By Mary Alice Murphy
Gila Regional Medical Center Interim Chief Executive Officer and Chief Financial Officer Richard Stokes led off the meeting with the press on Thursday, March 19, 2020 by phone. Also on the telephone were GRMC Board of Trustees Chairman Tony Trujillo.
"We wanted to let you know and let the public know about our preparation for if and when COVID-19 reaches Grant County," Stokes said. "We have several staff members with prepared remarks."
Dr. Tsering Sherpa, hospitalist and infectious disease specialist, said: "We know it's a national problem. The cases are increasing in New Mexico. We are keeping a close eye on them and monitoring the numbers and where they are. Social distancing is very important. We are keeping up with the Centers for Disease Control (CDC) recommendations that are constantly evolving. We are changing where we put patients. We have a readiness plan when we need to use it. We are better prepared than some other hospitals we've heard about. We, at this time, are only using our limited supply of tests on high-risk patients with symptoms. We are not testing everyone. We are also monitoring those at high-risk who have traveled elsewhere. So far, we have tested less than five admitted inpatients and all were negative."
She said those who wonder what will happen if they have a positive test, "your doctor will tell you whether you need to stay in the hospital or isolate at home. At this time, all our tests are going to the New Mexico Department of Health with a turnaround time for four to 10 days, with an average turnaround of seven to 10 days."
Chief Nursing Officer Rose Lopez said the hospital is also using LabCorp by sending its tests to Texas, where they are forwarded to Atlanta, Georgia.
Sherpa said LabCorp would be opening a test result lab in Phoenix, which would be closer for GRMC tests.
William Hemmer, infection preventionist, said the hospital is always following CDC guidelines. He noted that personal protective equipment (PPE) is always a problem everywhere in the country. "We are following CDC guidelines on how to use them if they are not plentiful. We are still using PPE, but carefully because we are in a shortage area. We are not out of PPE, but we are using PPE only when appropriate. We have instituted a policy of checking everyone's temperatures when they come into the hospital, employees, patients, everyone. We want to keep our employees safe and healthy. We had to give training to everyone, even the housekeepers on how to use the equipment when necessary. We have identified ways to improve correct usage. If someone on staff has a temperature, they go home, and we have to determine when it is safe for them to come back to work."
Chief Quality/Compliance Officer Tanya Carroccio said: "It's terribly important to have healthy staff. We had to make some changes to hospital policy, by not allowing any visitors, except for exemptions. We have listed the exemptions on our What you Need to know page."
[Editor's Note: The link is https://www.grmc.org/COVID-19/What-the-Public-Needs-to-Know.aspx]
To question about what exemptions, Carroccio said, for instance, for the birth of a baby, both parents can come into the hospital, and those with dementia, for example, can have one caregiver with them. Billy Casper Wellness Center closed until further notice as of Tuesday morning, March 17, 2020. "We still have physical therapy, occupational therapy and speech therapy."
Stokes noted that telemedicine is coming for speech therapy.
Carroccio said the front entrance to the hospital is closed to the public. The public can enter for an emergency through the emergency entrance 24/7, or for outpatient services between 6 a.m. and 7 p.m. Only patients may enter through the cancer center/surgery entrance from 6:30 a.m. to 4 p.m.
The parking areas have changed for employees and patients and signage helps people know where to park.
The cafeteria has removed half of its tables, self-service of any kind is not allowed, and most meals are packaged.
Carroccio said medical records can be requested at the emergency entrance, but by Center for Medicare and Medicaid (CMS) policy, it can take up to 30 days to receive, with exceptions, such as a physician needing them sooner.
"Please do not call the hospital with questions about COVID-19, as this could be very disruptive to staff caring for patients," she said. "Call the Department of Health hotline at 1-855-600-34531."
Although Chief of Staff Dr. Brian Robinson was not in attendance, he had Dr. Sherpa speak about outpatient elective surgery. "We are assessing elective surgery on a daily basis and prioritizing which ones are urgent and which ones can wait. A person must be prepared to have surgery cancelled if needed. We are not there yet, but we are assessing daily what is already on the schedule."
Stokes said the elective surgery across the country is dependent on the supply of PPE. "We have set a floor for usage and that will be our driving force."
Chief Nursing Officer Rose Lopez said the drive through testing, which the hospital had hoped to begin next week, will not happen until the hospital can get more tests. "We have contracted with LabCorp, which had 8,000 tests in stock, but there was a spike in testing demands in Texas, so they started allocating tests to high-risk places with concentrations of inpatient care. They promised us 600, but they had to send them to other high-risk locations. They had to prioritize."
Sherpa said the supply is limited to almost being insignificant for the need at this point.
Lopez said the hospital is still searching for more supplies of the viral test kit.
Sherpa described the kits as having a swab that is taken and then placed in a medium in a test tube to be sent for analysis.
Hemmer said when people use the term "kits" they are talking about the one Sherpa just described, but also the reagent that is used in the labs to determine whether the outcome is positive or negative.
Lopez said the reagent is also in short supply.
"Gila Regional, as a hospital, along with EMS (emergency medical services) has a surge plan," Lopez continued. "As the CDC changes its guidelines, we change. We can accommodate a surge at Gila Regional We have enough PPE, but we reserve it for certain patients."
Sherpa said Gila Regional has 68 beds, including six in the ICU (intensive care unit) and 10 in the emergency room. "We feel like we are prepared. This morning, we had a population of 22 patients, including the ICU and the BHU (behavioral health unit)."
Lopez said the hospital continues to receive most of the supplies it needs, with the exception of the test kits. "We have a multi-disciplinary task force that meets daily. It includes Dr. Sherpa and Dr. Steve Kotch, emergency department medical director. We adjust our plan daily, so we can continue to provide the quality care we want for our patients."
To a question about the availability of PPEs, Sherpa said the hospital has on hand enough even if the hospital were to fill up with patients. "At that point, we would begin being really stingy with the PPEs. We are already being very strict with the masks."
Lopez said everything the hospital is doing is established within the CDC guidelines. "For different types of isolation, different types of PPE are required. We have quite a few rooms. If we have a lot of airborne illness, we might relocate some patients to other places to optimize the care for the needs of every patient."
Stokes confirmed the hospital has plans in case of a surge. "Our plan may or may not involve use of the BHU rooms. We have a lot of contingency built in."
Lopez noted the hospital has a minimum of 22 beds in each pod, Med Surg 1 and Med Surg 2. "We have two isolation rooms in pod 2, one in pod 1, and one in the ER."
Stokes said because the task force is multi-disciplinary, there have been discussions about how things were 20 years ago. "They did the same things then, but in a different way from the way we do it now. Dr. Sherpa and Rose are good at thinking outside the box. Hospitals can use drinking alcohol, for example, for cleaning."
Lopez said: "Today we are so used to disposable items. Now we are asking caregivers to be creative and to think critically. It helps us determine what is most important. Patient care is always our north star."
Sherpa said masks in some cases can be reused.
Trujillo reported from the board perspective. "We are involved and being kept in the loop on everything. I want to, on behalf of the board, give a big thank you to the staff members who on a daily basis are taking care of patients. They continue to focus on the safety and health of the patients. It's incredible what everyone is doing."
Stokes said he can feel the board's support and "how much it means to us to go forward in achieving our mission."
Carroccio said she wanted to talk about accurate communications. She encouraged the public to look at GRMC.org, the New Mexico Department of Health COVID-19 web page, as well as CMS and CDC websites addressing COVID-19, https://www.cdc.gov/coronavirus/2019-ncov/index.html . "Avoid the Internet hype. Communication is really important. This is a pandemic, unprecedented in our time. We've all been in other natural disasters, but this one is different."
Stokes reported that next week, Gila Regional would give an update on the radio at 2 p.m. Wednesday, March 25. The special radio segment for "State of COVID-19 in Grant County by GRMC," will air on KNFT-FM 102.9, KSCQ-FM 92.9, and KNFT-AM 950 and 96.5.
"It is important for the community to email questions to COVID19@silvercityradio.com by 9 am on Wednesday, March 25, for consideration in having them answered," Carroccio said.
Lopez said that although one may be watching TV or listening to the radio, "nobody knows how long COVID-19 will last, a few months or 18 months. We are trying to provide information on protection for clinical and non-clinical personnel and community members. We have decided in some cases to go with traditional methods."
She held up some cloth surgical masks that volunteers from the GRMC Auxiliary have made for staff members. "They can be reused and laundered. The volunteers' goal is to make 250 to 500 of them. They are more than 300-thread count, so they filter out germs. We will use and reuse them. We have evidence-based ways to clean them."
Hemmer noted that EMS and firefighters, as well as law enforcement, were doing similar things for masking patients and others who are coughing.
"We are putting in place what we need for the county," Carroccio said.
"We want to save our county," Lopez concurred. "Our volunteers are coming together to sew these for our community."
Sherpa noted that nationwide there are not enough of the N95 masks for health care workers.
"Gila Regional is prepared to provide care for Silver City and Grant County," Lopez said. "Our task force does monitor our supplies for emergency planning purposes."
Carroccio said Hemmer and Eloy Medina, EMS director, are educating people inside the local community.
Lopez said the community is a high-risk community, as the median age of the population is 57.
Hemmer said the hospital has the machines to fit the N95s that people may have purchased. "To work well they must be fit to the person. We will be happy to help nursing homes and assisted living places with getting their N95 masks fit to the person."
Sherpa, to another question, said the hospital has six ICU beds, as well as being able to take ventilators to the ER. "We have nine regular ventilators, as well as portable ones, for a total of 20."
Lopez said once a person is on a ventilator, as they get better, they can downgrade to oxygen or oxygen concentrators. It doesn't mean they have to be on a ventilator long-term.
She emphasized that people need to promote social isolation. "Stay home. It will make a huge difference."
"If you don't have to travel, don't," Sherpa said. "And wash your hands."
To a question about whether the hospital has enough staff for a surge in patients.
"We'll be all hands on deck," Carroccio said. "Many of us are also clinically trained, inside and outside the hospital. We will find enough."
Lopez said the DOH is emphasizing having emergency staffing plans. "The only real requirement is that they be licensed, maybe not in New Mexico, but they must show licensure somewhere in the country."
[Editor's Note: GRMC will continue to update the community as needed. Check out their website, NM DOH's website and the CDC website. And if you have questions, send them to COVID19@silvercityradio.com by 9 a.m. Wednesday, March 25, to have them answered and aired on the radio segment you can listen to at 2 p.m. on KNFT-FM 102.9, KSCQ-FM 92.9, and KNFT-AM 950 and 96.5.)
Websites for information include: https://www.grmc.org/COVID-19/What-the-Public-Needs-to-Know.aspx ; https://www.cdc.gov/coronavirus/2019-ncov/index.html ; and https://cv.nmhealth.org .