BOARD MEETING 02-22-2022 C & Q

On February 22, 2022, RMCHCS Board Members held their monthly board meeting. The comments and question are listed below along with the answers listed accordingly.

Logistics:

1. Can we expect to get written responses to prior comments/questions submitted? I emailed you about this already and did not get a response from you.

Answer: Because so many questions are duplicative, we generally will respond to thematic questions.

2. Can the board please explain how the online price estimation tool works? I have used it to attempt to calculate services in the past and it never even comes close to what the hospital charges patients.

Answer: This is a complex tool which RMCHCS did not create; CMS designed the tool. If you have a sample service you would like to calculate, please let us know and we will assist you. Otherwise, if your intent is to price compare against multiple institutions, we suggest you contact CMS for an expert who works regularly with the tool.

3. Can the board please explain why the cost of services are more expensive at this hospital, compared to other hospitals around the state that have higher ratings and perceived higher quality of care? Given the median income of this community, the cost of services at RMCH are completely egregious.

Answer: We appreciate your opinion. We strive to maintain market sensitive pricing. We are in the midst of an update to our charge master. Moreover, pricing is often a function of realistic reimbursement rates from insurance companies and government programs, and regrettably, the system is not always sensitive to local economic factors.

4. Can the board please speak to the recent public announcement that only one support person is allowed in labor and delivery? Doulas should be seen as part of the professional care team, not a support person. I would like to see the guidance updated to include that language. Now that the state mask mandate has been updated, I recommend RMCH immediately update their visitation policy.

Answer: Thank You for your input on this important matter. We rely on guidance from various public health agencies when determining these processes.

6. Would like a detailed answer: Why was Dr. Lauber not allowed to enter the hospital for the last board meeting, a public meeting and he was escorted out of the building. Why did this happen?

Answer: This is a personnel matter and we never discuss such publically, especially when a litigation is involved.

7. Patients and community members are frustrated, dismayed, concerned, and scared by RMCHCS leadership's response to the issues at College Clinic and other serious patient safety issues and healthcare inequities. CHAG is submitting the following suggestions to the Board of Trustees to help strengthen communication and rebuild trust between RMCHCS and the community it serves.

RMCHCS has an obligation to alert patients and community members to hospital systems breakdowns.

Plans for infrastructure improvements need to include plans to avoid or mitigate disruptions to hospital services. It is not acceptable for a planned phone system upgrade to result in two months or more of non-functioning phones at a family medicine and pediatric clinic.

Communication about either planned infrastructure improvements or unplanned infrastructure issues needs to include more than a minimal explanation and as well as a concrete timeline for resolution.

More importantly, temporary workarounds and/or stopgap measures need to be implemented immediately when unforeseen issues arise, and those solutions need to be shared immediately with patients and community members.

Temporary workarounds or stopgap measures need to include a way for patients with urgent issues, or for whom those measures fail, to escalate their issues.

Communication requires consideration of accessibility for vulnerable patients, including those who live far away, who do not speak English as a first language, and who are elderly or who do not have reliable internet service.

CHAG would be happy to facilitate a small focus group of patients to help trouble-shoot communication and to work with RMCHCS administration to find patient-centered solutions to issues.

Moreover, we believe that RMCHCS could remedy its relationship with the community and position itself for success by implementing formal mechanisms for community accountability and input. So far, CHAG has routinely invited hospital leadership to engage with the community with openness, honesty and transparency through hosting town halls, by submitting comments and questions to the Board in advance of Board meetings, and by emailing administrators and Board members. Yet the administration and Board have not responded in kind.

CHAG would be happy to support the Board in improving public relations by:

Making regular public reports about issues of relevance to the community as proposed by Mr. McKernan in October in The New Mexico Source.

Answering questions submitted to the Board at Board meetings.

Reorganizing the Board of Trustees to represent local interests and reflect the diversity of our community, with a transparent process for Trustee selection that includes meaningful opportunities for community input, including a presentation of candidates with an opportunity for questions and input by the public.

Forming Community or Patient Advisory Board, which can bring community concerns directly to hospital leadership, can provide patient perspectives and inform solutions, and can provide the community accountability necessary for the equitable provision of health care;

Enabling access to members of the Board of Trustees, whose contact information should be made publicly available so as to allow for open dialogue with the community.

We hope you take CHAG up on its offer to facilitate dialogue for the benefit of the hospital and the entire community.

Respectfully,

CHAG Core Committee

Answer: While we are not familiar with who the Community Health Action Group is in terms of a local authority, we appreciate some of the ideas proposed in the commentary.

8. Concerned of the retention of physicians and nurses for RMCHCS.

Answer: The turnover rate at RMCHCS is comparable to that of general hospitals during the pandemic.

9. Personal Experience:

· Took 2 months to get in touch with her provider, took 3 months to schedule a mammogram, care delated by 5 months. Was also promised a call back by the provider in 24 hours, but that never happened.

· Community member complaints:

· They have had 3-4 different primary care doctors since she left. (high turnover)

· Some have not seen a provider at all since she left.

· Previous board meeting questions that have not been answered:

10. Did we find out why nurses have left?

Answer: We offer exit interviews for all exiting employees.

11. What is the progress for the 2022 Implementation Plan for RMCHCS?

Answer: If you are referring to the Community Health Needs Assessment, we are in the process of updating a new one given various complex issues such as the pandemic and staff shortages.

· Current and former employees have experience retaliation (based on her community survey.)

12. "The community built this hospital. We own this hospital. We've subsized the operations of this hospital to the tune of tens of millions of dollars. CHC was hired with the express purpose of managing the hospital and rebuilding trust between the community and the hospital. Yet it has done the exact opposite. The hospital is being mismanaged and wrecked and being made into a target for a cheap takeover. The phones at College Clinic didn't work for at least two months, and that's just the tip of the iceberg. CHG is operating the hospital without a working code button system on the Med Surge Peds floor. Doctors have been harassed out of their jobs and entire departments and units have been gutted. The hospital had a positive cash flow of $4.5M in 2020. CHG announced a $9M loss just a month or two ago. That's a change in financial condition in the scope of just one year of $14M. The hospital is falling apart in front of your eyes and around your ears. The Board owes the community not just an explanation but an immediate halt of the wreckage and reversal of course on this catastrophe."

Answer: We value your opinions, but the facts do not bear out your assertions. But thank you for your views.

Criticisms:

1. Point of Order

There was no roll call of board members

No review/acceptance of previous minutes

No introduction of members to the public

Answer: RMCHCS is a private not-for-profit corporation and not a governmental body that most follow open meeting laws. We voluntarily follow some parliamentary practices of open meeting laws.

Suggestions and Improvement:

1. Emailed a list of recommendations:

Formation of a patient advisory board- community members can take their concerns.

Efforts for local physicians to form a federally qualified health center because community members do not have primary care doctors. Dr. Wangler was told this was a conflict of interest. The community would like to know why?

Answer: Any employee and board member has a contracted fiduciary responsibility to RMCHCS. This is a common employment practice.

2. Would like to see progress/fruition with the Family Medicine residency program.

Answer: The Board and management whole-heartedly agree.

3. He came from a meeting that stated there was little support from Administration for the Family medicine program.

Answer: Administration strongly supports the residency program.