[Editor's Note: This is part 2 of the follow up community discussion on HMS issues held on July 9, 2025. It continues reporting what the speakers said and getting into potential solutions to the issues.]

By Mary Alice Murphy

The next speaker at the July 9, 2025 community discussion on HMS issues did not identify herself, but said she has lived in the community for four years. "And I've had concerns about HMS for four years., trying to find a primary care provider and having that person stick around. I didn't start looking because, luckily, I'm in relatively good health, until last year, when I started looking. I lost two health care primary providers through HMS, and this year I do go to Dr Jones, but he's not a primary care physician."

She said she understood it, because it is Grant County and Silver City, " and you know striving to recruit from here can be difficult, trying to get people who really want the rural life. But I think that once we have people, it's important to keep them and that it all comes down to leadership at every single level. I'm also sad that HMS won't be doing Senior Services any more as of August? That was an opportunity for them to be out in that community. As far as care satisfaction, I would say I was satisfied with the primary providers that I had, but that was my option. I would really love to see those surveys and what's included in those surveys. Is is primary; is it nurses; is everybody working together; or are they separate? And finally, I just want to say that there are a lot of reasons why things happen, and we get a lot of excuses and different reasons when we look at the numbers."

She concluded by saying she had different numbers from the ones mentioned earlier in the evening. The attrition rate of physicians is 67 percent across the country, and the nursing turnover rate is about 21 percent, so 22 is higher locally.

The following speaker identified herself as Mary, living in Mimbres. She began by saying the residents in Mimbres do feel the damage from the clinic coming and going. "But federally qualified health centers are often the bedrock foundation of health care in underserved communities. I'm a retired nurse practitioner. I loved my career and I miss my patients and my practice. I spent quite a few years in a federally qualified health center in rural Idaho, and it was the worst job I have ever loved. It beat me up and spit me out the other side every day. Every day it was really, really hard work. I want to say for providers and staff at federally qualified health centers, you love your work. It's worth it to be loved deeply, and we are, those of us who have worked in that setting. We do it because we love it, but it's difficult work because of administrative issues, of staffing issues, and just because the national medical culture leaves lots of burnout for nurses and physicians It's the culture of medicine. And just because that exists does not mean that is the situation here. And so subsequently, if there is a problem, take your ego, leave it at the door and get to work and figure out what the problem is. And if there's a high attrition rate and a big turnover of your medical providers, that's a problem. And it doesn't matter what the numbers are for the rest of the country. It's happening right here in this town, and the people who need their medical providers because they're good providers. They're just as qualified as anybody; they're just as smart and qualified as any other medical provider in any other medical practice, but the cost is very high to work under conditions with not much support, with the same patients and a lot of demand and not much support.This brings out the quality of care that anybody has received in each of these clinics at any time from any provider or how they were cared for and served by staff members. That's not the issue. The issue is leadership, administration, taking a sincere, deep look at what the problem is, and get to work. Get to work, make it happen. It doesn't have to be that way. And you know, I didn't work at HMS. As I said, community health centers are the bedrock in underserved communities. Ii is essential things you take a look at."

Facilitator Lilly Irvin-Vitela said some comments had come in online, but she wanted to go back to a couple of other questions posed by speakers, posing concerns of sexual harassment. "Does HMS have anything to say about that, as rumors like that make it difficult to retain providers and employees."

Board Member Rusty Tolley emphatically said: "This board member is not tolerating any legitimate claims of sexual harassment and will not. There was a past claim before my time on the board, and I'll ask Carmen to address all the plans of investigating that and dealing with whatever claims of sexual harassment there were, and if they were completely and thoroughly investigated. So I'm not willing to put you all on the spot to answer chapter and verse."

Irvin-Vitela said she completely respected what he was saying about not talking about it. Many people have concerns, but "I wonder if somebody on the board might be willing to talk to your policy in general around sexual harassment, what that looks like if it's reported within your organization at any level, and what a staff person might expect if they brought a concern forward in terms of how it would be addressed."

Board Chair Camen Acosta said it might lead to a lawsuit, but asked that the compliance officer, Lacey Brown, speak to it.

Brown said they take all complaints, whether they be from sexual harassment or any other complaints. "They go into our incident reporting system. I feel like a sexual harassment complaint would be take up to a supervisor. I don't know the policy from memory, but you take that to a supervisor. If the complaint is about your supervisor, you would direct those to HR. Thorough investigations would be performed for all parties involved. We would loop in the appropriate parties, from an investigation standpoint. Then the CEO would be notified if, if there's a complaint. If there's a against the CEO that would be brought to my attention, I make him aware, and then I would take that complaint directly to the board. And then if you can correct anything, and then see if there's any way for the board member to clarify. Again, if it's a sexual harassment, if it's against the CEO, the CEO is made aware of it, of course."

JoAnn Salcido asked for clarification. "If a sexual harassment complaint goes to the board and Dan is on the board, doesn't that just mean that you guys are overseeing yourself?"

Gonzales had a quick question. "What do you use for your investigation? Is it a police agency, or who is used?"

Brown said they have a internal and an external investigation.

Irvin-Vitela pointed out another concern was for providers and staff turnover. If HMS loses federal funds, patients would have to depend mostly on the private health care and this could be even more devastating to low income patients. In addition, why would you ask to speak to a board member, if you will be directed back to HR or a director."

A participant asked to know who online was asking these questions. Irvin-Vitela said they had no way of knowing who was asking them.

Magdaleno Manzanares said he served slightly over 15 years as a board member. "You think is that there is a problem, and that's why we are here. And so if there is a problem, let's try to find a solution, not blame someone else. That is not the way to resolve this. And this goes to the board, because I know the board. I know how it functions. And that's if you don't question the CEO, or CEO tells you things and you are not satisfied with that, it is your responsibility to ask the questions, and the board is the place to go. and you should try to offer solutions. I'm sad to see the senior centers go, because I remember when Sen John Arthur Smith get the money for the first senior center."

Irvin-Vitela brought up concerns about access. "But there's a more specific question from a person who emailed the question, which she read: 'I read the response from the board regarding loss of providers. Having to change providers is always difficult and disorienting. A change in providers potentially means treatment is interrupted, delayed or discontinued for the individual, especially individuals with severe mental illness. These events can be life threatening for the individual, the family and the community. What is the organization and the board doing to not only recruit qualified providers, but to actually retain the expertise to serve the community? And so I don't know if anybody is prepared to respond to how we meet the behavioral health needs, particularly in folks with severe mental illness, but you certainly can have an opportunity to do that if you're prepared to respond.' So the person was saying, hey, when there's staff turnover, of course, that's difficult and disorienting, and for people with severe mental illnesses, it's also life threatening, both for that individual, perhaps for their family and maybe even for community. And so what they're asking is what is the board doing? What in the future is estimated to ensure access to behavioral health? And I'm going to toss it to the board."

"So what are we doing to recruit for behavioral health?" Chief Executive Officer Dan Otero, DBA, replied, He said: "Every year we go through a comprehensive budget preparation process, which we all know is an assumption of the next year's services. And we have so many facilities that can hold so many providers, meaning that's the capacity that we have. The demand, obviously, is much greater than the capacity of HMS Grant County or Hidalgo County as a whole. So once we have our budget and we have our facility capacities to hold providers, we begin aggressively recruiting using all mechanisms possible. Our Chief People Officer puts out many of our positions to all of our national websites, like the National Association of Community Health Centers, where people that work in a QFC are constantly looking for opportunities. We use the National Health Service Corps, as a resource to our providers, which is a federal program to provide loan payback models for serving in rural communities. We also hire recruitment firms, which are very expensive, but we do statewide and national wide recruitment efforts that are handled by our executive leaders in collaboration with human resources. And again, I try to contribute and provide support as the best I can, so that we can get the provider. It's an example of how we were able to bring in eight providers relatively quickly with this recent resignation that happened at HMS in order to get people in to maintain access. And absolutely, I just want to add a couple points. When a provider leaves, there's two potential scenarios, whether they leave either regionally or elsewhere, We have a turnover. They may be going to go out of state to another location. That's the most painful piece. Some providers will stay in the community. And I think it's important to recognize that we're thankful for that. And I was at Gila Regional for a total of 17 years. And when physicians would leave Gila Regional and go to HMS, you would see those patients usually follow those providers and still get that continuity of care. Anytime we see a transition of providers that stay within the community, I consider that a blessing for our community. When they leave, that's a whole different difficult situation for us. I also want to make a point on, yes, if they leave and you're having to transition to a new provider at HMS, the process is, we notify those patients via letters. The Operations Department provides a choice of other providers that are available. And if you don't select one, and that you can choose to do, we auto assign so that we can make sure that your medications and your health care is being followed up with. So we have processes. It's very complex, and sometimes the capacity, the demand, exceeds the capacity to do that, but that's the process that we do. And again, I will stress to anybody in this room or anybody that's listening, if you have any problem with that, please call us. Call us directly and we take calls all the time. We will work with you. We'll stop what we're doing to make sure that you get the care that you need. We do it every day when things come up. We recently had a patient come to my office with a concern of getting a prescription refilled, and I personally took care of that for him, in collaboration with the staff. Our motto at HMS is, if you have a problem, we will own that problem until you get resolved. And are we perfect at it? No, but that's our intent and our goal every time, and my number is public. If you have trouble with somebody, please call me directly or text me, and my promise to you is I'll get back to you to help you."

The next speaker was Angela Salaiz. "I have been a patient with HMS for almost 20 years. I was originally with Dr Stanley's office before HMS took over, and I was seeing Dr Henry after a severe back injury from work. Dr Henry helped me fight for social security disability and for worker's comp. For years, we fought against all these people, and we won. That man was my rock. He really was. I heard he was ousted. He's gone. He's been gone for, what, four and a half years now? Since then, I've had four providers. I'm losing one right now, my fourth. My medical record is complicated, and now I've got to explain it to someone else. I don't care about 22% I don't care about the national average. I care about, you know, you say you send letters about when a provider leaves. I didn't get one about Dr Henry until two weeks after he was gone. That doesn't help with continuity of care. I've been with a doctor for 16 or 17 years, and all of a sudden he was gone. Every provider I've had since then, I don't get notified until after they're gone. How is that continuity of care? It can't possibly be when you blindside patients and you don't let them know till after the fact. I want answers. I want answers. I don't care about national averages. I don't care. My grandmother just started seeing this other provider, and now she's gotta go find someone else. When she's in congestive heart failure and afib, now she's gotta go find someone else? What do you say to these patients? What do you say to them? Do you look them in the eye and say, well, our average is lower than the national average. Do you use that? You say you don't use that. Okay, please don't do that here. There are patients that are genuinely concerned for their health and their well being. We don't want to hear about national averages. We want to know what you're going to do to fix the problem. And it is a problem, I'm not going to say issue. It's a problem. We want to know what you're going to do to fix this problem for this community. Thank you."

Zoe came forward and said: A great man once said: 'The buck stops with me.' Real leadership means taking accountability and then making changes. And when you mess up, if you keep messing up, maybe you step down."

Irvin-Vitela said: "There's a question online that I'm not sure what it's in reference to. So if this was your question, please add a little more specifics."

Salcido said she had served on the HMS board. Why is Carmen, still on the board, having been on the board for 20 years? The board chairmanship should rotate. I feel the board needs a change ad not the same ones there all the time. I think we need a new CEO."

Dr. Don Stephens, former HMS chief medical officer and director of the residency program, spoke up. "One thing I want to point out is that it was mentioned tonight that we lost the residency program. However, there's a low probability that it's going to come back. Someone asked why there are not more providers attending., and why some of the names that signed the letter of no confidence in the HMS leadership were not providers or former providers for HMS. If you look closely at those names, a lot of those providers have been in this community for years and served this community for years. They care about their patients and took action. Why would they stick their neck out? One thing I also want to ask, Why aren't more HMS providers here now? Maybe it's because they are afraid. They know there are consequences when they do in in this community. I'm not from here. I don't have family here. As far as I can tell, there's very little leverage over me. I have a job offer. A lot of the practices right now do not see HMS as competition because of its trajectory. So HMS can continue on the same path, but it won't be able to serve those who need their services. We can't confirm the numbers because they are confidential within the organization. I guess what I am trying to say is that it is time to make a decision of the administrators to do exit interviews. If they talk to the providers, we will tell you why we're leaving, maybe the board ad CEO will start asking the providers what they need, and perhaps they will stay."

Bayard Council Member Frances Gonzales said elected officials have been working on what to do for the behavioral health issues that are going on in the area communities. "Looking at Tu Casa, as one of the places where we were going to have a 24-hour crisis center to be able to evaluate patients and provide them with services and treatment so they could stabilize and then go into a level of care that they needed. I was really disappointed when that fell through. I worked with Gov. Napolitano in Arizona on a program that everybody was talking about that provided care. We have to re-address it and rebuild. What I'm concerned about is that the recommendations that were made in the first meeting really weren't provided back to the community or to folks. The next step is, what are we going to do to provide the mental health services to be able to extend out into some more specialized type of services, such as addiction counseling or for those who need to be housed longer. What kind of other organizations or agencies are we going to work with to get those services provided? Because they may have to go out of Grant County New Mexico to provide extended services that we may not offer. There are different aspects that I'm concerned about, because, as an elected official and working with our chief of police, I know that even in Bayard. our police get very frustrated when they have a mental health issue. They don't want to have to put them in jail. And sometimes we need to protect that person. A lot of our police officers have been trained in some form of crisis, and they want to get them help, not put them in jail. So I think there's some need to review those next steps."

"Is there anybody else who has ideas, about next steps, forward, solutions, and you'd like to speak your mind, speak your heart?" Irvin-Vitela asked.

A psychologist at HMS medical services, said: "What I think is important is to to try to find any way to start to talk again, to listen to every person. I can speak from the perspective of the provider that it's difficult. Many times I experienced, that is my subjective experience, that I wasn't heard, but then I just shut down. It's difficult, but to rebuild any entity and starting from the trust, we need to start listening to other people. So I think that to start talking and focus on communication and listening to each other and meeting each other, and that's the most important, because to get anywhere, and it's not easy to be provider, but it's also not easy just to leave, because it's a decision to come here. It's a choice we make and we have to spend a lot of time, a lot of personal time and resources to get where we are, and you want to use anything we can to do the best we can."

She addressed the woman who had been a nurse in the house, and "you said that it's very difficult. It' is very difficult to work at a Federally Qualified Health Centers for community health centers and I absolutely agree with you as you said: 'it's probably right now one of the worst positions that I love.'"

Irvin-Vitela said she, too, thought it was important for HMS to specifically make time to have listening sessions with employees.

She said that in a couple of days, she would be sending out the notes, both the notes that are in the chat, so "that way the questions and the ideas come back to you all to continue the work, to continue the conversation, to continue the problem solving. I also know that healthcare, I think there's some agreement, both from what we've heard from community as well as what we're hearing from the staff and board of HMS, is that we have some new systemic issues around health care, which isn't to minimize the other concerns people have raised, but to acknowledge the systemic and conversation policies. So it's organizing and advocacy. I just want you all to know how much I appreciate your letting me be here, hearing you and trusting me to give your story and your information back to you, to continue to use your way to look for solutions that are much needed and much desired Thank you all for coming out and giving some extra time tonight."

Board member, Randi Ibarra said she started on the board in 2021, "so I have four years and board experience. But also to Magdaleno, if you don't mind, if you have some ideas for some hard hitting questions that we need to be acting on we're also here. I want the community to know that we're not a board
of yes women. We do like to know exactly what's going on, and we do like to hold our leadership up."

Irvin-Vitela closed the meeting, saying she would appreciate any corrections to the notes she sends out.