Editor's Note: This is the final portion of the coverage of the Grant County Commission no-confidence vote on the Gila Regional Medical Center senior administration, although a great deal of other information, which drew public comments, will be covered in future articles.

Grant County Commission Chairman Brett Kasten, after offering a chance to speak to those against the no-confidence vote, then asked for discussion from those who wanted the commissioners to approve the no-confidence vote.

Al Grauer, county resident, pointed out that one-quarter of New Mexicans have no access to health care. "We have the most convoluted system of health care in the world, although it is excellent health care. We need to keep Gila Regional strong to help people who will be eligible for health care under the Affordable Care Act. I vote for this first step, for you to have a dialogue on how Gila Regional can provide care under the act. But also to get into an extended dialogue to maintain the ability for the hospital to provide for the community."

James Rogers, 21-year paramedic, said he retired from Gila Regional, but his wife works there. "I understand the financial problems. I feel your vote of no confidence should reflect that it does not relay back to the caregivers. There have been several instances where I felt the management put themselves above the HIPAA regulations. It has been broken by two senior management officials, but I was harassed for a minor HIPAA infraction. I've also had a discussion with Mr. Bentley on the safety of caregivers. My wife was assaulted in the emergency room. Gila Regional should have been more responsive. I would like to know management's salaries. I went to the board with concerns about safety. I was told by the chairman to come back in a year and he would let me know what's happened. Mr. Bentley said he works for you and the hospital is owned by the county. The information should be disseminated to the county. I feel staff people have been endangered. It's not only a financial situation, but the vote of no confidence needs to make sure everyone knows and it not be a surprise. Maybe changing leadership is not a good idea."

Dr. Teresa Arizaga-Morales said she wished the commissioners could have been at the Wednesday town hall, because so many spoke up about their frustrations.

"One of my biggest concerns is that the numbers keep changing," Arizaga-Morales said. "I think there is a level of dishonesty and lack of integrity. There is a lot of blaming the federal government and blaming the board of trustees. I think the board's intent was not to hurt people but to have them share in the cuts. I am an employee and would be willing to share in the cuts. I think there is false information. The information is that the state made the mistake. If the state made it, they must pay it back, and not put the burden on the hospitals, unless it was the hospital that made the mistake. There are not more people speaking today, because they wonder what will happen to them if they speak out. A lot of people are feeling a lack of confidence and agree with the vote. It bothered me that one reason not to cut across the board was because it would make it less desirable to recruit people. There is a lack of concern for people already here. So many people are willing to cut and take responsibility, rather than worrying about recruiting down the road."

A 13-year EMS member said he supports the vote. "My concern is why a lot of the cuts weren't make a long time ago. If Bentley knew two months ago, why didn't he tell us then, so the employees could make adjustments. I am told the way I wrote reports is why I'm not getting reimbursements. Then help us learn how to report correctly. With other help, we have raised reimbursements. Our shifts change constantly. There will be a lot of transfers out of the area. If there are such cuts, there will be more overtime. We have a boat with a hole in it. Instead of fixing the hole, they are throwing people overboard. I would take a 5 percent cut. Jobs are scarce. I don't think you need to terminate the administration, but you need to talk to them and discipline them. Revise the plan, so as a team we can support the community."

Joe Kellerman of the public relations department, said, as of May 19, he would be at 50 percent of his hours. "Once you take out the benefits, there's not a lot left. I was told if I could get another job, my co-worker could get fulltime back. I don't want pressure on the co-worker, but neither of us can survive on half pay. If I were to resign, I can't get unemployment without months of trying. The bank doesn't want to hear my situation. Sixty-nine others are going there with the same situation. We were asked for employee suggested options. We have been told they were given to a committee, which hasn't met yet, so not all options have been considered. Bentley said health care is changing. I don't doubt it. What about hospital districts and trying for other ways to keep the hospital going without just relying on patients coming in the door? A day off for senior administration is a slap. I don't have confidence in the current administration. They have not looked out for my well being."

Gary Stailey, Silver City resident, said he is in the category for either way on the vote. "My concern is that you have appointed a board to do the exact work discussed today. I encourage you to table the vote and be involved with the board."

Cecilia Bell, Silver City resident, said she is neither for nor against the vote. "I know each of us could need health care, so we need the hospital as a family of care for the community."

State Sen. Howie Morales said it was unfortunate how issues like this one could divide the community. "We have to continue to ensure the best possible care for the community. I'm in a unique situation as an employee of the hospital and having taken my oath of office as a legislator. In defense of the caregivers, they had no idea this was coming. It was done secretly I'm willing to stay at the 50 percent cut, but I was also asked not to attend administration meetings. The first ones cut had no say in the cuts made or in the finances. This is not the result of an urgent situation. There has been a trend of expenses and revenues dropping. They should have seen it coming, but there was no change in behavior. They didn't let the information be shared. The Human Services Department has not been speaking to the hospital, but just to the Hospital Association. If HSD made the calculation error, then it's the state's responsibility to pay it back, not the hospitals'. I know you have trouble getting information. We need transparency in what is the problem, what is the cause, what is the solution and what is the best solution. Caregivers will tell you they are willing to share the cuts. In December, supposedly the finances were solid, but the trend has not shown that. I'm asking for accountability, transparency and trust."

Sean Ormand, 1st New Mexico Bank president, said some financial situations are self-imposed: "some are thrust upon us. I'm not for or against. They say the hospital is out of debt. I challenge that because we have a securities holding on a revenue bond coming up for payment in 2014 at a BBB rating. It is an escrow account. I ask that everybody come to the table with full disclosure. Banks have had to make adjustments because of regulations serving the government, but not the public. We need the board of trustees to fully know what's going on. I worry about the unintended consequences of the vote."

Another resident said she was told she could accept a voluntary cut of hours. "That should have gone out hospital-wide, so more people could have chosen the option."

Another employee said she was discouraged from speaking because she would be fired. "It's clear we're in a bind, but we're pitting employees against employees. It would be better to be let go. There was no input from caregivers. My department wanted to voluntarily cut hours. We have yet to hear how administrators and directors will take a pay cut. No doubt there are too many employees, but Bentley said we could afford it them. It's not necessarily about whether the administration should stay or go."

Western New Mexico University President Joseph Shepard said he was there to speak on behalf of the community and the university. "I would not have moved here without good health care. People are looking at you from the outside and won't want to come without good health care. I pledge my support to help however I can to keep good health care here."

Commissioner Ron Hall said he appreciated hearing both sides, as well as the neutral ones, speak. "Being open is important. It took courage big time to step in front of the mic."

"The administration talked about openness and communication. Others talked about a lack of communication," Hall said. "We've tried to open communication and got it in bits and pieces from the CEO, and lots from caregivers. Transparency is important to me, I wasn't invited to the board meeting, but I went. It's better to maintain the dam than fix it after it broke. I listened to the administration talk about the proposed remodel and how well the hospital was going. That is not good business. I absolutely want to work with the hospital, because it has excellent care giving. We need to come together with facts and a good heart. Getting information on contracts and salaries has been hard. We stuck out our hand to communicate and got slapped. I don't know how else to get the administration's attention. I wanted to communicate, but it seems the only way is to say we have no confidence in you. We want you to change and to communicate. I don't want you fired, but I want to work with you."

Commissioner Gabriel Ramos said he was very disappointed. "It was sad to hear my constituents losing half their pay. In December, we heard on the bond issues. The information we got was bad. We all depend on good
information. When we approached board members as individuals, they didn't have any idea what was going on. So I have no confidence in what we're hearing. To me the most important view is to keep workers working and the hospital going."

Assessor Randy Villa said he wanted to say, as an elected official, that people move to the community for the hospital and the university. "We're talking about transparency to the workers and the community."

Kasten said it was important to hear from "every one of you. This letter in no way asks the board to let anyone go, including senior management. Ten years ago I was on the hospital board. We all attended the recent meeting and it was not a pleasant place to be. I feel like the solutions were not innovative. I feel like they are working not like a public-owned entity."

The vote of no confidence was unanimous.

The rest of the meeting, which featured other items of business that drew comments from the public, will be covered in future articles.