By Mary Alice Murphy

With no public input received at the the Gila Regional Medical Center Governing Board special meeting on Sept. 8, 2020, the members, consisting of the five Grant County commissioners, District 1 Chris Ponce; District 2 Javier "Harvey" Salas; District 3 and GRMC Governing Board Chair Alicia Edwards; District 4 Billy Billings, who is also vice chair of the governing board; and District 5 Harry Browne, started with old business.

The first item dealt with a resolution to amend the Economic Development Administration application, including CARES Act funds for a hospital roof replacement to reflect updated HVAC costs, which have to be replaced at the same time as the roof.

Landrum said the revised costs are $1.5 million for the HVAC and $1.592 million for the roof for a total of $3.092 million.

Edwards noted that with the increase in price, the capital outlay received for roof replacement will not be enough for the grant match, if the request is awarded. "(Southwest New Mexico Council of Governments executive director) Priscilla Lucero told me she will apply for a waiver on the 20 percent match."

Browne asked the odds of getting the waiver.

"She thought the odds were high that we would get it," Edwards said.

The second item was the adoption of the Infrastructure Capital Improvement Plan to be sent to the state.

GRMC Interim Chief Executive Officer Scott Landrum said the order that Lucero had recommended was 1) Two ambulances at a cost of $310,000, 2) Telecommunications equipment for $500,000, 3) HVAC $1.5 million, 4) GRMC medical equipment for $250,000, 5) GRMC roof replacement $1.592 million.

"We, of course, would like to get all five," Landrum said.

He also gave the final two items on the ICIP: 6) Energy efficiency improvements for $500,000 and 7) Labor and Delivery renovations. He asked if Interim Chief Nursing Officer Kelly Rodriguez could give an update on the Labor and Delivery plans.

Rodriguez said that to get the ball moving on the project again, "all I have to do it provide the current floor plans for the labor and delivery space and provide the plans for the projected space. I got them today from Ron Corbly [of the Facility Department]. I just need to send them to the state."

"We're almost doubling the space for a new mom and baby," Rodriguez said. "The fellow I talked to attested to the fact that he had been waiting for the plans since last year. He was happy we were moving forward."

She was also asked to list the medical equipment requested in the ICIP line item. "We need a new cardio-pulmonary ventilator. We have multiple ventilators, but many are at end of life. We need a pediatric and an adult compliant ventilator. We also have a non-functioning halter system, which is a cardiac monitoring system for outpatients to use at home. We are asking for additional ones as none is functioning. The next is also revenue producing. We need a new ultrasound machine for the ER. The one we have is at end-of-life. Part of the $250,000 is also for an infant security system. If we go down the path of the labor and delivery renovation, we will have the system and can save some money there."

Rodriguez also said a system in the maternal-child section, PeriGen, "doesn't interface with our MediTech system, so it's an issue where nurses have to take and chart every single laboring step. If we had one that interfaces, it would flow over to MediTech, so we are looking to upgrade the fetal heart monitoring system. It would save a lot of time for our registered nurses. We are also requesting an advanced piece of equipment for the ICU that monitors patients' outputs, especially those on ventilators."

She cited an additional request would be to replace "our computers on wheels, which are 8 years at end of life. The computers and scanners do not function well, so we've asked for a team of those to spread out in our areas. That's a total of $250,000 for all areas."

Browne asked if they had a team to run the pediatric ventilator.

"We do," Rodriguez said. "Our pediatricians and our ER doctors can intubate a child. We wouldn't keep the child here, but our respiratory therapists that are on 24/7 could keep them on the ventilator during preparation for transport."

A motion was made to approve the ICIP. Some questions remained. Billings asked about the vehicles.

Landrum said that Lucero had said the order of the items on the ICIP was important.

Ponce said at the last meeting, the members had discussed the items. "I wanted medical equipment to be No. 1, with No. 2 the telecommunications and No. 3 labor and delivery."

Browne concurred that was his list also, except with 2 and 3 flipped. "The problem as I see it is we may not know what Priscilla knows and she doesn't know what we know."

Billings also wondered why labor and delivery was so far down the list presented.

Edwards got Lucero on the phone and Lucero said she had to leave the last meeting early and never got back to the "last order you wanted. My understanding was that you were still finalizing the order."

She noted that she was working on the EDA application for the roof and HVAC, that she would work on a waiver for the match. "I think we stand a good chance to get the waiver. I want to add about 4-5 percent to administer the grant."

Salas asked Landrum what the adjusted cost for the labor and delivery project was.

Landrum said the adjusted base cost is $275,500, "but we need a cushion for overruns, which there always are."

Edwards said the loan/grant application to the USDA for labor and delivery had 15 percent as the grant portion, which of that amount would be about $41,000, so the $230,000 would be a loan.

She asked if the hospital could take on that loan.

Interim Chief Financial Officer Richard Alesch said he was reluctant, because once the hospital gets its critical access billing number, it will have to pay back the DRG (diagnosis related group) payments already received from Medicare since the critical access designation was set for July 1. If the loan came in before the hospital will start to receive its critical access payments, it would be a problem.

Browne noted that the USDA doesn't require immediate payback on loans, and it will take a while before the loan is put into place. "I think you can guarantee that the first loan payment will be after we start receiving enhanced payments."

Salas asked what should be done before the labor and delivery project.

Landrum said he believes the medical equipment is important and telecommunications equipment is past end of life.

Edwards read the final list as 1) medical equipment, 2) telecommunications. 3) labor and delivery, 4) roof replacement, 5) HVAC, 6) ambulances and 7) energy efficiency improvements.

Ponce pointed out that Lucero had said it would be a lean year for capital outlay. "So, to be successful, we need the medical equipment and the telecommunications equipment at the top of the list."

Rodriguez said she would prioritize telecommunications before the labor and delivery project. "We've been talking about the need for better telecommunications equipment for probably 10 years."

Billings asked if Landrum could make a case for the ambulances.

Landrum said the hospital has several. "We haven't been able to get in line for funding because of the number we have. I recently asked Eloy Medina (EMS director) and he said if they could get two up, that it would let the hospital be in line for a new one. So, there are other avenues for funding ambulances." He noted that adding energy efficiency improvements was "rounding up the asking." He asked for a cushion on the labor and delivery for overruns.

The final amount was decided to be $400,000 for the labor and delivery project.

The ICIP was approved.

The single item of new business was authorization for Landrum to spend above the contract policy limit on the pharmacy renovation. The resolution states that the limit shall be $850,000 specifically for the pharmacy renovation.

"The renovation is underway," Landrum said. "We need this to complete the file."

Browne asked if the hospital is redoing the project because the previous body messed up. "This authorization would be only for this purpose, because I would like to see the contract limit reduced from $500,000, which was what the previous board used."

Edwards said that's why the resolution is only for this contract. "And when Scott says to complete the file, he means that this was not done at the time the contract was approved."

"Is it the case at this point that there is no going back on this project?" Browne asked.

"Yes, it is almost complete," Landrum said.

Salas said he thought the resolution was going to have a limit of $800,000.

Landrum said some cost overruns had come up, because of an asbestos issue. "I had said $817,000, but we added another $9,000 for the asbestos issue and another architectural fee what was added to it. I'm told that $850,000 should close it out."

Billings said the figure previously presented was $822,000, so there have been some changes since. "I think I heard you say it was the fault of a previous body," he said to Browne

Browne replied that it was his understanding it had been approved during the time Ms. Arias was CEO, and that it may not have even been presented to the Board of Trustees for approval, possibly because she did not think it would reach the $500,000 limit or possibly she just failed to do it or to present it to the Board of Trustees. "It's also possibly both, that she couldn't do it for under $500,000 and didn't present it to the board."

The authorization resolution was approved.

The meeting adjourned.