Where will patients go for care if this Stanislaus County specialty clinic is closed?

Medical services such as orthopedics, neurosurgery, general surgery and diabetic management would be eliminated as the Stanislaus County Health Services Agency continues to take a smaller role in clinical services for low-income residents.

The county Board of Supervisors is being asked Tuesday to set an April 16 public hearing on proposals that would close the county’s specialty clinic in the black-glass building on McHenry Avenue, turn over the Paradise Medical Office in west Modesto to Golden Valley Health Centers and eliminate obstetrical care at the county’s McHenry Medical Office on Woodrow Avenue.

The county specialty clinic has served 1,700 patients annually who need treatment for back problems, neurological issues or diabetic complications and otherwise would have trouble getting appointments because they lack private insurance.

A county staff report for Tuesday’s board meeting doesn’t say how the county patients might continue to see their specialists if the clinic is closed. An attempt would be made to “collaborate for service continuity” with Golden Valley Health Centers, the report says, but the details are sketchy.

Dr. Gopika Gangupantula, a diabetologist with a Modesto practice, said she was told last week the specialty clinic would close under the county’s proposal.

Dr. G, as she is often called, said she’s worked four to five hours a week at the clinic, each time seeing 14 to 16 diabetic patients whose lives depend on managing the disease. A specially trained nurse practitioner also has seen 10 to 12 diabetic patients per shift.

The doctor said the typical wait time for getting to see a diabetes specialist is four to six months because few accept patients with Medi-Cal coverage, but the county clinic was able to schedule patients in less than a month. Gangupantula said she didn’t know how or where the different specialist services would be offered through Golden Valley, other than possibly moving to the west Modesto clinic.

“Especially in this community, the patients have transportation problems,” Gangupantula said. “They know where to find you at the McHenry clinic. Now it’s changing all over again to another place.”

Last week, a Golden Valley spokeswoman said the specialty services offered by the nonprofit are on its website. Those services include cardiology, kidney treatment, allergies, podiatry, sports medicine and mental health. And its primary care clinics manage diabetic patients.

Why physician time in specialty clinic has fallen

In the past, nonprofit clinics including Golden Valley would refer patients to the county specialty care center because of the shortage of specialists in the region and the meager reimbursements through Medi-Cal.

The county clinic usually relied on specialists who contributed several hours a week and on retired physicians. The county staff report says physician time in the specialty clinic has decreased due to retirements; in addition, the demand for specialty care requires them to spend more time in their private practices.

According to the Health Services Agency, physician capacity issues also factor into the proposal for Golden Valley to operate the Paradise Medical Office, at 401 Paradise Road.

A contract with Scenic Faculty Medical Group long has provided medical staff for the county’s primary care clinics to serve patients and also oversee the family practice resident physicians — or doctors in training — in the Valley Consortium for Medical Education program. Over the past decade, a number of Scenic Faculty doctors have left for other opportunities as competition for primary care physicians increased in the health industry, the county staff report said.

Golden Valley became a member of VCME in 2022, joining Doctors Medical Center, Memorial Medical Center and the county. Last year, the consortium sought to address the physician capacity issue and began talks with Golden Valley about a second teaching site in Modesto.

They settled on an alternative plan for Golden Valley to take over the county’s Paradise clinic and use Scenic Faculty and Golden Valley physicians to supervise the residents’ training. If county supervisors give approval next month, the specialty clinic would close June 30 and the Paradise center transition to Golden Valley would begin the same day.

After dropping the west Modesto clinic and medical specialty center, the county still will operate the McHenry Medical Office on Woodrow Avenue and the Family and Pediatric Health Center on Scenic Drive. The county Health Services Agency suggests that staff relocated from the Paradise office will keep the remaining clinics viable.

County health services in decline

About 20 years ago, Stanislaus County had seven health clinics serving around 80,000 patients per year. But changes came in 2014 with the nation’s Affordable Care Act. Many uninsured adults in the county were moved into the Medi-Cal program and its managed-care system, which expanded eligibility through the ACA.

The Federally Qualified Health Center program spurred the growth of the health care safety net, with Golden Valley Health Centers and Livingston Community Health, both based in Merced County, adding clinics in Stanislaus County. The county outsourced its clinics in Turlock and Hughson to Livingston Community Health and its Ceres clinic to Golden Valley in 2019.

While county health services once served two-thirds of the uninsured and Medi-Cal population in Stanislaus County, only 8% were using county health services in the 2022-23 fiscal year.

As of Jan. 1, Kaiser Permanente began management of some Medi-Cal participants in the county.

The Stanislaus County Board of Supervisors meets at 9 a.m. Tuesday in the basement chambers of Tenth Street Place, 1010 10th St., Modesto. The setting of a public hearing on the health service cuts is currently listed as a consent item for routine approval.