A proposal to get Madera’s hospital reopened deserves support of state lawmakers | Opinion

The Fresno Bee Editorial Board
Updated ·4 min read

Madera County’s only hospital closed at the end of December due to ongoing and overwhelming financial problems. Since then, the 160,000 residents of the rural area have either had to go to Fresno or Merced for a hospital. Some low-income residents have given up on getting treatment at all.

But from the bleakness of the current situation comes new hope. Madera County’s representative in the California Assembly, Esmeralda Soria, is co-authoring a bill that would create a loan program to help closed hospitals get the necessary funding to reopen.

The legislation, AB 412, is to be heard for the first time in the Assembly Health Committee in coming days. The bill deserves the support of lawmakers as it would help not just Madera Community Hospital, but similar medical centers in other parts of the state that are burdened with budget troubles and on the brink of closing down.

Loan to reopen Madera hospital

AB 412 would create the Distressed Hospital Loan Program, which would run through 2031. Loans would be given to nonprofit and public hospitals “in significant financial distress” to head off a closure or support a reopening. A fund would be created in the state budget and it would be continuously appropriated, meaning it would not have to undergo legislative approval every year.

To get help, a hospital would be required to submit an operating plan that outlines how the loan would be used to regain financial viability and get operations going again.

A hospital with a plan showing how it will reopen and remain operating for a length of time can qualify for loan forgiveness, Soria told Bee staff writer Yesenia Amaro. The details of that are being developed.

Reimbursement problem

Madera Community Hospital’s financial troubles stem, in part, from the low-income nature of the county. More than 20% of residents are considered by the U.S. Census to be in poverty. Karen Paolinelli, Madera Community’s CEO, said 84% of its patients were on Medi-Cal or Medicare assistance.

Reimbursement rates for those government-run programs have not been increased for years, while the overall cost of care has been steadily rising, she explained.

The COVID pandemic brought unexpected costs to the hospital’s budget, Paolinelli said. Not only did the hospital have to buy additional safety equipment for medical staff, but it also had to start using traveling nurses more to maintain mandated patient-nurse ratios. Traveling nurses make more than $200 an hour, well beyond what a staff nurse would earn.

Maria Rios, 59, looks at the camera while in her Madera home on Wednesday, Jan. 18, 2023. She had to stop working in the fields because of a fractured foot, diabetes and kidney problems. She gets dialysis three times a week to make up for the work her kidneys can’t do, and the pain caused by the procedure made her a recurrent patient at the now-closed Madera Community Hospital.

Madera Community, a 106-bed nonprofit facility, was in talks last year to be purchased by Trinity Health, a Catholic health-care network that operates Saint Agnes Medical Center in Fresno. But those discussions fizzled after Trinity balked at conditions required by state Attorney General Rob Bonta. His office has said the conditions were needed to ensure essential services continued.

With no other potential buyers lined up, Madera Community’s board filed for bankruptcy on March 10.

Statewide threat

The problems facing Madera Community are being experienced at small hospitals throughout the state.

Carmela Coyle, president of the California Hospital Association, told the online news site CalMatters that half of the state’s 337 hospitals are operating at a deficit. “We are at a tipping point; Madera is just the first one,” Coyle said.

Another hospital in the San Joaquin Valley confronting financial pressures in Kaweah Delta Medical Center in Visalia. It is on track to lose $75 million for the 2023 fiscal year. To address the difficulties, Kaweah Delta laid off 130 employees last year and has frozen retirement contributions. Top officials have taken pay cuts and the hospital is reducing how many elective surgeries can be performed.

Given Madera Community’s closure, patients must travel to either Saint Agnes in Fresno or Clovis Community Medical Center. Another option is Mercy Medical Center in Merced. But any of those three facilities require 30 minutes or more of travel time from Madera.

The loan program proposed by Soria is a solution that could provide immediate relief to struggling hospitals. The Valley’s lawmakers should get behind it and convince their colleagues in Sacramento to do the same. Madera County should not be without a hospital — nor should any community in California.