Photos and article by Mary Alice Murphy

From left are GRMC CFO Patrick Banks, Interim CEO Margie Molitor (slightly behind), Governing Board Chair Alicia Edwards, Member Harry Browne (slightly behind), Recognition Recipient Cristian Smith, Member Billy Billings, Risk Manager/Compliance Officer Denise Baird, and Member Eloy Medina.

Photo 2 From left are GRMC CFO Patrick Banks, Interim CEO Margie Molitor (slightly behind), Governing Board Chair Alicia Edwards, Member Harry Browne (slightly behind), Recognition Recipient Tami Bates, Risk Manager/Compliance Officer Denise Baird, and Members Billy Billings and Eloy Medina.

Gila Regional Medical Center Governing Board Chair Alicia Edwards opened the monthly meeting on June 29, 2023 by welcoming the members of the incoming GRMC Board of Trustees.

Edwards then recognized several hospital employees for their years of service. First was Frank Gramer for five years of service in rehab and wellness. Second was Pedro Corral for 15 years in nursing. Present to receive their recognition certificates were Cristian Smith, for 20 years of service in nursing and Tami Bates for 25 years in compliance and contracts.

"It's been a great honor for me to be able to honor all these folks," Edwards said. "Health care is definitely a calling. They are courageous, resilient and caring."

With no public input, the governing board members along with the incumbent trustees went into executive session.

When they came out of executive session, Edwards said she had failed to announce that Member Chris Ponce was absent because he was attending a Legislative Finance Committee meeting.

As is required after an executive session, she said that the members, trustees and leadership had discussed only those matters specified in the notice of the closed meeting, and no decisions had been made.

Members approved the consent agenda. And with no old business, they turned to new business.

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

The second item also considered recommendation from the MEC for approving the Nurse Practitioner Delineation of Privileges, the Hematology/Medical Oncology Delineation of Privileges, and the revision of the Credentialing by Proxy policy. Members approved all three.

They also approved the first amendment to EMS (emergency medical services) Medical Director Services agreement with Dr. Gregory Koury. The amendment allows Koury to be compensated while in training for the position.

The following item considered a professional services agreement for radiation oncology with Dr. Daniel Arsenault. Interim Chief Executive Officer Margie Molitor noted that Dr. Arsenault would be in town every other week as a part-time provider. Members approved the agreement.

Members also approved the Coverage Services Agreement for the Emergency Department with Emergency Staffing Solutions, Inc.

Molitor said: "As (Medical Chief of Staff) Dr. Colicia Meyerowitz had said [in executive session] Emergency Staffing Solutions would replace the current provider, Innova, with the same hours as currently. They will be on site from 7 a.m. – 7 p.m., and with on call from 7 p.m.-7 a.m. There will be an advanced practitioner on site 24 hours a day. They will provider our ER director services, and also our trauma director services. We were very pleased to get someone to step in when Innova gave us their 120-day notice."

Edwards said after the challenges the hospital has faced with the loss of providers, "This is a great turn-around. I want to acknowledge the help of Dr. Dalton and all the other folks at the hospital who made this happen."

Member Eloy Medina said this change offers assurance for the community that they will be able to receive emergency services.

Member Billy Billings asked if it was a permanent solution.

Molitor said: The agreement has a 180-day notice, "which is a better."

Chief Financial Officer Patrick Banks said he believes it is a three-year agreement to start with and at least one or two renewals possible. "It is our intention that they are our partners for a long time."

Member Harry Browne confirmed it was a three-year agreement with potential renewals.

Members approved the agreement.

The next new business item was a sales agreement with Cepheid for laboratory testing reagents. Banks said the hospital has worked with the group before. "They made our Covid tests, and they have taken over distribution of all the lab reagents themselves. So, the new sales agreement is directly with them."

Members approved the sales agreement.

Consideration of a consolidated services agreement renewal for imaging equipment with CareStream Health Inc. came up next. Molitor said the company provides maintenance of hospital imaging equipment. "Victor does a really good job of negotiating and it saved us some money."

Members approved the renewal.

The final item of new business addressed Resolution 2023-17, approval of the fiscal year 2024 budget. Banks said the budget is the same as presented in May. "Our core goals were to protect our current service lines and to expand services where we could, while fulfilling employment engagement and making improvements to the hospital where it makes sense to do so. Our expectation is to break even on operation margins in fiscal year 2024. That will be an accomplishment. We can't quite make it to break even this year, but we've proven we can, and we need to. On top of that, we're going to take $6 million in capital and grants for some major improvements, such as a telemetry system, a new MRI, and completing the women's services center, as well as various other improvements that our directors have identified as the most important to keep the hospital running the way it needs to. It's possible we will get some grant funding for what is currently budgeted as hospital spend, and if we do so, we'll re-evaluate and re-allocate to other capital needs."

Under discussion on the motion, Browne said the budget says across the board, but it's 3 percent merit raises, which doesn't make sense to him.

Banks explained it is 3 percent average across the board, including merit raises.

Browne said that made more sense.

Members approved the FY24 budget.

During reports and updates, the first was from the Chief Nursing Officer Cynthia Lewis, who was not present. Molitor said she would give the CNO report with her report.

Banks presented the CFO report, noting that his report was for the 11th month of the fiscal year, ending May 31, 2023. "I'll start with volumes as usual. We held rather consistent in the OR, with the ER continuing to run about 1400 visits a month. Outpatient visits, including imaging, continue to rise throughout this fiscal year. Overall, we're seeing a much more consistent year in terms of volumes as compared to the last two. Some of that is due to stabilization after Covid and people starting to seek care as they need it, as opposed to waiting. It certainly hasn't been totally consistent, so our goal is to manage volumes month-to-month, whether they are up or down in a particular unit. In May, we achieved again a surplus. That $877,000 surplus is great to see without a bunch of grant money this month, so that $782,000 shows a significantly higher margin than we posted in previous months. The reason is the finance team went back with our cost report preparer and carefully evaluated our Medicare cost report with the 2021 year as well as with the current 2023 year, and with our interim settlement with Medicare, we realized about $750,000 of non-recurring revenue this month that really relates to the entire fiscal year as a whole for the year while [intelligible due to someone coughing] settlement. So, it's a good result for us, and it bites into that operating loss I've been talking about for 9 or 10 months. We're sitting at a $600,000 operating loss for the year, and that really gives a good picture of how difficult it can be to recover, but also how powerful the cost report is in terms of staying on top of it and addressing the costs plan. I'm not forecasting that we break even on operating margins this year. I think there's a slight chance, but nothing I would forecast with any certainty. If we close out the year with a strong June, we can be confident going into next year that the operating margin goal, I just mentioned in the budget, is a goal we can achieve in fiscal year 2024."

He also noted that days of cash on hand had gone down a bit, but "I expect them to tick up to about the 120 days plus range. We can hold our heads high that we have four months of cash on hand. The reasons we hold that much cash is because we can't predict things in a small area like this. If a physician has a family emergency out-of-town and isn't doing surgery, those are hits on our revenue. We had to buy a new chiller on the roof, things like that. We don't want to have to think about how spending $75,000 will impact our ability to make payroll or not. We can't guarantee we won't have an emergency next month. I'm very pleased that we have been holding that much cash."

"As this is our last meeting together, I also want to remark on the partnership we've made over the past three years," Banks said. "When the commissioners realized the issues, they knew they needed help and hired Health Tech. The hospital had lost $6 million a year for eight years running and had nine days of cash on hand. That is about as scary a situation as a hospital can be in, and losing the hospital was never an option. During the past three years, we have turned the hospital around. We've posted a positive bottom line all three of those years, and that does put a focus on grant money to help much-needed projects. And it includes that approach to break even, which is close. I never want to say: 'mission accomplished.' This is an environment where health care delivery continues to change at a pace that it hasn't in a long time. There's no guarantee we won't face challenges over the next year. But approaching 120 days of cash on hand at the end of the year, we can say we hit that shared goal. The statement in 2020 was the goal to have Gila Regional be able to stand on its own feet for the long haul. We've proven we can, and we're tremendously excited to carry that flag. Most importantly, we've arrived here by recruiting and promoting local talent. We've given raises. We've protected our service lines and we have addressed infrastructure issues as they have come up and proactively. We believe what we are doing is sustainable."

He said there were key leadership roles as well. He said he never met the first CFO, but others included Greg Brickner (who was Banks' first boss as CFO and also became CEO), Paul Rogers, and John Freeman, "who doesn't get a lot of air play, because he prefers it that way. He is the Health Tech vice president who kept the focus on making incremental progress every year. It's not just executives. I've worked with several who have been around here for a long time and the ones who have stuck with us over the three years and continue to work. We had two controllers, who are unheralded heroes, who do the grants to keep funding flowing. I close with talking about our recent leadership development institute. I challenged every director to stand up and stay standing until they could articulate contributions they had made to our turnaround. Every single one was sitting within three minutes. It is not a one-person operation. I couldn't be more proud to be part of an organization that has weathered what we have and can now close the door on that chapter as we go forward with a new board."

Edwards said congratulations on "your first year as our CFO."

"We heard the chief of staff report in the executive session," Edwards said, "so next is the CEO report."

"This is my last meeting with your as the governing board," Molitor said. "I want to continue with the mutual admiration society. I want to say thank you for your stewardship leading this organization for the past three years; from dire circumstances to a successful position with which we can move forward. I look forward to working with the new Trustees. We had a very successful educational event in Albuquerque last week."

She noted the hospital had held its first Leadership Development Institute (LDI) in June. "All directors and managers attended, which I understand hasn't happened in years. It was a great afternoon. This is a valuable tool to make better leaders and align our priorities. We focused on employee rounding, just culture and performance recognition. LDIs will be held quarterly."

Molitor announced: "We have a slate of four candidates we will be bringing forward for formal onsite interviews for the CNO position July 7-13. My main criteria were: successful leadership experience, knowledge of tactics to improve the patient experience and employee engagement, experience in critical access hospitals and ties or experience in New Mexico. They will be interviewed by the directors, medical staff, senior leadership and will have a meet-and-greet with any interested staff."

She said the reason the Emergency Department provider group had elected to leave New Mexico is because of its unfavorable malpractice environment. "We are fortunate ESS has agreed to provide these services for GRMC and look forward to this relationship. They are currently providing our hospitalist services."

The hospital has begun its OR light replacement project, doing two rooms at a time so the OR schedule is not disrupted. "I have heard very good comments from the surgeons with the quality of the lighting."

The MATCH (Maternal and child) construction project continues to move slowly forward, Molitor said. "Our architects are meeting with the DOH today for a final review of our proposed amended plans. If it is favorable, we will submit an updated letter of intent with the plans for final review. This project will improve our labor and delivery rooms substantially by providing large windows, more space, larger bathrooms, and it will consolidate our delivery and postpartum care in one unit. This project is grant funded."

She said MediTech had been onsite that week meeting hospital teams and providing an in-person view of how the final project will function. "The comments have been favorable from providers and caregivers. The Go-Live is scheduled for November 7."

"With the higher temperatures this past week, a few of our chillers acted up," Molitor continued. "Mechanical issues are not uncommon in an aging building. We have a great plants operations team who worked tirelessly to keep us going. We do apologize to any patients who were temporarily uncomfortable with the increased temperatures. While the temperatures in the OR were within range, we elected to reschedule elective procedures on Monday and Tuesday, in an abundance of caution. All have been rescheduled. We should have 2 new compressors installed and functional this morning.

"And we look forward to Dr. Arsenault joining our team in September as our new Radiation Oncologist," Molitor concluded.

Browne said he had a family member spend four days at Gila Regional, after previously spending time in the two hospitals in Las Cruces. "Gila Regional was by far the best. We had excellent service by Innova. It was a remarkably quiet room with friendly and competent staff."

Health Teach Regional Vice President Scott Manis said he would give the third portion of the mutual admiration society. "I couldn't not take this opportunity for saying some things myself. After a long history here, I would be remiss in not recognizing that you stepped in, without compensation I might add, into a very sticky situation a little over three years ago, and you invited me to come be part of it. You all have been always available as board members and provided guidance to the leadership teams these three years. You've been parts of lots of difficult decision-making along the way, but your support was unwavering for the community and for the hospital. You have made great strides in improving the care and financial turnaround of the hospital. You've upgraded a lot of equipment and gotten grants to meet operational needs of the hospital. I do look forward to working with the new board members to continue to move the hospital forward and trust they will provide that same level of commitment and care and rigor that we've had thus far. It's not been easy, and even sometimes not enjoyable, but it's been a great ride to see where we've been, where we are and where we can go. It is my expectation that at the end of this fiscal year, we will finish at around $85 million net revenue, and I expect within the next couple of years, we will be knocking on the door of or exceeding $100 million net revenue, which is a remarkable place to be as a hospital, and leaps and bounds from where we started three years ago at about $59 million net revenue. John Freeman has been a stalwart behind the scenes as a financial expert."

"The last thing I'll mention is that we are continuing the CEO process," Manis said. "We want to have an opportunity to talk with the new board members on their expectations and characteristics we will be looking for, as they will appoint that new CEO."

"It's been a pleasure," Browne said. "Thanks."

Browne had no board comments.

Medina thanked Scott and Greg Brickner, Patrick and Margie. "I appreciated your professionalism as I came into the county commission and became a governing board member. To the new board members, 'Best wishes, work hard. This community deserves a great hospital. Thank you guys."

Billings said he, too, wanted to thank the new board. "And thank you to Scott, Margie, Patrick and Greg for your leadership. I hope we can find a new CEO. Permanent is not possible, but I would like to see a long-term CEO. That's what we really need for stability and consistency. Patrick, I appreciate your bringing up where we were. If we don't look back, we don't appreciate how far we've come. I remember when we had 10 days of cash on hand, but I've heard since, it was 9 days of cash on hand, and $4.8 million in accounts payable. Basically the hospital was bankrupt. We have come a long way. Eight years of $6 million loss a year is $48 million. I had someone ask me. 'If it's lost, where is it?' I said 'It's spent, it's gone, it's not findable it's lost.' I'm glad to see new fresh, very competent trustees coming in. You've had incredible life experiences, and I think we are leaving the hospital in good hands. I know you will make great decisions to move the hospital forward and that's what we need. At some point, we'll have to look at that old facility and consider replacement. I didn't think 40 years is old for a building, but for a hospital I've heard it is. We will get to the point, and maybe we're already there where it costs more to keep this one up than to build a new one. I hope we can get the community behind such an effort."

Edwards said when she started thinking about her comments for the last meeting, "boy, did I have a lot to say."

"I'd like to start by thanking my colleagues for their time and commitment," she began. "I think it's safe to say none of us had any idea where things were really headed. I'd also like to thank Charlene (County Manager Webb). I'm pretty certain no one has any idea how many hours she has spent over the last 6.5 years on the hospital. Her level of knowledge will be invaluable to the board. I am 1000% confident that we would not be having this conversation today if it had not been for the people who work at GRMC and Healthtech. Our people brought and continue to bring the courage, resilience and local knowledge and Healthtech brought and continues to bring the resources and expertise.

"I think it's helpful to remind ourselves what the context is for today's comments," she continued. "175 rural hospitals have closed since 2005, there 200 more at risk of closing in 2023 and 600 more after that are at risk of closing in the near future. Fortunately, GRMC has moved off the immediate risk list, but we are definitely on the list of 600. The hospital lost $44 million dollars between 2013 and 2020, basically none of which was spent on salaries, plant maintenance or badly needed equipment. Then there's the pandemic. The entire GRMC family risked their lives and the lives of their families to save the lives of our families, friends and neighbors under the most stressful conditions you can possibly imagine. The irony of the pandemic is that it actually saved us from going bankrupt in May of 2020 when we weren't going to make second payroll. Additional pandemic related funding kept us going beyond that…long enough to stabilize and get back on our feet.

"The good news is what has been accomplished in that same timeframe—GRMC is now a Critical Access Hospital and a designated Rural Health Clinic, both of which have greatly stabilized the hospital's finances and made possible an average of $15k annual improvement in salaries and benefits per full-time employee," she said "In the last three years GRMC has also been designated a level 4 trauma center, gained a full three years of Joint Commission Accreditation, added swing bed services, added New Mexico's first Heartflow services, a Dexa scanner, 3d mammography, saved the cancer center and received millions of dollars in grants and capital outlay for badly needed equipment, replacing the HVAC system and roof and to bring our labor and delivery department out of the stone age. None of this would have gotten done without the incredibly hard work of our care team, the expertise and resources of our management team and of course, without Priscilla Lucero (Southwest New Mexico Council of Governments executive director).

"GRMC is stable at the moment, but we have a 40-year-old, badly maintained facility and $50 million in capital needs," Edwards continued. "What we have before us is not unlike the aftermath of a huge, slow-moving storm. The water and electricity are back on, and the danger of fire is past but that could change at any moment. People are stressed, confused and scared. Nothing will ever be the same, but they are picking up the pieces. Rebuilding is starting to happen, faster in some areas than others. People are recovering, some faster than others but everyone is trying their best and getting better every day. Resources are starting to arrive and there's a glimmer of hope on the horizon.

"How we nurture that tiny flame of hope, which will determine the future of our hospital and what healthcare and wellness looks like in our communities for decades," she said. "We are standing on the threshold of transformational opportunity. We can choose to open our arms wide and embrace true partnerships or we can go it alone. We can choose between doing things the way we always have or we can blaze a new path as a model of community wellness in a rural setting. We can be a regional hub for rural healthcare innovation or we can be an ER and feeder to hospitals far away from our families and friends."

She said to the new trustees: "Thank you for taking on this enormous responsibility. I am counting on you to be objective, open-minded and non-partisan. to ask tough questions, choose facts over conjecture and gossip and to follow through until you're completely satisfied with the answer. to never stop educating yourself about patient care and wellness and how our extremely broken healthcare system affects GRMC operations; to understand and embrace your responsibility to our patients, the people who care for them and every single person in our community who may or may not need our hospital in the future.

"This is definitely our moment," Edwards concluded. "It's up to every single one of us to make sure we take advantage of the transformational opportunities in front of us."

The meeting adjourned.