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Category: Front Page News Front Page News
Published: 29 August 2017 29 August 2017

By Mary Alice Murphy

At the beginning of the Gila Regional Medical Center Board of Trustees meeting on Aug. 25. 2017, Board Chairman Jeremiah Garcia called for a moment of silence for the deaths of a hospital auxilian and the loved one of a hospital caregiver.

Chief Nursing Officer Peggy White gave the monthly safety report. "The scales that weigh pediatric patients are important to make sure they receive the correct dosage of medications. They must be weighed in kilos, and we discovered our scales were not able to convert to kilos, so we are buying new scales."

Two hospital employees received recognition for their many years of service to Gila Regional. Barbara Barela has served Human Resources for 45 years. "I started at Hillcrest, so obviously I like working here. My staff came to celebrate with me. I hope to serve one more year and then I'll retire."

The second recognition was for Susie Martinez and her 15 years in housekeeping. She was unable to attend the meeting.

During public input, Linda Nichols asked how the hospital knew what her records were from the Cancer Center. "I thought they belonged to New Mexico Oncology. I didn't sign a release, so I wanted to make sure whose they are."

GRMC Chief Executive Officer Taffy Arias replied that the records belong to the hospital.

Garcia said: "Generally we don't answer questions during public input."

Nichols said she would rephrase her questions. "I would like to see the revenue numbers for pharmacy and the numbers for labs for June, July and August. If I have to do an IPRA (Inspection of Public Records Act), I will. On public information, I truly appreciate what I got from the attorney, and I'm waiting on another one."

Susan Clare read from a written commentary from Ron Henry. "These are his words." The commentary began with "Once upon a time, there was a small community hospital that created a cancer center." He went on saying that the center started small, but got help from a doctor who would travel from Albuquerque. Funding from the state helped it grow, and the hospital was able to get a state-of-the-art radiology machine. "It became the envy of small towns all over the world." But the board of trustees did things behind closed doors, and refused to listen to cancer center patients, who tried to be heard. They said the transition would be seamless. Those who worked there didn't know whether they would have a job. The seamless transition did not happen. Now, very sick people have to travel. People in power are happy to blame everyone but themselves. The board of trustees is insulated from accountability."

Under reports and updates, Frances Day, Auxiliary president, said the organization gave 11 $2,000 scholarships to caregivers. She pointed out Joe Kellerman, GRMC director of marketing and public relations, who was a recipient. She said five of the recipients would graduate in December. She announced Sept. 13 as the auxiliary awards lunch, where the auxilians are served by members of the Board of Trustees.

Trustee Joel Schram asked how the Auxiliary raises its money for scholarships and for needed hospital equipment.

Day said three times yearly outside vendors come in, plus the auxilians hold four scrub sales a year, in addition to bake sales and the proceeds from the gift shop. "We have a $64,000 budget for the year. We have two local vendors, Melinda's and Morning Star who hold the scrub sales, and they pay the taxes for us. We also accept donations, and we offer meals for patients in the Cancer Center. We hope to start that up again as soon as possible."

The GRMC Foundation again did not present a report.

Arias said an offer had been made to a nurse practitioner for the Cancer Center. "The UNM physicians were down here two weeks ago. Our nurses are going to UNM for their training. We have a lead on a full-time oncologist to serve here. He is being vetted by UNM. Within a month, we hope to have the nurse practitioner on board."

She said hospital staff is having shift and daily safety huddles working through issues.

"I am aware of the issues with the Silver City Fire Department," Arias said. "I met with Town Manager Alex Brown and found him very supportive. We looked at the contract with EMS and SCFD and both of us had issues with the legality. Things change. Some elements both of us questioned whether they were legal. We will meet again. The hospital is offering thousands of dollars of medical supplies and capital equipment to the Fire Department. We have given them for years, but are they utilized? We are supplying all the drugs and supplies, including narcotics. We are questioning the legality of that. Both of us are willing to drill down until it's all in writing. Brown is very helpful and willing to come to the table to work through the issues."

Garcia said he believes working through the issues will be a win-win for the hospital and the Fire Department.

Arias said the agreement is currently a memorandum of understanding. "We're talking about making it a contract."

Garcia said the hospital buys in bulk, so it cheaper for the hospital to provide the supplies, "but we need to make it fair to both."

Arias said the Fire Department arrived first to a the house of her neighbor, who needed help, and then the Gila Regional EMS. "It was very warming to see how they worked together. We are also looking at the EMS structure. Often we have units out on 911 and sometimes transports, when other calls come in. We have to make sure we have the correct rigs available for 911 calls. We are trying not to deplete 911 for transports to Albuquerque, Las Cruces or El Paso. If a transport goes to Albuquerque, it's a nine-hour turnaround. Our main focus is 911, so we are staffing up. And you may have noticed news signs and paint in the parking lots to keep pedestrians safe."

During the fiscal year end audit, "we are doing a review of salaries and how many travelers we need. We will be aggressive at filling vacancies to eliminate travelers."

Arias said Gila Regional has put in a contract offer for an additional surgeon. "We are still doing recruitment for a chief financial officer. It has to be the right person to strategically guide this organization to make it sustainable. JoBeth (Vance) as interim has excelled at the lob, and we will keep her as long as possible."

She said other positions being recruited are for an ENT, (ear, nose and throat) and a pediatrician.

Schram said he had heard comments about the transition and wanted to comment in public. "We had a contract with the old provider that called for 90 days of transition. The provider chose not to provide the services. That's why we're in this delay."

Chief Nursing Officer Peggy White said her report was in the packet and she stood for questions. Trustee Jeannie Miller requested either less use of acronyms or a glossary of acronyms. "What is API?" White said it is the system that tracks scheduling when staff clocks in and out of the hospital, as well as other systems, for all employees.

Vance gave her CFO report, saying the month of July brought 167 admissions to the hospital, with 1,297 emergency room visits and 423 surgery visits. Gila Regional grossed $16 million, with a net $3.7 million. With $5.7 million in expenses, the hospital had a loss of $1.6 million. "We are behind on cash collections and still trying to get the system to report them correctly. On the good side, we have 61.33 days of cash, with 57.7 days in accounts receivable. That's more than I would like. We have 520 full-time employees, an average daily census of 18.4 and an average length of stay of 2.56 days."

Miller asked about there being more cardiology visits than in the family practice clinics. Vance said the cardiologist does some visits in the clinics and also consults at the hospital. "We collect those who are seen in the clinics and separate them from those seen in the hospital. That is an issue right now that has not been fixed in MediTech," Vance said. "The four practices are reported in Athena, not Meditech."

Vance also clarified that the term "beds" includes inpatient and observations, which are billed differently. And the inpatient number does not include newborns.

Miller questioned the low number of outpatients at 58. "That's pretty much an error," Vance said. She said the number should be 3,938.

Arias confirmed that laboratory, X-ray and other ancillary services have been greatly impacted by the loss of services in the Cancer Center. "That's why we, as much as anybody else, want the volume to be regenerated as soon as possible."

Schram said, in looking at recruitment applications, he has noticed on resumes that organizations that are double the size of Gila Regional are using half the number of full-time employees. "We have to look at ways to eliminate that salary expense."

White confirmed the hospital has a focus on such issues. "It includes the census on the floor and also the census of the staff. We also have an intense focus on wait times in the ER, and a total of nine other areas. In the ER, we are getting new providers, who are coming in and getting up to speed with Gila Regional systems. We should see an improvement in coming months."

Chief of Staff Dr. Gregory Koury had said he would be late, but he had not yet arrived, so Trustee Dr. Tsering Sherpa said the Medical Executive Committee welcomed the new ER director Dr. Preston Maxim. "For the most part, Meditech is going well, and issues are being addressed." She said the MEC would like more involvement in recruitment and has requested more communication between the administration and physicians on new things that are happening in the hospital.

Trustee Dr. Victor Nwachuku said he would like to look at the incomplete medical records policy.

Arias said CMS (Centers for Medicare and Medicaid) guidelines say that all medical records must be closed within 30 days. "We are trying to work with all the physicians to ensure their records are complete within the 30 days. It's a law. Our hospital can be severely penalized if we don't meet them."

Sherpa said some records are still showing up as delinquent, when they have been completed. "I think it's a problem within Meditech. I hope it gets fixed."

Nwachuku said: "There are still some issues with Meditech, but I worry that ultimately someone may get suspended, when they actually have done their job."

Vance said no one has been suspended. Meditech automatically sends out the letters saying they have seven days to complete the records.

Sherpa said she was told the letter has to go out. "Tell me how to fix it, if they will show us how, we will fix it."

Vance said Koury would see the letter before it goes out, and no one will be suspended.

Arias noted that some physicians would blame the system. Sherpa agreed and said if they are delinquent, they should be suspended. Vance said some staff in house could deal with the issue. "We still have consultants who can fix it, and if they can't, they have to call Meditech."

Arias said: "HIM (health information management), Nancy and I were here late to help a physician through this." Vance said HIM is not "here to punish. The issue is to stay compliant."

Board committee reports followed. The Executive Committee met and created the agenda. Schram said the Quality Improvement Committee "dove down into survey information." Miller asked how often information was updated. White said it was pulled daily and updated quarterly.

The Finance Committee, reported by Garcia, asked for approval of an MEC member agreement for Dr. Maxim, and a surgical on call agreement for Dr. Frederick Wendler.

Schram asked how many doctors were being compensated with extra funding, such as the $110 per hour for Dr. Maxim.

"We are not overcompensating," Arias said. "Is this an obligation or should we pay them for this service? I am gathering data and I will ask guidance. It's not what all hospitals do."

Nwachuku said most services are not compensated. Some committees, such as the MEC, require a lot of time. Some physicians do not accept the appointments even with compensation. "Maybe we should limit the compensation to a few committees, such as the OPPE (ongoing professional practice evaluation). I belong to several committees and I don't get compensated."

Arias said it was an issue to review. "It's my obligation to make sure we're financially sound."

On the issue of Dr. Wendler, he is paid extra above his required on call obligations to provide emergency surgical care.

Nwachuku said the hospital wants to know the exact number of hours of emergent care that is performed. "Everyone is required to take 10 days of on call. We get paid, but we also get paid for extra hours."

Sherpa said: "We are obligated to take the 10 days."

"There are holes and we need to review it," Nwachuku agreed. Sherpa said it could be a problem in bigger hospitals for those with no insurance.

Miller asked if a doctor gets paid by the hospital for on-call and also for services if the person has insurance.

"If he's employed by Gila Regional, no," Nwachuku said.

Arias said, because so many CEOs have served Gila Regional in recent years, "there has been a mélange of issues on contracts. We're going to standardize them."

Garcia said the hospital would work with physicians to help them understand the contracts, so "we can guarantee getting services. We have to take measured steps."

Trustee Michael Morones presented two resolutions to accept the June 30, 2017 financial statement. "These are template resolutions specifically mandated by the state auditor. We will use the template for the final quarterly report for fiscal year 2017. And another template for the budget for 2018."

Vance said the board already did a resolution in May, but the auditor wanted it after the end of the year.

Schram said the Plant and Facility Committee discussed some recent assaults in the Behavioral Health Unit in June. "Efforts have been put in place to provide better training."

Morones said the Finance Committee talked about the safety issue of the units and decided to move the issue to the Plant and Facility Committee. "We asked to review it on a regular basis."

Garcia gave the Human Resources report and said contract labor is still high. "We hope the Meditech teams will be dwindling. I know the CEO is looking at other contract labor that is not needed."

Morones asked about recruitment issues. White said lab techs and surgical techs are needed.

"We can't offer incentives," Arias said, "but we look at other ways. Things one can do in a corporate situation, we can't do in this business."

White said the one traveler nurse in the department would be gone in September. "We have three surgical tech travelers and some in the lab. We had 14 last year. When I came on, we had 27, so we have substantially cut the numbers."

Right before the trustees went into executive session, Arias thanked the public for coming and "thank you for wanting to know what's happening."