By Mary Alice Murphy

Reyne Maynes and an assistant coach, center, accepted the proclamation from commissioners from left, Alicia Edwards, Chair Chris Ponce, Harry Browne, Billy Billings and Javier "Harvey" Salas.

[Editor's Note: The meeting went for a bit more than five hours, with a very short break. Several articles will cover the presentations and the review of the regular agenda, in addition to county and commissioner reports. Part 8 will begin with the review of the regular meeting. This article will also cover the monthly GRMC update at the regular meeting.]

The first item to consider at the work session on Oct. 12, 2021, in the review of the regular meeting on Oct. 14, 2021, addressed a proclamation for the Cobre High School District AAA wrestling championships in 2020 and 2021. Commissioners approved the proclamation which recognized the coaches, Reynaldo "Reyne" Maynes with assistant coaches for both years Randy Maynes, Richard Marquez, Robert Rodriguez III, and Gabe Holguin. In 2020, Art Quintana, Sam Trujillo and Brent Horsley also served as assistant coaches. In 2020, Gavin Placencio (sophomore, 106 lbs.), Isaiah Marquez (junior, 113 lbs.), Niko Trujillo (8th Grade, 120 lbs.), Esteban Molina (junior, 126 lbs.), Ishya De La Torre (junior, 132 lbs.), Alex Holguin (junior, 152 lbs.), and Art Quintana (sophomore, 160 lbs.) captured individual state championship titles in their respective weight classes; and Izzy Jaurequi (senior, 138 lbs.), Aidan Quintana (freshman, 195 lbs.), and Leon Vigil (junior, 220 lbs.) captured state runner-up titles in their respective weight classes.

In 2021, Isaiah Marquez (senior, 120 lbs.), Niko Trujillo (freshman, 138 lbs.), Esteban Molina (senior, 145 lbs.), Ishya De La Torre (senior, 160 lbs.), Alex Holguin (senior, 182 lbs.). Art Quintana junior, 220 lbs.), and Aidan Quintana (sophomore, 285 lbs.) captured individual state championship titles in their respective weight classes; and John Roybal (freshman, 106 lbs.), captured a state runner-up title in his weight class.

Following the proclamation, Gila Regional Medical Center Interim Chief Executive Officer Scott Manis began the first part of the GRMC monthly report.

"Last week, we initiated the strategic plan kick off," Manis said. "It is helping us set up planning for the future, including capital planning now that we are at the point of financial stability. It's exciting. The report will come in the next couple of months. Julie Hayes is collating the information and assimilating the report. On another issue, we have initiated the availability of mammograms on a walk-in basis, which we started in September. Seventeen have already taken advantage of the walk-in availability.

"We had to put into effect the closure of the ICU (Intensive Care Unit) this past weekend (Oct. 9)," he continued. "We only had three patients, and they were transferred to higher level care. It is so we can utilize the ICU staff in the emergency department and in the med-surg unit. All of our directors were working extra shifts. Kelly (Rodriguez, chief nursing officer) has been taking night shifts. We had to deploy staff as creatively as possible. We were all involved in the process."

He explained that if a patient has a higher acuity of need and service that Gila Regional cannot provide, "we transfer them. We know that our stays in the emergency room are longer than we would like, but sometimes beds are not immediately available."

Dr. Sam, as he is called, the emergency department director, recently told Manis he was surprised it took so long for the hospital to close the ICU.

"It's the same across the country," Manis continued. "Everyone is trying to keep their staff. I personally meet with everyone, especially the nurses if they are leaving the facility. We keep the door open for them to return. Many are being enticed by extremely large financial packages to be traveling nurses. We've given nursing personnel raises recently."

District 1 Commissioner and Chair Chris Ponce asked if the closure of the ICU was a because of staffing or Covid or a combination.

Manis replied that it was a combination. "Sometimes patients are staying on ventilators for days or weeks, so they can't be discharged. That is not normal, because typically an ICU stay is much shorter. It's been a challenge. We've also seen ER visits increase, with the number of Covid patients coming in. Physicians are sending them to us. We will soon open a Covid infusion unit, so they aren't sent to the ER. An infusion can take 3-4 hours and that is what was being using in the emergency department. So, we will pull them away from the ED, as appropriate."

Ponce said there are so many rumors because the public doesn't understand the staff shortages.

District 2 Commissioner Javier "Harvey" Salas asked if the infusion process is determined by the severity of the case.

Manis explained that infusion of monoclonal antibodies is for the immediately infected. "The sooner they receive the infusion the better they are."

Salas said the numbers of those reporting as now getting Covid seems to be extreme.

Manis said the ones that are really sick are the vaccinated, but quickly corrected himself, with Chief Nursing Officer Kelly Rodriguez saying: "No, it's the unvaccinated. Their cases are much more severe. I don't know how to press the public to get vaccinated. Those unvaccinated are sicker and sicker longer and staying longer."

Salas asked if they are being transferred out to other facilities because of short staffing.

Rodriguez replied that people in nursing are migrating to larger hospitals. "We are not having success getting travelers. We are moving our ICU nurses to the emergency department. As for transfers, we tap into the New Mexico transfer line, but we also call other places like Yuma and Phoenix in Arizona, and also in Texas and Colorado. But many of them are becoming closed to out-of-state transfers."

District 3 Commissioner Alicia Edwards, who also serves as chair of the GRMC Governing Board asked if the hospital was also receiving non-Covid patients.

Rodriguez said that those presenting to the ER without Covid are ones who have neglected their health during the pandemic. "The acuity of patients coming in is so high. They are sicker and needing a higher level of care. I encourage you to see your primary physician, take care of yourself, get your children to their welchecks, and take care of your health."

"What used to be as little as a 15-minute wait in the ER, might be 3-4 hours wait time," Rodriguez said. "The ED is run on a triage system with levels 1-5. 1 is the highest and determines how long you wait to get into the ED. If you're having a heart attack, you'll be sent in quickly. If it's a chronic disease you've had for a long time, you will be waiting."

Manis said: "In other words, it is not first come, first served. Our team deserves a measure of grace from the community. We at the hospital and law enforcement are 24/7. Be kind to our staff. They are willingly being there."

Edwards asked if the hospital was seeing an increase in substance abuse and mental health and behavioral health issues.

"That has never died down," Rodriguez reported. "They are part of the transfers we do, but we're seeing the same amount of patients coming in with those issues."

Ponce said he would like to see a plan for the behavioral health unit.

"I would add that there is an ongoing conversation on the behavioral health unit," Edwards said. "Another thing hindering our getting travelers is the lack of nurses' housing."

Manis agreed and said the lack of rentals is a problem. "It is difficult to find short-term housing. We are exploring options, but there is nothing firm. If you know of any available short-term options, please let us know. No one wants to spend 13 weeks in a hotel room. We're watching the ICU closely and will reopen when we can."

Manis also talked about the EMS tariff increase request that had been submitted. "We have completed the public notice period, and the state gave us a letter that it will move to the PRC (Public Regulations Commission) with a recommendation to approve it."

He noted that with the help of Priscilla Lucero, Southwest New Mexico Council of Governments executive director, the hospital has submitted two grant applications to the USDA. "They are together for $1.6 million. We hope to hear withing 30-60 days. The funding will be all for medical and EMS vehicles and equipment."

Ponce said to Rodriguez. "Thank you for all you do and convey our thanks to your nurses, too."

Next, Interim Chief Financial Officer Greg Brickner presented the key metrics through the end of August. "Our financial strength index is now at a positive 1.96 compared to a negative 9.41 last year. Our volume trends are flat. For the month we had a net $356,000 profit, although we had budgeted for a loss. For the full fiscal year, we have a profit of $590,000 as compared to a $2.5 million loss this time last year. We budgeted close to $2 million for raises. We are investing in our facility."

Browne said he appreciated the decision to close the ICU to "keep the staff sane. May there be a financial hit?"

Brickner said because the hospital has critical access status, "we get paid the same in the ICU as in med-surg. The hit will be in the loss of admissions."

Manis added that "we think of the hospital as the inpatient component. 80 percent of what we do is outpatient. That is not being affected by the closure of the ICU. As long as we have outpatient traffic, we will stay firm."

Browne said he has been contacted by hospital staff members saying that other units might be on the chopping block.

Manis said: "There are no discussion on putting other units on the chopping block. We have to keep the ED, med-surg, labor and delivery, etc. staffed."

The next article will go into more of the work session review of the regular agenda and the discussions on those items.