By Mary Alice Murphy

Grant County Commission Chairman Billy Billings opened the public forum to hear from community members and gather their input on Gila Regional Medical Center.

The event, which took place at the Grant County Veterans Memorial Business and Conference Center on April 26, 2018, was the third of three presentations made by the commissioners to gather input.

"We met with physicians last night," Billings said. "We met with Gila Regional staff members this morning, and now we want to hear from you."

Commissioner Brett Kasten said: "Your opinion is very important to us. Please fill out the survey." He also introduced County Manager Charlene Webb, who was handing out surveys.

"A ton of rumors and misinformation is out there," Commissioner Alicia Edwards said. "The commissioners embarked on this process with serious intent. We know how chaotic the health care scene is across the nation. Our concern was how critically important Gila Regional is to this community. The hospital has had recent issues. The Cancer Center, four chief executive officers over the past 10 years. Early last year, we wanted to understand health care to ensure we have the highest quality health care here in Grant County. We have looked at lots of options, including remaining independent, and I want you to know absolutely no decision has been made. We understand it is a difficult situation to have everything up in the air. It's our intention to do this process as quickly as possible, but as thoroughly as we can. We have a lot of work yet to do. This is part of the listening phase. Reach out to us in any way, email, phone, text. We want access to the highest quality care we can have."

She then began the presentation, which was covered in http://www.grantcountybeat.com/news/news-articles/43929-grant-county-commission-holds-forum-to-hear-from-grmc-staff-members-042618

Edwards noted that more than 80 percent of hospitals across the country are going through a similar process of deciding how to best make quality health care available to their service areas.

"Our goal is the best quality health care for our residents," Edwards said. "It has been a challenging process. We have spent many hours, individually and as a group, learning more about health care. Probably more than I thought I could fit into my brain. I'm proud to be part of this group."

Billings said it is about finances, not about quality of care, staff or administration. "We have lost $22 million over six years. But I want to thank the Gila Regional Board of Trustees for their many hours of work. I acknowledge the work of the Chief Executive Officer Taffy Arias and the Chief Financial Officer Richard Stokes. I want to point out that Gila Regional is the last publicly owned hospital in New Mexico that was created under the Hospital Funding Act."

He emphasized again that no decision has been made by the commissioners. "We are thankful for your informed comments. The responsibility of the Commission is to make sure the hospital remains viable, because it is county-owned. We appoint the Board of Trustees, which manages the hospital. It is our duty to step in, because if we let the hospital go bankrupt, people would hold us accountable."

The first audience member to speak was Marcia Lopez, who said her grandson is the seventh generation of her family to live in Grant County. "Our concern is that health care services are provided here. Our concern is that if a profit-making organization takes over the hospital that it may not decide to provide the services that may not bring in money. Dr. Fowler provided the property, so the county could go out for bonds."

"Taffy has made changes," Lopez said. "She has hired a CFO, and I've heard good things about him. I would like to know what you plan."

Kasten said he has been in the community for about 57 years. "The land for the hospital was bought from Dr. Fowler's brother John. The bond went out in 1982 and the hospital was finished in 1983. We appoint the Board of Trustees. We have no opinion yet on a decision. We're still gathering facts right now."

Commissioner Gabriel Ramos said his kids are the fifth generation in the county. "I've been here my whole life. I take great pride in the community. Gila Regional is very important to us. I worked there for a couple of years. People call me. I haven't made up my mind. I don't think any one of us has made up our mind. We listened to the Gila Regional presentation, which was awesome, and now we're listening to the people."

Billings said his grandchildren are eighth generation in the county, but he didn't think it was relevant. "Caregivers took care of my grandmother and my grandson was treated a few weeks ago. I go for regular treatments at Gila Regional. And no, I don't own Lifepoint stock, unless it's in a mutual fund somewhere. It's irrelevant to what I think about the decision. I vary in opinion from day-to-day. We will collect information and Commissioner Kasten is correct that we are still gathering information. We have it designed as an open process. We have to do our homework."

Commissioner Harry Browne said he has been in the community since 1996. "I am undecided. We are in negotiations. It's unwise to say how we think. We have to be concise in our answers, so I'm going to stop, because we will have lots of questions."

Edwards said she has been in the community for 14 years. "I have not made a decision. We have not seen offers from anyone."

Dave Phillips said he would like to hear a characterization of what the commissioners learned from the physicians and the staff.

"The doctors requested to be heard in closed session, so I cannot divulge what they said," Kasten said. "It was a long, meaningful discussion, with a lot of substantial talk, and with good ideas and bad ideas."

Browne said the employees, he believes it was fair to say, have a lot of concern that the hospital will lose local control. "Their bosses were there, too, so I'm not sure we were getting balanced comments."

Trish Heck said she had talked to individual commissioners. "When I saw the name Quorum, it gave me chills. If you decide on them, please talk to me first."

She said she has spent 20 years at Gila Regional out of her 50 years as a nurse. "I have seen for-profit and non-profit operations. The for-profit ones work for their shareholders. It's a reality of modern business life. I became even more concerned when Memorial Hospital started trying to compete for our cardiologist. Be warned that many of the caregivers won't work for a for-profit company."

Lynda Aiman-Smith said she bought a house in Silver City in 2003, but "my ancestors came to New Mexico in the 1700s. You need $5 million to $10 million for improvements. You more likely need more. The vote for a bond a few years ago was for $33 million, to bring in $3.3 million a year. Was there a discrepancy in what was needed then and now?"

Edwards clarified that the $5 million to $10 million was for infrastructure, and more was needed for equipment.

Aiman-Smith said she was a management teacher. "I have a question. The $22 million over six years, did the county or the hospital make up that money?"

Another woman asked how the millions were lost. And what happened to it.

Billings said the hospital made up the money, but the days of cash were enough and Gila Regional used the money. The days of cash have gone down recently to 39, although they are back up to 73, according to CFO Stokes, he said. "Some people are calling what he and Taffy Arias have done a turnaround. We had a five-hour presentation by the hospital."

Kasten said the losses were from audited financial statements.

Browne said the hospital used to be depending on the sole community provider funding, which dropped precipitously. "The losses came out of reserves."

Wendy Phillips said: "Doesn't a lot of the money loss come from being dependent on this whole state and federal health care system being crazy over the past few years. Wasn't some of the money paid back? I have a problem with you guys insinuating it was the hospital's fault."

Browne said the problem was, "if they didn't have the expertise to predict they needed the money, it was a huge problem. There's another piece. None of us wants to beat up on previous administrations. But there was a huge problem in the revenue system, whether through billing or through the hospital. Payors are now being aggressive in not paying bills. So, it's another thing to deal with."

Derek Ratcliff, who is Walgreen's manager, noted that Lifepoint only works with CVS. "If you choose Lifepoint, it will affect other pharmacies. Right now, the hospital has a 4-Star rating. If you bring in a for-profit, the billing will be outsourced, lots of services will be outsourced. It will be bad for the economy of the county."

Kasten said the hospital received the 4-Star rating in 2015, and recently Leapfrog gave the hospital an A rating. "These are great accolades. I was unaware of Lifepoint using only one pharmacy."

Edwards concurred that it was a big part of the problem with money going out of the area. "Right now, the hospital is hiring outside consultants, so the economy has leakage. But is the capacity and expertise available in the community to fix the hospital? The hospital is also getting ready to outsource the billing and has hired Cardinal to do the pharmacy."

Browne asked a clarifying question of Ratcliffe. "Would Lifepoint force patients to use only CVS?" Ratcliffe said: "No, it's only for Lifepoint's employees, not patients."

Wendy Phillips thanked the commissioners and the trustees. "I can't imagine doing all this to learn how to do a business like a hospital. I appreciate the time you've put into it. I have a lot of thoughts. For eight years, we have been very invested in the county and its success. My personal feeling is to keep it local. I don't ever plan to go to Las Cruces. If you give away our power and lose control here, you will lose fabulous physicians. They, too, are interested in keeping it local. I'm from Michigan. Lifepoint is bad news. Do some research in Michigan."

Susan Beck asked if the commissioners had a timeframe for decision making.

"The next phase of the process is the offer phase," Edwards said. "We think we will see proposals, including from Gila Regional to remain independent. We will do it as quickly as we can and as prudently as possible. We are conscious that dragging it out is bad."

Frankie White said her family came to Grant County in 1898, so "we've been here 140 years, more than six generations. Watts Clinic was the hospital, then we had Hillcrest and Gila Regional. We believe, as family and friends, that the community should have a vote."

Cissy McAndrew said she came in 1996. "I moved here for the hospital. I was going in to the Cancer Center. I worked under Quorum. It was horrible. That organization led to bad outcomes. I am totally against corporate ownership. I sell the community [as a Realtor]. One concern I read in the paper is wages. Many wages are low here. We can't pay what Memorial pays. I'm pleased we're having this forum. My question is how much does the hospital cost and how much will it cost to keep it local?"

Kasten said that Quorum left two years before the downturn began happening.

McAndrew said someone is going to offer big money.

Browne said he didn't believe the decision will just be comparing dollars only.

A man named Jim, who has been in the community for 13 years, said the hospital has saved him twice. "I am all against a for-profit company. My brother worked in a not-for-profit that had surpluses. They gave it to the executives as bonuses. You say the hospital has lost $22 million. How much have you lost in the Sheriff's Department, in fires? The hospital should be losing. It's a service to the community."

Billings said Gila Regional can make money. "There are hospitals similar to ours that can make money. The new CFO has plans to make money and he stands by his numbers. Then we will have a surplus. The trustees can give bonuses, but I hope it goes to the bedside caregivers. Our caregivers are underpaid, but that is being addressed by management."

He said the process may look like a waste of money and "spending your taxpayer dollars. But this process has led to good things. The CEO said the hospital would be moving at this pace whether or not we lit a fire. We're working better with the Board of Trustees, who are reaching out to us and sharing information. A lot of that came out of this process."

Jesse Franklin-Owens said he needed to apologize. "My concern was that this had to be an open process and it is. I haven't talked to anyone that thinks it's a good idea to sell the hospital. I hope you come back with your idea to us and gauge the sentiment of the people. I suggest we slow down. The hospital administration is making good decisions. I thank you for your efforts."

Browne said he feels a sense of urgency, not because of an impending bankruptcy, which isn't in the picture, but the urgency comes from the physician and staff uncertainty.

A woman named Karen asked if the decisions would be contracts instead of remaining a community hospital.

"The only one who could bring in management is the Board of Trustees," Browne said. "We can sell it; we can lease it; we can make it a non-profit or for-profit."

A woman named Brandi thanked the commissioners who have called her back. "The big concern for someone like me with no income or a fixed income, was what happens to older people with little or no income. My son went to a private hospital, and it was appalling, with no nurse available. At Gila Regional, he had a nurse stay with him for two hours until the Medevac team got there. At El Paso, they shoved a tube down his throat and he threw it up. We had to call for help. They replaced it and he threw it up again, and we had to call for help again, because no one was right there."

Edwards said she thought she spoke for the whole Commission in saying that "not one of us would ever knowingly deny care to anyone in the community."

John Callahan said he was confused. "The Board of Trustees runs the hospital, but the commissioners can sell it?"

Kasten said the Hospital Funding Act, "the worst piece of legislation ever written," states the commission can sell or lease the hospital. It can choose to appoint the Board of Trustees. "This Commission chose to appoint the board members. The act tells how many trustees, how many terms, what month, that act is what we're following. We cede our authority to the Board of Trustees to run the hospital, and the board cedes its authority to the CEO."

A man said: "Basically, the buck stops with you guys. Why did you wait so long to step in if the hospital was $22 million down?"

"It appears we waited a long time," Kasten said. "In 2012 or so, the sole community provider funding went away. We recognized it before the Board of Trustees did. It took several trustees to force out the administration. They hired a new CEO. The hospital was making about $10 million. The Commission doesn't take any of it. That CEO was making the hospital $10 million, then lost $9 million. He got it back up. We went back to taking care of roads, the Detention Center, crime, the things we normally do. We started seeing losses again. Then we saw the Cancer Center hiccup. We work hard and butted heads over the Cancer Center. It is at that point in time when this process began. We're learning a lot. The hospital caught it twice without going bankrupt. Emotions don't do a lot of good. We need facts. The biggest mistake we could do is have Grant County without a hospital."

A man named John said: "The way the structure is now, you're responsible, but you can't do anything. Are you looking at selling it?"

Billings explained hiccups were under former boards, which because of staggered terms, are not necessary the same board.

John said: "You got elected. You wanted to be here. Get with the Board and work it out together."

Browne agreed and said the best option is working with the Board of Trustees. "It's an ideal outcome, if it works out."

A woman asked how the Board of Trustees is chosen. "Why is there a disconnect between the board and the commissioners?"

Browne said the three-year terms are staggered, but they have no term limits. "We had a process for choosing the last round. The board must have two trustees who are physicians, but only one applied for the physician spot, so we picked that one. Whereas, for the lay person, we had 13 applicants. Each commissioner rated them. The top five presented to the Commission, and we chose one."

"We appreciate we should work with the Board of Trustees," Billings said. "It should go without saying, and it should happen. I think we have an increased desire to work together."

A Mrs. Gonzalez said the trustees have hired the best CEO. "She has gotten us back up. I have gone to the Cancer Center and the care is excellent. I don't want the hospital sold or merged. Life Quest is lost because it merged [It actually lost state funding to another organization]. I'm glad you're working together with the Board of Trustees."

Ramos said the Board of Trustees hires the CEO. "We appoint the trustees. We look for people who have management experience, financial experience and knowledge of the hospital business. Health care is changing so fast, we need a CEO and CFO that the board doesn't have to pay attention to. We choose the trustees. There are good people on the board. Things are changing so fast, who knows how long funding for critical access will be here. We don't know what's coming next."

Gila Regional Chaplain Bill Holguin said he feels like the hospital is a family. "My comments on economic leakage with outsourcing is if the hospital were sold, it would leak more than the $22 million to outside of the community. I understand you have to have expertise. What if the owner of the hospital leaked out $22 million in six years? Who would make it up?"

Virginia Holguin said she feels like there is no accountability of the Board of Trustees. "Who are they accountable to? It seems like a lack of communication."

Billings said it was a good question. "Last year, over the Cancer Center, I got two calls. One was from Tita Terrazas. We had a long conversation. She asked how the hospital could change providers because there would be no transition. She said there was not enough fore-planning. I agree, but this is my opinion. I feel bad speaking because there are Trustees here who cannot speak and tell their story."

"The Board of Trustees members are very qualified," he continued. "There is no excuse for us not to be working together. The Hospital Funding Act insulates the Commission and the Board of Trustees from one another unless they volunteer to work together. That's what we are trying to change. I think I understood the CFO to say that he is accountable and wants to be accountable."

Susan Clair said she had a comment and a question. "I do not want to disparage the for-profits or non-profits in general. It seems to me that there is an inherent conflict of interest in a for-profit doing health care. For instance, the doctor or nurse can say, 'sorry, my shift is over, I have to leave.'"

"What if you sell the hospital and it's not making money," Clair asked. "So, their choice is just to close and it and then no more hospital here. Once you choose to sell, it's out of your hands."

Ramos said he agreed that health care should be for everyone. "Gila Regional does a great job in providing service for everyone. What if the hospital is very successful? What if it goes bankrupt? Are we going to lose the hospital? That's why we are trying to decide whether to partner up, or maybe get a management company to come in. What if we lease it? I assure you we will do the best we can to make a logical, educated decision, because I know people like you depend on us."

"I've gone through three CEOs during my tenure on the Commission," Ramos continued. "Each time, we thought the Board of Trustees had made a good decision on the first two. Rest assured we will do the best we can."

The first woman who had spoken said it was necessary to get to accountability and transparency. "If not for the newspaper, I wouldn't know what's going on. I see the Grant County Beat here, and I'm sure the other one is here, too. This is a small town. If we know what's going on, we'll let others know, especially if someone is screwing up."

Martin Miller said he attended the last County Commission meeting "where Taffy Arias and Richard Stokes gave an excellent presentation on the finances. And I just happened to talk to a health care person today who had worked in Belen in about the late 1980s. I might be wrong on the date, but the town sold its hospital to a private company. It went on for a few years, but then it closed. Belen still doesn't have a hospital."

A man named Jesse asked if it would be possible for the Board of Trustees to do the same process with a forum like "this one."

Ramos said it was up to the Board to make that decision.

Kasten noted that the Board of Trustees would meet at the hospital the next day at noon.

Billings said, during the Gila Regional presentation to the commissioners, the hospital presented its strategic plan. "I think it's a good one. We got a lot more information that we ever got from the previous CEO, when I asked if I could talk to him. He said: 'I'm kinda busy, just read the newspaper.' We've come a long way."

David Rose said he would give two examples of what happens when things are privatized. He said Nixon privatized the Post Office and Life Quest just folded, after providing a great service.

Shelly Carter said she has been in the community for 48 years, 24 years of which she has been a nurse, with about 20 at Gila Regional. "So, I have strong feelings for the hospital. I am the new manager of the Cancer Center. My question is: What will this mean for the Cancer Center, if a decision is made, for example, to have Lifepoint come in? What would it mean to the contract with UNM?"

"First off, Lifepoint is not the only option on the table," Edwards replied. "We're a long way from getting to that point. We've learned a lot. Whatever kind of transition, if that's the right word, we would make every effort to make the transition as smooth as possible. If, and that's a big if, we get to that point, we will ensure whatever we do is as smooth and unpainful as possible. I don't know the legal ramifications.

"I would like to come back to Life Quest," Edwards said. "We've heard two wrong stories about the organization. It was a 501c3, providing services for 45 years. In fact, what happened is that it relied on state funding and the funding dried up. They could not survive without it. We're also thinking about the possibility. The entire state economy of New Mexico is very tightly tied to government money. We have to address what happens when the stream of government money dries up and we don't have a plan B."

She said that should be the concern of everyone in the nation. "Very generally, health care is in chaos, but it favors for profits. That's not a good thing. I think we all can agree that a small local community hospital is what we want, but it's hard to make a go of it. We want to ensure it makes it."

A woman asked about the billers. "We need billers to bring in the revenue. What happens in this transition when the new consultant is coming here? It's going to cause quite the mess, where we might be in another situation. I don't know whose decision it was, whether the board or management."

Edwards said it was a management and Board of Trustees decision. "The Board handles the day-to-day operations. I encourage you to attend the Board of Trustees meeting and ask your questions."

Billings said after two hours, it was about time to conclude the session if there were no more questions or comments.

Edwards closed it by saying thank you to the Board of Trustees members and the Gila Regional administrators "for being here and thank you to each and every one of you for coming out to have a conversation on this very important topic."