Stanislaus County is considering major cuts to health care services, leaving only two clinics [The Modesto Bee]

Apr. 15—Stanislaus County supervisors are poised to eliminate county-provided health care services at a west Modesto clinic and end its role of training family-medicine resident physicians at the center.

The county also could eliminate a specialty clinic on McHenry Avenue for low-income residents needing surgery and cut obstetrical services at another medical office.

The proposals are set for a public hearing Tuesday and, if approved, would leave the county Health Services Agency with two remaining health clinics in a county with 550,000 residents, including 262,400 people in the Medi-Cal program.

The county plans to let the private nonprofit Golden Valley Health Centers operate the county's Paradise Medical Office, on Paradise Road, which serves neighborhoods west of Highway 99. Golden Valley is expected to make arrangements to continue orthopedics, general surgery and physical rehab services at the McHenry Avenue specialty clinic.

County officials said the changes are necessary because of a growing shortage of physicians and clinic staff as demand for health care increases. But the new proposals raise questions about what role, if any, the county will play in health care services going forward.

Stanislaus had a county hospital until it was closed in 1997 and once operated health clinics in multiple cities, providing care for 80,000 patients a year.

But the county safety-net health system gradually has faded away under the county's leadership in the past 20 years.

Golden Valley, a Merced-based system of nonprofit health centers, has assumed a bigger role with the family medicine residency of the Valley Consortium for Medical Education and will supervise the resident physicians trained at the Paradise center, starting July 1.

The three-year family medicine residency, training 36 young doctors, or 12 in each class, has been county-supported for decades as a tool to bring doctors to Stanislaus County, which struggles to recruit physicians.

As county health services have been reduced, Golden Valley and another group based in Merced County, Livingston Community Health, have been adding clinics in Stanislaus County.

In a written statement last month, California Rural Legal Assistance, a nonprofit legal service for disadvantaged residents, asked the county to allow more time to assess the impacts on disadvantaged residents and receive more input from the community.

'Legal and moral' reasons to provide care

Crispin Delgado, executive director of the Sacramento-based Insure the Uninsured Project, didn't know the specifics of the county proposals but said the county can't legally stop providing health care services for the poor. According to a staff report, the county has physicians and midlevel providers at its remaining clinics able to serve only 14,000 patients.

"There is a legal and moral reason why counties provide indigent care," Delgado said via email. Under the Welfare and Institutions Code Section 17,000, counties in California have a duty to "relieve and support" the poor and indigent who lack other means of support.

Delgado wrote that counties must set general assistance standards for providing benefits necessary for basic survival. "Section 17,000 creates a county obligation to provide medical care for the poor that must be satisfied with county funds," Delgado wrote.

The county supervisor who represents the west Modesto area said Thursday that county health services will remain in the game. "We don't intend to completely get out of the health care business," Supervisor Terry Withrow said. "We are shorthanded out there at the Paradise clinic. Golden Valley can bring more care to the table. They have more physicians than we do."

The county's Medi-Cal enrollment is expected to keep growing after a 2022 state bill extended eligibility to the last remaining undocumented adults who didn't qualify. As the need keeps growing, county health services evidently will play a smaller role in serving that population.

Golden Valley has 23 clinics serving 100,000 patients in Stanislaus County. Livingston Health, a smaller organization, opened a health center in Modesto last year and has a clinic each in Turlock, Hughson and Waterford.

Due to the lack of public discussion or analysis of the changing environment, it's not known how well Golden Valley, Livingston Health, the smaller county system and other providers in Medi-Cal managed-care networks can shoulder the burden of the growing number of Medi-Cal recipients.

Officials say Affordable Care Act brought changes

County health officials claim the expansion of Medi-Cal eligibility under the Affordable Care Act relieved the county of responsibilities for indigent health care. Starting in 2014, thousands of adults who historically received indigent health services from the county were moved into the federal and state Medi-Cal program.

Today, California counties have discretion over how much to spend on health services for Medi-Cal patients and the remaining uninsured. According to a Legislative Analyst's Office report in 2022, the number of California residents without comprehensive health coverage has declined to 8%, down from more than 19% since 2013.

A dozen larger counties including San Joaquin still operate county-owned hospitals and health clinics. Counties like Stanislaus and Sacramento have been known as "hybrid" counties, operating public clinics and contracting with hospitals for indigent patients.

In 2019, the county clinic in Ceres was outsourced to Golden Valley and the Turlock and Hughson clinics were turned over to Livingston Community Health.

If county leaders decide to shed two more clinics Tuesday, it will leave only the McHenry Medical Office on Woodrow Avenue and the Family and Pediatric Health Center on Scenic Drive, which see a combined 15,500 patients a year.

Noe Paramo, legislative advocate for the CRLA Foundation, said Thursday that the Health Services Agency's recommendations should be thoroughly vetted by the Board of Supervisors. Patients deserve to be informed and ensured that access to quality health care continues.

He said the county's public notice for Tuesday's hearing indicates the services to be eliminated will impact more than 13,000 poor residents with a cost impact of more than $4 million. Those people can choose whether to transition over to Golden Valley.

Delgado said that some counties choose to contract with community-based organizations to operate clinics for low-income residents. The agenda materials for Tuesday's board hearing don't include contract terms or formal agreements for Golden Valley to take over the two clinics.

Clinic transition would be patient-friendly, report says

If the board approves the recommendations, county staff will work to transition the clinics to Golden Valley with the least disruption to patients and help with transferring medical records, a staff report says. The Valley Consortium for Medical Education would refrain from relocating resident physicians to another clinic site.

David Quackenbush, a top executive for Golden Valley, said last week it will need agreements with physicians who see patients at the McHenry Avenue specialty clinic to continue orthopedics, neurosurgery and general surgery consultations. He said Golden Valley began supporting the Valley Consortium for Medical Education for the "selfish" reason of finding physicians to work in its clinics.

The county has contributed from $600,000 to $1.5 million a year to VCME. County participation and financial support for VCME are expected to continue for at least three years.

The county's health services are dwindling not long after the COVID-19 pandemic killed more than 1,900 residents and disabled others with long-term COVID symptoms. After the virus surfaced here in 2020, staff shortages forced the county health agency to pull employees from other county departments for contact tracing and mass vaccination events in response to the COVID emergency.

The Health Services Agency and its public health division played an integral role with hospitals and medical groups in combating COVID-19, but now the county lacks resources to operate more than two health clinics.

"We still have two clinics," Withrow said. "And we are very much involved in public health."

The Stanislaus County Board of Supervisors meets at 6:30 p.m. Tuesday in the basement chambers of Tenth Street Place, at 1010 10th St., Modesto.

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