Dr. Michael Mesisca faced a tall order.
As the chair of the Department of Emergency Medicine at the Riverside University Health System, he needed to recruit doctors to work at Palo Verde Hospital in Blythe, along Interstate 10 near the California-Arizona state line, 110 miles away from the Coachella Valley.
Melissa Daniels reported this story while participating in the USC Annenberg Center for Health Journalism’s 2026 California Health Equity Fellowship.
He wondered who would be willing to take 24-hour shifts at an aging, remote facility, let alone drive two or more hours east in the heat of the summer.
“I lost some sleep over it, just wondering how we can staff this very remote, distant place with high-quality people,” Mesisca said during a June public meeting.
It ended up becoming one of the proudest moments of his career. Within 10 days, Mesisca recruited more than two dozen board-certified emergency room physicians from places like RUHS, Desert Regional Medical Center and Pomona Valley Hospital Medical Center.
“As I would recruit one doctor, two more would call me. They would call because the person that I talked to (about) what we were trying to do here to support the community would share that with their friend,” Mesisca said.
The Palo Verde Healthcare District filed for Chapter 9 bankruptcy in September 2025, a last-ditch effort to stay open after years of financial struggles. If Palo Verde closed its doors, the nearest hospitals would be 50 to 100 miles away. Many residents are already driving about two hours for care at John F. Kennedy Memorial Hospital in Indio.
Rather than allowing the area’s only remaining ER to shut down, RUHS reached a 180-day management agreement in February to stabilize emergency services. But recruiting physicians is just one piece of turning around a distressed rural hospital.
Lisa Mackie, the RUHS clinical director of nursing, has been taking shifts at Palo Verde since February. She’s serving as the interim director of operations and head of nursing for the emergency department, where her goal is to stabilize day-to-day operations and support the existing staff.
Word is spreading that Palo Verde is improving, Mackie said, as evidenced by social media posts, as well as feedback that RUHS team members get at the grocery store when they’re out shopping in their scrubs. Other signs of success and stability: Staff are meeting regularly and receiving promotions; wait times are down; and the building itself has had significant upgrades like HVAC repairs and new cabinetry. In a literal sign of new life, three babies were born in Palo Verde’s emergency department this spring.
But it’s too soon to call the intervention a victory. The hospital’s finances are still precarious, and funding cuts to Medicaid and Medi-Cal could further threaten its stability. As of this writing, RUHS and the county have yet to reveal what happens after the 180-day agreement ends. And as Mackie noted, it’s much easier for a hospital to lose the trust of its community than it is to gain it.
“What we don’t want to see is a patient come in and have a different experience two different times,” Mackie said. “Trust comes from consistency in what we do every day.”
How Blythe Lost Faith
Palo Verde Hospital’s emergency room has typically served about 2,000 people a month in the city of Blythe, a remote desert town with a dwindling population of less than 18,000. Like other towns nestled along the Colorado River, one of Blythe’s best-known assets is its recreation opportunities, like boating, fishing and camping.
But Blythe is also one of the most impoverished pockets of Riverside County, with about one in five residents living below the poverty line. The latest unemployment rate is 8.6%, compared to the Riverside County average of 4.7%. When Chuckwalla State Prison closed in late 2024, it cost the city about 800 jobs, according to news reports.
Angela and George Colangeli, who co-founded Blythe’s nonprofit mental-health outreach and advocacy group Peace From Chaos, have a long history with health-care systems in Blythe, after navigating behavioral-health systems with Angela’s late son Steven, who was diagnosed with schizophrenia.
The Colangelis said Blythe’s struggle to attract and retain health-care providers leaves residents with little faith in the remaining system. A May 2024 survey from the Regional Access Project Foundation found that about 40% of Blythe residents said they had a hard time finding health care, because there are not enough doctors, or it takes too long to get an appointment.
“We went through a lot of therapists and psychiatrists, because nobody wants to stay in Blythe, so it was always hit and miss,” Angela said. “You always have to tell your story over and over again, because you get a new therapist or new doctor. We did that for six years.”
The onset of the COVID-19 pandemic put additional pressure on the system. Palo Verde Hospital saw a 30% increase in supply prices, plus the cancellation of revenue-driving elective services. By 2023, it closed its labor and delivery unit, meaning babies had to be delivered as far away as Indio. That year, it also received a $8.5 million loan from the state’s Distressed Hospital Loan Program.
More recently, Palo Verde faced costly litigation with a digital health company over a patient-data issue. The hospital also endured billing disruptions following a cyberattack in March 2025. That May, Providence Bank cancelled the district’s line of credit due to concerns about its year-end projections, and removed $2.8 million from its account. At that time, Palo Verde was dealing with about $1 million per month in negative cash flow.
The Colangelis said they’ve watched the financial issues unfold at Palo Verde Hospital, while seeing residents lose further trust in the institution. George Colangeli said people have been particularly wary of going to Palo Verde for fear of being airlifted to a hospital that’s hours away, where families may not be able to follow. For less-emergent issues, patients may get referred to a specialist who is hours away.
“It’s gotten better, because the county has taken over operations of the emergency room,” George said. “But in the midst of this crisis, families are thinking, ‘If I take my kid to the emergency room, or if I go to the emergency room, I’m going to be flown out.’”
Saving the Emergency Room
In June 2025, the Palo Verde Healthcare District implemented a 60-day emergency turnaround plan, which included ending inpatient services and surgeries. The hospital saved money by furloughing staff and ending physician contracts, but it meant that the facility was left with only an emergency room and support services, like radiology.
In late September, the Riverside Local Agency Formation Commission presented a report that noted the need for “a significant cash infusion” for short-term needs, and “a stable long-term revenue stream sufficient to support a fully operational and staffed hospital.” The report floated next steps like dissolving the district, a joint agreement with the city of Blythe and Riverside County—or filing for Chapter 9 bankruptcy.
Days later, the district filed for bankruptcy. Court filings showed that the hospital faced a structural budget deficit of up to $5 million, even after cutting $2.2 million in salary and staff, and making $4.7 million in non-salary cuts.
Despite the attempt at reorganizing debts, the hospital’s finances continued to worsen, with the city providing a bridge loan of $330,000 to cover a week’s worth of operating expenses in January 2026. That led Fourth District Supervisor Manuel Perez and County Executive Jeff Van Wagenen to propose county intervention. The Riverside County Board of Supervisors approved a $1 million loan, plus plans for a “strike force” to help stabilize operations via the RUHS management agreement.
In practice, the strike force includes a lot of RUHS health-care providers and support staff members taking on extra duties. Since February, Blythe has become a second workplace for many providers. Leah Patterson, interim chief of patient care services and the chief nursing officer, said RUHS team members want to come and work at the facility, because they know the stakes if a hospital isn’t around.
“People will die if this place isn’t open,” she said. “If you’re having a heart attack, if you’re septic, if you’re having a baby, if your kid is seizing, I just can’t imagine how awful that would be if this facility was not available for people. It just seems like a fundamental need that can’t ever be let go.”
Mackie said one of the most crucial updates has been a partnership with the physician group Vituity. Since May 1, the two dozen, emergency-trained physicians Mesisca recruited are there to provide 24-hour clinical services in the ER.
As far as concerns about medical evacuations, Palo Verde no longer has the ability to admit patients for inpatient care. Nationwide, about 20% of hospital visits result in admissions, according to hospital executives. Mackie, who used to work in hospital-transport services that flew patients out of Blythe, said providers will only transport out by helicopter or ambulance if “if the patient really requires it,” she said.
She said the team is well-trained and experienced, and is developing a strong working relationship with the nurses on staff, who have an understanding of their community and may even know their patients personally.
“They’re able to rapidly assess and stabilize, but also provide the patient with a sense of security about where their medical care is going to go, and provide them with the education and the resources that they’ll need for more long-term care,” she said. “I think it’s been one of the best things that we’ve seen so far.”
Earning Back Trust
For many patients, the changes they’ve seen are welcome. A 76-year-old longtime resident of Blythe requested anonymity to speak candidly about her health.
“Nobody trusts this (hospital),” she said. “If it is not any type of emergency, they will refer you to go over to a specialist in Palm Desert.”
The woman said she went to the ER in mid-June while experiencing pain she thought could be a heart attack. Fortunately, it wasn’t a heart attack, and though she was disappointed to leave without a diagnosis, she said she noticed a change in the care.
“The newer doctors when I was there seemed very competent,” she said.
Other improvements are more tangible. The ER has received new supplies, like an infant warmer and two more EKG machines. RUHS has assisted with infrastructure improvements like repairing bathrooms, cleaning sidewalks and fixing the roof and HVAC systems. Old furniture and equipment was cleared out to make more space in the facility.
Michelle DeArmond, the RUHS executive director who has been serving as Palo Verde’s interim executive director of administration, said these physical improvements help infection control and allow the hospital to meet regulatory standards. RUHS has also been able to provide services in-house or at a competitive price because of its supplier relationships.
“We’re finding ways to leverage existing resources as best we can,” she said.
RUHS has also implemented new board-meeting procedures for the Palo Verde Healthcare District modeled after those used by the County Board of Supervisors, DeArmond said. Meetings now have a process for people to sign up for public comment, and there is a consent agenda for faster votes. June’s meeting included training on ethics, the Brown Act (California’s open-meetings law) and public records.
Joanna Gonzalez, the clerk of the board and public information officer, said she’s grateful to the RUHS team “guiding us in the right direction.” She’s worked at the hospital for three years and said the employees are like family to her, so watching the improvements happen in real time has been an emotional journey.
“I’m moved to see all the support and effort and dedication they’ve brought with them,” she said of RUHS.
Robert Splawn, a doctor and consultant who is the patient-care ombudsman in the district’s bankruptcy case, wrote in his latest report that he’s received positive comments from staff members around “faster turn-around time for supplies and repairs, improved communication with frequent management meetings that include ‘huddles,’ and visibility of administrative staff.”
New leadership, even if temporary, has changed the demeanor of the place. Splawn wrote he “also experienced a sense of relief from staff since the facility is no longer pending immediate closure.”
Looking Beyond 180 Days
To help the community learn about the improvements, Palo Verde Hospital had scheduled an open house for the end of July. DeArmond said it’s an opportunity to give the public a chance to tour the upgraded facility and ask questions.
“We have been very focused on supporting this hospital,” DeArmond said, “and now we feel that we’re finally at a space where we can maybe pull back just a tiny bit and allow some space for people to come in and see some of what we’re doing.”
But it remains to be seen whether the RUHS efforts will lead to sustainable, quality health-care access in the long-term. As of this writing, details were not publicly available about what will happen when the 180-day management agreement with RUHS is over. The current agreement does not transfer ownership or the hospital’s license.
DeArmond told the Independent that RUHS and the county are still in its assessment period. At the end of the agreement, RUHS will make recommendations to the Palo Verde board as well as the Riverside County Board of Supervisors to review and consider. It’s unclear whether Palo Verde’s future will include the re-opening some of the shuttered departments like in-patient services.
George Colangeli, of Peace From Chaos, said the hope is that the county and RUHS will come up with a sustainable framework that can keep the facility open on an ongoing basis—one that improves care access.
“Whatever path we take, we want the same level of care that our other rural partners in the area have, whether the Coachella Valley or La Paz County or Yuma County on the Arizona side,” he said.
Regardless of what RUHS recommends, though, Palo Verde’s financial struggles are far from over. California’s health system stands to lose billions in federal resources in the next five years, per California Hospital Association estimates. That’s due to changes in HR1, or the so-called One Big Beautiful Bill Act, which cut federal Medicaid spending among other health-care policy and funding changes.
CHA president and CEO Carmela Coyle said smaller, disadvantaged communities often serve a disproportionate share of patients who are on Medicare and Medi-Cal. Those programs don’t come close to covering the costs of care or other capital-intensive needs—even before the cuts.
“For any hospital, where they’re going to end up after all these changes depends on where they started. And if (a hospital) started behind the eight ball to begin with, which many of our rural hospitals do from a financial perspective, it’s going to be even more devastating,” she said.
But for the time being, the efforts of RUHS and the staff at Palo Verde are a step in the right direction.
Mackie, who lives and works in Moreno Valley when she’s not taking shifts in Blythe, said she’s felt welcomed and appreciated. In early July, she said, she was filling up her gas tank, and someone driving by noticed she was wearing an RUHS jacket.
“A gentleman had his window rolled down, and he had his arm out the window, and he’s screaming, ‘Woohoo, thank you!’” she said. “And so it just kind of makes you feel good, and it re-energizes you to keep pushing and supporting the good work that everybody’s already doing.”
