The Madera County Board of Supervisors holds a special meeting to discuss Madera Community Hospital Thursday. Video screengrab

Ponying up cash to keep it operating, forming a special funding district and operating as a “super ER” were just some of the options discussed to meet the emergency medical needs of Madera County residents as their hospital begins shutting down this week.

The Madera County Board of Supervisors hosted a nearly-four-hour special meeting Thursday to assess impacts from the closure of Madera Community Hospital. As outlined by public health, emergency services, corrections and law enforcement officials, the absence will have far reaching repercussions directly impacting public health.

Jay Varney, Madera County administrative officer, offered further details about the hospital’s financial situation.  As part of the year-long acquisition process with Saint Agnes Medical Center operator Trinity Health that fell through last week, Trinity lent Madera Community Hospital $15 million that needs to be paid back.

“That would put us on a freer course to bring them out of bankruptcy,” Varney said.

The hospital has an operational shortfall up to $2.5 million a month, he said, estimating it would cost up to $55 million to reopen the hospital for the first year and $35 million for a second year.

Possible options for reopening the hospital include operating as a “super ER” with an expanded emergency department excluding other health services and forming a special funding district, but Varney noted that a special district would take voter approval — and would likely require another facility in Oakhurst to sway mountain community voters.

One thing is for certain — Madera Community Hospital is unlikely to operate in the same way again.

“We need to face the fact that the hospital in its current configuration will never return to offering all the services it offers now,” Varney said. “It’s pretty apparent that losing $2 million a month is not sustainable.”

Deidre da Silva, chair of the Madera Community Hospital board of trustees, clarified that the financial problems are due to the pandemic and not mismanagement. The facility has the lowest Medi-Cal reimbursement rates in the state, she added.

“We are paid less than what it costs to provide care,” da Silva said. “It’s not a working business model.”

Public health and safety officials outlined the domino effect that will take place with the closure of Madera Community Hospital. Ambulance services will have to take Madera County patients to hospitals in Fresno or Merced, with anticipated two-hour roundtrip travel times.

Madera County has nearly 300 residents each year treated at the hospital for mental health “5150” holds, according to the Madera County Sheriff’s Office. If ambulances are not available to transport those patients, deputies will be on the hook. It was estimated that a special sheriff’s transportation unit would cost nearly $2 million each year, in addition to five extra patrol units.

More deputies transporting patients means less available to answer emergency calls, officials noted.

Sheriff’s office leaders also pointed out that as a mandated reporter, Madera Community Hospital and its employees are a refuge for victims reluctant to report perpetrators of crimes including domestic violence and sexual abuse.

In addition to reporting possible criminal activity, the hospital also makes important patient referrals for Madera County public health services including diabetes prevention and child health.

Central California Women’s Facility near Chowchilla is the largest women’s prison in the U.S. with more than 2,200 inmates. About 50 inmates a month are taken to Madera Community Hospital for medical treatment. Community Regional Medical Center in Fresno would be a likely alternative facility.

Alternatives must be decided quickly. Madera Community Hospital has accelerated its shutdown schedule, with labor and delivery services ending this past Wednesday, rural clinics shutting down Jan. 10 and all remaining patients transferred to other facilities by Jan. 17.

A bankruptcy filing is expected Jan. 3, 2023, and the official closing date is Jan. 10 at 7 a.m.

Fresno County EMS Director Dan Lynch shared an update on patient levels at Madera Community Hospital. As of Thursday morning, 22 patients remained in the hospital awaiting transfer to skilled nursing facilities, an end to 72-hour “5150” holds or a simple discharge.

Of six patients that remained in the ICU Wednesday, five were transferred in a 24-hour period to hospitals as far as Delano and Sacramento.

Madera County and city officials looked toward federal funding from the 2021 American Rescue Plan Act as a possible lifeline. Madera County has $23 million in ARPA funding in its coffers, but it has already been allocated for other uses.

A Madera city official said they have $23 million in ARPA that has been allocated 100% to much-needed sewer and water system improvements.

Elected officials would have to decide to reallocate those funds.

Varney later discussed five directions the Board of Supervisors could take to mitigate costs and establish medical care in Madera.

The first would be to analyze the outcomes of other hospitals that have been in a similar position to Madera such as Watsonville and Tulare, which both became district hospitals following financial collapse.  

The second would be to work with other state and federal partners to raise short term funding to keep a portion of the hospital viable. Varney advises that if this route is taken, state partners must work in the Legislature to help Madera Community Hospital, and hospitals like it, flourish financially.

The third option would be to request and review the Madera Community Hospital financials as part of the short term and long term planning to determine if developing a hospital district is viable.

A fourth option would be to reevaluate which ARPA projects have been approved for funding by the Board of Supervisors and assess which ones are deemed essential. After that, board members would need to assess the projects that are not essential and discuss reallocating those funds to help fund a hospital or hospital district. 

The fifth direction the Board can take would be to have the Madera County Sheriff declare a state of emergency or a local health emergency — a declaration that would act as a formal request to the state and federal government asking for support.  

“There is a threat of imminent peril to our community, and I do believe that it likely fits the criteria for declaring a state of emergency. That is a direction I’m willing to go and we’ll bring that back for the Board’s ratification,” said Tyson J. Pogue, Madera County sheriff.

 If this is the route taken, the sheriff would act as the Director of Emergency Services for the Madera County Board of Supervisors and request that the Governor proclaim a state of emergency and request a presidential declaration.