PATCHING UP OLD WOUNDS
Necessity is the mother of invention, and for Northern Inyo Hospital District (NIHD), that invention is looking like a collaboration.
Though NIHD previously sued Southern Mono Hospital District (SMHD) which operates Mammoth Hospital, over a competing orthopedic clinic in Bishop, the now-indebted district is pivoting toward collaboration, seeking to jointly provide services across the Eastern Sierra.
At an inaugural joint board meeting Monday, the contrast between the two districts was hard to miss.
Mammoth Hospital CEO Melanie Van Winkle highlighted a hospital on solid financial footing and in expansion mode, while NIHD CEO Christian Wallis made a candid case for confidence in a district still working to stabilize.
To put it lightly, NIHD is in a precarious position, driven by a long-standing gap between expenses and revenue and heavy reliance on unpredictable IGT funds, which are a Medicaid funding mechanism that supplements rural hospital revenue.
It is currently running a $9.4 million operating deficit, only partially offset by $5.4 million in non-operating gains.
The hospital faces deeper structural issues, including limited space for growth, aging facilities, costly essential services, and looming debt. Its maternity ward, which delivers about 200 babies a year, loses roughly $12,000 per birth.
Plus, until recently, the district was not placing its funds in high-yield accounts typical for public agencies, effectively missing out on interest income.
By contrast, Mammoth Hospital is financially stable and growing, with rising patient volumes, expanded services, and ongoing upgrades. Its focus is forward-looking, centered on completing a $158 million North Wing expansion largely funded through reserves, while managing staffing and demand.
“You can show the iteration of progress… it’s so great. We hope to be at that point someday,” Wallis said. “We haven’t made strides. Every year, we just hope something different happens and it doesn’t.”
Both CEOs are new to their roles; Van Winkle stepped in as interim in January before formally taking the position last month, and Wallis started in October 2025.
“It took new blood” to get this collaboration off the ground, noted NIHD board member Jean Turner. Historically, the relationship has been strained.
During the meeting, board members alluded to past conflicts, most notably a 2017 lawsuit brought by NIHD through the Local Agency Formation Commission after Mammoth Hospital opened an orthopedic clinic in Bishop.
“I sat on the LAFCO board and saw the money just…” NIHD board member Lara Smith trailed off. “Going to the attorneys?” Van Winkle replied, prompting nods around the room.
Still, despite that history, there was a clear effort from both sides of the aisle to reset the relationship.
“There is a rivalry, we are somewhat different cultures, but ultimately, people need healthcare, and the better we in this room can help achieve that, the community benefits,” said SMHD board member Ryan Wood.
Under the proposed arrangement, the hospitals would not merge but instead form a legal collaboration to coordinate services and jointly assess regional needs. NIHD is currently undergoing an external provider needs analysis by Wipfli, and Mammoth Hospital could conduct a similar study, with both districts aligning recruitment and service lines based on shared results.
For example, if both hospitals show a need for half of an orthopedic surgeon, one provider could serve both communities. The model could also allow one hospital to scale back certain departments while the other expands.
“There’s a lot of synergy that can be gained,” said SMHD board member Yuri Parisky. “I would prefer having cardiology at your elevation.”
He added that better coordination could also improve patient outcomes.
“It’s always impressed me that, for some reason, we would send our patients who are oxygen starved in their recovery, north. Why not utilize sending them south for their recovery?”
The collaboration could also strengthen applications for state and federal funding.
“[The Feds] are really pushing the rural districts to work together,” Van Winkle said.
There was brief discussion of including the Toiyabe Indian Health Project, but extending the partnership to Southern Inyo Hospital, the only other regional hospital district, was quickly ruled out.
The hospital, located in Lone Pine, came out of bankruptcy in September 2020, and is now getting by “month to month,” relying on the same unpredictable IGT funding streams as NIHD.
“As much as we’d like to help them, we can’t be sunk,” Parisky said.
Next steps include developing a legal framework for the partnership and holding a follow-up meeting, this time on NIHD’s home turf in Bishop, as the two districts test whether cooperation can succeed where competition failed.
