This rural California county lost its only hospital, leaving residents with dire healthcare choices

By: Melissa Gomez

The Los Angeles Times, June 6, 2023

It was dinnertime when Sabrina Baker, a mother of six, felt the familiar twinge of contractions.

At first, she brushed it off as Braxton Hicks, false labor pains not uncommon in the late stages of pregnancy. But after dinner that night in early January, the pain sharpened and radiated to her back. The contractions intensified, and Baker knew this baby girl was coming fast.

She had a decision to make — and the options weren’t good.

Two days earlier, Madera County’s only general hospital had shut its doors. The abrupt closure of Madera Community Hospital and its affiliated medical clinics capped years of financial turmoil. Still, most residents in this rural county in California’s geographic center were caught off guard, unaware of just how much was at stake until their hospital was gone.

Twenty-five minutes after the first contraction and two pushes later, she delivered her daughter, alone, on her tan love seat. The baby was breech, which upped the anguish and the risk during delivery. When it was over, Baker tied the umbilical cord with new shoelaces and wrapped Onax in a San Francisco 49ers blanket. An ambulance rolled up 20 minutes later to take mom and baby to the hospital.

“I mean, I’m lucky,” Baker said, standing outside her home in a swath of Madera County surrounded by cropland and almond groves. “We could have died.”

During its half-century run, Madera Community Hospital provided a crucial link to healthcare for the 160,000 people who call Madera County home. Spanning from the heavily farmed floor of the eastern San Joaquin Valley to the forested central Sierra, Madera is majority Latino, and 20% of the population live in poverty.

For most residents, the hospital was more than a place to go when disaster struck. Madera Community helped them sign up for Medi-Cal, the state’s version of Medicaid insurance for low-income adults and children. It was readily accessible by bus, and it coordinated services with community clinics where residents could receive routine care and prescriptions. Sometimes the hospital was the only place people saw a doctor. Unlike the many private providers that exclude certain types of health insurance — including Medi-Cal, with its notoriously low reimbursement rates — Madera Community served everyone.

“It’s the worst thing that could have happened to us,” Tony Camarena said of the closure. Camarena runs a business that enables sending money abroad, and many of his customers made use of the hospital’s services, he said.

Healthcare experts say Madera’s closure — and the untenable financial realities that brought on the collapse — offer a case study on the challenges facing rural hospitals across the country. Nearly 30% of all rural hospitals in the U.S. — more than 600 of them — are at risk of closing, according to the Center for Healthcare Quality and Payment Reform.

For Madera Community Hospital, already operating on thin margins, rising costs for medical equipment and the spike in salaries for traveling nurses who were in high demand during the pandemic proved too much to absorb.

Hospital leaders tried to broker a deal with Trinity Health, a nonprofit Catholic healthcare system that owns Saint Agnes Medical Center in Fresno. Atty. Gen. Rob Bonta conditionally approved the sale of the hospital but placed terms on the deal that would have required Trinity to set price caps on certain services, maintain charity care programs and commit to providing emergency care and clinic services for five years. Trinity Health pulled out of the deal in December.

Madera Community Hospital shut its doors and by March had filed for bankruptcy.

Residents were anxious. Many don’t have cars and worried about how they would get to hospitals in other counties. Longer wait times at those remote emergency departments meant they would miss the work and pay they need to survive.

Time hasn’t healed those concerns. It has created new ones.

“It really put a community against the wall,” said Linette Lomeli, executive director of the Madera Coalition for Community Justice, a grassroots organization that helps residents access food, housing, employment and, now, medical care.

Along Highway 99, a main artery that bisects miles of farmland, Madera Community Hospital stands frozen in time. Three blue tarps hang over the entrance to what was once the emergency department. The grass outside is ankle high, and leaves are piled against the curb.

Inside, a haunting silence hung in the darkened hallways as hospital CEO Karen Paolinelli surveyed the place where she started her career four decades ago. She sighed as she pointed out the CT scanner the hospital had just purchased to replace a 15-year-old machine that was always breaking. The new one wasn’t even plugged in when the hospital closed.

Paolinelli walked past rows of empty beds in the intensive care unit, a place that was packed with patients during the pandemic, and thought about the doctors and nurses who stepped up during the terrifying heights. The hospital and its clinics were a lifeline for the community, she said.

In the weeks leading up to the closure, it was as if opportunities to save the hospital kept slipping from her grasp, she said. But she holds out hope that a potential partner might see value in helping Madera Community reopen.

“If we don’t do it quickly, it may never open again,” she said.

The fallout from the closure resonates beyond Madera County. On a recent weekday evening, the emergency department at Community Regional Medical Center in Fresno, 35 miles south, overflowed with patients. A security guard told those arriving they’d have to wait outside. There was simply no room.

The ER also spilled over at Fresno’s Saint Agnes Medical Center, and rows of people sat outside under a white tent, hoping to be called.

“It’s always been busy, but it’s just snowballed,” said Xiomara Russell, a licensed vocational nurse at Community Regional Medical Center who formerly worked at Madera Community. “We have ambulance waits and a full lobby all the time.”

Russell said access to medical care was tenuous in Madera, and people used the emergency room as a way to get basic medical needs met. She worries people will delay getting care until their conditions are harder to treat. Like Paolinelli, she wants to see Madera Community reopen.

“It has to,” she said. “There’s so many people who need it.”

State legislation could provide the first step.

Last month, Gov. Gavin Newsom signed legislation creating the Distressed Hospital Loan Program, which will provide $150 million in zero-interest loans to hospitals teetering on financial ruin. The aim, according to legislators, is to help struggling hospitals stay open and to assist with the reopening of recently closed ones like Madera Community.

“There is no other option but to continue to push and fight and demand that these resources come to our community so that we do have a hospital that opens,” said Assemblymember Esmeralda Soria (D-Fresno), who co-authored the measure.

Still, it’s not clear whether Madera’s hospital will be able to access the funds, or whether they would be enough to reopen the doors anytime soon. Deidre da Silva, chair of the hospital’s board of trustees, argued in a May 23 letter to lawmakers that the loan program won’t “lead to fiscally viable operations” at rural hospitals unless the state also finds a way to raise Medi-Cal rates.

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