County Steps Up: Town Steps Back: Holy Cross Spanked

Vox Populi

For political scientists, who study local government and their quasi-public-private partners, Tuesday, Sept. 24th marked a seismic shift in Taos County government. Taos politics can be as complicated as the complex geology below ground in this valley, floating on the slowly-shifting Rio Grande Rift, which threatens, say geologists, to tear the earth apart, come another million years.

But here above ground in Taos Valley—in a completely transparent manner—Commissioners Dan Barrone, Gabe Romero, and Larry Sanchez, at the urging of their constituents, implemented new policies aimed at bringing the community closer together, collaborating, ever so politely but firmly, with the Town of Taos, state and federal agencies, their political partners, Questa, Red River, and Taos Ski Valley as well as Holy Cross Hospital.

At the Tuesday joint meeting, the Taos Health Systems board d/b/a Holy Cross Hospital and Quorum’s itinerant management professional, CEO Hofstetter et al got “the Taos lesson: don’t be screwing with the locals.” When Taos County Chairman Barrone runs for Mayor of the Town of Taos, Commissioner Gabe Romero will make a fine county commission chairman. The spirit of democracy, long since demolished in Washington D.C. and barely aflutter—if at all–at town hall, flies 24/7 at the County Complex–like the flag in the county-owned central Plaza of the historic district. There’s a new sheriff in town, folks, called the Taos County Commission. He’s a democrat named, vox populi.

E911-Dispatch  JPA

First, commissioners adopted a Memorandum of Understanding (MOU) with the Town regarding a proposed joint powers agreement (JPA) aimed at managing the controversial E911-Dispatch operations. As if he had a moment on the road to Damascus—a come to Jesus moment—Mayor Darren Cordova, who has pushed away his partners and terminated the current JPA in a semi-successful effort to relocate at the expensive and ill-designed Kit Carson Command Center, said, “We have to work together.” Cordova reminded commissioners that problems occur when the PSAP (Public Safety Access Point) is “owned by the Town” and that a JPA, managed by professionals, modeled on successful management principles, should make decisions. Say what?

Commission Chair Dan Barrone put it more succinctly, saying we have a “health, safety, and welfare situation. Our citizens need to get services when they need it.” Indeed. Vice Chair Gabe Romero asked Attorney Bob Malone to outline the MOU, a preliminary step in creating a JPA that assigns appropriate decision-making power to the JPA or new “fiscal agent” once instituted, which entity would ultimately make decisions about “location” among other contingencies. Chairman Barrone invited representatives of Questa (Mayor Garcia) and Taos Ski Valley (Village administrator Mark Fratrick) to comment, both of whom expressed interest. Mayor Calhoun of Red River expressed her community’s desire to remain working independently on its own state—assigned PSAP.

Ancianos

Then County Manager Steve Archuleta briefly outlined a proposed reorganization of the federal-state Ancianos program. The program has been troubled by administrative problems during the last few years. The state has urged the County to take it over. Archuleta said there were three options: 1) do nothing; 2) act as fiscal agent for the board; 3) bring it in house. The County proposed that the Town transfer ownership of the Taos Ancianos Center on Lovato Place (across from the Complex on Albright St.) to the County. The Town agreed and Mayor Cordova promised to continue some form of town support. Chair Barrone mentioned the importance of the Ancianos’ food and exercise programs, programs that serve seniors in Taos, Chamisal, Amalia, and Questa. The state department of aging has served as the federal pass through agent for the program but the lack of local oversight by a citizens’ board has compromised the administration of the program.

Camino del Medio

And the County and Town also agreed to collaborate on a proposed community development block grant (CDBG) proposal aimed at securing funds to redo Camino del Medio in both the town and county.

Holy Cross Conundrum

Mind you, the scene above played out in front of a packed house at the County Commission chambers. Most of the audience had come to hear county and town representatives discuss the troubled state of the Taos Health System’s troubled Holy Cross Hospital, a hospital managed by Quorum Health Resources, a Tennessee company, which cost the 501 © 3 non-profit board, according to its 990 tax form, almost a million dollars in management fees. In addition the non-profit board pays another $300,000 to CEO Hofstetter and $185,000 for Chief Financial Officer Eisenring (almost $1.5 million if you’re counting).

CEO Hofstetter presented a point and click slide show on the multiple screens in the chambers, while discussing a decline in revenues and patients, the upsurge in federal scrutiny and continuing uncertainty, due to the effects of Obamacare, federal sequestration, potential government shut-down, and other federal-state unknown unknowns. All in all, there can be few more complicated endeavors today than trying to manage a hospital in an environment of tight budgets and financial complexities, due to bureaucratic rules governing county, state, and federal reimbursement, not to mention the presence or absence of patients with and without insurance.

Indeed, one might think a collaborative discussion might take place among the staff (nurses, technicians, doctors), the executives and the board before making decisions from one day to the next to lay-off 44 employees and disrupt services for ICU patients, etc. According to Hofstetter, a claim confirmed by nurses who testified, Holy Cross rates very high in terms of patient satisfaction.

Commissioner Gabriel “The Good” Romero insisted on hearing from staff at the meeting, a sentiment that echoed with town councilor Michael Silva and all the elected officials present. Apparently, a sudden change in policy by the hospital board and administration from a Monday to a Tuesday resulted in a decrease in the number of ICU beds, which caused patients to be airlifted out (at $30,000 a crack) from Taos to other communities, and induced wear and tear on families and staff.

Nurse Martha Jaramillo of Union 1199 mentioned how she had taken a $5,000 pay cut last year, which did little good. She said there was no “accountability,” when it came to the “board” or “administration. Decisions are made behind closed doors. It’s a community hospital. Everyone should be involved.” Nurses and one pharmacist doctor testified about the sudden disruption in their health care “family” and the destructive effects on patients. One professional said she mentioned to CEO Hofstetter that due to  layoffs, try as she might, she couldn’t clone herself or be in two places at once—but he cracked wise in response. “You better learn.”

By the time the Holy Cross health care family finished testifying, the community, elected officials, and the board and administrators learned that a “flexible” and “transparent” approach to reorganization could save money and save lives as well as wear and tear on family members forced to accompany relatives to out-of-town health-care facilities, due to what appear to be unimaginative policies dictated top down by an uninformed board and executives more interested in the bottom line than in health care collaboration.

Sure, all the elected officials, staff, and families of patients had high praise for Holy Cross, including potential town council candidate, Jerome Lucero, who said how his family had been well taken care of at Holy Cross.  And Taos County Assessor Darlene Vigil testified that her first grand child recently born at the HCH facility was well cared for by nurses, doctors, etc. But five days after release, her family was notified of test results that required immediate hospitalization. Then the infant was airlifted to UNM Hospital, Albuquerque: it cost $12,000 for the ambulance ride to Taos airport; it cost $47,000 for the air flight and another $12,000 ($71,000 total) for the ambulance from the airport in Albuquerque to the hospital. All the while Darlene praised the nurses and staff but she also mentioned how Taos County government has prospered and become more effective due to “transparency.”

(Attorney Bob Malone, armed with three ring binders, sat catty-corner from Gabe at the four-cornered table and forum of officials.)

So here comes Ms. Nancy Jenkins, 30-year THS English and drama teacher, retired, now a volunteer at HCH. “I always tell my students to ask the dumb question,” she said. “Who owns the hospital.”? Gabe turned to Bob Malone: “The county owns the buildings and some of the equipment and leases it to Taos Health Systems, Inc. It’s run by a nonprofit” with Quorum as manager, said Malone. He also mentioned provisions in the lease for a 180-day notice of termination.

Then Nancy asked how the board was selected. In so many words longtime President Ron Burnham said members were nominated for four-year terms at regular intervals in an effort to preserve institutional memory and give new members time to learn the complex nature of the operations.

What Burnham didn’t say is that the board is self-selecting and nominates folks, according to geography in the community, not according to their resume, say, a retired health care administrator or professional.  The rubber-stamp board functions much like the gerrymandered KCEC Coop, wherein board power is concentrated in representatives from the villages and towns outside the greater Town of Taos area. The Quorum CEO manages the Taos Health Systems board similarly to the way CEO Luis Reyes manages the trustees at KCEC.

In the past, the HCH board refused to nominate a county commissioner, fearing populist politics. When town mayor Fred Peralta served as President of the board back in the early double aughts, HCH/Quorum administrator Kean Spellman and his hatchet man, in collusion with Peralta and town cops arrested and handcuffed union 1199 representatives while they dined in the hospital cafeteria. They were fined by the town’s municipal court for allegedly violating the collective bargaining negotiations, a negotiation the union ultimately won at NLRB hearings.

Back to yesterday, Burnham told Jenkins that “none of these decisions have been reached in a vacuum.” Nancy suggested the hospital board include members of the work force.

Commissioner Gabe Romero said, “I appreciate Ms. Jenkins, she was my teacher 30 years ago.” He continued, saying since the people of Taos County own the hospital and people are going to other hospitals, it’s time to “review the lease” and set up a task force on the hospital. Commissioner Sanchez noted how important the operation of the hospital was to his community, Questa, given the dangers at Chevron Mining, etc. and noted the testimony, point by point of HCH staff. Commissioner Barrone, ever fair, friendly, and diplomatic suggested a need to “enhance communication, make some additions to the board,” including employees or union members.

Taos Health Systems, Inc. President Burnham immediately responded that “union members” on the board were a no, no and employees were problematical due to complex “conflict of interest” issues.

Mayor Cordova, playing catch up (all day), said the town wanted to be involved in a county task force that looked at the hospital. The motion to set up a joint task force passed both the county and town unanimously. Prior to its passage, Commissioner Gabe “The Good” Romero had the last incisive word: “We need to look closer at the 180 day notice” to terminate the lease. Termination can occur with 180-day notice without cause, according to Attorney Malone.

Here’s the message: It’s time for this hospital board and administration to shape up and listen to staff and citizens or the county will wield the big stick as they have been forced to do in response to unilateral town declarations re: the Emergency 911—Dispatch JPA, or due to messiness and a weak board at Ancianos, or board neglect and outright corruption at the Taos County Housing Authority. This is a county commission and staff that know how to govern and work for their constituents.

Tuesday was amazing. The political power in the community shifted completely from town to county. Old Fred Peralta didn’t have a word to say about his protectorate, Holy Cross Hospital. Not one active medical doctor, per se, testified. Surgeons were MIA. Maybe they had their surgical gloves on and were working on patients the way commissioners, work gloves on, were reviving the vox populi with transfusions of democracy.

On another note, members of the art and writers community in Taos are not so high as politicians and staff are on Holy Cross Hospital: “Take me anywhere but there, I don’t want to die” is a common refrain. Oh yes, they say, “It’s also a good place to die or get screwed.” I wouldn’t say it if they didn’t say it.