Attempts to Save Small Hospital Prove Futile--and Costly : Health: Calexico facility closes after long downhill slide. The city is stuck with big bills, and ailing residents have to go to other towns for care.

If the Calexico hospital were a patient, its obituary would have said that it died after a long struggle with multiple diseases. And that the hospital’s final months were spent on life-support systems that stuck the survivors with enormous bills.

One of California’s smallest hospitals in one of the state’s most economically depressed communities closed in October, leaving this Imperial Valley border town of 24,000 without a hospital.

The grass in front of the hospital is still green, and the vending machines inside are being filled with snacks.

But the emergency room is shut, the 34 beds are empty and the hospital van that once was used to ferry senior citizens--emblazoned with the motto “Commitment to Quality Care”--sits idle and vandalized.

Nonetheless, Calexico residents still show up at the modest cinder-block building seeking care for their injuries, their chronic wheezes and their undefinable pains.

Security guards such as Eddie Coronado tell them they will have to go to the hospital in El Centro or Brawley. For those in desperate condition, such as the elderly woman who collapsed with chest pains, guards call 911 for an ambulance and paramedics.

“It’s sad,” said Coronado, a 20-year employee of the hospital. “People still think we’re here to help them.”

The signs on the hospital door, in English and Spanish, say the hospital is “temporarily closed.” Only the most incurable optimist can see much hope that the hospital, built in 1951, will reopen.

“It looks kind of grim,” said Dr. Amalia Katsigeanis, the hospital’s guiding spirit during most of its rocky existence. “We always felt that if we ever closed down--even for one day--the hospital would be done for.”

The hospital board has surrendered the facility’s license to the state Department of Health Services. The action was taken lest the state revoke the license because of repeated violations of state health codes involving record keeping, cleanliness, and training of personnel.

Even before the license was surrendered, Medicare and Medi-Cal officials had stripped the hospital of its right to treat patients from the publicly financed insurance programs. The board has filed for Chapter 9 bankruptcy to forestall collection of $10 million in debts, including $1 million to the Internal Revenue Service for unpaid payroll taxes.

The hospital also owes money to doctors, radiology specialists, the city, state and its former employees, who often went weeks without paychecks as the hospital limped along with only a handful of patients referred almost exclusively by Katsigeanis.

In the end, nothing helped. Not repeated changes in management, not loans from the City Council and not even a name change, from Calexico Hospital to Imperial County Doctors’ Hospital--a name nobody uses.

The hospital that was once the source of considerable civic pride has now become a source of community rancor. Just three years ago Calexico voters voted overwhelmingly to impose a half-cent sales tax to fund the hospital, making it the only hospital in California to enjoy such a tax.

Now the ceaseless controversy has undermined support for the hospital among business owners and the City Council.

Mark Holloway, a manager in the department store owned by his family, said the hospital board has bungled so badly that it is time to rescind the tax. Holloway’s grandfather was one of the civic leaders who led the movement in the 1940s to found a public hospital in Calexico.

“I think a lot of people in Calexico feel they’ve been conned,” Holloway said. “We’ve lost a lot of faith in the people who promised us quality medical care if we voted for the sales tax and then gave us nothing but mismanagement.”

Rosalie Timbres, a resident of Calexico for 40 years, echoes Holloway’s complaint: “You have to call it what it is: incompetence. Nobody was taking care of business.”

At an acrimonious meeting last week, the City Council, weary of the hospital as a political liability, rejected a plea for a $400,000 loan to help the hospital reopen. The lone voice on the council in favor of the hospital was Katsigeanis, who is also Calexico’s mayor.

“It’s very sad that our community will be without a hospital,” said Councilman Richard Romero. “But what can we do? It’s time to stop thinking about the hospital with our hearts and begin thinking with our brains.”

Although the hospital is closed, there is no indication that the political furor swirling around it will abate soon.

In fact, Calexico voters in March could be faced with two competing ballot measures: One asking that the sales tax be rescinded, and one asking that the hospital be rescued by making it a department of the city government.

Lupe Acuna, chairwoman of the hospital board, liquor store owner, and publisher of the Calexico Chronicle, brushes aside criticism of malfeasance on the part of board members.

“It’s one thing to accuse,” she said, “and it’s another to sit there and try to do something.”

Acuna and other hospital boosters blame the hospital’s closure on several misfortunes: Nit-picking health inspections, a bad business deal involving $6 million worth of high-tech equipment that was grossly overvalued, and mismanagement by a series of consulting firms and administrators from outside Imperial County.

“We know what we did: We trusted the professionals we hired to run the hospital,” said Hildy Carrillo-Rivera, managing editor of the Calexico Chronicle and a former hospital board member.

Although the 100-bed El Centro Regional Medical Center is only 12 miles away and the 80-bed Pioneers Memorial Hospital in Brawley is 15 miles away, distance is a relative thing, particularly in the Imperial Valley.

From Calexico, which stares across the border at the city of Mexicali, the towns of El Centro and Brawley can seem a world away. Both are north of Interstate 8 and both are thought of as “Anglo cities.” Calexico is 90% Latino, and Spanish is the language of choice on many of its streets.

It is an article of faith with Acuna and Carrillo-Rivera that patients from Calexico, particularly the Spanish-speaking elderly, do not get the same quality of care in El Centro and Brawley that they could get closer to home, where they feel more comfortable and where they know the staff.

For that reason--and because of a longstanding animosity between Katsigeanis and the El Centro Regional Medical Center--the hospital board has rejected overtures for a cooperative venture with the Imperial Valley Health Resources Authority. The authority is a joint-powers agency that oversees El Centro Regional Medical Center and Pioneers Hospital.

Bill Daniel, administrator at Pioneer and president of the authority, is chagrined at the standoffishness of the Calexico hospital board.

The board, he said, is stuck “with a vision from 1955” of a small community hospital, a vision that he believes has gone the way of the $10 office visit and the doctor who makes house calls.

At its peak, Calexico’s patient population was almost entirely made up of Medi-Cal and Medicare recipients. Experts in health financing say that to stay afloat a hospital needs a strong share of higher-paying patients with private insurance to balance the Medi-Cal and Medicare patients.

“The rest of us are trying to complete a health care system for the Imperial Valley,” Daniel said. “Calexico has health care needs that are not being met and not being planned for, and that is not good for the rest of the valley.”

Still, Acuna clings to hope that somehow the hospital will reopen. She hopes that the Chapter 9 proceeding will stall the hospital’s creditors sufficiently, a lawsuit over the equipment purchase will prevail, and Medi-Cal and Medicare will provide payment for services rendered before the license was surrendered.

“We’re trying to take care of our people,” she said. “That’s what you do in America.”