By Mary Alice Murphy

The first item of business on the Grant County Commission regular meeting on March 8, 2018, was the monthly report from Gila Regional Medical Center Chief Executive Officer Taffy Arias.

"We had a positive meeting last night between the Board of Directors and a large number of physicians and caregivers," Arias said "It showed a further need for greater communications between us. Everyone had the same goal, exceptional quality care for the communities for years to come."

She said she was clarifying the relationship between the University of New Mexico Comprehensive Cancer Center and Gila Regional's Cancer Center. "This partnership is different from the one with the previous provider, New Mexico Oncology Center. The key point is that the UNMCCC is collaborating with Gila Regional Cancer Center to provide services. This is our clinic. We have contracted with the group coming down. Gila Regional manages the business of our Cancer Center. UNMCCC's contracting model is to provide a contracted full-time oncologist to be here five days a week. As stipulated in the contract, UNM will provide a medical oncologist one day a week on Friday and more often when possible. The previous provider was sending only one medical oncologist a week and never had a plan for a full-time. At the end of the contract they were providing more coverage to make sure patients had up to date services during the transition period that did not occur."

She continued that two candidates for the full-time medical oncologist are interested in the position at GRMC. The first will visit on March 22, 2018. "We are very optimistic, and we want to show him the best of our city and that's the people who live here."

Chairman Billy Billings said he heard Arias say the previous provider had only one oncologist a week.

"And more often toward the end, for several months," Arias said. "It was extensive, and it was done very, very well on their part."

Billings said he was hearing 2 ½ visits a week. "That service kept the appointment time relatively short. Now, how long would a person have to wait?"

"It depends on the case," Arias said. "If they are in remission, and not emergent, it could be several months out. But they are bringing in another oncologist a week when needed, but it is not regular. It will be much better soon. Radiology will begin again in April. It is our service. Before, it wasn't. All the equipment is now ours; we have paid for it up front with no debt. The patient records are now ours. The service is ours; the equipment is ours; the program is now ours. If ever we were to change vendors, they would still be ours. It would be much easier. All of that will remain ours."

Billings said the numbers are ramping up to 243 from 176 last month, but "it's still low from last year's 849. "

"Once radiation is up and running, you will see a completely different picture," Arias said.

Billings said he has heard that the community cannot support a full-time oncologist, "but if you can hire one, it will be great."

"I appreciate the opportunity to present this report to you each month," Arias said. "With that comes growth. We must continue to grow. This is a vibrant community, and we must help it. When we bring providers in, we must show the pride we have in our community. We are growing, and we cannot afford not to have services. Otherwise, someone else gets the revenue."

Billings said: "I certainly can agree that we need to grow. I'm willing to put on my best face. It seems like a big jump to go from one day a week to a full-time oncologist. "I didn't go to the meeting last night, because I saw they were going into executive session, but then they didn't."

Arias said the need for the full-time oncologist is "there."

Commissioner Alicia Edwards said the agenda listed an executive session, but the board members removed it at the beginning of the meeting.

"My contention is that it could have violated the Open Meetings Act, because, in my opinion, it wasn't advertised as it went down," Billings said. "I would have liked to have been there."

Attorney Abigail Burgess said she thought it might have been recorded.

Billings said he read the legal notice and the executive session at the beginning kept him from going.

"I apologize for any confusion," Arias said.

Arias turned the podium over the Richard Stokes, new chief financial officer.

"I completed my move from Texas yesterday," Stokes said.

He gave the statistics for January 2018. "We had 210 admissions, 30 more than the same month last year, and above budget, which was 197. Our out-patients were 3,740 as compared to 3,986 in January 2017. But we exceeded our budget which was 3,400 visits for the month. We had 1,452 emergency room visits, 110 above last year, and exceeded our budget of 1,375. Surgeries were 416, 78 above last year, and above our budget of 361. Our patient revenue was $17,891 million, $439,000 more than last year. That was a bit below budget of $18 million for the fiscal year. Excess revenue or profit for January was $202,000, compared to a loss of $309,000 last year. Fiscal year to date, we have a loss of $4.2 million compared to a negative $6.2 million for the previous fiscal year at the same time. A little better than a $2 million improvement over the past 12 months."

"We have 43.3 days of cash versus 76.8 last year," Stokes continued. "I've been here about a month. JoBeth Vance is still here for the transition. She's been working on special projects and handling day-to-day activity. I've been taking a deep look into the revenue cycle. It's my responsibility to have a smooth revenue cycle. I want to initiate activity to increase cash flow. We've done a supply evaluation to cut costs. My goal is to reduce patient cost by $100 a day. Starting Monday, we initiated an optimization review of the computer system. It's time to bring someone in to review how data flows through the system. The data flow is good, but there are problems in the revenue cycle. It will take three to four weeks to give us a roadmap on how to improve. We are developing benchmarks within the next 30 days."

Commissioner Harry Browne asked for clarification that the year-to-date terminology meant from the beginning of the fiscal year. "Is the supply cost benchmark adjusted for small rural hospitals?"

"It is based on number of beds size and the gross revenue and rural," Stokes said. "The company we're using specializes in rural health care."

Browne asked who is doing the evaluation of Meditech 6.

Stokes said, to date, the process has been a targeted approach to fix targeted items. "When I first got here, I started asking questions about who was doing what work. I have worked with a company that are rural health specialists with deep experience. They are giving us an umbrella look at the revenue cycle. We need to improve net revenue. Finance is the revenue side of the clinical operation. They understand how Meditech should work, instead of how it's working."

Edwards said she likes hearing and seeing the report. "It's refreshing to hear a clear report, and it's refreshing that you are setting benchmarks. Things I've been hearing about Meditech is that after investing money in it, it cannot be updated other than by customizing it. Typically, software has iterations. Is Meditech 7 next? Can we upgrade to version 7 without a repeat of these issues?"

Stokes said Meditech is used in hospitals from 10 beds to 500 beds. Meditech works, if it's built correctly. "I realized there were issues with the build of Meditech. This company can make significant improvements. We have an update that we have not installed, but I will start installing it. As Meditech releases upgrades, we will update. The problem with Meditech 6.0 was that it was a hybrid of old and new code. Version 6.1 was primarily new code within the past five years. It will be at least a decade before it is completely rewritten. As it exists today, as long as we have sufficient hardware, we can update it."

Arias shared: "In January 2017 had an almost $309,000 loss." "In January 2018," Stokes continued, "the hospital had a $202,000 profit. That is almost a $510,000 swing."

"The point is that in January 2017, our Cancer Center was running full," Arias said. "During that time frame, monies were not coming to our hospital. Now we are doing the billing. Now we are doing the collections. We pay for a contracted service for physicians to come here, but that money is coming back to the hospital to reinvest. Although I know it's very tempting to look at a broad topic and make assumptions, when you dive into the detail of it, which is not the burden you ought to have. That is our burden. You start tweaking out the business of health care, whether service line, products, that's when you start making the significant changes that need to be made. I wish history were different. History is fraught with errors. When we make mistakes, we learn from them and do not repeat them. That is where the growth is. Our hospital is in the growth mode and that's where we are."

Edwards said she appreciated the comments about growth. "Let's talk about the report we got today; it was more information than we got from the hospital during the first eight to nine months of my time on the commission. I agree with you diving into the weeds is your job When communication is not happening, assumptions happen. But we want and need more information. Going into more depth, such as what you have done today, is important and appreciated. It is very important to keep the lines of communication open between the hospital and the commission."

"I totally agree with you," Arias said. "The first seven months of my tenure have been a bit on the rough side. It takes a while understanding and learning about how things work, and you see things that aren't there, but when you explain things, we can understand, attack and fix. Things have not been smooth sailing. I think the most recent meetings of the Board of Trustees and the leadership team have had with the commissioners, we are all appreciative of the jobs we all do. Not just my job and Richard's job, and your jobs, as long as we have the deep appreciation of our deep responsibilities, and we do try to communicate, we can make something so glorious. When we isolate and silo ourselves is when things start cracking."

Billings thanked them for their report. "We truly appreciate the information."

Commissioner Brett Kasten moved to have the proclamation for the wrestling team be moved up. It was seconded and approved. Commissioner Gabriel Ramos read the proclamation. Photo can be seen at http://www.grantcountybeat.com/news/news-articles/42801-grant-county-commission-holds-work-session-march-6-2018-part-3-review-of-the-regular-meeting-agenda-and-county-officials-reports

Ramos said the sport takes dedication. He told the students: "Take it with you for your everyday life."

In public input, Nick Sussillo, Silver City resident, discussed the proposed Holloman Air Force Base over flights of the area. He said he has two relevant experiences. He is a former Air Force officer, assigned to the Aeronautical Systems Division at Wright-Patterson AFB in Dayton, Ohio, from 1968-72. "Second as a volunteer for the Silver City Fire Department form 2013-15, I assisted in the development of a draft Community Wildfire Protection Plan for Silver City and the ETZ. These experiences have led me to believe that it's OK to say no to the Holloman proposal."

He said as part of his Air Force job he recorded flight test data for the evaluation of new airborne systems and to elicit feedback from flight crews. "In doing this, I flew more than 30 missions in four years with the training crews of Tactical Air Command's Training Squadron. It taught me that training is not only important, it is essential. At the same time, there are appropriate areas over which to conduct combat training, but not over town, county, forest and wilderness."

Sussillo continued that the use of flares is an important countermeasure against enemy infrared missiles. "But the use of them over the Gila seems to fly in the face of the following: The dryness of our weather and the fire vulnerability of our vegetation; the 2012 Whitewater-Baldy fire that burned nearly 300,000 acres in the Gila, a state record; and accidents with flares can occur, resulting in ground fire."

He said some may see opposition as unpatriotic, but "in my opinion the potential price to our county is too high. … Since Holloman has another option called Alternative 1, I believe that our responsible position is to say we support F-16 training, but not here. It is OK to say no—and still be patriotic."

Patrice Mutchnik, a resident of Gila Hotsprings, thanked the commissioners, "who have been listening to us. The Commission is instrumental in making this afternoon's meeting public. My sentiment is that this is something the community can come together on. We really do believe that you commissioners have the health and safety of the county in mind. Might it be possible to address what is common among you as either a resolution to support the residents or to articulate the concerns? The idea is that the voice of the County Commission won't matter. It might be true, but you do have influence with our congressional delegations. I urge you to work together to articulate your concerns."

Peter Russell, resident of the Gila Valley, said he, too, was there to talk about the Holloman proposal. He handed out a map with Alternative 2 and a chart of decibel levels of activities in Tempe, Ariz.

"I have concerns about the noise," Russell said. "With 10,000 sorties, 10 percent supersonic and half at night, no one will sleep. At 500 feet altitude, a jet flying over at 500 miles per hour will create noise at 103 decibels. A fire alarm is about 100 decibels; a jackhammer is more. Thirty times a day and 30 times at night, it jolts you every time you hear it. The noise has debilitating effects over time. At the last meeting the citizens of Alamogordo said the sound doesn't last a long time. The average background noise is not what you hear, but you will hear this every time. It doesn't quit."

He said the Air Force actually recommends such training be over water, and when it's over land it should be at more than 30,000 feet altitude.

On the Gila River, in the middle of the MOA (military operations area), Russell said the decibels are at 20. "Imagine 30 flights. That's a spoiler of the peace and quiet. Our job is to tell the Air Force why we don't want it. Tell them our concerns."

Allyson Siwik, executive director of the Gila Resource Information Project and the Gila Conservation Coalition, said: "I want to express my sincere appreciation for your pushback to the Lt. Governor. The Air Force has not made its decision. It is in the early stages of the environmental impact statement. Right now, the Air Force is collecting information. The F-16s are not a done deal. From our perspective, it would be naïve to compromise since we have little information. Silver City was left out of the scoping. As you heard described, this is the time the Air Force is gathering information. Make our thoughts known on noise, wildfire, peace and solitude, outdoor recreation. They have to understand our needs."

Susan Beck, a retired Air Force colonel who served twice in the Secretary of the Air Force's office, encouraged looking at Holloman's alternatives. "Any way, I can help with my expertise in having Holloman move to another area, I will be glad to help. I'm trying to get up to speed as quickly as possible. I am meeting with Allyson after this meeting."

Lorna Rubelmann of the Great Old Broads of the Wilderness, said her previous husband was a flight surgeon. "I have membership in the community. I have a background in public administration and organizational development. I volunteer now. As we know and have learned how important it is to include stakeholders and to open meetings to the public, you have done that remarkably in this situation. My comment on the Gila Region is that they are finding out how important it is to include you elected officials and the community."

Dan Otero, Hidalgo Medical Services chief executive officer, gave an update on three topics. "With the senior centers, we had concerns with funding, but they were mitigated by the Legislature and by hard work of our staff. We want to make sure we get the facilities up to Area Agency on Aging standards. We are continuing to work on that. The demands of the senior community are to provide more social programs. For congregate meals, we have doubled our numbers, and our delivered meals have exceeded our expectation. Transportation is also exceeding our contract. We have doubled those numbers. We submitted to the Freeport-McMoran Community Investment Fund a grant to support the additional costs. It has had a financial impact on HMS. We will get a report on how HMS has taken on and exceeded the contract reimbursements."

He said HMS is also working with Healthy Kids, Healthy Communities on an intergenerational garden project. "Our projections are that we have spent $50,000 more than the AAA budget. We will share that information when we have it, probably next month."

Edwards said she appreciated HMS's commitment to the senior centers.

"On another topic, Dr. Bowen and I have been working with the Human Services Department on the mental health New Mexico Carelink NM. It is funded by Medicaid, and we were selected recently as one of seven in the state to be a Carelink New Mexico home," Otero said. "It's a combination of chronic health conditions and several mental health issues. It's a two-county project in Grant and Hidalgo. It's a two-year project but can be renewed. We were selected because we have taken a lead on mental health issues."

He also reported on the Tu Casa substance abuse treatment facility under construction. "It is just about completed. Our original opening date was April 1, but we've been told by the state we can't get the license to operate it until at least June. Other licenses follow, so we now have an opening date of July 1. A big part of the challenge is getting money from the state for detox services. It will give us additional reimbursement."

"The final thing for Tu Casa is staffing with qualified medical practitioners," Otero said. "Our maximum number is 31, but we need 21 to safely open the doors. We want to make sure we can recruit individuals to the staff."

Edwards asked why the delay in the license.

Otero replied that the Department of Health told them they couldn't get it done before June 1. "We wouldn't have been able to find 21 staff before April 1 anyway. We need physicians, nurse practitioners, and we will also contract with psychiatrists, nurses and mental health providers of which there is a shortage all over the country."

Edwards said: "We need to make Grant County as attractive as possible. There are not a lot of nurses with behavioral health substance abuse treatment background."

Otero said Western New Mexico University does train a few, with Jim Helgert as instructor.

One of the items on the agenda was to appoint members to the Tu Casa Advisory Board. Each commissioner named the ones he or she supported.

Browne said the board should decide how to divide up the three-year terms so there was overlap. Billings noted that only one peer consumer had applied, so they needed to go out for applications again.

Ramos chose as at-large members, former Commissioner Ron Hall, who was instrumental in getting Tu Casa started; Susie Trujillo who has also been involved with the process; Mike Carillo, involved and Detention Center administrator; and Sylvia Madrid, who works in the mental health field.

Kasten said he agreed with Ramos, with Hall first, Susie second, and Carillo. "My only variation is Ray Goellner, who has a pharmacy background."

Edwards agreed with Ramos. "There are people on this list who have given hours to the project. But there is some value to nominate those who were not involved to bring a new perspective. My choices are Carillo, Madrid, Hall and Emily Pollom, who would bring a very different perspective."

Browne chose Hall, Susie, Carillo and was intrigued with Pollam.

Browne had kept a tally and said; "With Hall, Susie Trujillo and Carillo being agreed upon by all, Madrid had the next highest number of nominations."

Ramos noted that a "lot of good people were interested. We may consider adding two more positions."

Edwards said the level of interest was "fantastic with this many applications. I thank all those who have worked so hard on the process. I would have liked to appoint them all."

Other agenda items were covered in an article: http://www.grantcountybeat.com/news/news-articles/42801-grant-county-commission-holds-work-session-march-6-2018-part-3-review-of-the-regular-meeting-agenda-and-county-officials-reports

Elected officials gave reports at the end of the meeting. Sheriff Raul Villanueva said: "Business as usual. We are keeping up with the work load. I'm proud of my staff and I acknowledge their work protecting citizens."

Assessor Raul Turrieta congratulated all those who had won municipal elections the previous Tuesday, including Villanueva for retaining his position on the Bayard City Council. "We are interviewing for a temporary appraiser position. Our department got evaluated this week. April 2, we will mail our tax valuations. We ask the property owners to look at them closely. I met with the Trails Group, and Mischa (Michael Larisch, county planner and economic development director) gave input." Turrieta announced that he will file for re-election on March 13.

Treasurer Steve Armendariz said his office has collected 63.58 percent of taxes due for 2017. "We have collected almost $8 million in taxes for the county, with $2.2 million left to collect. In the past month, we collected $52,000 just for the county."

He commented on the presentation on bonding [which can be read at http://www.grantcountybeat.com/news/news-articles/42785-grant-county-commission-holds-work-session-march-6-2018-part-2-and-the-presentations ].

"I think he's optimistic about what our county excess revenue is," Armendariz said. "We still have some debt, about $740,000. We have $400,000 in payments through 2023. I recommend caution at going over $6 million. The last bond issues haven't been expended completely. We have $500,000 left for ongoing projects. I'm not saying not to go out to bond, if you have projects in mind. I think you stand a better chance at approval if it's for $6 million."

Browne said he had questions for the bond presenter, Mark Valenzuela. "I thought the reason was to stave off the Department of Finance and Administration reducing out mill rates and that we should pay down our debt, so we can start again. It's always easier to explain a level rate."

Armendariz said the county had just paid off it 2005 debt. "In reality, we're paying out what's coming in for debt service. Our reasoning for the excess was in case of anything happening in the economy to be able to continue paying off our debt. We have just enough cushion to keep the DFA from messing with us. If we do get the $6 million, it will keep the DFA away from us."

Billings said he thought the commissioners should talk more with Valenzuela.

Ramos congratulated Villanueva and to all those who ran and won.

Browne said he would attend the Democrat Party state convention and support Michelle Lujan Grisham for governor and Howie Morales for Lt. governor, as well as Xochitl Torres-Small for congressional District 2, McCamley for auditor, and Fishcmann for PRC commissioner.

He also announced a rally against the proposed Holloman Air Force Base training flights at noon before the 1 p.m. meeting.

Ramos announced a Tardeada fundraiser for Morales on March 11.

Kasten talked about the GRMC position statement to remain an independent hospital.

"My comment is that the statement was no surprise," he said. "However, the timing did surprise me. It came just as the site visits are beginning. Why do it prior to knowing if anyone is interested in buying the hospital? The board has made its decision without having all the information. I admired the resolve to be independent, except they told me they could remain open-minded. The county will continue to explore options and give updates. At the end of the process, we may have the same resolution. A couple of groups have already visited, and we are anticipating more site visits this month into April."

Billings said the county has to determine its needs before asking for more money from the taxpayers. "I'm happy the asset management plan is in process. A big part of the asset plan is the almost 700 miles of roads. Roads that get fixed are when the community squawks. I prefer a process to address roads that might need fixing. I think people who live on dirt roads would agree with spending more money. I also acknowledge the county manager and the airport manager, as well as Boutique Air. I hope that service continues to work as well as it does now. We had 11,000 enplanements in 2017. We need at least 10,000 this year. Boutique continues with the fewest cancelations and delayed departures. If we start having more of them, people who are using it will start driving. We except the same service in 2018, as in 2017. I would like to see regular reports from the airport manager."

County Attorney Abigail Burgess asked the commissioners to have their professional photos taken before they went into executive session.

This is the final article on the Grant County Commission work and regular meetings March 6, and March 8, 2018.