By Mary Alice Murphy

[Editor's Note: The YouTube video is now available, so this author had added the first part of the open session to what was already here. The addition begins at ADDITION and ends at END of ADDITION.

The Gila Regional Medical Center Governing Board, made up of the five Grant County Commissioners, District 1 Commissioner and Commission Chairman Chris Ponce, District 2 Commissioner Javier "Harvey" Salas, District 3 Commissioner and GRMC Governing Board Chair Alicia Edwards, District 4 Commissioner Billy Billings, and District 5 Commissioner Harry Browne.

The members approved the agenda.

Edwards said: "I am pleased to introduce the Interim Chief Executive Officer Scott Manis. Thank you for being here."

GRMC CEO executive assistant Joann Holguin, Chief Financial Officer Richard Stokes and Interim Chief Nursing Officer Kelly Rodriguez introduced themselves.

Holguin said for this meeting public input was to be emailed to Taysha Walter, Grant County Manager executive assistant. Holguin said she spoke to Walter right before the meeting and no public input had been received.

Edwards noted that public input can be sent to a new email address: publicinput@grmc.org and also can be sent to the county at twalter@grantcountynm.gov .

The members moved to go into executive session.

After they came out of the executive session,  GRMC Interim Chief Executive Officer Scott Manis addressed the Quality gave the CEO report.

ADDITION:

"For myself, this is my initial observation," Manis said. "Thank you for the warm reception. I've been introducing myself to hospital staff, holding directors' meetings, and have introduced myself virtually to all employees. With the community I' am doing an overall assessment and looking for opportunities. We did a board orientation meeting on May 18, which is required by the Joint Commission survey for the critical access designation. To give you an update on the critical access application, we did receive a notice of approval of our application on April 9. We've also notified the New Mexico Office of Rural Health and they are aware of our application. We are waiting for the Joint Commission survey. It will be virtual, potentially as early as the next couple of weeks. It will be unannounced, so we are preparing for it as soon as a week from Monday, possibly. Subsequent to that, we need to update payer contracts with managed care companies and take other provider enrollment steps. Then next month the budget will show part of the year as a critical access hospital, with the first part of the year as a regular access hospital, which is using a PPS (Prospective Payment System). It will be retroactive, but it won't kick in until likely the end of the year. Preparation for the Joint Commission survey is going well. It will consist of four days virtually and then two days onsite when travel is deemed safe. Because it's an unannounced survey, we have to be ready."

Browne asked if the delay in sending someone onsite would delay the critical access designation.

"No. We asked that question," Manis said. "They have said that is the virtual survey is satisfactory, that will be the effective date of the designation. The onsite visit will be validation of things they want to see onsite. We could be cited onsite when they come."

He also addressed the Rural Health Clinic designation. "It is moving along as well. We are awaiting the virtual life safety survey next Tuesday. We will engage a third party after we pass the life safety survey. We expect that to happen late June. The family practice location could be designated an RHC in July. I also want to highlight a program that was announced before COVID-19 hit. It is a Community Paramedic Program that will use our EMTs to go out to patients on the Blue Cross Blue Shield Medicaid program. It will pay us to check in on Medicaid patients. It will be scheduled to be done with other Medicaid payers, too. (Emergency Medical Services Director) Eloy Medina is pursuing the other payers. The EMTs expect to be able to make 4 or 5 visits a day during their off time. We receive annual EMS funding for our three county stations. We got $30,961 for the three stations for equipment and training."

As an update on COVID, "We still have only 15 positive cases in the county. We have had no new patients in the past couple of months. We have sufficient PPE (personal protective equipment) if more should occur. We are still limiting visitors to the hospital. Our volumes have been soft due to COVID, but we are ramping up the road to recovery, while always following state guidelines. We encourage residents to contact the physicians and call us for needed services."

Browne asked if there were any services not available at this point.

Manis said the gym (as of Friday, May 29) was still now open, but would open partially again on Monday (June 1). "Otherwise, other elective services, such as mammograms, outpatient surgeries and such are open."

Salas asked whose responsibility it is for EMS equipment maintenance and replacement.

Manis said the equipment is a county asset but is owned by the hospital. "We are responsible for maintenance and replacement."

Interim Chief Nursing Officer Kelly Rodriguez gave her report next. "I will report on a couple of months activity. We are still recruiting for an ER director and a maternal/child director for labor and delivery and the nursery. We do have a new surgical services director. Jeff Rushing has made positive impacts for the Joint Commission survey preparation. All of the clinical directors are working hard preparing to be ready for the survey. We are doing process improvement, so we can call back the program for non-English speaking patients, so we can solidify it. IT is streamlining the medication reconciliation process, so it is more efficient for caregivers, and so we fall into step with meaningful-use guidelines for clinical exchange with outside providers. We are looking at our sepsis program, ensuring we are hitting those key marks for sepsis management. We also made a recent change to the moderate sedation policy, which we are rolling out. If a patient comes to the ER with, for instance a dislocated shoulder or hip, we can make sure they are adequately sedated for us to manage it. We continue to make improvements to out quiet environment. It's funny, without visitors, it's been pretty quiet. We are ramping up the quiet times, which will be from 2-4 p.m. and from 10 p.m. to 6 a.m. We will try to decrease visitation in the afternoons, so patients have a restful time to recuperate. Our baby-friendly designation was due for renewal, but the survey has been placed on hold. We'll let you know when it happens."

She said the Trauma Level 4 survey is on hold as well at this time.

"With our road to recovery, numerous outpatient procedures need to move into full schedule," Rodriguez said. "For staff recognitions, I would like to recognize for May Angie Cox, clinical educator. She does a phenomenal job, including a lot of bedside education. I would also like to recognize CNA (Certified Nurse Assistant) Myra Jaquez in medical surgery. She can float to any department so easily."

Browne noted that he really like Rodriguez's description of integrity. He read it: "'Integrity commits to character over personal gain; to people over things; to service over power; principle over convenience; and a long view over the immediate.' I suspect that if all our institutions followed that, we would be in much better shape."

Rodriguez said the nursing directors worked on it last year, when she was Interim Chief Nursing Officer at the time.

Although Chief Quality/Compliance Officer Tanya Carroccio was on the phone, Manis said because it is hard to hear on the phone, he would give the CQ/CO report.

"For the COVID response and the hospital road to recovery, we always put patient and staff safety first," Manis reported. The road to recovery has three phases. We are watching for certain triggers and staying in lockstep with New Mexico guidelines. We also want to recognize a couple of staff members, Denice Baird and Angie Zimbelman, who have undertaken continuing education criteria to become certified professionals in health care quality. The CPHCQ is hard to attain and puts the stamp of approval by certain nursing associations that these people know how to provide quality care. To have two individuals working on this is a great testament to them. We continue to support them.

END of ADDITION

"We have reinstituted the Policy Committee at the hospital," Manis said. "We will oversee the process to make sure that each new policy is vetted properly. We will also review all the policies to make sure they are relevant and up-to-date. This is all related to the Joint Commission Survey preparation leading up to the hospital being declared a critical access facility. We also do rounds on the peer environment in the hospital. We make observations that need to be approved. All these we are doing in preparation for the survey and for the Chief Quality Officer report."

Chief Financial Officer Richard Stokes started off his report by quoting what they say in his department: "'Talking ain't doing,' so we talk some and then we do implementation. The financial report this month isn't pretty. We lost $4.4 million last month bringing our loss year-to-date to negative $12.2 million. We did a study and determined that we were down 64.9 percent since last April, not unique to Gila Regional. Even the Hospital Association is down about 60 plus percent in activity. It's similar all over the state. On April 10, we did receive $6.2 million from the Payment Protection Program. We have about $2.5 million today, and it's payroll day today, so much of that will be gone. We will put in another request for $1 million, and we have the paperwork done to request the loan turn into a grant. We have 49.3 days of cash on hand; accounts payable is running about 27 days. Total gross patient revenue for April was $10.8 million down from $14 million in March and $15 million in February. Activity has substantially slowed down. We had a small uptick in May and anticipate increases going forward.

"We are asking the community to come back to Gila Regional," Stokes continued. "We are a very safe hospital. We practice the same safety protocols as Mayo Clinic."

Browne said he was reminded that Mimbres Memorial Hospital in Deming is having troubles. "Has it affected our hospital?"

Stokes said he was not familiar with the issue.

Manis presented the Chief of Staff report in the absence of Dr. Brian Robinson. "The Medical Executive Committee and basically all committees are meeting virtually. They are all doing preparations for the Joint Commission Survey. We already discussed the credentialing in executive session. We held a Surgery Committee meeting and surgeries are starting to be scheduled and are ramping up."

The board had no old business.

Under contracts, Manis said because the contract with Dr. Ronald Dalton, Chief Medical Officer and Pediatrician would expire soon, "I would recommend a 60-day extension to give us more time to decide if we want to change anything."

The Blue Cross Blue Shield employee health insurance plan expires the end of June. "In order to have time for open enrollment and any changes that personnel might want to make, we need to approve it today," Stokes said. "The cost is 4.2 percent more at about $220,000 for the year, raising the annual payment from $5.3 million to $5.5 million. The hospital pays 75 percent and the employees, 25 percent."

Browne said that meant about $150,000 more for the hospital to pay. "Have my fellow board members thought about passing more of the increase on to the employees?"

Salas said he is inclined to let most of the burden fall on the hospital. "We need to find out through the SWOT (strengths, weaknesses, opportunities and threats) where we stand. I would rather find other ways to save money rather than putting it on the backs of employees."

Ponce agreed. "It does seem contradictory to our goal of saving the hospital money, but looking around Grant County, I see a lot of unemployed people. I agree with Salas that it isn't fair to the hospital employees. I think we will find other ways to save money on the hospital."

Browne said he appreciated the discussions. "I thought I would wake up with a clear thought on this, but I didn't. I think you have swayed me to support the administration recommendation."

The renewal of BCBS insurance for employees was approved.

The next contract item was the HealthTechS3 management services agreement.

Edwards said the agreement is not ready. "I suggest we table it."

Salas asked if there were any idea of a timeline for approval.

"I don't know," Edwards said, "but we are moving along more quickly than it was."

The item was tabled.

Under other action items, the first one addressed approval of patient care policies.

Manis said the governing board is part of the Joint Commission survey. "For critical access designation, we must go through the patient care policies every two years. We have made the policies, of which there are many, available to the governing board. They have been developed by content experts and are not just thrown together. I recommend they be approved as presented."

Salas asked if the policies are open to amendments, to which Manis replied: "Yes, as needed."

The policies were approved.

The next item addressed changes or potential changes to a service line. "I recommend that the hospital suspend the intake of psychiatric patients," Manis said. "Because we are not able at this time to meet the qualifications for the Joint Commission survey, without an inhouse psychiatrist, we need to not take in more patients."

Browne noted that Manis had made clear to them that finding a psychiatrist to fill the position is going to be difficult.

"It's very difficult across the country," Manis said, "and especially in rural New Mexico. Your former psychiatrist, who still lives here, has chosen not to continue to provide patient care. It will be extremely difficult to find someone to replace her."

Browne asked if after the survey, it might be possible to reconsider the suspension.

"If the governing board chooses to reinstate accepting inpatients it would be subject to the Joint Commissioner survey at that time," Manis said.

The third item was acceptance of the Medical Executive Committee report. "This is including the privileging and credentialing. I recommend you accept it as presented in the executive session."

It was approved.

The fourth item was acceptance of the Quality Improvement report. "We reviewed it in executive session. It is traditional to hear the report monthly. I recommend acceptance as presented." The governing board members approved it.

The final item addressed the Board of Trustees officers. Edwards is the chair. Billings was presented as vice chair, and Browne as secretary/treasurer. Billing said he agreed to accept the position. Browne also agreed, and said he hoped Joann Holguin would continue to take the notes. Both were approved.

The meeting adjourned.