The Lone Hospital in This Central Valley County Closed

Driving along Highway 99, the Central Valley artery that runs alongside freight train tracks and groves of now-blossoming almond trees, it’s difficult to miss the skeleton of Madera Community Hospital.

A blue tarp hangs over the entrance, covering stucco where scraped-off letters once notified the public of an open emergency room. Only the post is left from a giant road sign that had borne the hospital’s name. On a recent morning, a lone security guard kept watch outside the abandoned building.

The 106-bed facility closed in January, leaving the largely rural Madera County — home to 160,000 people, most of them Latino and nearly a third of whom work in agriculture — without a general hospital. The closure has forced those seeking medical care to drive an extra 30 minutes southeast to more populous Fresno, overwhelming emergency rooms there and prompting Madera and Fresno Counties to declare states of emergency.

The problems in the San Joaquin Valley provide a window into the pressures on rural hospitals nationwide. Over 250 rural hospitals across the country are at risk of closing within the next three years, including six in California, according to a January study by the Center for Healthcare Quality and Payment Reform. Just an hour’s drive from Madera, Kaweah Health Medical Center in Visalia is among those having serious money troubles.

“Losing the hospital was a really large blow,” said Jennifer Hidalgo, a district representative for State Senator Anna Caballero, a Democrat who represents the Madera area. “It’s a crisis right now in California, specifically in the Central Valley.”

After years of financial troubles, Madera Community — a nonprofit private hospital that had been operating for a half-century — and its three health clinics shuttered after negotiations with a large health care system to buy the hospital fell through in late December, CalMatters reports. With no other potential buyers stepping forward, the hospital filed for bankruptcy last month.

The biggest effect in Madera County — which stretches east from farmland in the San Joaquin Valley into the mountains of Yosemite National Park — isn’t on the sickest patients, who are still able to quickly summon ambulances to their homes, Dr. Simon Paul, the county’s public health officer, said last month in an NPR forum. It’s on local residents with chronic conditions who would have gone to the emergency room for treatment were it closer, but now will avoid the 30-minute drive until their symptoms worsen, he said.

“It’s people whose heart failure is getting out of control, whose diabetes is out of control,” Paul said. “They’ll end up at the hospital, but three days later, much sicker and maybe needing admission to the hospital as opposed to coming back home after getting tuned up in the E.R. — and that’s a very big group of people.”

Those patients will also leave Fresno hospitals with follow-up plans to see specialists and have tests done in Fresno. “The people that have the fewest resources are going to have the biggest difficulty navigating that new complication to health care,” Paul said.

After the closure of Madera Community, state legislators proposed ways to funnel more money to California’s ailing hospitals to prevent more from shuttering — though it’s a bigger lift to reopen a facility that’s already closed. Hidalgo told me that preliminary conversations were underway with the University of California, San Francisco, and the University of California, Merced, to transform Madera Community into a teaching hospital, but, for now at least, its doors remain closed.

“It’s a really difficult time for rural hospitals,” Paul Ginsburg, a University of Southern California health policy professor, told me. He said that many rural hospitals nationwide were contending with declining patient populations, as well as low insurance reimbursement rates that made it difficult to make ends meet.

Over 180 rural hospitals have closed in the United States since 2005, with a record 19 closings in 2020 alone, my colleague Emily Baumgaertner has reported. This trend is medically and economically devastating for communities, she writes; hospitals have historically supported one in every 12 rural jobs and, after a closure, a community’s population typically begins to shrink.

What we’re eating

Almond cake with cardamom and pistachio.

Where we’re traveling

Today’s tip comes from Carol Swain, who recommends Morro Bay:

“So many choices of fun things to do are available in this jewel of the Central Coast. Kayaking, paddle boarding, diving, fishing, whale watching — you name it. All these activities start from right on the bay. One of our favorites is to rent a kayak — why schlep it? — paddle 20 or so minutes across the bay to the sand spit and then hike across there to the ocean beach. Have a picnic, take a walk, dive in the water and enjoy.

On land, there are great walks and trails: the boardwalk out to the rock or the one near the marina, Black Hill, White Point — near the Natural History Museum, which is great for all ages — Harmony Headlands, Montaña de Oro — all easy, plus many more advanced trails for hiking. Bicycling is super popular here, too.

Art galleries, restaurants and shops are great for a town tour.”

Tell us about your favorite places to visit in California. Email your suggestions to CAtoday@nytimes.com. We’ll be sharing more in upcoming editions of the newsletter.

Tell us

After a rainy winter, spring has arrived in California. Whether it’s road trips, festivals, sunny afternoons or wildflower sightings, tell us your favorite part of spring in the Golden State.

And before you go, some good news

In 2022, researchers at the California Academy of Sciences described for the very first time 146 new animal, plant and fungi species, greatly enriching our understanding of the earth’s biodiversity.

Among the new kinds of lizards, sea slugs, ants and beetles identified by the museum’s scientists were some native Californian species.

During a helicopter trip through California’s Klamath Mountains, Julie Kierstead, a research associate with the academy, stumbled upon an unfamiliar species of allium — the group of flowering plants including onions, garlic and shallots. She found the plant, blooming with light pink petals and a thin magenta stalk, on the summit of the remote Minnesota Mountain, and her research partner later found another small patch of the new species on the summit of nearby Salt Creek Mountain.

“As far as we know, the Minnesota Mountain onion can only be found on these two neighboring peaks,” Kierstead said in a statement. “It clearly favors this specific habitat.”