By Mary Alice Murphy

The safety moment at the Gila Regional Medical Center Board of Trustees meeting on Friday, March 29, 2019 addressed a notice that the hospital has posted in various locations throughout the facility.

Chief Executive Officer Taffy Arias said that nationwide hospitals are making these announcements.

It states that abuse of or interference with medical personnel will not be tolerated.

"I would also like to recognize someone who was called into the ER," Arias said. "The doctor on duty did not have the skills needed for the emergency that came in. We called in Dr. (Okay) Odocha and he came in willingly and treated the person successfully."

In public input, Chris DeBolt said, as a result of her work with health councils in southern New Mexico, she has become aware of the No. 1 issue with the populations served by the councils. "It's self-harm and suicide. In addition, health care practitioners have a high rate of self-harm and suicide, including nurses, doctors, physician assistants and nurse practitioners. One of the things that comes up is the passion to help human beings when they are at their most vulnerable. They want to have autonomy to take care of them the best way they can. Their intentions meet up with insurance and regulations and consequently they are in conflict. The discussion uses the language of war, such as being on the front lines. The conflict causes what is called moral injury. They can't reconcile what they have to do in today's medical industry with what they would like to do. I have heard medical practitioners call electronic medical records 'glorified cash registers.' We are driven by codes, by reimbursement, by all of these things that get in the way of what practitioners really want to do. A group is looking at health care through the 3.0 lens. It is led by doctors nationally. Too many practitioners hear: 'You are not burnt out.' They use victim-shaming words, such as: 'You're not resilient enough. You need to adjust to reality.' The moral is that it is the same as what soldiers face. Take care of yourselves. Help one another."

Trustee Tony Trujillo said he wanted to comment on DeBolt's efforts in Santa Fe. "She sought money for the Health Council in Grant County, but it didn't get through."

DeBolt said: "But we passed a new law. We'll get the money."

"She takes care of Grant County and the health councils all over the state," Trujillo said.

In board input, Trustee Dr. Victor Nwachuku said: "As we struggle with finances, we need the input of the community to continue to help us fund the hospital."

Trustee Joel Schram read from a prepared statement: "I've served on this board for almost three years now. I am not an expert in health care, but I know how to reach out and engage to learn from others so I can make an informed decision."

He next referred to a letter sent to board members by Trustee Ed Wilmot, who was attending by telephone.

"Ed's letter to us, dated Feb. 22, shows me that he has not reached out to the hospital's executive team to resolve things he feels represent an extreme sense of urgency to publicly challenge the expertise of our executives," Schram read from his statement. "The last I knew Mr. Wilmot has no experience managing a hospital or medical-care facility. And I believe he shouldn't make such broad-sweeping comments, unless he has specifics and evidence supporting these comments, especially in an open meeting. I have five years of experience serving as a hospital trustee, and this executive team is the most experienced and transparent team, I have had the privilege to work with. If Mr. Wilmot cared so much about this hospital, he would make a better effort to know the executive team and share his concerns with them to effect solutions for positive change. Taffy and her team inherited a broken system in need of repair. This was clearly a good-old-boy system that was self-serving, making decisions that cost this institution millions of dollars. Mr. Wilmot, stop trying to micro-manage Taffy and her team. Become more familiar with how hospitals should be run, attend a couple of health-oriented seminars and start making positive contributions to the future of the hospital that you claim to care so much about. If you don't want to make this effort, then step down as a trustee. Don't contribute to the forces that could take us back to where we were."

Trujillo said he also had the letter pulled up. His recommendation was to put Schram's comments in as part of the minutes. "My only concern when I read Mr. Wilmot's letter was to leave it as is. It would be difficult for me to leave it, as a trustee and not respond to charging me that I am potentially creating an unhealthy work environment for employees and the way they are treated, that I'm creating an integrated risk facing the hospital. Those types of allegations being put into the minutes could put this board into an unknown situation. I want to challenge Mr. Wilmot's letter and say that it does not belong as part of a public record. I know it is, but those were not true comments that were alleged in that letter."

Wilmot replied that he did write a confidential letter to the board that he felt was ignored. "I think it is urgent to talk about these issues. I ask you to review the confidential letter passed out to you. Maybe there are some misunderstandings. I would like to thank Dr. Nwachuku and (Trustee) Jeannie (Miller) for their extra efforts over the past few months and for their leadership in getting us prepared for the strategic planning session. If it's the feeling of the board after we go through the strategic planning exercise that I am not a good fit for the board, I will ask the commission for permission to resign. I apologize for not being there today, but I have a health issue keeping me at home. My not being there is not for lack of concern for the hospital."

In reports and updates, Jennifer Yost, Auxiliary president, said she did not include in her report for the packet that several auxilians attended the District 4 meeting at Memorial Medical Center in Las Cruces on April 12.

"Our volunteer hours are down a little; our membership is down a little, but we have four or five in the pipeline," Yost said. "We have revised our application for auxiliary membership. It has a lot more detail on what we have to do for Human Resources, fingerprinting and such. We have more associate memberships, as several of our men and women have had hip and knee replacements. Our membership is aging. The most recent wish list of equipment is in the process of arriving. The language cart is already here. We will have two fundraisers in April, a scrub sale and a bake sale before Easter."

To a question about types of membership, Yost said the Auxiliary has regular members, MAP (medication assistance program) members and associate members. She said the MAP members give people help with their medications.

Miller asked if the hospital has a system for translation? "If someone walks in, do they speak into something and it gets translated?" Yes, the hospital has such a system.

Chairman Mike Morones admitted he has little knowledge of how to get around the hospital. "I cut my finger and needed stitches. Without the auxiliary, I would have had no clue where to go or what to do."

To a question about whether auxilians work on the weekends, Yost said they do not. "But we have hired a man to help on busy weekends, such as the Tour of the Gila, to be here part-time. The reason we don't staff on weekends is that it's a matter of finding enough volunteers."

Allen Townsend gave the GRMC Foundation report. "We are getting the golf tournament together for June 1. We will have a meet-and-greet committee for Hospital Week when we get it together. We are currently looking for a Foundation coordinator. We got a bomb threat through email—a threat to the hospital. We reported it. We were down a couple of members but got a couple more through Joel. We have a lot of active members this year."

Arias for her report pointed out a couple of attachments to her report. "One is a Cancer Center volume report and the other is a recruitment update."

Miller noted that the hospital held a trauma meeting. Arias said it brought in hospital representatives from throughout the region.

Chief of Staff Dr. Brian Robinson pointed out that the closest high-level trauma center is in El Paso, but there are other levels in Las Cruces.

"We talked a lot about transportation issues," Arias said. "The meeting was well attended."

Miller said GRMC has hosted that meeting and the consortium on the border health issues. "We're being active with good work going on. I saw in the Cancer Center report that we are getting about eight referrals weekly from outside the region. Are they coming in to see our full-time oncologist?"

"Yes," Arias said. "When they come here, they become our patients. They establish treatment with us."

Miller asked about support groups that used to be connected to the hospital.

"Now that the Cancer Center program is developing again, we will hold those groups again," Arias said."

Interim Chief Nursing Officer Kelly Rodriguez was not present. Miller said she was impressed with what was going on.

Arias agreed and said: "Every day we have new opportunities. Some of our international nurses are coming in. It takes a couple of weeks for them to get social security numbers, settled into housing and driver's licenses. And they will be ready to go soon."

She also answered a question about the interns. "Interns become permanent staff."

Miller said she had other questions she would pose to Rodriguez.

Chief Quality Officer Tanya Carrasco was also not present, but Denice Baird of the quality office stood for questions. "We haven't had a risk manager for a long time before we hired Angelia Peyton. She works hard to assess risk to the facility, as well as financial risk to the facility. She also works hard to protect the nurses and doctors in the facility and their documentation, as well as working on education and policy. We recently purchased a policy module. It will be managed online. It will be searchable. It is set up so it will send out reminders to the policy owner to review it periodically. The critical part is to make sure that attestation is made to show the reminder was read. It's about a 16-week implementation and we're about three weeks into it. We have already uploaded a lot of our policies. We're very excited to have that."

Chief Financial Officer Richard Stokes said part of the conditions of participation is ready access to the most current policy. "When you have a manual system, as we did, it's typical to have various versions of the same policy all over the place. This module will allow staff to have immediate access to the most current policy. For compliance, it will be a nice asset for the organization."

Trujillo said he used to spend a lot of time with risk management at the mines. "Does it help the hospital insurance?"

Stokes confirmed that it does. Arias said that Peyton is also looking a real time risks on the floor, so it is immediate. "She has found some openings in our process that could lead to high risk. We also do thorough risk analysis throughout our various departments at different times during the year."

Nwachuku asked about access to the policies. Baird said there is a link to the actual software. Nwachuku said everyone should be informed about the new software. "The nurses and physicians may not be aware of it."

Arias noted that when uploading the policies, they found many antiquated policies.

Schram said he hoped it was a good solid vendor. "Please make sure it has been well vetted."

Arias said the IT Department and its head, Ken Stone, "are very into vetting vendors and software."

Stokes echoed that and said "Ken is very involved in vetting vendor security protocols. It's part of our evaluation of vendors."

"Our policies are already on our Intranet," Stokes said. "You can access them from any device with the correct credentials."

GRMC Marketing Director Doug Oakes gave his report. "It's in the packet."

Miller said she was looking at the Sleep Center on the website and couldn't find information.

"It hasn't been updated yet," Oakes said.

Arias said the marketing campaign is doing specialist services right now.

"I had an opportunity to hold a physician's talk with Dr. Robinson," Oakes said. "We will do it with the Daily Press on a monthly basis. We are continuing to promote our service lines. I believe engaging the community will be good for the hospital and the community."

Miller asked where the two billboards are that are mentioned in his report.

"We have two billboards on the highway in Deming, viewable from whichever direction the driver is coming," Oakes said.

Nwachuku said he hoped Oakes could promote all the physicians.

"We don't promote individuals, except in articles," Oakes said. "We have to be careful from a compliance standpoint. It might cause issues. For instance, we can't list phone numbers. I work with a professional photographer I have worked with for about 20 years."

Miller said the pamphlets she has seen are "cool."

"I'm trying to roll them out across all service lines," Oakes said. "We have great media support here, from radio, the Daily Press and the (Grant County) Beat."

Miller asked if the hospital could underwrite on NPR. Oakes said he would have to go through a process and hasn't gotten to it yet. "There are a lot of areas that we need development in."

Trujillo said: "If we don't tell our story, no one else will. You're doing a great job."

Oakes said the podiatrist Dr. Iwaasa has been extremely busy due to the ads about his services. "It may take a while to see growth overall. I got responses to the new logo signage package. We only got one bid. I want the most effective, high-quality signage for our hospital. I will go over it with Taffy next week."

Stokes noted that if a person enters credentials into the Intranet from a remote device and is not in the active directory, he or she will be bounced away from the site.

He then presented his financial report for February. The excess revenue over expenditures for the month of February 2019 was $29,529, added to last month's $3,000 plus gives a total of $32,560 excess revenue over expenditures for the fiscal year 2019, as compared to last year's deficit of $1,158,576.

This February's EBIDA (earnings before interest, dividends and amortization is a positive $1.9 million. Stokes said EBIDA is basically cash flow.

He reminded the trustees that the unbilled on the report is not actually unbilled but is a factor of the Meditech process of reporting. Cash collections are at 31 percent and cash to net revenue is at 101 percent.

Stokes described the Experian Health patient access solution as a vastly more competent solution than what the hospital is using at present. "We did a test run with the Meditech ambulatory system. According to the vast majority of feedback, the staff sees the value but is not looking forward to the conversion. But compared to what we did last year, it won't be as significant a change. It will be a solution we ride on as long as we have Meditech. It will allow us to leverage the existing Meditech programs and we can extend it out to the physician networks. Quadax is moving along to the next level of opportunities for contract compliance. I will bill Blue Cross Blue Shield and we can determine if when we receive the check if it's the right amount. We will look at Medicare, Medicaid, Blue Cross Blue Shield and United. Quadax will actually tell us before we send the bill and will alert us that we are undercharging for the product. It will bounce back to us if we have been underpaid. We can then request a review of the bill through the software."

Stokes reported fewer admissions for February, and that the number of patient days is remaining below four. Emergency room visits increased. Cash collected was $4.18 million."

Morones asked if the hospital had heard from the New Mexico Finance Authority on the financial requests approved at the legislative session, but that are still pending the governor's signature.

"I attended a meeting with them yesterday," Stokes said. "I answered their questions. And there were questions. All of our requests have been approved by NMFA. We have to map out the financials. We will receive $2.5 million for the PET scanner, $90,000 for the chemotherapy room renovation and $860,000 for our IT replacement. They asked me about that amount for the IT equipment. Just to replace our current structure would cost us about $1.2 million, so it is cheaper to use the newer technology. We have approval, but it will be decreased by whatever amount is in the cigarette stamp tax fund and the rural cancer center fund. We will be taking out about a $2.5 million loan, but the legislation will allow us in the future to service the debt from the cigarette stamp tax fund. The cost of the IT equipment loan will be repaid out of our revenue."

Miller said once it is worked out, the hospital will not be taking out a more than $3 million loan.

Stokes confirmed that and said it would be more along the lines of a $2.5 million loan. "But we crafted the legislation, so that in future years we can access the cigarette stamp tax funding to service that debt."

Wilmot asked if anyone from the board had talked to the editor at the Silver City Daily Press about the inflammatory headline alleging that the hospital was taking out a huge loan. "It made it sound like it wasn't as good for the hospital as it should have been."

"We had a conversation," Stokes said.

Geoffrey Plant, the Daily Press who wrote the article, but did not create the headline, said: "Commissioner Harry Browne got back to me that the amount of loans indicated a high level of confidence for investors."

Stokes said even once the loans are executed, the hospital has not maxxed out its borrowing capacity.

Morones noted that bringing in a mobile PET scanner on a regular basis is a cost that will not be borne after the purchase of this combination PET/CT scanner. "We want to make sure the service is more accessible."

Stokes said once the scanner has arrived and training on it is complete, patients needing the scans will be able to get to treatment, including cancer treatment, more quickly. "Having the combination PET/CT scanner also gives us redundancy. A lot of the scans come through the ER."

Arias said the prices of such equipment are high. "It needs to be used as often as possible. When our current CT scanner goes down, we have to transfer people out. This redundancy will help us with that and with patient flow."

Miller asked if the scanner would be brand new, to which Stokes said: "Yes, ma'am. The expectations of the Finance Authority is that anything purchased will be new equipment. It will follow the capital acquisition process."

"I just want to say how much Gila Regional appreciates Mr. Stokes, as well as Tony and his wife, Susie, for battling for our facility and this county," Arias said.

Robinson gave his chief of staff report. "We have 114 members on our medical staff. About a third of those are telemedicine. The Credentialing Committee report will be done in executive session. The Ongoing Professional Practice Evaluation Committee is going through a restructuring, as well as new bylaws. Delicia (Dimberg) has made the continuing medical education get through an enormous restructuring process."

Miller asked, when it talks about the documentation requirements, if Meditech has it standardized.

"It's a point and click or dictate process," Robinson confirmed that it is accomplished through Meditech.

Miller asked if it was strictly for inpatient procedures.

"I'm not an employed physician of the hospital," Robinson said. "I don't think Meditech has been implemented in the physician clinics. So, unknown is my answer. Right now, I know we're using it for surgery inpatient services. The code is different for outpatient services."

Wilmot said he had found a typo. He said he found where an internal memo should perhaps be removed. Dimberg agreed that it can and should be removed.

Morones gave the Executive Committee report and said the members created the agendas for the various committee meetings and the regular meeting.

Miller presented the Quality Improvement Committee report. "It's amazing how active everyone is and how everyone works together. Quality drives finance. We are working on letting the community know how to recognize heart attacks. We talk a lot about the culture of safety. Teams are looking at a Good Catch program. We want people to understand that safety is important. People need to recognize when things are not working right and that they should report it. It's rather interesting that a lot of multi-disciplinary siloes are falling apart."

Schram presented the Finance Committee report. "We had a good discussion on the current state of finances."

"We are very close to signing a contract with Western Skies," Stokes said.

Schram said the hospital is also close to a contract with the auditor and will be allowed to keep the same one this year, and he is familiar with the hospital.

"We put a lot of stuff on Excel," Schram said. "That leaves a lot of room for error. The Axiom solution will help us get more accurate information."

Several contracts were up for approval. They included a12-month employed physician agreement with cardiologist Dr. Norman Ratliff; a 12-month surgical services provider employment agreement with Dr. James Rosser; a 12-month employed nurse practitioner agreement for Deming with Certified Nurse Practitioner Diana Portillo; a 12-month employed pediatric physician agreement with Dr. Lindsay André Worrell; a 12-month agreement with Dr. Donald Stinar to serve as medical director for the cardio/pulmonary department; and a six-month agreement with Dr. James Lawyer as medical director for anesthesia services.

Nwachuku said physicians and surgeons are concerned why the anesthesia director is not in house.

"The provider must have qualifications," Arias said. "This is what was given to me from quality and compliance. There is an out clause."

Robinson noted that it said recommended, not must. "The other side is that the hospital has multiple directors. We were talking with the insurance company and a woman said it did not have to be a physician. We're talking about saving money and optimizing things, and now we're talking about a six-month contract? That's unbelievable."

"We will be looking at it, but we needed someone in place," Arias said.

Robinson said he would like to see the documentation and that he disagreed with the decision.

Morones said: "So we have six months to hash this out." And Miller asked if it was discovered that the position did not have to be a physician, the out clause could take care of it. "Yes," Arias said.

Trujillo asked that it be reviewed and presented at the next meeting. Arias agreed that it would be.

Morones agreed that it was important to have directors on site.

All agreements were approved, with Nwachuku abstaining.

Robinson said the hospital has had medical directors that were not paid. "It's changing times. If a medical director of anesthesia, for instance, is not an anesthesiologist, that person does not have to be paid. That's the choice of the hospital to pay or not."

Stokes noted that the employment contracts just approved were for one year, but they do have renewal clauses for up to three or four years.

Miller gave the Plant and Facility Committee report. "We had robust discussions. We know when the roof project starts, we will have to track it. We were told about the Southern New Mexico Health Care Coalition, and we are considering joining it, because during disasters and such, they come together and share supplies and equipment. There was discussion about the bomb threat and how it was handled very well and how well all the parts of the organization and outside agencies worked together. The notices about not tolerating abuse or interference will be placed in frames, so they are not ripped off. The whole collaboration across departments is working well. Nothing can happen without it."

The Human Resources Committee will meet next in April.

Morones noted the dashboard illustrating the numbers at the hospital for January and February.

Nwachuku requested information on the traveling nurses and the changes they will bring.

The trustees, after a short break, went into executive session.

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