Supes give direction to hospital’s closure

Wendy Alexander/The Madera Tribune

The Madera Community Hospital sign is removed from the backside of the hospital on Friday afternoon.

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After a four hour Special Board of Supervisors meeting in which many residents expressed their concerns about Madera Community Hospital closing, Board Chairman Tom Wheeler, on the advice of County Administrative Officer Jay Varney, gave staff direction on six topics in moving forward.

1. Review counties in California who have formed hospital districts and examine the methodology used.

2. Request and review Madera Community Hospital financials in preparation for short and long term planning to ensure if the forming of a hospital district is viable.

3. Work with local, state, and federal agencies for possible short-term funding for maintaining vital hospital functions, such as emergency medical treatment.

4. Work with state and local leaders to create a steering committee to assist with Madera Community Hospital.

5. Work with state partners to enact legislative changes.

6. Work with the Office of Emergency Services regarding the possible proclamation of a local emergency pertaining to the Madera Community Hospital closure.

“Everyone should write to the Governor and the Attorney General,” Wheeler said during Thursday’s special meeting. “There are three things people always ask when coming to a new community — How are the schools? How is public safety? What kind of medical services does it have? We are probably in the top 10 in new buildings per population in the state. It has helped us. Forming a district takes a while and takes a lot of money. For the hospital, it’s really important to do that.”

Madera County Sheriff and Operants of Emergency Services Director Tyson Pogue spoke about the possibility of proclaiming a State of Emergency because of the hospital’s closure.

“After listening to department heads, colleagues and input from the public, I do believe there is a threat of imminent peril to the community,” he said. “I am not aware of any other county that has declared similar circumstances. This declaration is a formal request to the state asking for their help and their support. I would ask that Dr. Paul (Dr. Simon Paul- Health Care Officer of Madera County) also research declaring a potential health emergency. I do think this is going to impact public safety.”

Later Thursday, Pogue did proclaim a local emergency for Madera County due to the significant impact of the closure of Madera Community Hospital.

“The lack of hospital services in Madera County is expected to strain local resources deployed within Madera County, thereby depleting ambulance and response resources such as Law Enforcement and Fire,” said the proclamation. “By proclaiming a local state of emergency we are formally requesting help from state and federal officials.”

“We continue to closely monitor this evolving situation,” Pogue said “The closure of Madera Community Hospital will have widespread effects on our community as a whole. 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.”

After hearing public comments that ranged from why having a hospital is important for the community to what the hospital means to them, and offering solutions and blame, Varney gave his suggestions and Wheeler gave his approval.

“These are my suggestion to the board of how to direct staff to do,” Varney said. “First, review the Tulare and Watsonville hospital models. They both became districts.

“2. Continue to work with other governor entities to try to raise short-term funding to keep at least a portion of the hospital viable. We will need our state partners to work on any potential legislative changes to help not only ourselves, but other cities. On the rural hospital-side, we may be the first, but we are not definitely going to be the last to face this. People are going to watch to see what we do. This may be the perfect time to make the legislative changes so that other rural hospitals continue to flourish, including Madera.

“3. Request and review the financials of Madera Community Hospital as part of the long-term and short-term planning. We would have to do that to do our due diligence if forming a hospital district is viable. With the current options available to us, that seems to be something we should get started on sooner rather than later. It does have some long-term viability to it.

“4. Bring back to the board in terms of what projects have been approved for funding and which ones the board wishes or does not wish to consider reallocating the funding towards either a short-term fix. If you are going to form a hospital district, it will cost money and time in negotiating. MCH is a private entity. When the district starts, it’s going to need some money.”

Madera City Manager Arnoldo Rodriguez also spoke about the involvement of newly-elected Assemblywoman Esmeralda Soria and State Senator Anna Caballero.

“When we heard the unfortunate news, we started working around the clock with county staff, alongside Assemblywoman Soria, Senator Caballero and the Attorney General,” he said. “There has been a lot of movement behind-the-scenes. Sometimes it takes time for things to come to fruition. We just heard the news regarding the affiliation not moving forward. Our City Council has not met on the issues. We are as concerned as everyone else in the community. It will have a tremendous impact on public service in the community.”

However, like the county, Rodriguez said the city doesn’t have deep pockets, but will do what they can to get the hospital back.

“We don’t have deep pockets, like the county, just like the hospital, just like our schools. We all want to help, but it’s always challenging,” he said. “The City of Madera received funding, $23 million. We gave 100 percent to the city sewer and water system, which is in dire, dire need of attention. Any potential funding from ARPA (American Rescue Plan Act) would have to go to City Council to seek redirection of funds.”

Varney informed the Supervisors that in order to bring the hospital back, it would need up to $55 million and about $30-$35 million into the second year.

“Through the initial attempt to become affiliated with Trinity Health, Trinity loaned $15 million to MCH,” he said. “In terms the of what the county has to consider, outside of the need for a medical facility, is how to pay for it. We have $15 million of one-time money to pay back so the hospital has a better course to bringing itself out of bankruptcy. The other issue is that the hospital faces an operational shortfall of $2-$2.5 million a month beyond current revenue.”

Varney spoke of one solution to be able to at least use the emergency room at the hospital, but is not sure if that will be a fix.

“We are going to have to determine what type of services are important to the community,” he said. “The hospital, under its current configuration, will be highly unlikely to offer the services it offered. Losing $2 million a month is not sustainable. If we throw money at the hospital and it only stays open for four more months, we haven’t done right for the citizens. We can look into solutions that have long-term sustainability.”

When fingers were pointed in blaming someone for the closure of the hospital, Supervisor Robert Poythress, who is also a member of the hospital’s Board of Trustees, was quick to point out that it was a perfect storm of situations that more and more rural hospitals will be facing in the future.

“Every hospital is having problems,” he said. “Any hospital that is primarily a MediCal hospital in terms of reimbursement and has to pay the salary for traveling nurses is a recipe for disaster. There’s nowhere to go, but down. For MCH, traveling nurses are 40 percent of our nursing staff. Before COVID there were just two or three traveling nurses. When those two factors hit, it’s nothing but a spiraling vortex. There was no room except for where we are today.”

Poythress also pointed out that Trinity Health, the hospital’s apparent savior that pulled out at the last minute, lost $565 million in the first quarter of last year. He also pointed out that Trinity Health and St. Agnes was the only hospital to talk to them.

“It wasn’t like we had bidding wars,” he said. “There was one hospital and one hospital system. We reached out to everybody.”

He also pointed out that California Attorney General wasn’t the one to blame.

“The Attorney General gets involved to make sure a hospital comes into a market and overcharge and things like that,” Poythress said. “This is the opposite of that. We are just looking for someone to come in and provide a measure of care. We understand that they can’t step up to provide everything. We thought St. Agnes could use our excess beds. Maybe we can consolidate services. They did provide a proposal way in advance of his December 15 announcement. They said this is what we’ll do. You can read between the lines of a hospital system that lost $534 million in one quarter. They probably aren’t going to do everything. They don’t want to take over a losing hospital. They wanted to take over services to be able to turn things around. However, their hands were tied. They immediately rejected it. They aren’t coming back to the negotiating table. That ship has sailed. The Attorney General stole defeat out of the jaws of victory. Trinity wasn’t going to provide every service, but a measure of something. They were going to provide something because they couldn’t afford to bring on a losing hospital.”

In terms of getting relief money from COVID from the federal government, Poythress said that the money went to the higher revenue hospitals first.

“The way the federal government distributed COVID money was based on total revenue,” he said. “If you were a money-center hospital, you got a lot of money. They probably had people who were pretty healthy go to your hospital. The rural hospitals got COVID-relief money, but it was based on their revenue and had sicker people. There was relief money, but it didn’t get here. It’s going to be a long, drawn-out process to get the hospital back.”

Supervisor Leticia Gonzalez wants to make sure everyone is going to work together to get the hospital back.

“I want to be sure to put a working group together that includes our local, state and federal stakeholders so we are all working together,” she said. “That’s what I’ve seen here today. Everyone wants to see some success come out of this tragedy. It is very devastating for our community. We have several members of the community that will work together.”

She also would like the community to get the word out about the hospital closure to prevent people from heading to a closed MCH.

“There are a lot of people that aren’t going to be informed. It’s very important to provide some public outreach. If we can magnify that and put the information out there so that people aren’t driving to the hospital from Fairmead to find the doors shut,” she said. “I’m looking forward to continuing discussion to really help. It is time for the County to step up, and I know the County will be a good partner for the community.”

Soria offered a glimmer of hope in trying to either keep the hospital from closing permanently or getting it reopened soon.

“We want to see some type of financial plan to see what we can advocate at the state level to bring those resources and leverage it with whatever the county and city will do,” she said. “We want to work together to bring the resources to bring the level of care for the most vulnerable communities most impacted by the closure of the hospital.

“We are extremely committed. I have been laser-focused to work together. I feel there is an opportunity to work together to figure out a pathway to ensure there is a true safety net in Madera for the most vulnerable population.”