Why a shuttered California hospital is 'just the tip of the iceberg' 

There's been plenty of headlines on the financial pressures leading to Madera (Calif.) Community Hospital's closure and the domino effect it's had on the surrounding region in the state's Central Valley. But the story of what's unfolding in Madera County "is really just the tip of the iceberg," says Carmela Coyle, president and CEO of the California Hospital Association. 

"Madera County happens to be the first place this is happening, but we have many others — communities, counties — who are at risk of hospital closure," Ms. Coyle told Becker's March 8. "And this is nothing that we have seen in recent history." 

Madera Community Hospital began to shut down services at the end of December, leaving the county's 160,000 residents with at least a half-hour drive to hospitals in neighboring Fresno County. On Jan. 10, Madera Community's three affiliated clinics in Madera, Mendota and Chowchilla also closed. 

"When Madera closed, it triggered a public health emergency in the county, and then when patients began moving toward Fresno for care, it triggered another PHE in Fresno," Ms. Coyle said. "It's a reminder that the healthcare system is only as strong as all of its component parts."

Fresno County's largest health system, Fresno-based Community Health System, operates four hospitals, a cancer institute and other outpatient facilities in the area.

"We're in dire straits. Patients are suffering and it's really hard," Danielle Campagne, MD, chief of Community Regional Medical Center's emergency department, said in January. "Madera … is going to be the tipping point for us."

Dr. Campagne said the hospital was "blowing up" with patients, and dozens of beds filled the hallways. Physicians were caring for patients right on those beds, she said. 

Two large state prisons are also located in Madera County. With no local hospital, Fresno-area providers are seeing an influx of inmates in their facilities, the Fresno Bee reported Jan. 30.

"In Fresno, Community Regional is full and at the children's hospital there are adults presenting for care," Ms. Coyle said.

Some 40 miles south of Fresno in Visalia, Kaweah Health Medical Center also reported receiving at least eight patients from Madera.

"Financial pressures are closing hospitals in California and across the nation," Community's COO Robyn Gonzales told Becker's March 10. "Now another Central California hospital, Kaweah Health, may soon face the same fate it we don't get help navigating three main challenges: Government programs that are underfunded and overextended, California's looming seismic mandate, and unrelenting cost increases."

In a recent meeting with the Tulare County Board, Kaweah's CEO, Gary Herbst, warned the hospital "will not continue to exist" if outside financial support isn't received, according to a March 5 report from The Sun. Mr. Herbst said he is open to various forms of help, including a sales tax measure, a parcel tax and American Rescue Plan Act funding. 

"We need to keep Kaweah alive so it doesn't burden Fresno County," Dr. Campagne said in February. "If that hospital falls, I think we all could fall."

With Madera's closure, "We have left families and entire communities," CHA's Ms. Coyle said. "If we were to lose one more, the situation becomes desperate."

Less than an hour south of Visalia is Sierra View Medical Center in Porterville, where CEO Donna Hefner, BSN, RN, has been writing to elected officials saying the 167-bed acute care facility will be unable to continue providing care "unless something changes," according to the CHA.

One of the largest financial challenges for many hospitals is dependence on state and federal programs such as Medicare and Medicaid, which don't reimburse providers nearly as much as commercial insurers. At Madera, more than 80 percent of patients were publicly covered.

But California hospitals in dire financial straits are not limited to the Central Valley or even to rural areas. Ms. Coyle said there are a number of urban hospitals in the Los Angeles area and in Imperial County on the U.S.-Mexico border, "that are equally challenged with high numbers of Medicare and Medi-Cal [Medicaid] patients." For that reason, the CHA has asked Gov. Gavin Newsom for $1.5 billion to be distributed to the most financially burdened facilities. 

Hospital closures can happen quickly once word of financial distress gets out, and the CHA is concerned it could happen elsewhere in the state because "many more are on the brink." Ms. Coyle said it could be detrimental to name other distressed systems publicly for that reason, and shared that Madera lost much of its nursing staff once its contracted agency learned of its financial troubles.

Meanwhile, efforts to restore services at Madera Community have been ongoing for months. On March 2, hospital board members, local officials and residents convened to discuss the matter. 

Stell Manfredi, vice chair of the hospital board, said the hospital was developing a preliminary plan that would enable the facility to reopen with reduced services in two months, according to a report from yourcentralvalley.com. The hospital had hoped a consultant would advance the rest of the preliminary plan created by hospital staff. If approved by the Madera County Board of Supervisors, it would have taken about 60 days to restore limited services. 

However, the county board turned down the idea when it was presented to them March 7, according to KVPR. Madera Community Regional is still in talks with other hospital operators to secure an agreement and continues to seek support from the state. As of March 2, Madera Community had entertained between 10 and 12 conversations and letters of intent from other organizations to take over operations, according to yourcentralvalley.com. 

Finding a "rescuer" could prove difficult, since even the largest systems have faced significant financial setbacks in the wake of the pandemic. 

"They used to be able to step in when a hospital was failing … they no longer have the financial wherewithal to do that," Ms. Coyle said.

"No matter what, Community Health System will keep doing all we can to serve the people of Central California," Ms. Gonzales said. "But without changes, vital services will be threatened."

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