Before its collapse, Madera hospital faced fines for violating safety rules

The hospital faced a number of high-priority safety violations that threatened the hospital outside of its financial picture.

Madera Community Hospital was fined and reprimanded for violating state and federal health and safety standards before it shut its doors and declared bankruptcy, a McClatchy report found.

The backstory: The hospital was the only general, acute care hospital for adults in Madera County, which has a largely Latino population of low-income agricultural workers. Serious violations included physical and sexual abuse of patients, and negligent monitoring of suicidal patients.


  • Despite ceasing operations, the hospital is seeking to reopen with a new financial partner after securing a $52 million state emergency loan.
  • The hospital had at least six “immediate jeopardy” designations indicated in state inspection reports from 2016 to 2022, the period reviewed by McClatchy. These types of penalties can result in the eventual loss of federal Medicare/Medicaid funding, which can financially cripple a hospital.
  • Some state inspections were prompted by reported incidents or complaints and can lead to enforcement actions, such as financial penalties.
  • The hospital’s recent track record as a healthcare provider is important to consider as multiple suitors have emerged to help reopen the hospital, and a bankruptcy judge will have the final say.

Driving the news: The most serious violations can be upgraded to what state and federal inspectors call “immediate jeopardy” situations, ones that can cause or have caused serious patient injury, harm or even death. This rare designation can result from one violation or a series of them in a short period of time.

  • According to a 2021 analysis of hospital deficiencies reported by Centers for Medicare and Medicaid Services over a 10-year period, only 2 percent were elevated to immediate jeopardy designations.
  • Jason Goodwin, a healthcare consultant with Kaiser Permanente, UC Davis Medical Center and Sutter Health, said that a series of repeated immediate jeopardy situations can erode a hospital’s reputation, making it hard to recruit physicians and nurses.
  • Karen Paolinelli, the hospital’s CEO since 2018, said that the hospital responded to the serious violations by replacing managers in the “key areas of concern” in 2020 and taking responsibility for any events at the hospital.
  • Hospital inspections are carried out by the California Department of Public Health’s Center for Healthcare Quality Licensing & Certification Program, which performs onsite inspections of facilities and operations and sometimes interviews staff and former patients, among others.
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