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By Mary Alice Murphy

Lilly Irvin-Vitela, president of Community Connects Consulting of Peralta NM, served as the facilitator for the townhall at the Grant County Veterans Memorial Business and Conference Center on Wednesday, May 28, 2025. The event was organized by a number of providers, most of them former HMS employees,  and patients of HMS (Hidalgo Medical Services). Simon, also with Community Connects Consulting managed the tech for the session.

It started off with tech issues, but Chamber of Commerce Director Romeo Cruz came to the rescue, connecting cables and checking things, and soon the presentation was visible to all participants, estimated at more than 60.

Irvin-Vitela said they would hear from providers first, then current HMS patients and then community members. She clarified that the request for the townhall had not come from HMS. "We want to hear from all of you, but we are not here to roast anybody, right? This isn't a personnel meeting. We're not here to point fingers or to attack, but we are here to be really honest and open about concerns and ideas you all may have. it's just so important that people get to say what matters to them in terms of their health and well being, and when they're concerned that when something is being compromised, that they have an outlet to express those concerns as well as generate ideas about solutions. We're trying to do some of that tonight."

She introduced herself by telling where she had received training and where she had previously worked before starting her own consulting business. "I've been dong this sort of work for 30 years." She noted that she was raised in a family that had its healthcare at a federally qualified health center, which is what HMS is and that's one reason why she was at this particular session.

Dr. Twana Sparks was the first provider to speak. "I've been in the community all my life. I practiced ear, nose ,and throat surgery and allergy care here for 30 years. I think I know probably a good 80% of you, I signed the letter which began circulating about a provider, saying we're concerned about what's happening at HMS. I'm very concerned, because I've watched it go from a huge, vibrant, well run, terrific provider source for dental, mental health, all kinds of services available that nobody else could provide at such an inexpensive or at a quickly rendered location. Over the last few years I've watched it lose their residency program. This is huge. We were producing two good family residents a year in this little town, in this little clinic, adding them mostly to New Mexico's count. And so that was horrifying to me. I don't know why. I just heard a rumor the residency program was gone. The second thing is, of late, I've heard we're losing our mental health provider, Dr Teresa Arizaga, which is a disaster for HMS. We're losing Dental is another rumor. So I don't want to take a lot of time, but I want to tell you what spurred me to sign the letter I've been supplying in the last four years medical aid in dying, which means, because it's legal in New Mexico, someone who's terminally ill with less than six months to live, suffering horribly, of sound mind and can decide, I can write them a prescription and they can take a medication and pass away. I was the only provider for that in the southern half of the state, until recently. Now we have one in Las Cruces, and we have another one here in town. I went to Dan Otero (HMS Chief Executive Officer), who I've known since he was a little kid and when he was an EMT. His wife was my transcriptionist. I work with his mother-in-law. I know his kids. I respect him. I love him. I went and said, Dan, I know that probably, as a federal provider, this clinic cannot refer people to me, just like you can't refer people for marijuana or for pregnancy termination, because those three things are not federal laws, and so that clinic is not supposed to provide referral for that or care for that. So I went to him about a year ago and said, Can you at least say here's Dr. Sparks' card. Just tell them I exist. And he said, I will ask our attorney, I will ask our board, I said, and CEOs in Santa Fe and Albuquerque have come up with a way to do this, even though they're federally funded without risking their funding. And he said, 'so I will talk to CEOs.' And I said, I'll come back in a month and see what you can tell me. I just wanted a yes or no. I came back a month later, and I said, So what do the CEOs and the attorney and the board say? He said, 'I never said any of that.' I couldn't have been more astounded.  I said, 'Yes, you said you were checking with your board and your attorneys.'  He replied: 'No, you misunderstood.' I said, 'Well, I guess this conversation is over.' But at that moment, it occurred to me if the CEO is going to be dishonest or afraid to face big issues, it's no wonder that they have lost so much. So I'm not here to criticize Dan. I'm just telling you I don't understand, and I think that as long as we have this CEO and this board supporting his decisions, this is going to continue to degenerate until there isn't any more HMS and thank you for letting me speak so long and speak first."

Marisa Shapiro participated via phone. "I made the difficult decision to leave my position at HMS as a nurse practitioner late last year. This was partially due to personal circumstances, but also largely due to systemic issues within the organization that I felt were impacting patient care and provider well being. As you all know, over the past few years, HMS has been experiencing a high provider turnover, which many of us believe to be largely due to a lack of responsiveness from the CEO to ongoing concerns, As providers left, the remaining team was expected to absorb additional patients without adequate support or resources. This created an unstable cycle. High workload led to burnout, which led to more resignations, and the cycle just continued. Unfortunately, despite multiple efforts to address these concerns, leadership failed to implement meaningful change. Myself and many others felt it was extremely difficult to provide equitable, high quality and continuity based care in that environment."

"I want to stress what we're not just a group of disgruntled employees with the list of workplace grievances, but we're medical providers that care about this community and care about health equity. Many of us chose to work at HMS, because it's an FQHC. It's a safety net clinic. FQHCs deliver care regardless of a patient's ability to pay, their immigration status, or insurance coverage. They're cornerstones to rural healthcare models, For the many of you that had to change primary care providers several times over, it probably doesn't surprise you that a loss of continuity of care causes worse outcomes for patients. This fragmented care is linked to poor management of chronic diseases, delayed diagnoses and increased hospitalizations. I want to stress there are still a lot of excellent providers and employees still working at HMS. I hope that you as community members are willing to help us with creating positive change to help keep HMS up and running. Thank you so much."

Those in the room applauded her comments.

Dr. Don Stephens spoke next. "I'm pretty much a newcomer to the area. I got here in 2022. When I interviewed at HMS, they had a fully functioning residency program. It was run by Dr Derek Nelson. He was an awesome doctor. The residency program was about to become independent and be on its own. When I actually showed up, everything, more or less, was gone. The residents were gone. Dr Nelson was gone, and other attendees were gone. I stepped into the role as medical director.
I won't get into the details, but I had to resign my position because of disruptions which I felt were detrimental to patient care. I also stepped in to be the residency site director. We were trying to get the residency program up and running for all the obvious reasons, and they needed a board certified family medicine physician to be on site. I found out that basically, in my opinion, they just wanted my title.

"I did not have any decision making ability," Stephens continued. "A residency program is run by physicians, not by the administrators, so if there's any issue with residents, it goes through the program director. What we were hoping for with the residency program is that some of the residents would  obviously stay in the state of New Mexico and ideally stay in Silver City. Unfortunately, that did not come to fruition, so I'm glad everybody came out tonight. Like Marisa said, FQHC is here for the people. It's here for the community. It's here to not only benefit the community medically, but also from a behavioral health standpoint. So I congratulate all of you coming  out, stepping up and taking charge."

Irvin-Vitela said there was a question about whether Dr. Stephens was in still in town.

He replied: "I'm going to start at Cassie Healthcare this Monday."

When no other providers came forward to speak, Irvin-Vitela moved to patients.

A woman said: "Good evening, everyone. I'm so pleased to see a number of people here. I am also so pleased to see that there is comprehension of what the blue blazes is going on at HMS. I have seen a system where it seems to me to be combative. In other words, what's the mission, what's the goal, or what are the goals? What are the objectives? And it should be to work collaboratively with other members of the medical profession instead of being at odds and combative. It should be to take care of people in the way one does it in the medical profession."

Another woman, Patty, spoke: "I moved to Hanover from the San Francisco Bay Area two years ago. Big difference, obviously, but what surprised me the most was health care, not the shortages, but decisions from the CEO. I thought I'll pay him a visit myself in person, because what I found when I did lodge complaints, you get a letter explaining how everything was just perfect. My life was put at stake because, and I've documented the mistakes for two years, that isn't going to do me any good if I'm dead. Perhaps my husband could sue. Who knows? Anyway, when we go back to California to visit our grandchildren, and then up to Reno, Nevada to see the others, when I come back into high elevation, I have to have certain medication, and that medication was not ordered because the staff, who maybe they don't have enough time to do their job, said the phones weren't working. At that time, they perhaps weren't working, but when I came back, she said the same thing. When a person cannot get insulin, when a person cannot get medications that keep them alive ,and the staff, the young girls, laugh like it's funny. I don't think it's funny. My life does matter. And so I don't think this is only a situation with the CEO that people have spoken about. I think it's a situation with people not taking their jobs seriously. Some of their the providers say, 'Well, you know, I wouldn't trust the phone system. You need to get on the portal with a very lackadaisical attitude.' I'm not used to that. I came from really good healthcare. I have to ask to have my labs ordered. That has nothing to do with the CEO. That means that the provider is not looking at my chart in the computer and seeing that I'm supposed to have labs done. My last labs were done in July. They should be every three months. So what does that have to do with the doctors that can go other places? That means the providers need to do their jobs that they went to school for. Now, I'm not saying every provider doesn't do that. There's a lot of good ones, but I don't just see this with HMS. My husband goes elsewhere. Hasn't had a physical in two years. I've not had a physical in two years. So I don't really know what the answer is. I know that we do have a shortage of specialists, and you have to go elsewhere to see them, but what I would like to see is everybody caring, from the provider to the assistants that think it's funny if your medicines are not sent in to the letters that you get in the mail, I'm not going to deal with letters. I'll just make an appointment to talk. I don't see understand why, if there's this crisis, why isn't this on the news in Albuquerque? Why isn't an investigation done?

"Why are there not people standing in front of HMS being interviewed on how many times they've had to change providers?" Patty continued. "Then I go to a new provider because the one I saw twice is leaving, and my prescriptions again aren't sent in I'm at the point where I have to ask supervisors to order prescriptions. That's ridiculous. So I don't know if they're not getting enough hours in the day to do their jobs, but I think this is an overall problem. I am not going to stand by until I'm on my deathbed or have to move out of state to get proper care. I will go to the media. I will go to the newspapers. I will find out why this problem seems to be overall,. It's just ludicrous to me, and I will pray that the outcome is better. There are going. to be other people that haven't gotten prescriptions. There's got to be other people that feel the same way. I can't move back to California. I'd love to, because my grandkids are there. I'm going to be staying here, but not if this continues with my life at risk. So I hope for a good resolution, but I think we've been too nice. I don't mean fighting, I mean exposing where we are interviewed and we are people like, what's going on in Grant County?"

 The next speaker said his name is David Sweet. "We moved to Silver City about six years ago. Immediately I got in with HMS, and it was great. But I want to push back just a little bit about the blame being on everybody, including the providers, because everything went great for about a year and a half, and then all of a sudden it started crashing, and there was this continual turnover of people. I actually even had one appointment with Dr Stephens before it got to the point where he had to leave. And what I've noticed in the time since are a couple of really small things that really are nothing relevant to this whole thing, but they just seem to me to be an indicator that something's going on at the top, not for the people that are trying to provide your daily service."

"One of them was at a certain point, with all the mix ups and appointments and things, you'd go in there and say I'm here for my appointment," Sweet continued. "Oh, your appointment's over in the other building? Yeah, well, you go over there, oh, you have to sign in on this automatic system but  trying to do that doesn't work. Somebody has to come out and do that for you. Now, the people who are giving you care didn't make that change. Right? That came from above. Somebody thought that was a priority, rather than keeping the people who are providing your health care happy. I started getting phone messages from HMS, asking me to call back. When you try to call back, of course, you can't get anybody. But they kept coming, and I finally answered the phone and talked to the person, and it was somebody who said he was on some kind of, I can't even remember what he described it as, but he wanted to know if my needs were being met, and all this kind of stuff. And again, nobody who's a health provider decided to institute that. That came from above, and it just indicates to me that not only are they not paying attention to things that need to be paid attention to, but they're instituting a lot of stuff that does nobody any good."

The next speaker said: "My name is Mary Lynne Newell. I've been in this community since 1982, and I've been with HMS almost that entire time. At the beginning, everything was great. Dr Sargent was here, and then Meredith Heidenfeld was here, and I had providers consistently for a couple of years, more than that for a stretch."

"And then things began to change" Newell said. "And what I noticed was that the provider used to come in and you'd sit down and they'd ask you, look in your ears, look in your throat, ask you how things were going, check extremities, blah, blah, blah. And then it stopped being that way. I told someone in my family one time, it's like they've been told not to touch a patient. And so I developed diabetes after my kids were born. Nobody in my family had it. Big surprise to me, and so I've been treated for that, like 20 years doing okay. But when I go in now and they ask, how are you doing? But nobody does any further examination unless I specifically ask for it. And I'm kind of a pushy person, and I'm perfectly willing to ask for it. Hey, I haven't had a Pap test in two years. Well, you're old now you don't need to have it. Well, I want one, thank you. I haven't had this in a long time. Well, you know, again, you don't really need that. I said, I still want it. You know, there's cancer in my family. I want to make sure that things are okay. So I'm very proactive, and I keep track of everything.

"I've had a couple of good providers in the past few years, one of them was Marisa, who we heard from on the phone. And I've had a couple that weren't so good. But since Marisa left last November, I have had a change five times. I have a new person that I'm supposed to see on June 2, and I called HMS and said, 'By the way, is she going to be here on June 2?' 'Oh, yes, she's not leaving until such and such a date.' So I haven't even seen this woman, and already she's leaving. I keep asking, Is it me? Is this something I'm doing? And I know that part of it is pressure that providers get from insurance companies. You know, it's kind of like you go through the drive-through at McDonald's. That's because they're trying to meet their quota, their low number of seconds of each person at the dang drive-up window. And I hate to think of HMS becoming like a drive through for that, but
I know that they have to work people through quickly, and I try to be efficient. I go there with a list and say, 'These are my priorities for this month,' and usually by the time I begin to see a provider, those priorities have changed. Because, okay, that's no longer a problem, or I've managed to see a specialist or something.

"I feel for HMS, because I know it's hard to run a big entity like this, but I used to work out of all three counties, and in Lordsburg, the HMS building down there was really a cornerstone for the community," she continued. "And I live out in the Mangas Valley, and I go to the Gila clinic occasionally, again, another cornerstone. At one point I had this wonderful doctor who left, who figured out something nobody else figured out, why I was having these terrible problems that had continued and gotten worse for two, three years. And he finally looked at me and said, 'Stop the Metformin you're taking.' I stopped it, and that cured it. You know, I developed this intolerance to Metformin after almost 20 years of being on the drug for my diabetes, and it cured it. No longer was I having to avoid going out of town because I couldn't drive for long without finding a restroom. Spare you the other details, but you know, and he was wonderful. That was Dr Marino, and then he left. So there have been wonderful people here, but we're not keeping them. And it has gotten to be the point where I did realize it has to be from something further. It's more than the insurance company. It's not disgruntled practitioners. I've had wonderful practitioners. Marissa was another one. She liked it here. She would take her dog and go hiking in the Gila. I know she liked it here. So why can't we keep people? This is a beautiful area. We really need people here. We need specialists. Here."

Newell said: "I go out of town to see a dermatologist, because poor Dr. Arizaga finally got to retire, and I'm glad he did, because we pretty much worked him out. I mean, my son used to go to him when he was a pediatrician. So that's how long I've been here. I go to Deming for podiatry, I think we have a podiatrist here in town, but that's who I got started with. I go to Las Cruces for a dermatologist, and I'm happy to do that as long as I'm physically able, but I'm not going to be physically able forever, and that's another thing our community lacks, is medical transportation. So HMS was addressing a lot of these things, and now suddenly everything is falling apart there. And to me, that's not just providers. That's something else, and several of you are thinking about those deeper systemic issues. Thank you so much."

Carolyn Metzler spoke next. "I came here to listen this evening. I wasn't planning on speaking, and I wish I had persuaded my husband to come, because his story is really the one that matters. We've lived here for seven years and used HMS for that whole time. I would say in general, the care we've received has been good, but variable due to discontinuity with the changing of care providers. I had this whole experience that this gentleman mentioned of having to sign in electronic system. And I, you know, I spoke with my provider about it, my counselor, and he agreed that it was not good. So I wrote, I contacted the administration about it, and was treated with real off handedness. And what struck me was that I used to go in, and it took less than a minute to check in, in person and have a face-to-face encounter, and then I had to go through this whole electronic thing. And then it evolved that there was always a person standing in the lobby offering to help me, so there was no decrease in staff. But there was this impersonalization that occurred, and I find that a bit tragic. But the real tragedy is that my husband, a few years ago, went in for some back pain to see his regular doctor who wasn't there, and he ended up seeing a resident, who prescribed a drug that was inappropriate. So he, after like two days of taking this medication, passed out and fell twice in one day and injured himself so badly that like he was climbing the walls with pain for a long time, and has been in severe chronic pain 24/7. As a result of that injury ever since, to this day, he contacted HMS, and I believe he ended up speaking with Dr Nelson, who basically said, 'Oh, sorry, too bad, and we don't want to hear any more from you.' And that was it.We spoke to a lawyer who said, 'Well, yeah, you could sue, but it would cost you a lot of money to do it, and you wouldn't end up getting enough out of it to be worth time. So, that's that. I think this doctor was someone who left like, I think, a few days after he prescribed this drug. And I just wish that HMS had been willing to take some level of responsibility for that."

Another woman spoke: "I'm Shari Morrison. I'm going to be very succinct, hopefully I'm going on my fourth year at HMS primary care, dentist, chiropractor, Dr Joe, chiropractor, the best I've ever had, as far as dentist. Dr Bailey, my dentist. I love her. I've had two excellent primary care providers. Marisa Shapiro couldn't beat her. Before her was Marisa Simpson. One time, Marisa Simpson waited until nine o'clock at night on a Friday, waiting for a stat report from the hospital. I had COVID. She thought I had a pulmonary embolism. Never got the stat report. She said, 'How are you feeling?' We talked about it. The next morning, she called to check on me and she said, 'you get to the ER. Now. that's good care."

She continued by talking about two occurrence with Dan Otero. "When I was first patient there, I had a situation which I don't care to discuss. I emailed him. He picked up the phone and called me. We had a conversation. He took it to the board. They took some care and got back to me. I was proud for that. The last time I had an issue, I did the same thing, I was dismissed. So his workload must be heavy, okay, so that's my background, but I'm here to speak on behalf of the women employees who filed sexual harassment issues with the board about the way they were treated by the CEO. Nothing has been done. Sexual harassment is not allowable. It cannot be. It cannot go on this way. Somehow that has to be addressed. It is and it hasn't been. I say that the board is complicit with the actions, unless they step up to their responsibility and address it."

Irvin-Vitela said she knew that some people are listening and giving each other encouragement. "It's important to share your voices." She gave them a QR code that worked during the session, and said that note cards were on the tables, with pencils to write down concerns and ideas.

Jean spoke next: "I believe in being part of the solution when there's a problem, which is why I'm here tonight. I am a mental health therapist. I do not work for HMS, but before that, I was in public relations, and it doesn't take much in the way of PR to understand there's a problem. And I have been blessed. I've had amazing providers from HMS, but the turnover we're seeing is not normal, especially since some providers are switching clinics. There's a problem, and I feel like it's going to take us supporting the providers so that we don't have this high turnover. We can sit idly by or we can do something about it. There's no one that's above the law, and there's no one that should be protected in this manner. I'm really, really amazed that the providers sent out that letter. That took a lot of courage. So kudos to all the providers. And now it's time to not let this just disappear, like some things do. It's time for all of us, because we know that we're the ones that came here to this meeting. But I'm guessing there's many people who weren't able to. We need to put out the rally cry. The Gila is, or this area is probably, I'm guessing, somewhat difficult to recruit to. But we do have, when you don't have the salary to match the big hospitals, you say, come here for the beauty, come here for the wonderful people, and you treat your employees well. It's not always about money. It's about how you treat your employees. I've been here 20 years now. I don't plan on going anywhere, but I do not want to see this important community health organization fail. Rally your troops. Rally your friends, write letters. Don't let this just be swept under the rug, like so many things are. Thanks a lot."

Another woman spoke and introduced herself as Robin." I have three things to talk about. One doctor here in town, one of the few left, explained to me that the reason the doctors are leaving, is that the state law changed and it's unending how much they can be sued for now. So their insurance rates have gone through the roof. Second, a doctor told me that nurse practitioners only have 15 minutes to speak with us. That's why they don't ask us any questions and we don't get any answers hardly. And that's why so many quit. And every time I go there, that's a new one."

The third thing was about medication. "I too, was given Metformin three years ago, and a certain dosage and all this. And then the diarrhea started three years ago, and then two years ago the IBS, and then all they did was give me a really nasty medication for that. It wasn't until a few weeks ago when I had surgery in another hospital in Las Cruces. a nurse was amazed at the amount of metformin I was being given. That's a really dangerous medication, and she was taking me off of it immediately, and she said also that the diarrhea and the
irritable bowel syndrome would go away within two or three days. And sure enough, they did. Turns out I don't need it anymore anyway, but I am really upset, because every single time I saw a nurse practitioner in the past few years, I had complained about the IBS and nobody ever did anything. I'm to a point right now, I don't trust the system at all, because I can't ever see a doctor to actually get some information, like about the diabetes and so on."

Mary Gruska said she wasn't sure which group she really fit into. "I'm not an HMS patient. I'm not a nurse practitioner or physician, but I am a registered nurse, and I've worked at the hospital for over 30 years, and I'm here because I'm concerned. I coordinate lactation services and infant feeding support for our hospital, and have done that for quite some time. At one point in time, there was a whole group of providers at HMS that I could do warm handoffs to for our patients that I could coordinate with on issues we provide. such as support after discharge as well as during a hospital stay. I don't have that anymore. I don't have anyone there to coordinate with."

She continued. "I'm concerned about mental health and and seeing that service deteriorate for our community, a high percentage of the mothers I work with have challenges with anxiety or depression or mental health, and they need support if they're going to be able to parent Well, right? And that goes to really the health of our community. Then I'm concerned about the Lordsburg community. One of the things I do when I interview or do an intake with families is I ask which pediatric provider they're planning to see. When I ask families, I can't tell you the number of times that I've asked a family from Lordsburg if they're planning to see a provider at the Lordsburg clinic, and they laugh at me or say, are you kidding? And that's sad if those families feel like they must travel here when there's a clinic in their community that could be providing them with that ongoing care with their child. So I'm just here because I'm not sure what's happening, but I've seen steady deterioration, and I'm worried. I'm worried for our community in our corner of the state."

Next came community members who wished to speak.

"My name is Bill. I'm a retired clinical social worker that's done clinical work with families, children, and also administration and statewide programs. Our provider base here, we have good providers. We have caring people that really care about what's going on with the community and their patients. But I see the issue as being management, and I don't know if that emanates solely from the CEO on down, or whether it's more of a systemic issue. I think a lot of the issue has to deal with the board itself, and either that being a social program for the people that are members of the board, or whether it's a hands on experience for the board as being community members. I think what we have a lot of is people that enjoy being important, and I think what we have to have are people that really like their involvement with being in the program, with the community itself."

He continued: "I've been with HMS for a short period of time, that being just four providers quickly, and that is absurd. That does not give my provider any time at all to get to know me, to get to know my case, get to know what my clinical issues are. You know, trick me bad. So I guess the issue is what the hell is going on? Why isn't the board taking this seriously, getting in there, getting down and dirty with the community and fixing this problem?  People! This is us. These are our providers. If we have no health care here, where do we go? Cruces, Tucson, Safford, where? This is our community, and if we don't step up and start demanding that either, one, the board do something, deal with this, or get somebody else in there that can do it. We're lost. It's up to us."

Simon said: "We have Dr. Randi Murphy on the phone. She's a former practitioner, and she'd like to share her thanks. Apologies, Randy. I know you can hear us. Hi, Dr. Murphy, thank you for joining us."

 "I'm a family practitioner," Murphy said. "I was born and raised in Silver City and grew up in Grant County. Right now I'm living in Washington. I relocated. And so first off, I just wanted to say hello to everybody. I think a lot of you are my patients or were involved in my practice at some point. And I just want to say I miss you all very much, and thank you for the time that you allowed me to be part of your community and your family as I practiced in the area. I'm here today because I genuinely still care so much about all of you, and I am notably concerned for the things that everybody's voiced. And I do want to say personally, thank you to everyone who fought alongside me, as I tried so very hard to provide care to our community and patients. Thank you for advocating for yourselves and each other when there were not systems in place that were supportive in the ways that they should have been, and for all the things that you've had to face and deal with. I'm so very sorry. I hope to see that change, and so I'm here to speak for that today, and I genuinely would like to be focused in what I say next, and that is that I have made the very difficult decision to leave the area because of the needs, not only of my daughter, who has severe special needs and was not able to receive appropriate care in our community, but also because of the challenges that I faced in practicing as a provider, and my goal was to provide evidence-based quality care, and I didn't feel that I was able to do that where we were And I did try very hard, and felt that patients even advocated strongly for the things that would have been necessary for that to be a reality. But myself, and it sounds like so many others that came before me and after found that that was not achievable under the current circumstances."

"I do understand that the board for HMS has voiced confidence in current leadership," Murphy continued. "And I would like to question what measurable outcomes have inspired confidence. I've relocated to a very comparably resource-deprived area where there is a different but very comparable system in place that is also a federally qualified health center. And I will say that this, too, has challenges that are not unique to our community. There are comparable challenges in other areas. I will say that I see better outcomes in other areas. I see better support of clinicians, and I see better outcomes for patients. And if I had any way to replicate what I have been able to participate in here and have that happen in the area that I have had to step away from, I would absolutely go and be part of that. And I hope that that's possible in the future. Up to this point, I have not seen that there are patterns in place to facilitate that. But if at any point in time that were to change, I would be happy to be a participant in seeing the things come to pass that I believe all of our community deserves and should be the standard of care for the population that we are so passionately desiring to see improvement for. Thank you all for your time."

A woman spoke who said: "I come from being a community member and a provider as well, and what I want to talk about is from a provider's perspective, because I hear so many of you patients, and I feel for your stories, but we go to school to have autonomy, and when that autonomy is stripped and your expertise cannot be used to serve a patient, you have no choice. And I feel like a lot of providers here are are silenced because they're probably worried about the messenger. And when it really comes down to who's going to take away what you've worked so hard for, you're going to make that decision because you worked for it. And I am emotional because this is my hometown, and I know that there are a lot of providers here that either had to move away. They weren't as fortunate, and I hope that these providers here still stay and serve our community, because it is important. You guys need good health care. But nothing was said tonight about autonomy, and I really feel like that is a big elephant in the room. And like you mentioned about the residency program and how it's it's not right for a CEO to talk to the residents, because a CEO is not a medical provider. They don't know those kinds of things. So that's my two cents."

The next speaker was Michael Trujillo. "I have been in Silver City for 51 years, and I am here to speak on behalf of my son, who passed away about three years ago. We went to HMS, me and my son, because he had some chronic health issues, and the doctor that we saw was very condescending, to the point that I went to go see Dan Otero. And I have known Dan Otero for probably 30 some odd years, so I knew him. I called to speak to him about what was going on with his doctor, and I left a message, didn't get a return call, to the point that I went to see him personally in his office, and he was not in so I left a written message for him to call me back, and he never did. I feel that there's a lack of leadership in the institution right now,

Trujillo continued: "I have been with Dr Saucedo, who has been my primary care doctor, and I'm so glad that he is going to Silver Healthcare, and I can continue to see him there. But more importantly, I'm here to speak on behalf of my son, who's not with us any longer, and I feel that the ball was dropped in his healthcare. Thank you so much.

Irvin-Vitela said: I just want to acknowledge that you all are sharing hard and painful information, and it takes a lot of courage and it also takes a lot of respect to just give space for people. So for those of you who are listening and those of you who are sharing it, thank you.

The next man to speak was Paul Foreman." I got a question, I got a letter. I got it today in the mail from HMS, and if I looked at it right, because I looked at it in a hurry, coming here, there are no MDs. Is that right? They say one's coming on board. Well, I tell you I got a history. I had three years ago, I had Covid. I was in the hospital for seven months, in five different places. I finally found a doctor the other day to investigate and see what he can find out about the type of Covid I had. That's been a mystery. It starts with an A that's all I can tell you. That's all I can remember.  I shouldn't have survived four times. I should have passed away, and I didn't. Now, it affects me today. I'm not a third of what I used to be, or fifth of what I used to be. I was hoping this MD would dig up something. I lost my wife a year ago. She had cancer. They cured the cancer. Nothing to do with HMS started up north. I lived up above Quemado. I went to Arizona, four different places. I took her to they couldn't determine what it was. I brought her down here to an old doctor that was retiring, that I've known since I was a kid, and she wasn't in there five minutes, and she said, My god, she's got cancer, and they ended up curing her from the cancer, but she had so many chemo and radiation treatments she got the dementia. So she tackled that dementia for years, and then she broke her hip. I put her in a nursing home 30 days. I got her out there because she's starving, almost dead, and brought her home. We go to HMS, and I ask them about the ligament in her leg that was deteriorating. I asked him, could you give me a referral to a specialist that I could go talk to to see if they could do something about that. Well, they wouldn't give me a referral.

I don't know whether they could or not, but I thought if I could get they hold of the specialists to talk to me. I called all over the country. They wouldn't talk to me without a referral. I just begged and pleaded. Give me a referral, let me go sit down and talk to him, see if there's a possibility. I don't understand HMS. Home health showed up out there. They wouldn't do anything. I had her up walking with a walker after she broke her hip. No physical therapy. No nothing. They told me, to quit walking her around with the walker. I said, 'why not? She's walking with the walker. She gets out. I got a side-by-side. She getting in the side-by-side. And I take the doctor's office or the local store or something in a post office or somewhere back then, and she thoroughly enjoyed it. But I was told to stop. And then I had hospice coming. I didn't ask for it, but they walked in my house and told me, looked at her for five minutes, turned to me and said, quit taking care of her and let her die.

"I mean, I really got a problem with medical field, okay, and I shouldn't. I used to be an EMT, but I'm so fed up with medical field I can't see straight. I just don't think it they care anymore." I would like to see somebody that cares about you."

The next woman to speak said: "Thank you for those of you that don't know me, I'm Guadalupe Cano, the Silver City Mayor Pro Tem. I've been a patient at HMS, since it was Med Square. About five years ago or so, Dr Ferguson, who's no longer here, also saved my life. He realized that I was in kidney failure. I'm now on a kidney transplant list. I've been on it for three years. I have about 15 doctors. Two of them are in Silver City. One is at Cassie, and one is, was, at HMS. However, she won't be my doctor anymore. When I came to my last transplant team meeting, which is a couple of weeks ago, the concern wasn't that I wouldn't make through the surgery. It wasn't that I wouldn't follow directions afterwards. It was who was going to be my care provider in this community if I had an issue. And after talking to that transplant team, we've decided that I need to have a primary care person at UNM because they know that person's gonna stay there, that person's gonna be able to follow me, and I'm gonna be able to be able to see them if I have an emergency. Right now, I'm not the only person who's on the transplant list in the community. There are several of us that are patients over two dozen, at least, and all of us have the same concern, If we can't see a primary care person within, you know, a couple of days, it's a problem. It can be a life or death situation. Right now, there are so many of us that are concerned about that, and it would be really nice to hear that there's going to be an actual doctor, because sometimes people are medically complex enough that they need an actual doctor instead of a nurse practitioner, and not having access to that is very difficult for some of us. Thank you."

The next woman said: "I am an ex-patient of HMS. I have very complex issues with my spine as well as internal organs. And it was Dr Ratliff who said, no to HMA, because we weren't getting any results. We weren't getting test results sent over to cardiology. We weren't getting information to anybody for my benefit. He said, 'That's it. You need to go to a doctor, and I'm recommending Anne Rogers, who's right around the corner from me, and you need direct care, and you need care that's going to be taken seriously, as opposed to folks not getting back on the phone with the doctor or not returning the information from the hospital. All these tests were sent to HMS, and they refused to give me them in person, in a paper form. So I let everybody know I've been going door to door, getting my paperwork in person. They will not give me my paperwork."

A man, said: " I'm the next patient, but I wish you all luck. I hate talking the microphone, but I just have to say one more thing, on behalf of the medical profession in general and individual health care providers. None of the issues with medical education, licensing, malpractice insurance,  health care insurance, are going to be resolved until everybody in this country has free medical care, period."

Irvin-Vitela said: "We're going to shift gears a bit, and we're going to hear from community members at large. So you may be someone who doesn't use HMS services, but again, we're all impacted by the well being in our community."

Patricia Cano, Lupe's mother spoke next." I am a patient at HMS currently, but I'm speaking on the community side. I am one of four women who started the emergency warming center for the unhoused. We worked with them about 63 days that we were open. We saw many, many of the unhoused and what we about, 30% of them each night, were severely mentally ill, and that is what's caused, and is causing the problems downtown and wherever. I know you're not ready for solutions, but it seems to me that HMS is just flipping everybody the bird, and they don't really care. We need behavioral health. I am tired of going and hearing updates about Tu Casa and learning that they can't update us on anything because nothing is going on. So my solution is to say, the hell with HMS and bring another agency to take care of us, because we cannot afford to wait. There are so many people suffering from schizophrenia that could be helped and could lead good lives if we had the behavioral health care. And so I'm really disappointed with HMS. I tried to be patient, but I want to see behavioral health in my lifetime."

Hugh Epping spoke next. "Some of you probably know me as a little red Corvette that drives around town. My background is I ran a not-for-profit clinic for several decades, and what I learned was that the person at the top establishes the atmosphere in which you work, and that atmosphere can be very educational, it can be very freeing, or it can be extremely toxic. And one of the problems we have here is that it's a toxic atmosphere. That's the reason people are leaving."

"Take a look at the turnover. The first thing that stands out is there's a problem, a real problem. Now, the other thing I learned is, when you work with a board of directors, the only source of information for the board of directors is the CEO. That's the only place they get their information. Now, some boards are open to the public. HMS is not. Try and get a hold of copy of their minutes. You're not going to be able to. I've had not a long history, but I started out with HMS. My first thought was not for profit. I ran a not-for-profit. That's good. I tried to get a hold of them on the phone. You can't do that. I've written several letters to Dan Otero saying, fix the damn phone. I got a boilerplate letter back saying 'we're working on it.' And how many years has that been? Still working on its. Answer the damn phone. A lot of this new stuff coming out, it really makes you disassociate yourself. It's like when I go to the bank and they say, Well, you know, you can do this online. Well, if I get it online, I can't talk to you and I want to talk to somebody. Those are my observations based on my experience of running a medical clinic that you have to give your personnel the leeway to do their job, and if you do that, you're going to look good.

Sylvia Madrid said: " I've been a therapist at Border Area Mental Health for 30 years now, and we have extended our clinic quite a bit. We have like, eight therapists and four or five medical providers. So we are here for the community, and if we can't see you in person, we will see you in telehealth. But the reason I'm here is because I've had about five or six clients that although do have some behavioral health issues, the majority are there because of anxiety due to HMS and not having medical primary care physicians. That's their problem. They're tired of being shifted from one provider to the next. This one client had four. And every time he went to see one of them, they were gone. And so they went to the next, they had another appointment. Again. They went to that provider. They were gone. This is the fourth provider that he's praying that he'll be able to see him. I had a client that was very upset because he heard the CEO belittle this receptionist at the window when the receptionist was trying to talk yo make an appointment, and they said: 'I'm never going to go back there again.' If that's the way they treat their their staff I am not going to go back there. So those are my concerns. But Patricia, we are here. Border area is here. We have grown quite a bit. We have offices in Las Cruces, Deming, Anthony, Silver City. So we're here."

Irvin-Vitela said: We don't want to ignore you. Was there anybody else who is from community, or maybe you're a community member or former patient, you check all of the boxes and you'd like to weigh in? So we also have some time set aside, and this gives us more time to move into kind of the what's possible, potential solutions. And we've heard some of them, and I made a mark on the flip chart, so I can pull them into this section when I give you a report back, but I can tell that you all are creative and resourceful people, and already I've heard some solutions in what you're saying. You've talked about the importance of treating people like they matter, having continuity of care, so that way people will have the time to get to know who they're serving so they can help make more informed decisions. Because no amount of expertise works if you don't know the patient, right? It's just not enough in terms of long term well being. What other solutions do you all have in mind? What are some things that can make HMS the organization you need and want it to be."

One of the previous women speakers said:  I've often wondered why there isn't a patient group, you know, like we have the board of directors, but why doesn't HMS look to the patients and have a board of patients or a committee of patients, or something that could give them feedback? Where does Dan Otero get his feedback that he's going to give to the board? So why not have a patient I don't know if advocacy is the word?

Irvin-Vitela said some federally qualified health clinics have patients on their governing boards. So that model exists within this country. The idea behind most FQHCs, at least when they were originally established, was that the boards of directors were representative of the communities that they served in, inclusive of patients. So your point is well taken and well made.

A woman said: "I hate to be negative, but it sounds to me like he wouldn't pay attention to the board if he won't even answer a phone call for someone who's called and called and called."

Irvin-Vitela said: "Good point. So you raise, you raise an important point. Always when we're trying to solve problems, sometimes it's easy to think about one person, and there are people who can have a tremendous impact, but often people exist and operate within systems, and systems issues are thornier to solve. So I'm going to ask you to think about both. What are the people issues? Because people issues matter, but what might be some systemic or some kind of step solutions to get the kind of care that you all want and deserve, and you know what you and your other community members need.

Joanne Salcido said she used to serve on the HMS board, and "I know that they were always worried about encounters, so they wanted to see as many as they possibly could so they could make a profit. But I believe that there should be other board members coming in, not the same ones year after year after year."

Irvin-Vitela agreed. "Not only is that true in healthcare, but that's just a best practice across all governing boards, that you don't have lifers, that you bring in new ideas, new energy, new talent, and you maintain your organizational history and memory, but you do that with a deep commitment and rootedness in community. So I appreciate that feedback very much."

One of the participants asked: "We've had our email addresses collected tonight, and perhaps the people who hired you could send a monthly email? Here's our plan, and each month here's the next step that was accomplished in the plan. Because a couple of people have mentioned, you know, we're all talking here, they want to hear from the community, and maybe it isn't going to go anywhere, so we really want to hear that it's going somewhere. Thanks."

"I'll say a couple of things, and then I'll talk with folks to see if there's a more appropriate and extended response," Irvin-Vitela said. "Why we have your email wasn't to have a forever listserv and wasn't to share it with anybody else. It's just that's my commitment. If I'm at a meeting, I want to be accountable to the people that I've heard from. It's your information, not mine, and I'm sending it back to you. So there is no outside solution or somebody who is going to fix this. It's us, it's you. And so I will share the results from this with Dr. Otero and with their board. And of course, I'm going to share it back with all of you. So it will at least go that far. The HMS board still has governing responsibility, right about who's in what roles, about the direction of the organization, about how they maintain quality standards, and all of that is happening with federal funding, right? And so I just want to emphasize to you all that there is accountability. I will give the information back to you, but that advocacy is your own to do, but I'll talk to the folks, the providers who asked me to be here, given their concerns, and see if there's some ongoing commitment about follow up and additional actions that will be taken."

"I seem to think that there are entities that provide funding to keep HMOs open, and I think they probably have policies and different things that need to be looked at. And I think that's probably MCOs, the managed care organizations. I think that's probably Department of Health and the Health Care Authority. And there's also HRSA, and there's a federally qualified center regional office. I think all of them need to be informed of what's happening. And the buck doesn't just stop here. I think there are lots of other avenues by which we need to take. We need to make sure this gets in the Albuquerque Journal and different different things. To that point, Alicia Edwards is taking really good notes, and so I'll make sure that, in addition to this contact information, which were some original ideas with the planners, that we include others as well for you to think about."

Carrie Lemon said "I just want to add to this topic right here about follow through in my different roles in the community, including working at the university, doing projects with the town, with the county, and there's all these efforts to do strategic planning and community surveys and etc, etc. And then it just sits on the proverbial shelf, collecting dust. And those efforts take time. They take money. They take a lot of people's effort. And what happens in my, my personal opinion and experience, is when those efforts happen, and there's not follow through, and there's not updates, there's a sense of trust that's broken, and then there's a sense of, why would I take that survey? What are you going to do with that? And then you start losing engagement, and I think it happens within the organization itself, but then also with community members. And so if this is going to really propel change, propel something forward, I think at least a quarterly update, or something that shows, here are our next steps, and here are progress so that trust can be built, and I think that that's the first step."

A woman gave a question as well as a comment. "This gentleman mentioned that the board meetings, the minutes of the board meetings are not made public. So my question is, can they be made public so that there's more transparency around decisions that are being made and issues that are being discussed?"

Irvin-Vitela said the New Mexico Foundation for Open Government provides support to organizations all across New Mexico who are pushing for openness and transparency for any organization that receives government funding. "And so we can also include FOG's contact information".

The letter that was written by the medical community. already give the community pretty much a blueprint. "They're calling for the for the leader to be removed and replaced and for the board to do that whoever's on the board that gives too much support to to him needs to be replaced, also. So that should be where the community all of us, if you read this article, you'll find out all the people that were involved already, so they've kind of given us a blueprint to follow, and so all we need to do is get behind them, because they've stepped out with enough of them and all their names on this letter and others. In order to we don't have to spin our wheels trying to figure out a plan of action, they already have one for us. If it's a petition or whatever the medical people say, in order to get Dan Otero replaced, everybody's going to have to get behind that and just follow their lead in this, because that will work, I think. And if we don't know for sure whether it's questionable board members and if they're all on board with him, then they all have to go, okay, and we have to vet very carefully whoever gets on the board if we're going to try to keep HMS alive,. Otherwise, start a whole other medical agency with patriots who care about the care of their fellow citizens, men and women and a lot of medical people in the community could actually be involved in that. So that's, I think, an excellent option when it's really hard to move people out of the positions that they want to hold on to and ignore everybody who's trying to replace them.

A participant said: "A lot of comments have been made about Dan Otero and I can't find out who's on the board, and I think it would be really good as a community if we knew who those people were."

Another person said the website is outdated.

Irvin-Vitela said: "So there's some information. It's out of date, but you raise an important issue, that if folks are supposed to be serving, representing, governing on behalf of Community, then it's important to know who they are. Did you want to add something as well board terms? Is anybody aware of how long board terms are at HMS?"

Another participant said in looking at the their website, some of the board members have been on there a long time, and "I have written letters to the board members and Dan Otero opens every damn one. So they never see them."

Another commenter said: "A board needs to be an active board, and they need to listen to their constituents."

A previous speaker said: "We recently saw Governor Michelle Lujan Grisham get rid of the board of WNMU in one fell swoop, and Joe Shepherd was tarred, feathered and run out of town too. If that could happen to the wonderful university that we have, we can conquer this some way. I don't know how, but we've got to do it. So maybe calling Michelle Lujan Grisham and saying, why don't you check into this? It's using federal funds that are administered through the state of New Mexico. Would that help? Well, the governor's contact information, so I know that they when you fill in the contact list, it's always read, it's always responded to, and when there is frequency around an issue, that issue tends to get action.

A woman in the audience said: "The governor will be here July 17, with her entire cabinet."

A woman said: "Most of you have spoken with me at HMS. I worked there for nine years. I was just a front desk person, but I like my community, and I've lived here, gone to HMS since I was in school, got all my shots. Now I'm a former employee, but I had one of my staff members from when I was a supervisor that has been fired since, from HMS, that wanted me to read her feedback on why she was afraid to come here today. She feels like it's not going to do anything. HMS doesn't care. The board doesn't care. Nothing is going to change. She would be getting worked up for nothing. She literally had to survive on medications, working the last few months there, thinking that maybe she would be better off killing herself. Her physical and mental health deteriorated immensely that the last few months in that hell hole, she's barely getting her mental stability back. She is not letting HMS take a run at any more of her peace. She wanted me to read this as verbatim. She doesn't want her name out there. I've had many staff that were fired. I have stories that would take longer than 15 minutes up here."

She read: "Procedures were reasons why I was pushed out. I was made to feel you need to put your notice in, or they're going to find some reason to fire you. They haven't found one yet, but they're looking and at this rate, they were just going to make something up. So at that rate, I tried to advocate for my staff. I know that there are patients that had to come to me because nobody would answer the phones. They couldn't get their prescriptions. I was just the office manager, but I would have to go back physically, find somebody that could help someone.

"Then I was told that, you know, after nine years working there, I was there before Dan Otero, no, Dan never did anything to me personally. With that being said, I don't think there's anything that goes on in HMS that he doesn't know about or has a part of. But at the same time, there is no autonomy. You're told, when something comes up in an issue and there's a negative fashion, you tell that blanket excuse: 'Oh, everything's fine. We're great. Nothing's wrong.' Don't ever deviate from that. Myself and other people, my own staff were written up because of that. If they ever said a negative comment about, oh, you know, I just don't like those kiosks. Sorry. They're all or nothing. But I can't help you. I have to stand over here in case somebody needs help with the kiosk. So with that being said, I agree completely that things that shouldn't be focused on, like this gentleman said, are taking focus instead of the patients. Doctors are sometimes kind of needy. Yeah, it's just in general, but I think if you take care of your providers. It's not, oh, I'm going to pay you X amount of money an hour, but treat you horribly. You're never going to get admin time. Who cares if you don't get a lunch work on the weekend, but don't see any patient or call a patient on the weekend, because that's just illegal. There really is no autonomy. You can't do anything, right? Nobody matters. I was told I would get an exit interview. That never happened. People who left on their own or were fired after, you know, I was gone, were told that if they did get an interview, it was going to be by Dan Otero himself. So I think that was almost a scare tactic so nobody responded. One of the other doctors that isn't here, that I don't see, stated that we're not little people. We need to have a voice or no one's going to change anything. It is going to get put on a shelf collecting dust. So this is our opportunity. I think that there was a comment on the board being switched out or, you know, re-elected every two years, but I don't think that's happened in like five or eight.

Someone said: "We actually got some feedback from Dr Derek Nelson, and the terms are indefinite. But along with that, he also provided us with a way to find the current board members, which you can find at https://hms-nm.org/about-hms/board-of-directors/ 

Irvin-Vitela thanked everyone for being here and having the courage to hold space for folks who couldn't be in the room and be okay. So that kind of ongoing commitment to folks on your team is pretty incredible."

Dr. Stephens said: "You just heard from a person who's very competent, obviously very bright. She's a go getter. She's right. You know, physicians, we can be a little needy at times. However, I was not allowed to go to her. She's the office manager. She was supposed to do her job, which is to run the office. I was not allowed to go to her with any concerns. I had to go to my supervisor. If my supervisor felt that my concern was important, then he would go to his supervisor, and then that supervisor would tell her what to do or not what to do. That is in a nutshell what's wrong with HMS. It's the micromanagement. There's a lot of capable people there. A lot of capable people pass through there. They're not allowed to do their jobs. When that gentleman said that, Dan Otero opened up the letter and read it and it never got to the board. That's how it works. Dan Otero reads our emails. There is no autonomy. You are not allowed to show any initiative. It's a very toxic environment. And I wasn't going to go down that road. I was trying not to make it personal. But if you're going to ask for my opinion, speak to the providers. If you can speak to providers personally, what needs to be done, ask them. Obviously, at the end of the day, is what the community wants. Is what the community needs. Now, I do not represent the providers. I represent myself. If you're asking for my opinion, nothing's going to change unless the board is gone and Dan Otero is gone."

A patient asked: "I have a question for anybody who's got more experience organizing, but as a patient, can I exert more pressure for change by sticking with HMS or taking my healthcare needs elsewhere?"

Irvin-Vitela said: "That is a really good question, and I think people are needed in both. You don't have to sacrifice yourself or your well being to be a good advocate within HMS, but if you feel like you can get your needs met sufficiently and stay there, that's an option too. So there's there's no guilt, there's no wrong option. You have to do what works for you and know that your well being matters.

Patricia Cano spoke up: "Yeah, excellent. The more I hear, the more I realize that it's time for a protest in front of HMS. And we can demand to see Daniel Otero and we can demand that the board come and listen to the community, and I am willing to organize that."

JoAnn Salcido note: "HMS is a big organization, and it seems to me that we have failed to mention HR. Where has HR been in through this whole chaos that's been happening there, because there are not only the providers, but there are other staff members that have had their issues, and they have left, and I don't hear anything about HR. What did HR do for them?"

Someone asked: "What about the senior citizens? I'm very concerned about senior citizens. There's quite a few seniors. I went to a Commissioner's meeting, and that was a lot of talk, I mean, a discussion about it. They're worried about it. I'm worried about it.:

Irvin-Vitela said: "So bearing in mind that there are impacts on health care, but there are also impacts on well being. Thank you all for hanging in there tonight."

https://hms-nm.org/about-hms/board-of-directors/ 

 The facilitator asked the Beat to add this information for your convenience:*

 *NM Governor’s Office https://www.governor.state.nm.us/contact-the-governor/need-assistance-from-the-governor/

Federal Delegation:

HMS Board of Directors:

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