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Downgrades, finger pointing: A plain-English explanation of the Community Hospital dispute

Despite a lapse in neurosurgical care coverage, the trauma center at Community Regional Medical Center (CRMC) is still maintaining its Level 1 status. 

A contract between Community Medical Centers (CMC) and the Central California Faculty Medical Group (CCFMG) for 28 physicians – including six who provide 24 hour neurosurgical trauma care – expired Tuesday. 

Those 28 physicians are employed by CCFMG and contracted to CMC. They also serve as faculty for UCSF Fresno. 

Central California Emergency Medical Services (EMC) Director Dan Lynch told The Sun that CRMC notified EMS that the hospital would not have neurosurgery on-call coverage starting midnight Thursday. 

CMC President and CEO Craig Castro said in a statement Thursday that the hospital hopes to restore neurosurgical coverage on Friday. Castro did not provide any details explaining how the care will be provided. 

Some possibilities to restore coverage presumably include coming to a new contract agreement with CCFMG, signing a contract with another group of physicians or bringing in locum physicians in the meantime. 

While CMC is figuring out a solution, CRMC will have to transfer any incoming neurosurgical patients to another hospital. 

Lynch said Visalia’s Kaweah Delta has stepped up to assist in the transfer of neurosurgical patients. 

Although CMC is hopeful to restore neurosurgical coverage Friday, Dr. Yu-Hung Kuo, the Chief of Neurosurgery at UCSF Fresno, is disappointed to see that a new contract has still not been signed with CCFMG. 

“As the Chief of Neurosurgery, the lack of a finalized funding agreement with CMC is devastating to our program and to the patients we serve,” Kuo said in a statement. “We have had a working agreement for funding for the last eight years, and when CMC chose to change the agreement, we wanted to be good partners. 

“However, we have yet to see a complete, mutually beneficial contract we can sign. In order to retain the doctors on my team, we need stability. As a physician, especially now, what we want to do is take care of patients.” 

Without current ongoing 24-hour neurosurgical trauma coverage, how does CRMC still maintain a Level 1 trauma center status instead of a Level 3 status like CCFMG asserted earlier in the week? 

Lynch said it is because CRMC expects the lack of coverage to be a short-term problem. 

“We recognize that CRMC has a plan to correct the deficiency and that the issue may be short-term,” Lynch said. “We would not suspend their Level 1 designation unless it was clear that they were unable to consistently maintain adherence to the state regulations. 

“If they are unable to maintain the Level 1 requirements, they would be suspended as a trauma center. They would not be downgraded to a Level 3. They would not have a designation at that point. They would need to be reevaluated in order to obtain a new designation or get back to the Level 1 designation.” 

Another issue currently ongoing at CRMC involves 23 advanced practice providers who’s contract with the hospital was terminated.

Advanced practice providers are typically physician assistants, nurse practitioners and the like.

The 23 advanced practice providers – all of whom provide neurosurgical care – are employed by CCFMG and contracted to CMC. CCFMG received notice from CMC Tuesday evening that the hospital gave a 60 day notice of termination for that contract.

Since the providers are employees of CCFMG, they are still employed. However, their contract with CMC will end on Nov. 1.

On Wednesday, CCFMG and CMC pointed the blame at each other, saying the other group sent the termination notices. 

A spokesperson for CCFMG confirmed to The Sun Thursday that the medical group did not fire its employees but instead received notice from CMC that the contract is terminated.

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.