By Mary Alice Murphy

At the Friday, April 28, 2017, Gila Regional Medical Center Board of Trustees meeting, Interim Chief Executive Officer Alfredo Ontiveros recognized Pat Nesbitt, who was with Gila Regional overseeing facilities for 10 years. He recently resigned and went to work for Hidalgo Medical Services.

"My second announcement is that Carrie Young, who has been our counsel, has submitted her resignation," Ontiveros said. "She will take the uniform bar exam, so she is able to work anywhere with her Juris Doctor degree. She is also a nurse."

Board Chairman Jeremiah Garcia said to Young: "You've always been here for us. She has taught us a lot, including that we should go to our counsel to make sure we're doing things right."

Board member Magdaleno Manzanares said his daughter is a young lawyer. "I have told her about you," he said to Young. "I told her you are a woman who tells a bunch of guys what to do."

"I want to thank the board for interacting with me," Young said. "You spend a lot of time dedicated to this hospital."

During the formal recognitions, Nesbitt received acknowledgement for this 10 years of service to Gila Regional. Camelo Bacho, who works in the nursery, was recognized for her 35 years of service. Ernesto Garcia, who was present, received a plaque acknowledging his 15 years in housekeeping.

"We always talk about our caregivers," the chairman said. "But if we didn't have this type of dedicated service to make sure things are sanitary, we would not receive the quality accolades we have gotten. His 15 years shows his commitment to us."

During public input, Karen DeGenevieve, a nurse practitioner in the Cancer Center, said she started the Cancer Center in Silver City, beginning in September 1998. "A lot of caregivers were skeptical and said chemotherapy was risky. But I asked Dr. McAneny to come down with her New Mexico Cancer Center. She has remained loyal to our patients. She has done everything to make the clinics successful. Clinics come and go, but she kept hers here. It takes hard work and perseverance to make it work."

DeGenevieve said she, for years, picked up the practitioners at the airport and never asked for compensation. "Our clinic grew and the care received was great. Dr. McAneny continued to work here without a contract, which she finally received in 2007. Before she only billed for professional fees."

"Now after 22 years of uninterrupted services, you announce in a press release that you have awarded the contract to the University of New Mexico," DeGenevieve continued. "UNM lobbied hard against our getting a cancer center. It took Sen. Ben Altamirano and Susie Trujillo going to the Legislature for funding to get our Cancer Center started. "

She said that evidently there had been little difference in scoring the two requests for proposal and not much financial difference in them.

"I feel disrespected by this decision," DeGenevieve said. "No one asked my input. The decision was made without any input from the patients, the staff, the providers nor the caregivers. I found out about it through an Internet press release. How dare you demean us that way!"

She said the Gila Regional Cancer Center is one of ten centers in the country certified as a cancer home. "UNM does not have this certification. Our care is offered by providers and practitioners dedicated to their patients."

"We are appealing this decision to make us vacate the clinic within a set time," DeGenevieve said. "Dr. McAneny has offered to take over the financial part of the center to prevent denials. She is willing to negotiate on denials."

DeGenevieve said making such a decision without input from the Cancer Center staff and providers is "unconscionable. I hope you revisit the decision. After reading the press release, I feel devastated. The transition will be difficult and will impact our patients' care."

Ralph Dominguez, retired GRMC employee, gave emotional comments to the board members for the excellent care he has received at the Gila Regional Cancer Center, and how quickly he received necessary care. "The caregivers are excellent, gentle and caring. I wanted you to know what's going on."

Dr. Laura Davenport-Reed, primary care physician in internal medicine and pediatrics, said she has spent 15 years on staff. "I am a major supporter of the hospital and the Cancer Center. I was chief of staff years ago."

"I have seen the way the hospital makes decisions, without input from the caregivers and providers," Davenport-Reed said. "Case in point, the way we were informed about home health and hospice being removed from the hospital.

"I think this was a poor decision," she continued. "There was only one physician on the review for this decision, while there were three on committee making the decision for the CEO. I think the Medical Executive Committee needs to be involved in decisions like this. We met last week, but the press release went out the evening before.

She said: "I'm here to support the New Mexico Cancer Center. They give excellent care, and so we can continue with the group that is here. Karen has done an excellent job. I call her regularly, even daily. The patients are devastated that things might change."

Johnny Reed, physician assistant, said he has patients who are being treated at the center. "They are devastated and worry about their care. I'm here to support Karen and the Cancer Center."

Garcia said generally the board does not comment on public input. "But we are all passionate about the hospital."

He read a statement that said in part: "We hear your concerns. Gila Regional is always concerned about care for our patients, including those in the Cancer Center. That's why we have state of the art equipment. We remain committed to quality oncological services. We feel UNM will meet our needs. We appreciate your input. We have numerous contracts throughout the hospital. Sometimes we have to bring in other contracts."

"The last part of the process is negotiation," Garcia continued. "We have to look at everything. We have to do our homework. We hope through negotiation that the present caregivers are part of the transition team, so patients receive the same care from the same caregivers and providers. We thank you for sharing your concerns."

A woman, who said she did not sign the public input sheet, so did not speak, asked where she and others should send letters. Garcia said to the Gila Regional CEO and the chairman of the board.

Frances Day gave the Auxiliary report, and said the group had a great bake sale that morning for those who got there early. "We have eight new members over the past six months, and we've lost five to moving and two to retirement. We welcome your input, and if you have jobs for us, we will try to find someone to do what you need."

Ontiveros gave his CEO report. "Our new CEO is reviewing the final contract, but as she has agreed to a firm start date, we don't think we face any problems."

"The contract with UNM to provide oncology services is in process," Ontiveros said. "We still have a ways to go, and it's not done until the contract is signed. I know the current contractor has filed an appeal."

He said insurance costs for staff through Blue Cross Blue Shield of New Mexico has increased by $503,000. "We did negotiate the rate increase down to 14.99 percent. The hospital will continue to pay 75 percent of the insurance costs, with the caregiver being responsible for 25 percent."

The MediTech6 upgrade is still on target to go live on June 1. Ontiveros reported IT communications received a rural health grant to help improve broadband at the hospital.

"We are improving our financial process," Ontiveros said. "We continue to work in recruiting a potential ENT, that we are talking to. We are also recruiting for a family practitioner, a second urologist and a pediatrician."

He said he has been doing community outreach, including at the Chamber of Commerce monthly luncheon and monthly reports to the County Commission.

Garcia said Ontiveros also did a radio show and talked about opportunities at Gila Regional. "Raul Turrieta, George Mesa and E. J. Montes asked good questions on the bilingual station."

Ontiveros read from a letter he received from Mediech, which pointed out some items that needed to be corrected, but that did not put the go live date in jeopardy.

Trustee Mike Morones noted on the Cancer Center request for proposal, the board had empowered the administration to facilitate the process. "But it culminates in a board decision. The board will have to made the decision and staff will have to justify the decision."

Ontiveros agreed. "The final decision will be made when we have negotiated a contract. We may find something, an issue that they can't do or we can't accept. It's not over until it's over."

Morones re-emphasized that the board has not made a decision.

Assistant Vice President of Administration Liana Ryan said three initiatives, as well as another project in the strategic plan of work, have been completed. "We are at 45 percent completion for the strategic plan of work. We are working with the emergency room to provide services to cardiac patients. We have had our highest revenue in cardiology and the highest volumes at the Family Clinic in pain management. We had ENT Dr. Patricia Murphy visit. She is reviewing the contract."

Trustee Magdaleno Manzanares said a patient had asked him to pass on to the board that she has received excellent care at the Billy Casper Wellness Center.

Garcia asked Ryan if the hospital is getting closer to improving scheduling.

"We are doing work on scheduling," Ryan confirmed. "The chief medical officer is involved. We tasked an outside vendor to help us look at it."

Garcia asked about veterans using the Veterans Choice Program and if they were getting more care.

Ryan said the Veterans Choice initiative is complex. "We are making sure to focus on Meditech, then we will look at Veterans Choice again."

Chief Nursing Officer Peggy White said everyone, who had been part of the reduction in force, has been absorbed into open slots at the hospital, except for one who decided to move on.

"They went into positions that were open and needed," Ontiveros said.

Trustee Joel Schram asked if they had to take a substantial reduction in salary, to which White replied: "Yes," and Ontiveros clarified by saying those who had been in senior positions went to staff positions, so "Yes."

White reported her department is down to two traveling nurses. "We've met our objective. Now we need to look at utilization of staff and how to pull patients through the system."

Chief of Clinical Services Ray Goellner highlighted the financial dashboard in his report. "In the first nine months of the fiscal year, clinical services has been $800,000 over budget in revenues and $500,000 under budget in expenses. The new nuclear medicine camera is installed and training will take place next week. It will go live on May 8."

Ontiveros said the hospital had finalized recruitment of an echocardiography technician. "He's also fully accredited for pediatric echocardiography."

White said this recruitment is in line with the pediatric radiology reading capabilities with Dr. Wong.

JoBeth Vance, interim chief financial officer, said the high point in her report was the positive bottom line of $289,134. Plus volumes are up.

Ontiveros said Vance had looked at April and "it was looking good. We are cranking up collections."

Garcia asked confirmation that the hospital is finished paying the safety net care pool payments, so "now we will receive payments."

Ontiveros confirmed that. Vance said the hospital has 64.61 days in cash, which is about $13 million cash on hand. "We're looking good." She said Jacobus consultants were unable to attend this board meeting, but would present their findings in May. "It is a work in progress and we will get you where you want to be."

Chief of Staff Dr. Gregory Koury was not present, and no questions were raised on his report.

In Board Committee reports, Garcia said the Executive Committee had met and discussed the agenda and other items.

Schram gave the Quality Improvement Committee report and said mostly they looked at the revenues dashboard.

Trustee Dr. Victor Nwachuku asked for approval of several contracts. The first was with Dr. John Stanley to be cardiopulmonary medical director, with a contract for one year, not to exceed $14,400 at $100 an hour. Certified Registered Nurse Anesthetist Aaron Rudd will receive $110 an hour serving on the Credentialing Committee for a two-year term. Dr. Brian Etheridge has agreed to serve on the Medical Executive Committee for two years at $110 and hour. A third amendment to the anesthesiology agreement with Dr. Mark Donnell, at $167 an hour, will allow coverage during other anesthesiologists' vacation time. A third amendment extends the negotiation with Gila Pathology's Dr. Pavel Capek. The last agreement was for the hospital to make a Cobra insurance payment of $1708.16 for Dr. James Lawyer for a bridge until he can receive Gila Regional insurance.

"On Dr. Lawyer, we usually initiate insurance ahead of time, because there is a 30-day waiting period, but it fell through the cracks," Ontivero said. "In future contracts, we will cover that cost."

Manzanares said the Plant and Facility Committee took a tour to see the new nuclear camera. "As Mike and Joel noted, it is not readily known to the public about the availability of the excellent equipment we have."

"We are always trying to answer the negative, but we need to do more to promote the positive," Ontiveros agreed.

Manzanares asked White to speak about the safety training.

"We have a lot of safety training in our internal education program," White said, "including active shooter."

Schram reminded the trustees that in Silver City, "we have had three consecutive months with gunshot victims coming to the hospital.

Ontiveros said the hospital is contracting with an outside firm who will train about 100 caregivers on safety. "Also Wayne Heath has a meeting with law enforcement."

Goellner said Ron Corbly is transitioning well into the facility management shoes of Pat Nesbitt. "He is doing an excellent job."

"We committed to him," Ontiveros said. "We told him we wouldn't let him fail."

Ontiveros noted that the hospital would fund fixing the air-conditioning system at the Wellness Center.

In the Human Resources Committee, chairman Trustee Tony Trujillo was not present, so Garcia gave the report.

"The dashboard is about normal," Garcia noted. "Contract services are slightly up, but they are usually assisting our staff to improve. Labor costs so far this year are $4 million, in contrast to the $1.4 million final cost last year."

Nwachuku noted that Meditech expenses would soon be gone. "We also have to try to find physicians and not use locum tenens."

For the board bylaws, Nwachuku said he would like to wait until the next meeting for approval to give the trustees time to look at the revisions.

Trustee Dr. Tsering Sherpa asked if it was OK for the Quality Improvement Committee to meet quarterly rather than monthly, because some months did not have much to discuss.

The trustees took a break before going into executive session.