By Mary Alice Murphy

The official maximum capacity of 155 in the Grant County Administration Center Commissioners’ Room almost reached its limit Monday afternoon. Gila Regional Medical Center Board of Trustees Chairman Jeremiah Garcia noted at the beginning of the meeting that only 18 more people could be admitted to the room. Chairs were moved in from every nearby room to accommodate the residents who attended and still some people had to stand.

“We have never had a Board of Trustees meeting here in the Commissioners Chambers before,” Garcia said. “Welcome to this meeting.”

He asked Trustee Joel Schram to read the mission, vision and values, which were addressed later in the meeting during public input.

Garcia asked for respect with no outbursts, so everyone could hear the board’s concerns. “This is a critical decision for us to make on the Cancer Center."

With a roll call, trustees Schram, Dr. Victor Nwachuku, Mike Morones, Jeannie Miller, Tony Trujillo and Garcia were present. Garcia said Dr. Tsering Sherpa was traveling and, if possible, would try to attend part of the meeting by phone.

When Morones moved to approve the agenda, Trujillo asked to propose two alternate motions. "First I recommend we vote no on the approval of the agenda. I don't think this constitutes an emergency meeting. The Open Meetings Act calls for an emergency meeting in unforeseen circumstances. I don't believe these constitute unforeseen circumstances. This RFP was issued in April, four months ago. I have issues with how it was awarded. We knew about this deadline today. I asked twice in the special meeting to deal with a path moving forward after this deadline. It's a legal issue going forward. I will shield myself by voting no on the agenda.

Schram seconded the first motion by Morones.

Garcia said he knew Trujillo was talking about the Open Meetings Act, so he asked for clarification from hospital counsel CaraLyn Banks of KempSmith law firm out of Las Cruces.

She said the OMA requires a public meeting to provide notice of routine meetings. "This is an emergency meeting because it meets the criteria. We have contracts that expire tomorrow. That's an emergency. The items on the agenda to read EKG tests are being considered because tomorrow no one will be available to read EKGs. It's the same with the oncology agreement. People have been working hard to get the contracts done. If we don't, it will have to be addressed immediately. We will provide information to the Attorney General why this was an emergency meeting."

Trujillo asked if there was a necessity to talk to the Attorney General to decide what an emergency meeting is.

Banks said AG guidelines state that the reasons for the emergency meeting are sent to the Attorney General after the meeting.

Trujillo asked about when the hospital went into negotiations with the University of New Mexico Cancer Center.

Banks said she was involved with the request for proposal necessity and the criteria, "making sure process was followed."

Trujillo asked if negotiations had been going on since April, with GRMC sitting and talking to UNM.

Chris DeMeo, GRMC counsel, with Seyfarth Shaw out of Houston, Texas, said he has been working on the negotiations. "We've been talking since the (RFP evaluation) committee made its decision.

"What unforeseen circumstances could not be anticipated?" Trujillo asked. "Did we not foresee the deadline? Why not just a special meeting?"

Banks said it was her understanding that the contract negotiations were not decided until recently.

"We are looking at it as an emergency," Garcia said. "The cancer patients may be in jeopardy if we do not do it in an emergency meeting today."

Trujillo said he was having trouble swallowing that it was an emergency. "What if the contract is not approved? Or is it a done deal? Is there a contingency?"

When Garcia replied: "Good question," laughter was heard from the audience. "It's serious," Garcia said.

Trujillo said: "If we don't have a plan going forward, it was poor planning on our part."

DeMeo said the negotiation agreement was not completed until moments before the emergency meeting was called, last Friday afternoon.

"The present vendor chose not to continue the 90-day transition," DeMeo continued. "If we want a contract with the same provider, we would have to go back to the RFP. This meeting was called at the moment the contract was completed. We are moving forward on that premise."

Garcia said in the contracts, agreements were there with the current contractor, but "the bridging agreement was not honored by the current provider. The hospital asked the current provider for the 90-day transition, and the hospital would pay for the current provider services, but the provider decided not to provide the 90-day transition."

DeMeo noted the 90 days would be from the effective date of termination, which was Monday, July 17, 2017.

He said if this contract is not approved, "there will be no Cancer Center services."

Trujillo asked what would happen if the hospital went back to the drawing board. "If this contract does not go forward, we have to take care of our patients."

Morones brought up a point of order on the first motion to approve the agenda not having been voted on. "Maybe this is an amendment."

Trujillo said he was voting yes to NOT approve the agenda. Schram, Nwachuku, Morones and Miller voted no, and Garcia abstained.

"I had a second motion to approve public comment," Trujillo said. It received no second.

Garcia said since public input was not on the agenda, "in respect to all the people here, I will give them the opportunity. I will allow one hour, with each speaker allocated up to 5 minutes. Please sign in to speak."

Banks suggested withdrawing Trujillo's motion to allow input. Trujillo pulled his motion.

The agenda was approved with five ayes and one nay from Trujillo.

Nancy Thomas was the first to speak. "This is the first glimpse I've had of the board wanting to hear what we have to say. That meeting at the hospital was a travesty, with people having to stand in the hall."

"Thank you for the opportunity to tell you board members what an inept bunch of, I'll leave out the expletive, and you can put in the one of your choice, you are. You have left us guessing what's going on at the Cancer Center. As for the mission, you have failed the 'patient-centered care in a healing environment.' Tomorrow I will take my sister to Albuquerque for care, but what about the people who can't get to Albuquerque or can't afford to stay there?"

She said she feels that any time a person or group has to "lawyer up, they have something to hide. Thank goodness this decision is not a burden on my conscience. You bear the burden. Live with it."

Ron Henry, who has lived in the community for 25 years, said: "I love our hospital. I've been there three times in the last three weeks. I want to thank Taffy Arias (GRMC chief executive officer) for trying to meet the crises. It's a flawed process that has been made on the Cancer Center due to your fiduciary responsibility. It's an insult to the care given, which has been world-class care. We the patients were disregarded and disrespected in the whole process. We had the cancer center that was the envy of every small rural hospital. We will now be transported to Las Cruces. Patients are being put in harm's way. At our beloved Cancer Center, we were always put first. This process is a travesty."

Henry asked the trustees to vote no and to ask the current oncological group to stay. "Maybe some of our treasured staff can be asked to stay. I hope someone will listen to us."

Sharleen Daugherty said she has been a patient at the Cancer Center since 2015. "I wrote a letter to the Board of Trustees about my concerns. I think this whole RFP process has been flawed. As of today, I will be following Karen deGenevieve to Albuquerque for my follow up."

Orpha Gonzales said she is a patient. "Board of Trustees, you have not put yourselves in our shoes. I feel abandoned. Your values and vision are not there. You are not putting any of us first. Some of us have to go every day. We get so sick, we can't travel. Nurses cannot execute their job without a doctor to give orders. When has UNM come to tell us who will take care of us? I will have to go to Albuquerque. It will be hard medically, emotionally and financially. I will have to stay overnight. You have not been through what we have. It's hard to understand your mission, vision and values. I don't think so."

A woman named Barbara said she worked at the Cancer Center for 12 years and the group was the most compassionate and caring she had seen. "I can't believe that Dr. McAneny said no. It takes two certified nurses to provide chemo. I'm ashamed of you."

Teresa Terrazas said, among tears: "I don't understand why it's happening. Will we have anyone like Karen deGenevieve to call at all hours of the night? I already haven't had chemo twice because I was too sick. Please consider keeping the Cancer Center the way it is. There is no reason to take them away."

Susan Clare said: "The ineptitude is stunning. The secrecy is stunning. You are turning your back on patients who need care, as well as on the nurses and doctors. You have totally failed. You're a trustee. Who trusts you? Dr. Fontaine has been chosen as the top oncological doctor. How much of a privilege it has been to have her here. You lost a golden opportunity to market this fabulous facility, but you screwed it up. McAneny has been elected to be the president of the American Medical Association and you let her go. I will not continue going to the UNM Cancer Center. This Cancer Center provided unsurpassed care. I will go to Dr. Fontaine quarterly."

A woman did not identify herself. "There are people here who have treatment every day. What are you going to do about those who don't have the ability to travel? I think Taffy Arias ended up in the middle of this. I don't blame her."

Johnny Coburn said: "By your actions and inactions the hospital has put hardship on your patients. Radiation will likely be delayed by two months. I can't afford to pay for traveling. If this is the smooth transition you promised, I would hate to see a rough one. Those patients not being able to afford the care and travel, you have put those patients in danger."

Carolyn Johannes said she had worked at UNM and the New Mexico Department of Health. "I have first-hand experience. It has come to my attention that you are no longer participating in the New Mexico Breast and Cervical Cancer Program. 2014 was the last year you were part of it. Women have been excluded from participating in the screening. If they participate, it makes them eligible for Medicaid. It can save you some money."

Chris DeBolt said she worked at the hospital for 10 years. "First, we are taught: 'Do no harm.' The integrity in this process is lacking. You say one of your values is compassion. Look at what's happening. Patient-centered care? Respect? I don't think so. Excellence? We know nothing about what UNM services will be. I expect legal action from some in this room because of malfeasance by public official doing harm. This transition plan? We've heard nothing until tonight about Dr. McAneny's group refusing. There will be other paths that will be taken. What will happen to you and the patients who need care tomorrow? What you've done is wrong."

Wendy Walgren said she didn't understand the timeline. "We've heard the current provider's contract was over in January? And they have a 90-day grace period? It doesn't make sense."

An unidentified woman said she wanted to say thank you to Tony Trujillo.

Gwyn Jones also thanked Trujillo. "You are right. It was not an unforeseen circumstance. Nothing will happen this week. This meeting is being filmed and can be watched on CATS. Thank you, Tony, for your efforts."

Dr. Laura Davenport-Reed said she has talked to multiple people. "I'm glad we could all be here today, and I, too, appreciate Tony's efforts. I don't understand the Board of Trustees' inability to see what is going on. The RFP had many things that couldn't be quantified and that included the doctor-patient long-term relationship. It can even be life-long. I think your biggest liability, as the board, is that the process was flawed from the start. There was no input from patients, from the medical staff, nor referrals from the medical staff. If this moved forward, it makes this process OK. Look at the future, six month or a year from now. If and when Deming gets its Cancer Center built, the loss at this hospital will be great. Most will not follow up with UNM."

Frank Ogas, a lifelong resident of Grant County, said he is a patient. "The family members and spouses are going through this with the patients, financially and emotionally. The stress they are going through, too. I got a call from the Cancer Center that said I cannot go to Albuquerque or Gallup, but I can go to Las Cruces. I would much rather be able to go to Albuquerque to see people I know. My wife takes a big part in my health. She would have to take off work to take me. I can't understand or remember everything they tell me. This affects the families and friends and the community as well. We are also losing revenue from people who come here from Arizona and even from Texas. It's a huge burden on the patient and hard on the families. It will have a major impact. At times, we get put at the mercy of others who determine what level of care we get. If it's a money-making thing, what about the people in the community? I served on the hospital Community Collaboration Board. I got out when I couldn't see things at the hospital improving. I could see it slowly slipping away."

Lynda Aiman-Smith, Silver City town councilor, said her fear of a transition fraught with disaster has come true. "This emergency is of your own making, to push through something that you have already decided. Because of the darkness of the process, we don't know what criteria made your decision. In June, Dr. McAneny said she would be willing to do the transition. It was a huge surprise that the blame was laid at her feet. It seemed like it was a management decision to dig a hole and fill it the way you want it."

Cheryl Spier-Phillips said she is a cancer survivor and a professional in mental health practice. "My concern is the 90-days transition from today or tomorrow. 90 days not to have services for cancer and for EKGs? I'm concerned the legal information of the RFP was not in the best interest of this hospital or patients with New Mexico Cancer Center and UNM. Why did this not get addressed before? If there is no contingency, you need to work all night on it, so you do not have someone die or get worse."

Henry Torres said he has listened to all the negatives. "I have served on more boards than most of you, including the County Commission. I am familiar with many RFPs. I've never seen an RFP handled this way. I agree with Tony Trujillo. You need to go to NMCC and UNM and start the transition. I understand UNM has already hired some people. NMCC has already laid off some. Others at NMCC have been hired by GRMC. My understanding is that you have no transition."

Garcia said: "Each of us is an individual. We listened. It's not only one of us empowered to make this decision. I want to clarify the activities on what we're deciding."

Morones said the first item on the agenda is the contract between GRMC and UNM, as well as four parts that pertain to the agreement. "The details I will defer to staff."

Interim Chief Financial Officer JoBeth Vance said the following items on the agenda, which include Elekta service and support, Elekta hosting agreement, Eclipse platform agreement and Eclipse hosting agreement pertain to the equipment for the next five years.

"If I understand it, it's not a four-part contract?" Trujillo asked.

Vance said the contract between the hospital and UNM is separate, and the four items are related to the equipment the hospital has to purchase.

"If I vote no, will these other parts apply?" Trujillo asked.

Vance said the capital purchases of Mosaiq software license for radiation oncology and another Mosaiq software license for medical oncology refer also to the new equipment the hospital will have to purchase. "They are related to the treatment and licensing."

DeMeo said the agreement with UNM is currently an agreement with the UNM Health Sciences Center based on standardized agreements. "It is essentially a standard agreement with negotiated changes."

He said the 90-day transition is in the contract with New Mexico Hematology and Oncology. The hospital asked for the transition, but it was denied by NM Hematology and Oncology, the owner of New Mexico Cancer Center. They offered clerical help, but not clinical help. They received a 180-day termination notice in January, which was up on July 17, but that was in addition to the 90-day transition period, DeMeo said.

Garcia said the hospital, after negotiating with NMCC for a year and was unable to reach an agreement, stated that the contract had been extended for the 180 days.

"We had tried to negotiate a new agreement with NMCC," DeMeo said. "But we were unable to agree. So NMCC and Gila Regional agreed to a request for proposal process. The 180-day termination letter was not given until NMCC had agreed to the RFP process. We were in a hold-over period in June. The federal Stark Law allow partners to hold over and provide services."

Morones said that he, coming from municipal and county government, and living in that world, he found a lot of processes had to live in a strict process. "Some things in the hospital world have struck me as odd. I have had to educate myself better. Because it's a hospital, it has a lot of exceptions in the Open Meetings Act and in the Procurement Code. "It helps kind of explain a little bit the direction we took. Could someone talk to me about our process and what exceptions we chose to use or not to use to be as transparent as possible?"

Banks said: "When we're talking about hospitals, if they don't comply with the Stark law can have their Medicare certification pulled. We had to look at Stark and the holdover contract. January was precarious, because other entities have to comply with procurement or professional service agreements. We don't have to go through the RFP for professional services. The RFP has specific criteria. There were questions on the RFP that were very detailed, so people could look at the scores for the particular entity. This hospital has chosen to use the RFP process with the Emergency Department and with Radiology. We had to have an agreement between the parties to do an RFP. Packets were sent to several groups, but we got only two responses—UNM and NM Hematology and Oncology. The evaluation committee scored them. The process here was done the same as other professional services agreement. Both entities gave good information."

Trujillo asked if the RFP responses were by sealed bid.

Banks said they were no a bid per se. The responses were public except for the financial portions.

Trujillo asked: "The committee evaluated the responses and then the committee decided to award the RFP?"

"The committee selects the offeror in order to begin negotiations," Banks said.

"Why would the committee not have to take it back to the board of trustees to make a recommendation?" Trujillo asked.

Banks said they were presented to the board with the recommendation to go into negotiations.

"We were all aware of the recommendation," Garcia said.

"I think we were informed of the process, but didn't vote to recommend," Morones said. "We were never to the point of stopping the process, but just allowed it to continue."

Banks said typically entities continue with negotiations, and then the Board approves the contract.

"Why were we negotiating with UNM if we did not vote on it?" Trujillo asked. "Then I get to decide at the end whether the evaluation committee made a good decision?"

Nwachuku said this was not the first time the board had talked about the process. "You, Tony, asked questions about when you would get to vote. At the end, you get to vote. If I recall, we had no motion to stop the process. I did suggest going to the attorneys to stop the process, but I never got an answer from the interim CEO."

At about 4:30 p.m. the trustees voted to go into executive session. They came out of executive session at 7:55.

Morones stipulated that no decisions had been made in closed session.

"I would entertain a motion to approve the contract between Gila Regional Medical Center and the University of New Cancer Center," Garcia said.

Schram made the motions and Morones seconded it. Discussion was called for.

"I thank everyone for the opportunity for discussion," Trujillo said. "I will be voting no. I strongly feel this is wrong. As a cancer survivor, I chose to go to M.D. Anderson in Houston for my treatments. The normality of the process is important. When you have significant change, it impacts your treatment. I can understand the comments from those who spoke today and at other meetings. I tell patients who have spoken to me and to the community: 'I feel your pain.'"

Morones asked some questions before the vote. "I ask the staff if it is your recommendation and do you feel comfortable with it."

Arias replied: "It is well-negotiated to benefit the community and enhance the services. It is well-written, well scrutinized and will serve us well."

Morones said he struggles with the process. "I want to be assured we followed procurement code."

"My assessment is that we did," Banks said.

Nwachuku said he, personally, as a physician, spent a lot of time on the process. "I didn't want to lose sight of the goal to take care of patients. We did a lot of back and forth trying to do what is right. I am voting with my conscience to keep good care for patients. I will continue to monitor and to push for good care for patients. We will engage with the UNM provider. The process continues to make sure the patients have good care. My vote will be done with the hope that patients continue to get good care."

Schram said, like the billboard that says he is not just "'your banker, but also your neighbor,' I am your neighbor. You have to believe we are serving in the best way possible for the best care. Trust in us. We have your backs."

Miller, the newest appointed trustee, who said she has not yet attended a regular meeting as trustee, said she has attended most of the community meetings and talked to members of the community who have experienced cancer or have family members with cancer. "I feel strongly about the hospital and serving to make it the best it can be. My vote will be base on what we have heard, other than in the press, and having read the contact. I call for a vote."

Garcia said he echoes every concern heard. "We will do a roll call on the first contract, with individual votes. This is so critical for Gila Regional and our patients."

Schram-yes
Nwachuku-yes
Morones-yes
Miller-yes
Trujillo-no

"I heard form the audience that even through my wife is a patient at the Cancer Center, some thought I might not be fair," Garcia said. "I will abstain in honor of what patients have said, who don't know that I am a fair man."

On the contracts for Elekta service and support, Elekta hosting agreement, Eclipse platform agreement and Eclipse hosting agreement, Trujillo said he would vote no on all the items, in order to be consistent.

Vance said the first Elekta contact was for equipment so treatment planning can be done. The medical records will be hosted on the cloud. "These are all interrelated equipment and service contracts."

Schram, Nwachuku, Garcia, Morones, and Miller voted yes, and Trujillo voted no.

The votes on each item were the same to approve them.

In the capital purchase section, Vance said the Mosaiq software was a license for radiation oncology and the second was for the medical side, the chemo, of oncology.

Both received the same votes as the earlier ones.

In the agreements for EKG reads with Dr. John Stanley, Dr. Donna Bornmann, Dr. Norman Ratliff III and with Dr. Ronald P. Dalton, elicited a comment from Trujillo.

"My objections to these are nothing personal," Trujillo said. "One is my doctor. I am against the process, so I will vote no."

Each agreement amendment was for one year at $125 per day. The same votes occurred here, with Trujillo being the only nay.

"Prior to adjournment, I would like our CEO to talk about the transition with UNM as the service provider," Garcia said.

"We have started processing two physicians through our credentialing process," Arias said. "On their website, they will be advertising for a full-time physician to be here Monday through Friday, as well as for a nurse practitioner or family physician. We are also looking at locums (which are temporary traveling physicians or nurses). Starting tomorrow, we will be working with the patients. We have about 30 active chemo patients, so we want to minimize disruption of care."

She said the linear accelerator will have to be recommissioned.

"The main objective is to care for our patients," Arias said. "We wrap out arms around each and every patient and family member. We want to let them know they are loved and we will take care of them during the transition."

Garcia said the process has been "hard on all of us. I want to recognize Ms. Miller. She is strong and intelligent. I thank the trustees for our respect for each other. Generally, we come up with concensus. It's a great body of people to work with. Ms. Vance, our interim CFO, I thank you for going through everything. You have brought to the table the good, bad and uglies of our finances. I want to recognize our legal counsel. If it weren't for you pulling strongly to get the best contract possible, we might not be here. We have to trust in you as our counsel. Thank you for your immediate responses that we needed during the process."

"In executive session, a lot of information was given to all of us," Garcia continued. "I really believe this will be a win-win. We have to embrace the patients and the families to show them that we really care. We don't want this to drag on. We have to guarantee to bring in staff to meet UNM's meeds."

Gila Regional Medical Center Chief Executive Officer Taffy Arias said Gila Regional offered opportunities within GRMC to every staff member. Five will stay. "I'm glad they looked at their obligation to patients. Some will be liaison with UNM. Mike (Torres) and Karen (DeGenevieve) did not stay, but we truly wish them the best. We will be working to fill vacancies. We will be careful to choose those who have compassion for our patients."

"I know it is so traumatic," Arias concluded. 'We will be right there with the patients and hope that they realize it will be the best for them. That's what we want."