Testosterone Replacement Therapy in Madera, CA

Updated Thursday, May 4, 2023 at 7:00 p.m.

MADERA, Calif. – Madera Community Hospital could soon have access to state funding to help reopen services.

The California Senate and Assembly approved AB 112, outlining the “Distressed Hospital Loan Program.” The final step in the law is a signature from the governor – which would allow the law to go into effect immediately.

The program would open up $150 million in state funds to help reopen struggling hospitals like Madera Community Hospital.

According to the bill’s language, the loan program will provide “interest-free cash flow loans to not-for-profit hospitals and public hospitals in financial distress or to governmental entities representing a closed hospital to prevent the closure or facilitate the reopening of a closed hospital.”

Assemblywoman Esmeralda Soria acknowledged the Distressed Hospital Loan Program is only a short-term solution to a much bigger problem. Soria said it’s meant to incentivize a potential operating partner who would shoulder the total costs and responsibilities of a reopening process.

“At minimum, this will provide a gap-filler,” Soria said. “And I'm sure that whoever comes as a willing partner will put a proposal together that is sustainable.”

Soria has been working on the loan program as part of Assembly Bill 412, which she introduced in February. In late April, it was incorporated into a budget trailer bill, Assembly Bill 112. A budget trailer bill typically goes through budget committees and outlines specific details of a program that will be implemented under the budget.

In rural California, a hospital with millions in equipment sits empty and closed

The urgency to pass the bill was accelerated in April and coincided with an impending deadline to renew the Madera County hospital’s license with the California Department of Public Health, which expires May 26.

“Madera has been the driving force behind this,” Soria said.

Although the hospital suspended its license following the closure, the license still remains active and would require a $100,000 fee to renew it this month.

A lapse in the license renewal would force the hospital to meet all-new hospital building standards in order to qualify for another license, something that could sink the chance of the 1971-era building to reopen for services.

“[The state is] very fully aware of the licensing issue and made a commitment that it wouldn't be a hurdle when Madera would attempt to reopen,” Soria said.

Kaweah Medical Center in Visalia is another struggling Central Valley hospital that could benefit from the program. Chief Executive Officer Gary Herbst issued a statement Thursday in response to passage of AB 112.

He said, "Hospitals like Kaweah Health with high Medi-Cal rates suffered some of the biggest losses in the state. This funding is an important step in keeping hospitals open and helping them get back on their feet.”

Kaweah Medical Center 'limping' toward recovery as pandemic costs strain the hospital

A hospital financial report released in April showed 20 percent of California hospitals are at risk of closure.

The California Hospital Association, a hospital advocacy group, has pushed for the state to approve$1.5 billion in emergency funding to bail out hospitals that it says have suffered$8.5 billion in losses, just in the last year alone.

Soria said in addition to the hospital loan program, she hopes to initiate talks with UC Merced to turn the facility into a teaching hospital for its medical education program. But so far, no plans are in the works.

A Modesto-based company vying to take over a shuttered, bankrupt Central San Joaquin Valley hospital is accused of sending the hospital’s chief executive a $150,000 check that the hospital’s lawyers say was an attempt to “improperly influence” her decision-making.

According to a statement by the hospital executive, Karen Paolinelli, chief executive of Madera Community Hospital, she received an “unsolicited” job offer and the check made out to her personally during the competitive bidding process to find a financial partner to take over hospital operations.

Upon receiving the offer and check, she notified the hospital’s board vice chair, and then sent a certified letter response returning the check and declining the offer, according to bankruptcy court records.

American Advanced Management Inc. offered to retain Paolinelli in “an active leadership capacity” if they were to move forward as the hospital reopening partner, according to court filings, as well as providing her a $150,000 “signing bonus.”

“The entire interaction made me feel very uncomfortable,” said Paolinelli, in a court declaration submitted on Friday.

Attorneys Riley C. Walter and Kurt F. Vote said in court filings on behalf of Madera Community Hospital that the unsolicited offer and the check were an “obvious attempt to improperly influence the Debtor’s (Madera Community Hospital) decision-making” as well as an attempt “to improperly gain a competitive advantage” during the bidding process.

Karen Paolinelli Declaration by Melissa Montalvo on Scribd

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In an email statement sent to The Bee on Sunday, an official from American Advanced Management Inc. said that at the time of their offer they did not believe there were any other interested parties or competing offers to operate or sell the hospital and they wanted to secure her services as an executive going forward.

“When American Advanced Management presented Karen with an offer letter and signing bonus in May 2023, our focus was on reopening the facility as quickly as possible for the community,” said Matthew Beehler, chief strategy officer for American Advanced Management Inc.

Beehler said Paolinelli’s continued involvement was key to a fast, efficient hospital reopening.

“We had been in talks with Karen and the board for six months at that point and believed they were moving forward with us as their partner. With Karen’s experience and specific work to reopen the hospital, securing her commitment seemed to be the next logical step,” he said in the emailed statement.

As the CEO of Madera Community Hospital, Paolinelli is involved in finding new reopening partners for the hospital, along with the hospital’s board of directors. The hospital has the exclusive right to submit a business reorganization plan – such as a plan to reopen under a management service agreement with a partner – to the court until Oct. 6.

Paolinelli doesn’t have the final say on the decision, however. Any proposed partner is subject to approval by a federal bankruptcy court, creditors, the California attorney general, as well as the state health department that has earmarked a $50 million loan for the hospital to reopen.

Index of Exhibits in Opposition to Motion to Compel by Melissa Montalvo on Scribd

Madera Community Hospital closed its doors in late December and filed for Chapter 11 bankruptcy in March, after a deal to sell the hospital fell through, leaving Madera County’s 160,000 residents without access to an acute care facility.

The hospital announced in late July that it signed a letter of intent with Adventist Health, a faith-based, nonprofit health system operating in California, Oregon and Hawaii, to reopen Madera Community Hospital. The letter said that Adventist Health would plan to enter a management services agreement with the hospital contingent upon the hospital securing state funding.

In August, the state announced a $2 million bridge loan for the hospital, plus an additional $50 million contingent upon submission and approval of a “comprehensive hospital turnaround plan” from Adventist Health.

Less than a week later, AAMI, a hospital management company that operates eight California hospitals as well as clinics and urgent care centers, made public during bankruptcy proceedings its interest in being considered as a reopening partner.

AAMI, which is also a creditor with a claim in the bankruptcy proceedings, told a bankruptcy judge as well as The Bee that their proposal to take over hospital management should be considered because it’s a better deal for the community and creditors alike.

Hamid Rafatjoo, a partner with Raines Feldman Littrell LLP and lawyer for AAMI, criticized the hospital’s leadership for not seriously considering their offer and filed a motion for discovery to investigate why the hospital did not report AAMI as another possible reopening option to the court.

Paolinelli said in a declaration to the court that they had signed a non-disclosure agreement with AAMI and other third parties and could not divulge AAMI’s interest in the hospital.

Rafatjoo also alleged during a bankruptcy hearing that Madera Community Hospital management chose to move forward with Adventist Health “to preserve their jobs in the future.” Paolinelli said that the accusation was “completely false.”

This also is at odds with what Paolinelli said AAMI executives told her in an August meeting. AAMI leaders told Paolinelli that Adventist Health would “not keep you” once any transaction closed, according to a declaration Paolinelli submitted to the court. (Adventist Health’s letter of intent doesn’t specify details on hospital management’s future employment.)

Walter and Vote, the lawyers representing Madera Community hospital, said in court filings that American Advanced Management Inc.’s recent actions – and claims their proposal is better than that of Adventist Health – are an attempt to “harass” Madera Community Hospital and interfere with its right to create and propose a reorganization plan.

The hospital has the exclusive right until Oct. 6 to come up with a reorganization plan to keep the business alive and pay creditors over time.

AAMI said their offer to take over Madera Community Hospital is still on the table.

“We will continue to pursue all avenues to get support from the debtor, creditors, and bankruptcy court for our offer,” Beehler said. “Our offer will pay the creditors, take financial responsibility for current and future operations, and begin opening the hospital as soon as the court approves,” he said.

Walter, the lawyer representing Madera Community Hospital through the bankruptcy proceedings, said in an email statement to The Bee on Sunday that Madera Community Hospital is hard at work pursuing a management services agreement with Adventist Health.

He also said that when the hospital brings forward a potential deal to the bankruptcy court, “it will be very public and transparent so that dissatisfied parties can voice their opposition and be heard by the court.”

Approval of the management services agreement will be subject to objections if any party feels it is a bad decision, Walter said, but it will not be subject to bidding.

“MCH (Madera Community Hospital) is confident it can and will show that the decision to go with Adventist Health is best for the community,” he said.

A hearing is scheduled for Tuesday, Sept. 12 at 9:30 a.m.

This story was originally published September 11, 2023, 11:32 AM.

The ultimate expression of the Oaxacan people, the Guelaguetza, is coming to Madera County for the first time this year.

The idea of holding the Guelaguetza in the city of Madera has been in talks for some time, said Minerva Mendoza, president of the Comité Guelaguetza Madera, composed of members of the Oaxacan community in Madera.

However, it was until this year that the committee met in March to get the ball rolling and start working on making the cultural event a reality in Madera.

“Madera is a big city, full of Oaxacans for the most part,” Mendoza said.

The event, “Vive la Guelaguetza,” which includes traditional dances, food and music will take place on Sunday, Oct. 8, from 11 a.m. to 5 p.m. at the Rotary Sports Complex, 1901 Clinton Street.

Although this year is the inaugural Guelaguetza Madera event, Mendoza said the committee’s dream is for it to become an annual event.

Mendoza said the committee expects approximately 1,500 people to attend the event that day which will feature Ballet Folklorico El Valle de St. Helena and Mixtecos Unidos de Madera with La Danza de los Diablos and La Danza de los Rubios among other groups.

Bringing a new cultural event to the Madera community can have some challenges to the group of community volunteers.

“I think the biggest challenge has been fundraising,” Mendoza said, adding that the committee has organized several food sales.

Mendoza said the committee, whose mission is to preserve Oaxacan culture, decided to celebrate the Guelaguetza in early October, since it takes place near the ‘Indigenous Peoples Day’ holiday in the United States.

“It’s one more step of recognizing and promoting our culture,” Mendoza said. “We are very excited.”

Mendoza said the Madera Guelaguetza Committee has no association with El Centro Binacional para el Desarrollo Indígena Oaxaqueño, an organization that began holding the Fresno Guelaguetza in 1999, or other organizations and is comprised solely of volunteers.

For more than two decades, the annual Guelaguetza Fresno event has been organized by El Centro Binacional (CBDIO), the Frente Indígena de Organizaciones Binacionales (FIOB) and the Comité Organizador de la Guelaguetza.

In 2022, Guelaguetza Fresno returned again to Calwa Park after two years of the event being postponed due to the COVID-19 pandemic in 2020 and 2021.

The grand event has been held in Fresno for 22 years with a mission to promote cultural richness and preserve the languages, music, food and dances of the millennial heritage of the Central Valley’s indigenous Oaxacan communities.

Guelaguetza Fresno 2023 will take place on Sunday, September 24 from 10 a.m. to 4 p.m. at Calwa Park, 4545 E Church Avenue in Fresno.

Although Guelaguetza Fresno has been taking place for more than two decades, Mendoza said that because Madera is home to many indigenous Oaxacan communities, the committee “believes Madera needs its own Guelaguetza.”

Mendoza said that also because many families are sometimes unable to go to the Fresno Guelaguetza for transportation reasons, it was important to “bring a little bit of Oaxaca to them here.”

Mendoza said that in addition to the Fresno Guelaguetza, the Sonoma County Guelaguetza 2023 recently took place on Sunday, July 16, in Santa Rosa organized by the Oaxaca Tierra del Sol organization based in Healdsburg in Northern California.

The city of Bakersfield also has a Guelaguetza event in September, Mendoza said.

This story was originally published July 25, 2023, 12:58 PM.

As concerns grow with the closure of Madera County’s only adult acute care hospital, a local lawmaker is making tweaks to a piece of legislation aimed at helping struggling hospitals ahead of the bill’s first hearing next week.

Various local stakeholders and leaders, such as UC Merced’s chancellor, are also becoming interested in helping find ways to reopen the hospital, which closed its doors in January. Assemblywoman Esmeralda Soria, D-Fresno, plans to meet with the president of the University of California system in coming weeks to pitch the idea of a teaching hospital.

Meanwhile, Soria said she is making changes to the language in Assembly Bill 412, which she introduced in February, and is working with the governor’s office on the amendments.

The bill, Soria said, would establish a state emergency loan program for distressed hospitals either at the verge of closing or those with a plan to reopen. The tweaks will reflect that the loans would be forgivable if a viable plan demonstrates that a hospital can stay open for a certain amount of time. The specific criteria, she said, hasn’t been established yet.

The loan would end up turning into a grant, she said.

“What we intend to do is, we want to make sure these hospitals stay open, and that it doesn’t become a burden that they have to figure out how to pay that loan off if it would make their situation worse,” Soria told The Bee. “We want to make sure that there’s sustainability so if the hospital can demonstrate that they can stay open — we again don’t have the criteria for how long — then the loan can be forgivable.”

The bill was supposed to have its first hearing on March 28, then postponed to April 11 and now the hearing in the Assembly Health Committee will be pushed to April 18 to allow for the changes in the language to be completed.

Soria said an urgency clause has been included in the bill.

There’s still no specific timeline on how soon the program would become available. But the Madera hospital, for example, still stands to benefit from the program if the legislation were to pass, which Soria hopes would help entice a potential buyer to reopen the hospital.

The state Legislature, Soria said, already allocated $5 million in its last budget cycle for the Madera hospital, which was already struggling financially. Money through the emergency loan program would provide additional funding.

“That earmarked ($5 million) it’s still in the budget, but it can’t be tapped into until there is a plan to reopen,” she said. “The goal is that by having these $5 million, and access to this new program that we are establishing, that it would help us incentivize an entity to essentially buy it (the Madera hospital) and have a plan to reopen.”

Soria said she’s working closely with Sen. Anna Caballero, who also represents Madera. Caballero’s district also covers a portion of the central coast, where Soria said there’s another hospital that’s struggling financially.

“There’s a lot of interest from the governor’s office, and we’ve been working very closely with their office over the last couple of weeks,” she said. “I feel very confident that we are going to be successful in creating this emergency loan program for hospitals in distressed situations.”

Soria said over the last couple of decades, there have been efforts to bring a medical school to the central San Joaquin Valley and housing it at UC Merced.

A teaching hospital, she said, would also be needed to help train the future doctors.

“I said, ‘What an incredible opportunity would it be... since we have this now-empty hospital, and we know it’s very expensive to build a hospital, that this hospital could potentially be that hub to teach the future doctors of UC Merced,’” she said.

Soria said several stakeholders have been supportive of the idea. She said she has already met with UC Merced Chancellor Juan Sanchez Munoz, and other people from UCSF, “who recognize that this is an opportunity, but nothing has been developed as of now.” Soria plans to meet with Michael V. Drake, the president of the University of California system, in coming weeks to pitch the idea.

“We recognize that there’s a doctor shortage in the Valley, and a need to really train those future doctors and we need it here in the Valley,” she said. ”That’s the pitch that I would make, and so, we shall see. I have no indication whether that’s something that they would support because I have yet to talk to them.”

Sanchez Munoz seemed supportive of the idea.

“While we look to continue to build our medical education program in partnership with UCSF and UCSF-Fresno, we are considering a wide array of options and decisions for the near and longer terms,” he said in a statement to The Bee. “We share the community’s deep concerns about the closure of Madera Community Hospital, and are of course willing to join with others in taking an active look at any effort to revive it.”

This story was originally published April 11, 2023, 12:49 PM.

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Yesenia Amaro covers immigration and diverse communities for The Fresno Bee. She previously worked for the Phnom Penh Post in Cambodia and the Las Vegas Review-Journal in Nevada. She recently received the 2018 Journalistic Integrity award from the CACJ. In 2015, she won the Outstanding Journalist of the Year Award from the Nevada Press Association, and also received the Community Service Award.

This story is part of the Central Valley News Collaborative — a bilingual, community journalism project funded by the Central Valley Community Foundation and with technology and training support from Microsoft Corp. The collaboration includes The Fresno Bee, Valley Public Radio, Vida en el Valle, Radio Bilingüe and the Institute for Media & Public Trust at Fresno State.

Maria Rios sat in the shadows inside her Madera home last week, a contrast to the sunny day outside and a metaphor for what’s happening to so many people in her community.

Rios is in the dark about what’s next now that Madera Community Hospital has closed. Her chronic medical conditions and lack of transportation options made her dependent on the local hospital.

“My doctor prescribed me painkillers in November when extreme abdominal pains sent me to the hospital,” Rios said in Spanish. “With two pills left, now God only knows where I’ll find more of them because not all doctors prescribe them.”

Rios, 59, moved from the Mexican state of Oaxaca to Madera in February 2000. She said she had to stop working in 2015 due to a fractured foot that didn’t heal well, diabetes (which has impaired vision out of an eye) and kidney problems. She needs dialysis — a procedure to clean waste products and excess fluids from her blood because her kidneys don’t work properly — three times a week.

Like many Madera County residents, Rios is Latina and undocumented. More than 60% of the county’s population identifies as Hispanic or Latino, the U.S. Census reports. Out of the 159,000 population, close to 10% are undocumented, according to the Migration Policy Institute.

Rios said she did try getting her immigration paperwork sorted, but was unsuccessful.

“We don’t have papers, we don’t have where to go, and we need a clinic, a hospital,” she said. “Fresno is too far, too far for someone to get there with excruciating pains.”

Madera Community Hospital closed because of financial distress and stopped serving patients the week between Christmas and New Year’s, definitely closing the first Tuesday of the year.

Now, there are no emergency rooms between Merced and Fresno.

Madera not only lost its only general hospital in the county, but its residents are a 30-minute drive away from the closest hospital with an emergency room, Fresnoland reported.

Fidelina Espinoza is a community organizer with the Centro Binacional para el Desarollo Indígena Oaxaqueño, or the Binational Center for the Development of Indigenous Oaxacans, in Madera.

Espinoza has been trying to help and guide people to medical resources as they approach her office.

“We don’t have resources to transport people nor provide transportation,” Espinoza said in Spanish.

Neither the community nor the organization were notified or given any information about Madera Community Hospital closing until it suddenly did, she said. Espinoza said she also witnessed how the hospital struggled to meet the demand of services needed by the community.

“It was a bit limited,” she said. “When there were things they couldn’t do, they would send people to other hospitals with more technology and specialists.”

Madera Community Hospital opened in 1971. Since then, “Madera has grown and will continue growing,” Espinoza said. “So we should have a big-enough hospital to meet the community’s needs.”

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Rios did not imagine the hospital’s closing would have ever happened. She continued to ask why it did, thinking about the harvest seasons that are soon to happen across the Central Valley.

“Why did they take away the hospital? Why did they close it if they know people need it a lot?” She asked, “if something happens to farmworkers on the fields around here, how are they going to make it all the way to Fresno?”

Emelia Guzmán worked in the fields near Madera when she collapsed in 2019.

“I suddenly lost the strength in my legs and fell,” Guzmán said in Spanish. ”I tried to stand up again, but couldn’t.”

She was taken to Madera Community Hospital. Guzmán had previously noticed bumps on a breast and was initially told during a clinic visit that they’d go away by themselves. The biopsy performed at the hospital showed it was cancer.

Guzmán, 52, underwent chemotherapy but said she is still on medication to keep her cancer at bay while on medical supervision for the next five years. She was recently getting ultrasounds and blood tests done at the hospital for undiagnosed abdominal pains.

“The doctor that treated me and prescribed my medications worked there (at the hospital),” she said. “Now I’m worried because my medications are running out and where will I go? Who will I go to to get my pills?”

Like Rios, Guzmán has diabetes, is undocumented from Oaxaca, has lived in Madera for decades and had to stop working because of her health.

Though both women have Medi-Cal coverage that helps them pay for some of their medical expenses, the loss of their primary care providers, specialists and prescription renewals has left them in healthcare purgatory.

Madera city and county leaders are scrambling to find both short- and long-term solutions to support Maderans through the turmoil, but a solution could be at soonest months away.

“I was very shocked,” Madera City Councilmember Elsa Mejia said during Wednesday evening’s City Council meeting. “I think I share the community sentiment and this was a very hard blow for us as a community, especially during the holidays.”

“It’s a very fluid situation,” Madera City Manager Arnoldo Rodriguez said during a presentation to the council. “There is no clear path and there’s no clear answer at this point.”

Community members who want to comment publicly about this situation can do so at Madera City and County meetings.

For public comments at Madera City Council, community members can:

For the Madera County Board of Supervisors, chief clerk Karen Scrivner said:

This story was originally published January 22, 2023, 5:30 AM.

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