By Mary Alice Murphy

The special meeting called by the Grant County commissioners on Wednesday, May 24, 2017, had as the main agenda item a discussion of the request for proposal (RFP) process for operation of the Cancer Center at Gila Regional Medical Center.

Commission Chairman Brett Kasten reminded the audience that the trustees and their guests, counsel Caralyn Banks and Chris DeMeo, "are our guests. Treat them with the utmost respect."

 

Kasten said the Commission had sent a list of question compiled by the members—Commissioner Billy Billings and Commissioner Alicia Edwards— who put on last week's Cancer Center forum as individuals, not as commissioners.

To the trustees, Kasten said: "I know you cannot say some things. I appreciate the three trustees, which is not a quorum, being in attendance."

Commissioner Harry Browne said he looked forward to clarification of questions the community has.

Jeremiah Garcia, Gila Regional Board of Trustees chairman, said he had been asked to make a statement.

"We appreciate the opportunity to address the 23 questions and concerns," Garcia read. "We want everyone to know our priorities. We hear you. I live it daily, as I have a family member entrusted to the care here. We understand your concerns and we are passionate about the care at Gila Regional. We appreciate commissioners Billings and Edwards for having the forum.

"Our highest priority is patient-centered care," Garcia said. "We want no interruption to care if at all possible. Our goal is to maintain the Cancer Center staff as it is today. We have a team of people here at this meeting."

He introduced Trustees Magdaleno Manzaneres and Dr. Victor Nwachuku, Interim Chief Executive Officer Alfredo Ontiveros and Assistant Vice President of Administration Liana Ryan, as well as the legal counsel members. Banks is out of Las Cruces, and DeMeo comes from Houston.

"Hopefully, you will understand the process as we clarify items," Garcia said. "We will address the list of questions."

Question 1:
Who initiated the change of operations of the Cancer Center from New Mexico Cancer Center to the University of New Mexico?

Garcia said Gila Regional had a contract with NMCC that expired on January 31, 2016. "We tried to negotiate a new contract, while extending the contract to May and then to November. The primary issue was the fair market charges of the services. We were not able to come to agreement. A contract requires a termination date. We issued that in December. The parties, Gila Regional and NMCC, mutually decided to go to RFP."

Question 2:
Was the change politically or personally motivated?

"No," Ontiveros replied. "I came on board on 9 January. One of my tasks was to make sure there were no risks to the hospital because of the RFP process."

Garcia said the actions were needed to comply with federal law. DeMeo said non-compliance could lead to fines, prison terms or other extreme penalities. "That's why it took so long to get to this point. We have to have compliance."

Question 3:
Because some of the trustees are involved in the process and others not, would the trustees have an independent process to show no concerns with the process?

DeMeo said the process is by state procurement code.

Banks said: "The hospital has to follow state procurement code. They have to do it for other contracts, radiology, emergency room, for instance. They always want to make sure to get the best quality for the best dollar. Gila Regional did the RFP process in the right way in the right time frame. They received two responses and evaluated them using the criteria."

She listed the criteria: the first, which was weighted at 35 points was relevance, expertise and reliability; the second at 35 points was confidence the responder could provide the services; for 15 points, past experience in rural communities; and last, at 15 points, was price, including cost and compensation.

"The respondents were notified they would be evaluated on weighted criteria, including cost," Banks said. "They knew the criteria. The evaluation team scored the proposals. That's how you go through this process. The UNM Comprehensive Cancer Center was the successful bidder. The hospital followed the statute."

Question 4:
Why didn't the administration wait for the new CEO?

"The hospital didn't wait when I came," Ontiveros said. "They kept the process going. It will be my responsibility to effect the transition with Mrs. Arias. There will not be any hold up in the process, so we don't run afoul of federal or state statutes."

Garcia said the term of the extended contract ended on December 30, 2016. "We had to take action." "They did the process," Banks said.

Question 5:
Who was the selection committee?

Ontiveros said the Selection Committee was composed of the Trustees Executive Committee and hospital staff. "They were selected because it was the team involved in ongoing negotiations with NMCC. The committee was also assigned to evaluate the criteria. One of the trustees is a physician."

Question 6:
Have some trustees been more involved in the process?

"Yes, the Board Executive Committee," Garcia replied.

Question 7:
What staff members specifically?

Ontiveros said a PharmD, three physicians, with one of them being a board member and another from the Medical Executive Committee and the third from a family practice, a nurse, and Ontiveros himself.

"We have met with UNM only one time," Ontiveros said. "There are issues and items on both sides of the fence, including entering into a non-disclosure agreement. The contract has not been let and won't be until after the two have come to agreement. It took a year with the current contract holder not to get to agreement."

Question 8:
Who contacted UNM?

"We sent out the request in legal notices," Ontiveros said. "We wanted folks to send in proposals. I am personally not aware of anyone personally asking for responses."

Banks said an entity has to publish legal notices for an RFP. "If someone is interested, they can respond."

Garcia said the legal ad was posted on Feb. 3, 4, and 6 on the state RFP website.

"Dr. McAneny (the owner, director of NMCC) called me and asked me if it had been posted," Ontiveros said. "We sent her the RFP. I personally asked our staff to send her the RFP."

Question 9:
Several have expressed concern about what involvement the hospital's physicians had in the process.

Nwachuku said he has had the opportunity to take care of patients in the Cancer Center. "My concern is that my patients receive the best care. Some remained here; some went to UNM. I have a good relationship with UNM. I talk to a lot of local physicians. Of course, they all have concerns on the best care for their patients. I talked to Dr. Skee. I talked to Karen DeGenevieve. I have had two meetings with physicians since the RFP respondent was chosen. Our biggest concern is the best care for our patients, and to make sure, if it's possible, to keep the same staff to provide continuity."

He said the physicians are also concerned about access to information. "One issue is for the physicians to be able to get records from UNM. This process is very direct. We did not all agree. From my point of view, we made the right decision. The most important is for patients to continue to get the best care without interruption."

Garcia asked about clinical staff. Nwachuku said several are providers that have direct contact with the patients. "Our goal is the best care and that the care not be disrupted. I am invested in the best care for my patients."

Billings said he had heard that physicians have made a vote of no confidence in the decision.

"I have had two meetings with physicians as it has evolved," Nwachuku said. "I think most physicians understand the process."

Question 10:
Why was it announced that UNM would be coming?

Banks said entities typically announce the successful offeror and then go into negotiations. The one with the highest score is announced. The draft contract sent with the RFP has a lot of details on the structure of the relationship, per the procurement code.

Question 11:
How can this change occur by the end of July?

"We have had a meeting," Ontiveros said. "We have to address how to take care of patients during the transition, if there is a transition. But we have to plan as if there will be a transition. Yes, we will have to discuss the transition with Dr. McAneny. It will be a transition for the patients, the records, the process, the ordering of drugs. The legal requirements told us we have to give NMCC notice, which we have done. We have to determine how long the transition will take and we have to come up with the legal vehicle to minimize risk to us. It includes McAneny agreeing to it."

Nwachuku said the goal is a smooth transition. "We are hoping we can keep the current staff as much as possible, which will help with a smooth transition to make sure patient care is not affected."

Demeo said the hospital has some legal possibilities to extend the contract to bridge any gap.

Question 12:
How many patients does NMCC treat locally?

"About 160 right now," Ontiveros said. "About four to five receive radiation per day; six to 10 receive chemo; each physicians sees 16-21 per day. We average 110-120 new patients a year. We had sorted that out with McAneny. 120 patients will not allow payment for full services by UNM. We also have a fiscal goal to make a fiscally agreeable goal in the negotiations."

Banks said those responding to the RFP were given the numbers. "There are about 9,200 treatments during a year here."

Question 13:
Will UNM have a local oncologist or a locum tenens?

Nwachuku said UNM plans to have one physician stay locally, but it will depend on the number of patients.

Garcia said when that one is in training or attending required conferences, UNM would make sure another physician is available.

"We broached with UNM to accept Karen DeGenevieve," Ontiveros said. "UNM replied that it might be best for Gila Regional to hire the non-physician staff, such as radiologists and other techs. I would rather ours stayed."

Question 14:
If the Cancer Center is a large revenue generator, how can we assure it continues?

"The Cancer Center minus the chemotherapy drugs runs at a loss," Ontiveros said. "When you add in the chemo drugs, it generates positive revenue. Trying to get the numbers has been tough. (Interim Chief Financial Officer) JoBeth (Vance) and I plan to have the numbers before I leave and before JoBeth leaves. The center is break even; at best, it is a few hundred thousand dollars to the positive."

Question 15:
The Cancer Center is working well for the community, so why change it?

"It goes back to the first contract with NMCC in January 2016," DeMeo said. "NMCC and the hospital could not reach consensus.

"I got a call from McAneny asking us to negotiate at that time," Ontiveros said.

"Both sides discussed it and both came to the conclusion to go to RFP," DeMeo said.

"That is one of the questions we asked legal before we could go to RFP," Garcia said. "We didn't go into the process until we got agreement from NMCC."

Question 16:
Will UNM move patients to Albuquerque?

"Our goal is to keep them here," Nwachuku said. "There will be some situations when patients will need advanced care."

Question 17:
Was public input sought?

"No," Garcia replied. "Any service Gila Regional provides has a process we have to follow. During the process with my wife's care, she has had three different physicians. She was concerned why she was getting a new physician. When treatment is established, if a physician has to leave, there will be another physician to take care of the patient. We all have choices of physician. Any time there is a change in physicians, we are always looking for the best quality. We always want to make sure we have the right team in place. We have to trust we are getting the best physicians."

"I'd like to add that because of rules, a patient has to approach me. I cannot ask for their business," Nwachuku said. "I talked to providers who had input about the RFP process."

Garcia said any time there is a new physician, "part of the recruitment is to have their ducks in a row before we accept and credential them. Input is very sensitive."

Question 18:
You're gotten significant input that people are interested in their care and like their treatment. Is there any way to walk it back?

"We have gotten a lot of feedback," Nwachuku agreed. "We are very, very, very sensitive to feedback. The RFP process has started, so we can't walk it back. During negotiations, we will ask for quality of care or even better to make sure patients are comfortable with their care."

Garcia asked DeMeo: "Doesn't the contract require no disruption of service?"

DeMeo replied: "Both parties must agree to no disruption."

"That is part of the negotiations," Ontiveros said. "The only decision made so far is the RFP and to proceed with the process. We have to run the process."

Banks said: "It's how it is. The criteria are established. If you change it, you violate the procurement code. We need to go through the contracting process. We can't go back on the RFP."

Garcia reiterated that patient-centered care is the priority.

Billings said he wanted to make clear that the questions being asked are not his personal questions, although his name is on them. "They came from people at the forum."

Question 19:
At the forum, 34 to 35 people spoke in in favor of not changing providers and one spoke in favor of the change.

Ontiveros said: "I was the first to speak. I did not say I was in favor of change, but only talked about the process. Has every trustee read the forum coverage?"

"Yes, all of us," Garcia said. "Yes, we understand a lot of the patients and their families were passionate about the care they are receiving."

Question 20:
Was it presented to the news media that the change was only recommended?

"In the board meetings, with press in attendance, it has been made clear that it is not over until the contract is signed," Ontiveros said.

Question 21:
Do you think the public is being misled?

"We cannot disclose some things," Garcia said. "We must try to find the best service provider at all times. We do the best we can as a hospital."

Ontiveros emphasized that the hospital cannot disclose some things under the RFP process. "I heard the call to action asking people to be part of the board. Being a trustee is very serious. It is not easy. A misstep can bring an individual to prison. Medicare certification can be pulled from the hospital, if we don't follow the rules. And 60 percent of our patients are on Medicare."

Question 22:
Can the trustees be polled by the administrators to support the change?

"We have to protect the hospital and the patients," Garcia said. "Can we be polled? No."

"There are concerns over compliance," DeMeo said. "The hospital had to part ways with the current service provider because the parties could not come together."

Question 23:
Was there a dollar difference in the responses?

"That cannot be disclosed," Garcia said. "The cost is only one of the criteria factors."

"I read you the criteria and the weights," Banks said. "The most important criteria were weighted higher than the costs."

"Now that all the questions have been addressed, we come to the next portion of the meeting," Kasten said. "I'm glad you brought up the duties. One of the things we can get into trouble for is to get involved with other autonomous boards. We're in a bad situation. It could become litigious. If we allow questions now, they are for us."

He also offered the Commissioners' Chambers to the Board of Trustees for their meeting on Friday at noon, but "I know you won't take us up on it."

Browne said he had a follow up.

"The hospital personnel have to leave by 10:45 for another already scheduled meeting," Kasten said. "I will offer 15 minutes for the public, no more than five minutes at a time."

Dr. Laura Davenport-Reed, internal medicine and pediatrics physician at Gila Regional and Silver Health Care said she had a couple of things to discuss.

"I appreciate the board members, Ontiveros and legal counsel being here," she said. "One question I had on the RFP policies and procedures is that they may or may not be in place. Maybe it's a good idea to have the forum before the RFP is let and to have meetings with physicians before the RFP. It was not discussed at the Medical Executive Committee meeting before the RFP. In the procurement rules, you might consider having medical input, patient and community input.

"And the second part of my comments is on the medical staff," Davenport-Reed continued. "Yes there was a vote of no confidence on the change at the MEC. I attended ad hoc meetings where the chief of staff canvassed the physicians. There was no confidence for the whole process."

Kasten said it is not part of the Commission's responsibility to be part of the hospital's RFPs.

Nancy Thomas said she appreciated the eloquence of the trustees, but "I'm not sure I agree. I have many questions. I believe when someone is talking about money and they can't disclose, something is going on. For eight months my husband and I lived at the Cancer Center. He went first to the University of Arizona, but came back here because the travel was difficult for him. My sister was sent to UNM. That's another story. If my husband were alive today, we would go back to Arizona, not UNM."

Ron Henry said he has been a patient at NMCC for 10 years. "My question is when you looked at the criteria, there is no way I can believe that UNM scored higher on anything except maybe dollars."

John Colburn directed his comments to the Commission. "At no time during the process were any of the patients asked for input. We resent the fact we were shut out of the process."

Linda Nichols said: "If this goes forward, you may not have a lot leave, but I will go to Albuquerque to NMCC for care. Please talk to Boutique Air and see if you can get special rates. I'll be talking to hotels for special rates. We will take resource dollars out of Silver City."

Orpha Gonzales said she has had 35 years serving on boards in education, the city and the housing authority. "The main reason I have been a patient for nine years, is that I wouldn't be here if not for them. I was told I hadthree months. I have had the best care anybody can have. I don't understand why NMCC was rated lower, except perhaps financially. Are we going to get the care we need? Karen, Dr. McAneny and Dr. Fontaine, not to exclude radiation, all take care of us. We have received the best care and more. I feel we will not be treated as well by UNM. It's better to pay more and get the best."

The next portion went into commissioner questions.

Browne asked the hospital officials if they would be opposed to an independent review of the RFP process.

Banks said it was not something the procurement code allows.

Browne said the Commission would ask for it as information gathering.

Ontiveros said he could discuss it later with Mrs. Banks. "I would look at it after the process. We can't change what we're into. Gila Regional might be willing to look at it after the process."

Banks said the process sets out what must be done.

Garcia reiterated that the hospital is still in negotiations. "If we cannot complete the process, it goes back and establishes the RFP process again."

Banks said the hospital could go to a second RFP, but procurement code for health care does not allow going automatically into contract with the second respondent, but requires another RFP. 

Billings thanked the hospital representatives for answering the list of questions, but "I think people will leave with more questions. I'm frustrated that the County Commission has no authority except to appoint the trustees. It has been said that the Commission could release trustees. That is not true. The commissioners could not call the forum. It was hosted by two individuals who also happen to be commissioners."

He said the Commission would be appointing two trustees. "Those interested can apply through June 5."

Edwards thanked the Board of Trustee members, Ontiveros and the attorneys. "We appreciate your coming to this special meeting. I do appreciate the effort to be more transparent. This is an important process. It's the beginning of how change happens."

Commissioner Gabriel Ramos said he did not have questions, because the hospital is in the RFP process. "I appreciate the Board of Trustees members for their dedication to the hospital."

"I appreciate the questions and the audience," Kasten said. "I suggest you attend the board meeting this Friday (May 26, 2017) at noon at the hospital.

"I have thought a lot about this, but I'm not sure what we can do," he continued. "I asked our management to put out an RFP request for a management firm to determine if we are running the hospital to the best of our ability. I don't know if we will change anything, but I need to know if we're doing it right."

Browns supported examining options. "It's the smart thing to do." Edwards echoed the effort.

The special session was adjourned.

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