[Editor's Note: This is the first article in a series of reports on the Grant County Commissioner work session on Aug. 20, 2019 and the regular meeting on Aug. 22, 2019.]

By Mary Alice Murphy

The Grant County Commission work session on Aug. 20, 2019 began with county reports. 

Detention Center Administrator Mike Carillo said two newly hired officers were continuing their training in the jail. He, as a member of the Tu Casa substance abuse treatment center advisory board, attended a meeting where a Sept. 7 recovery celebration was discussed. It will take place at Ben Altamirano Sports Complex, with details to come.

In his report on numbers of inmates, he said on Aug. 3, the detention center had 60 inmates, and on Aug. 14, 90. "Today we have 99. We went up to 103 and down to 88. We're close to capacity."

General Services Director Randy Villa said the Community Wildfire Protection Plan development is underway. "Our first meeting with partners will take place Sept. 12. We are using a contractor to help create the plan. The Lower Mimbres Volunteer Fire Station will hold a remembrance ceremony on Sept. 11 to honor those who died and who served in the national disaster."

"I want to make sure to warn residents to heed dry fine fuels," Villa said. "With a not very robust monsoon season, things will dry out quickly."

He said that someone had torn down the gate at Bataan Park over the weekend. "We filed a police report. And it is back up but will need to be painted."

At the Grant County Airport, Forest Service activity for fire season is winding down. 

"The roof is done on this building," Villa said. "They have come for inspections. CID (New Mexico Construction Industries Division) will come today to inspect it. When inspections are complete, we will receive a 20-year warranty."

He said the contract for handicapped parking on the west side of the Bataan Park Pavilion had been signed. "We have also set up a dog waste station near the Courthouse."

Community Development and Planning Director Michael "Mischa" Larisch said the Whiskey Creek Volunteer Fire Station expansion is closer to completion.  

"We will finish the Rosedale Road project, funded by Colonias by the end of the month," he reported. 

For the Airport terminal building renovations, "we will work through them with a temporary terminal building coming in."

The Tyrone ADA project is an item on the agenda for commissioners to approve the bid award, funded by the Colonias Infrastructure Fund.

"We were told by the New Mexico Department of Transportation that our North Hurley Road project is on the list of projects to be funded," Larisch. 

Chairman Chris Ponce confirmed it. "I got a call yesterday from the governor's office. The project was approved for a little over $1 million, with the county match of $77,000."

Larisch said it was a $1.5 million request. 

He plans to send notices of intent to the Water Trust Board to apply for drainage issues on Bandoni and Fleming Tank roads. "Hopefully, we can get it to stick this year."

Commissioner Harry Browne asked about recent news that Hurley might have to take out a loan to complete the portion of the regional water project that will bring water to Hurley.

County Manager Charlene Webb said she thought Southwest New Mexico Council of Government Executive Director Priscilla Lucero would be able to answer that. "There are a lot of pieces of funding that went into that project. I will ask her."

No one provided public input.

The first presentation was from Gila Regional Medical Center Chief Executive Officer Taffy Arias and Chief Financial officer Richard Stokes.

Arias said the hospital was again planning its Trunk or Treat Halloween celebration, which draws hundreds of adults and children.

"I have exciting things to share," Arias said. "We have two new board members, as you know. Joel Schram will return, and new ones are Cynthia Moreno and James Marshall. We are excited to welcome them. Our new executive members are Chairman Tony Trujillo, Vice Chairman will remain Dr. Victor Nwachuku and our secretary is Jeannie Miller. We knew it would be learning curve for new board members, so we formalized our orientation. They have signed their confidentiality and conflict of interest forms and have received a four-inch thick binder, which we update every year. They received their iPads, and we will offer orientation sessions. The first session is on Wednesday and will be a financial overview. Jeannie and Richard will meet with the two new members. Richard will get into the details. We will also offer sessions on quality, safety, risk, compliance, medical staff services, human resources and ancillary departments, for just a few of the topics. Because they are voluntary positions, these sessions are not mandatory, but we are offering them."

In recruitment, she said Dr. Kelly has completed all the applications and is now waiting for her New Mexico license.

"We interviewed an ENT (ear, nose and throat), another surgical candidate and an acute-care nurse practitioner for the ICU (intensive-care unit) and on the floor," Arias said. "Tomorrow, we interview a pediatrician candidate. Dr. (Gregory) Koury is leaving, which will leave a hole in pediatrics. Dr. Worrell will be by himself, so we need another pediatrician."

She talked about program expansions. "The new tele-neurology will start in the emergency department and will expand onto the floor for strokes. We are working with the same company to provide telepsychiatry. Dr. Ratliff is starting a new procedure, and Dr. Rosser is expanding to a heartburn clinic."

Arias said the architect had finished the design for the Bayard Family Practice building. "We are now waiting on the cost estimate to renovate the space. We are also looking for a urologist and exploring recruiting a gerontologist. We're also looking at reinstating home health and hospice, which were services GRMC once had. There is a great need in the community for both. We will submit our idea to the board."

In an update on the rural health clinic designation, when it is implemented it should save the hospital about $400,000 a year, which will be reinvested into services for the community. "In Pharmacy, we are redoing a room to meet state code. We are also looking at roof construction to replace our roof. We are doing updates on the security systems for behavioral health and OB, so only authorized people can enter the areas. We are expanding camera capabilities. On the community piece, we plan a community update as we did last year in the not too distant future. The board will hold a strategic planning session, and we will share the results with the community. And we will be participating at the Mimbres Health Fair. We are also involved in a state program for opiate use. The Department of Justice visited, and all our providers are in compliance. We are doing a wage analysis. We did a wage adjustment for nursing and now we're looking at other departments. When we complete the employee safety assessment and survey, we will share the results. It's a whole program, with the employees to be involved in improvements."

Browne said he appreciated the detailed updates. "I have a question. I've gotten three emails with rumors about discouraging things happening. The perception, and it's making people not want to go to the hospital, is that the hospital has been taken over by immigrants that have brought diseases."

"We have seen an enormous decline in the numbers of immigrants," Arias said. "The detention centers close to the border are providing health services to the immigrants. Early on, we saw malnutrition, gastrointestinal issues, and respiratory illnesses. The health care they receive in the countries they come from is different from ours. We haven't seen the overcrowding seen in El Paso, Houston and Florida. Here it's nothing like it was several months ago. Our doctors in the emergency department are extremely proactive. If they see an issue with a patient, they isolate the person. It's just as likely for some of these problems to occur with anyone in the community without means to get health care. I think those are gross rumors. We need public education to reduce the fear. Hospitals take care of anyone who comes in the door. New rumors get way out of control. I wish it were different. The more information we can get out, it reduces the rumors and fear."

Browne said he believe there is strong support in the community for the hospital to treat everyone.

"In totally operational updates, Gila Regional has a contract with Innova to provide ER services," Arias said. "We recently had a change of directorship in the ER."

Stokes then presented his report for June, the end of the fiscal year. "You may notice different numbers than usual. We made certain entries during the year, but we reversed those entries and put them all into June to get ready for the auditor visit, so the entries were easy to find. It shows a $4.2 million profit, but in reality, it's about a $299,000 profit at the end of the fiscal year. Over the past year, we have been aggressive in revenue accrual and less conservative in payments."

He noted a change in the controller and in the business office director. "We have collected 32 percent of charges and have seen 112 percent cash to net revenue. We were notified by our Medicaid audit that in 2016, we were underpaid by about $5 million, but we have no opportunity to recoup that money. The good news is that we didn't have to pay anything. We are cleaning up things this week because the external auditors are coming next week."

Stokes said additional practices belonging to the hospital will be converting to the rural health clinic status. "We've been working hard on how we reflect the clinics on the Medicare cost report. This year, we're trying to show the above the line payments, meaning reimbursement versus non-reimbursable items. In the past, this was handled OK, but not optimally. We are putting in the effort to make sure we have the clinics reflected correctly."

He reported that they had received a detailed analysis of Gila Regional, if they decided to go to critical access status. "The impact to the hospital would be from $4 million to $6 million, about what we expected from looking at the four previous fiscal years. I feel good that we got good numbers. There are issues we would have to address prior to moving to critical access. One would be the impact on Medicare beneficiaries. We are putting a process in place to look at and address the impact."

At the end of June, the hospital had 25 days in cash, and "yesterday [Aug. 19], we had 26 days, so we're staying steady. June was a lower collection month at $4.4 million, but still about $230,000 more than last year."  

Commissioner Billy Billings asked what the bottom line would have looked like without putting all entries in for a total of $4.2 million. Stokes said the hospital was slightly above breaking even for June.

Browne asked about the Medicaid underpayment.

Stokes said he was not sure he wanted to answer it in open session. "People highly skilled are needed to present the initial data. We have highly skilled people now, but we did not have that capability in that year."

He also explained that the state has no way to redistribute overpayments that were made. "It's a complex formula and I'm not aware of any redistribution mechanism. My understanding is that the Department of Health will try to recoup the overpayments, and the feds will let them use it as they want to."

The next article will begin with a presentation from the Gila National Forest.