Photos and article by Mary Alice Murphy
The Gila Regional Medical Center Governing Board, made up of the five Grant County commissioners, Chris Ponce (who was absent), Javier "Harvey" Salas, Alicia Edwards, who serves as governing board chair, Billy Billings and Harry Browne, met in regular session on Thursday, Aug. 25, 2022.
Edwards opened the meeting with introductions, recognitions and announcements. She noted that a guest, Dr. Roberto Carreon of Southwest Bone and Joint, was in attendance.
For recognitions, she recognized Kristine Clark for five years of service in information systems; Ezekiel Sifuentes for five years with EMS; Natalie Hall for 10 years of service in physical therapy; Elyse Toney for 15 years in physical therapy; and Susie Martinez for 20 years of service in environmental services. "We deeply appreciate our hospital staff and the amount of time and dedication to our hospital Thank you so much for your service."
"We have two other recognitions this morning," Edwards said. "We will thank (Marion) 'Tony' Thompson (interim chief executive officer) and Paul Rogers (interim chief financial officer) for your service during these past months."
Dr. Carreon came forward for public input. "I am one of the orthopedic surgeons at Southwest Bone and Joint and at the hospital. I grew up here, graduated from Silver High School and left to get my education, always with the intent to return. I owe a lot to this community, which molded me. I have had the privilege of taking care of the community for over 19 years at Southwest Bone and Joint. I've been involved in the community. You can find me at countless athletic events taking care of our students. Seven months ago, I decided to change employment. I approached Gila Regional, as well as other hospitals. I made it clear to everyone that Gila Regional is my first choice. I want to stay here until I retire. At first, the administration was enthusiastic and said I was a valuable part of the community and productive. They gathered data and did a comparative national analysis on numbers and decided to proceed. Soon after that I received a 20-page employment contract. I spent a great deal of time reviewing the contract and also hired financial and contract experts for advice. I met with the CEO and said I had some questions on the contract, nothing major. I was told I would soon hear back. Two-and-a-half months later, I still have not heard. I have pursued it. My questions have been ignored and my calls unanswered.
"Dr. (Brian) Robinson (orthopedic surgeon and owner of SWB&J) and I met with the CEO, and we decided to move forward," Carreon continued. "Dr. Robinson said he did not want to interfere with my employment process. The CEO did express a willingness to pursue my employment, and we were going to go forward from there. I obtained counsel, and I went to the CEO and said I would like to have a clear picture by the end of this month (August). I still have not heard anything. I did hear from our new interim CEO (Greg Brickner) about a meeting today. That was after the MEC (Medical Executive Committee) met this week and decided to approach the administration to let them know that Dr. Robinson and I want to stay here, and we should stay here. All the medical doctors have approached me and said I need to stay here. I am productive at this hospital. I love what I do. The bottom line is I still don't have anything, and I need to know where I'm going with this, or I need to move on. I do have some other options at other hospitals, but I want to stay here. I am the most productive surgeon at this hospital. Orthopedic is the most productive surgery, other than cardio-thoracic, which we don't have here. I take call two-thirds of the time, so that the emergency room is covered the entire time. I came here just to make sure the board knows what is going on. If this is under your control and direction, I will reluctantly take my services somewhere else. If it has not been under your control, then I would reiterate that I want to stay and serve this community."
The board members moved into executive session.
When they came out of executive session, Edwards said the agenda items were discussed, but no action was taken.
With no old business, board members went straight into new business. The first item addressed consideration of the recommendation from the MEC for provider credentialing.
Members approved the report.
The next item covered consideration of the Medical Staff Rules and Regulations revisions, followed by the Medical Staff Bylaw recommended changes.
Because of uncertainty if the items should be addressed at this meeting or at a future meeting, the members skipped them and returned to them later in the meeting.
The next topic considered the GRMC water management program 2022.
Brickner said the facilities department has put together a program, which is the process of which maintenance is flushing toilets and sinks not being regularly used and testing them.
Browne asked if there were changes to the program.
"This is an improvement. We're making sure we're up to best practices and meeting regulations," Brickner said. "It's a policy that we're asking approval on."
Members approved the changes.
The consideration of ratification of the nurse practitioner employment agreement with Karen DeGenevieve, certified nurse practitioner for oncology services, was enthusiastically approved by the members.
"Wow, we're so appreciative of your coming back, Karen," Edwards said.
Members considered and approved the professional services agreement with Maximus L'Amour, M.D. for surgical services (locum tenens for the clinic and on-call). Brickner said Dr. L'Amour would be covering the surgical call seven days a week, "which is kind of critical and helps us maintain continuity."
Another professional services agreement was approved with Donald Stinar MD for pulmonologist consultation. Brickner said it allows medical practitioners in the hospital to do consults with Dr. Stinar, and he will be paid on a per need for those consults."
A professional services engagement letter with EZ-ERC for payroll tax consulting came next on the agenda.
Chief Financial Officer Patrick Banks said this firm would help the hospital do a report on Covid-19 financial aid, which was originally the payment protection program, originally set up for one application. "We should be eligible for additional aid for the 2021 calendar year." Members approved the engagement letter.
The next two items addressed signatory authority for banking specific authority and for contracts and documents. Banks said that Browne, Brickner and he have signatory authority for banking, as well as contracts and documents. Members approved both.
The final resolution for amended GRMC Bylaws of the Board of Trustees. Banks said it adds two paragraphs to the bylaws, showing consistency with the 501c3 status. "We've been working on the certification for a while. Our lawyers are confident this will be the change that clarifies that we are not changing anything, but our operations are in alignment with the non-profit status. We believe that the IRS will approve our dual status designation after we complete this."
Members approved the resolution.
Returning to the Medical Staff rules and regulations and bylaws, members approved tabling them to the October meeting.
Edwards said the reason the items were being tabled was because the MEC members must vote on them in person, not by email, so they will have to do that at their September meeting.
Next came reports and updates.
While technical items were being addressed, Edwards welcomed Brickner back as the interim CEO. "We appreciate your coming back to continue your work, now as interim CEO, and continuing to do the work that you and Tony started."
"It's a pleasure to be back here," Brickner said.
Brickner presented the CEO report. "I'm pleased to report we promoted from interim both Robert LeRoy to facilities director and Beverly (Bush) to HR (human resources) director. We are trying to reopen the large pool at the Billy Casper Wellness Center. The large pool is very old and needs a lot of work. We have some engineers coming in to assess it. We hope we will have staffing issues resolved to use the two smaller pools. The Gila Valley EMS MOU has been reactivated. We will stage an ambulance and truck in a central position during the bridge outage (which has been resolved). We discussed in prior meetings the rate of hospital closures. They have been declining since it peaked in 2020. What we're seeing is today is mostly service line disruptions, mostly in obstetric, pediatric and psych. We, at Gila Regional, are working hard to recruit new physicians to our hospital to provide care for our residents. We are working hard to maintain the cancer center. We are continuing to add services. We just bought a Heartflow analysis technology, which Dr. Norman Ratliff said is the most advanced for diagnosis of heart issues, including assessment of blockages of blood flow to the heart. [Brickner showed a short video of Ratliff talking about the procedure.] It is non-invasive, using a fractional flow reserve measurement that can save lives. Gila Regional is the first in New Mexico and the second critical access hospital in the country to have this technology."
[Editor's Note: This is the link to the news release announcing the purchase: https://www.grantcountybeat.com/news/news-articles/74025-gila-regional-medical-center-adopts-new-technology-by-heartflow ]
Chief Nursing Officer Melanie Vigil said the hospital is opening up to the community again from 6 a.m. to 10 p.m. "Mask wearing is still required, but all ages may visit. We continue to support a safe and caring environment for patients. The nursing students are back at their studies at WNMU. We're welcoming them to Gila Regional and creating relationships, so that we can retain them here. For outreach, our education will be on fall prevention; another will be the early signs of stroke; and possibly working with the community on hand-only CPR. We've been doing leadership rounding with our patients, focusing on the patient experience. Lastly HR is heading this with our employee engagement specialist. We are wanting to show our appreciation for our staff. We are developing a lot of programs, especially in admissions."
Browne thanked her for sending out the information on the visitation policy. Edwards said she also appreciates the communication.
Banks presented the CFO report for July, the first month of the fiscal year. "July generally is a lower month for revenue, because of seasonality, so surgical and outpatient volumes are a bit lower. We expect a recovery in August and we're already starting to see that. We posted a net operating loss of $1.3 million, with EBIDA down to about $1 million, but revenue came in reasonably well. We continue to have traveling nurses and techs, and we appreciate their work, but contract labor has become a fixed cost. We've worked hard to get our cash up, and our key measures of liquidity remain solid for the month of July. Our days of cash on hand is at 107.4, and our average payment period is considerably lower than a standard critical access hospital, which means we are not financing our operations through rendering accounts payable. We are continuing to finance them through operational cash flow. That's a really good sign for a hospital. We plan to finance $501,000 in capital purchases in quarter 2 of fiscal year 2023 out of our bank account. We've identified our most urgent needs, working with nursing and facilities. In addition to these capital expenses, we recently took possession of a new ambulance, thanks to a USDA grant. We paid our portion out of cash. We still have work to do, but I'm confident that the hospital is in a solid place to continue to make investments in our capital needs."
Edwards said it was great to hear that the hospital is funding operations out of operating cash.
There was no chief of staff report.
Edwards noted that the next report from Ramona Wilson, chief quality officer, was her first report.
"I'm really excited to lead quality and safety in the organization," Wilson said, "as well as supporting Denice (Baird, former CQO) in compliance. She is taking a well-deserved vacation this week."
Wilson said she has met with a few stakeholders on quality and safety. "I will be working with the providers and nurses to increase quality and safety across the organization."
In building her team in the quality and risk departments, she said they have onboarded Selina Shannon, who is the quality and risk R.N. "She will transition to infection prevention to support that department as well. Camille Ormand, also an R.N., will be working in employee health. She hit the ground running. We are four months behind in employee health, so our goal is to get caught up by the end of September. We hired
April Zambrano as support specialist for infection prevention and employee health. We also have a great candidate for the health analyst position. This is an internal applicant. We are also working on highlighting our patient liaison Valerie Johnson to support staff, providers and patients and their families. She rounds with all the inpatients and will help with the discharge process as well. She is key to patient satisfaction."
"We are implementing a new process for taking patient complaints and concerns, and following up in real time, to make sure we meet their needs and that they are not discharged with any uncertainty," Wilson said.
The patient experience committee focuses on what they want the patient experience to look like. Leadership is also rounding. She said they look to improve their survey response with Press Ganey, which will provide educational tools for the staff in the patient experience.
She noted that infection control has kicked off the flu vaccine campaign. "We want to reach 85 percent by the middle of October. We are also supporting the swing bed transition."
Edwards asked if the swing bed program is operational yet.
Vigil said they are hoping to go live soon.
Bricker said if "we identify someone that needs the swing bed, we will move them in, if needed."
Edwards noted that they have to be already admitted and then would move into the swing bed if needed.
Billings asked for an explanation on the swing bed for the public.
Wilson said the swing bed option is for a patient who needs short-time rehabilitation. "We can provide it within the organization. A person would move from acute care, such as a knee or hip surgery, to the swing bed to make sure they meet daily goals, so they can have a safe discharge home."
Edwards said it "prevents us from having to send them out of the area. They remain close to home."
Brickner also noted that a person who had been treated in Las Cruces or Albuquerque could come home to Gila Regional for rehabilitation, so they could be closer to home and family.
HealthTech S3 regional vice president Mike Lieb presented his report. "I want to thank Tony and Paul for their service and welcome back Greg Brickner and our brand new administrative team, with Ramona and Melanie and Patrick. We are progressing on the CEO search. We are going slowly, because we have to get the right fit. Special thanks to Ron Green for all the work he and the team have done to bring the cancer center back in house. We have procured the services to protect the radiation oncology practice. We are working through the final paperwork to have a medical oncologist in house and a radiation oncologist, it looks like as well. Our goal is to have that here as a permanent structure quickly."
Edwards asked for some timelines on the cancer center process "for the edification of the public."
Lieb said the radiation patients are all finishing their treatments by the end of August. "The new starts will go to either Las Cruces or Albuquerque for their treatment. We will have the 'registration' for the linear accelerator transferred to us this month. For medical oncology, those patients that started their treatment with UNM are able to continue their treatment right now with Karen DeGenevieve right here in our facility, so there is no disruption there. New patients for a few weeks, while our medical oncologist clears the credentialing process here, will need to start at UNM or Las Cruces, wherever they choose. We expect that to be a relatively short, and we expect new starts to come back here in mid-September. We have made arrangements for those who do have to go out-of-town for this short window. A few patients, in consultation with their physician, have opted to wait the couple of weeks to start their treatment here. We expect by mid-September, first of October for radiation therapy to start them here."
Edwards asked if she was right in saying that Ron and his staff were helping those who need to start treatment elsewhere to make arrangements, so "we are not leaving anyone hanging."
Lieb confirmed that. "Ron has been meeting with every cancer patient we have. It has been quite a team effort. We are close to having all the bows tied soon, and I'm pleased to report that."
Under board comments, Billings welcomed Brickner back. "I feel confident we are moving in a positive direction. I want to commend Tony for working on staff morale. That's been a big issue for a long time. I'm hearing from staff that they are pleased with the way things are working. Greg told me a while ago that he is the 15th CEO in 22 years here, so I hope he will be here long enough to keep some continuity before we get a permanent CEO. I want to express confidence. I haven't had as much confidence since I've been a governing board member."
Salas mirrored what Billings said. 'I'm feeling good to see the hospital doing so well. There are no critical issues holding the hospital back."
Browne said he had nothing to add.
Edwards said she, too, wanted to acknowledge Thompson's work on employee morale. "I had a conversation with Melanie and Ramona. I was happy to hear the enthusiasm, the smiles and ideas that are coming together. There's a real difference in the community about what they're hearing about the hospital. Yes, we've had 15 CEOs in the past 22 years, but a lot of hospitals have closed and that peaked in 2021. We are one of those organizations that got through that peak. It's because a lot of things really came together at the right time and the right place, and the most important thing that came together at the right time and the right place are the people. We have some new people, and we have some old faces. It's great to see things coming together. Greg, this is for you: 'I Love this Hospital.'"