The Modesto hospital that has operated a medical clinic inside Yosemite National Park for 15 years is leaving, and the park doesn't yet know who -- if anyone -- will operate the clinic.
If nobody is found, the Yosemite Medical Clinic could close Dec. 31, ending 80 years of health care in the old hospital building in Yosemite Village. That would leave visitors and park employees more than an hour's drive away from the closest medical care, in Mariposa.
Park officials said they're talking with two providers, and a third has expressed interest in running the clinic. A contract could be signed by mid-October, they said.
But finding a new clinic operator hasn't been easy. The clinic has been a money-loser for Tenet, the Dallas-based investor-owned hospital company that has held the concession contract to operate the clinic since 1995. Doctors Medical Center in Modesto, a Tenet-owned hospital, has been running the clinic as a 24-hour, seven-day-a-week outpatient center.
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To keep the clinic open after Tenet leaves at the end of the year, the park may have to agree to fewer hours of operation -- and the park may have to subsidize the operation for the first time.
"Obviously, our goal is for the park service not to be in the clinic or health-care service," said Tom Medema, acting deputy superintendent of the park. But, he said, Yosemite is "committed to keeping the clinic open and providing at least a basic level of services for park visitors and local residents."
7,000 patients a year
The clinic has six triage rooms and a four-bed emergency suite.
Last year, nurses and doctors at the clinic saw 7,000 park visitors, park employees and vendors with myriad health conditions, from minor scrapes and bruises to life-threatening injuries and illnesses, such as strokes and heart attacks, said Sean Pence, the clinic manager.
The clinic functions as an emergency room, Pence said.
"Anything will show up here," he said. "We're able to stabilize anything that comes in." Critically ill and trauma patients are flown by helicopter to hospitals to be admitted, he said. The clinic can keep patients for only four to six hours.
Providing the medical services isn't cheap, and Tenet has experienced significant losses over the year for operating it, Pence said.
Carin Sarkis, director of public relations at Doctors Medical Center, would not say how much the clinic has cost the company. But 18 months ago, hospital officials asked to meet with park officials to try to reach an agreement that would allow the hospital to continue operating it, she said.
That meeting did not happen, she said. In May, when the park asked for bids to run the clinic concession, Tenet opted not to participate, Sarkis said. The current contract expires Dec. 31, she said.
Medema said the National Park Service cannot subsidize a concession.
Yosemite officials sought other concession bidders for the clinic in May. None, however, was chosen after a panel of park service employees met to evaluate the offers, said Anne Altman, chief of the commercial services program for the Pacific West Region of the National Park Service.
The bidders, whom Altman declined to name, had to meet park terms and conditions and demonstrate managerial and financial capabilities to operate the clinic. None of the bidders met all three of the criteria, she said.
Yosemite wanted the clinic to continue as a concession, Medema said, but without a viable concession proposal, another option open to Yosemite was to find someone willing to enter into a procurement contract.
Under a procurement contract, the park could pay a contractor an amount not collected from patients or insurance companies to cover the costs of running the clinic, Medema said.
But that means the park could be in the "position of the National Park Service having to subsidize the operation," he said.
Yosemite's goal is to find a contractor who will operate the clinic without a subsidy from the federal government, Medema said.
To accomplish that, the clinic hours may need to be reduced, he said. For example, the clinic might operate during standard business hours, and any emergency calls on nights and weekends would be handled by providers outside of the park, he said.
The park is talking with two entities about a contract, Medema said. A third party has shown interest, but has not submitted a proposal, he said.
Medema would not name the two providers currently in discussions with the park, but said one was a local provider from counties surrounding the park, including Madera, Mariposa and Merced.
Alternatively, the park may enter into an agreement with the U.S. Public Health Service. The health service would provide medical care at the clinic, and the park would pay the salaries and operational costs.
The park could have a contract by the middle of October, Medema said.
Pence, the current clinic manager, said employees are concerned about the clinic's future. Most live in Modesto, Turlock and Merced, he said.
He'd rather see hours reduced than for the clinic to close.
Clinics at Yellowstone National Park are open for eight hours a day and are staffed at an on-call basis after hours, he said. Decreasing clinic hours at Yosemite would work during winter months, when patient volumes dip, he said.
As a bare minimum, the clinic should be open eight to 12 hours a day, Pence said. "At least you'd have a clinic here." A decision as to what happens next is up to the park service, said Sarkis.
Fresno Bee reporter Barbara Anderson can be reached at firstname.lastname@example.org or (559) 441-6310.