Business · Fresno · Highlight

As status downgrade looms, 23 advanced practitioners at Community Hospital terminated

Update (9/3/20): Central California Emergency Medical Services Director Dan Lynch told The Sun that CRMC still maintains its Level 1 trauma center status. However, CRMC does not have on-call neurosurgical coverage, which the hospital is hoping to restore on Friday.

CRMC will have a need to transfer patients that need neurosurgical care, Lynch said, and Kaweah Delta Medical Center in Visalia has stepped up to assist.


On Tuesday evening, 23 advanced practice providers at Fresno’s Community Regional Medical Center (CRMC) were notified that they will be let go in 60 days.

This comes after a contract between Community Medical Centers (CMC) and the Central California Faculty Medical Group (CCFMG) expired that funded 28 physicians, including six doctors that provide 24-hour neurosurgical trauma coverage at CRMC.

Without the 24-hour neurosurgical trauma coverage, CRMC’s trauma center will be downgraded from Level 1 status to Level 3, meaning new patients with serious head injuries would be sent to hospitals in Sacramento and the Bay Area. 

“For me, [it] is just a gut punch,” Dr. James Davis, CRMC Chief of Trauma, told The Sun. “My stomach has been in knots for several days over this. This is just the last place I ever wanted to be.” 

That looming downgrade is only made worse by the termination of the 23 advanced practice providers.

“Physician assistants like nurse practitioners do a wide range of care,” Davis said. “They help with the ICU care in the neuro patients. They see and evaluate patients when they first come in. They really are an extension of what the neurosurgeons can do, and with our volume of head and spine injuries, it’s really important to have them.” 

Davis pointed the finger at CMC, saying the health care provider terminated the advanced practice providers without providing a reason for the decision.

However, CMC released a statement late Wednesday evening which flipped the script, saying CCFMG sent the termination notices, not CMC.

While the hospital will eventually lose the advanced practice providers, CMC and CCFMG had still not come to an agreement late Tuesday afternoon on a new contract to keep the 28 physicians funded whose contracts expired on Tuesday. 

No new contract Wednesday spells high likelihood that CRMC is downgraded to a Level 3 trauma center. 

On Wednesday, CMC President and CEO Craig Castro stressed that CRMC will continue to provide trauma care despite the contract negotiations.  

“Community Regional’s trauma services will continue. There is no reason to alarm Central Valley residents or our health care partners by threatening a change in access to our trauma services at CRMC,” Castro said in a statement. “For decades, Community has provided our region with the highest level of care, so we prepare for the unexpected. It is unfortunate, surprising and highly irregular for the CCFMG neurosurgeons who work at Community Regional to stop treating patients with such short notice. We will not let this prevent us from continuing to provide trauma services for Central Valley residents who depend on us for this level of care.” 

Davis said that while neurosurgeons will keep serving their patients currently hospitalized, they will not be able to take on new patients who have head injuries because the contract expired. 

“The neurosurgeons will remain committed to taking care of the patients they already have established a relationship with,” Davis said. “They’re not abandoning their patients. They will continue to care for people that are here. The problem will be if there’s anybody new that has a stroke or has a head injury, they won’t be doing any new patient contacts or consultations.” 

Castro and Davis both confirmed that CMC and CCFMG are working to come to an agreement on a new contract. 

“Our commitment to supporting outpatient specialty care clinics that depend on supplemental CMC funding has not waivered,” Castro said. “We are earnestly working through the remaining details with CCFMG to ensure the necessary agreements are in place to continue the outpatient clinic support we provide. We value our partnership with CCFMG in serving the health care needs of Valley patients. We are in this together. We simply need to complete the amicable path forward that we’ve begun.” 

The 28 physicians are employed by CCFMG and contracted to work with CMC through grant funding. 

“I’m going to attempt to remain optimistic that the hospital administration is going to back off on their intransigence and that they’re going to become reasonable and try and work something out at the last minute,” Davis said. “I really hope so. I really think it would be just nearly unforgivable for them to put the community in that kind of jeopardy. 

“This hospital is a public asset. It doesn’t belong to them. It belongs to the people of the community, and for them to put in jeopardy like this – I’m at a loss for words.”

Daniel Gligich
Daniel Gligich is a reporter for The San Joaquin Valley Sun, focusing on Fresno State Athletics and the southern San Joaquin Valley. Email him at daniel.gligich@sjvsun.com.