By Mary Alice Murphy

The Grant County Commission met in a special meeting held at 6 p.m. on July 18, 2019, to allow people to attend after work to hear from the final seven candidates for the Gila Regional Medical Center Board of Trustees.

The first item of business addressed the agenda. It was moved and seconded that Dr. Donald J. Stinar be moved to be the first to speak, as he was on call.

Each applicant had 10 minutes to answer five questions given to them prior to the meeting.

Stinar said he has served as a physician in Silver City for the past 23 years. "I've been on the board twice before." He proceeded to address the questions.

The first question asked: What do you think are the most important characteristics of a successful trustee?"

He recommended that any applicant be prepared for "blood, sweat and tears. Being on the board is not a joke; it's not fun; it's work. And if there is any other reason than wanting to help the hospital, there are other things you can do. A trustee should be an expert in something that aids in the management of the hospital, whether it is financial expertise or something related to a health field. You must have the energy and intelligence to become knowledgeable in other fields. The second time I served, I was on the financial committee. I had to meet with the chief financial officer before every meeting. You have to be prepared to sit and read through hundreds of board papers to be prepared. Sometimes, it was obvious who had read the notes and who hadn't. You have to keep up with changes in health care, and be aware of rules that change, so you don't become discouraged… or suicidal. A trustee should have no conflict of interest. For instance, the CEO of another competing hospital should not apply. You should be able to laugh at yourself and be able to forcefully speak out if the hospital is headed toward disaster."

"And the most important characteristic of a board member is you have to care deeply about the hospital," Stinar said.

The second questions was: "Tell us about a time when you had to challenge the prevailing consensus of a group, how you went about doing so and what was the end result?"

He began by saying about 15 years ago, surgeons decided to open their own free-standing surgical center. "Most of my colleagues joined. I didn't join because I said the surgery profits should go to the hospital. The project was later abandoned, because they hadn't planned the facility well, and the hospital built a new surgical center. Another time I challenge the prevailing consensus is now. It seems some think the hospital needs continued scrutiny to the point of unpleasantness. It could make the board meetings negative and is not collaborative. The general feeling at the hospital is that Gila Regional is moving forward. I challenge the concept that this administration requires remedial supervision."

The third question was: "Tell us what you foresee as the role of a community hospital in the health care of the future in the United States?"

"I believe the success of community hospitals was easier in the past," Stinar said. "Some of the physicians' income was dependent on hospital services. Now physicians practice without hospital privileges. The hospital must at times compete with other providers. There doesn't seem to be a movement to keep small hospitals open unless the hospital profits. I think a community hospital is very important for immediate intervention for the poor as well as the wealthy, so they don't have to travel great distances to see a physician."

The fourth question was: "What experience of collaborative leadership do you have and what role did you play on the team?"

"First I had to look up the meaning of collaborative leadership," Stinar said. "It's a process that involves all stakeholders in an issue. Since I was a youth, I served in the Air National Guard – no collaborative leadership; asphalt surface sealing – no collaborative leadership; Camp Dearborn trash pickup – no collaborative leadership; four years in private practice – no collaborative leadership. Now I attempt to include my team members at Gila Regional. Collaboration works well at the hospital now. I think some problems of past administrations, the impact of leadership could have prevented some problems had they used collaborative leadership. It is satisfying to participate in the collaborative process."

The fifth question was: "How much time do you anticipate you will have to devote to the board in order to be a successful trustee and what specific activities do you anticipate spending those hours on?"

"When I first served on the board, the meetings took seven to eight hours," Stinar said. "Then the second time, the meetings were better managed and lasted about four hours. You also have about an hour a week reading notes and an hour a week reading contracts. You serve on a committee or two, which has meetings and you have to read the notes before every meeting. I estimate eight to nine hours per month. I admire everyone who is willing to put in one free day a month to support the hospital."

Commissioner Chairman Chris Ponce noted that Commissioner Billy Billings was absent and had sent his apologies as he was dealing with a family medical emergency.

The second applicant to speak was Cynthia P. Moreno.

"I am a nurse practitioner at Gila Family Practice," Moreno said. "I've been a nurse practitioner for about 8½ years of my 23 years as a nurse. I have spent the majority of my career here in Silver City—21 years. I've worked at the hospital, and I've always been proud to work at our hospital. I've had confidence to send my patients to this hospital and to be a patient here. I've had care at other larger hospitals and I never had the quality of care that I received here. The employees at this hospital, most of them live here and want their patients to feel well cared for and safe. I'm a hospital employee, so I have a vested interest in keeping the hospital strong. I don't feel it's a conflict of interest because it makes me motivated to want to keep the hospital strong. I would like to see the hospital be financially viable, by following a strategic plan to sustain growth and move the hospital forward."

She addressed the first question on important characteristics for a trustee. "In your private and your professional life, you should have honesty and integrity and be a principled person. You need to think independently but be open-minded and be able to work together by being courteous as a listener, not always having your mouth open. You must make others feel they have value and that you bring value. You don't have to be popular, but you must ask questions and stand up for yourself. I believe discretion is an asset. I'm familiar with HIPAA and the need to keep information private. I consider that things on the board may be part of this discretion."

Moreno said she combined questions two and four on challenging prevailing consensus and collaborative leadership.

"I am prepared to serve as part of a team," Moreno said. "What prepared me the most was serving as night nurse at Gila Regional in the ER and on the floor. At night, there is a finite amount of resources. You have to know other people's strengths and weaknesses. When things go down, you have to believe in yourself, be ready to lead and delegate and you must remain calm. You also have to be able to advocate and stand up for your patients, even if it requires calling a physician at 3 a.m. I want to be an advocate for this hospital. I want it to be what the community needs."

On question three about the future of community hospitals in the U.S., Moreno said: "Gila Regional serves a huge geographic area. We have to be at and work with all other entities to reach our full potential. We have to support each other and find common ground."

She said Gila Regional has to be lean as a hospital, but financially viable as an organization, "so we can pull people here. We have to have specialists, such as ob [obstetrics] and pediatrics for families and coronary and ortho for retirees. We have to be able to recruit and retain specialists. We have to provide what specialists need in equipment and OR [operating room] time, for example. We need a good financial plan when we are growing services, so we have a way to get revenue back from investments. The more patient share we have, the stronger we are when we take a seat at the table with insurance companies."

The fifth question asked about time commitment. "I am about to be an empty nester in August, and I'm sad, but I will have time. Any time I spend as a board member is for the community. I am willing to do it as an advocate for the hospital."

Next up was Dr. James R. Skee, chief executive officer of Silver Health Care.

"I've been a doctor here for more than 38 years," Skee said. "I'll address the questions first. I feel every trustee should have four major characteristics. First, a willingness to put in the time and energy, which I estimate at 8 hours a week. It's not just meetings, but also reading and analyzing the packets and sometimes having to ask questions, as well as outside education and reading. Health care is changing so rapidly under our feet. There are new laws, new contracts. When I came on the board before, the hospital had an educational program for new board members. If they don't still have it, I hope it comes back."

He read from a statement about the role of community hospitals in health care.

[Editor's Note: This is paraphrased.]

Community hospitals play a significant role in health care. The future is unknown, but the responsibility of leadership boards is to provide the time and expertise to the hospital with knowledgeable and educated members.

As Skee sees it, the board members should be willing to put in the time and effort and have a dedication to the mission, vision and values of the hospital. "I've seen problems where actions are taken that are against the mission, vision and values of the hospital. Keep the North Star in sight."

He believes other characteristics of a successful trustee include objectivity and fairness. "Clinical decisions have implications. For instance, if you were to stop mental health care what would be the economic realm implication? Your cash flow is the engine of the hospital. Another characteristic is organizational. The most successful leaders make you want to please them and make you want to do a good job. Ethics, legalese and politics all enter into it, as we saw with the recent political changes in funding at the state level. Historical perspective is important. The board needs to know what has been tried before and what worked and what didn't. Recently, I've seen a lack of historical perspective. There was a time when no board member had more than three years of experience on the board. A board meeting is a complicated thing. I advocate that the commissioners listen to the current board members and not try to change things just to change things. Being a board member is complicated with a long learning curve. And the last characteristic is to somehow on the board have all these bases covered. It would be hard for one person to be knowledgeable about all this, but each member must be willing to defer to someone more experienced."

As for challenging consensus, he said a former Gila Regional Chief Financial Officer Cliff Olson presented a budget. "I raised objections that things didn't make sense. He was fired soon after for cooking the books. A couple of years ago, the hospital decided to get rid of home health and hospice. Many of us felt that was the best part of the hospital and protested getting rid of the services, but the board had already made the decision. We were saying it was not home health and hospice that weren't making money, it was the billing office. Which it turned out to be. That CFO was also let go. It was big mistake for the hospital to let go of those services."

Skee said a hospital is always a safety net for the community. "A community like this one without a hospital would face direct and indirect losses. The direct would be jobs and revenue. The indirect would be people leaving and no new people or businesses coming in. A hospital also needs to be an organizing force."

On the issue of collaborative leadership, he noted that he has spent 20 years as a CEO of Silver Health Care, which requires a collaborative effort. "They say it's like herding cats, but some days it's like herding tigers. About a decade ago, when The Department of Health was facing issues with certifications for Fort Bayard Medical Center, I worked with the DOH to take care of Fort Bayard Medical Center to get it up and running again."

He said when he arrived in Silver City, most people who could went out of town for medical services. "The hospital staff worked hard to get people back. I think we've lost ground in that fight. Ten years ago, sometimes 68 beds weren't enough. Now it's hard to fill 25 beds. That needs to be reversed."

Gail Stamler was next to speak. "I've been a mid-wife in the community for 40 years, 25 of them delivering at Gila Regional Medical Center. I've delivered 2,000 to 3,000 babies. I have concerns about the institution. It has a unique opportunity to care for the community, but I've seen the struggles. I have a great admiration for all those who provide care. Because of all the work we have poured into out unit, we have reached our goal to become a better unit. We have brought in patients from all over. It is remarkable to see people choose Gila Regional when they could go anywhere. Two nights ago, I took care of a young mom who came up from Deming. Her family said they had learned more in half an hour with me and the nursing staff than they had during the whole rest of her pregnancy. That's what I want to hang onto at Gila Regional. It's why I want to serve on the board. We must meet the litmus test of how every decision impacts the patients we serve. It's tempting to think it's only financial, but we must put every patient at the center of our care, with every decision a spoke of the wheel. We will get money when we provide the great care. We must find all available funding and go after it for our community."

She said if each trustee and team member recognized his or her strengths and weaknesses, "we can better function as a team. We must be as informed as possible about the different aspects of the hospital and reach out to the community. I know the history of this facility, so we don't make the same mistakes. I value transparency and it must be a constant goal. We must seek the truth behind every issue. I will keep asking why."

Stamler said she has had to speak out against prevailing opinions. "I spoke out to support midwifery at the state level and to my colleagues and administrators, always keeping the patients' needs in mind. Most developed countries have thriving midwifery practices. I worked to get hospital privileges for nurse practitioners and midwives. I listened to their concerns and answered their questions. We became the only hospital in New Mexico where midwives can admit patients. In March 2019, the New Mexico Legislature passed a bill that all hospitals be required to allow midwives to practice there. We were six years ahead at Gila Regional. We also gained voting privileges."

She noted that recently for the second time in 15 years, the temptation arose to turn over the hospital to some other entity. "I feel the right decision was made. We are about the only private health care system in the world. I don't think it will last much longer. Rural hospitals are falling like flies, but I believe we will be the leader to provide care to the community. A U.S. Senator is looking at a bill to force hospitals that want to close to sell to their communities before they decide to drop health care for their residents. Health care is changing, but I think we are the future."

On the issue of collaborative leadership, she said her role is often as leader to make sure "we give time for everyone who walks in the door. I respect the contributions of every team member. I'm also good at promoting a sense of team pride."

"I won't admit to having a lot of time to be a trustee," Stamler said. "I have a busy job and family commitments. But I will take time to serve as a trustee. I see hundreds of patients a month. I listen and talk to the concerns of staff, which I have recently presented to the board. I am interested in working with HR to address the high turnover and to raise morale. I am interested in serving as a trustee to keep the hospital offering the most appropriate services to our community."

James Marshall spoke as the fifth in line. "I am the fourth of six generations in Grant County. I spent 27 years at Gila Regional. I strongly value its services. I have developed a passion for the organization. I desire for the hospital to be the best it can be. It is critical that a trustee be an analytical thinker to understand the impacts of any decision. They must act on correct data and be an active listener. I've served on boards and it's rare to find myself as an outlier, but when I do, it is important to verify that everyone is using the same information. If a person is the change maker, how he provokes it is critical. And at the end of the vote everyone must respect the outcome."

"Early on in my tenure as mayor, I lost a vote," Marshall said. "I refined the resolution and articulated my goal and objectives much better, and it passed at the next meeting. Community hospitals will remain critical to this country. We have to continually build relationships throughout the continuum of care. As funding opportunities change, the hospital must be nimble to forecast and adjust to the changes. While community hospitals are hit the hardest by some changes, we must still provide services at the highest quality and meet the needs of patients and employees."

He said the commissioners had his resume and could see the boards he has served on. "Collaborative leadership is more effective at providing consensus. Full information sharing is critical. It is also critical that the entire board understand the whole gamut of issues. I practice sharing and collaborative leadership. I am prepared to take the time to do what the hospital needs and to stay informed on issues. I recognize the impacts of the board on every community member. I feel my knowledge and skills would enhance the board."

Joel Schram said his application details why he wants to continue as a trustee for an additional three years. "In the essence of time, I will address the questions first. For important characteristics, a trustee must understand the needs and embrace them for governance and accountability. A trustee must utilize performance data to improve quality and safety. The trustee must work collaboratively with the hospital administration to make sure strategic planning is implemented. The trustee must understand the complexity and changes in health care delivery and embrace accountability and transparency."

As an example of going against prevailing consensus, he said he was president of the New Mexico Trap Shooting Association. "They had always held their shows at four different locations throughout the state. As the president, I noted that choosing the one site that best could support the competitions was critical. I convinced them, they selected the permanent site and now they are on a solid financial status."

He noted the current political environment suggests a move to single-payer health care, "namely Medicare. Because Gila Regional derives a large percentage of its revenue from Medicare payments, it is critical we capture as much as we can while developing the highest quality services. Hospital costs can be controlled through outpatient services, the surgical center, family clinics and cardiology."

For the collaborative leadership question, he said that he, as a banker of 43 years, has been involved in conversions and acquisitions. "In July 2011, I was CEO of Foothills Bank in Arizona. We acquired a failed bank, Summit Bank. I was the lead person on the acquisition prior to the conversion. I successfully accomplished what they said we couldn't do. We remodeled the building, and then on a weekend, we converted the processing system to the Foothills Bank system, moved the branch and opened on Monday."

"How much time will it take to be a trustee?" Schram asked. "I have an advantage of almost three years of service. I estimate 12 to 20 hours monthly on average. There are the board meetings and the preparation, the committee meetings and preparation, special meetings such as strategic planning, training and webinars and seminars, and physician recruitment and retention."

He said he wanted to share some comments from the Community Hospital Association on what it takes to do a turnaround. "Ones with an orderly approach mostly prevail, rather than ones in crisis mode. Communication with the CEO to the community is critical. The hospital has to look for opportunities to streamline with astuteness. It must measure prices and staffing against comparable hospitals, and it must focus on growth for the future. Sustainability is not possible without growth, which can be achieved with revenue enhancement and new service lines."

"I urge each and every one of you to put your full support behind Taffy Arias and her administration," Schram said. "She is keeping Grant County residents as her first priority."

Raymond Goellner was the final candidate to speak.

"Our hospital is one of the jewels of our community," Goellner began. "Without a viable hospital it is impossible to attract people to Silver City and Grant County I am applying to the Gila Regional Medical Center Board of Trustees to utilize my expertise to ensure we have a strong hospital and that it is the employer of choice."

To the important characteristics of a trustee, Goellner said each must be willing to listen to divergent points of view, put the hospital over personal interests, use one's expertise to contribute to decisions, work to reach consensus and agree to disagree without being disagreeable. "One must be a team player. It is an asset to have experience in hospital operations and to know what questions to ask and what answers the trustee should receive."

An example of challenging the prevailing consensus occurred when he was director of pharmacy at the University of Arizona Medical Center, a large department with 110 pharmacists and technicians. "I wanted to deploy the pharmacists that worked from the central pharmacy to work in patient areas, so each unit had a pharmacist. The College of Pharmacy lobbied strongly to have only those with a Pharm D and a residency in patient areas. I wanted to put the ones who were interested in serving in the patient areas. I promised a study would be done at the end of six months on the three different groups of pharmacists. One group had no Pharm D or residency, usually a bachelor's degree; another group had a Pharm D, but no residency; and the third group had a Pharm D and a residency. At the end of six months, we did the study and it showed no difference in performance. The College of Pharmacy dropped the issue."

The role of a community hospital is multi-faceted, Goellner said. "It must provide the best care possible to its patients and be able to hire and retain the best possible staff. It is essential to play a leadership role with other health care entities to minimize competition and duplication. Competition must be replaced with cooperation."

On the issue of collaborative leadership, he said it is the type of leadership utilized to best effect. "A collaborative leader builds relationships, shares control and handles conflict in an effective manner. The leader must realize that people are the most important asset, especially in health care, where people are taking care of other people."

As chief of clinical operations at Gila Regional, he was over several departments, including pharmacy, lab, imaging, housekeeping and laundry. "Each area had directors and managers. A budgetary plan for each was in place. I was head of the team to ensure that goals were met. Two or three times a week, I met with directors to ask if they had any issues that they needed my assistance with. We shared issues. We also had a monthly meeting with the management group to share successes and address obstacles."

He said he is retired, so he is available to spend as much time as needed to carry out his responsibilities as a trustee. "I expect most of my time would be working on projects and reading. I conservatively estimate 15- 20 hours a month."

"I've been in health care managements for FORTY years in three different states," Goellner concluded. "I can say that of the people I've worked with, the best caregivers are here at this hospital."

The first to speak in public input was Chief Financial Officer Richard Stokes. "As I listened to the presentations, I realized these are all very good candidates. I think two candidates brought this up, but I want to point out that there is a triad of leadership at the hospital. It encompasses the Board of Trustees, the medical staff and the administration. As you deliberate, you need to be aware that the board is only one leg of the three-legged stool The board members have to build a relationship with the medical staff and the administration. The three legs when they work well together, then we have a high-functioning hospital."

Tony Trujillo, member of the GRMC Board of Trustees and recently elected chairman of the board, congratulated all the candidates. "I'm glad you're making this decision and not leaving it to us. But mainly, I want to thank you for this process and system, which I think is necessary. It is a system that works. I wish you luck in selecting the ones we look forward to serving with as trustees."

Taffy Arias, GRMC chief executive officer, thanked the commissioners for the process. "I want to give comments and an observation. I've been thinking about what I've observed when I sit in the audience at your meetings, not just as a presenter, but as an observer. I listen to all the topics raised to you that you have to vote on. It is so much more than just the hospital. I've observed in public input, which you are so gracious to allow, that those who have opinions on a topic are passionate about that topic. There is an equal number of people who are as passionate with the opposite view. They each have facts, opinions and ideas and the passion. You have to sift through all that to figure out the truth. It's a huge responsibility and you deserve great respect. I've seen people thank you and others accuse you of things, point fingers at you and call you names. Today, it seems people think that's OK. I think that it is not OK. I want to extend an apology to you that no matter what is said about me, it gives me no right to treat you with less respect. You are not dealing with one decision. You have to make decisions and take responsibility for thousands of lives. I have great appreciation and respect for your role."

Next were commissioner reports. Commissioner Harry Browne had no report.

Commissioner Alicia Edwards said she would not be present at next Tuesday's work session, but she wanted to explain an item she had put on the agenda that day. "Mary Beth Folia of Literacy Link-Leamos will give you a presentation on the loss of funding that the organization is facing and why."

Edwards said she has been working with Rep. Rebecca Dow's office, the New Mexico Literacy Coalition and Literacy Link-Leamos trying to figure out what's going on. "I thought a letter of support might be good, but it may not be time for it yet. It may be helpful, but we'll know more after we hear from Mary Beth. I want us to be prepared to take action if it is needed. Literacy Link could lose up to one-third of their funding."

Commissioner Javier Salas thanked the board applicants for their interest. "The citizens of Grant County are so lucky to have the brain trust that is in this room. They have the amount of education and intelligence to take this on. We commissioners have been doing our due diligence. It's going to be a difficult decision with so many qualified candidates. I think the hospital would benefit for having all of you serve on the board. You will be a public servant. It's a hard job. The hospital commands a lot of respect and scrutiny. I feel honored to have people of this caliber willing to step forward."

Ponce also thanked everyone for applying. "You've made it difficult for me with so many good candidates. I've made it known that this rural hospital is a gem in our community. We need our hospital. We need it to succeed. I am looking for people who will work together. Our goal is to make the hospital succeed. We need to appoint those who will work together to make the hospital successful."

"Thank you for making my job hard and for a difficult decision," Ponce concluded, "But I'd rather be going through this than wishing we had other candidates."

The meeting adjourned.

The commissioners will make the decision at the regular meeting at 9 a.m. on Thursday, July 25, 2019.