Cierra Shelton suffers from hypertension and can’t find a doctor in Merced.
Frequently the 30-year-old mother of two takes only half the prescribed dose of her blood-pressure medication to make the medicine “stretch” until she can get an appointment to refill the prescription.
“I’m told to go to urgent care if symptoms are serious enough that I need to be seen during the week,” Shelton said in a recent interview.
Shelton says for people like her, who depend on Medi-Cal, preventative care in Merced County is “nonexistent.”
More than half of Merced County residents – about 51 percent – are on Medi-Cal. That’s about 127,000 people in Merced County.
Merced County for years has struggled to convince doctors to come live and work in the rural, impoverished Central Valley community, resulting in a ratio of about 45 doctors for every 100,000 residents. The doctor-resident ratio statewide is about 77 doctors per 100,000, according to a recent study by the Merced County Department of Public Health.
But despite efforts to provide incentives to doctors to live and work in Merced County things have gotten much worse in recent months for low-income families in need of local healthcare.
Low-income healthcare provider goes bankrupt
About 80 percent of Horisons patients were on Medi-Cal, according to documents filed in federal Bankruptcy Court in Fresno.
Horisons left countless patients in the dark, as they began to shut down certain services and locations, physicians left and patients were refused service.
Several patients said nobody would tell them why the clinics suddenly were gone.
The clinic in Los Banos left a note on its closed door saying the shut down was due to its “current financial condition.”
The legal battles surrounding the nonprofit clinic began when long-time CEO Sandra Haar was fired and sued in February by Horisons over allegations of mishandling finances. The lawsuit filed in Merced County Superior Court on March 3 accuses Haar, her husband, two daughters and a former board member of misconduct that allowed Haar and her family to profit from the clinic.
Among several allegations, Haar is alleged to have authorized “excessive personal salary and benefits” without the knowledge of the clinic’s board.
The suit accuses Haar of receiving a loan of $758,346 used to “purchase properties that were then to be leased to and occupied by Horisons.” She also is accused of employing her husband for an annual salary of $65,000 with a $50,000 annual pension “even though he had no formal position or actual operational duties,” according to the suit.
Then on March 24 eight more Horisons board members filed a lawsuit accusing “a renegade group of board members” of seizing control of the board and “squandering Horison Unlimited’s assets” and “ voting to make large expenditures and improperly giving large raises, bonuses and benefits to various employees.”
Both sides of the bitter legal battle continue to slug it out in court, but meanwhile, thousands of low-income patients have been left struggling with even fewer healthcare options.
Remaining clinics overcrowded
The number of patients visiting Livingston Community Health clinics in Merced and Stanislaus has doubled since the closures, making it that much harder for a patient to see a doctor when they need one, said Leslie McGowan, CEO with Livingston Community Health.
“Whatever happened and whatever does happen with (Horisons) negatively impacts the fabric of the safety net when anybody anywhere is not able to see patients,” she said.
Since at least July 11, Horisons was not on the list of clinics in Merced County who accept Medi-Cal patients, according to the Central California Alliance For Health officials, the exclusive Medi-Cal provider in Merced County.
Horisons actually was dropped from the list of Medi-Cal providers in Merced County at least a month before its closure. Officials with the Central California Alliance for Health, the group that oversees Medi-Cal services in Merced County have been trying to work with patients and doctors to ease the sudden new burden.
Jennifer Mockus, Merced County regional operations director with the Alliance, said it’s important for patients to know how to reach out to the Alliance if they need help finding information.
Many patients were frustrated with what appeared to them to an abrupt and mysterious shutdown. Many are angry. And at least some would like to just simply find another doctor outside of Merced County if that’s where they have to go.
But while Medi-Cal helps thousands of low-income patients pay for healthcare — when they can find a doctor — it also restricts where they can receive services.
Other than a few rare exceptions for specialists, if you need to use Medi-Cal to pay for a doctor, the program requires that doctor to be in Merced County.
This story is the first in a three-part series. Monica Velez’s reporting on healthcare barriers for low-income residents in Merced County was undertaken as a fellow of the California Health Journalism Fellowship at USC’s Annenberg School of Journalism.