By Mary Alice Murphy

Gila Regional Medical Center Chief Executive Officer Taffy Arias presented a safety moment at the beginning of the GRMC Board of Trustees regular monthly meeting Friday, Oct. 27, 2017.

"We have recently experienced errors on our CT scan machine," Arias said. "We never want to have a patient on the table for a needle biopsy and have to quit the machine. In the past two weeks, we have replaced numerous parts, so we're dealing with that. As for patient safety, nothing will happen, except they might have to go through the preparation again."

Board Chairman Jeremiah Garcia asked if the scanner was being recalibrated, to which Arias said: "Yes, for patient safety."

Board members recognized Beth Dalton for 30 years of service in financial services, and Michael Laramore for 25 years of service. He now serves as a house supervisor in nursing. Chief Nursing Officer Peggy White said he was sleeping between two night shifts, but he had asked her to tell the board that he "appreciates the recognition."

Chris DeBolt, county resident and former GRMC 10-year employee, gave public input. "First I want to congratulate you on a very successful cancer center opening. Thanks to everyone who made it happen, especially Taffy. She got it done in only three months. Kelly (Rodriguez, interim cancer center manager) told me nine patients were seen on Friday and more are scheduled today."

She also congratulated Arias, Eloy Medina and the Coffey sisters for getting ambulance service back to Mimbres Valley. "It's such a security for everyone in the Valley," DeBolt said.

"Regarding my support of the new CEO," DeBolt continued, "I was on the search committee. I want everyone to add in supporting her vocally and often. I think the Board of Trustees has a huge role to give her what she needs to succeed. And we need her to succeed."

She said the competition for nurses because of the shortage is "frightening. A number of nurses haven't had a raise in years. I know nurses are getting offers of $3 to $6 more an hour. We must make sure our nurses are supported financially and emotionally. It may have to come at a cost of other things in the hospital."

Trustee Tony Trujillo, who was attending by phone, said he knows the public input is a time for the trustees to sit and listen, but "I want to thank Chris DeBolt for her input. She has brought us a lot of good input."

Garcia concurred and said: "She has a passion for this hospital, the good, the bad and the ugly."

Auxiliary President Frances Day gave the auxiliary report. " On Dec. 1, we will have a fundraiser with Carol Young silver jewelry. She is new to us, but will have items costing from $5 to $35 from 8 a.m. to 8 p.m. It's time to buy holiday gifts. On Dec. 7, we will have a bake sale starting at 7 a.m. We will participate in the Trunk or Treat on Tuesday, Oct. 31, in the main parking lot. We ask the board members to attend with their cars. It will take place from 4 p.m. to 7 p.m."

Joe Kellerman, marketing director, said GRMC will partner with Ambercare, Melinda's, Southwest Bone and Joint Institute (which he said had not yet confirmed, but he was sure would participate), Rotary and Phaze Zero Therapy. "All of them will be in our parking lot."

Day ended her report by saying the auxilians are doing their annual training.

Arias began her CEO report by saying the Cancer Center held its opening on Oct. 19 and Dr. Amy Tarnower saw nine patients on Oct. 20. "These patients are brand new to these providers. She's back today to see patients. We're still looking for a second radiation technologist and UNM continues searching for a full-time oncologist to live here in Silver City."

The hospital recently had a safety inspection. "After addressing a few minor items, we passed the re-inspection with flying colors. We have safety huddles every morning. There are so many things that need to be addressed, we assign someone to be accountable for each one. Usually it goes to plant operations because of the age of the facility."

The community safety drill with law enforcement is being rescheduled for November.

"JoBeth (Vance, interim chief financial officer) and I met with the Silver City Fire Chief and Eloy to talk about the supplies that we give to them," Arias said. "We talked about how the medications are managed. The processes we thought were in place weren't. We talked about specific patients needing specific medications. The conversation is ongoing."

Arias said the second surgeon will start on Nov. 1. "We are looking at additional office space for him. He will do his IT (information technology) training first, because he will not be credentialed to do surgery for a couple of weeks. But he can order labs. He will be very good for the community. We are still looking for a permanent CFO."

She said a clinical manager has been named for the pain clinic.

Trustee Jeannie Miller asked what it means to be credentialed.

"We check with the medical board, verify that he attended a credentialed medical school, get his DEA number, make sure he has clean records and verify references. Then it goes to the credentialing committee, then to the Medical Executive Committee and finally to the Board of Trustees. All physicians must be credentialed to practice in the hospital, but they are not all hospital employees."

Garcia commented on the Silver City Fire Department conversation. "Hopefully, we are all working on this process. Hopefully, we're collaborating on a checklist, so we can come together to determine how the supplies are provided to them."

The EMS director and Dr. Neeley, who will retire soon, oversee the process. "I want someone thoroughly engaged and overseeing the competencies. We will start having joint monthly meetings. We won't be separated. We must be focused on doing what is best for our patients."

Miller said: "Good. It bothers me that the city operates there and we operate here."

"We need a way to complement each other with the same goals of treating patients," Arias agreed.

"We want to be a team as we deliver patient care," Garcia said. "I compliment Mrs. Arias and (Town Manager Alex) Brown for coming together."

"We need to demonstrate appreciation for all our responders," Arias said.

White presented the CNO report. "I have an update on the licensure impact. It will affect about 15 of our nurses. Taffy has said the hospital will pay for the New Mexico licensure for them. They must have New Mexico licenses by the first of the year. The issue is affecting all hospitals in the state that are near state borders. We have to process all the paperwork and pay the fees."

Trujillo said the issue could have a pretty serious effect on Gila Regional. "New Mexico is one of only four states impacted by this compact. It will also impact travelers. The governor is on board, but the drop-dead deadline is Jan. 20. The legislative session begins on Tuesday, Jan. 16, 2018. We've offered our support to communicate the critical nature of getting it approved by the House and Senate and signed by the governor before the deadline. I will emphasize the importance of getting it done."

"As soon as I talked to Tony, he was on the phone getting things going," White said.

"Our job is to communicate to the legislators," Trujillo said.

Miller asked about the consequences of not getting it done.

"We are not part of the Enhanced Compact of 26 states," White said. "Every nurse has to join the compact. It will also affect travelers, if we don't get into the larger compact. It's only New Mexico and three other states. What we call travelers are actually contractors. The 15 we're talking about are already on staff."

Trujillo said Gila Regional has nurses who live in Arizona and commute to work. "They won't be able to do that anymore if we don't get it fixed."

Garcia then asked White about wait times in the hospital.

"We've been putting together a team to address the issue," White said. "We have identified the problem areas."

Trujillo said he has had a hands-on approach at seeing Gila Regional operations.

"One night, my 18-month-old grandson was in the ER, then that Friday, I was in for surgery," Trujillo said. "Our grandson is fine, and I'm recuperating. I'll put this hospital up against any other. Everyone was professional and they are focused on doing what they need to do. I can't tell you enough good things. And I'm on board about evaluating what we have to do to keep our nurses. We have to compare ourselves to the Demings, who are offering more money, to see how to structure ourselves to take care of our nurses."

Interim CFO Vance said volumes are good in the hospital, except for outpatient visits, due to the Cancer Center. "We had 149 admissions in September, which is right in line with last year. We had 2,889 outpatients in September as compared to 3,907 last year. This year we had 347 surgeries and 36 births, both of which are up. Our clinic practices are considerably higher than last year, especially in cardiology. We took in $14 million gross, less than last year, but it netted us $4.5 million and we had $4.9 million in expenses down from $6.1 million last year. It brought us a loss of $1.3 million, to bring us to $4.32 million loss year-to-date. We still have 52.8 days of cash, so we are holding our own. Our accounts receivable are coming down in days, and are now at 43.6 days average. We are keeping our accounts payable paid on time. We have dropped our daily expenses to $187,000 average a day from $198,000 last year. We are down to 506 full-time employees from 539 last year, with 300 on contract, as compared to 600 last year. Overtime is down to 2.3 percent, and our average daily census is 16.9."

Garcia said: "I want to compliment the team. We've dropped our average daily expense and it's dropping over time, which means the team's managing the business side. We knew we would have challenges with the Cancer Center, but I thank Mrs. Vance for putting expense control in place."

Miller said most of the clinics were coming up, but she wondered why not pain management, as she doubted people have less pain.

"He was gone for a month," Arias said.

"And he's really busy," Chief of Staff Dr. Greg Koury said.

Koury in his report said he wanted to add a couple of things to what was in his report. "We have taken the initiative, starting with the medical staff, to use Dragon Naturally Speaking to let physicians dictate their records. Each has to teach the system how he or she works."

"Dr. (Colicia) Meyerowitz has been my Ongoing Professional Physician Evaluation Committee chairman for six years," Koury said. "She's been excellent and does a great job with the doctors. She has agreed to continue doing a fabulous job. It is one of the most difficult jobs, because doctors don't always receive criticism well, but she does it so nicely."

Vance said she appreciates helping physicians find a way to make it easier to get their bills out.

Koury said a problem has arisen in being able to buy a reagent to do quality lab results. "We will sit down for a solution, but it may require a new machine. There has been a change in manufacturer and supplier, so the reagent isn't available. That's why the medical staff needs to talk to the Lab head to find a solution."

Miller said: "I think we need to get the hospital out there and market it better."

"I couldn't agree more," Trujillo said. "It takes all of us trustees, the medical executive committee and everyone to tell our story."

Trustee Dr. Victor Nwachuku asked for approval of bylaw changes, one which will approve changes to the election of officers, and another change on how to replace the chief of staff.

"It's for when the vice chief doesn't want to take the job," Koury said.

Another change takes out the quorum requirement for any presentation to general medical staff. " "Because we have so many, it's hard to get a quorum."

All bylaws changes were approved.

Koury, also in a non-hospital-related issue, said he would be taking two adult soccer club teams—men and co-ed— to a tournament and hopes to return with trophies.

In committee reports, Garcia said the Executive Committee spent time discussing and setting the agenda.

Trujillo reported the Quality Improvement Committee spent a lot of time talking about wait times and how to improve them.

Nwachuku, in the Finance Committee report, asked for three contract approvals.

The first was a one-year amendment to a three-year contract for Dr. David Friedman, general surgeon.

"If it's a three-year contract, why do we re-negotiate?" Miller asked.

"Because that's the way they've been done, in one-year increments," Arias said. "We look at them each year. It was designed that way." She said it is not usually done that way, but at Gila Regional it has been that way. New contracts are changing that practice.

The second general surgeon employment agreement was approved for a new three-year contract with Dr. Tariq Ibrahim. Trustee Joel Schram asked if the contract amount would be covered by the business Dr. Ibrahim would bring in. Arias said yes, and it was a three-year contract with no re-negotiation.

Trustee Mike Morones said new contracts are structured differently. "Are there clawbacks?"

"Definitely," Arias replied. "And there are rewards if they exceed what they are required to do."

Morones explained they are evaluated on billable work, called RVUs, relative value unit. "I haven't seen it in a long time. But I like to see people rewarded for production."

The third agreement was with Dr. Pavel Capek for professional services in pathology and to be lab director.

Miller asked if Capek is with the hospital.

Arias confirmed that he has no other office or clientele other than Gila Regional. "He does it solely for us. It's based on a service he performs. He is not a revenue generator."

Trustees approved a charity care write-off policy. Nwachuku said the policy would allow the hospital to write off any bill that was more than 180 days past due and not likely to be paid.

Vance said the old policy, if people did not know they had to apply to qualify for help within 60 days, they were no longer eligible. "Now, if someone plans to pay, but has changed circumstances, they can come in and apply for financial assistance."

Morones said in the old policy, if people didn't apply for financial assistance, the bills could remain on accounts receivable forever. "We want to write it off and get rid of it."

Vance said the old policy was also convoluted. "We have a large population that can do financial assistance. There will be some who don't qualify. A new policy will follow this one and will address bad debt."

Miller asked for clarification. "This one is about applying for financial assistance, not bad debt, right?" It was confirmed that the policy was about applying for financial assistance. It passed unanimously.

Schram reported on the Plant and Facility Committee. "We had a good discussion. We noticed an uptick in security stand-by hours. We are monitoring that. We also took a tour of IT elements. The general public doesn't realize the huge infrastructure we have here managing IT in this hospital."

Although Trujillo is the chairman of the Human Resources Committee, he did not have the iPad, so did not have the dashboard. Garcia said that overtime is decreasing, which he called an improvement "controlling overtime."

Contract labor was down from $650,000 to $330,000 for September. Garcia said the committee will meet on a quarterly basis, with its next meeting set for December.

Garcia also said that the Bylaws Committee had provided a copy of the most recent bylaws for each Board member for their notebooks.

The Trustees had a 15-minute break and then went into executive session.

Content on the Beat

WARNING: All articles and photos with a byline or photo credit are copyrighted to the author or photographer. You may not use any information found within the articles without asking permission AND giving attribution to the source. Photos can be requested and may incur a nominal fee for use personally or commercially.

Disclaimer: If you find errors in articles not written by the Beat team but sent to us from other content providers, please contact the writer, not the Beat. For example, obituaries are always provided by the funeral home or a family member. We can fix errors, but please give details on where the error is so we can find it. News releases from government and non-profit entities are posted generally without change, except for legal notices, which incur a small charge.

NOTE: If an article does not have a byline, it was written by someone not affiliated with the Beat and then sent to the Beat for posting.

Images: We have received complaints about large images blocking parts of other articles. If you encounter this problem, click on the title of the article you want to read and it will take you to that article's page, which shows only that article without any intruders. 

New Columnists: The Beat continues to bring you new columnists. And check out the old faithfuls who continue to provide content.

Newsletter: If you opt in to the Join GCB Three Times Weekly Updates option above this to the right, you will be subscribed to email notifications with links to recently posted articles.

Submitting to the Beat

Those new to providing news releases to the Beat are asked to please check out submission guidelines at https://www.grantcountybeat.com/about/submissions. They are for your information to make life easier on the readers, as well as for the editor.

Advertising: Don't forget to tell advertisers that you saw their ads on the Beat.

Classifieds: We have changed Classifieds to a simpler option. Check periodically to see if any new ones have popped up. Send your information to editor@grantcountybeat.com and we will post it as soon as we can. Instructions and prices are on the page.

Editor's Notes

It has come to this editor's attention that people are sending information to the Grant County Beat Facebook page. Please be aware that the editor does not regularly monitor the page. If you have items you want to send to the editor, please send them to editor@grantcountybeat.com. Thanks!

Here for YOU: Consider the Beat your DAILY newspaper for up-to-date information about Grant County. It's at your fingertips! One Click to Local News. Thanks for your support for and your readership of Grant County's online news source—www.grantcountybeat.com

Feel free to notify editor@grantcountybeat.com if you notice any technical problems on the site. Your convenience is my desire for the Beat.  The Beat totally appreciates its readers and subscribers!  

Compliance: Because you are an esteemed member of The Grant County Beat readership, be assured that we at the Beat continue to do everything we can to be in full compliance with GDPR and pertinent US law, so that the information you have chosen to give to us cannot be compromised.