City Council staff report. A spokesperson for Costa’s office said the FEMA reimbursements are still pending.

Nationwide trend

The closure – and call for help from state and national leaders – is part of a nationwide trend.

According to a September 2022 report from the American Hospital Association, 136 rural hospital and health systems have closed between 2010 to 2021, and the COVID-19 pandemic patient volumes and labor demands, among other factors, added additional pressures to rural hospitals nationwide.

The American Hospital Association report also called for increased attention from state and federal governments to address policy barriers and invest in new resources in rural communities.

“Although rural hospitals have long faced circumstances that have challenged their survival, said the report, “we will most likely see more rural hospital closures as they attempt to adapt to the unprecedented challenges brought on by the COVID-19 pandemic.”

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Melissa is a labor and economic inequality reporter with The Fresno Bee and Fresnoland.

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