By Mary Alice Murphy

During the recognitions portion at the beginning of the Gila Regional Medical Center Board of Trustees regular monthly meeting on May 26, 2017, members presented a plaque and congratulations to Mary Gruszka for her 25 years of service in parenting education to Gila Regional. "I'm fortunate to do a job I love," Gruszka said.

Also recognized but not present were Irene Arellano for 15 years in patient financial service and Nicole Rodriguez for 15 years of service in nursing.

Board Chairman Jeremiah Garcia announced a meet-and-greet for the incoming Chief Executive Officer Taffy Arias to be held for the public from 5-6:30 p.m. Thursday, June 8, in the Billy Casper Wellness Center Conference Room.

Garcia said to a room holding at least two dozen individuals standing around the walls of the room that public input would be limited to five minutes per person. "I ask everyone to be respectful."

The first to speak was Mike Trujillo. "I'm Taffy's husband. I understand the legalities of the request for proposal process, but the horse is out of the corral. I have a couple of comments about the University of New Mexico hospital. Our son and daughter have had high disservice at UNM. I don't know if the criteria include service to patients. If they did, there is no comparison to the service here.

"When I heard what was going to happen, I said: 'I know board members, they can't let it happen,'" Taffy Trujillo said. "Karen DeGenevieve has been here 22 years. At the special meeting the other day, I got the feeling that the commissioners were disappointed. The care is high here. Dr. McAneny and Karen have put two decades into this cancer center. I can't imagine they wouldn't comply for no reason."

She said the commissioners offered to hold the board meeting in their chambers. "By crowding us in here, somebody is trying to prove a point. This is our community. Where was UNM at the forum last week? Everybody at our Cancer Center is great. I've been to Mayo and Karen and Mike (Torres, Cancer Center manager) are just as good. The staff members move in harmony with the patients, administrating chemo and radiation. The slightest mistake can kill someone. The state-of-the-art equipment is only as good as the tech and they are great. When people go elsewhere, the dollar losses will filter down to the hospital. I can't believe those of you who are my friends would do this. Karen and Mike deserve better."

"It is ludicrous to have the meeting here today," Nancy Thomas said. "I grew up on a ranch. The holding pen for our cattle was better than this. I've lived here a long time and I've never been a public speaker, but this issue brought me out. In no way, would we get the same care we get today if you go with UNM. My sister was sent to UNM. If the transition goes through, she was told up there that if she needs chemo or radiation from here she should go to El Paso or Las Cruces.

"I don't believe half of what was said on Wednesday," Thomas continued. "We need to keep the care we have here. Don't let politics or finances get in the way of care."

Sharon Barris said she knew her question was not going to be answered, but "whose idea was it? A board member told cancer patients this is a done deal. I would like to know whose idea it was to take away our excellent care."

"Mayo is the best of the best, but it doesn't have the home grown care we have here," Barris continued. "A doctor at Mayo told my husband that Dr. Fontaine is very good. If this change is a done deal, you need to tell everyone it's a done deal."

Dr. Fred Fox, a family physician in private practice and in the ER at Gila Regional in the past and is doing public health in his semi-retirement, said: "I did chemo in my office. I was glad to turn it over to the Cancer Center. I believe in best practice and I believe New Mexico Cancer Canter is excellent. I believe UNM is OK. Why the change? Was it finances? Negotiations? I can say the quality of care here has been excellent. We need continuity. Those with follow up will go to Albuquerque to NMCC."

"My concern is that there was no obvious public input," Fox said. "There should have been public and staff input. I would like to keep the relationship with NMCC."

Johnny Colburn said: "It's about cancer patients. We seem to be the people who have been forgotten. Nobody but that patient knows the mental and physical anguish. The staff here at the Cancer Center has earned our trust and respect. They have earned mine."

"This venue shows me a couple of things," Colburn continued. "You guys have no respect for us and think of us as collateral damage. If it's a done deal, do not insult cancer patients that you are doing it for us, because you're not."

Ron Henry said he stands in front of the trustees 10 years after his initial treatment. "I know UNM oncologists, because I drove there. I had to wait hours and could never get phone calls returned. The evaluation committee members were all from professional ranks, but the committee ignored the patient expertise. We are front line. We know a heck of a lot because we spend hours in the clinic under stress. Our expertise is not valued. In the negotiations, care could not have been the sticking point. Was it money?"

Henry alleged that Garcia should have recused himself because his wife is a patient. The Medical Executive Committee had a vote of no confidence. "I beg the trustees who represent us, do whatever you can do to vote against this. Start the process over and get it right this time."

Susan Clare said she agreed with the preceding comments. "Those standing around the room are patients. You talk about patient care and don't make accommodation for them! At the public forum, Dr. Fontaine talked about a patient who three months ago was not doing well. That patient is me and I am standing here today because of the care—the extraordinary care. I have quality of life today. I have one more thing to share. I have had experience as a cancer patient at UNM and here, and the care here is far superior. UNM is large and cannot give the targeted care they give here. There is no comparison."

Dr. Laura Davenport-Reed, an internal medicine and pediatrics physician, who also served as chief of staff at Gila Regional, said she has attended every meeting to support "my patients who are here. I can call Mike or Karen at any hour and easily get care for my patients. No other services in the hospital are the same. I can tell you that you won't get the same service at UNM. I can't get calls back or get hold of records. If a patient is seen here, I have the record on my desk the next day."

"Cancer is the scariest word anyone can hear," Davenport-Reed continued. "The care here is the other part. I can't tell you how proud I am of the care my patients receive."

"At the Wednesday meeting, the process was explained in detail," she said. "My question is why NMCC did not get 100 points. I want questions answered. The policies and procedures for Gila Regional for requests for proposal (RFP) need to change for sensitive items such as cancer care. I hope you are unsuccessful with UNM. The policies and procedures need to include community, staff and medical staff input. If you're looking at other RFPs, you probably don't need this quality of input."

Carolyn Johannes said she retired from the UNM school of education and worked at the Department of Health. "I am horrified that you are taking this care and putting it into a teaching hospital. You will have attendings and residents. My late husband was treated at UNM and at NMCC. I remember at UNM, people not being seen in the ER for four days when there was a snowstorm. As a nurse program manager, I worked with New Mexico Cancer Center and had professional and timely responses. You have a model and you are discarding it. You will not have continuity of care. I know the providers get here, even if they have to drive." She said there is no comparison between a private group managing care and a teaching hospital.

Gywn Jones, who is a patient at Gila Regional Cancer Center, said: "The care here is excellent. I have had experience at UNM when my daughter was hospitalized there. They never figured out what was the matter with her, but gave her spinal taps to release the pressure. She's fine now. I had surgeries at UNM. That's another issue. If UNM comes, you folks should pay attention to their administrative processes. They sent me bills that said: 'Pay this,' without going through insurance. And for other things, they sent me no bills. You will need to determine their efficiencies in the system for their billing."

"I understand procurement and that you have to follow the rules," Jones said. "My main concern is the local staff. Administration is great with Karen and Mike. I have called her in the middle of the night. I want the current staff to stay home that may get tossed out by UNM."

James Hiltsey said: "I can't say anything more. Double it for me."

Dr. Annette Fontaine of New Mexico Cancer Center introduced herself.

"I joined the group 11 years ago and have been providing services," Fontaine said. "I was here, went to Ruidoso and moved back here about two years ago. Our cancer center is dedicated to providing rural care. Our commitment to provide to rural areas such as Gallup, Ruidoso, briefly in Las Cruces, and, in Silver City, it has been going on for 22 years. We want to continue here. It's a huge factor for patients getting care. Even for Las Cruces, the main barrier for care is transportation and money support. When we tell patients how we can help them, it's a relief for them. We give the same service here as we have in Albuquerque. Rachel finds out personal issues and we work around them."

She said Dr. McAneny's NMCC was "certified as a Coming Home facility to make sure we decrease hospital visits and emergency room visits. We proved it saves money. People don't want to spend days in the hospital. We got our Silver City staff trained in the protocols, so the patients can call day or night so we can keep them out of the hospital. The things we can manage, we manage at the Cancer Center. I really have appreciated working in Silver City. We have a great relationship with surgery and primary care. We appreciate that what you are doing is a business decision, but we are asking to have further conversations with you."

Chris DeBolt said she didn't write down her name to speak, because she wanted to listen. "I've worked with cancer patients and their families. They are the bravest people I know. You had the opportunity to make patients comfortable here. They shouldn't be forced to stand. I'm getting mad about the things not being said. The pressures, the personalities, you people need to be honest and transparent. You are not showing the values the hospital espouses. Yes, it's making me angry. Rumors go around. No, you say, it's not a done deal. Negotiations are ongoing. Talk to the County Commission and talk about next steps. Look at the Board of Trustees leadership and the bad decisions that have been made. You need to consider that UNM is a teaching hospital, and as a state hospital it is tied to state funding. The quality of care will not be the same. Keep talking. The decision has not been made."

The last to speak was David Sanchez. "I am a cancer patient, stage 4 terminal. I have sinus cancer—a rare form. Because of the New Mexico Cancer Center, the ENT, and Dr. Fontaine, 18 months later, I was in remission. A few months later the cancer came back. I was told they could not do surgery. I was sent to UNM. I woke up after surgery to find half my palate gone. They had not told me before that it might happen. I finally got to see the doctor, but I was turned away from the UNM Cancer Center. My wife called the Cancer Center here, which got me to a dentist to get a plastic palate in, so I could speak. I went back to UNM, where I felt herded. They told me the doctors couldn't help me. I've been through Mayo, M.D. Anderson and the American Cancer Centers. I've been seven years dealing with this cancer. I had to go to UNM to get to go to M.D. Anderson, where I was able to see a doctor."

"The thing with my cancer is that no chemo can help me," Sanchez said. "The UNM doctors recommended chemo and we were excited, but UNM sent no paperwork to NMCC. We finally had to call UNM. Dr. Fontaine and Karen DeGenevieve did genetic testing and discovered the chemo would have killed me. Dr. Fontaine and Karen found a pill in December. The cancer has stopped growing and now the cancer is shrinking. I think it's a big mistake to get rid of the care we get here. The ER said the tumors were invading my brain, but radiation killed the tumor by my eye. Seven years ago, I was told I would go blind within 18 months. The ER here sent me home with a call for hospice. What would have happened if I had stayed at UNM?

"I can't see myself getting care anywhere else," he concluded. "Dr. Fontaine and Karen DeGenevieve counseled with M.D. Anderson; they send paperwork back and forth. The care I get here is second to none."

After public input was finished, Trustee Tony Trujillo said he knew during public comment that his role was to listen and take the input. "But I want to make clear comments I have as a trustee. It's not a done deal. I truly want to apologize for the accommodations here."

Trustee Magdaleno Manzanarea echoed what Trujillo had said. "We are still in the process of negotiations as far as I know. The choice was not done under any political pressure. I have no dog in this fight, except as a trustee looking for the best care in the hospital."

Trusteed Dr. Victor Nwachuku said he wanted it made clear that the trustees are volunteer positions, not paid. "As a physician, I spend hours on the job. I always want to do what is best for my patients and that the hospital gives the best care we can. We, as trustees, may know some details that you don't, but we have listened and we are concerned that you get the best care. We had no political pressure to do anything. The pregnant women I have sent to UNM have gotten good care. I have no special interest to bring UNM here. My concern is to make sure the community gets the best care. We are listening."

Garcia thanked everyone for the input. "My patient wife is receiving the best care. We believe in the staff that is here. I'm proud of our Cancer Center and the exceptional quality team. The patients will always have care. We have not made a final decision. If, in the negotiations, we cannot reach agreement, we will go back to a second RFP. The team members are our community caregivers. A lot of hard things are coming for the hospital. We have to make the best decisions."

"Thank you for being here," Garcia said. "Don't be afraid to contact any board member. You may also drop off your comments at the administration office. We apologize for the accommodations. We're a small rural hospital."

To the trustees and hospital officials, he said: "We will continue with the rest of the agenda."

After approving an amended agenda to include approval of the agenda, the trustees approved the agenda and the consent agenda of draft minutes of committee meetings at about 1:30 p.m.

Frances Day, Auxiliary president, announced that Mrs. (JoBeth) Vance (interim chief financial officer) had won the raffle cake. The Auxiliary raised $800 at the bake sale. "We also took care of a closet of clothes at the ER, for when clothes are needed by someone who has, for instance, after an accident, had to have the clothes cut off. We got rid of some and laundered the rest."

Garcia asked if the auxiliary had a Facebook page, and Day said she didn't think so. Marketing Director Joe Kellerman said he would help the Auxiliary set one up.

No one attended with a Foundation report, but said one would be on the next month'sagenda.

In the chief executive officer report, Interim CEO Alfredo Ontiveros said he had been talking to the incoming CEO Taffy Arias on a weekly basis. "We will have discussions on May 29 before she takes over May 30. I have given her a solid written report. We talked about the Cancer Center and its non-Gila Regional staff. UNM has already told us that Gila Regional should hire the cancer center non-physician staff."

Ontiveros answered one of the continuing complaints received from the public about the process. "We could not talk to the Cancer Center staff, because of non-compete rules. They are hired by the New Mexico Cancer Center. We do have clearance for Dr. Stanley to talk to Dr. McAneny to make sure about the patient transition. Although we are still in negotiations, we are moving on things in case of a transition. We have the potential to have a bridging agreement for another 90 days. It's another opportunity to make sure we take care of our patients. Mrs. (Liana) Ryan (assistant vice president of administration) is the point of contact internally for Gila Regional. On the negotiating team, we have three physicians, Dr. Nwachuku, Dr. John Stanley and Dr. Colicia Meyerowitz, three senior staff members, and we meet every Wednesday."

Trustee Trujillo asked when the contract was likely to be let.

"A lot of items will still come to you for review before any contract is let," Ontiveros said. "You all are the final approving authority."

Trujillo asked if UNM physicians would provide the same quality of care.

Nwachuku explained that all the physicians that would serve the Cancer Center would have to apply for credentialing and privileges at Gila Regional.

"We will look at the specialties," Ontiveros said. "Right now we have radiology oncology, medical oncology and hematology. We kept extending the negotiations with New Mexico Cancer Center, but could not come to agreement, so both did agree to move forward with the RFP. Maybe the negotiations will break down, then we will have to start the RFP process all over." He said contracting with the hospital is not the same as, for instance, a construction contract. "We have different rules and we have to start over."

Garcia confirmed that a new RFP process would have to begin if negotiations fail.

"Every day, we have issues on Meditech 6 upgrade," Ontiveros said. "Every day we fix them. June 1 is still the go live date. We have the command center for the go live in the conference room. Meditech, too, wants to get it done. We will not allow them to invoice us, if a problem is their fault."

Ontiveros said he listened to the forum, the participation in the forum on the radio. "I have talked about it in interviews with Ben and Mary Alice, and I will be consistent in my message."

Garcia said he had seen Dave of Jacobus Consulting, who said he heard Ontiveros on the radio. "Dave told me you said we were the best Board of Tursteees he had ever worked with."

"I'm glad you selected me for the interim," Ontiveros said.

"The Board of Trustees would like to thank you for accepting the job," Garcia said. "You told us you liked challenges." He presented gift certificates to Jalisco's and Diane's restaurants, plus a 100-star pin, some temporary GRMC tattoos and other gag items.

"We were very fortunate to have refound Mr. Ontiveros," Trujillo said. "We went through the screening process. He competed with good talent. What we wanted was someone to hit the ground running and he did more than that. I sincerely thank you."

"It's been a good run," Ontiveros said. "You have great staff. And I was happy to find JoBeth again when you needed an interim CFO. All the hospital directors have been supportive. I think the transition will gel."

Manzanares said Ontiveros was "'green,' as in a recyclable CEO," to laugher from all.

Nwachuku also said he appreciated Ontiveros coming when "we needed a new beginning. You have faced difficult challenges and you changed the outlook at the hospital, which is now positive. The finances have improved. Thank you."

"We can check 100 percent of the items we tasked him with," Garcia said. "He's done a lot of homework. My hopes are that he and Taffy (Arias, incoming CEO) can collaborate and get to the next step, perhaps using him as a consultant."

Garcia said the hospital is down on full-time employees, and has cut some administrative jobs. "I know there are some holes, but we brought in seasoned administrators, with the interim CEO and interim CFO. Thank you for finding the resources to help us."

Trujillo said he had read that the County Commission was doing an effort to look over the process. "That is truly unfortunate in my opinion. Bringing in outsiders, rather than have community members who know the community as trustees. I wish taxpayer money were being spent better."

Garcia said (Commission Chairman Brett) Kasten, as a former Gila Regional Board members, knows the challenges. "I think he wants the new commissioners to have a comfort level."

"This board has been the most active at looking at problems and finding solutions," Nwachuku said. "Maybe a consultant can see what we've done. Maybe Quorum (a hospital management firm) could come here as a consultant."

"If the commissioners think something is broken, they should talk to us and ask us," Trujillo said.

Shelly Carter came into the room and asked if she could speak to the trustees. When she was given permission, she said: "I have been with the Cancer Center for 13 years. I'm here on behalf of the patients, who don't understand the legal parts. Our patients are scared. We don't know how to answer their questions. These people are fighting for their lives. I tell you from the bottom of my heart that what we have works. Continuity matters. Will the chemo continue? Will the radiation continue? What doctor will I have? Those are the questions I hear. They need to know what will happen."

Nwachuku asked Ontiveros if Taffy was aware of the Cancer Center situation. "Yes," Ontiveros said. "She reads about it and we discuss it."

Ryan, as AVPA, said the hospital has completed 52 percent of the initiatives over five months. We added one and already completed it."

She reported on the issue of rural health clinic status. "It is tied to a capacity of less than 50 beds. We will postpone consideration to 2018."

On provider contracts, Ryan said she met with Chief of Clinical Services Ray Goellner's team. "We increased the cardiology services by four hours a week. We have three more slots for echo-cardiograms for Gila Cardiology."

In the revenue cycle, the financial dashboard is complete, with the revenues and expenditures listed on the dashboard. "I've been meeting with providers and asking them to meet with accountants. We have addressed the challenges in the timely financial reporting. We have a turnaround of $700,000 with changes in timely reporting."

A contract with an ENT, Dr. Patricia Murphy, will move forward with a letter of intent, "although we are still working on the contract."

"We purchased equipment—a spinal cord stimulator and radio frequency ablation—for Dr. Light to be able to provide services," Ryan said. "In recruitment, we have had a recent pediatrician visit and are scheduling another recruit."

Chief Nursing Officer Peggy White said the equipment for Dr. Light had been purchased through the surgery department.

White said a few issues have been put on hold due to the transition in leadership. "We will work on the pods to open them and use them efficiently. Soon we will be without travelers, although two travelers remain in the surgery department."

Goellner thanked Ontiveros. "It has been a pleasure and a privilege working with you."

Garcia had a question for Ryan. "How do we expedite moving into imaging where there are bottlenecks?"

"The director of imaging has streamlined the scheduling, depending on the modality," Ryan said. "They have also worked with cardiology."

Ontiveros said a couple of things discussed addressed the needs of the clinics. "If it's a real need, they need the imaging quickly, similar to surgery."

Nwachuku said some of the clinics had complained about not receiving prompt service. "Contact the clinics and see what complaints they have."

Ryan said the CFO has worked on bringing the clinic officers to a tentative meeting at the end of July.

Ontiveros said that Goellner has tasked his directors to market the imaging equipment.

Garcia noted that the service works both ways, with the hospital sometimes not getting the authorizations to perform the services.

Goellner said he would provide a report at the June meeting. He answered a question saying that the new nuclear camera had replaced one that was at the end of its useful life. "The revenues will be enhanced when the techs get up to speed. We are training them."

CFO JoBeth Vance said she had corrected an error on her report that showed a negative $1 million when it was actually $1 million to the positive. She said the hospital had received some money from the state. "The bottom line for April was $153,000 to the positive. Our days in cash are 69.8. Our daily spend is $198,000- $199,000."

White noted the hospital has 529 full-time employees down from 569 last year.

Ontiveros said White told him her team knows how better to run the nursing department.

Chief of Staff Dr. Gregory Koury said he has been making a big push to his colleagues to finish all their medical records before the Meditech go live date of June 1, so they flow seamlessly into the new system. "We are training a physician assistant in the ER now."

Ontiveros said the super users on the Meditech 6 upgrade are Drs. Koury, Brian Robinson, Brian Etheridge, Kendall Allred, and Tsering Sherpa.

Garcia noted the critical component for Meditech was the physicians.

"They're coming to training and learning how it will make things easier for them," Koury said. "Kendall Allred has done a go live before, but he's leaving Innova in July and getting a job one mile from his house in the Bay Area."

Nwachuku brought up approval of the staff bylaws and moved to approve three items.

Kari Lane said the bylaws must be approved by the general medical staff and the board, while the rules and regulations come through the Medical Executive Committee to the board for approval.

In board reports, the Executive Committee created the agenda.

In the Quality Improvement Committee, Trujillo said, at the April meeting, the main item was the time people spent in the emergency room. "In quality stats, they are telling a good story as we are seeing improvement after improvement."

Ontiveros said the incoming CEO served in the Emergency Department and as a chief nursing officer. "Her clinical expertise will help."

Nwachuku said the emergency room would get feedback on how long patients are waiting.

"I will make the report," White said.

Nwachuku gave the Financial Committee report. "I am hoping we can hold up two of the recommended contracts."

Koury said the bylaws are being forwarded to a new attorney, "so we need to table all three pending contracts."

Ontiveros said the issue would be discussed in executive session.

The Plant and Facility Committee did not have a quorum, so did not meet,

The Human Resources Committee discussed contract labor and overtime with the trend going downward.

"We went from $500,000 to $300,000 in contract labor, but overtime increased," Garcia noted.

"We have holes in the schedules and are trying to prevent burnout," White said.

Nwachuku asked for approval of the final board bylaws. "We can have continuous review and changes." They were approved.

Trujillo noted the County Commission appoints the trustees, but for removal of a trustee, the trustees have to go to the commission and request it.

Garcia confirmed the bylaws set out the Commission responsibilities and the Trustee responsibilities.

The trustees, after a short break, went into executive session for several more hours, according to Garcia, when the Beat called him later Friday evening, asking about the final open meeting agenda item, which was a cancer center contract negotiation update.

"We inherited the issue," Garcia said. "The committee will continue with negotiations to stay in compliance. We have to discern how to make the best decision."

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