GRMC Board of Trustees meeting of 112219

By Mary Alice Murphy

The Gila Regional Medical Center Board of Trustees met in a regular meeting on Nov. 22, 2019, instead of Nov. 28, to avoid the Thanksgiving holiday.

As is customary at the beginning of the meeting, members heard a safety moment. Chief Quality Officer Tanya Carroccio said it was recently brought up and "we had a dialogue on the issue" that providers were seeing heightened numbers of people on drugs and experiencing it turning into psychosis in the behavioral health unit. "We need to focus on the processes. We have put more security up there, but we need more discussions on making sure that we keep other patients and staff safe."

Chairman Tony Trujillo said: "I've said this before, but one of the best things we do is recognize our employees."

Deb Root, who serves in quality and analytics, has worked at Gila Regional for 25 years. "I love GRMC and I have served in lots of departments."

Ellen Schweigert from physical therapy has also served the hospital for 25 years.

In public input, Kathleen Ryan said she has sent documents and letters and received replies from Chief Executive Officer Taffy Arias. "I need my records."

She described herself as a survivor-thriver of domestic violence. She went through a litany of her experiences when she went to the emergency room in June and alleged that neither her caretaker nor her brother was allowed in with her, and her anxiety was "coming off the chart. I didn't want to be transferred to Mountain View, but I was." She asked to see her primary or her neurologist in Tucson. Her family, she alleged, had no idea where she was. "I felt like I had been kidnapped and held for ransom."

When she finished her story, Trujillo said "I sincerely appreciate what you are saying, and we will have a discussion about the situation."

Ryan left saying: "I love Gila Regional Medical Center."

The second person to speak in public input was Chris DeBolt. "I want to comment on the last Stepping Up meeting and what Tanya said. She said that acuity of the drug situation is happening everywhere. I thank you for the work you are doing. I am the county's representative to the Non-Metro Area Agency on Aging. I spent time on the senior report put together by Hidalgo Medical Services. The results show that Grant County is tied with Sierra County as the fastest aging counties. Many things are doable. We are trying to get in front of this effort. We have to take it on and follow the recommendations. Could there possibly be a service line? It is reimbursable. It is a cutting-edge thing. I hope you are looking at the possibilities. Whatever information I can provide, I will be happy to do so. I would love to take back to the Area Agency on Aging that our hospital wants to be part of the solution."

Arias noted DeBolt had received a recent award. "You've been so instrumental in bringing the hospital back into the community. Your award was from the National Frontiers Communities. Congratulations."

In board input, Trustee Dr. Victor Nwachuku said, as it was the last meeting of the year, due to holidays, "Happy Holidays to all. We will continue to move forward on the financial health of our hospital."

Trustee Joel Schram said he was happy the board was not having to talk about illegal immigration at present.

Trustees Ed Wilmot, James Marshall and Cindy Moreno passed on board input.

Trujillo noted no regular meeting would take place in December, but a special meeting might be called if business needed to be completed before the end of the year. "I appreciate everyone's work and the support that we get as trustees."

In reports and updates, GRMC Auxiliary President Marilyn McCracken thanked everyone who "made our 50th anniversary so memorable."

"The wish list is open," McCracken said. "And we're doing turkey baskets for Thanksgiving."

She said the Auxiliary is creating a new brochure. "We count on having publicity to get new volunteers. Come shop in our gift shop."

Vicki Schram presented the Foundation report. "We are working with the Auxiliary on the Thanksgiving baskets. The Light Up a Life, a very thoughtful event, will take place on Dec. 4 in front of the main entrance."

She reported the TV at the Wellness Center was not working, so the foundation replaced it. "We're also working on a new brochure for people interested in donating to the foundation. We are trying really hard to fundraise."

Arias said the applications for Foundation director had slowed down.

Nwachuku asked if the Foundation could look at the TVs in the patient rooms. "They are like from 50 years ago."

Chief Nursing Officer Rose Lopez said she would take Schram to show her the TVs. "We estimate it would cost $6,000 to $7,000 to replace them all."

Schram agreed to go. "Please make suggestions for us to help."

Arias in the CEO report said the hospital is actively looking for an additional psychiatrist. "Dr. Teresa Arizaga has been doing it alone for years. We need another to help develop the program more."

She reported Joseph Romero was on board as a new practitioner in the emergency room.

"We also have a new initiative," Arias said. "We are reaching out to work with Mayo Clinic in a program called e-consulting for specialty areas."

She introduced EMS Director Eloy Medina and Chris Chavez, who is the security officer.

"The trailer we occupy is set up for mass casualty," Medina said. "We're been getting it restocked. It carries 10 emergency kits; has generator power, backboards, blankets and we can tow it anywhere. We have memoranda of understanding with other counties, including Catron, Hidalgo and Luna. We are looking to get more supplies with state funding. We have it ready in case of mass casualties."

Chavez said: "We also have a Hazmat trailer, with a decontamination tent and shower. We also have a decontamination unit here at the hospital. We have redundancy for the decontamination. On emergency management, we need more supplies. We are inventorying. We got the outdated supplies out. We want to make sure we get what we need. We are involved with the Coalition of Hospitals from Socorro on down southward. The cache for supplies will be at Memorial Medical Center in las Cruces."

Arias invited the board members and press on a field trip, out the front door to the trailers.

Trustee Jeannie Miller asked how far off the beaten path the trailers could be taken.

"Most fire departments feel we can decontaminate wherever needed," Chavez said. "The decontamination is needed before a person is put in an ambulance."

Medina said the process helps EMS be self-sufficient.

"We have done a lot of coordination," Chavez said. "We would rather have our own equipment, so it's readily available to go on the road to where it is needed."

Trustee Wilmot asked why the need for redundancy.

"If we are in the early stages of a spill, the fire department may not be available," Medina Said. "We have to decontaminate people before they come into an ambulance or into our facility. We are becoming self-sufficient."

Chavez said the hospital has one decontamination shower.

Trustee Marshall said the in-house shower water goes into a 42-gallon tank. "To have the wastewater removed is expensive. About 60 percent of people who have encountered hazardous materials arrive at the hospital in personal vehicles, with the rest of the people being decontaminated on scene. Because of those arriving before being decontaminated, it's important to have it here, too."

"We were talking about putting a tank on the trailer," Medina said.

Miller asked where the contaminated material goes.

Chavez said it goes into a vinyl pump and then into the tank. "Griffin's Propane will take it and dispose of it."

The trustees went on the "field trip" and looked at the mass casualty trailer and the decontamination trailer. Chavez said EMS, the hospital, the local emergency planning committee and the Coalition of Hospitals are "finally working together."

After everyone came back into the meeting, Chief Nursing Officer Rose Lopez said she is pushing for better customer service among the nursing staff, which includes sound management.

"We have a stop light in Med Surg Pod 2 and one in the ICU," Lopez said. "It's a reminder to tone down the decibels. It's called a Yakker Tracker. Green is an acceptable level, yellow is getting louder and red is too loud. Some of the cart squeaky wheels turn it on. The door turns it on. So, it's reminding people to be quieter."

She said her department is working on a chest pain presentation. "The American Heart Association has established standards and guidelines for smaller hospitals. It's an ad hoc committee working on it, with a hospitalist and ER representation on it. It's to help us determine appropriate transport. It's a process. We take a patient who has been transferred to another facility and determine the appropriateness of the transfer."

Lopez said one of the nurses has been a traveler coming back to Gila Regional many times off and on over nine years. "We have offered a permanent position that hopefully she will accept."

She noted the Nursing Department held a luncheon for 12 nursing students from Western New Mexico University. "I think they will want to stay here. We are focusing on residencies for student nurses. We have a vacancy in nursing of about six."

Wilmot asked how long it takes for a new graduate nurse to be up to speed.

"For meg surg, about three months; for OB, about six months and for more specialized practices, up to a year," Lopez said.

Miller asked when the hospital accepts them after graduation, before or after their tests.

"These 12 will take the licensing tests in January," Lopez said.

"On the transfer issues, we have three physicians who review the cases after their transfer and return to determine the common needs among them," she continued. T"he teleneurology program can prevent transfers if we can treat them here."

Carroccio highlighted in her report the continual review of regulations to keep up to date on them for the Joint Commissioner accreditation. "We monitor maternal safety through the quality department. By the time the next Joint Commission survey comes around, we should be ready. We still have a high mortality rate all over the U.S. We want to continue our better rates here at Gila Regional."

She noted the hospital had not seen the flu season hit yet, but they are prepared for it when it does. "Of our staff, we have 86 percent vaccinated. Our efforts have been good, but we still want a higher rate. We are also tracking waste management and making sure items are put in the correct receptacle. We are monitoring it and will look at education on it, too. We're sometimes finding regular trash in the bio-hazard receptacle. That gets expensive."

Trustee Schram asked if hazardous waste is still incinerated.

"We have a company that takes care of it for us," Carroccio replied.

In the absence of Chief Financial Officer Richard Stokes, Controller Jennifer Klotz, gave the financial report.

For the month of October, the hospital had $12,614 excess revenue over expenditures and EBIDA (earnings before interest, deductions and amortization) of $428,753. Cash collections were at 32 percent, and cash to net revenue stood at 120 percent. "We are reaching out to self-pay clients. We give them a 40 percent discount if they come in and pay in full."

Volumes rose year-over-year, with 170 admissions in October compared to 151 last year. Patient days stood at 548, with 1,346 ER visits, which Klotz described as steady. Outpatients were 3,930 and oncologist visits were 288.

"We are slightly up in days of cash on hand at 22.6," Klotz said. She noted that gross revenue was also slightly up from October 2018.

Trustee Moreno asked about a page in the report in their packets. Klotz said it shows what ancillary services are referred from each local provider.

Trujillo said: "We asked Richard who is referring patients to the hospital and he generated this report for us."

Wilmot said that Stokes had said this would provide evidence that some community provers are not supporting the hospital.

"We are looking at services that others are providing," Klotz said. "We have the potential to bring some back into the hospital."

Nwachuku said that most of what is considered ancillary services are labs and radiology. "I think it's positive that we can go back to providing some of the services. I say we should work together. If providers are sending people for labs elsewhere, we need to ask how we can help them work together with us."

"We are not judging, but we need to better the relationships to get referrals," Klotz said. "It's a way for us to generate more revenue."

Schram noted that the Finance Committee had talked about this issue. "One of the issues we have is with HMS (Hidalgo Medical Services). We are unable to provide an electronic receipt back to them."

Arias said they have access to them, but "they need to click another icon. It wasn't in the format they wanted, so it was not as easy for them to get."

Trustee Marshall said it was the second month in a row to see lower expenses under revenue. "That's nice to see."

"When we eliminate some of the contracted items, it will drop more," Arias said.

Marshall said he has seen a "bunch of work being put toward decreasing costs and increasing revenue. We should be able to predict on certain days. We should be watching so that if we do certain programs, we should see benefits to the bottom line."

Arias said the board had talked about posting full-time positions. "We went from 130 something to 57. We went to directors and they had to say to us why they have to staff the way they do. We punched the numbers to maintain while not affecting patient care."

Trujillo asked if the positions were budgeted.

"Some are approved now," Arias said. "Some didn't exist when we did the budget. We need additional nursing staff for the BHU (behavioral health unit) for safety."

Trujillo said: "Every Monday we get a report on the days of cash on hand. On Monday this week it was 33."

Klotz said the hospital received $1.6 million to reimburse the hospital for its Medicare volume decrease in 2016.

Reports from board committees came next.

Trujillo said the Executive Committee met and approved agendas for meetings.

Miller said the Quality Improvement Committee discussed issues, including about the BHU. "We asked risk management to draft a paper addressing the issue in the unit."

Schram said the Finance Committee talked about the change from HRG to AVEC, which will save the hospital about $400,000 and hopefully increase revenues. "Ultimately, we hope to bring the system back in house. Wells Fargo is working with us on fraud protection."

Wilmot presented the Plant and Facilities Committee. "We have two important things to report. Three of us made the commitment to Richard to do a review on the pharmacy department, which is moving along smartly. We have the additional scope for the non-regulatory portion to go along with regulatory requirements. We had a discussion about IT and replacement parts needed. It seems like we want to think of IT from a critical infrastructure viewpoint. Maybe it needs more priority."

Marshall gave the Human Resources Committee report. "If we compare the minutes from the last meeting to prior meetings, things look a lot better. The turnover rate was only 2 percent. That's good. The termination rate was zero. That's good."

The Bylaws Committee reported no changes. "When we hire a lawyer in the new year, we want to go through the bylaws."

The trustees went into executive session.