[Editor's Note: The Grant County Commission combined work session and regular meeting of Sept. 18, 2018 will be covered in a multi-part series of articles.]

On Tuesday, Sept. 18, 2018, Grant County commissioners at their combined meeting heard first the Gila Regional Medical Center monthly update.

GRMC Chief Executive Director Taffy Arias said she is excited about the several initiatives the hospital has embarked upon. "The Patient Experience program improves every touchpoint a patient has with a caregiver. To the patients, it's what they consider as quality of care. What they understand is the care that is given at a touchpoint. It involves every employee in every department. People have a choice where to receive care."

She said the hospital has also been recruiting. "We have an offer out for a surgeon. Two more are coming to interview. We also have an offer out for a full-time oncologist and two more interviews. We are seeking four more nurse practitioners for the clinic expansion. We will have a new podiatrist at the end of October. We have already announced a salary increase for bedside nurses. As of this week, we are moving to increases in another department—the environmental department. They are very important to the cleanliness of our hospital—our housekeepers and those who wash the linens. The raises are up to 7.5 percent. How could we not give increases to show how important they are? We will continue looking at increasing salaries."

Chief Financial Officer Richard Stokes said in July, the hospital lost $514,000. "To put that in perspective, last year for the same month, we had a $1.557 million loss, sowe have made a $1.043 million improvement on our operations. We had a census issue in June and July, but the trend has been reversing. For July we had a $112,000 loss for our EBIDA (earnings before interest, depreciation and amortization). What that means is that we spent $112,000 out of our cash balance. Last year, the hospital had a $1.191 million EBIDA loss."

The unbilled came through the system as $3 million, "but the true unbilled is closer to $1.5 million—which is about what we anticipate per month."

The Meditech update in August "took place one minute past our intended go-live date. We had to prove to ourselves that we could do it on time, and we did. We had several issues, but the vast majority were resolved during the first 24 hours. The last remaining issue was resolved yesterday. We got a code from Meditech to get it solved. We installed a major step up in the pharmacy module, which will increase revenue."

The hospital in July saw 16 fewer admissions, but the average stay dropped from the previous year. Stokes said surgeries were down, oncology visits were up, and births were down. "We collected $4.17 million this July as compared to $3.5 million last year."

In the look ahead, Stokes said it depends on how well the hospital can collect cash. "We had projected to collect $4.8 million in August. We did better than that. We ended at collecting $5.4 million. It shows we are improving the revenue cycle. Internally, we have set goals to have accounts receivable at 45 days. Our goal for cash collections is $6 million a month. We can hit that, but not consistently."

Commission Chairman Billy Billings said in looking at the chart, it looked like oncology activity had a downtrend in July.

"In July, we know that patient volumes are normally down," Stokes said. "The number is back up in August. It might be a blip. For trending data, it will take maybe six months to be able to determine the reliability of data."

Arias said the Patient Experience program should help the numbers. "In the Emergency Department, we are working with Innova, the provider of services. We have a strong relationship, and we are working on the Fast Track for the lower level severity of cases. We want them in and out within 60 minutes. It will be for the benefit of the patients and will allow the ER to focus on the most emergent."

She said the hospital is also working internally to admit people to upstairs rooms that within 30 minutes. "In addition, we are working on the ease of access for outpatient testing."

In public input, Fiona Bailey was the first to speak. She is the assistant principal at Aldo Leopold Charter School high school. As part of the Title I reading program, she works with The Learning Center for Dyslexia. "I brought my daughter and three of my students, all of whom have dyslexia. We use the Take Flight reading program. Dyslexia is not a disability, it's simply a difference in how the mind is wired."

Lorna Ruebelmann, a member of the Great Old Broads for Wilderness and the ACLU, said she was speaking only for herself on an issue that several addressed. "I am here to request that you oppose the construction of a border wall. I'm asking you to help us build our community from one that has become hostile and divisive. I thank you for listening to our input."

Simon Ortiz introduced himself as a former business owner and entrepreneur. "I'm now retired. I'm here because it is possible that Howie Morales' seat will be vacant when he becomes lieutenant governor. I know the Commission is an important part of the nominating and replacement process. I will seek your support as a possible replacement for Howie as senator. If Howie is not elected, I thank you for your attention and consideration."

Joe Saenz, outfitter, said he supports not building the border wall. "I oppose building a wall on what is our Chiricahua Apache historical land."

Rachel Sierra, El Refugio Inc. director, thanked the commissioners for proclaiming October as Domestic Violence Awareness month. "Our public proclamation will take place at 9 a.m. Monday, Oct. 1, at the Woman's Club. We expect different branches of law enforcement to attend. We are happy to report that in Grant County, we had no domestic violence deaths in 2017 and none this year up to now. Domestic violence continues, but no deaths is good. Lives do matter."

Mary Lynne Newell, also of Great Old Broads for Wilderness, said she is the one who asked for the resolution that the commissioners would be considering later in the meeting. "The bottom line is we have environmental concerns if the wall is built. We're part of the environment, too. It will affect Grant County. This area is a gem. We are the lynchpin in the wildlife corridor and genetic diversity. People come here to hike, bike, hunt and fish in the area. There is already a lot of encroachment on the environment. In Grant County, where outdoor recreation and tourism are so important for hiking and fishing, the border wall would cause destruction. Once the populations of wildlife are destroyed they cannot recover. When I first came before you, I had some information I shared. Now we have a more recent GAO (U.S. Government Accountability Office) report to Congress that came out in July. It said for the design and construction of the wall that the border patrol is proceeding without key information and without proper vetting. Thirty laws were pushed aside to make the wall possible. This is what Great Old Broads stand for. Studies should be put in place; are there other alternatives that could be put in place, such as drones or more Border Patrol of the border, which is what ranchers in New Mexico and Arizona have called for. "

She read a quote from the report that said new barriers without cost determination and baseline information on prior barriers will cost more, take a longer time or not fully perform as expected. Without enough information, it could not proceed in the most cost-effective manner. "Our concerns are whether it is needed or will be effective and its impact on the long-term health of the environment. Another report said a border wall will not make us safer and will cause a humanitarian crisis. "

Laiken Jordahl for the Center for Biological Diversity said he would speak against building the border wall. "It will be a disaster for the environment and would be an absolutely senseless waste of taxpayer money. The borderlands are a bridge between the tropical and montane ecosystems. We have many endangered species, including the ocelot and jaguar in the area. A wall will 'undoubtably' affect wildlife diversity. I don't live here, but I come here to recreate because of your incredible diversity. This outstanding diversity will be compromised. It will be a hit to our environment and our taxpayer dollars. Walls do not stop people. A wall can be overcome with a $20 rope ladder. There is no evidence that a wall will keep people from coming over the border. We can agree with the GAO and Steve Pearce that there are better and cheaper ways to stop illegal crossings, without decimating Grant County."

Stephanie Smith said she was speaking on behalf of the Great Old Broads for Wilderness, the Unitarian Universalist Fellowship of Silver City and SEEDS (Securing Economic and Energy Democracy), all of which are opposed to walls for the reasons already mentioned. "We support healthy, strong vibrant communities—human on both sides of the border and wild. Please vote to support this resolution opposed to this sham of a wall."

Charles LeBlanc said he was speaking not as a volunteer fireman, but on behalf of himself. "Every state in the United States that has an international airport has a border wall. Think about that. When you come from any other country in the world, you have to go through Customs. And the reason is to keep our country safe. The only way we can do that is to regulate who comes in and who goes out. We as a country or as a county can say we don't want a wall, because we want people to come back and forth. We don't want fentanyl in our country. We don't want illegal aliens in our country. There is a way to legally come into this country. It's through immigration. I have worked in every country in Central America, except for Costa Rica; I have worked in five different countries in South America; and I have worked in the Caribbean and in Europe, and I can tell you now that every country I have gone into, I had to go through Customs and Immigration, because they want safety in their country. They want to regulate who comes in. They want to keep the bad guys out. I understand the ecological concerns with a border wall. But we have to think about our young people and we have to think about the economy. Out of our economy we have to pay for a lot of people who come here. How does our country continue to pay for a larger and larger Border Patrol? A wall does not require retirement pay; it does not require health care for a Border Patrol agent. That is money we save by having a border wall. That wall will not retire. It may someday be torn down when the problems in Central America have been solved. But until that occurs, we will be paying for more Border Patrol and it is a dangerous job as well. I don't want to see the ecology ruined, but I'm more concerned about our children and the financial health of our country, because we are having to pay out more for the problems in Central America. That is not your problem as a county. Let the governments help fix the problems that are causing a rush of people from Central America. Thank you for your time."

Kathleen Rothwell, a recent newcomer from Florida said she was speaking for herself as an observer, having lived on both coasts and all over the U.S. and in South America. "If it's an economic issue, I want to give you the dire situation of Florida as a border. We have borders, not a wall, but a dam was built across the state, which stopped the natural flows. We blocked water for the sugar farms and for cattle. Because of that we have the, I forgot the term, basically the green scum, which has caused destruction for the animals and for the people. This is a waste of money. A wall is a waste. I lived in Los Angeles for 33 years. The problems are in Central America because we exported our culture down there. I am in opposition to any ridiculous idea that a wall can regulate. We do not keep ourselves safe. I am in opposition to a stupid wall."

The next article will begin to cover the County Commission agenda business.

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