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Category: Front Page News Front Page News
Published: 06 April 2020 06 April 2020

By Hallie Richwine

After the meeting opened the agenda was altered to let healthcare professionals give their presentations and get back to their respective jobs. 

Dan Otero, CEO of Hidalgo Medical Services (HMS), spoke first. He said HMS continues to work with the Center for Disease Control (CDC), the New Mexico Department of Health (DOH), and the Occupational Safety and Health Agency (OSHA) to demystify as much as possible the risk to patient, employee, and community safety. "Health care systems are always keeping the highest standard when it comes to sterilization, etc," Otero said, "This is not the first virus that has gone around." Otero said as "we navigate this together we need to retain a high level of confidence in our health care systems."

Dr. Darrick Nelson, Chief Medical Officer at HMS, continued the discussion of preparedness. "HMS has taken the philosophy of screening at a distance," he said. The plan is to funnel patients through one entrance and screen individuals for symptoms before allowing entry to the building. Symptomatic folks will be ushered directly to an exam room. 

"One of the things that has been talked about is the really high percentage of people with minimal symptoms that are carriers and therefore they are spreading it without knowing it. But I do understand the protocol," Commissioner Alicia Edwards said.

"That's where social distancing comes in," Nelson said, "In the case of limited supplies where it is not infinite in the amount of test kits we can get or use. The test itself is also an exposure risk." 

Commissioner Harry Browne asked for an update on senior services and Otero said that drive-thru services have been employed.

"Do you know if the governor and the Area Agency on Aging (AAA) are foreseeing the need for congregate meals because there are other risk factors that are going to impact food security?" Edwards asked.

Otero said the demand exceeds the capacity in the two counties served by HMS. If new funding is received then they will reassess the current model.

"I know home delivery of meals has been a funding challenge, and historically with more demand than funding I think the possibility of home delivery would increase when friends and family cannot help with those resources," Edwards said.

Otero said individuals traditionally receiving meals will continue and the congregate meals are now provided through a drive-thru service and it has been going well. Otero said they are also working on a collaborative effort with Dr. James Skee of Silver Health Services to have a drive-thru testing center in Bayard. "There have been some barriers but we are continuing the conversation to help with that testing model."

Commissioner Billy Billings voiced concerns about hoarding. "On Facebook I see posts where one person has taken several hundred rolls of toilet paper and is leaving Walmart. I believe in the free market but we're going to need access to basic needs." Billings said he heard Walmart was going to implement a two paper product rule from the corporate level. "What other items do people need that we should encourage that we ration, for lack of a better word?"

"Sanitizer, Clorox, facial tissues...and disposable dinnerware like paper plates," Nelson said. Disposable things make it easier if one family member needs to be quarantined.

Edwards said she's heard talk about transmission on solid surfaces.

"We know it's transmitted through aerosols, so it's not quite airborne but if someone coughs on a solid surface...we're not sure how long the virus lives at ambient temperatures," Nelson said. 

Otero said, as testing sites are determined, the criteria will remain in line with the DOH.

Next Chairman Tony Trujillo of the Gila Regional Medical Center (GRMC) board of trustees and Rose Lopez, Chief Nursing Officer at GRMC, presented their preparedness plan."There's a lot going on right now," Trujillo said. "Our focus right now remains to be that we want the safety and health of our patients, caregivers, and community as we go through this." He said a lot of planning and coordination takes place daily.

"GRMC is the only hospital in the county and we want to be a major part of prevention, including the treatment and containment of patients," Lopez said. The two-fold plan is surveillance and communication. GRMC has limited its entrance points so all patients and employees can be screened. The communication piece includes daily intranet updates, newsletters twice daily, and education about Personal Protective Equipment (PPE). Lopez said the staff members have worked hard to identify supplies and medications they foresee needing to address the surge of patients, as well as areas of the hospital that can be identified for use of isolation.

Trujillo said they will also start drive-thru testing. 

"We are currently planning to conduct limited time, two to three hours daily, of drive-thru testing," Lopez said. "There's a lot of logistics involved. The team cannot receive paper from the patient so we're working through regulatory issues like HIPAA." She said they have come to the conclusion that they can perform this function for the community.

Chairman Chris Ponce voiced concerns about the health of the staff of GRMC and HMS. "Do we have any contingency plans if staff get sick, like bringing in other personnel. How do you plan on looking at this?"

"That's part of the surge plan. We anticipate call-ins and we have adjusted our plan to reach out to PRN employees and non-clinical licensed staff that are ready to come in and work the floor," Lopez said. She added that the administration will address and adapt leave policies on a daily basis while monitoring those who have called out and why.

Billings asked if testing would be accessible to everyone.

"The screening process we're adopting is the process Washington state is using," Lopez said. This would include those with symptoms, and those without that have come in contact with confirmed cases.

"You mentioned two entrances to the hospital, does that mean closing the main entrance?" Browne asked.

Lopez confirmed the only entrances open would be the oncology entrance and the emergency room.

Browne asked if any of these changes would interfere with the hospital's relicensing efforts.

Lopez said the state of emergency changes the requirements as hospitals are able to make more beds and rooms available to handle the emergency needs.

"Clearly the governor is evaluating a lot of different aspects of this for emergency funding," Edwards said. "Has there been any talk in Santa Fe to give any funds to rural hospitals given the concern for their revenue cycles?"

Trujillo said he gives full credit to the administration and the governor's administration for really pulling out the stops. Daily meetings are assessing all of the updates in news conferences.

"I really think that we already know we're on a razor's edge with the revenue cycle and would anticipate us needing some help," Edwards said. "And about PPE, and I assume that's everything from sanitizer to suits, on a scale of 1 to 10, how well stocked are we?"

"Just like everyone in the country, we are limited," Lopez said. She believes GRMC rates at a five.

"The county manager has been sending a lot of information and we've been watching the news. What can we do to get the general public the information they need?" Billings said.

Trujillo said the hospital will disseminate information to the county commission directly. He also said the GRMC website will have updates.

Billings said the White House has put out a pamphlet and the CDC website has updates. 

"I'd like to follow up on your comment about the CDC website," Edwards said, "the site is packed with information including a family plan." Edwards believes the CDC website will be the #1 source for the public as news unfolds.

Gilbert Helton was next to inform the commissioners of departmental efforts." The Office of Emergency Management and County Manager have been talking with all levels; the governor, Homeland Security, the Department of Health. Local counties are sharing information." He added that this is not a time to panic, but a time to work together and "do our part."

"As far as county facilities, will we be able to use them as we see a surge in people that need isolated?" Browne asked.

Helton responded. "If I could recommend anything it would be within the guidelines of the CDC and DOH. There's too much information for me to go into right now but if it gets to that point we will have that in place."

"I am just hoping we know where the supplies are," Browne said.

"Be assured the state has plans to tap into. We're ready to tackle this," Helton said.

County Manager Charlene Webb asked if there have been challenges for regular housekeeping.

Jason Lockett of the Facilities Department said that it has been difficult finding supplies. "We have been cleaning door knobs and high traffic areas. The cycle of ordering is trying to limit what is purchased," he said, "Things are getting restocked. We all have to do our due diligence. We are prepared, we have bleach and sprayers readily available."

Kim Dominquez of Corre Caminos talked about changes they are making. "We are trying to maintain social distancing. One plan is to suspend the fixed route services and only do on demand routes." She said prioritization would be on doctors appointments and trips to grocery stores and that they would work to eliminate nonessential travel and the amount of passengers on the buses. "We have stepped up cleaning. We have high contact areas and we have the supplies. We are keeping the buses sprayed down."

Browne thanked Corre Caminos for taking safety measures. 

"One of the things they're talking about is the droplets," Edwards said, "Some people may need transportation or need services that are coughing and sneezing. Do we have masks to give those people?"

Dominguez said the department hasn't looked into it but it also may be worth looking into for the drivers' safety.

"I recognize masks are as hard to get as toilet paper at this point," Edwards continued. "I do think people are going to need transportation who are sick." She thinks offering masks would be worth considering.

Detention Center Administrator Mike Carillo stepped up to give updates on what is happening at the Grand County Detention Center (GCDC). "A big difference is in our visitor programming. We've had to be flexible." GCDC recently updated to video visitation for their tracker program, and with the system already in place all they have to do is convert its usage to all visitors. "Plans were to update in the future, but this accelerated that plan," Carillo said. With no visitor access to the building, now families and visitors can call in on Saturday and Sunday from 9-4. Each detainee has 30 minutes and families have been given the information on how to use the system. Users will need to show identification, and the detainees will need to have adequate money in their accounts. "I think it's going to work out well. We may even see an increase in the amount of visitors." Carillo said they have implemented infectious disease protocols and are working on ways to change court transportation. 

"We are fortunate to be at the trailing edge of the rest of the country. Have you considered screening visitors and staff, taking temperatures?" Browne asked.

Carillo reiterated that no physical visitations take place at this time. "If staff feel ill then we are asking them to remain at home. Before they come back we are asking for a medical release." Carillo said there will be a meeting with the judicial departments to review conditional releases to reduce stress on the facility.

"How many people do you process, on average?" Edwards asked.

Carillo said maybe five detainees per weekday and fifteen a day on weekend days.

"The reason I'm asking is because there are so many hard surfaces. I commend you all for your proactive measures. That said, if we were going to consider testing everyone, the GCDC might be a place to do that." Edwards said, referring to the dangers of asymptomatic carriers.

Webb said GCDC adheres to the American Correctional Association guidelines as well as the CDC and DOH, and has been reviewing Washington state corrections' best practices. "Things change frequently and we're trying to stay ahead of any issues," she said.

"How are you handling rec (recreational) time?" Ponce asked.

Carillo said they haven't changed that at this time. "Once they are back in the general population we take more time to clean the recreational area, so we have had to modify that."

Webb spoke next about changes to the County Administration Building itself and the departments therein. "As far as facilities and staff, I recommend suspending all events at the Conference Center, town park, and County Fairgrounds until April 9 unless things change and we are advised to extend that date." She referred to the order from the governor cancelling mass gatherings of 100, then 50, then 10 people. "I'd next ask to consider authority to suspend public access to the Administration complex until April 9," she said, "We would close public access and put procedures in place notifying the public as far as how to do business."

Webb said they have already put an end to travel. "We are authorizing employees to do remote work if they are high risk or if they care for those who are high risk," she said. She added that employees that feel sick are to remain home. "The next challenge is the closing of the schools. It's caused a child care challenge. I'd like to address that on a case-by-case basis." Webb said she doesn't want employees to use their accrued leave. "I also recommend a hiring freeze for anything other than the Sheriff's department or GCDC," she said. 

Ponce said he appreciates everything the departments are doing. His main concern is that kids are being fed, and that the financial toll will not close too many businesses. 

Browne wanted clarification on what types of services may be impacted by a closed building. Webb said if things could not be done by phone or email the departments could make a scheduled appointment.

Matthew James, Deputy Chief Assessor said most of their business can happen via email and scanned documents. He said the office can also make appointments or offer delays. 

Chief Deputy Treasurer Veronica Rodriguez said their office will limit employees by working half time. With most of their payments coming in by mail, their plan is more about limiting exposure than changing their processes.

"Whatever is decided needs to be consistent," Ponce said, "That's the message the County needs to send to the public."

"One of the reasons for closing the building to the public is reducing staff contact with the public. County employees can still come to work," Webb said. "This way we're not dealing with pay and use of leave. They can still perform their duties. It's a challenging time and a challenging situation."

"I'd like a sense of the inconvenience to the public," Browne said. "The treasurer's office seems easy. We don't want to impede construction projects. People need to take care of things. We can't do this without considering ramifications."

Webb said the most difficult offices will be the assessor and the clerk. 

Grant County Clerk Marisa Castrillo said they have given a lot of thought to their operations. "It's important that the public and building staff remain healthy. We have an election to run. We're willing and able to do things by mail. We can use email and phone." Castrillo expressed concern about the coming election. "The President said this may go into July or August. The primary coming in June and we don't know what is going to happen. It's a big topic," The Clerk's office has been on calls with the Secretary of State regarding safety and the virus, as well as calls with the CDC. 

"So another part is the deadline to reevaluate. The schools are out until April 6, but April 9 is the time most people are talking about," Edwards said.

Webb said with so many things changing there may be a reason to have a special meeting by phone, particularly when it comes to funding. "We may have to make an emergency declaration in order to receive funds, so that's an additional reason we may need to get together." Webb said the executive orders were until April 9 but those could possibly change. "If the orders are extended we will have to react accordingly."

Edwards asked Webb directly what her personal plan is. "We are counting on you to run this whole show. What is our Plan B if you get sick?"

"I will be working remotely as much as possible," Webb said, "I will rely on ( General Services Director) Randy Vila as the onsite person. If something needs addressed and I can't do it by email or phone, that is my Plan B at this time."

Edwards confirmed that Vila could serve as acting County Manager, if needed.

Ponce took a moment to thank the Daily Press, Grant County Beat, and CATS for getting information out to the public.

"We've got a big red block of COVID-19 information on the website, and we're updating Facebook," Webb said, "We're trying to get any changes out to the public as best as we can."

Browne took a moment to discuss balance as changes take place. "I need to preface this by saying I'm extremely appreciative of the thought put into this. For weeks I have been watching this, especially as a school administrator. I am concerned with flattening the curve and slowing the spread. But i have spent more time thinking about balance." Browne wants to make sure the county is acting at the right time, so as not to be fatigued in the coming months. 

Ponce said he wants to err on the side of caution. "We don't know how many people in Grant County are walking around with it and haven't been tested," he said.

Browne said the school system changes are different than whatever the County decides since they are statewide. "Rural context is different than city," he said. And while he though Zoom and phone meetings were a good option, he doesn't support them fully at this time.

Ponce said he agrees about meetings. "It's a lot to take in and a lot of information. We have a business to run and this is a business. What's the most effective plan to protect employees? We can figure out how to bounce back later on."

"I've actually been thinking a lot about balance," said Edwards. "It's difficult to think about balance when one side is terror." She said she doesn't agree with Browne although she feels he has solid thinking behind his proposition. "I've been reading the same things and I'd maybe be inclined to agree more if I didn't know for a fact that there are people downtown that are not from here, that are potential carriers of the virus," she said, "We have an amazing amount of tourists in town right now. It's mind boggling, but we're at a grave risk of having happen here what happened in Italy. I understand fatigue and there will be fatigue. Our healthcare providers are at risk. But my inclination at this point is to err on the side of caution."

Webb reminded the commissioners that they had not heard from the sheriff. 

Sheriff Frank Gomez said training has been delayed and driver tests have been postponed. He has three non-sworn employees that can work from home, and the office is cutting back their hours. 

POnce asked about PPE.

"We have spit masks and gloves, but no regular masks," Gomez said. "And it's hard to purchase sanitizer." He said they posted the CDC guidelines and are practicing proper hygiene.

"Mentioning sanitizer again and the shortage; we should all have access to it. If you think it is necessary to take action to ration it so all the public can access it, I certainly would not be opposed," Billings said.

Randy Villa took a moment to thank Lockett for his leadership during the situation. He said the airport is still open and there is limited contact with any passengers.

Browne asked how enplanements are going.

"The cancellations of events are causing the cancellations of flights," Villa said. 

Moving on, Browne reminded everyone of the importance of filling out the census online or by mail. "The government is obligated to send someone to your house," he said. Filling out the census in a timely manner helps minimize contact.

High Desert Humane Society President Heidi Ogas gave the annual report. Fees from both impounds and licensing exceed past years, which may be the result of the new ordinance that allows for stricter enforcement. After the sudden passing of Buddy Howard, Ogas said Animal Control will be turned over to the county. "The shelter is extremely overloaded. There are only 23 pens," she said. "With the COVID-19 situation, with schools closed, it has been a hangout." Ogas plans to meet with shelter administration about how to address the increase in activity as it is a health concern. "Taking in and adopting is critical, but how to restrict it, I'm not sure. We do practice handwashing, and we were luckily stocked up on sanitizer before this happened."

Ponce again thanked the Daily Press, Grant County Beat, and CATS for keeping the public informed.

The regular meeting for the Grant County Commission happens March 19, 2020.