Recognizing the 20-year stint of service at GRMC by Ernesto Garcia, in red, from left are CEO Tony Thompson, Governing Board member Harry Browne, Garcia, board members Chris Ponce, Alicia Edwards and Javier "Harvey" Salas.
Photo and article by Mary Alice Murphy

At the beginning of the Gila Regional Medical Center Governing Board meeting on April 28, 2022, Chair Alicia Edwards, who also serves as a Grant County Commissioner, announced those who have served and continue to serve the hospital.

She saved the longest serving one until last. Others include Melissa McCants for 15 years of service in the float pool, Robert Trotter for 15 years of service in infusion, Marlene Lambert for 10 years in recovery, Faviola Garcia for 5 years in EMS, and Rene Medina for 5 years in physical therapy.

Ernesto Garcia, who has served 20 years in environmental services, personally received his plaque of recognition.

During public input, Michael Sauber said he and his wife periodically go to Mayo Clinic for testing that cannot be done locally. "I discovered something there. Everyone who goes into a hospital is in stress. It causes stress hormones to go throughout the body and affect everything, and it takes longer to heal. It might help reduce stress and help the staff if you have a flat screen TV with calming images, not the normal spouting of whatever that is often on those TVs. I found it calming to see these images." He showed them some calming images he found online similar to those he saw at Mayo.

"One needs to take care of self and have compassion by serving others," Sauber said. "Taking care of self can include calming breathing—four seconds to inhale, hold it for 7 seconds and then exhale for 8 seconds to calm the body while patients are sitting there. I think it could help, and the bottom line, it would also help staff and patients and help the bottom line at the hospital."

Edwards said she thought it was a marvelous idea.

The board went into a short executive session.

When the board members returned the regular session, Edwards noted that no action had been taken in the closed session. Members approved the consent agenda of a board meeting minutes and a special board meeting minutes draft.

The Interim Chief Executive Officer Marion A. "Tony" Thompson presented his verbal report.

"I am working with medical staff and through their committee structure ,and they are working on their bylaws," Thompson said. "It will be at least a couple of months before they come to you. You'll see in the financial report that things are working well at the hospital financially, and we're working with all our teams on our process improvement."

Chief Nursing Officer Kelly Rodriguez presented her report. "I would like to briefly talk about our active recruitment efforts. We have visited Doña Ana Community College, UNM (University of New Mexico), Pima College in Tucson and Eastern Arizona University in Arizona. In two weeks, we'll be going to UTEP (University of Texas, El Paso). We have provided flyers to NMSU (New Mexico State University) as well as Cochise Community College. Out of that we have issued offers to two applicants from those recruitment efforts. We are excited to have those registered nurses apply. In addition, in radiation, we have three graduate imaging technicians coming over for the start of their career. In December, I reported that we had a registered nursing vacancy rate of about 25 percent. Including our nine graduate nurses, in the past six months we have hired 22 nurses. We still have 17open nursing positions. All of our recruitment team members have packets of information. Nationally, we know that the average rate of vacancy is about 17 percent, and we're at 21 percent. Related to turnover, it's taking an average of 87 days to recruit a nurse and costs an average of $46,000. We've been able to successfully recruit an emergency room director. She starts May 9. She has 12 years of nursing experience. She's a well-rounded person and I think she will be a great addition to the emergency department."

Rodriguez noted the next week was Nurses Week and they would have planned events every day, which would be tokens of appreciation.

"We are working on process improvements projects," she said. "We are auditing our pain assessment process for everyone who comes into the emergency department, into inpatient areas, into surgical areas. We have to have a pain assessment if we do any medical or medication intervention. We are in full audit phase right now on the initiatives we have put into place. Additionally, we are actively assessing medication reconciliation to understand what our patients are taking at home, when in the hospital and preparing for discharge. We are going to start another project on discharge education to make sure patients understand what medications they are going home with and how to take them, as well as their discharge instructions. We want to mitigate risks and decrease our readmission rates. We also are kicking off our C Diff and sepsis management to prevent and mitigate any adverse events."

She said the Women's Center plans are still under review. "We submitted an application to USDA for anesthesia machines."

For her monthly recognition, Rodriguez chose Chris Draper, who is the imaging supervisor, and has worked at the hospital for 21 years. "He can work in every modality in the imaging department and has served multiple times as imaging director when we needed one."

She also noted that Susie Head, after 28 years of service at Gila Regional, has retired. "We are sad to see her go."

"The 'Good Catch' award goes to Nikki Montoya, one of the night shift supervisors, who caught paperwork discrepancies in the ER that could potentially have impacted one of our patients, so I applaud her for that," Rodriguez said.

She also noted the hospital was celebrating Lab Week.

Board Member Chris Ponce asked if Rodriguez had ever sat down with WNMU President Joseph Shepard on how he can help the hospital. "He has some good ideas."

Rodriguez said she plans to meet with Shepard.

Board Member Harry Browne asked about the progress on the Women's Center.

Rodriguez said they had received the 80 percent scope of work and brought some financial numbers to the table that "we weren't expecting. We have had some conversations on the money with Priscilla (Lucero, Southwest New Mexico Council of Governments executive director) about the scope. We have realigned our plan and the contractor will have the plan to us on May 12."

Thompson said the floor plan and finishes are under discussion. "When we make the selection of finishes, we will create another set of boards showing what has been chosen."

GRMC Governing Board Chair Alicia Edwards said the boards will be in the lobby at the hospital and maybe at this meeting to show to the public.

Browne also asked about humidity control in the OR.

"We do daily check ins on the temperature and humidity in the OR," Rodriguez said. "It's a piece of equipment that hasn't been implemented yet due to some IT issues. Our interim facilities director is working on mitigations."

Edwards congratulated Susie Head on her retirement and said she appreciated Lab Week. She asked Rodriguez to send her the schedule for Nurses' Week so that board members could participate in some of the events.

In the Interim Chief Financial Officer report, which covered the month ending on March 31, 2022, CFO Paul Rogers reported a total net surplus for the hospital at $5.377 million. He noted what he calls normalizers as unusual receipts, such as the Provider Relief Fund Income Recognition at $3.9 million and receipts of disproportionate share funds at $1.2 million. Without the normalizers, the net surplus stood at $277,000.

He said he was comfortable that the hospital had earned these dollars. "If we couldn't have documented them, we would have returned them."

He noted the PRF funding was received in fiscal years 2020 and 2021, but can only now be recognized as income, because they had to be matched with lost patient revenues and expenses incurred relative to the Covid event or they would have to be returned. The matching has now occurred, he said.

Rogers said the DSH funds were a reimbursement for a disproportionate share of Medicaid patients and covers accounting periods, not including March.

Volume trends were all favorable, with one exception. Discharges were up, which means admissions are up. Outpatient visits also trended upward. Surgeries were down from February, but up from January. ER visits trended upward across the board. He noted surgeon vacations caused the decline in surgeries and the need to close some OR rooms in January were culprits.

He said the hospital should see the numbers improve in April.

Edwards asked about the decrease in surgeries related to surgeon vacations. "Is there an effort to staff, so as not to see these drops?"

Rogers said he did a graph and aligned full-time employees compared to patient numbers and whether the hospital is able to flex staff.

Thompson said: "We encourage providers to be mindful of their time away. We see an excellent response. The surgeons try to schedule for surgeries so not all are gone at the same time."

HealthTech S3 Regional Vice President Mike Lieb said it relates to small numbers. "We have three general surgeons. When one is out, the numbers drop. But we do have two other surgeons."

Rodriguez said it occurs across the board. If a time is blocked for a special surgery, and one is not going to occur, the schedules will open to see if someone wants to slot in a surgery.

Rogers continued his report. Total operating revenue was $12.335 million compared to a budgeted $7.7 million. Total operating expenses were $6.6 million, compared to a budgeted estimate of $5.7 million. EBIDA (earnings before interest, depreciation, and amortization) stands at $5.7 million. The net surplus is $5.377 million. He noted that absent the normalizers, total operating revenue would have been under budget by $.5 million. He also said that contract labor costs exceeded budget and prior year by about $700,000, and purchased services, legal fees and other operating expenses were all over budget.

Year-to-date total operating revenue is $63.5 million, with operating expenses at $53.6 million and net surplus at $7.383 million.

In the key measures of liquidity for March 2022, net AR (accounts receivable) are down from the previous months, but days in cash are up to 122.4 for March. The current ratio is significantly trending upward, with the average payment period dropping. He noted that AR accounts are trending upward, meaning that "bills are being paid more quickly."

His report included capital expenditures for the nine months ending March 31, 2022 for a total of $1.058,824, with the most recent expenditure for a new ambulance and an invoice No. 1 of $433,000 for the roof replacement. He noted that some of the expenditures would be reimbursed.

Rogers included the budget calendar leading up to the end of fiscal year 2023 on June 30, 2023.

Edwards gave a brief information overview of the chief of staff report in the absence of Dr. Brian Robinson. He reported that the medical staff had approved a policy on the use of oxytocin in certain situations, as well as a blood pressure medication, and [some wording that made no sense to this reporter and Edwards had trouble pronouncing.]

Chief Quality Officer Denice Baird gave her report, which the board usually hears in the executive session, but this time she highlighted items in the public meeting.

"We have added some new quality measures," Baird said. "Two came from CMS (Centers for Medicare and Medicaid). We went back and got four quarters of information covering all of 2021 to use as a baseline. These are publicly reported items. One is for the venous thromboembolism prophylaxis rate, and the other is related to the opioid crisis, looking at current prescribing in the facility."

She said Rodriguez and her team are working on a few performance-improvement projects that align with the hospital's mission of providing quality care.

Baird noted the hospital-acquired infection rate at Gila Regional during the pandemic "when we were seeing very sick patients needing, for instance catheterization, which brings big risks for infection, our rate remained at zero. That is a big indicator of our quality care. Also related to quality are our Caesarean birth rates, which also remain below benchmarks. These are indicators of the high-quality care we provide."

Ponce said he had a call about a concern. "I reached out to Denice, and she took care of it in a matter of minutes. Thank you."

Browne and Edwards also expressed their appreciation for the work Baird is doing.

Lieb gave his report. "We will flesh out the action plan from the draft you approved. On the Cancer Center progress, the letter you approved last month has been countersigned by New Mexico Oncology Hematology. We are working on the final documents and compiling data, preparing for the transition. We're moving in the right direction. I'll be happy to fill you in on the details after the meeting."

Under new business, board members approved the credentialing report from the chief of staff.

The next item addressed a memorandum of agreement renewal with Hidalgo Medical Services CareLink for mental health issues. Members approved it.

A first amendment to the lease agreement with licensed health care provider HMS was also approved for a lease in Lordsburg for cardiologist Dr. Norman Ratliff to provide services. Thompson said Dr. Ratliff really enjoys his outreach.

Members approved the inpatient services agreement with Presbyterian Medical Services at Catron County Medical Center and Quemado Health Center, which provides for patient record transfer.

"If patients from there want to come to us, this agreement allows us to share information if they need to transfer them to GRMC," Thompson said.

An advisory services agreement for insurance services was approved to move Gila Regional from the current broker to Daniels Insurance Inc. Thompson said it was important to have their representatives attend the quarterly meetings and do annual claims reviews to help with liabilities, workman's compensation, equipment breakdowns, fleet coverage and cybersecurity and internet breach, and it would include an annual advisory report at an increase of 4 percent annually over the previous two-year agreement.

To a question from Browne, Baird said they had reached out to legal counsel about procurement, and "Yes, we are within our legal bounds to make this change."

Edwards clarified that it was business insurance, separate from the work done on employee benefits. Baird nodded affirmatively.

The next item was the annual state of New Mexico Audit engagement letter with Dingus/Zarecor and Associates PLLC. Thompson said it was the preliminary to a contract. Members approved it.

The following service agreement for clinical services with Gila Health Resources was for four years at $53,000 annually. Because of uncertainty whether it was within procurement code the item was moved to table to the May meeting.

A master agreement Exhibit A for a single sign-on with Net Health Systems, Inc. was approved at $750 for the initial set up and $21 a month to enable single sign-on. Thompson said the master agreement was approved in January, and Net Health Systems provides electronic medical records software for the hospital outpatient therapy patients. He said the single sign-on was a technological issue in progress when the agreement was approved previously.

The next item considered a products and service agreement with TEAM® Program with HSS. Thompson said it would provide education for "all our employees. Specifically, it addresses training for effective aggressive behavior management or TEAM. So, think of this as de-escalation when dealing with patients and patient family members. It could also include between employees. It deals with just about anyone who would come into our facility. It includes a train the trainer process, which would cascade out to train all our employees."

Edwards said they would train five people and then the hospital would have five people who could provide the training to everyone else in person. "Is it all in person or also online?"

Thompson said it was in person and online. Members approved it.

The final item considered a second amendment to the professional services agreement for on-call specialty service coverage by Dr. Fred Wendler. Thompson said Dr. Wendler had agreed to help the hospital with on-call services among the general surgeons. "We would pay Dr. Wendler $2,000 after an agreed-upon 10 days of on-call services, beginning in May."

To questions about market rate, Thompson said he compared with doctors who would have to come in to cover and they would cost $2,345, so he said it stands the test of market rate. Members approved the second amendment of the PSA.

The next item was board comments. Edwards said it is the first time to add to the agenda. Salas had no comments. Ponce said he gets questions from families about when the hospital can open up to families.

Thompson said they are monitoring daily the CMS and the state guidelines, and "as soon as we can open up, I will be pushing for it."

Edwards asked: "So CMS and the state have authority to regulate when we can open up?"

Thompson replied: "Since they have the purse strings, yes, they can stipulate."

Rodriguez said the CMS, CDC and the governor's mandate only regulate mask wearing, so "I've had discussion with the CMO and he would like to open, so we're redrafting our policy. Masking versus visitation are separate entities."

Edwards said the board would like an update before the May meeting.

Browne and Edwards had no comments, and the board adjourned.