By Mary Alice Murphy
[Editor's Note: Because you have access to the entire recording of the comments, this author has chosen to report what the primary players in this scenario had to say, and then will just put into the text some of the comments from others.]
More than 100 people, 112 by one count, attended the Cancer Center Forum on Tuesday evening, May 16, 2017. Many accepted the chance to provide input on the care they receive and why they support the doctors, nurses and system in place.
Almost everyone spoke in opposition to the proposed change of the contractor for the Gila Regional Medical Center Cancer Center from the New Mexico Cancer Center under the leadership of Dr. Barbara McAneny's New Mexico Oncology to the University of New Mexico Cancer Center.
The dominant theme of the evening was: "If it ain't broke, don't fix it."
The position stance from just about every speaker was how exemplary, how excellent is the care and how caring, how welcoming, how helpful is every staff member from Karen deGenevieve, nurse practitioner, who pushed for and succeeded in getting cancer treatment to the hospital and continues in her care role, and Mike Torres, NM Cancer Center office manager, to every nurse, tech and aide the patients deal with on a regular basis, including Kelly, Shelly, Maggie, Christie, Martha and others.
Commissioner Billy Billings led off the session clarifying that the forum was not being hosted by the Grant County Commission, but by two commissioners, he and Commissioner Alicia Edwards, as individuals.
"By state statute, the commissioners, although we own the hospital, do not get involved in the operations of the hospital," Billings said. "We are not taking a side tonight, but just hearing your concerns." He asked that comments be kept to five minutes or less and that all speakers be respectful and refrain from personal attacks.
GRMC Interim GRMC Chief Executive Officer Alfredo Ontiveros spoke first. "I am the interim CEO for about another three weeks. I came into the position on 9 January. It has been a daily challenge."
He said he was the GRMC CEO from 1995-1998 for about 3 ½ years and came back in 2007 on an assignment.
"I will talk about the request for proposal," Ontiveros said. "It is my understanding of the process that the hospital entered into an RFP with Dr. McAneny a number of years ago. The hospital received only one bid at that time. The hospital went into negotiations, but never completed full negotiations ending in a contract, so Gila Regional just kept extending the agreement. It is my understanding that we agreed with NMCC (New Mexico Cancer Center) to go out for RFP following state procurement. Nine groups requested proposals, but only two applied—Dr. McAneny's group and UNM Cancer Center. A committee evaluated them on criteria that had been set up and reached a decision to choose UNM. We have entered into negotiations. Gila Regional has to come to a contract agreement with UNM. If we can't, we will be in the same place as before, not being able to complete negotiations. The goal is for a smooth transition and continuation of services. There will be cancer services in Grant County."
DeGenevieve said in response to finding out about the suggested change: "We were not happy. We've been 22 years here and we have done a good job as the other free-standing cancer center in New Mexico. Dr. Clark was here from the beginning until April 25 of this year, when he retired. He was dedicated. When the planes didn't fly, he drove down to meet patients and drove back home that night. Dr. Fontaine has been here for 19 years. Dr. Aladina is going to take Clark's place. Our patients love them. We love them. We have no answers on transferring care, but I'm sure it will be people coming from UNM."
She gave some history on the cancer center. "Susie Trujillo and then-Senator Benny Altamirano lobbied for money for Gila Regional to build a cancer center. UNM fought against us getting the funding for a cancer center. It's difficult for me to swallow for them to take over what they fought against."
DeGenevieve also said having only one doctor on the evaluation committee didn't make sense. "They asked for no input from us. When we built the cancer center, we got public input and we gave you nine of the 10 things you wanted. We couldn't give you radiation at that time. Now you have the best machine in the state. We've been here 22 years and have had no major problems. Switching at this time doesn't make sense to me. We are the first of 10 certified as a Medical Cancer Homes. We try to take care of patients immediately so our patients don't have to go to the ER."
She also noted that Dr. McAneny was running for president of the American Medical Association.
Mike Torres told the story of how the cancer center began. "People have dreams. Karen deGenevieve had a dream. She started cancer care in Grant County, one patient at a time. One of the cancer patients gave Karen a card from Dr. McAneny. Karen called her and McAneny flew down. They started with a clinic within a month in a small room with one chair and a desk. Karen kept dreaming and they moved to where the pharmacy is now, with a few more chairs. Doctors continued to come down. We have several patients from Truth or Consequences and Las Cruces."
"The hospital got $5 million from the Tobacco Settlement Fund and built the cancer center," Torres continued. "It has been here for 10 years this year. For nine years, we have had radiation. It's due to the dedication of Karen and her hard work. When she heard 'No,' she said: 'Why can't I?' For the past 22 years, we've been proud to serve with our former and present nurses. We have made it possible. We are grateful they trusted us with their lives. It's disappointing to us that those who have provided the service may have to exit."
McAneny came to the podium and had members of the cancer staff stand to be recognized. "When we started this whole thing, when Karen said you're coming down to give cancer care, I had met a force of nature. We travel so you don't have to."
The hospital would like to have a full-time oncologist, but "you have here about 120 cancer patients a year. A full-time oncologist sees about 300 a year."
"We private practice doctors do what we do because we have dedicated our lives to taking care of patients," McAneny continued. "We form relationships, so we feel ownership of our patients. It worries me that academics want to come do care, while they do research and teaching. I worry about how long they will stay."
She said no RFP was released until 2015. "We spent a couple of weeks filling it out. We worked to keep people locally. We didn't try to take over imaging and other services. If they get cancer care here, they stay here for CAT scans; they have their gall bladders out here. They stay here. It takes a team of doctors to take care of patients."
McAneny said she heard from the Gila Regional lawyer that "we had to renegotiate. They we heard from the lawyer that the hospital hadn't had time for negotiations, so we kept getting extensions. We were shocked when we got the termination letter. We wrote our responses to the RFP criteria. The first, which was worth 35 points, was to provide medical and radiological oncology. We thought we got all 35 points. The second was to provide services for Gila Regional, which we were already doing, so we think we got those 35 points. The third was 15 points for rural services. We have dedication to rural services here and Gallup. We think we got those 15. The last was money. It takes money to run the services, so we listed all the salaries of those who serve. We think we should have gotten all 100 points."
She said she called the doctor at UNM and told her she would like to talk to someone about the transition, but "I never got a phone call or email in return. It worries me a lot about who will provide care for our patients here. We have made an official appeal. I talked to Dr. Skee and a lot of others, who were very encouraging."
McAneny said the county requested the criteria and was sent a redacted version of our RFP. "I would like to see how they scored us and UNM. I thank everyone in this room for being here for us. We want to stay. We want to keep taking care of you. We want to grow our services. We're trying to do the right thing. I request an open process with input from everyone."
After she received a standing ovation, she said: "You made me cry."
Dr. Annette Fontaine thanked "everyone for being here. It's been a tough day. I couldn't fly home this afternoon because I was taking care of patients. I'm trying to fight back my emotions of not being allowed to care for my patients. It's hard to go through the separation of patient and doctor relationship. You get a cancer diagnosis and you meet with the doctor who promises to be with you through the struggle."
She talked about one patient who has been taking a medication for three months. "It has made such a difference. Every patient I see is my family. How am I going to let go of that? I hope the hospital can reconsider. I've been coming here for two years and want to continue to take care of my patients. You have Karen. You can call her any time and she will take care of you. Mike is amazing. He has a long list of patients, and he makes sure everyone is seen. So many of you have few resources and can't drive to Las Cruces or Albuquerque. I worry they won't get care and may find themselves dying sooner."
Chris DeBolt, who worked at GRMC for about 10 years, said her deep concern was for all those who choose to go into cancer care because it is "hard" and she said the Cancer Center is the "shining star of the hospital." She noted UNM Cancer Center is related to the state and relies on state funding. She also said she has too often seen a small hospital become a feeder hospital for a larger hospital.
Nancy Thomas said: "I want to make clear I am not a paid protester," to laughter from the audience. Her husband was diagnosed last year with cancer and they were sent to the University of Arizona, "where he received excellent care. When we discussed coming home, the doctor was in full agreement and said Dr. Clark and Karen deGenevieve were renowned for their care and services." She, like many, said: "I thank our Cancer Center for the love and compassions you gave to us and you give to every patient. Everyone was always there for us." She also said she worried about UNM, because when her sister was sent there for cancer care, she had to wait for three hours because her doctor was home receiving furniture. "The doctor the next day explained what kind of cancer she had and told her to Google it. After her first chemo, she did not get the prescription filled because it had not been signed, but deGenevieve got the medication to her. We don't have to read about some 'class' something coming here. We have it."
Linda Nichols said she is a cancer survivor and was first treated in 2003, when the waiting room was one couch and three chairs. "All this time Karen deGenevieve could have worked anywhere, but she stayed here. Along with treatments, I prayed a lot. It's not broke, do not try to fix it. Numbers take people out of the equation. Don't buy into the story that you won't notice any change. It's not too late to change this change."
Nina Chavez, NMCC chief operation officer, said NMCC has nurses trained to make sure what they do is the appropriate treatment. "We take excellent care of our patients and it's always about the patient."
Click said going through the Cancer Center has been like having family here. Since she was treated there, she became a police officer, "so I can give back to my community."
Susan Sumrall, a Grant County native, said she served four or five years on the Gila Regional Foundation and was president when the hospital sued the foundation. "This room is full of love and care. Where are the trustees? They should have been here to face us. They are going to do what they are going to do and not listen to us. I want to know who was on the committee, who chose the members and who the one doctor was." She said sometimes cancer patients have their surgery elsewhere, then have their treatment in Silver City, "because it's world class."
Debbie Steel said: "We're just at the beginning of our cancer journey, but we feel so loved. We don't want to see it change."
Vernon Rawson said he has had two relatives choose to stay here for excellent cancer treatment. "I don't understand this process. It should be open. This sure smells like something is being done under the table."
Sharon Barris said she has been to Mayo Clinic, which is considered the best of the best. "This is the best of the best. We heard from Mayo Clinic that Dr. Fontaine is the best of the best. We have a bunch of girls here who went to school with my ids. They are loving kids to take care of us."
Charlene Jones said she is a cancer survivor thanks to Dr. Fontaine and the Cancer Center.
Orpha Gonzales said she was a patient "here to support what we already have. We patients were not included in the discussion. We fear Karen deGenevieve may have to leave. She made sure we wouldn't have to travel by bringing doctors and nurses to take care of us here." Her questions were: Why weren't the patients, the medical staff and the office staff informed before hand? Will the patients have the same staff members who care and know what patients need? "We are greeted with our names and treated with love and respect. Are we the patients going to feel left out?"
Ron Hall thanked the commissioners for having the transparency of the forum. "My wife Jane had to be treated elsewhere for a blood disease, but I tried to get her back here. I called Mike and in one hour, he called back and said: 'Get ready, you're coming back.' We had the best of care here. The bad thing about the care here was that I was spoiled. I told everyone they should visit the Silver City Cancer Center."
Ron Henry said the feeling of community in Silver City is one of the major reasons he lives in the area. "I was told I have incurable non-Hodgkins lymphoma, with a life expectancy of five years. I'm standing here 10 years later, because of all the support I've had from family and friends and the highly professional care at Gila Regional Cancer Center. They are not only professional, but also warm and caring. I'm not a number. I'm someone they know and care about. I do not have to leave Silver City to get care. It must be about the money. If UNM costs less, they will have to cut something. It could be a something that is serving us supremely well. "
Susan Clare said she is currently a patient. "I'm the patient Dr. Fontaine talked about. I have metastatic breast cancer, but I can walk again and feel good. The heart, the compassion, the dedication is phenomenal. I have been a part of UNM. The care here far surpasses what I got at UNM Cancer Center, where I never felt like anything but a number. The UNM system is so large, they can't provide the personalized care we've come to expect here."
Johnny Colburn, a cancer survivor, said: "So far, I have received nothing but the best of care here. I called around and was told I couldn't get better care than here. Why aren't the trustees here? Why is UNM not here? I have friends in Albuquerque and UNM Hospital is not their choice. Why should they be forced on us?"
Sharleen Daugherty read from a letter she hand delivered to the Gila Regional Board of Trustees. Read the entire letter at http://www.grantcountybeat.com/editorial/36534-letter-to-the-gila-regional-board-of-trustees "In April 2015, I was diagnosed with stage 2 breast cancer, and a two-year journey that brought me to my knees." She said Karen deGenevieve and the list of caregivers she named propped her up. "To my dismay I read about the 'world-class care of UNM.' Maybe they are cheaper, but don't let them claim they will give Silver City something better than what it has. Speaking of myself and everyone before me, understand what you have. It couldn't be the equipment, because we have state-of-the-art equipment here. ... Cancer treatment involves more than chemo and radiation. The Cancer Center here treats the whole person, not just the malignant tumor in my breast. Every time I go to the Cancer Center I feel blessed to know I am receiving world-class care."
Lynn Myers said she has had leukemia since 2012. "I'm being treated. They tell me it's a good kind. I am an EMT. I love our hospital. The Cancer Center is only part of the hospital. No one complains about the Cancer Center. They complain about us, about the ER, about the floor, but not the Cancer Center. I feel like we need to keep the Cancer Center as it is. I intend to go to more Board of Trustees meetings making my views known."
Lynda Aiman-Smith described herself as an academic researcher. "The type of change here is the worst. My dear Arthur Larry Taylor was told in 2010 he had one year to live. We had almost 3 years." She asked who would make the final decision and "how will we hear what was said. Organizations can move from care-centered to cost-centered. My fear is that this is what is happening. They are digging a hole and getting paid to fill it. I worry it is setting the hospital up for acquisition. I echo what Ms. Myers said about the board assigning the committee, but they are not here. Put in your application now to become a trustee."
Karen Hughes said she was Born in Space along with Harrison Schmitt. "I love the community, especially the Cancer Center. I am a survivor. Karen deGenevieve and Mike never gave up on me. I had esophageal cancer and tried to cure myself. I am a true believer that it was the compassion and emotional part that they put into their work. I appreciate what everyone did. They were so compassionate and kind."
Gail Dunigan said she knew she was preaching to the choir. "We know the fear of hearing you have cancer. Mr. Trustee, oh, my god, you have to have all your teeth out, but you have to change dentists. That's what this is. Karen learned my family was out of town and my husband had Alzheimers. I wish bad teeth and new dentists for the trustees."
Steve Reese said he has lived in the community all his life and retired as a police officer after 30 years of service. "Ron Hall was one of my mentors. He raised me to have honor and integrity. My father was being treated for cancer and then they found prostate cancer. On April 15, he lost his battle. I watched that man travel to Albuquerque for treatment, but the last few years he was here. You were a blessing and made my dad's life bearable. They try to deal with not only the patient, but also everyone attached to them. The trustees are not here to listen. Why aren't your applications flooding the commissioners for the Board of Trustees? The commissioners only get to pick from those who come. You guys are responsible for the hospital. I ask anyone from the committee to stand up and take accountability for the Cancer Center. This is the tip of the iceberg." He said he knows the trustees are hands off on day-to-day operations, but "you commissioners are responsible."
GRMC Anesthesiologist Dr. Nathan Williams said he would not be able to add to what has been said, "but this decision was not based on clinical care. It was almost certainly made on an administrative, regulatory, and maybe financial basis. The UNM COO won't be here to take care of Medicaid patients on the ward like Dr. McAneny has."
Carrie Johannes said she is a retired nurse, who has served at UNM and with the Department of Health. "My husband got to choose between UNM and New Mexico Oncology. He chose New Mexico Oncology. At UNM, which is a teaching hospital, the health care was fragmented. You will not get the level of individual care from UNM you will get from New Mexico Oncology. My husband died of an indeterminate cancer. With UNM, you will have students and academic medicine. If UNM takes hold of this Cancer Center, I will take my business elsewhere. I don't think they are taking a long-term view."
Gwyn Jones said she has been a patient at the Cancer Center this past year. "I received excellent care and I'm back. Amen to all of your stories. Talk to the commissioners to find out what recourse we have. Is it possible to change it back? The trustee position is open. Can the Board of Commissioners exert influence on the Board of Trustees? I don't think UNM will care like the New Mexico Cancer Center has demonstrated."
Commission Chairman Brett Kasten, who was in the audience, said he and Commissioner Harry Browne were there as audience members to hear what everybody had to say. "Alicia and Billy did a great job of getting you here. Yes, the commissioners appoint trustees once a year, one or two at a time. The only time we can take a position is in open meeting. I can't answer what we can do."
Dr. Laura Davenport-Reed, in her 15th year as a family practitioner in internal medicine and pediatrics, said she remembered standing years agi in the same room listening to the commissioners trying to sell the hospital to a private entity. "I'm glad it didn't happen. I am on the medical staff. There are a lot of formalities. The commissioners appoint the trustees. This year there are two openings, one a physician and one open to a community member, that are not yet filled." She listed the committees under the Medical Executive Committee, which makes recommendations to the Trustees. She said the committee that was formed to address the RFP that was created by the administration, with only one physician on it, whereas the new CEO selection committee had three physicians on it. She noted the announcement of the change to UNM came out in the newspapers and then was posted on Facebook. "I have issues with the person responsible for the press release. The physicians met a day later, and I made some waves. The MEC weighed in on the issue. They wanted to have a vote of no confidence on the decision. They felt it needed to involve the community. This meeting should have happened months ago." She said 40 percent of her patients today are cancer patients. They can call up Mike or Karen any time, and have care anytime. We will never see that again if they leave."
Sheryl Spier-Philips said she had chemo at the Cancer Center here and radiation in Albuquerque. Two months later radiation came to the Gila Regional Cancer Center. She said many people helped her get through the cancer and with the financial portion because she had no insurance. "I worked with Mr. Ontiveros as a mental health care provider. He has brought transparency to the hospital." She said she worked the whole time she was undergoing treatment, except when she had to move to Albuquerque for radiation. "I provide a chance to talk to me the first time gratis when someone is diagnosed with cancer. Let's put our resources to make the Cancer Center grow."
Dr. James Skee said he has been a physician for 36 years, with 22 of them at Silver Health Care, which he helped found. He also served as chief of staff at the hospital. "For medical issues, I refer to Barbara McAneny without reservation. UNM is not on my list and it is not in the same class as New Mexico Oncology under Dr. McAneny. Every practitioner I talk to says it's just a bad decision. If the hospital thinks the numbers will change, they are absolutely wrong. I suggest the commissioners look at how they appoint trustees. There have been a series of bad decision over the years, for close to a decade. It is really disappointing to see the diminution of services. We have already lost a lot of the hospital. The trustees have to give the CEO a hard time, which makes for a stronger institution."
Martha Stuart said: "I sat in one of those two chairs at the beginning." She said she felt really bad over a recent weekend and called on Monday and got in early Tuesday. "They have taken care of me over the years. Every four weeks they give me a new immune system. We can't let this go."
Billings thanked everyone for speaking and said he thought he had received 90 percent of the information. "I was wrong." He said of the seven trustees, three had very good personal reasons for not attending. "June 5 is the deadline for trustee applications. The hospital attorney contacted our attorney and cautioned us. I don't like attorneys to wag the dog. I'm not going to drop this. I think and hope we can act on this."
Ontiveros told the Beat after the meeting that, should UNM get the contract, the trustees have asked UNM to hire the current staff, and "if not, Gila Regional will consider hiring them."