Adventist Health has dropped out of the competition to run Mark Twain Medical Center, an official with the hospital district said Wednesday.

Mark Twain, the third-largest employer in Calaveras County, is in the midst of deciding whether to run the hospital itself or lease the San Andreas hospital and other medical facilities.

Officials with Adventist Health, the faith-based nonprofit with more than a dozen hospitals in California, Oregon and Hawaii, including Adventist Health Sonora, did not respond today to requests for comment.

Mark Twain Medical Center’s current lease, which expires Dec. 31, 2019, is with Mark Twain Medical Center Corporation, represented 50-50 by Mark Twain Health Care District and Dignity Health, a nonprofit organization based in San Francisco with 39 hospitals and more than 400 care centers in California, Arizona and Nevada.

“Adventist Health said they’re not going to continue a proposal to lease Mark Twain Hospital,” Dr. Randy Smart, executive director for Mark Twain Health Care District, said Wednesday in an interview in San Andreas.

“So when Adventist Health dropped out, that left the district with three options,” Smart said, speaking after a special meeting of the district finance committee. “One, we could sell the hospital; two, we could operate it independently; or three, we could lease it to Dignity Health.”

Smart said he believes the five-member Mark Twain Health Care District Board will vote later this month to either run the hospital independently or lease it to Dignity Health.

Mark Twain Medical Center has a workforce of 324 employees and 35 doctors, and its payroll approaches $30 million a year, Smart said.

“The negotiations and the lease are not just about a hospital,” Smart said. “It’s about an economic hub in Calaveras County.”

In October, more than 130 staff members and 24 health care providers who work at Mark Twain Medical Center and its clinics signed petitions in favor of remaining under Dignity Health.

The health care district is bound by nondisclosure agreements to keep some information confidential for the time-being, Smart said. That could change in the next week.

“We believe that by next week we’ll be able to disclose a lot of information about the Dignity proposal,” Smart said. “We have to have a fair market valuation of this facility. We’ve contacted a consultant and we hope to have it in the next two weeks.”

Officials at the Dignity Health corporate office in San Francisco did not respond to a request for comment Wednesday.

Before 1989, the health care district ran the hospital. The current lease can’t be renewed because it’s against the law, Smart said. A new arrangement has to be agreed upon going forward.

Earlier Wednesday in the finance committee meeting, board members Ann Radford and Susan Atkinson heard from J.R. Krieg, district controller, and Ken Malcoun, district accountant. They discussed draft financials and a draft audit for fiscal year 2016-17, both of which had yet to be finalized.

They talked about operating income, gross revenues, cash flow, a budget loss, a monthly balance sheet and investments.

According to a Mark Twain Health Care District web page, the district is a public agency that owns the buildings and grounds of the Mark Twain Medical Center. The district leases operations of the medical center to the Mark Twain Medical Center Corporation, which also runs five rural health clinics in Arnold, Angels Camp, Copperopolis, San Andreas and Valley Springs.

The district was established by voters in 1946. The hospital was founded in 1951.

Today, the Mark Twain Health Care District board oversees about $900,000 in public funding through annual tax allocations, as well as $100,000 in public and private grants and funding opportunities to increase health and well-being in Calaveras County.

If the district decides to lease the hospital, the district will put its recommendation before voters, who must approve it in 2018. If the district decides to use an independent management company, a vote is not necessary under California law.

The next regular meeting of the district board is scheduled Jan. 10.

Contact Guy McCarthy at or (209) 588-4585. Follow him on Twitter @GuyMcCarthy.