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Published: 31 March 2018 31 March 2018

[Editor's Note: This is part 2 of the GRMC Board of Trustees meeting. It covers the regular business of the board, but also has news in it about recruiting and transparency.]

By Mary Alice Murphy

Board of Trustees Secretary-Treasurer Mike Morones chaired the Gila Regional Medical Center board meeting on Friday, March 30, 2018, in the absence of Chairman Jeremiah Garcia, who attended the meeting by telephone.

Chief Executive Officer Taffy Arias presented the safety moment. "We had a code the other day that came over the public-address system. But nobody knew what it was. We had to educate the staff on what codes we use and what they mean."

When it came time to approve the agenda, Morones requested that item G, revenue cycle contracting, with sub-headings of 1) HRG and 2) Cardinal, under the Finance Committee report be moved to after the executive session. Trustees approved the change.

Morones recognized Interim CFO JoBeth Vance as she attended her final meeting. "We recognize the value she has built. We had so many issues on so many levels, but we are starting to see the dividends of her many hours of work. I, for one, truly appreciate what you have brought to Gila Regional."

Trustee Tony Trujillo echoed the sentiment: "What you have brought us is outstanding. You put out documents that I understood. And the hours you put into the work and your availability were also outstanding."

Vance replied: "I have truly enjoyed working with the good people here. You have an excellent replacement in Richard Stokes."

Garcia said: "Thank you for staying with us and for the hours you put in. You're special and we will miss you."

Trustee Joel Schram said, he as a banker, also appreciates all she has done for Gila Regional.

Trustee Jeannie Miller noted that Vance had done wonderful research into the hospital's issues. "I, in my former life in systems, was always the one brought in to fix things. At a different level, you set the base. I'm excited for you that you get to retire."

Trustee Victor Nwachuku said: "We thank you for your contributions and wish you the best."

In public input, Chris DeBolt said she retired from Gila Regional a couple of years ago. "I want to congratulate the hospital for the remarkable award as one of the 100 best rural hospitals in the country and the only one in New Mexico. I am a proud advocate and supporter of this hospital. Next week, I will attend, from Tuesday through Thursday, the New Mexico Public Health Association annual conference, as it focuses in its 101st year on the theme Public Health 101. Public health is everybody's business." She said workshops would cover many topics, including health disparities, chronic disease and obesity. "The community is getting more and more ill at a later time in life. We are trying to do new things. We're behind in the time frame. Thank you for everything you do."

Morones announced an upcoming change in the agendas for the board meetings. "We want to have trustee comments after the public input. We want to work on being more transparent. There are a couple of schools of thought. Say the legal minimum, and we risk not saying enough and being criticized. The other extreme is say the legal maximum and maybe risk saying too much. I want to say as much as we can. It helps the community and staff to understand our thoughts and motives, as we set out our strategies and plans for the future. I want us to be very careful. Lots of changes have been made and more need to be done, so we have to be careful and sensitive to those that this affects. My biggest concern is employee morale. We, as trustees, must be careful as we move and motivate our staff. We must try our best to maintain morale and build morale on issues we have."

Miller asked: "When we make these comments if we are addressing things that we will talk about in executive sessions, what do we do."

Morones said it will not be a time for discussion and debate. "It's a time to express what we hear from the public."

Miller said she likes the idea. "We have to be aware of what we can say."

Trujillo thanked Morones for giving the trustees a chance to speak. "We all have our daily lives and hear things out there good or bad. Transparency is important, so everyone knows what's going on out there. Going back to being in the Top 100 rural hospitals in the nation, we should be extremely proud. And it's our caregivers whose fingerprints are all over it. We would be nothing without them. We need to celebrate it."

Trustee Dr. Tsering Sherpa, who arrived late, said she thought it was special that Gila Regional was the only rural hospital in New Mexico to receive the award. "It's done by an independent group that looked at quality markers. I say thanks to the patients. Without them we wouldn't be here. They give us good feedback and show us what needs to improve."

Schram said the board and the administration have set forth a plan that will lead to good financials. "We have a good team. It's too bad that there is discussion on the fate of the hospital. I still want to maintain us as an independent hospital and we needs the public's help to do that."

Nwachuku said the hospital has been through tough times, "but we are moving forward. The public needs us to be as transparent as possible to keep the public trust."

Auxiliary President Frances Day gave the first report. "We are not just volunteers. We are part of the hospital. The New Mexico Hospital Association, Auxiliary branch, is hosting a district conference here on Wednesday, offsite. I want to express my appreciation to the board, who are also volunteers as part of the hospital. Some of you have other jobs. I want to thank Taffy for coming to our last meeting. She was open in discussing issues, and she read the board statement and we discussed that. People talk to us a lot—in the hospital hallways, at the grocery store. We hear a lot of questions about what's going on at the hospital. I, too, want to thank JoBeth. We, as the auxiliary, have put quite a few thousand dollars into equipment for EMS. They will demonstrate to the auxiliary some of that equipment in the conference room on Wednesday, April 11. We are processing seven new members and are getting more people interested in volunteering here."

No representative of the foundation was present.

Arias presented the CEO report. "We are looking for a replacement in surgical to take Dr. Friedman's place and we have an applicant for that. We have an ear, nose and throat offer on the table, and he is going through the process. A second ENT applicant is coming in May. In the Cancer Center, we will start radiation the first of May. The end of April the physician will start setting up patients for radiation. We put out an offer for a radiation tech, and he has accepted, so we are fully staffed with two now. We are recruiting for two additional internal medicine, primary care or occupational medicine physicians for the clinics. And we are recruiting for practitioners to help at the clinics. We are looking for a second site for expansion, and we have found a site in a nearby community, which we won't mention yet. And we made an offer to the oncologist who visited, and he will let us know next week."

Trujillo noted that "he is a good one."

Arias said the offer was made by UNM, "per our direction, and we hope he accepts to provide full-time cancer care."

Garcia said he wanted to thank Arias and the team for their hard work in recruiting. "What's really exciting and makes me proud is that these physicians and caregivers are willing to come to work with us. I think they want to be part of a hospital that is in the top 100 rural hospitals in the country and contribute to health care in our community. I appreciate the hard work you're doing. Knowing our vision, I appreciate the due diligence in finding the best caregivers for us."

Morones noted that, even though offers have been made, the hospital continues to recruit, just in case.

Chief Nursing Officer Peggy White said the transition of care program is taking off and is going well. "We are collaborating with HMS and are reaching out to Silver Health Care and other health care systems in town."

White said a software program that provides after-hospital care information for patients when they go home. "We started in surgery and will expand it throughout the hospital. We can add or delete items from it, while staying within the best evidence practices."

Miller also noted a portion that talked about getting the right information when a patient comes in to create a better billing process. "I think it's really important to get it right at the start."

Trujillo asked about traveling nurses. White said the number is increasing, with a need for more in surgery and med surg. "We have 11 now. It's creeping up above my comfort level, but we are addressing it."

Trujillo said Presbyterian has built a new hospital in Santa Fe and held a job fair looking for caregivers. "That will be a challenge for us. We have to figure out how to keep them."

Nwachuku said many of the nurses at Gila Regional come through the nursing school at Western New Mexico University. "How is our relationship with them? If they see us there providing education, it should create a better relationship."

"We got away from it," White said, "But we just hired a new educator, who will work with the university, so we can volunteer and visit classes. We have plans to build the relationship again. Now that Tanya (Chief Quality Officer Carroccio) is here, we will be tight on quality issues."

Miller asked about the Cancer Support Group. "Will there be newsletters to the cancer patients?"

"We are working with Doug (Marketing Director Oakes)," White said. "We've only held two sessions for the support group, so far, but it's expanding. We are facing it aggressively."

Miller agreed that marketing is important.

"Every person in the hospital is important," Morones said. "From housekeeping to administration, they led us to the top 100 rural hospitals. Nursing is at the heart of all we do. I have an appreciation for everything they do. Our resources are so limited, but we will continue to pressure (CFO) Richard to help us keep our nurses."

White said, "aside from wages, we need to show positive reinforcement. We're doing good, positive things. We need to focus more on the positive."

The CFO report was covered in a previous article to be found at http://www.grantcountybeat.com/news/news-articles/43232-grmc-board-receives-encouraging-financial-news-033018

Chief of Staff Dr. Gregory Koury was not present, so Nwachuku asked for changes to policy for resident physicians. "Residents can write orders, but they must be co-signed by the attending physician within 24 hours." Kari Lane explained that it is a Meditech issue not allowing physicians to sign immediately. "Nurses can still carry out the orders."

In board committee reports, Morones said the Executive Committee met and approved the agenda.

Arias interrupted and said she was remiss. "At our last meeting, we announced the Chief Quality Officer, but she wasn't here. She's here today. "Arias acknowledged Tanya Carroccio as the new CQO.

Trujillo gave the Quality Improvement Committee report. "One thing Tanya brings is a lot of new ideas. We will modify our agenda. There is also going to be a survey sent out to employees."

Miller asked if the dashboard is based on the calendar year, "not our fiscal year?" Carroccio confirmed it was the calendar year.

Trujillo said a lot of data shows how the hospital is taking care of patients.

Nwachuku presented the Finance Committee report, which had several contracts to be approved by the board. Four contracts created six-month extensions to physician on-call service agreements.

Schram asked why only six-month extensions. Arias said some may be a matter of not renewing a contract based on negotiations, which might take up to six months. Each extension was approved.

The first was a professional services agreement for on-call specialty service coverage between GRMC and nurse anesthetist Dan Zerger. Four of the physician professional services agreements for on-call specialty service coverage were with Dr. Robert Carreon, Dr. Michelle Diaz, Dr. Victor Nwachuku, and Dr. Nathan Williams. A physician member agreement for utilization review services committee was with Dr. Gregory Koury for two years.

An additional contract extension was addressed by Stokes. "This is our third year with Dinguz/Zarecor and Associates PLLC for audit services. I propose we approve this for the third year. They will be here in August."

Morones noted that the state of New Mexico often puts limits on the length of time that an auditor may serve certain public entities. "But with this complexity, it takes time for auditors to understand. It's not easy to be an approved auditor to provide these services to public entities. The first year, they may see a clean audit, but in the second year, they realize there are systemic issues. As a CPA, I would say we should retain this group. Now is not the time to change auditors. The state auditor oversees all audits of public entities. He scrutinizes the audit we send, and he has to approve the audits. In reality, we are audited twice, once by the auditor and the second by the state auditor."

Stokes agreed and said the auditor for the hospital must be approved on an annual basis.

About the Plant and Facility Committee, Schram said: "We will follow what Taffy said during the safety moment. We are looking at the Behavioral Health Unit and the facility director is reviewing policy for safety. We have safety issues with the roof. We have a three-year plan to address getting the roofing structure upgraded. The total project cost will be about $650,000."

Trujillo presented the Human Resources Committee report and said they didn't meet this month, but the dashboard highlights the overtime and contract labor, which is still high. "But we dropped to $280,000, which is about half what we had in January. We have 433 full-time employees, as compared to 469 last year. We also have to take into account the part-time employees, which equal 633, as compared to 733 last year. The total number leaving so far in this fiscal year is 111, compared to 131 last year. We are trying to do exit interviews. We need to do a better job. We only had 27. The survey may help.

Nwachuku noted year-to-date the hospital has spent $3.4 million on contract labor.

Schram asked White if nurses were leaving because they were uncomfortable with the news of the possibility of the hospital not remaining independent.

'We try to have two exit interviews with each person leaving—one with the director of the department and one with HR," White said. "Yes, some have a fear of what's hanging over us. Some are because of no raises. And families are leaving because the spouse can't find a local job. Yes, there is discomfort in what's hanging over us."

Trujillo confirmed the impact.

Nwachuku, too, said he sees a lot of anxieties about the future. "Are we staying, are we closing, will we be sold?"

The board issued a position statement, which can be read at http://www.grantcountybeat.com/news/news-articles/42791-gila-regional-medical-center-board-of-trustees-holds-special-meeting-030718?highlight=WyJwb3NpdGlvbiIsInBvc2l0aW9uJ3MiLCJzdGF0ZW1lbnQiLCJzdGF0ZW1lbnQncyIsInBvc2l0aW9uIHN0YXRlbWVudCJd , stating their wish to remain an independent hospital. An evening meeting the same day had physicians and other community caregivers chiming in on the issue at http://www.grantcountybeat.com/news/news-articles/42824-grmc-holds-evening-public-meeting-on-its-position-statement-030718?highlight=WyJwb3NpdGlvbiIsInBvc2l0aW9uJ3MiLCJzdGF0ZW1lbnQiLCJzdGF0ZW1lbnQncyIsInBvc2l0aW9uIHN0YXRlbWVudCJd 

The final article will cover the meeting after the executive session, when trustees came out and reported on discussions.