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Grant County commissioners hear county reports, including GRMC update

By Mary Alice Murphy

At the Tuesday, June 8, work session, Grant County commissioners heard county reports.

Brian Cunningham, Gila Regional Medical Center chief executive officer, gave an update. "This is from the end of May," Cunningham said. "We want to thank the community for their participation in the foundation's Golf Classic, where almost $20,000 was raised for much needed equipment for the hospital."

He said the linear accelerator for radiation treatment for cancer patients has been installed and saw its first patients June 11. A grand opening saw about 75 people attend. "Rep. (Rodolpho "Rudy") Martinez carried the bill for the funding two legislative sessions ago, and with support from Sen. (Howie) Morales and others got the funding. It was a complex project but we met all deadlines. The technology is not available anywhere else in New Mexico."

Cunningham said Dr. John Stanley and Joe Ramirez would replace strong board members, Dr. Darrick Nelson and Robert Morales Sr., "who served during difficult times for the health care industry. We are replacing our ER contractors EmCare, and are about halfway through the process. We will finish the onsite interviews this week. We plan to replace the group by the end of the calendar year and perhaps sooner."

He said, as of the end of May, the hospital had a positive bottom line of $5,000. "We knew with the end of sole community provider funding at the end of December 2013, we would be losing money, but we've been losing less each month since January. On the cash side, as of June 2013, we had 109 days of cash. As of the end of May, we had 128 days of cash. The graph of the increase in expenses has been on an upward trend nationally. We wanted not only to bend, but to break the upward trend. In June 2013, our daily spend was $191,000 a day. At the end of May 2014, it was $175,000 a day. This is a clear indicator of the work we're doing on efficiencies, due to a tremendous amount of effort of our caregivers and staff. We had a deficit of $9 million at the end of last fiscal year. At the end of May, the deficit was $2.1 million, with one month to go in the fiscal year. We have turned around by $6.5 million to $7 million in 10 or 11 months. Our goal this fiscal year is to turn it around to a positive bottom line."

His last topic was the home health and hospice services, which the hospital will be discontinuing. "Let me put it into the context of the health care challenges. Health care is in trouble across the county, with costs that are unsustainable. Gila Regional is not immune to the situation. It still hurts; it's still upsetting, but no hospital can continue to operate in the same way. We have to make decisions on what we can offer and what we cannot. Services, such as home health and hospice are replicated in the community."

"We need to consolidate our core services," Cunningham continued. "We did deep analyses of every department. From that work, we came to the decision to discontinue home health and hospice, which are businesses we cannot be in. We are focusing on the transition and how to transition our patients over the next 60 to 120 days.

"One other agency in town—Horizon Home Health and Horizon Hospice— offers the services," he said. "Another business is interested in coming in. These organizations will fill the gap as much as possible. We are not cutting anyone. The focus will be to absorb as many as possible internally, in nursing, for instance. We will transition others into other organizations because the demand will remain. We hope there will be zero net loss of jobs to the community. Hopefully, every patient will transition and so will every caregiver. We still have $6 million to go to get back to a healthy bottom line of $4 million to $5 million. Services will continue and most caregivers will still have jobs."

Commission Ron Hall said a patient had talked to him and said he seemed to be blindsided by the decision. "He wondered why the public wasn't informed, so he could make other plans, such as moving to another town."

"The final decision was not made until the board meeting, less than two weeks ago," Cunningham replied. "It was not appropriate to say we were talking about this or that. We had to talk to our caregivers first. The notice that we are discontinuing the service, but will transition, was the appropriate time to notify the public. We told people after the decision was made."

Hall asked if there were adequate caregivers. Cunningham said: "Right now, no. Because Gila Regional had 60 to 70 patients, we started talking to Horizon Home Health immediately so they can increase their employment model. That was part of the conversation. There will be bumps, but it will settle out."

Hall noted the transition period was very important and should be done with compassion.

Commissioner Gabriel Ramos thanked Cunningham for considering the transition and asked what it would do to the hospital's debt.

Cunningham said the loss to home health was about $1 million a year and hospice was about break-even. "That is through no fault of caregivers, but is the result of the reimbursement structure."

Ramos asked what percentage of personnel the hospital would be able to absorb.

"Out of 40 caregivers, at least half," Cunningham said. "We have 15 nursing positions open. I will report on the progress every month."

Commission Chairman Brett Kasten said he had been asked a question about whether GRMC and the town of Silver City were duplicating ambulance service, as both seem to show up when a call goes out.

"That's a great question," Cunningham said. "I wish Councilor (Cynthia) Bettison were still here and James Marshall, the emergency services director. That is one of the same departments we've been talking about—services that can be replicated in the community. Ambulance service is one. Outpatient rehab is another one. We are trying to decrease our footprint to be more break-even in revenues and costs. The emergency room loses money, but we would never consider getting rid of it. For one thing, our licensing requires it. But we know we need to work on processes to increase efficiency."

Commissioner Ron Hall said, as the ER is the most expensive point of entry to the hospital, and there are other community resources for minor emergencies, "Have you worked on education of the public?"

Cunningham said many insurances are paying less for inappropriate emergency room services and education needed to be increased.

"We appreciate your care for the community," Hall said. "But you have to make the hard decisions."

"We want to make sure we are providing the best quality for the community," Cunningham said.

Mike Carrillo, Detention Center administrator, presented the next county report. "We have two vacancies. Our newly hired officers have completed tactical defense training by our training officers. Lt. Aguirre and Sgt. Galindo. We are trying to find funding for the intervention inmate support system." He reported the average daily population was 87 from June 25-July 8, up 14 from last month. The average length of stay for an inmate is 8.24 days.

Earl Moore, Road Superintendent, said the department got started in the Viva Santa Rita subdivision, and the residents are "pretty happy. We'll be out there a couple of weeks."

County Planner Anthony Gutierrez said he has been spending his time reading a number of reports that have come into his office. "Many are related to the lack of water. I will have comments on both potential mandates from the New Mexico Environment Department. The Gila groundwater reports are in. The U.S. Bureau of Reclamation draft report has been issued. These reports are from 100-300 pages long."

He noted that California is having water auctions. "It's imperative for us to protect our natural resources." Gutierrez said he is also dealing with the Mexican Wolf issue, which is in the comment period. "There will be two public meetings—one in Pinetop, Ariz., and the other in Truth or Consequences. I want to get a handle on all these reports so I can comment on them."

Gutierrez said the Loma Verde Subdivision road improvement district has already received almost $16,000 of the required $40,000. "So the New Mexico Finance Authority loan will be at least $16,000 less than anticipated."

He said the fairground plumbing is stubbed in.

Randy Villa, General Services director and Fire Management officer, said a lightning-caused fire on Separ Road burned about 382 acres. "We protected the old ranch structures. The property owner had just closed on the property that morning. The Forest Service sent in a smoke jumper, and several volunteer fire departments contained the fire."

"I thank the sheriff for jumping on all the fireworks complaints," Villa said. "We will have Gabe Holguin from the forest service talking on Thursday. I've been talking to the rural fire chiefs, and we are still in drought conditions. Silver City is talking about lifting restrictions. We need to be all on the same page. I don't want to confuse the public. It might be raining at your house, but not five miles away."

He said Public Works is still manning the airport. "We have a planning meeting next week and you commissioners are invited."

Linda Vasquez, financial officer, said her office is working on the year-end process and the final budget. "The auditors will start the first step next week."

Sheriff Raul Villanueva said the Fourth of July weekend was a busy one for his officers, with lots of calls on fireworks everywhere in the county.

Clerk Robert Zamarripa said the reason for the inventory deletion of voting machines was because the Secretary of State requested and received $6 million to purchase brand new voting machines for the whole state. The same amount purchased voting machines for the more populated counties last year. "In August, we will receive the new ones, and the state will pick up the old ones later. We haven't decided whether to use our present machines or the new ones for the General Election. The new ones seem a little more complicated, but we will have training on them in August. The state is sending us 15, which is a bit tight, because we have 13 polling locations on Election Day. We may have to use our M-100s for this election. We have 36 of them, so we have spares. The new machines, just like the old ones, process paper ballots. This November election would be the last time we could use the M-100s, because they will be decertified for use in New Mexico. But we need at least five spare machines, so the county would have to purchase at least three at $13,000 each."

Interim County Manager Abigail Robinson answered Kasten's question about securing airport fuel.

"The contract agreement fell through," Robinson said. "I sent a new request for proposal for fuel and trucks. Now that the rain has started, it's not an emergency anymore, so we are working on the normal bid process. Pilots can still refuel in Deming or Lordsburg."

Villa said he had just received all the information needed, and he and Public Works Director Justin Reese and Jacob Zamora were getting the process going.

Ramos thanked the outgoing GRMC Board of Trustees members Robert Morales, Sr., and Dr. Darrick Nelson for their service.

"We held a Parks and Recreation Committee meeting, which went well," Ramos said. "We presented an option to raise the employees' cost of using county facilities to 20 percent, because it is hard to pay for the electricity and cleaning with the 10 percent. We will have a recommendation at the following meeting."

Hall said the Cliff-Gila area wants the county to enhance the exhibit building at the fairgrounds for other uses in the area.

"I talked to the Silver School superintendent, and he is offering the ball field at Cliff School for teams to use," Kasten said. "I concur that the fees for employees need to go up to pay for cleaning and electricity in county-owned facilities."

The commissioners adjourned from the following executive session, in which they discussed an interview timeline for the county manager position.

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