Fresno councilmember to formalize requests for CMC audits, new tower at downtown hospital
A Fresno City Councilmember is calling for Community Medical Centers to live up to its commitment to its downtown hospital.
Councilmember Miguel Arias also says the city’s redevelopment agency has secured special counsel to review all past and current city agreements with the nonprofit CMC and he plans to request various reviews of CMC, all in the wake of a Fresno Bee investigation. Arias is the redevelopment chair.
Rep. Jim Costa’s office told The Bee a review of CMC would be appropriate.
Before announcing how he expects to bring accountability to the nonprofit hospital, Arias opened a Wednesday news conference by apologizing to the Fresno County community, especially to those who depend on CMC as their safety-net health care provider.
“I and other leaders should have done more to hold Community Medical Centers’ leadership accountable much sooner because of the really self-interested actions that they have engaged in at the expense of Fresno residents,” he told reporters.
The Bee on Aug. 25 published online a four-part investigation, Care & Conflict. The stories detail that CMC, which recently changed its name to Community Health System but is still largely known by its former name, has taken state and federal money intended to offset the cost of providing care for indigent patients, primarily in downtown Fresno, and used it to help fund a $1 billion hospital expansion in Clovis over the past decade.
The Bee’s investigation found CMC had plans to build two new patient towers at its downtown Fresno campus in order to meet earthquake standards. Instead, two new towers were built at its affluent Clovis campus
Today, 90% of the acute care beds at Community Regional Medical Center in downtown Fresno face the threat of closure if CMC fails to bring its key facilities at that campus up to compliance with earthquake standards by 2030.
“What Community Medical Centers has done over the last 10 years may or may not be illegal, but it should be,” Arias said. “Taking a billion from the poor may not be illegal, but it is wrong, it is unethical and it will cost lives of the most vulnerable in our city.”
It’s unclear how much such money CMC has spent on the Clovis expansion. The hospital corporation has acknowledged it spent Hospital Quality Assurance Fee program funds — federal and state money intended to offset the cost of providing care for Medi-Cal and uninsured patients — on the expansion, but will not disclose how much. The vast majority of those fees are generated by patients served by the downtown Fresno hospital.
The Bee has reached out to CMC for comment. Earlier this week, CMC spokeswoman Michelle Von Tersch said the nonprofit hospital “is confident that all funding has been properly used to support the healthcare needs of the region, with a particular focus on vulnerable communities in Fresno.”
She added that CMC lost $175 million in 2021 caring for Medi-Cal patients.
The Bee’s investigation also lays out what many consider conflicts of interest among hospital board members. Most notably, CMC board chairman Farid Assemi and a longtime former board member, Flo Dunn, own a for-profit medical school less than a mile away from the Clovis hospital. The private school has already seen many benefits from the hospital, including contracts, sponsorships and student clinical rotations. Three board members for the nonprofit hospital board also sit on the board for California Health Sciences University. Dunn, who serves as president for CHSU, continues to attend CMC board meetings as a guest.
CMC also purchased land from one of its board members in Clovis. The hospital began to build a skilled nursing home, but paused construction during the coronavirus pandemic.
Councilmember plans to pursue five actions
Arias said his office has begun to take five specific actions intended to hold CMC accountable. The city has hired expert legal counsel to review past and current city redevelopment agreements with the nonprofit hospital. If the conclusion is that those agreements haven’t been met, he said, then CMC could expect the city to pursue litigation to ensure compliance.
In coming days, Arias said, his office will make a formal request for CMC’s board to abandon its efforts to secure an exemption or extension for the 2030 siesmic requirements, and to move forward with building a new tower at the downtown Fresno hospital.
The years that CMC has to meet compliance is “plenty of time for them to build it and they have sufficient financing to complete this task,” he said of a new patient tower at CRMC.
The city of Fresno, Arias said, has a state and federal lobbyist, and the city council has the right to direct the lobbyist to challenge or oppose any requests by CMC for an exemption or extension for the state’s earthquake standards.
In the coming days, Arias said, he will also formally ask the California Attorney General to conduct a full evaluation of CMC’s “nonprofit status to assess whether they have met their legal obligation to disclose financial conflicts of interest and take any appropriate action necessary.”
Additionally, Arias’ office will submit a request to Congressman Costa, D-Fresno, for a review by the U.S. Centers for Medicare and Medicaid Services’ Office of Inspector General of federal funding allocated to CMC, and the hospital’s accounting of how it was spent.
Anthony Camacho, press secretary for Costa’s office, on Thursday said the congressman believes it’s appropriate to review federal and state funding that has been allocated to CMC.
“(Costa) will consider what protocol and process is appropriate in concurrence with other efforts that are taking place,” he told The Bee in an email. “He has been a longtime supporter of the downtown Fresno medical campus and supports a medical school located in downtown Fresno.”
Costa, Camacho said, in 1999 assisted in securing $50 million for the trauma center at the downtown Fresno hospital. In 2002, he said, Costa committed to the state, through UCSF, to build a $26 million building that now houses the residency program and supports training for doctors.
Lastly, Arias said, his office will ask the California State Auditor to conduct a performance policy evaluation of CMC’s use of county, state and federal resources meant for the “most vulnerable” in the city. It will also call for a review of the nonprofit hospital’s “financial ability to fully fund a downtown medical tower that meets modern earthquake standards.”
That request will be submitted through state representatives, he said, and will then go to a bipartisan committee that oversees state audits. Arias said Assemblyman Jim Patterson and state Sen. Andreas Borgeas, both Fresno Republicans, are on the committee.
The Bee has reached out to the offices of Patterson and Borgeas for comment.
“We try to pursue these actions with a heavy heart because we believe that the health and safety of our residents demands it,” Arias said. “CMC exists to serve the most vulnerable. It’s our community’s hospital, not the personal bank of its board members or executives.”
Arias said he couldn’t trust the Fresno County District Attorney’s Office or local law enforcement “to thoroughly investigate and take appropriate action, given their long history of inaction when it comes to well-connected leaders in Fresno.”
Arias’ experiences at downtown hospital
Arias also shared some personal stories of experiences he’s had first-hand with CMC. Fifteen years ago, he said, nurses at the downtown Fresno hospital “gifted” his older brother “with a dignified end-of-life treatment and care.”
Ten years ago, he said, doctors at the downtown campus saved his mother’s life with emergency brain surgery.
“That earned them my appreciation, my confidence, and my trust,” he said. “But Community Medical Centers is no longer the place it was 10 years ago, and I don’t say that lightly nor based solely on recent investigative news stories. I have seen it for myself.”
Arias said he went to the downtown Fresno hospital’s emergency room this year only to discharge himself five hours later.
“It wasn’t just the rodents jumping on the ER tents, it was the young woman that was discharged by a nurse after she broke the news that she had been diagnosed with a miscarriage in front of a room full of patients,” he said. “There was no privacy, much less dignity. The ER staff even advised me while I was there that I was better off going to (the) Clovis emergency room for better care.”
Also this year, he said, his mother was discharged into “the streets of Fresno without” notifying the family and without a diagnosis and treatment.
Since The Bee’s stories were published, he said, many of his constituents and other local leaders “have shared similar stories on the deterioration of healthcare services in our flagship hospital.”
“The trust that Community Medical Centers’ doctors and staff showed for decades has been eroded by its current leaders, as they depleted more than a billion from its flagship hospital for private profiteering of well-connected (board) members and executive staff,” he said.
Eric Payne, executive director of the Central Valley Urban Institute, was at the news conference and told The Bee he’s “extremely disappointed” at the actions by CMC, the hospital’s inability to meet quality of care standards in Fresno and the lack of board representation that is reflective of the community.
“Where there is an ethical conflict in this billion-dollar theft of public resources, some board members should look to step down,” he said, “to remove any unethical behaviors that the public may perceive from the actions that they have taken recently.”
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