A county without a hospital

Your guide to California policy and politics
Ben Christopher BY Ben Christopher January 20, 2023
Presented by Dairy Cares, Climate-Smart Agricultural Partnership and Southern California Gas Company

A county without a hospital

Up until this month, Madera County — with a population of more than 150,000 spread out across 2,000 square miles of Central Valley farmland and sparse Sierra — had a single general hospital.

Then, on Jan. 3, it closed its doors for good.

As CalMatters health reporter Ana B. Ibarra and California Divide reporter Nicole Foy explain, the shuttering of Madera Community Hospital is a local tragedy, but it’s also a flashing warning sign for a rural healthcare system in California that has been under financial strain for years.

In Madera, adults across the county now have to drive an extra 30 or 40 miles to Clovis, Fresno or Merced for emergency medical care. That’s assuming they can drive.

  • Pedro Dominguez, 80, whose wife has severe asthma: “Many people don’t know who to turn to.”

There isn’t just one reason that Madera Community Hospital went bankrupt: 

  • More than half of the emergency room visits to the hospital came from patients enrolled in the Medi-Cal, the state health insurance program for low-income residents that reimburses providers at lower rates than private insurance companies.
  • The hospital had to pay out big to hire travel nurses and retain burned-out staff during the worst of the COVID-19 pandemic.

But these problems aren’t unique to Madera. They’re found at hospitals serving rural communities across California. Roughly half of the state’s hospitals are spending more than they take in, according to Carmela Coyle, president of the California Hospital Association.

  • Coyle: “We are at a tipping point; Madera is just the first one.”

If you heard a large thump on Thursday, it might have been the sound of the federal government smacking into its congressionally-imposed borrowing limit. The U.S. Treasury hasn’t run out of cash just yet. With some financial gymnastics, Treasury Secretary Janet Yellen said the biggest spending government on earth can keep chugging along without a hike to the debt ceiling until sometime this summer.

Still, one wonders what a fiscally straightjacketed federal treasury (or worse yet, a first-ever default by the U.S. government) might mean for California, which has its own budgetary concerns.

I put the question to Department of Finance spokesperson H.D. Palmer. His short answer: Nothing good.

There are three main potential impacts to the state’s finances, he said:

  1. The possibility of the U.S. government not paying its bills would likely rattle the stock market (more than it already has). The state of California draws a disproportionate amount of its individual tax revenue from capital gains on stocks and other investments.
  2. New reductions in federal spending could be on their way, which might mean less cash for California.
  3. Uncle Sam running out of cash could slow the entire global economy, tugging down the state’s revenues with it.

But there’s no reason to panic yet. Congress and the White House have months to hammer out of a deal and Palmer said he remains confident.

Palmer: “If there were not to be a timely and satisfactory resolution to this issue the economic impact would not be limited or contained…But we certainly hope and expect that more reasonable heads will prevail.”


The coronavirus bottom line: As of Tuesday, California had 10,996,443 confirmed cases and 98,800 total deaths, according to state data now updated just once a week on Thursdays.

CalMatters is also tracking coronavirus hospitalizations by county.California has administered 87,556,084 total vaccine doses, and 72.5% of eligible Californians have received their primary vaccine series.


1 Biden visits the storms’ aftermath

President Joe Biden talks with Paradise Beach Grille co-owner Chuck Maier as he visits with business owners and local residents in Capitola, Calif., Thursday, Jan 19, 2023, to survey recovery efforts following a series of severe storms. Photo by Susan Walsh, AP Photo
President Joe Biden talks with Paradise Beach Grille co-owner Chuck Maier as he visits with business owners and residents in Capitola on Jan. 19, 2023, to survey recovery efforts following a series of severe storms. Photo by Susan Walsh, AP Photo

President Biden has been called “consoler in chief” and on Thursday he turned his empathic eye to California, which is only beginning to recover from an historic drenching that since Christmas has dumped some 32 trillion gallons of water — an average of more than 11 inches across the entire state — and that has so far claimed 21 lives.

By helicopter and by foot, Biden toured Santa Cruz County, accompanied by Gov. Gavin Newsom, Sen. Alex Padilla and a phalanx of local leaders and first responders. At a brief press conference in Aptos, the president touted the help the White House has sent the state’s way. 

He also offered what was, for Californians, a grim, if welcome, statistic: Since taking office two years ago, he said, California has received $9 billion in federal relief to cope with floods, fires and other disasters.

  • Biden: “We know some of the destruction is going to take years to fully recover from and rebuild. But we gotta not just rebuild, but rebuild better.”

That’s likely to come with a hefty price tag. Preliminary estimates peg the destruction to public infrastructure and private property at as much as $1 billion.

More to come? This season’s nine lashing storms weren’t likely the result of climate change, but were just part of California’s historic boom-bust precipitation cycle, according to climate scientists interviewed by the Los Angeles Times. 

But according to a new paper published in the scientific journal Nature Climate Change, uncontrolled greenhouse gas emissions could result in considerably more destructive atmospheric rivers, dropping more water over a larger area in a shorter amount of time.

The giant, flat bowl of the Central Valley, which was inundated during the Great Flood of 1862, is particularly vulnerable. And the financially distressed cities such as Stockton are ill-equipped to hold back the water.

  • Barbara Barrigan-Parrilla, executive director of Stockton-based Restore the Delta: “We are at the bottom of the bowl…We’re the drain. And they don’t value us.”

2 Charges in New Mexico, calls for change in California

Actor Alec Baldwin attends a news conference at United Nations headquarters, on Sept. 21, 2015. Prosecutors announced Thursday, Jan. 19, 2023 they are charging Baldwin with involuntary manslaughter in fatal shooting of cinematographer on movie set. Photp by Seth Wenig, AP Photo
Actor Alec Baldwin attends a news conference at United Nations headquarters, on Sept. 21, 2015. Prosecutors announced on Jan. 19, 2023, that they are charging Baldwin with involuntary manslaughter in a fatal shooting on a movie set. Photp by Seth Wenig, AP Photo

More than a year after actor Alec Baldwin shot and killed cinematographer Halyna Hutchins with a prop revolver that he said he did not know contained live rounds, Santa Fe-based prosecutors said Thursday they plan to charge the actor, along with the film production’s weapons handler, Hannah Gutierrez Reed, with involuntary manslaughter. 

As the Los Angeles Times reported at the time, the film set of the western “Rust” had been plagued with gun safety issues, misfires and complaints from unsettled crew even before Hutchins was killed during a rehearsal.

  • District Attorney Mary Carmack-Altwies: “On my watch, no one is above the law, and everyone deserves justice.”
  • Luke Nikas, Baldwin’s attorney: “Mr. Baldwin had no reason to believe there was a live bullet in the gun — or anywhere on the movie set.”

The on-set killing prompted calls for new safety standards across Hollywood — and in Sacramento, too.

Last year, two bills stalled in a legislative committee. One, introduced by state Sen. Anthony Portantino, a Glendale Democrat, was backed by the Motion Picture Association. Another, written by Democratic Sen. Dave Cortese of Campbell, was pushed by organized labor.

Portantino, chairperson of the powerful Senate Appropriations Committee, decided to hold back both, citing what he called a failure by “broad entertainment interests to work collaboratively to bring forward a consensus approach.”

After Thursday’s charges were announced, Cortese said he planned to reintroduce his own proposal.

  • Cortese: “I call upon the motion picture and television industry to immediately cooperate with our legislative efforts to codify safety protocols and ensure set safety supervision.”

Other Hollywood woes:

3 More than $3 billion, with strings attached

Students walk along the bridge leading into campus at the University of California Merced on Nov. 4, 2022. Photo by Larry Valenzuela, CalMatters/CatchLight Local

From CalMatters higher education reporter Mikhail Zinshteyn:

In the land of University of California finances, big numbers rein supreme. The system has an operating budget of $47 billion. It receives roughly $5 billion in state support for student instruction and construction. That billion-dollar theme stretches into UC’s fundraising apparatus. This week, the system said it raised $3.3 billion in the 2021-22 fiscal year, the most recent data, which is the largest-ever haul and the first time the UC crossed the $3 billion threshold.

But unlike state support, which mostly gives the campuses discretion on how to spend the money on its academic mission or on specific building projects, just $31.6 million of that massive $3 billion raised in donations is unrestricted. That means more than 99% of the gifts and donations the UC system receives can only be used for purposes specified by donors. 

The largest pot of gift dollars in 2021-22 went to campus departments — about $1.2 billion. Roughly $426 million was for campus improvement projects and $333 million was for student support.

All that largesse is spread across 412,000 individual gifts. More than 500 gifts were $1 million or more. Donations flow from foundations, corporations and individuals, including alumni. 

Some campuses bring in more money than others. UC Berkeley, UC San Francisco and UCLA each received more than $700 million from donors. UC Merced got $11.9 million. Unlike the long-established other UC campuses, the campus at Merced is 17 years old. It has only graduated roughly 16,000 students in its entire existence. 

But the campus is on course to bring in much more in gifts — the UC regents on Thursday approved its plan to raise $200 million by 2030. UC Merced has brought in around $75 million for that campaign so far. 

Helping the effort was the $20 million billionaire MacKenzie Scott, former wife of Amazon founder Jeff Bezos, who gave the campus in 2021 — the largest in the campus’s history.

  • UC Merced Chancellor Juan Sánchez Muñoz: “It put us on the radar of major foundations and corporations as an institution at the University of California in the Central Valley doing great things in teaching and research and service.”

CalMatters Commentary

CalMatters columnist Dan Walters: Unemployment insurance, the California program that supports workers who lose their jobs due to layoffs, has been dysfunctional during the last two recessions. It’s time to fix it.

Other things worth your time

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Meet three California startups taking on America’s child-care crisis // Los Angeles Times

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U.S. Supreme Court poised to reconsider key tenets of online speech // New York Times

How crime in San Francisco changed in 2022 // Mission Local

Kiley, Duarte among California GOP reps to land roles on key committees // Sacramento Bee

SF power couple feel cheated after giving big to George Santos // San Francisco Standard

500,000 gallons of sewage fouls San Diego Bay // San Diego Union-Tribune

See the finalists in competition to design L.A.’s 1871 Chinese massacre memorial // LAist

Huge new BART housing project will test if transit is still a draw // San Francisco Chronicle

Truckers say this dusty roadside diner is California’s best restaurant // Eater L.A.

Photo Essay: Beautiful 1950s surf snapshots // Traveler

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