Emergency department patients held in hallway at St. Agnes Medical Center in Fresno, California, on Jan. 28, 2023. Credit: Submitted / Submitted

What's at stake?

Fresno hospital and county officials say it will be harder for Fresnans to access emergency department care as hospitals ERs absorb an influx of patients from Madera.

Fresno County officials are warning people to avoid local hospital emergency rooms as much as possible as hospitals absorb a surge of patients from Madera — including state prison inmates.

“The emergency departments currently in Fresno County really are not the place for people to go” for non-emergencies, said Dan Lynch, emergency medical services director for Fresno County and the Central California Emergency Medical Services Agency, in an interview with The Bee/Fresnoland. CCEMSA is a public agency that coordinates the delivery of emergency medical services in Fresno, Kings, Madera, and Tulare Counties.

The Madera Community Hospital closed nearly a month ago after St. Agnes owner Trinity Health called off the purchase of the distressed hospital. Following Madera County’s lead, Fresno County declared a state of emergency following the closure of the hospital – a move they hoped will prompt assistance from state and federal officials.

But so far, local officials say the state hasn’t offered much help – either financially or with staffing – as Fresno area hospitals – Community Regional Medical Center, Clovis Community Medical Center and St. Agnes Medical Center – are seeing an influx of Madera residents for emergency needs.

During Tuesday’s Board of Supervisors meeting, David Luchini, director of Fresno County Department of Public Health, reported that CRMC was at 119% of hospital capacity, with 68 patients on admit holds — where admitted patients are boarded in the emergency department waiting for beds to become available; St. Agnes was at 100% capacity with 45 patient holds; Clovis Community at 99% capacity with 14 patients on holds, and Kaiser Permanente Fresno Medical Center at 110% capacity with zero patients on hold.

As of Jan. 17, CRMC saw, on average, five Madera patients per day in the emergency department, and three more per day in the inpatient area. Clovis Community has reported two Madera patients per day in the emergency department. While the numbers don’t seem high, hospital administrators say the strain has been significant.

But one issue has been particularly challenging for the County and hospital officials – an unexpected stream of state prison inmates from the Chowchilla-based Valley State Prison and Central California Women’s Facility in Madera County – each accompanied by two guards, according to an update by CRMC hospital officials during the Fresno County Board of Supervisors Meeting on Tuesday.

Dr. Danielle Campagne, the chief of CRMC’s Emergency Department, said the unexpected prison patient influx is “really the straw that’s breaking the camel’s back.”

Community Regional Medical Center in downtown Fresno photographed on Saturday, Jan. 22, 2022. Credit: CRAIG KOHLRUSS / Fresno Bee file

State inmates cause bottleneck in Fresno hospital hallways

Campagne told the Supervisors that earlier this month, for example, 12 prison inmates and 24 guards arrived at the hospital and were held in the hallway of the emergency department.

“This is a hallway that’s like five feet wide and maybe 20 yards long, that’s meant for egress (and) ingress into hospitals,” Campagne said. “It’s not meant for a patient care area.”

She added that the hospital isn’t notified when inmate patients are on their way which makes it harder to plan for their arrival.

Campagne told the board of supervisors that typically, the hospital sees a few patients per year from the two Chowchilla-based state prisons when they have serious medical needs or are very sick, and “that’s very appropriate.”

And while Merced is “technically” closer to the state prisons, Lynch, of CCEMSA, told The Bee/Fresnoland that CRMC already has a contract with the state, which means the state already worked through a process with them.

But the difference is that now, they’re seeing more patients with primary care needs, such as a check-up or an X-Ray, Lynch said.

“In today’s environment,” he said, this is “quite a burden.”

Fresno County hospitals are under additional strain nearly a month following the closure of Madera Community Hospital. One particular burden is the influx of non-emergency state prison patients from Chowchilla, county and hospital leaders said in a presentation to the Board of Supervisors on Jan. 24, 2023. Credit: Fresno Bee file

Local leaders are urging the state and correctional facilities to use another medical site, Lynch said, “especially during this time when we have a proclamation of an emergency in the county of Fresno for capacity issues at our hospitals.”

It’s not immediately clear how the Madera Community Hospital’s closure has impacted medical care access for the Chowchilla-based prisons, or whether the state has contracts with Mercy Medical Center in Merced.

The Bee/Fresnoland’s requests for comment to the state prison spokespeople, via email and phone call, were not returned.

In an email statement to The Bee/Fresnoland, a spokesperson for the California Correctional Health Care Services said: “Our institutions offer varying levels of care based on the specific facility but all locations offer services on par with a community primary care clinic.“ Specialty care and those who need a higher level of care than what is available within our system receive care in a community setting. CCHCS contracts with health care facilities statewide including Community Regional Medical Center (CRMC).

”The CCHCS spokesperson also said they’re “currently meeting with external stakeholders to address the recent closure of Madera Community Hospital that previously serviced emergencies for patients at a few of our central valley prisons.”

Help from state falls short some county, hospital leaders say

Nearly a month after Madera Community Hospital shut its doors, Fresno County and hospital leaders say that conversations with the state about the impact of the hospital closure are not going anywhere.

While they acknowledged the state has been working with CRMC on staffing, help has fallen short.

“It really hasn’t worked out well with the state providing any staffing,” Lynch said, “so we’re pretty much on our own.”

County and hospital officials said CRMC was promised 16 nurses from the state’s California Medical Assistance Team (CAL-MAT) to assist with staffing needs, but only six arrived, and some lacked proper licenses or relevant clinical training.

“Overpromise and underperform,” Supervisor Steve Brandau said Tuesday in response to the promised staffing shortfall. “Fresno County is used to that from the state of California.”

But Central Valley representatives say they are committed to advocating for the region in the aftermath of the hospital closure.

In a statement to The Bee/Fresnoland State Sen. Anna Caballero acknowledged the challenges and said her office is “ready to support the CDPH (California Department of Public Health) and the Fresno County Board of Supervisors to find solutions.”

“Nursing shortages are something that we have been grappling with regionally, as a state and as a nation since even before the pandemic,” Caballero said. “Unfortunately, with the closing of the Madera hospital, our region will be further burdened.”

She added that these regional needs “are why she worked to acquire funding to establish the UCSF Medical school.”

For now, Fresno County’s state of emergency remains in place until Feb 7.

The County Board of Supervisors will decide next month whether or not to extend the state of emergency.

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

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