[Editor's Note: This is part 1 of a multi-part series of articles on the Gila Regional Medical Center Board of Trustees meeting held on July 26, 2019. This covers recognitions and directors' reports.]

By Mary Alice Murphy

Newly elected Gila Regional Medical Center Board of Trustees Chairman Tony Trujillo changed the venue of the meeting to a larger room, the hospital conference room, in order to allow more members of the staff and public to attend. He also, because a flag stands in the room, led off those gathered in the recitation of the Pledge of Allegiance.

Former board chairman, Mike Morones, in his last meeting as a trustee, read the Gila Regional mission, vision and values.

Trujillo said he requested the change of room for the meetings to open it up more, to allow more interaction with the trustees and because there are two public exits from the room.

GRMC Chief Executive Officer Taffy Arias told, in a cautionary safety moment report, about a hospital in Utah that reported an unexpected death during an open-heart surgery, because the tubing had not been clamped, so the patient bled to death. The tubing was under the drapes that were over the patient and no one checked. "No one took care of the details. Everyone has to notice the details."

The next part of the meeting addressed the introductions, announcements and recognitions. Trujillo said it was always his favorite part of the meeting. "This list represents 170 years of service to this hospital."

Jane Dunne-Brady was recognized for 15 years of service in the Mental Health Unit. "I'm grateful for this recognition and this hospital. This is a long gig for me. I am also grateful to God."

Suzy Head received recognition for her 25 years of service in the Recovery Room, but was unable to attend.

Ray Muniz has served 30 years at the hospital. He said he started with Emergency Medical Services and was there for 25 years before switching to Security.

William "Robbie" Birch had served 30 years with EMS. When asked how he did it that long, he replied: "One day at a time. I started as a volunteer. There have been a lot of changes. We started with four trucks; now we have 10. I thank everybody."

Former interim Chief Nursing Officer Kelly Rodriguez noted that Birch is also one of the EMS trainers.

Director of EMS Eloy Medina said: "Robbie and Jo Dee are the backbone of the Gila EMS. The community talks about how well they support the Gila-Cliff area."

Jo Dee Birch, Robbie's wife, has also served EMS for 30 years. "He pulled me along with him. I started when he did. I'm also an instructor at The Wellness Center."

Steve Garcia has served Gila Regional and before that Hillcrest Hospital for 40 years, now in cardiopulmonary. "I started at Hillcrest and the hospital is the only place I've ever worked. It's been a great journey at the greatest hospital in the Southwest."

"These are the people who make Gila Regional what it is," Trujillo said.

Trujillo also recognized Morones for his three-year tenure on the board. "He came on three years ago, got started and involved immediately. I have big shoes to fill in the chairman position."

Trustee Dr. Victor Nwachuku said he has served with Morones. "We had a lot of discussion during difficult times."

Trustee Jeannie Miller said she could thank Morones for making her chairwoman of the Plant and Facility Committee. "We will miss him."

Trustee Joel Schram, who last week was reappointed by the Grant County commissioners to the board for another term, said he came on at the same time as Morones. "I value his expertise. We are colleagues."

Trustee Ed Wilmot, who was appointed in 2018, described himself as "his (Morones') difficult child, but he let me express my opinions."

Arias said Morones had brought so much to the hospital, with his governmental and financial experience. "He saved us from many bad things, when he would say: 'You can't do that.' He is someone we could trust for his knowledge base and guiding us in the right direction. He also kept the board calm during very turbulent times. He was a voice of reason and respect on our board. Thank you very much."

Chief Financial Officer Richard Stokes agreed with Arias. "Mike has been someone I could bounce things off of. He could gently remind us that something may not be the best course of action, so thank you, Mike. "

"It has been a wonderful experience," Morones said. "Thank you all for allowing me to be as successful as we all could be."

Trujillo also recognized Trustee Dr. Tsering Sherpa, who would be leaving the board after a three-year term, but was unable to attend the meeting.

"We're going to take a five-minute recess to celebrate the recognitions and board members with some cake," Trujillo said. "You'll find out things for me often involve food."

After the cake, the board reconvened. No one had signed up for public input, so it became time for the board members to give input.

Wilmot said to Arias that he appreciated the comments she made at the County Commission meeting.

Trujillo said he would forward the agenda in the future to Grant County Manager Charlene Webb and the commissioners.

Schram said he appreciated the commissioners' confidence. "I hope the next three years will be better. We are going in the right direction."

Morones commended Trujillo for changing the venue for the board meetings. "Our board room is nice, but it's small and this government entity is subject to the Open Meetings Act. This is much more conducive for the public to see us work. I'm very proud of what has happened over the past few years. We have faced and overcome a lot of hurdles and challenges. We are working in the right direction. I'm glad Joel reapplied and glad they reappointed him for his experience. I leave understanding you still have a big job in front of you, but I appreciate what you are doing in continuing to be positive."

Miller said when she was recently in Seattle visiting family, "I wandered over to the University of Washington Medical Center. It had things I thought were interesting. I will turn the thoughts over to Rennie (Mariscal, clinic and cancer center director). The medical center has an information center for patients. They had many pamphlets on cancer. I suggest we look at something like that. There were other things I liked, too. We will miss you, Mike."

Nwachuku thanked Morones again. "I thank you for what you brought to us. As we go forward, we have to think positively and continue to work together to make sure we are a viable hospital."

Trujillo gave "our thanks to the outgoing chairman. He taught us a lot. I thank you for letting me take over the chairmanship. I thank the commissioners who went through the process of choosing trustees out of 11 applicants, all committed to be on the board. I thank them for showing they care for the hospital. Congratulations to the two new board members, James Marshall and Cynthia Moreno, and thank them for reappointing Joel. I look forward to keeping the hospital viable and continuing to offer high quality care."

No one was present to give the Auxiliary report or the Foundation report.

In the CEO report, Arias said she has continued with the changes to the format of her report to highlight the leadership members of the hospital staff "to let them explain what they do."

Rennie Mariscal confirmed that as clinic director, his duties include the Cancer Center. "As of today, in order for New Mexico to reach national standards, we need 126 more primary care physicians and 147 more nurse practitioners, and the counties with the biggest shortages are Eddy, Lea and Otero, and I think Grant County comes in close to that. I have to applaud our recruitment efforts. We are getting high quality candidates. We are also getting our own house in order."

He said that a customer service training will be held at all clinics. "I am also focusing on working with Doug (Oakes, marketing director) for a marketing campaign promoting our service lines. The Deming Clinic is up and running. It opened on July 15, and we had representatives from the Attorney General's office and from the Children, Youth and Families Department. The new surgery and pediatric offices are coming next week. We hope to have an opening in mid-August."

Miller noted that it looks like things are steady at the Cancer Center. "Are we expecting an upward trend?"

Mariscal said the center is in a lull. "I'm looking into it, but things are clicking along as expected. I want to make sure people know about all our services. We want people to know we have services here, so they don't have to travel out of Silver City to get treatment."

Miller asked if referrals at UNM were coming back to the GRMC Cancer Center.

"Yes, when they stabilize from surgery, they can get treatment here," Mariscal replied. "We call them after the first treatment and make sure they know their treatment modality, and we determine if they need financial assistance."

Nwachuku said: "I think we need to establish confidence to come back here for their treatment after surgery."

Mariscal said that now with the full-time oncologist things have stabilized, and "we will be notifying members of the cancer support group and talking to the community about what we offer here."

Wilmot asked about the Bayard Clinic. Mariscal said they were waiting for the architect's information on an estimate before getting a contractor.

Miller asked about the nurse practitioner Mike Harris. Mariscal said he lives in the community and comes with an established patient base. "We also plan to have a second clinic in Silver City, too."

Chief of Staff Dr. Brian Robinson said he just had a patient that day who said his primary physician was Harris, but at another clinic.

"He just started at the Gila Family Clinic this week," Mariscal said.

Schram noted that volumes at the clinics were good. "With the new software, will it track revenue and expenses?"

Mariscal confirmed that it would and would also benchmark data.

Miller asked how many nurse practitioners the hospital employs. Arias said six, including at the Cancer Center.

Arias introduced Briana Roma, the interim director of medical staff services.

"We are the gatekeepers for patient safety," Roma said. "We have the responsibility to credential new providers and re-credential existing providers. We make sure licenses are up-to-date. We are responsible for the CME (continuing medical education) program for providers and some community members. We recently rebuilt the CME program and were re-accredited in May. We review and implement federal rules and establish and facilitate meetings. We managed 111 medical staff meeting over the past year. We assist in medical staff bylaws and policies, manager the peer review process, do the locum tenens program and work with the chief of staff Dr. Robinson, the vice chief of staff Dr. Colicia Meyerowitz, with Dr. Ratliff, and other directors. In the very important credentialing, we ensure all regulatory processes are followed. We compile and evaluate physician data. We review, research and validate discrepancies and evaluate privilege requests. In the past year, we processed 73 original applications and 76 re-appointment applications. We must and do process applications within a 60- to 120-day window."

She said that all applications are now automated, and "we are getting good feedback from providers," Roma said.

Wilmot said requirements had recently changed for applications. "Are you getting pushback?"

Roma said Medical Staff Services did receive pushback, but "after we explain why we do it, we usually get the information we need." To another question, she smiled and replied: "Yes, we work well with Dr. Robinson."

Stokes said the requirements that Medical Staff Services has to comply with are the very same criteria that every other hospital in the country has to meet, whether in Las Cruces or the University of Washington. "There are no exceptions for small rural hospitals. In talking with other hospitals in the area, I learned we have implemented much more to be handled electronically than a big hospital near us. I congratulate Brianna and her team. We have had the software for several years, but it is just in the past year that it has been developed and deployed here."

Roma confirmed that her department handles the credentialing of physicians, nurse practitioners and physicians' assistants, as well as those nurses that operate as licensed practitioners. "Human Resources does most of the nurses."

Arias noted that Medical Staff Services handles all the tele-medicine credentialing, too. "The credentialing is a lot of work because each telemedicine provider has a huge bucket of physicians. Medical Staff Services has to stay abreast of those coming and going. They also have to keep up with the changes. Some say the rules 'don't apply to me. I'm special.' Medical Staff Services has a calming way to say: 'Get over yourself,'" Arias said. "I applaud the department. They are calm and nurturing to providers."

Miller noted the hospital does not take the word of the tele-medicine providers but does the credentialing and validating for the safety of Gila Regional.

Roma said the tele-radiologists and upcoming tele-neurologists come prepared for the credentialing process.

"Medical Staff Services is the first stop," Arias said. "They keep them from getting to me or you if they don't meet the qualifications. The Credentialing Committee is very aware of the requirements. Medical Staff Services can stop an application in its tracks for red flags. They help us keep our high-quality providers."

Stokes said he is very impressed with the medical staff for vetting applicants. "There is always a lot of pressure to bring certain specialties here. "Robinson will not let anyone get through who is not qualified."

Arias said it provides great comfort to her that Medical Staff Services knows how to weed out the unqualified.

"We appreciate Brianna," Robinson said.

Arias introduced Angelia Peyton of Risk Management and Compliance.

"This is my first anniversary here," Peyton said. "Our patients are an asset. We are pro-active in managing risk. We also try to limit or mitigate legal litigation. When I came, the records-keeping process was a hybrid of electronic and paper files, so it was hard to find information. Event reports are important to identify trends. We look at the near misses and accidents and work closely with the Quality Department. We usually are the front-line people. Reporting was fragmented, and the system was so cumbersome we couldn't get paper reports. The new event-reporting process allows the end user to put in the event and it populates out to everyone who needs it. We become aware of the event in real time and can react in real time. We have trained 500 people on this module. The most important thing is that it gives a voice to everyone who works here. Every choice impacts a patient. Even in registration, if they get something wrong, it can impact safety all the way down the line. With the module, we gave power back to everyone, even someone in housekeeping. We were seeing 60 to 70 paper incidents. I looked this morning. The module went live on June 22. We've had 514 reports filed. Of those, about 257 were ones we would generally see on paper. Research shows that hospitals that have vigorous reporting systems are safer places. My goal is for everyone that comes in here to feel confident they will receive safe, high-quality care."

Next to speak as part of the CEO report was Kathy-Lyn Pacheco, who gave an overview of the recruitment program.

"I've been here six months," Pacheco said. "I have a marketing background, as well as having done recruitment for years. June was a positive month for us. We had a tele-neurology practice, general surgery and a critical care nurse practitioner come for site visits and interviews. We will interview an ENT (eye, nose and throat specialist) in the coming days. In August, we have a pediatrics candidate, another ENT candidate and a general surgeon coming to visit and interview.

"We use multiple different steps to attain success," Pacheco continued. "We have open ads on multiple platforms, including in the Journal of the American Medical Association and on Indeed on the Internet. There is communication between me and the individual who has shared a resume or interest in the hospital, as well as with those I am actively prospecting."

She said she holds a 10- to 15-minute phone call with the candidate. "They learn about the hospital, the position and the community. I also ask about their personal interests. Then, on my recommendation, the CEO does a 30-minute phone call with the person. Upon CEO recommendation, we coordinate a site visit and interview. I plan their travel logistics. Each candidate is given the opportunity to meet with a variety of physicians and community members, as well as senior administration. It's full-day's agenda. They do a tour of the hospital and clinics. If their family comes with them, I arrange meetings with school districts or other community members that fit their needs, so the family members can experience the community for themselves. The CEO and CFO manage the employment contract for the prospective new hire. Human Resources helps with the transition. We work with Medical Staff Services. Gila Regional is working hard to ensure a strong primary care network to reflect the changes in the community and to provide care for the community."

Wilmot asked what the average spend was on a site visit.

Pacheco said the bulk is airfare, which the candidate purchases and "we reimburse. We also take care of the hotel and a rental car, if they haven't driven here for the interview. It can be as low as $200 and as much as $2,000. Having been in recruitment, I know a lot of places spend more than I do."

Wilmot asked Pacheco if she travels. "Yes, but not much," Pacheco said. "I will attend the Academy of Medical Education conference in Ruidoso. It will give me the opportunity to interact with attendees. I'm very mindful of being a good steward of resources."

Schram asked what impediments Pacheco has seen to attracting physicians to the area.

"There is a shortage across the country," she noted. "We have to find the right person, who wants to come and will be happy here. I tout what we have. I respect giving them time to make a decision. Timing is important."

Miller said the partner in a couple is also important. "We have to keep the partner happy, too. If they are two professionals, can both work here?"

Pacheco said she has been in those shoes. She moved here with a husband and two small children. "I make sure the family is thought of, too. I try to make connections for them."

Arias said it was the end of her report. "I hope this is helpful to you. These people are extraordinary, they do an extraordinary job every day, and they own it."

Wilmot asked about a community meeting. Arias said it would be discussed in executive session, but "I would like to hold a community meeting in August."

The next article will feature administrator reports, beginning with the Chief Nursing Officer Rose Lopez.

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