Commissioners hear reports on Gila Regional Medical Center

By Mary Alice Murphy

After the usual opening actions at the Grant County Commission regular meeting on Oct. 15, 2020, District 1 Commissioner and Chair Chris Ponce wished District 5 Commissioner Harry Browne Happy Birthday, but no one sang.

Gila Regional Medical Center Interim Chief Executive Officer Scott Landrum gave the monthly update. He began with what he said are probably the most important ongoing ones for the survival of the hospital.

"Changes in coding are going on; as are changes in registration; and we have created a revenue cycle department to streamline and make more efficient what we've been doing at the hospital," Landrum said. "Certainly the billing issues have been a big problem in the past, and as part of your new contract, we are being very aggressive in getting those fixed. In fact, we have the company CFO, Derek Morkel, here this week looking at how we drop our bills and how we register our patients. And we have a revenue cycle person here who has been here about three days, an expert in the field, here this week to get us to the point where we need to be. We're getting ready to open our observation unit [which will allow a person to stay no more than 24 hours for observation purposes, without being admitted and filling one of the 25 beds]. If you remember, because we are a critical access hospital now, that means no more than an average of 25 beds filled each day, at least 35 miles from another hospital and limits our stays on average to a four-day stay. Gila Regional is a very, very sophisticated critical access hospital. It is a regional medical center with 80 percent of our work being done on an outpatient basis. We have the cancer center; we have orthopedic surgery regularly; we have cardiology; we do a lot of things. Gila Regional is something all of you can be very proud of in this community."

The limit on 25 beds currently has a waiver for COVID, as do all other hospitals, he said. "We run 13 acute beds, six ICU (intensive care unit), four post-partum, which is babies, and two for level two nurseries, for babies that need extra care after birth. These are all on an average basis," he continued.

The previous day, "we had our second meeting with Dan Otero (Hidalgo Medical Services chief executive officer) and their psychiatrists," Landrum reported. "And we focused on trying to get the behavioral health unit reopened. I hope I am not scooping Dan on this, but we are entering into a full partnership with HMS. We are also working with Tu Casa. We want to provide a continuum of behavioral health care for this community. Dan and I agreed in spirit to bring someone into the community to look at what we have in behavioral health care and help us figure out how to provide the most efficient behavioral health in the community. We are transporting lots of those patients out-of-town. I think we're working very quickly with HMS to bring back the service to the community. We are working on our productivity system to right-size our staffing for the volumes. We have a new compliance officer—a brilliant woman. She's been at the hospital a long time. [Denice Baird] We will have a compliance audit to look at what we need to do with regard to the hospital. Governing Board Chairwoman [and District 3 Commissioner Alicia] Edwards and I just found out from the Chief Nursing Officer [Kelly Rodriguez] that yesterday, we received a letter giving us a waiver to move OB patients into much larger rooms. We have a lot of positive things going on at the hospital."

District 4 Commissioner Billy Billings asked about the new OB rooms.

Landrum said the hospital has the space to move the OB rooms from where they are now to an area nearby with larger rooms that can be renovated. "They miss the state requirements by just a tiny bit, but we have the waiver to move forward with getting the rooms ready to be used. They have private baths, windows, everything you would want as a laboring mother. Plus, it puts them very close to the rest of the action for that department. We got the letter yesterday saying we are free to proceed."

District 5 Commissioner Javier "Harvey" Salas asked if the OB rooms add or subtract from the 25 beds.

Landrum said the four post-partum rooms are part of the 25, so "we're maintaining the four we've had. We're starting to see Covid babies, not babies with Covid, but perhaps precipitated by Covid. I hope I said that right," he said to laughter. "I wanted to be genteel."

He explained that the four, the same as the 25, are averages. "We remain cognizant of the numbers. But remember that moving to critical access status will ensure that we have a vigorous hospital for years to come in this community."

Salas also clarified. "You still have to follow the same regulations with the behavioral health unit."

"Oh, yes," Landrum said. "That will be part of what Dan is doing. He is reaching out to people he's known in the past, and I'm reaching out to HealthTechS3 to make sure we are meeting regs. By opening up the BHU, we'll have to go through inspections and all that. I think something else came out, too, yesterday. Geropsych is also something we are looking at. It's what it sounds like, psychiatry for the aged. We will be looking at the needs of the community."

Salas asked about the finances of opening up the BHU.

Landrum confirmed that is part of what they are looking at. "I think we lost more than a million dollars over the last year on the BHU. We have been meeting and talking at length with Ms. Priscilla Lucero (Southwest New Mexico Council of Governments executive director) about what we're trying to do. I think right now what we're looking at is finding some grant funds that will help supplement the losses. What we're hoping to do is run much more efficiently when we do it. That's the plan. I think we're entering into it with HMS in a joint way, as part of the partnership. We're attempting, at Gila Regional, to partner with everyone in the community, whether they are employed by us or are free-standing doctors. That's what we're asking Priscilla to help us with, because there will be some needed monies."

Salas pushed for whether HMS would be splitting the costs. Landrum said that HMS and the hospital have agreed to split the cost of a survey. "I think that's a good indication of what our partnership will be. I can't answer for Dan."

Landrum said another step forward in the partnership is that Otero will be invited to attend the Gila Regional Governing Board meetings and Landrum will be attending the HMS board meetings.

Browne said: "You said that moving the labor and delivery rooms will also help the nurses because they will have all their charges in the same place instead of in two different places. And I wanted to add that it will be better for the families, too, because they won't have to move from one place to another before and after having the baby."

Edwards commented: "How many decades have we known the labor and delivery issues needed to be fixed? Thank you for making it happen."

No public input.

Chief Deputy Treasurer Veronica Rodriguez reported that the office had rolled over the 2019 taxes, for a total collection of 94.89 percent, totaling $5,184,490.54 for the general fund, leaving $334,784.98 outstanding. "This month we have collected more than $8,000. For 2020 taxes, we have collected 1.03 percent with $56,700. We are expecting to mail out next week 34,431 2020 tax bills."

The taxes for 2020 total $11.868 million compared to last year's $12.64 million when the Treasurer's Office mailed out 34,727 bills. She noted the biggest change in the total was from a lowering of school debt. "We also during the year combine multiple properties owned by the same person so they don't receive so many bills. And sometimes, mobile homes move out of the county. I can print out a report on why there are fewer bills this year."

Clerk Marisa Castrillo reminded county residents that early voting is going on at the Clerk's Office on Monday-Friday from 8 a.m. to 5 p.m. through Oct. 30 and at the Bayard Community Center on Tuesday-Saturday from 9 a.m. to 6 p.m. through Oct. 31. "We've been averaging about 350-400 early votes a day. From Oct. 6, the first day of early voting through Oct. 14, they had had 2,816 voters. The process has been fairly smooth. I expect a record turnout. We do have a ballot drop box for those dropping off their absentee ballots. The ballots must be dropped off only by an immediate family member or caretaker of the voter."

Edwards said she has heard positive feedback on the process from voters.

Browne asked about the absentee ballot drop off box. Castrillo said it is located on the right side as one enters the Clerk's office. She noted they are logged in as having been received, but then the absentee ballots are put on hold. The Absentee Board can start going through them as early as five days before Election Day. "The board is evenly divided by party. The absentee ballot can be dropped off or it can be mailed."

"I've seen a few not following the mask rule," Browne said. "Why does your posting say masks are requested instead of required?"

"I cannot turn anyone away from voting," Castrillo said. "It is their right. We offer a face shield to those not wearing a mask. Some of them accept them. When a person is receiving their ballot, we use a popsicle stick as the stylus for signing their name and then the person puts it in the trash bucket. The person is given a marker along with the ballot. When they turn in their ballot for tallying in the machine, they put the market in a tub to be sanitized before reusing. After a person leaves a booth, that, too, is sanitized for the next person. We only allow six people in at one time to vote. Waiting in line has averaged about 20-45 minutes, and most people have been understanding about that."

Edwards asked how the drop-in ballot box is being secured.

"It is monitored at all times," Castrillo said. "It is locked onto the table and the box itself is locked so no one can get into it."

Edwards also clarified that absentee ballots can be dropped off at the Clerk's Office or mailed in at least five days before Election Day.

"Yes, up to five days before, to make sure we have them by 7 p.m. Election Day," Castrillo said. "As absentee ballots are received, in the drop box or by mail, we log them in and verify the signature and last four digits of the Social Security number. We don't open the secrecy envelopes, and we put them in a locked box for the Absentee Board. The board also verifies the signature and last four digits of the person's Social Security number on the back of the envelope. Then, they can start separating the envelopes, the secrecy outer envelope from the interior envelope holding the ballot. Absentee Board members are the only ones that can separate the secrecy envelope and the inside ballot. They then tabulate the votes into the machines, the same way voters do."

Edwards said she had been asked what happens if a person is unable to stand for 45 minutes.

"A staff member does a walk around," Castrillo replied. "They offer chairs to those who need them. They keep the chair as they move through the line."

Billings asked how the absentee ballots are secured after closing hours.

"We do not leave the ballots in the box overnight," Castrillo said. "They have to be processed as received. We're making sure that they have the required signature and last four digits of the Social Security number on the outside of the envelope. They can track whether their absentee ballot was received at NMVote.org. We also have a 'curing process,' where if the outer envelope is missing information, we reach out to the person and the voter can come in and fix it."

Billings asked what would stop someone other than a family member or caretaker from turning in absentee ballots?

Castrillo said the person is asked who they are, and they have to sign in. "We have a lot of checks and balances."

After a short recess due to service going down, the commissioners returned.

The next official to give a report was Sheriff Frank Gomez. As Gomez walked up to the podium, Ponce said when he came in that morning, one of the deputies was helping someone change a tire. "Please tell him thank you."

Gomez said he would. "Our training continues. I thank the county for helping my deputies get advanced training. We are still doing driver's license testing, a few every day. We are planning to resume the D.A.R.E program in January in the Silver and Cobre schools. October 24 is National Drug Takeback Day. We will have deputies on hand in Cliff and in Mimbres that day. [Visit https://www.grantcountybeat.com/news/news-releases/60745-cliff-and-mimbres-join-drug-take-back-day-on-saturday for more details on times and locations.]"

He continued and said Devon and Dora, the D.A.R.E. lions, as well as three deputies wearing masks, would be on hand for a drive through trunk or treat at the front of the parking lot at the Grant County Administration Center on Halloween. They will offer a bag of candies and treats that have been donated. "We have signed an MOU (memorandum of understanding) with Tu Casa, which is an invaluable resource for Grant County. We have received some applications from certified deputies, including one that wants to return to our department. We've seen an increase in DWI incidents. The state has approved two vehicles under the Stonegarden funding. I want to announce a couple of recognitions of deputies for their community efforts. Sgt. Medina is coaching Silver High School basketball and Cpl. Bill Mize owns and runs Indian Springs Ranch. It's a 501c3 attempting to reduce suicide in veterans and first responders, including law enforcement. He uses equine therapy. He had to reduce the size of groups because of COVID, but he's still running the ranch and serving as a deputy. I also want to recognize Sgt. Torres, Deputy Vasquez and Deputy Jensen, as well as Dispatcher Jasmine Sandoval. [He read a letter from the family of a lost person, who was found]. All of them showed genuine concern in the case of a lost person. The family expressed how grateful they were for everyone's compassion and skill. I put the letter on our Facebook page, with the family's permission. It has received 34 positive comments. In Grant County, for the most part, everything has gone great. The citizens know we're there for them."

Gomez then presented some statistics, including that HIDTA (High Intensity Drug Trafficking Areas) had arrested someone with 4 ½ pounds of methamphetamine, plus firearms. He reported 21 domestic violence calls, 12 accidents with one fatality. "Our calls for service are remaining steady."

Edwards said: "I can't tell you how much we appreciate your going to homes to address issues."

Salas said he found it remarkable that Mize could do his job, as well as operating the ranch in Mimbres. "He has built a large amount of good will in Mimbres. It's amazing that he is so driven to do what he's done. It's great to see that there's not an adversarial relationship with the Sheriff's Department. I commend you for your positive actions."

"I'm blessed with my deputies," Gomez said. "We've become family. We respect one another. We lead by example, with everyone being very professional. I thank Manager Webb for allowing us all the training, so they are prepared. It's my job to support my deputies."

Salas noted the Gomez ran on a platform of creating a drug enforcement unit. "What you've done is so much more than just rhetoric."

Billings said he appreciated all the DWI arrests, too, because it keeps the roads safer. "How many deputies are you short now?"

Gomez said as of yesterday, a 17-year certified veteran deputy had accepted a position with the Sheriff's Department. "We were down 11 when I came into office, and now we're down 2."

Billings said: "We used to hear that the department was losing deputies to State Police. Now they're coming back."

Gomez said they have two former State Police officers.

The agenda of the regular session is reported on in an article posted Oct. 21: https://www.grantcountybeat.com/news/news-articles/60769-grant-county-commission-holds-work-session-101320

During commissioner reports at the end of the agenda, Edwards said she would take the opportunity to give a six-month report on the hospital and the contracting with HealthTechS3 to manage Gila Regional Medical Center.

"I am thanking the CEO and all the folks working at the hospital," Edwards said. "One of the reasons I was advocating for HealthTechS3 was because I wanted to see an organization with no prior history at the hospital. I wanted an objective view. I am amazed at all they have done. The SWOT (strengths, weaknesses, opportunities and threats) process is still going on. I think they have done an amazing job. We have had our fourth coding audit over the past few years. This last one has revealed serious coding issues which left millions of dollars on the table that are not going to the revenue side of our bookkeeping.

"There have been, and I've heard this for years from many of our professionals, our providers, about what a mess the registration portion of the cycle has been for a very long time," she continued. "The revenue side starts with the patient, which starts with the registration and everything that the patient does from registration to discharge. How that is coded determines how the hospital is reimbursed. There have been extensive changes to the positive. Many of the things we're hearing about the hospital are problems that have been going on for a long number of years.

"HealthTechS3 has been in place for six months and has made a tremendous amount of progress in addressing issues," she said. "They are getting ready to do the financial compliance side of the audit of revenue. This is part of understanding what has happened with the finances. There has not been a financial compliance audit done in many years. It is certainly possible that had more attention been paid to the compliance side that some of the issues we're dealing with may have been found sooner."

Edwards also mentioned that in addition to HealthTechS3 interim CEOs Scott Landrum and Scott Manis, "we've also gotten a great deal of help from Lt. Gov. Howie Morales, our congressional delegation and local legislators for getting advanced payments from CMS and CARES money. I would like to mention that it has been brought to my attention more than once that had we not had the CARES Act funding and the advanced payments we might not have been able to make payroll in May. That's how serious the problems at the hospital are. "

"I've heard a lot of negative feedback on what the Commission did on the transition to becoming the governing board," Edwards continued. "It has died down over the past couple of months. Part of the reason is that it is becoming more obvious to the public that there were some serious problems at Gila Regional and that maybe the action we took was reasonable and necessary."

She said, on a personal level, "it's patently obvious to me that our actions were extremely necessary. We're not out of the woods yet, but items such as the critical access designation, the rural health clinic designation, getting the audits done and hiring a revenue cycle expert that all these are actions that HealthTechS3 has taken will stop the bleeding. So, we have a little bit more time to go. The transition from being a PPS (prospective payment system) hospital to critical access involves giving back all the money the hospital has billed during the transition and getting back the reimbursements under the critical access rate. As we are in the process of giving back and then getting it back makes the cash situation shaky, so we're not out of the woods yet. However, I'm very confident that what is happening right now has put us on the right road."

Another thing she wanted to mention was that not just the governing board, but also the appointed group of community members are advising the governing board on the CEO search. "This is an amazing group of people. They have heartfelt conversations about what we're looking for and how important this CEO search is, how critical it is that we make the right decision on the permanent CEO. There are some things that have come up in these meetings about the prior administration that we are taking very seriously. One is transparency. The lack of transparency in the previous administration is fairly shocking. The prior boards may not have had any clue as to how untransparent the administration was about problems facing the hospital. I've heard many stories from housekeepers to doctors and everyone in between about how truly terrible morale is up there. I would like to point out one of the things contributing to that was a lack of listening. There has not been a relationship between administrators and people providing the health care services. When I hear health care providers telling me stories, more than one person, with tears in their eyes, about how amazing our hospital was and how far it has fallen and what are we going to do to make sure we can get back to what they call an amazing little hospital that could really serve our community. I want to assure the public that myself and my fellow governing board members are taking it very seriously and that ourselves along with the CEO search committee are really rolling up our sleeves and working to understand what the right direction is for the future of our local hospital."

Edwards said from the start she wanted brutal honesty about the situation at the hospital. "Brutal honesty meant that it was not a pretty picture, but the other side is we have a great partner in HealthTechS3. We have truly amazing people working at Gila Regional and in health care in this community. One of the ways we are showing people how serious we are about health care is our continuing discussions with Dan Otero (Hidalgo Medical Service chief executive officer) and Landrum about addressing behavioral health. We are making amazing progress."

She also acknowledged Jim Greenwood, who received Gila Regional's first Daisy award, an international award for nursing service, for his nursing service during his career. "Jim is now retired, but he spent more than 30 years in nursing."

"That award give you a little glimpse of the quality of people on Gila Regional's staff," Edwards concluded. "I think it's an important time for the community to hear the details about what we know and what's happening up there and how we're fixing it."

Billings said he wanted to add one thing as an example of what HealthTechS3 is changing. "It's been more than three decades since my wife gave birth to our three children in that old labor and delivery room. She shared a bathroom with another mother. There was discussion about 30 years ago about doing something. A few years ago, it was going to cost millions to fix it, and now, it may not even cost the $450,000 we allocated. Scott, you thought outside the box and you are going to pull the rabbit out of the hat and how many children have been born in that old facility. Thank you, Chair Alicia Edwards, for acknowledging Jim Greenwood. We were a recipient of his care with my 97-year-old grandmother several years ago. Boy, did he make an impression on this family."

Browne thanked Edwards for her comprehensive report. "Thank you for your leadership. I know you've put a lot of time into it and it showed last night at the second meeting of the CEO search advisory committee. Last month, I called that group an all-star cast and part of the problem with all-star casts is that their egos can get in the way. But last night was a very collaborative effort, looking forward to the task of finding a permanent CEO."

Salas said he echoed his pleasure at the way the hospital is going. "I want people to know how scary it was to take it over. Maybe our vindication will be a healthy hospital. I'm pleased that we are looking at the aspect of getting at least part of the behavioral health unit up and running again. The cross-representation of members of the community on the search committee is great. We hope the fruition of their task will be a very good CEO. Thank you, HealthTechS3."

He also commended the clerk. "You are handling the election with great professionalism. And the sheriff and so many deputies are also doing great work. Negative views are being reversed. Many people tune in to these meetings and see that we are working for the best for the county."

Ponce said: "All of us had Gila Regional on our list for comments. I want to thank the advisory committee and the time they're taking and the seriousness they are showing with the task. I get a lot of calls on Gila Regional. The hospital is usually at the back of our minds until we need it. The purpose of our taking over the hospital is that without it, it would devastate the community and the surrounding communities. I can take heat about bringing it back. We have a long way to go, but we're coming back. We have to make that hospital work. I think we're taking positive steps. I want to also thank HealthTechS3 and the information they have provided us. We're trying to fix it. Maybe there are also other areas we need to work on at Gila Regional. We have trust among the employees and the administration and with the commissioners, as the governing board."

He also said he appreciated the Clerk's Office. "I thank Marisa for the steps she has taken to make voting as safe as possible. I also appreciate members of the county voting."

The meeting adjourned.