[Editor's Note: This first part addresses public input and hearing from SWNMCOG Executive Director discussing the proposed ICIP.]

By Mary Alice Murphy

Gila Regional Medical Center Governing Board Chair and District 3 Grant County Commissioner Alicia Edwards opened the meeting by introducing and welcoming Neil Todhunter, HealthTechS3 president, who would later give the HTS3 management report and John Freeman, HTS3 associate vice president, for his first visit to Grant County. Also, in attendance were Interim Chief Nursing Officer Kelly Rodriguez and Priscilla Lucero, Southwest New Mexico Council of Governments executive director.

Edwards then proceeded to read the one item of public input, a letter from Colicia Meyerowitz, M.D. at Silver Health Care, who also serves on the Medical Executive Committee, as well as serving on the credentials, peer review and bylaws committees and attending medical staff meetings.

Meyerowitz thanked the members of the board for the opportunity to express her concern about recent changes at the hospital. The letter said she has been serving her patients in Grant and Luna counties for the past 17 years and chooses to stay because she truly cares for her patients and is honored to serve in such a tight-knit community of excellent practitioners in various specialties. Unfortunately, she continued, "I have recently been apprised of clinical changes at the hospital that have been made or are in discussion phase that have failed to even be mentioned at one of our clinical meetings…. As vice chief of staff and an outpatient provider, I should not be hearing about these discussions and decisions from nurses and staff. Clinical decisions should be brought to the attention of the MEC during executive session, so that providers can provide input so clinical and financial decisions can be made as a unit. Buy-in from medical providers can increase volumes and benefit the hospital at large."

The letter cited two clinical issues of "vital concern at this time. The first matter of concern is staff of radiology, specifically their scheduling department. I prefer to keep radiology business in town and have done my best to do so to decrease travel for patients, as well as to allow better access for communication with the reading provider for myself. Now that the scheduling staff has been downsized significantly it is even more difficult to reach an individual to set up a patient appointment or check on the status of an exam. One or two schedulers are going to have difficulties scheduling for all modalities and fielding calls. For better service we need more access rather than less. Thankfully, my second concern about the infusion center has been addressed and resolved after I brought it to Mr. (Interim Chief Executive Officer Scott) Landrum's attention. I'm glad he understands the importance of involving the referring practitioners and the MEC on decisions that impact them and their patients. I want the best for my patients and will advocate for them to my best potential. The MEC is the ideal place to discuss any decisions that might impact practitioners and their patients. It is of utmost importance that we all realize this is a team effort."

Edwards said Lucero was present to talk about an item on the agenda. "We had a discussion about it in our executive session earlier this week about the ICIP, but our members have questions."

District 1 Commissioner and Governing Board Member Javier "Harvey" Salas asked the first question about how important the order of items was on the Infrastructure Capital Improvement Plan.

"When I look at developing the ICIP, I need to know what the priorities or the organization are," Lucero said. She said if the purpose was to go after legislative capital outlay, the most important have to be in the top five. "In a year with money, put the higher dollar ones at the top for that year. In 2021, we don't know what the dollars will be. It will likely be limited to severance bond dollars. I doubt there will be much in the General Fund. For federal funding, the item has to be in the funding year."

Salas asked if it was better to phase projects, such as the roof for the hospital.

"If you're going after capital outlay, phasing may be appropriate," Lucero said. "But any phase has to be totally functional at the end of the construction. I did the ICIP for Gila Regional two years ago, but last year Mr. Stokes did it."

She said if the top five are really good, if you get another funding source award, the priorities of those five can change. "There are so many variables. I try to figure out the best scenario for you."

Salas posed an example of a project that would cost $1 million and breaking it up into four $250,000 requests, but it wouldn't finish anything.

Lucero said: "That's why we have the Prospectors Forum every year. You need put the request in logical chunks. I like to see a project phased in different ways. If the process is not followed, Prospectors may not support the project. We have to be logical about the process. If it's too expensive it won't be funded. You don't want to jeopardize what your legislators can fund. And the minimum request is about $25,000. Anything less isn't worth it because of the paperwork."

Salas also asked if the hospital ICIP goes after the same legislative pots of money as the counties and municipalities, to which Lucero said it does.

"The ICIP is a planning tool," Lucero said. "You are eligible for general fund dollars and severance dollars. You have to be a political subdivision under state law."

District 5 Commissioner and Governing Board Member Harry Browne asked what other pots of money were available. "How will ordering these projects affect applications to other funding sources?"

"It's why we are here to help prioritize your projects," Lucero said. "The top five are for capital outlay funding. The others must be listed in the fiscal year that you want the funding for. With the CARES money this year coming to the state or state agency, the project has to be asking for money this year for fiscal year 2022. We know the CDBG money this year will be for rent and housing assistance. From a long-term prospective, any project needs to be on this list."

She requested input for her call later that day with the Congressional delegation. "They are asking for shovel-ready or near shovel-ready projects. The federal government is looking at specific projects that are ready to go. They are looking for a stimulus bill for just projects. I need them by Monday. I try to show consistency in all planning documents. It's a plus when we're looking at other funding sources."

Browne said what it sounded like to him was the top five are critical for capital outlay, but for other funding, they just need to be on this document. "It tells me if I mess with this order, I'm not jeopardizing the balancing act you're doing to get funds."

Lucero agreed. She said she thought the roof project was important. "You have a match for it from capital outlay. The last conversation I had with a funding agency, I asked if I could include the HVAC in the proposal, and they said yes, but we don't have the cost estimate yet, which we should get today. But it worries me if they can't fund the entire project. However, if we get an award for say $2 million and we need another $250,000 we could go to capital outlay and say we got an award, but we need this much to finish it. Now, there's no guarantees on any of this."

Browne said so HVAC needs to remain in the top five, but the roof doesn't.

Lucero noted that she is the Economic Development Administration representative for the region. "We got money for recovery. $158 million is available for the five-state area. One-third is already given out. The ICIP goes to the legislators, so if you amend it, you must let them know about the amendment. They have to know in order to divide up their allocations."

Salas asked Lucero to define "capital project."

Lucero replied that a capital project could include a feasibility study, design, construction, equipment, furnishings and information technology. It also includes roadways and public works.

She said the ambulances for the hospital are capital projects. "The Legislature funds them because there are not a lot of other funding mechanisms for them."

Governing Board Member and District 4 Commissioner Billy Billings asked it if would be appropriate for the members to renumber the ICIP items at that time.

Edwards had a clarifying question first. "Mr. Salas mentioned a $1 million project broken into four at $250,000 each. If the first phase costs $400,000, we would have to ask for that in order for it to be functional, right?

Lucero agreed that if it will cost $400,000 to make it functional, yes, that is the amount to ask for. "If it costs less or the estimate is less, you can change the dollar amount later."

She said she felt confident on getting funding for the roof, because the hospital has the match to it. "You definitely need to keep the HVAC in the top five, in case you need to ask for capital outlay for it, because we may not get both funded at the same time."

Edwards also asked about the hospital, county and municipalities competing for the same dollars. "If these entities aren't talking, each one will send in their projects and priorities."

Lucero said that goes back to the Prospectors. "They will prioritize the projects. Often the legislators ask me what's most important and they work together to each give $100,000 to a larger project that will cost $300,000, for example. They also look at the cost benefit ratio. Is it designed, not designed? They will look at whether it is ready to go. We have to follow every step from the Prospectors Forum to Grant County Day. This year, some of the events here and at the Legislature may be virtual. At the forum, you have to justify your requests. I try to guide the entities so they can have fully funded projects. It's best if it's shovel-ready or mostly designed or fully designed. And for capital outlay the request must come from a government entity. I will ask if the funding can funnel to someone else, like a non-profit.

Billings said the first four items on the GRMC ICIP are needed medical equipment, IT, HVAC and the reconstruction of the labor and delivery area.

Lucero said HVAC needs to be in there, for sure. "As you prioritize some of these, note that the dollar amounts are incorrect. My other concern is I'm not sure where the $4 million for the labor and delivery came from."

She said costs for ambulances are escalating, and medical equipment as a priority is too generic. "We need to determine the particular piece of equipment needed."

Edwards said that could be done before the Prospectors Forum.

Governing Board Member and District 1 Commissioner Chris Ponce asked when the ICIP is due.

Lucero replied, Sept. 4, but "I can request an extra week extension. The ICIPs are usually done in the spring. You're way behind."

Ponce said he didn't think they had all the information they needed.

Lucero said that Jennifer Klotz at Gila Regional may have all the documentation for the requests that are on the proposed ICIP.

Edwards said she and Lucero had had preliminary conversations. "We agreed the HVAC price was too low. Here at the county, we paid about $500,000 for nine units. The hospital has 13, so at a minimum each costs $50,000, that's about $650,000."

Salas said he worried that the hospital does not have a full plan for the labor and delivery area.

Lucero said one of her concerns was that the amount seems way beyond what it should cost. "We need to ask Kelly (Rodriguez, interim chief nursing officer). I'm not understanding this amount."

Interim Chief Executive Officer Scott Landrum said that Rodriguez had been able to find the documentation, including for the HVAC. "We will ask Kelly to give a synopsis as part of her report."

Lucero said it is very important that in the labor and delivery ICIP item, if equipment is needed, too, "don't lump it into the word construction. it must be in the title, for instance Labor and Delivery Construction and Equipment."

Lucero had to leave for another meeting, her SWNMCOG board meeting.

The governing board members went into executive session to discuss the quality report and credentialing.

Part 2 of the meeting will be covered in a future article.