[Editor's Note: This is part one of a likely two-part series of articles.]

By Mary Alice Murphy

The Gila Regional Medical Center Governing Board, made up of the Governing Board Chair and District 3 Commissioner Alicia Edwards, Board Vice Chair and District 4 Commissioner Billy Billings, board members District 1 Commissioner Chris Ponce and District 5 Commissioner Harry Browne, with District 2 Commission Javier "Harvey" Salas not in attendance, approved the agenda and moved to introductions.

Edwards introduced the hospital's new Interim Revenue Cycle Director Nicholas Hallas and newly appointed Compliance Director Denice Baird.

Hallas came to podium and said: "It's a pleasure to be here. I was brought in by HealthTechS3 (the management company on contract to bring Gila Regional back up to its potential) to address the hospital's needs. We've made tremendous strides in access in opening up the current lines of business. We're also introducing new lines of business as well, which I predict will bring in a significant amount of revenue to the hospital. We now have a plan of action in place for access and registration. I'm trying to see it turn around the community's perception of the hospital."

Browne asked if Hallas could give some details of the plan of action, which he did.

Hallas said: "During my second week here we identified two individuals who are significantly qualified to train in registration for prior authorization and eligibility. I asked these individual to put together a curriculum of action and go to our registration and access team over the next three weeks. We will move forward to making it policy for the hospital as a whole, so there is no hit-and-miss access process. We identified several holes in our scheduling department and we are addressing them as we speak to assist in the backlog of patients. I understand it's a perception issue for the community. I hope these two main points of the plan will benefit GRMC."

Browne thanked him for the focus on training people already working at the hospital.

Edwards next introduced Denice Baird as the new corporate compliance officer, "although she is not new to the hospital."

Baird said: "No, I am not new to the hospital. I've been here about 30 years now. I started as a CNA, then through hospital and auxiliary scholarships I received my nursing degree. I worked as a nurse for a while, then was named director of the med surg department for 11 years. I was next asked to spend two years in accreditation coordination. Then I took on the quality management. Now I am the corporate compliance and risk management director. My career is because of this hospital."

Edwards also introduced internet technology director, Ken Stone, who would be speaking to the board members during the executive session. "I spent my first 8 years here as an engineer, then three years as director. And now I'm doing information security, and I operate the IT department."

With no public input, the members went into executive session.

When they came out of executive session, Edwards said they had not taken action on anything.

Interim Chief Executive Officer Scott Landrum gave his report. "We got final approval that we will receive $1.2 million from the cigarette tax. We will spend the moneys for taking care of our cancer patients. It's two pieces. One goes in and helps us update our electronic health records in order to continue that portion of the business. The pharmacy has been upgraded and is almost complete with hoods and storage, etc., which is also part of taking care of cancer patients with the preparing of chemotherapy. The hospital also received its PTAN number (provider transaction access number), which goes to Novitas, our fiscal intermediary, which allows us to bill for critical access. We will begin the process the first of next month. We have also hired a new pharmacist. We have been searching through Cardinal Health and we've had four interviews, two while Scott Manis was here (as interim CEO) and I've done two. This is the person we have chosen to take our pharmacy forward. I guess everybody knows we are having a second wave of Covid, in addition to dealing with our fall and winter census, so we're making efforts to fit within the critical access numbers (of an average of no more than 25 beds filled per day) and we're doing a good job with that. The observation unit, which does not count as part of the numbers will begin soon. Ms. Rodriguez will talk about the surge plan to deal with future Covid patients."

Chief Nursing Officer Kelly Rodriguez gave her report. "We will be having our Baby-Friendly designation virtual survey the first part of November, so Mary Gruska, our lactation specialist, has prepared us for the survey. This one looks like a Joint Commission survey, with them coming in and looking at our policies and procedures and interviewing our staff. The other program we're working on is with the surgical services director as well as with the IT department looking at streamlining and improving our pre-op booking process to make it more efficient for our community providers. We are very happy to work with our providers and come up with a process that will eliminate some issues around patient scheduling in the OR. Another thing we're doing is reviving our Nursing Review Committee, with Robin Stewart in charge. We're back on track with it starting probably in mid-December. It's nice to have processes that have fallen by the wayside getting re-implemented. We are in the planning phase for a recruiting dinner for Western New Mexico University nursing graduates, who will graduate in December. I wanted to highlight a couple of people. One is Suzanne Corbly, who is my administrative assistant. She does a wonderful job keeping everything moving. Ron Corbly, her husband, is maintenance supervisor and he did a wonderful job expediting the renovation of the observation unit. His team do a great job."

She began talking about the surge plan. "It's a sensitive subject, and it's a hard population to manage. We cannot discuss the numbers because we have to protect their health information. We live in a very small community and its very easy for someone to determine; 'oh, that's my neighbor. I haven't seen him in a couple of days.' We will not be discussing the numbers with the public. You can look at the Department of Health website for more information. We do have Covid patients and suspected cases coming into our ER. We determine whether they need a higher quality of care and do we transfer them, or do we have the capacity to serve them in our hospital. And the third option is can they go home and quarantine, which is the best option for many of them. When we receive an influx, it stresses our system. We're looking at it on a case-by-case basis. If we get to a certain threshold in the emergency room, whether they are waiting for admission into the ICU or onto the floor, we will begin implementing our surge plan. Really our surge plan is going to be almost a rotation of patients, with the most critical to the ICU or if they are a medical Covid patient, they will go to the med surg unit. In that case, before they go there, all our med surg patients would be moved to the med surg unit 1, which is on the other side of the facility, so they will be separated. The post-partum mothers and g.y.n patients will be moved to the operative side of the facility, which makes them farther separated from any Covid or suspected Covid patient. The pre-op area would be for post-partum mothers and g.y.n surgical cases. The pre-op and PACU (post-anethesia care unit) patients will be in the PACU area. The surgical and post-partum patients will be the farthest away from the medical units. We have standard operating procedures for every department, whether surgical, ICU, med surg, registration, materials management, everyone has a standard operating procedure, so when we get into a surge, we will be implementing our SOPs."

Rodriguez noted that the hospital still has to run, so most of the nurses and nursing directors will be at the bedside caring for patients. "We even have non-clinical director buddies that will be taking on the responsibility of daily operations in our department, such as payroll, ordering and such, so things continue to move as we're working. Discussions will also continue on whether to do elective surgical cases. That's kind of the last possibility. And what about outlying clinics and decisions about whether to pull nursing staff from the clinics to the main facility to facilitate patient care. We hope we never get to that point, but we want people to understand that we are very much ready and will be able to care for patients."

Browne said during the first shutdown it seemed there was some question about what made an elective procedure. "Have we more clearly defined an elective procedure?"

"The first shutdown," Rodriguez said, "almost all groups, like ortho or ob/gyn have guidelines, and so those will be the same guidelines that we followed the first time and will follow again unless we have more strict guidelines from the governor or any regulatory body, so that's how we guided it. We also have to weigh whether it's acute or chronic. That would also determine whether they can wait or we need to bring them in right away."

The next article will continue the reports and action items.