Medical work spaces sit empty and powered down inside Madera Community Hospital, which served a low-income, rural and agricultural region of California for 50 years before closing its doors in January 2023. Photo by Soreath Hok/KVPR

This story was produced from a partnership between PBS NewsHour and KVPR.

To read more, please click here.

The sprawling San Joaquin Valley has long been short on medical providers. According to a 2019 report published by the California Future Health Workforce Commission, the region is served by 40% fewer primary care physicians than the wealthier San Francisco Bay Area, and fewer than half the number of specialists.

The situation was exacerbated earlier this year when a hospital serving a disproportionately low-income county 90 miles north of Villa shuttered. The closure of Madera Community Hospital, as well as three associated clinics, left Madera County’s 160,000 residents with no general hospital and only a small handful of clinics operated by other providers.

According to the American Hospital Association, the U.S. is served by an average of two to three hospital beds for every 1,000 U.S. residents. Using that calculus, Madera County would offer 320 to 480 beds – or at least three times the number of beds its former hospital had.

Now, there are zero.

Before it closed, the hospital reported around 30,000 emergency room visits each year, which now must be shouldered by the two next closest hospitals, each more than 20 miles out of county. Madera County issued an emergency declaration due to the resulting strain on first responders.

For farmworkers, “this is uncharted territory,” UC Merced’s Flores said. “We don’t know the risks to people’s well-being that we’re going to see during major public disasters when there’s a closure of a community hospital in a place like Madera.”

“What we are seeing here is tremendous neglect, lack of infrastructure,” said Mari Perez-Ruiz, executive director of the nonprofit Central Valley Empowerment Alliance. “Hearing that the hospital has been closed is heartbreaking.”