By MARIJKE ROWLAND
CV Journalism Collaborative
When two of Modesto’s county-run health clinics closed at the start of July, Andriana Rodriguez was in a better position than most to know what might happen next for Valley patients.
The 42-year-old Modesto resident had been a patient at the Paradise Clinic, run by Stanislaus County, for the past six years.
But for years before that she was with Golden Valley Health Centers, the Merced-based private nonprofit healthcare provider that is taking over the operations and management of the clinics. Rodriguez’s two daughters, ages 6 and 15, have both been Golden Valley patients since birth.
While Rodriguez said she initially switched her own care from Golden Valley to the county clinic because it was only four minutes from her west Modesto house, she said she liked how responsive the staff at the county clinic were, and how quickly she could get appointments.
At the Paradise Clinic it usually only took a week, at most, to see a doctor. With Golden Valley, she said, the wait could be months.
“(The Paradise Clinic) would always answer the calls and (I) would get appointments quickly,” Rodriguez said through a Spanish translator. “When (we) have to do physicals for (my) daughters (at Golden Valley), you have to anticipate months in advance…to get it done on time.”
In April, county supervisors approved the closure of the Paradise Clinic, which offered primary and urgent care services, and a specialty care clinic in the large black-glass medical building on McHenry Avenue. Golden Valley Health Centers, a federally qualified health center, which receives taxpayer funding as a safety net provider, took over both clinics July 1.
Since 1933, California counties have been bound by state law to “relieve and support all incompetent, poor, indigent persons, and those incapacitated by age, disease, or accident,” which includes providing health services. But over the ensuing decades – and especially in recent years – Valley patients have seen many of those county services disappear.
The shift began in earnest in 1997, when supervisors agreed to close the county-run Scenic General Hospital and open a string of community health clinics. In 2000, the county had nine clinics, including sites in Ceres, Empire, Hughson, Salida, Turlock and Oakdale. As of July 1 of this year, the county only has two clinics left, which are both in Modesto.
The need for county-provided care for the poor has decreased in subsequent years because of increased health insurance access from the Affordable Care Act and state’s expansion of Medi-Cal eligibility. But many still bemoan the shrinking of the county’s health-services footprint. About 12,000 county residents were patients at the Paradise and McHenry clinics.
Perfecto Munoz, chief executive officer of the West Modesto Community Collaborative, said he has spoken to people in the area who are worried about what the closures mean for their care.
“One of the biggest questions had to do not so much with access, but quality of care,” he said. “(People) prefer to have the county operate the clinics because they felt comfortable with the quality of care there. They get to see the same doctor, the same provider each visit.”
Rodriguez said one of the issues she had recently when taking her daughters into Golden Valley was that the doctor was in and out of the exam room so quickly that she did not have a chance to ask any direct questions.
Munoz said his group has expressed its concerns to county and Golden Valley officials.
“We know Golden Valley is making every effort to try to improve the quality of care,” he said. “But it’s a difficult time to see the county is closing and moving clinic services around.”
Golden Valley leader hopes to ease transition
Golden Valley Health Centers CEO, David Quackenbush, said the transition of the two county clinics is among his most pressing priorities.
The county is not partnering or contracting with Golden Valley to provide financial support or other resources. Instead, Golden Valley is taking over the leases on the buildings and installing their own operations.
Quackenbush said the group plans to maintain all of the services the county provided, including primary and urgent care at the Paradise site, and specialty care, including orthopedic, general surgery, neurosurgery, wound care and physical rehab services at the McHenry Avenue site. He said most of the specialists who worked in the county clinics – at least 20 – have agreed to join Golden Valley to provide continuity for patients under their care. All medical records will also stay with the clinics and be stored by Golden Valley.
The organization is also taking over stewardship of the existing residency program, which is a critical pathway for bringing more doctors into the Central Valley. The July changeover was timed to coincide with the start of the new residency year.
By taking over the Paradise and McHenry clinics, Golden Valley has expanded its regional presence to include 47 clinics in three counties – Stanislaus, Merced and San Joaquin – that serve about 145,000 patients with a staff of around 1,300. Twenty-three of the clinics are in Stanislaus County and serve about 90,000 patients. Most of the patients are on Medi-Cal, the state’s Medicaid health care program for low-income residents.
“(Taking over these sites) was something we felt very comfortable with,” Quackenbush said. “We are already right in the neighborhood. We’re trying to provide continuity of care.”
Quackenbush acknowledged that the same issues which drove county supervisors to close the two clinics – difficulties hiring and maintaining staff – are also a challenge for his organization. But, he said, Golden Valley’s expansive network of clinics and doctors gives it an advantage over the county.
“Most counties have stopped (running clinics) a long time ago,” he said. “I give Stanislaus County credit for trying to maintain some level of care. It’s super expensive to provide care for the indigent.”
Advocates express concerns over clinic closures
Still, some argue that the county’s duty of care to its poorest residents should – and must – continue, despite turning the clinics over to Golden Valley.
Representatives from the California Rural Legal Assistance Foundation, which advocates to improve the economic, social and political conditions for rural communities, spoke at Board of Supervisors meetings against the county closures. Now that the decision has been made, said Noe Paramo, a legislative advocate for the foundation, county officials should monitor both the transition and continued care provided by Golden Valley.
“The county has had a pattern of regression when it comes to care for indigents, from closing the Scenic Hospital several decades ago to now,” Paramo said. “Stanislaus County has a legal obligation through institutional codes, and they need to maintain that. Even though these transfers are going on, that does not usurp their obligations to assure that access of care for indigents continues in the county.”
Paramo’s recommendations include creating a steering committee to provide oversight on how Golden Valley and other providers are servicing the poor in the area. He also suggests an ombudsperson be named as a patient advocate to help them navigate the transition and provide assistance accessing services and financial support.
“People can’t fall through the cracks,” he said. “They can’t be waiting for months for an appointment, whether specialty or primary care. The board can’t just pass off that obligation.”
It’s the same concern Rodriguez said she had when she first received the letters saying the clinics would be closing and transferred to Golden Valley.
“I’m worried about people with chronic conditions, older people who really need the help,” she said. “They might not have answers to why the change happened and not know if they still have access. Otherwise people might have to travel farther away for care.”
CVJC Executive Director Alma Martinez provided translation services for this report.
— Marijke Rowland is the senior health equity reporter for the Central Valley Journalism Collaborative, a nonprofit newsroom which publishes The Merced Focus, in collaboration with the California Health Care Foundation (CHCF).
