[Editor's Note: This is part 4 of a multi-series of articles on the Grant County Commission work session and regular sessions of Feb. 13 and 15, 2018.]

Vice Chair Alicia Edwards presented the Territorial Day proclamation to Committee member and Assessor Raul Turrieta as Commssioners Harry Browne, Gabriel Ramos and Brett Kasten look on.

Below: Vice Chair Edwards presented the Western New Mexico University Quasquicentennial proclamation to Abe Villarreal, assistant dean of student affairs, as Commissioners Ramos, Browne and Kasten observe.

Photos and article by Mary Alice Murphy

In a Feb. 13, 2018 work session review of new business on the agenda for the Grant County Commission regular meeting of Feb. 15, 2018, two proclamations were on the agenda-one for Silver City's Territorial Charter Day on Feb. 17, 2018 accepted on Thursday by Raul Turrieta, representing the Territorial Day Committee and one for Western New Mexico University's Quasquicentennial, which was celebrated on Feb. 9, 2018 at the university. According to Abe Villarreal, assistant dean of student affairs, who accepted the proclamation at the regular session, celebrations of the 125th anniversary will continue during the semester.

Commissioners, at the regular session approved a statement of assurances for fiscal year 2019, an application to the Local Government Division of the Department of Finance and Administration for distribution funding, another grant funding application through the LGD of the DFA, a memorandum of understanding with DFA, an assurances and cooperative agreement with the Department of Finance, an amendment to the grant agreement with the DFA LGD and lastly a resolution authorizing the county to submit an application to the DFA LGC to participate in the Local DWI Grant and Distribution Program and delegating authority.

McClean, at the work session said the prospects are "way low for funding this year. We receive from two pots of money. The distribution is set in law, with a guestimate for how much we will receive through the formula and we also each year apply for a grant. I think we will get $133,000, which is $40,000 less that last year, because of a bill that sunsets. Last year, they swept funds from us and increased funds to the drug courts, a total of $1.6 million throughout the state. A bill this year would raise to 45 percent the amount we get, which was 41.5 percent as of July 1. The bill would give 5 percent to the drug courts. This bill was a New Mexico Association of Counties priority. When DWI programs first began, the liquor tax would go to the excise tax to fund us. I'm fiscally conservative and we may not have to spend as much this year. I applied for a grant for Corre Cantinas. If we don't get it, no Corre Cantinas. If we are cut, it doesn't leave us much for curricula. We received in the past year about $90,000."

She said a lot of the funding goes toward prevention programs. "We serve three classes at Snell Middle School, with a 15-week program, using some support videos. We have lots of hands-on activities. We also have a nine-week bully-proof program and a 'smoking stuff' program we also do at La Plata Middle School. At Cliff Elementary, students wrote empathy letters to share, in a nine-week program. We had at Stout Elementary a 12-week drug danger zone program. We are at Opportunity High School all year. La Plata did a community project and service learning, plus risk and protective classes. In our summer program, we had 300 kids. We participated in the Red Hot Children's Fiesta, at prom and after prom. We also did a Kick Butts campaign against smoking. We have 110 to 115 on supervised probation. We gave 40 drug tests in the past month and 90 percent were positive. But I think we're making an impact in the community."

Commission Vice Chair Alicia Edwards asked how many people Corre Cantinas serves. "We serve about 7,000 a year. It went down but is coming back up," McClean replied.

Commissioners approved on Thursday the certified road mileage after Road Department Superintendent Earl Moore said at the work session he had had to correct several inaccuracies, but the mileage maintained by the county totals remained at 697.93 miles.

A resolution in opposition to a border wall that was on the regular agenda was removed at the work session to a later date by Commissioner Harry Browne after the commissioners said they didn't have enough information to be for it or against it.

A kitchen remodel at the Silver City Senior Center bid was awarded to Holray Construction at the regular meeting. County Manager Charlene Webb said Holray was the apparent low bidder and the amount was well within the budget. "He did a remodel in our office and did a good job."

As the Health Plan Claims Board, commissioners at the regular session approved claims for December in the amount of $53, 915.08 of which 18 claims were to Gila Regional Medical Center and seven were for the GRMC ambulance service. Also approved was an invoice from May 2017 that in the MediTech 6 update had not transferred and was not discovered until October. Webb recommended paying it in the amount of $14,156.97.

Browne wondered if other billing had been lost in the transfer.

Commissioner Brett Kasten asked that a potential sale of real property be added to the executive session to take place after the Thursday regular meeting, in addition to pending opioid litigation.

At the beginning of the regular session on Thursday, Edwards, who led the meeting as Commission vice chair, asked for a moment of silence for those killed in the school shooting in Florida the day before.

Gila Regional Medical Center Chief Executive Officer Taffy Arias gave her monthly report and began by introducing new leadership team members.

Tanya Carroccio, who grew up in southern New Mexico, will serve as the Chief Quality Officer. She is completing a doctorate at the University of Arizona in nursing administration and is also a nurse practitioner. "I come with some strong ideas for quality," Carroccio said.

Richard Stokes will serve as the Chief Financial Officer, replacing Interim CFO JoBeth Vance. Stokes is originally from South Carolina, but most recently served in a small rural hospital in Texas. His 22 years of service have primarily been in rural hospitals. He is a Certified Public Account. "I see lots of opportunities for improvement," Stokes said. "My top priorities include assessing the revenue cycle, which starts when a patient walks in the door. I will put in place an audit program to ensure that first information is accurate and that charges are correct. I know you are working through problems in how to manage patient accounts, including self-pay accounts. We will be making sure charges get to billing and then to the those who pay."

Doug Oakes has been named the director of marketing and PR. "My wife and our six children just moved here in January. We fell in love with this town. I have spent 30 years in marketing in health care, primarily in community medical centers. I've been from Deming to Reserve and have seen the spirit of the community and volunteerism that makes this community special."

"One of the most staggering pieces of operations is how we run our staff," Arias said. "Thank yous go only so far. We need to do a wage analysis. We cannot match what other agencies are paying. Our people are attracted to that $6 to $11 more an hour than they are making now. They are tempted and take the job, but now are in contracts they can't break and want to come back. The grass is not always greener on the other side. We are doing a wage analysis within 100 miles, which includes Las Cruces.

"Our CFOs are delving in on saving money on another side in order to give wage adjustments," Arias said. "We have been successful in recruiting top talent. We will have another urologist and another ENT and are talking to another family practitioner. We want to provide services so that people don't have to leave here to get health care."

Webb said Commissioner Billy Billings had asked her ask questions about what he had heard relating to the hospital. They included that UNM was sending only one oncologist one day a week, and he asked if there is something in the contract between Gila Regional and UNM to provide more oncologists, so the Cancer Center can provide the same level of service as the previous provider.

"Yes, we have Dr. Rabinowitz on Fridays," Arias replied. "Which means a new patient could not get an appointment until April. Other physicians will be slotting in as often as they can. During January and into February, they came down multiple times. Dr. Tawnower will come once a month to help out.

"I have engaged with two recruitment firms to look for a full-time oncologist, even though the physician will be an employee of UNM," Arias continued. "UNM has been challenged because of our location, but we still have to pursue this, as aggressively as possible, because we need the coverage. I will continue to reach out. Dr. Rabinowitz will come once a week and others will plug in when needed. UNM does continue to provide extra days. If it is a critical patient, all we have to do is call the department and an appointment will be arranged."

Kasten said: "What I heard is that UNM is not fulfilling its contract to provide physicians."

"That is not true," Arias said. "When the transition happened, there was no transition that occurred, which kind of put things behind. UNM has not found a full-time provider for here. I don't think it's anyone's fault based on the state of affairs in health care. I know they are making a strong attempt, because we are on the phone at least weekly. It is on everybody's top priority list. There was some discrepancy in what the previous administration expected for coverage and what was real at the end. The previous provider increased services for the last couple of months to be sure people had a plan and were current with their treatment because they knew there would be a gap."

"It seems like UNM should have coverage for us," Kasten said.

Browne said: "This question has political overtones, but it is not my intention in asking, what is the difference between a chief quality officer and what Howie Morales was doing?"

"A big difference," Arias replied. "This chief quality officer is taking the place of Carrie Young, who also had a J.D. She was the compliance officer. It is an important role encompassing compliance, quality, regulations and contracts. Morales had an important role which I want to acknowledge. I also want to acknowledge that he was so very helpful and influential, as senator, in moving the nursing compact act through the Legislature. He continues to prove he has a true affiliation and commitment to Gila Regional and the community. Ms. Carroccio does not have a J.D. but has years of experience in quality and compliance."

Browne thanked Arias and Vance for providing the commissioners a copy of the financial information.

Vance reported the hospital had 172 admissions in December as compared to 185 last year, 3,708 outpatients as compared to 3,718 last year. ER visits for the month stood at 1,520, 300 more than the previous month. Surgeries were 406 compared to 296 last year for the month of December. Gross revenue was $16.4 million as compared to $15.9 million the previous year. Net revenue was the same as last year at $5.8 million. Expenses stood at $5.3 million for December, compared to $6.4 million the previous year. Excess revenue was $138,751, compared to a negative $831,691 last year. Year-to-date revenue over expenses is at negative $4.4 million, compared to negative $5.9 million last year. Days in cash is 41.5 compared to 77.3 last year. Days in accounts receivable is 57.7 compared to 49.6 last year. Days in accounts payable is 45.5 compared to 39.9 last year. Daily expenses have gone down to $182,706 in December compared to $202,192 the previous year.

Edwards also thanked Arias and Vance for providing the financial reports to the commissioners.

In public comment, Donna Stevens, Upper Gila Watershed Alliance executive director, said she was unable to attend Tuesday's work session, but watched the video. "I listened with interest and heard concerns about pilot training. I want to emphasize we are not against the military nor pilot training. We think the F-16 pilots should use areas already set aside for military purposes, such as White Sands Missile Range and Fort Bliss. When Mr. Shafer gave his presentation, he said that it would be a boost to the economy. It would be the exact opposite for Silver City. We rely a lot on tourism dollars and they don't want planes flying over the wilderness. If Alamogordo is going to benefit, they should suffer the noise and inconvenience. I encourage the commissioners to oppose the flyovers."

Cerise Grijalva of the Southwest New Mexico Council of Governments said she had been asked to give an update on the Copper Trail between Santa Clara and Bayard. "The New Mexico Department of Transportation will call it a Safety Trail. A plan was submitted in 2016 to create a trail on the west side of Highway 180 from Highway 152 to Bayard. It will cost $1.4 million. We got a road safety audit. The DOT will fully fund the trail. The actual design and timeline have not been determined, but I will update you on it as it moves forward.

Commissioner Gabriel Ramos thanked her for the update and said he appreciates the hard work of the COG. "Priscilla (Lucero, SWNMCOG executive director) has done so much for us. We appreciate you."

Ramos asked Lucero for a report on the previous day's Grant County Water Commission meeting, which he chairs, but was unable to attend.

"I brought Olga Morales of the Rural Community Assistance Corporation (RCAC) to talk about the challenges," Lucero said. "One of the differences with the continuing phases of the Regional Water Plan and the first phase was that Phase I was to bring a primary water source to the town of Hurley. For the rest of the area it's supplemental water."

She said Olga Morales provided a process map for regionalization to go through the needs. "We have concerns about fees to the residents. In our best interest, we will have new leadership at the next meeting who will begin to ask questions, among them is if the water commission will do billing and what the purposes of the commission are. We're not there yet to get funding from USDA. We will take a step back and put the USDA application on hold. The main priority was to get water to Hurley. We talked about bringing in, not just the county and municipalities, but also the water districts. Our next meeting is set for March 28."

To Manager Webb, Lucero said one of the questions will be how to address North Hurley, as the county is not in the utility business, so how will the residents be billed to pay for the improvements.

Edwards thanked Lucero for persevering in helping all the county.

Financial reports can be seen at http://www.grantcountybeat.com/news/news-articles/42319-grant-county-commission-discusses-air-force-proposal-to-fly-over-the-gila-and-hears-financial-reports

Debbie Gray of Kreigel, Gray and Shaw out of Las Cruces presented the fiscal year 2017 audit for Grant County. She said the independent audit report is a combination statement, separating out the funds, the balance sheet and income statement. "We look at the original budget and the final adjusted budget and how they compare. We saw no unfavorable variances."

She pointed out the summary of accounting practices, "most of which are prescribed." Other specific pages she pointed out were the required schedule for pension liability, the supplementary information for each fund, additional supplemental information, tax roll reconciliation, the schedule of expenditure of federal funds, and a summary of determination of funding for the Grant County Airport and the Community Development Block Grants, where she found no findings.

"Back to page 101, we look at system control, where we usually find opportunities for improvement," Gray said. "We had two findings. The first was related to the gas purchase card, where the county wasn't consistent with its own policy. The second related to internal control, where you are not enforcing procurement card policies, The policies are great, but are not all are being followed and not consistently."

She said there were no compliance issues with the federal programs and no prior year findings. To a question on one part, she said: "As an auditor, we do not audit what other auditors found. I think the hospital could contact its auditor to explain what was found."

Browne asked if underfunding of PERA (Public Employees Retirement Association) is a liability of the county.

"I've heard both sides," Gray said. "It's paramount if something happened. The state is saying legally the county would be liable for a shortfall, there are a lot of variables. I put it in because of what's happening nationally."

Browne asked if she were the county, would she form reserves.

"I'm not sure how the county could work with the Legislature to make sure the fund works," Gray replied. "One entity cannot control the fund on its own."

Browne asked about a line that showed $36 million extra. When Gray looked at it, she said the column had been moved and it was net expenditures.

The next article will address the county reports heard at the work session and the elected officials' reports from the regular session.