Photo and article by Mary Alice Murphy

From left are Scott Manis of Health Tech, GRMC CFO Patrick Banks, Outgoing Interim CEO Greg Brickner, being recognized by Governing Board Chair Alicia Edwards, with Board Member Chris Ponce behind, New Interim CEO Margie Molitor, CQO Ramona Wilson, CNO Melanie Vigil, Risk and Compliance Officer Denice Baird, Board Member Eloy Medina and Chief of Staff Dr. Gregory Koury

At the beginning of the Gila Regional Medical Center Governing Board on Feb. 23, 2023, members made some changes, including moving the introductions and recognitions to just before board comments toward the end of the meeting. They also removed a word from a couple of agenda items.

They proceeded into executive session.

After coming back into open session and announcing no decisions had been made, members approved the consent agenda of a board meeting and no minutes from the past executive sessions, noting that in the closed meeting, matters discussed were limited only to those specified in the notice of the closed meeting.

With no old business, they delved into a long list of new business items.

The first considered the recommendation from the Medical Staff Executive Committee (MEC) for provider credentialing. Members approved the credentialing.

The next item included more MEC recommendations. Members approved:
a) the deletion of dietician delineation of privileges;
b) the amendment of pediatric delineation of privileges;
c) the approval of James Rosser, MD to the MEC as Department of Surgery chair;
d) the adoption of the restraint policy;
e) the adoption of the transfer hold patients in the Emergency Department Policy; and
f) the adoption of inpatient holds in the ED policy.

The following item addressed a professional services agreement. Outgoing Interim Chief Executive Officer Greg Brickner explained the "fee of time compensation" for Michael Durando, MD, would provide backup for the medical oncologist. "This rescinds prior contracts and finalizes this one, making it the only contract for Dr. Durando." Members approved the agreement.

Members approved a shared professional services agreement naming Ronald P. Dalton, MD and Tsering Sherpa MD as medical director(s) for the special care unit, also referred to as the ICU (intensive care unit).

The next item of new business considered the first amendment to the professional service agreement to extend locum tenens coverage with CompHealth. "This extends the contract with the staff agency for recruiting personnel for the hospital," Brickner explained. Members approved the amendment.

The following professional services agreement named Suzanne Sandoval as medical staff services director. Brickner explained that this item and the next one to name Jeanne Gustafson as case management director replace interims serving in the positions. Members approved the two agreements.

Board Chair Alicia Edwards said she appreciated these appointments as "we haven't had a case manager and medical staff services director for quite a while."

After Chief Financial Officer Patrick Banks explained that the next item provides a tool that IT (internet technology) uses to make sure things get tracked through the system. Members approved the software licenses subscription and maintenance support agreement with PC Connection for Manage Engine for ticketing/tracking systems for the IT help desk, contracts and HR (human resource) departments.

Banks also explained the next agreement, which members approved. The Health Information Exchange (HIE) agreement with SYNCRONYS, the New Mexico HIE and software applications provider for processing of electronic health care information, is a state requirement. It provides benefits to the patients.

Edwards said it means that medical records can transfer through HIPAA (Health Insurance Portability and Accountability Act of 1996). Banks agreed, but said patients still have agency of their medical information.

Another agreement addressed an order amending the master sales and license agreement No. S-47171 to upgrade software and hardware, including professional services for the Picture Archiving and Communication System (PACS) for the GRMC Imaging Department. "This is fundamental to the Radiology Department," Banks said. "This investment lets us bring information home and save money down the road. It was based in Albuquerque." Members approved the purchase.

Banks recommended approval of the hazardous and medical waste services agreement with Trilogy MedWaste "to take care of our medical waste. This agreement extends the contract for a year with the option to go year-by-year for the next three years." Members approved the agreement extension.

The next two items addressed resolutions for signatory authority for banking, which removes Brickner and adds the new Interim CEO Margie Molitor; and signatory authority for contracts and other documents, again removing Brickner and adding Molitor.

The final resolution addressed the plan for the nurse call system improvements. "We plan to use funding to contract with a vendor for nurse call system improvements. We ask for your approval at this time. We hope to get it done within a couple of weeks. We are still in negotiations, but we are confident that we will find one of the vendors we are talking to will meet our needs." Members approved the plan.

In reports and updates, Chief Nursing Officer Melanie Vigil talked about how the service lines and departments require the support of all ancillary departments. "It takes everyone to do the work. We are working together as a team. We are creating a Sitter program, where we will hire people to keep an eye on individual patients that need extra care to prevent falls, for instance."

She said the department continues to focus on patient satisfaction. "We do leadership rounding to hear patient feedback in real time. We really care about our patients."

Vigil noted that the emergency department is at the hospital to meet the critical needs that arise "in our community. We treat them here, if we can, or transfer them if we can't."

In inpatient services, the maternal-child area of the hospital will soon undergo renovations. "Everyone is looking forward to that being completed." Other areas where nurses are vital are in the medical surgical unit and the special care unit, as well as the operating room, which provides more than 200 surgical procedures each month. "They all have great teams and great physicians."

Outpatient services include infusion therapy, labs and imaging, cardiological services, stress tests and sleep studies.

Beginning Years offers care for growing families, from prenatal care to the child at age 5, with home visits.

"The timeline for my tenure has been shortened," Vigil announced. "This is my last report. I am proud and excited for the future of Gila Regional." [She told the Beat, her husband had taken a job in Colorado, and they would be moving soon.]

Governing Board Member Billy Billings, who attended by phone, praised Vigil for a great job as CNO.

Edwards said: I want to acknowledge that you have done an exceptional job. Your leadership has raised the bar for the job."

"I haven't done it alone," Vigil said. "I have had a great time here."

Banks presented his financial report. He said, as usual, he was reporting a month behind, so for January. "Melanie went into a lot more detail than I'm usually able to do on our service lines. I want to highlight the operating room The OR team does an incredible amount of volume for a critical access hospital. The standard would be about 300 surgeries a month. What Gila Regional is able to do for our critical access hospital is pay for anesthetists to support the volume. We fit into a place where it makes it critical that we maintain our volumes at a steady rate. The team does a great job keeping the volumes steady and taking care of our patients. It allows us to keep our revenues up. We were a bit off on operating budget due to volumes, but we can adjust operating expenses to match revenues."

He noted that last month's deficit was about $400,000 and "we recovered this month up to a deficit of $190,000. That doesn't happen without everybody monitoring labor and everyone doing what they are supposed to be doing. There are a couple of factors that aren't outlined in regular financial statements. This month we are training 13 new nurses. We also are making retention payments to those who have been with the hospital for at least two years. The positive EBIDA (earnings before interest, depreciation and amortization) means we're paying our bills. Grants also help our surplus. They are funding our medical equipment. This month continues our succeeding at our goals."

Banks said the fiscal year-to-date, "the surplus of $5 million versus a budgeted surplus of $1 million is driven by our success at ERC (employee retention credit). It puts us in a good position as we near budget season."

On the key measures of liquidity, he noted that the current ratio and the average payment period "couldn't be better. It shows we are sticking to our strategy and paying our bills on time. The current ratio is indicative of our flexibility, as well as keeping our AP (accounts payable) low. AR (accounts receivable) has crept up a little bit, but it's still lower than any benchmark for success that you would set, so we're pleased to have it there. The reason it creeps up is that we continue to build in our Cancer Center, and as providers come in, we may have a month or so of services that wait to be billed. I would like to note that all our cancer center providers are now billing, and receipts are coming in. We managed that in-sourcing without the common issue of losing payments coming in."

No one had any questions.

Chief of Staff Dr. Gregory Koury gave an overview of the credentialing. "Credentials (committee) did meet and the MEC (medical executive committee) approved the recommendations. We have a couple of radiologists to monitor. Dr. (Nicholas) Mittica was approved as a re-appointment, as requested, and we have no issues with credentialing."

He noted a deletion of a dietician of delineation of privileges, which becomes an HR (human resources) process. "We have completed our pediatric delineation of privileging. Dr. James Rosser has been elected to the MEC as department chair of surgery. And we have three policies for your approval."

Chief Quality Officer Ramona Wilson presented the quality report. "I want to highlight that CMS (centers for Medicare and Medicaid) again upheld our 4-star rating, as one of two of the 48 hospitals in the state with that rating. We have accomplished a lot over the past year. We have strong goals around patient safety and the quality of care that we provide at Gila Regional."

She showed a chart of how likely patients, families and neighbors are to recommend our critical access hospital as compared to all other critical access hospitals. "Over the past two quarters, we have achieved some of our goals. I would like to point out Greg Brickner for his leadership rounding and the quality of service we provide to every patient at Gila Regional. We have achieved our goal of reaching 55 percent on the Press Ganey report. We have sustained over the past couple of months right around 60 percent. With the initiatives we are working toward, we are set for success as Mr. Brickner hands off the baton to our next chapter. The past quarter we showed improvement in our discharge process. We have a new director in dietary and we look forward to working toward our goals in to meet the patient expectations of their meals."

She presented a Press Ganey report, which showed two areas of two stars, communication with nurses and quietness of the hospital environment. "We are listening to our patients, so we can continue to meet their expectations."

"This is an exciting initiative we are working on in the patient experience steering committee," Wilson said. "It is a health care equity charter. We are looking at patient social determinants. A nurse will ask the patient a series of questions. For instance, if a patient says they have had a problem in the past 12 months of having trouble paying their utilities, we will send case management in to help them find services and resources for their social needs. One source is findhelp.org, to which I was connected to. You put in your zip code, and it pops up with the local resources to help solve the problem. For instance, if a patient has a food or housing inequity, with putting in the zip code, it will list the resources with contact information.

"I'm very excited about this next one," Wilson continued. "The New Mexico Hospital Association awarded scholarships to four of our staff for professional development in quality initiatives. The four were Melanie, myself, Selena Shannon and Nikki Montoya. This year, we will also issue a submission to the Quest for Excellence Award for our C. diff initiative to cut down on C. diff infections in the hospital. I would like to highlight inpatient services director Amanda Mondello and Selena Shannon for the infection prevention work with lessening the risk of C. diff in the hospital, as well as providing education to patients and families in our community to decrease the risk of C. diff."

Edwards noted the CEO report for the day would be given by the new Interim CEO Margie Molitor. "Welcome to Grant County, Margie."

"Thank you," Molitor said. "It's a pleasure to be here. I am an RN, with a long service in rural health care. I served 14 years as chief nursing officer and then 18 years as a CEO in various places. I live currently in Thermopolis, Wyoming. This is day four here, so I don't have a long report. I am now spending a lot of my time in meetings and meeting people and asking lots of questions about how this organization works. My No. 1 priority is to find a permanent CEO for Gila Regional. This hospital has very engaged leaders and team members. Your directors are working with a lot of rigor to bring temporary staff to be permanent and they're doing a great job. The residency program you have for the 13 new nurses is exciting, too. I've been walking around the hospital. It's a beautiful facility. It's a beautiful community. I look forward to getting to know it better. I want to give a shout out to EMS. There was a serious accident in Hidalgo County, and through mutual aid within 20 minutes we had four units headed down."

Billings welcomed Molitar to Silver City.

Scott Manis, Health Tech regional vice president, presented the HT report. "Health Tech management extends its thanks to Greg for the past six months as interim CEO and his prior stint of 14 months as CFO. It's been a pleasure working with you. Greg leads by example and brings a sense of joy. That smile of his is not fake. I also thank Margie for stepping away from family to serve here. We are continuing the permanent CEO search in earnest. I also want to thank Melanie, who has brought her leadership to the CNO position. It's been a pleasure working with you."

Under recognitions, Edwards recognized Kamala Golden for 20 years of service in surgery, and Emily Crespin for 5 years of service in the Laboratory Department.

Edwards also made a formal recognition of Brickner's service to Gila Regional. "I have always recognized that it takes a team, and Mr. Brickner has been an extraordinary leader. He has shown how critical it is to develop leadership skills and in helping to bring contract labor in as permanent staff members. On the 340B prescription issue, what a snarl that was. Without him, we couldn't have solved it. He did an incredible turnaround on hospital insurance and insurance benefits. The number of layers of finances is mind-boggling. Greg came in and did so much, including the hiring of the current CFO Patrick Banks. I have personally learned how important succession planning is. I look forward to a long-term relationship with Banks as permanent CFO."

Billings said: "No one can completely understand what Greg and Melanie have accomplished at our hospital. Thank you to you both. You will be missed."

Member Chris Ponce, who missed part of the meeting due to another commitment, thanked Brickner for everything. "He was one area of consistency from CFO to CEO. I appreciate your leadership, because it comes from the heart. You believe in doing what's right. I appreciate your leadership. You would answer calls. This is a county-owned hospital, so it is owned by the public. I hate to lose you, but I think you have left us in good hands with Patrick. We will miss you. It's too bad, the short time we had with Melanie. I have seen your leadership, and you will be missed."

Member Eloy Medina thanked Molitor and Brickner for their support for EMS. "I also, as a commissioner, appreciate your support. Your shoes, Greg, will be hard to fill. I also thank Melanie. You will be missed as well."

For board comments, Billings had nothing.

Medina thanked the hospital for addressing safety issues.

Ponce had no additional comments.

Edwards said she wanted to mention how important it is for the community to understand what a critical access hospital is. "Critical access is a financial designation about how we are reimbursed for care and has absolutely nothing to do with the services we provide. I want to remind the public that Gila Regional is a Level 4 Trauma Center, and we provide full labor and delivery services, 200 or more surgeries a month, and we have a great team to take care of your health care needs."

The meeting adjourned.