Work Session Meeting June 10, 2024

MINUTES

Work Session

Monday, June 10, 2024 @ 1:00 PM

City Council Chambers, City Hall

PRESENT: Councilor Johana Bencomo, Councilor Yvonne Flores, Councilor Becki Graham, Councilor

Becky Corran, Mayor Eric Enriquez, Councilor Cassie McClure, and Councilor William

Mattiace

ABSENT:

1. JOBS OF THE WEEK 1.1 Sarah Raney, New Mexico Workforce Connections presented Jobs of the Week. Councilor Becki Graham moved, seconded by Councilor Johana Bencomo, to allow Councilor Corran to participate via Zoom.

RESULT: Carried

MOVER: Councilor Becki Graham

SECONDER: Councilor Johana Bencomo

AYES: Councilor Johana Bencomo, Councilor Yvonne Flores, Councilor Becki

Graham, Councilor Becky Corran, Mayor Eric Enriquez, Councilor Cassie

McClure, and Councilor William Mattiace

2. PETS OF THE WEEK 2.1 Amy Defelix, Animal Services Center of the Mesilla Valley presented Pets of the

Week.

3. AGENDA ITEM 3.1 PRESENTATION OF THE LAS CRUCES PUBLIC LIBRARIES MASTER

PLAN

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Carol Brey, Director Quality of Life introduced the topic.

Brad Waters, Godfrey and Associates Consulting gave the overhead presentation.

Councilor Bencomo said the salary for libraries really stuck out to me in your presentation. Can you share with us what that range is right now and are librarians' part of the blue-collar union or not unionized?

Brad Waters said not that I am aware in this state. We do recognize you did have a compensation study done and has elevated a lot of those salaries. We will put that into a cost model we have to tell you exactly how much it is going to cost to staff these future libraries and we will add in the benefits and everything so you know exactly what it is going to be but you saw the difference between your salary of 53 and the peer average is 74, again those are from Colorado, not from Texas, mostly from

Colorado and other places in New Mexico.

Sarah Booth, Library Deputy Director said our librarians come in, our regular librarians start at $43,500.

Councilor Bencomo asked those are folks with master’s degree?

Sarah Booth said correct.

Councilor Bencomo said that is very, very low. That is embarrassingly low.

Sarah Booth said yes, it is, and we are very lucky to have such wonderful staff.

Councilor Bencomo said yes, absolutely. Staff salaries have been a longtime priority for myself, and I know for this council so I am glad that you are raising that issue, and we will certainly follow up with the City Manager about that. That is very concerning to me. Can you speak a little bit more about the Library Foundation? I am not familiar with that kind of model, and I think if said if its legal? Did you say that, or had I misunderstood you?

Brad Waters said the Library Foundation is clearly a 501(c)(3), so if would have to be formed and actually I believe when Carol was Director there was a Library Foundation of what had been formed.

Councilor Bencomo asked under the city?

Brad Waters said no. It was a nonprofit individual, independent thing.

Carol Brey said in approximately 1997/98 we formed the Library Foundation, and they were a separate 501(c)(3) organization. The Friends of the Library at that time were not as active and I forgot to mention we have our Friends present out here today. You probably noticed people wearing purple are out here. They are very active, and they have been actively raising funds, but a foundation can dig in a little deeper and look at

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longer term financial goals. Look at capital campaigns, look at what we need for long term planning and as Brad mentioned also look at the estate funds we already have and make the most of those funds. So, we don’t know if somehow that organization might still exist on paper, and we are looking into that.

Councilor Bencomo asked what is the city’s role in something like that?

Carol Brey said we have a similar situation with our foundation of our museums for example. The museums have a foundation now and so basically, they have a board.

They meet on a monthly basis, and they report to the Deputy Director. They work with our Deputy Director for museums, and I am involved to a certain extent in working with them, but they basically work independently but in tandem with our goals and our objectives and they understand that when they come to the board.

Brad Waters said the best model is an advisory board that volunteers in the community but that they hire development personnel, development professionals.

Usually, it is one individual who is a fulltime, that goes out and knows how to ask people for money especially the wealthy people or corporations, etcetera with probably a halftime or parttime clerical person as well. So, their salary is based on how well they do but they are overseen by an advisory board. Those foundations will raise in the millions of dollars in a year when they are up and running and being part of a capital campaign is a good way to start one. So, if you decide that you want a bond for a branch library and I will use this as an example then having a Library

Foundation up and running and then they can piggyback on that and raise money privately and help maybe furnish or do whatever to add that capital money on that campaign.

Councilor Bencomo asked can you just repeat a little bit about what you said getting it from the national average to 85% to 95% or something like that, can you give more context to that?

Brad Waters said when we look at library funding and when we look at what comes from local government, what comes from state government, what comes from federal government, what comes from other sources. Other sources is private, mostly it’s the

Friends of the Library, if there is a foundation then that would be there as well.

Nationally 95% of public library funding comes from local government revenue. You get state money and you get a good amount because of your population size the way it works in New Mexico but because I think you rely on the Branigan and the other endowments you have our concern is that nest egg is shrinking faster than it should and so if you are going to increase staff salaries, whatever you can raise that 85% to

95% and have a foundation that safeguards the nest egg and grows it and then that would be ideal.

Councilor Bencomo said I wanted to thank you for including the question on the raising of the GRT. I know we are having a very tough but important conversation around some of that so I appreciated you showing the support that this community would show for public libraries. I think it shows the importance and how loved they are in our community and under invested so I appreciate that as we head into that

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conversation soon and then of course and maybe this is for the City Manager, but I assume any sort of capital expansion to the public libraries would also qualify for a

GO Bond question possibly? He says yes, thumbs up. I know we are two years from that I definitely want us to have that at the top of our heads as we go into the next GO

Bond cycle and what that might look like for the library.

Councilor Flores asked you mentioned that there is an endowment and who controls it and how does it work and who oversees that and why is it shrinking? Is it something that can be invested?

Sarah Booth said back in 1935 Alice Branigan generously donated money to the City of Las Cruces for a library. Since that time the library has been using the money that she left for us to purchase books. I have been here a year and half, and we don’t have a dedicated line item in the city budget for books. We are using the endowment left from Mrs. Branigan very generously from Mrs. Branigan for books. So, this endowment is shrinking because this is our source for materials.

Councilor Flores asked is the endowment limited?

Sarah Booth said it is limited to buying materials for the library. We could not use it for a capital outlay project.

Councilor Flores asked is there a restriction on having a fund that builds on that endowment? It seems to me that when there is money that is going to shrink, you look at how it won’t shrink.

Carol Brey said what I have seen other libraries do and actually Brad may know something about this as well, he probably does. When there is an endowment like that, and many libraries do have those because if you think about the Carnegie

Library as in other libraries that are in the world mostly in our country that have been established by some generous patron. There is often money that goes a long with that and it’s amazing that we still have that endowment here actually. I will say that our goal would really be to build up that endowment as an investment towards the future and this is where a library foundation would come in. A library foundation could raise additional funds to allow us to get to a point where perhaps we would only use the interest off the Branigan endowment.

Councilor Flores said it does explain. My question is why hasn’t that been done before? It is almost like we’re running out of gasoline in our gas tank, and you passed up all these gas stations and now you are in the middle of a desert. It is not a criticism it is just an observation and a comment.

Carol Brey said I would just say that was the goal of having a library foundation originally when I was here as the Library Director. I don’t know what has happened over the years since exactly. Obviously, the foundation doesn’t exist anymore so for whatever reason, perhaps it was not successful, or it was not thought that it was needed but many public libraries in the country do this kind of thing, so it is pretty common.

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Brad Waters said when I talk about legality, I would assume there would have to be some sort of legal transfer of that money from the city to a library foundation. That is when I mentioned the legality of the foundation. That is what I was talking about.

Councilor Mattiace asked have you looked into partnering with the Community

Foundation of Southern New Mexico?

Carol Brey said that is an excellent suggestion and actually that has been suggested to me by, I still have ties with the El Paso Community Foundation when I worked there, and I am actually in a rotary club with the head of the Community Foundation here so that has been suggested. We have not looked into that yet but that would be an option I would think.

Councilor Mattiace said it would be good. They are very effective with campaigning and helping with running bond issues and like Dr. Flores mentioned help with the investment of any balance left in your endowments. I hope you do that.

Carol Brey said we appreciate that suggestion. The reason I know about the El Paso

Community Foundation is because they are currently working with the Foundation of the El Paso Public Libraries to do what you are suggesting.

Councilor McClure asked going to the foundation what would like look like in terms of creating it? Would it be a resolution from our end or what is the mechanics of that?

Carol Brey said in the case of the ones I have been familiar with you bring together individuals who you know, have a strong interest in the library, have a strong financial background, have the interest in creating a foundation that would actually help build the structure for the future and we worked with an outside attorney at the time that when I was here before to get our 501(c)(3) status and that kind of thing and just go through the normal process of establishing a nonprofit corporation. Now the museum’s foundation, I don’t know if Rebecca wants to speak to it a little bit. The museum’s foundation that we have currently in placed followed a similar procedure as

I understand it.

Rebecca Slaughter, Assistant Director of Quality of Life said the Museum Foundation is more of a friends board but yes they went through the same process and they have a Memo of Understanding with city so that they can fundraise on city property and fundraise for the museums adjacently and then they use those funds either by giving them directly to the museums for a project or one of the biggest projects they have done is that they went to the state legislature and asked for funding to repair the caboose that sits next to the Railroad Museum and then they gave those funds directly to the city through city council then the city’s Public Works Department then spent that money as a Public Works project to work on the caboose. So, it depends on what the project is and how that works, how those funds are spent and how they are raised but if the foundation does the fundraising at least the museums fundraising on city property the MOU covers them and they don’t have to come to city council every time they do an event or go out and say that they are doing it for the museums

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and it works very well in that process and if I can speak for what I know of the

Branigan Estate one of the impediments in the past or the discussion has been because there is a very strict restriction on that funding the discussion has just been about mudding that water and I think that would just be the legal issue that could be taken to Legal Department and then having that discussion about breaking that trust to change it to a different type of funding and also Alice Branigan was really awesome and actually paid for the building of the Branigan Cultural Center and building the

Branigan Library, not just books but now it is just books.

Councilor McClure said I am thrilled to see the support that you have got here. What would that look like in terms of creating that bookstore? I am a big fan of seeing that, how quickly could something like that get implemented?

Brad Waters said we actually had a discussion this morning about getting a temporary space going as soon as possible maybe as early as this August. The members that used to run the bookstore before it was termed not viable, were making maybe about $100,000 a year by selling books on a daily basis. Maybe four hours a day, four to five days a week and that is not uncommon for places that do have an ongoing operation.

We have seen bookstores that rival half price books, 2000 square feet but you don’t need that. Initially I think we can carve out about 500 square feet in the library now and really make a difference in the revenue stream and that could be done with shelving that we already have that is surplus.

Councilor McClure said I find it slightly horrifying that it isn’t a line item because I know the cost of books are incredible especially journals and things like that are very pricey. I think people don’t know necessarily all services you all offer but also what you pay for them, so I think explaining to what that is and asking for that funding. I am down to support the library as most of you all know but yea, I am looking forward to this expansion. What would that look like? How quickly can we get something like that together?

Brad Waters said I think we have a decent concept. We will share that with you in the final report. My hesitation is with current financial fiscal climate in the country. Every

December Library Journal Magazine publishes a list of all the buildings that have been renovated or built new in the public libraries in the country and this last

December we count the numbers and cost per foot for new library construction was about $700 a square foot. So, if you talk about adding 21,000 square feet to Branigan now, that is just adding the new space you are looking at a $20 to $22 million project.

That doesn’t include renovating the other space that is there so a Branigan renovation and expansion would be $25 to $30 million. Brand new 35,000 square foot branch, prototype branch library would be about $25 million in today’s dollars and because of the inflation situation it is really hard for me to warrant those numbers as much or very far into the future. I am a licensed architect to practice in Texas and Wyoming and looking to get my license in New Mexico. I would love to design of renovation or expansion of the Branigan building. I have grown very fond of it. It is a really cool building and it was a really cool concept when it was designed but it has been kind of

Frankensteined with all of the additions that have happened to it and where there was natural light coming through the building originally it has all been covered up with new

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construction so I think a timeline you would have to look at six months to a year in design and another six months to a year in construction drawings and a couple of years in construction. So, a two to four year start to finish, from design to cutting a ribbon.

Councilor McClure said the last thing I would say is if we are not fans of having Texas doing it better, think of the amount of how many are in El Paso. How many branches do we have in El Paso, 12? They are a bigger town than us but if you want to reflect what our values are in terms of the services that it provides and it is just not books, it’s workforce development, it’s all the things you guys mentioned. That is what we value, do you know off the top of your head?

Carol Brey said yes, I believe they are at 14 libraries. I think that is 13 branches and the main library currently.

Councilor Mattiace said we have so many local great authors. I just met Lynn

Underwood, Denise Chavez. That would be a great place with the bookstore for signings and it would probably draw a lot of people to the library.

Carol Brey said thank you for that. Yes, I think that is the intent. Our library has always worked with local authors, but you are right we have some amazing ones here and showcasing them and having a place to do that is always really important.

Councilor Flores said I just want to thank you Ms. Brey and Ms. Slaughter and the

Friends, I am a Friend of the Library too by the way. Libraries are just the life blood for, and I know I as a child it was really my oasis. Going to the library was probably the most wonderful thing in my life and the love of books and my mother, may she rest in peace was a reader. Just being in a library and looking at all those books and reading and reading and I think it is just the life blood of society of a community. It really opens paths, it opens your heart, it opens your eyes, and it is inspiring. So, whatever we can do as you can see, I think you have a favorable council here that is very pro-library. I think for a building we could probably get a GO Bond or capital outlay. I just really want to thank you all for the work you do.

Mayor Enriquez said I would also like to say thank you for the presentation. Thank you for the information as you can see you do have the support up here at council.

This is long overdue, and this is something that we would like to see to move forward whether it is a capital outlay request or the GO Bond or as a GRT as we look into increasing, I feel this would truly be a critical infrastructure that is much needed for our community as the pin states, Strong Library Strong Community. I thank you for the pin and thank you all for being here today to show the support that you have for our library and thanks again for the presentation.

3.2 MEMORIAL MEDICAL CENTER OVERVIEW. John Harris, CEO Memorial Medical Center gave the overhead presentation.

Mary Armijo, Chief Operating Officer Memorial Medical Center continued the

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presentation.

John Harris continued the presentation.

Councilor Bencomo asked does MMC have things like Quality Score Cards that the hospitals measure certain outcomes on, whether it is patient outcomes, patient safety, patient satisfaction, staff satisfaction, and safety?

John Harris said we have a very elaborate and comprehensive cancer program at

Memorial Medical Center and one throughout Lifepoint I might add.

Councilor Bencomo asked did you say a Cancer Center?

John Harris said no, a comprehensive quality program.

Dave Schmidt, Chief Nursing Officer said yes, we do. We use national standards for our Quality Programs through HCAHPS which is a measure thousands of hospitals use in the nation to measure patient experience in nursing communications, doctor communications, and so forth. We also have a national program through Lifepoint that measures our infection rates, falls, and a bunch of other quality measures as well making sure that we present a quality program to our community and our patients at

Memorial.

Councilor Bencomo asked how often do you collect that data?

Dave Schmidt said it is collected monthly. We report out monthly, we report out through a whole hospital committee called Patient Quality and Safety Committee and anybody from the board is invited to appear on Teams or in person. We also post it on

Units for personnel to read and also it is available for patients. These are nationally reported things through CMS and through other national quality programs that look at our reimbursements.

Councilor Bencomo asked can you share any of those with us, any of those data outcomes?

Dave Schmidt said specifically I just want to do an overview that. I have been here about a year and a half. I came in January 2023, and there are two reasons why John brought me from Pennsylvania to New Mexico. Number one was to open up the

Behavioral Health Unit because I have experience doing that and working with behavioral health and also to get our Quality Program back to where we needed to be from the effects of Covid. Through Covid most hospitals around the nation saw about a 3 to 4% decline in their quality scores, Memorial is no different. So, I was brought to build our quality program back up focusing on infection rates, focusing on falls, focusing on readmissions, and then also focusing on patient experience so that when they leave our hospital, they want to return to us because we present a great program for them and also a great environment as well.

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Councilor Bencomo asked are you able to share some of those score cards with the

City Manager that he can then share with us?

Dave Schmidt said yes, and we do have our monthly board meeting with our member which there are some present as well.

Councilor Bencomo asked do you have today numbers on hospital revenues for the last several years that you can share with us?

John Harris asked which specifically are you asking about?

Councilor Bencomo said I am curious about hospital revenues and more specifically on how some of those revenues are invested back into the hospital system.

John Harris said as I mentioned in my presentation, and we invested last year alone $9 million in the facility through a variety of different technologies. The other thing that we invested in as I mentioned before I think we probably had the most aggressive physician recruitment and advance practice recruitment program in the region.

Councilor Bencomo said I think I am asking specific numbers for revenues because I don’t know, you said $8 million in capital improvement and in our asset agreement there is a specific piece in here about the hospital committing to capital expenditures, lessee shall make annual capital expenditures in the operation of the hospital which an amount shall collectively average between 4% and 5%. So, $8 million sounds great but I don’t know if that is 4 to 5% of what is agreed.

John Harris said well the national average of reinvestment in hospitals is 1 ½ %, it is not 4 times that.

Councilor Bencomo said that is what is in our lessee agreement.

John Harris said and we talked with the city and the county about that some period of time ago about what do hospitals invest and they just don’t invest in equipment and buildings as they invest in bringing doctors to the community, bringing nurses to the community, bringing advanced practice practitioners and we bring about 35 to 45 practitioners at an average cost of about, when we recruit a doctor is about three quarters to one and a half million dollars each and then there is a loss thereafter maintaining those physicians in the community and we have 28 clinics of practitioners throughout this community and in the region. So, you just don’t invest in equipment you invest in a variety of things including software applications, electronic medical records that are in the tens of millions of dollars.

Councilor Bencomo said I know you don’t just invest in capital improvements but that is specifically in the agreement that we have with you and that is why I am asking about it.

John Harris said what was recognized at the time, I am just telling you by the City

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Manager Robert Garza and also county was that we end up investing in a variety of different things to help this community have better care. So that is very large and complex question. I would be happy to sit down on another day and discuss that with you in detail.

Councilor Bencomo said I would love that, absolutely. You know in 2020, the last time you all were here the conversation we had at that Work Session was regarding the capital improvement plan and the hospital was requesting to lessen it to 3% and I don’t believe that ever came back to council for an official vote. So according to the agreement that was made many years ago that is still between 4 to 5% so I understand that it is $8 million in investment, but I would just like to understand what that is, how much that is.

John Harris said the only thing that I would ask you to recognize is that I think between all of that is that we had a worldwide pandemic that hadn’t caught our attention for four years so.

Councilor Bencomo said I think the other thing that has changed in the last few years is that MMC was also acquired by a private equity firm, Lifepoint and so it is not just the NBC article that came out recently and I did my research and there is tons of articles out there about the concerns that equity firms pose to local health care and I just wanted to read you a couple of these because I think and you said the pandemic impacted some of these quality control issues but this Journal of American

Association article of 23 says, “private equity acquisition is associated to increased hospital acquired adverse events including falls central line stream blood infections along with a larger but less statistically precise in surgical site infections”. That is from

JAMA, the New York Times reported something similar and then Business Insider as well. So, I am curious to hear from you on what your perspective is on how hospital outcomes have been impacted since Lifepoint acquired MMC.

John Harris said I am going to tell you I have operated hospitals for 50 years in a variety of different states. I have never worked for a finer company than Lifepoint and that includes from the top to the bottom. They have never asked me to do anything that was inappropriate. They have always asked me to do the right thing for the community and you saw what the core values are. I think we would be well served by not letting outsizers cast dispersions on a hospital, an institution that has been here in operation for 70 years, we have been here for the last 20 of it and I can tell you that I have worked for less than a hand full of hospitals in this world and I have worked internationally and they don’t pay me enough to tell you what I am about to tell you.

This is an outstanding manager owner and operator of hospitals. Don’t let anyone dissuade you from that. If you want an answer to a question about what the care is here, whether it be quality, whether it be any other aspect of this you call me because

I will tell you the truth. I will not try to dissuade you in any other way. This is an outstanding hospital. It is only going to get better, believe in it, support it and you will save lives. Not only for this community but throughout this region. So, in my judgment

NBC didn’t do a good job, they came in here for other reasons. It was not really about

Memorial Medical Center. It was an obstacle in the way and what I am telling you is the truth. This is a great hospital, and it is going to get even better. You have a person

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sitting with your City Manager and always have at that board that has input as into how that hospital is managed and does the county. Let’s work together, lets believe in each other. That doesn’t mean that we pass over issues or things that we are challenged by, whether it is cancer care, emergency care, or whatever, and let’s bring great quality care to this community. That is what they deserve and that is what I am here to provide.

Councilor Bencomo said I appreciate that, and I am glad that you said that because I think that really means that we are on the same page about what we want for our community and I think for me that means that sometimes having to ask tough questions, right? The majority of our job as elected officials has to happen in public, right? I cannot operate privately in private meetings just with you. The things that I learn in my own research to do my job well I want to ask those things publicly because that is how change happens, right? Please don’t see this as a call out but a call in. In order for us to do better work together and one of the reasons I am saying that is because I had a bit of a wakeup call when I read this other article about through private equity stakeholder project which Apollo is the Global Management

System for Lifepoint, right? Apollo’s stronghold on hospitals and one of the quotes in here specifically talks about Las Cruces and it says, “in August 2022, Lifepoint’s

Memorial Medical Center in Las Cruces, New Mexico closed its psychiatric ward citing staffing shortages. According to the hospitals lease with the city and county and the termination of psychiatric services could be grounds for termination of the lease though city officials have not yet taken any action against the hospital.” This particular article calls me out. It’s calling us out, right? For our inaction to ensure there is accountability in our partnership and so I feel now like perhaps the city and perhaps the county, It won’t speak for the county but certainly the city maybe has been asleep at the wheel maybe just a little bit. So, I am just taking more responsibility in my role as a city councilor for our constituents because we have the same goals of providing quality care to our folks and in preparation for this meeting last time you were supposed to be here in April I took a whole Sunday afternoon and read through most of the agreement which as you know is hundreds of pages. It wasn’t super exciting, and it wasn’t super sexy reading, but I went through it and I made certain notes on here that I think that are really important for us to remember and some of those specific ones are about indigent care. In volume one, part one on page 13 specifically it talks about the policies for treatment of indigent patients comparable to those presently in effect in the hospital. I just basically talks about the commitment that the hospital is making to indigent care and I hear you say today that we will not turn anyone away and you at the top level are saying that we won’t do that however at the community level and I am not talking about outsiders I am talking about residents and not just one or two but continuously residents that have said I have been turned away.

I have been turned away for my status as an insured person and so whatever the reason and so what do you think the discrepancy is between the information that you are sharing with us today and the information that we are hearing from our residents.

John Harris said I talked about earlier about the complexities of health care. I can assure you. Lynn Fletcher for example, most of this discussion is around cancer care.

Lynn Fletcher has won every humanitarian award there is to earn locally and earn nationally. In terms of her professionalism and how she runs that cancer center. She goes through great length to try and qualify anyone who comes to our door. There are

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always stories behind the stories, and I would say to you that we have researched every one of these that have come to our door. We only know of maybe two or three that are even questionable. We have had inside parties, outside parties research these but if anyone in this community has a complaint, a legitimate argument for something we have done or not done we apologize. If we have not done the right thing, we are always interested in talking with you. Again, what I am telling you today is that we go to great lengths to serve the population not just in Las Cruces but throughout the region and sometimes that is at the cost of a great deal of money. But you want the same thing I want and that is what this company is based on quality safe care because the way I view this, anyone of us could be the next patient that comes in to the that ER with a heart attack or some other major problem, so I want you to know who runs this hospital, it’s me. It is not Apollo. Local operations are run by me, and I am always available to each and every one of you. Chief Story knows this, and we met each other when I was at the chamber meeting and others of you know this. So, the point being is that we are available to each other. We don’t need an NBC reporter or anyone else in this country outside of this community to come to us and talk about our health care system. If you know something, a friend, or someone else that has had a problem with Memorial Medical Center, I can’t answer for three crosses or

MountainView but the buck stops at my desk so you call me, and I will give you my cell phone number. I am not going to state it publicly but I am going to give each of you my cell phone number so you can text me, you can call me and if you want a meeting with me all you have to do is call and I will come over to your office.

Mary Armijo said so for all the quality reports that you are asking for we will go ahead and provide the information that you need. We also obviously work with Ikani so we can filter that through. Ikani, if you would like we will send them to you directly.

Councilor Bencomo said thank you I would appreciate that follow up and I hear you sir. I also cannot discount that the Journal of American Medical Association is a trusted source for information regarding our health care system and when they are publicizing information regarding equity firms and the serious decline of care, quality care for our patients that these acquisitions have brought, I hope that you understand that they raise justifiable red flags for me and that is important for me to talk about here. Again, I think this is an important next step. I understand that these are tough questions, but I don’t often have the chance to have you in front of me so when you are I want to ask them. There have also been narratives in our community regarding staff concerns. Staffing concerns and the quality of safety for staff and I want to make sure, and I hope that those score cards also include staff surveys that we might get. I think one of the pieces that Ms. Armijo presented at the end was about specialty care.

I am curious if you have any response to the concern that even though you are bringing this very specialized care that some of these services further jeopardize our community by subjecting them to inappropriate procedures at high costs when not necessary. Additionally, I am wondering if any of these services are at the expense of providing a central services like general surgeries, behavioral health services, primary care OBGYN, emergency care, or cancer care?

John Harris said we don’t do that. We are a highly professional organization. We are not unethical, and I know there isn’t anyone, there are people that are trying to this whole PE discussion trying to convince people that somehow or another or these PE

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firms run these hospitals. Believe me Apollo that owns Lifepoint does not run

Memorial. You are looking at who runs Memorial, it’s me. I don’t do things like you described and those are irresponsible comments being made to you in the community and they all deserve reputation on a fact-based basis, none of that is true. I wouldn’t associate with an organization that does that.

Mary Armijo said like I said when I got here and I did an assessment on the community and looking at just cardiology alone when you look at the data for example just out of our own hospital there was over 1,800 patients diagnosed with AFib, which means irregularities of the heart and heartbeat and so when you don’t have an electrophysiologist here at your hospital able to take care of it what was happening is most people were either having to leave Las Cruces to get care or go to El Paso or not get care at all. The majority of patients in this area do not get the care that they need that is why we built the program that we have today so when you look at other specialties such as general surgery, oncology, and you know we have a full line of general surgeons at our hospital that continue to see patients. Medical oncologists are very difficult to recruit. We have lost a couple of our medical oncologist over the years but that is very high specialty, they are very hard to find and so having to recruit to

Las Cruces is difficult. We have talked a little bit, I have spoken to the Mayor before we want to be able to sell Las Cruces as a destination to come here but we need to be able to show that we have schools that are able to support their children. We talk about all the things about Las Cruces and why you want to come here, low crime rate, it is a great place to live. The cost of living isn’t expensive but then again with the item that I talked about earlier with Med Mal Capitation, that is going to be extremely difficult to recruit those high need specialist. So, another example is ear, nose, and throat for this population of 300,000 people we have 3 EMT’s in this community. That is also another high specialized area, it is very difficult to recruit, and it goes on to GI, radiation oncology, and that is why as John had stated before we need to work together to make sure that we are able to recruit to our hospitals. So, it is not that we don’t want to provide services and we are very fortunate actually to have the doctors that we do in cardiology. It took me 16 months to recruit our medical director over to this program and when he realized when he got to Las Cruces and I did I showed him all of the data because we were so under served and what he realized is that people take it for granted that when you are in metropolitan area that you have the specialists that you need at your fingertips but in a community like Las Cruces you do not and so as difficult as it is do you want to continue to provide the services that we offer.

Councilor Bencomo said tension like this builds when there is a lack of communication and lack of transparency and so this is just an invitation to have more of those conversations. Like I said I have talked to our new City Manager about making this a priority and so I will make sure that I am no longer asleep at the wheel when it comes to the partnership of, such an important partnership of our community and so this is just an invitation for us to have some tough and courageous conversations but certainly to keep having them so that we can address some of these community concerns that I believe are very valid and better ways to address them.

John Harris said one of the things you have to appreciate that we like most hospitals really locked down during the Covid pandemic. We were doing all that we could to keep up with that. Our entire focus was on that. Prior to that there was a lot more

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communication between the parties. You referenced earlier a meeting you invited us to we immediately said to the County Clerk that we were unable to attend that meeting at that time which is how this meeting got set up. So, there was never a meeting scheduled that we did not show up for that we agreed to be at. We are always available to you for the most part it is just that we have busy schedules just like you do. So, we are happy to accommodate you in any way that we can but these kinds of irresponsible dispersions that are being passed in this community, there is no truth to these. We stand for quality safe care. This hospital earned the highest award that Lifepoint has to offer in Las Cruces. For first and foremost quality, how it treats its employees, how it works with its doctors, how it integrates with its community and lastly that it is financially viable. Apollo does not run this hospital, I do and I run it with everyone that is sitting here before you and many other dedicated people that live in

Las Cruces, respect Las Cruces. They take care of their friends, their neighbors here.

That is what we are about. We have our antenna up for any type of procedure done by any type of specialist that is here and if it’s not appropriate we are talking to them.

Believe me that is policed in any well managed hospital which Memorial Medical

Center is. That kind of thing is not going to go on under my watch but what Mary referenced is what we are trying to do is that there are patients that have gone on without being diagnosed properly and there have been issues in this region but what we are doing is we are taking health care from here to here and the individual for example in cardiology, he is boarded in six different areas of cardiology practice. He is our Medical Director, that is who you have got that is at our side when we are looking at cardiology. We are going to do the same thing in every major specialty for this community. So, take the time, call me, make an appointment, you want to talk we can sit in the board room at the hospital, and we will answer any of the questions that you have about any aspect of how Memorial is run. It is a hospital you should be proud of, believe me I am.

Councilor Corran said I appreciate you all presenting today and I am really interested and a lot of what you said was trust me and talk with me and I am really just here to ask for the receipts because that is what we are asked for and so typically I think

Mayor Pro Tem eluded to some of your safety reports and I think frankly these need to be presented at a public meeting. So, I’m going to not accept your invitation, but we would invite you back for a formal. I think I am interested in a number of the things

Councilor Bencomo mentioned so specifically I would ask that we have another public meeting. I would like to schedule you all to come and present some actual data and information for us and I have a few specific asks I am hoping that you can do that, and

I don’t know how many months it might take you to develop that, but we can hopefully schedule another Work Session, specifically safety related data as Councilor

Bencomo mentioned. I would also like to know of the charity care, I would like to see that broken down in two ways. One, the types of things being compensated for charity care and the demographics of folks who are receiving that charity care. So both of those facets of the $53 million that you eluded to and then the last part is related to specifically to continuity of care and not just moving forward and we will have to speak to the City Manager in terms of how this is presented or if this is presented at the board meetings but I would like to see the continuity of the types of care that are being provided for instance, basic surgery, coverage, how often are folks being referred out of town because of the lack of staffing or some of the staffing issues that

Councilor Bencomo eluded to. I would like to see some specific data about that as

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well because I think it sounds like you have really beefed up your cardiology and acute care for cardiac patients and that’s great but of course we know that there are a number of other things that are sort of expected especially as part of our lease agreement. My first ask is that we plan another meeting, and my second ask is for those specific data points that we can share them with the community again and not be asleep at the wheel in terms of paying attention to what kinds of services you all are providing.

Councilor Flores said I want you to understand that this is not an attack on you. It has to do with the fact that as city councilors we are the frontliners for everything. We get it all, but this particular issue is disturbing to me because we used to have a Health

Policy Review Committee and we would have people come in and one of the councilors I believe who started it Jack Eakman and he was a hospital administrator and he was in the audience and I don’t see him, he’s gone. The concern right now is that patients who are indigent are not being treated humanely. People who don’t have insurance aren’t being treated humanely. I know that when I broke my ankle a year ago it was like my world fell apart. I couldn’t get around. I was incapacitated and then I think if I found out I have cancer and I didn’t have coverage and the stories we are getting from different people, different sources. I went to Medical Memorial, say my coverage Humana, whatever I have wasn’t good enough what would I do? And adding insult to injury not having the hospital say well look you are indigent, or you don’t have insurance, or we don’t take that insurance or whatever, but this is what we will do, we will work with you. I haven’t heard that from Mary, Ms. Armijo, or you. What do you do in terms of someone coming and you can’t provide the service and in this case, we have a lot of people in our community with cancer which is probably a fall out of the trinity bombing, so what do you do?

Laura Thomas said I oversee our eligibility team. We have a very large eligibility team.

I have six people that dedicate their workday only to ensuring that we have eligibility.

Councilor Flores asked if you could just go through the process?

Laura Thomas said one of the things that I felt was most unfair about the article was that it portrayed our teams that work very hard and work with people who get the C diagnosis.

Councilor Flores said I did not read the article, I am talking from experience of people who have come to us.

Laura Thomas said what happens is that someone is going to come to our door, and they are going to say I don’t have insurance. I don’t have a means to pay. The only way that they are going to get to our door is because they have a referral from a primary care practitioner. So that is how we get referrals to the Cancer Center. We also get referrals out of the Emergency Department. That is why I was talking about that other group of people, the six people that I was talking about because we actually place them in the Emergency Department to see which patients are coming to the

Emergency Department and do not have a primary care service provider. So, we can figure out how can we provide a primary care practitioner to that population.

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Councilor Flores asked what if they don’t have any insurance?

Laura Thomas said we also pretty much hold their hand trying to help them get into some type of insurance plan. For people who are part of Better US citizens they can go through the expanded Medicaid process, so we provide them with education and application processes and resources to do that.

Councilor Flores asked you have to be a US citizen to receive medical care?

Laura Thomas said no, I am talking about getting a resource for insurance. So, there is also an option for undocumented noncitizens called the New Mexico Insurance

Pool. We worked really hard to become members of that insurance pool so that we could provide care for those patients that needed insurance through that insurance option or resource.

Councilor Flores asked the behavioral unit on the fifth floor was closed down because of Covid but I was closed down for a long time, why is that?

Dave Schmidt said when I arrived at Memorial in January and the department was closed since November and we had closed down because we had lost providers not so much staffing. We did not have doctors, nurse practitioners to provide medical care and the psychiatric for these patients that they needed. We had some staff that stayed in the hospital that were then kind of moved to other units to keep them employed at

Memorial if they wanted to be there. Other behavioral health nurses decided to leave because they were not sure when we would open it up again. Trying to recruit like

Mary talked about a psychiatrist care to New Mexico or just try to recruit a psychiatrist to a hospital is very difficult. There is a very small pool to try and pull psychiatrists in the United States and like they talked about it takes at least six months to get a doctor licensed, their DEA certificate from a different state in New Mexico that is why when we went down that route and had some roadblocks and get psychiatrists to come to

New Mexico. That is when we reached out to the PEAK and Mesilla Valley to see if there was anyway to partner with that already established provider pool. Which the

PEAK came out. We talked about two or three months we had to do a contract with them which again takes time between both the facilities and the PEAK and our facility as well and then have that provider come in and train our EMR credentialed, making sure that when they go through credentialing, all of their paperwork, their medical checks, make sure they went through the right school and have the right abilities to provide care, the hospital is there and that takes about two months in itself. So again, it was a process that we were working on every single day to make sure we were helping this unit as much as possible and then we found the providers we had to make sure we had enough staffing to do this as well which we started conjunction the last three months of that conjunctioning process.

Councilor Flores said we are all aware that there is a shortage of doctors, physicians in the state of New Mexico. Apropos of that do you have a lobbyist that goes up to the

Capital, Santa Fe to ask them why they are raising, I know Dr. Devastali, is and I know there are other doctors to who have just decided to retire because as good as

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they are and as wonderful as they are if you don’t have medical malpractice it is impossible to practice. So does your organization, does Lifepoint, Apollo, they are pretty powerful you would think there would be a lobby that would work with the legislators of our respective states?

Dave Schmidt said we do have a lobbyist that goes up and State Bill 75 is something we would like you to take a look at and offer your support to that to the round house.

When we talk about lobbyist also there is a lobbyist for plaintiff attorneys as well. In the state for malpractice cases. Again, that is a very strong lobby as well so any support we can get from the county and city council we would really appreciate that.

Councilor Flores said that is an issue to, but you didn’t mention that as a factor and to the shortage of doctors. I know two of my doctors have gone to El Paso and two of my other doctors were already in El Paso we because we didn’t have them here.

Mary Armijo said if you look in the packet that we gave you we actually included the actual bill so that way you guys can familiarize yourself with the bill because the med mal caps are high. It factors only two insurance companies now that are willing to ensure physicians in the state of New Mexico and so when we talked about some of our specialty services, another area is urology. There is an independent urolgy group here in Las Cruces and we actually had four urologist that were practicing at

Memorial. One has elected to leave Las Cruces and go to El Paso fulltime and which we are down to three which two of the three are down to retirement age and so we will then be down to one and she is contemplating whether to stay here or not because of medical malpractice because they have to pay for that out of pocket. We have the ability as a larger corporation to cover medical malpractice for our employed physicians which is a benefit for this community but not every physician who practices here in the state of New Mexico has that. We just wanted to make sure you guys are very well aware.

Councilor Flores said it is interesting though that to me that is an obvious factor in providing services and again I want to state that it has a lot to do with caring for people and the people we hear from feel that they are being pushed aside so just keep that in mind in terms of how you and I am not criticizing you I am just saying that those are definitely bonified concerns.

Mary Armijo said access to health care is just going to become more difficult in the state of New Mexico because of physicians leaving the state so we are not only impacted here in Southern New Mexico but also in Northern New Mexico it is the same case because they are a very overwhelmed system there so our goal is to continue to recruit in physicians and specialist and you know we have a team of recruiters that helps us with that but again it is really selling them to come to New

Mexico to practice but that is a barrier for us is med mal.

Councilor Flores asked being part of Lifepoint, being part of Apollo do they work with local hospitals and doctors to make sure that medical mal isn’t prohibited?

Mary Armijo said yes ma’am. We have a team that works with us that will help us with

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all of the assistance that we need with medical malpractice and getting physicians here however you know with like I said there is only two now insurance companies that will provide medical malpractice insurance for the state of New Mexico it is becoming a little bit more narrow but it’s very expensive.

Laura Thomas said I just want to make sure that everyone knows that it is just for hospital services center with Lifepoint. Apollo has no operational responsibility for our site. That name keeps getting brought up. That is a funding source that is not an actual operational company.

Councilor McClure said I guess I am echoing some of the sentiments that have already been expressed out here. I was hoping there would be a little more specificity to how your strategy is with some of your economically disadvantaged population, our heavy uninsured population and I look forward to hearing more about that specifically in the next Work Session. What I would like to hear a little bit more about is strategy in terms of care, Medicare is ranking you 2 out of 5. Tell me how you are aiming to change that rating?

Dave Schmidt said in reference to our quality scores and what is publicly reported and the time frame that they are reporting that is usually lagging by about a year, year and a half in some with some of these scores. So, for example with the CMS scores most of the scores are drawn from 22 to probably the first part of 23 just because of the amount of information that comes into Medicare and also to another organization called Leapfrog which looks at a rating from A to F. A lot of information that we are viewing online on hospitalcompare.gov is old data and what we present in our board meetings and PCCQ is the running 12-month data because that is data that we really want to see as we improve our scores from back in June of last year to May of this year.

Councilor McClure said that means that you had a strategy to change that. I have not seen any reporting from any of the offices so at that point how have you lifted yourself up from that rating?

Dave Schmidt said one of the first things I did when I got there was an assessment of the hospital and the culture and what we call the culture of safety. How safe do the nurses feel when they come to work because that translates into safe care of the bedside and we do an internal survey called a Cozy Score which just looks at that survey of culture in our hospital. When I first arrived, we were at 82% of our staff taking that survey which is a fantastic number for a large hospital like ourselves. This year we actually raised it to 83% of our staff members. So just over 1,000 staff members told us how they feel about working at the hospital about our safety program which is really important because then they give us specific information about how they feel working, what we can improve upon, and also what we are doing good on.

So, I took that information and really looked at what can give us the best bang for our buck in a very short time frame and that is what we call a harms reduction or something that happens to a patient we don’t want that to happen, infections, falls, urinary tract infections, and so forth that we deal with on a daily basis and also patient experience. What I focused on was those harms. This is process driven. That was the

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first year that we really increased those numbers. We decreased falls, we decreased infections, and now we are turning that attention to patient experience, nursing communication, doctor communication, that is more culture. As over the last year we have seen our harm’s number go down and those infections go down we are now seeing in the last four months, Ikani will see that in our presentation those patient experience scores starting to come up because there is different sense in the nursing staff, in the staff that are non-nurses, and have a lot to do with that patient experience.

The dietary folks, the EVS folks, facilities folks, the radiology folks but have interaction and have a big impact on the patient so when that patient leaves, they want to come back to our hospital because of the experience. We look at best practices and local hospitals in our environment and also we talk to our sister hospitals. There are 50 some other hospitals that we can then share ideas throughout the country and do what is best for our patients.

Councilor Bencomo said I hope that we walk away here knowing what the NBC story was lifting up wasn’t a criticism on your front line staff which I am sure are doing their best under what they believe the rules are, what they believe procedures are that they have to follow when they are having their interactions and so I don’t want it to be a walk away that there was a criticism. I did not receive it as a criticism of your staff. I received it as a criticism of a much larger system in place and I think I just also lastly want to say that I understand that it is difficult to receive criticism, trust me. I understand how difficult it is to receive criticism and sometimes you have to swift through a lot of noise to get to the core of why people are really frustrated and right now there is a very legitimate conversation for us to be had about frankly the system we live in which is for profit health care in this country and that is having a very serious and real impact on the people in our community and that is the conversation that I hope we continue to have in good faith because this is a good and important partnership and we want to make it better and stronger and I hope that is what we walk away with here today.

Mayor Enriquez said I just want to say thank you John for attending and delivering the presentation today. I want to mention to council if there is any additional questions, data information, please relay that to the City Manager. Ikani will then get with MMC and see about a future Work Session with some of those items. I think we are definitely all on the same page of what we want here in this community is the best health care that can be offered to our residents, and I know you are working at it. All the staff in front line to everyone and so continue and that there are a lot of partnerships that you do in the community. Just a week or two weeks ago sponsoring the Superintendent with his State of the District Address, those type of things as we talk about what we can do to better this community so that we can get better health care. I look forward to seeing you again. 3.3 A LAS CRUCES INNOVATION AND INDUSTRIAL PARK (LCIIP) UPDATE

AND PROPOSED CHANGES TO THE INDUSTRIAL PARK OVERLAY

ZONE. Elizabeth Teeters, Economic Development Director gave the overhead presentation.

Sara Gonzales, Economic Development Project Manager continued the overhead presentation.

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Councilor Flores said it makes a lot of sense in terms of the types of businesses and everything. So, when it comes to the sidewalks to the businesses would they be responsible for paying just the way developers do when they are building homes?

Who would absorb that cost, would it be the city, or would it be the business?

Sara Gonzales said currently right now the way the code is written it is up to the developer to install and so unless a waiver is approved by city council for an applicant to come in and not do sidewalks into a development that is up to the city to basically to say yes or no to. Code does require for every developer just like in any subdivision would come in and install sidewalks. With that also being said though there is also the provision that if the sidewalks are now installed and have gaps, we have to look at maintenance as well as the cost because once the sidewalk is installed then the city is to maintain it because it is now part of our right-of-way.

Councilor Flores asked so depending on how the parcels are sold it may be a patch work of sidewalks and no sidewalks, gap?

Sara Gonzales said that is correct. Right now, we see sidewalk gaps because we do have several parcels that are already developed and so that portion of those parcels would not be complete that would be up to essentially the city would have to come in and do those improvements.

Councilor McClure said if we are trying to draw in perhaps international connections are you considering how industrial parks look over there? Just as sort of a side, a couple of years ago I went to Nuevo Leon in one of their industrial parks and it was very walkable actually. There were a lot of people who were walking to get food, our hotel was in the industrial park. So, if there was consideration of looking at what international customers might be interested in too that is just side note more so then anything else.

Sara Gonzales said that is something that we can look into. I did not research that as part of the research and just knowing of what we have in our environment as far as when we look at landscaping, the irrigation. If we want to install the sidewalks, we definitely need to be looking at the landscaping that is going along with those sidewalks because we don’t want it to be where you are walking and it’s just natural vegetation, we would want to see the tree canopy extended as well.

Councilor Bencomo asked regarding the sidewalks on the southside we had recently a request for some sort of appeal from Loves so is the recommendation that we, I am assuming that we are coming back with that appeal that we say no and the conversation that I heard at least the last time that we talked about Loves that at least the part of the inside of the park that we did want to see sidewalks? I think we wanted to see the park developed so that it met the needs of the people who work out there, who probably don’t have the luxury to come into downtown for lunch during their lunchbreak because it is so far away and so the desire was to develop that and certainly with the understanding that it is an industrial park but that it also has people there and so I am just curious about if I had heard that right or if we are sort of making

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that assumption about Loves and the request that they had made from us earlier.

Sara Gonzales said our main resource is to give you more information to decide what is going to be better developed for our park and so we are providing recommendations based on studies that have been provided, the actual traffic that works through there. We are also currently working with the business owners. We had started reaching out to them to see if the sidewalk is something that they wanted to see in the park. Second of all is it something that they would be willing to install if the city were to maintain it. So that we would understand what kind of cost we would be looking at because of course if it doesn’t get installed now then that does come down to the city installing it and the cost coming down to the city and so those have to be those recommendations. We are looking at the park from a design of the north side and south part are two different ideas as to what is being developed but overall, it is if we have all this information what do we want to see as a city. We can understand and basically installing that on that northside because you will have that walkable space where you are walking to something, and not necessarily will I be and personally me am I going to be walk across the highway or am I going to stay on the southside. It depends on how far yes people want to walk, what are going to be the services provided for them to walk. On the south side we only have a limited amount of commercial and that is what I think changes the actual property. Based on our zoning map these are our commercial parcels right here. Everything else is considered industrial at some point and so most of our commercial is going to be that north side so this may still end up being that heavy truck traffic that is going through there. In speaking with one of the actual business owners out there they actually referred to not having sidewalks. They would actually rather have stop lights on the corners due to truck traffic right now and so we are learning a little bit more I think from our business owners who have actually been in the facility and have had to work out there and see what their needs are and so those may be some of the infrastructure needs that we need to start looking at.

Councilor Mattiace asked the money that we are going to be spending for sidewalks, that would be from the companies that come in and the reason I bring this up is that you mentioned wastewater gaps, electrical gaps, would it be better to concentrate on those gaps? In reading the New Mexico Border Inc., I was down in Santa Teresa for eight and half years, I noticed Grants, New Mexico is getting a 7 million square foot manufacturing company. I noticed Albuquerque and Rio Rancho and Roswell are getting huge manufacturing companies. Is there a possibility that if we provide and fix the gaps for water and wastewater, electrical, and build the platforms, the foundations for the factory to go up right away would that be advantageous to actually recruit more businesses to the industrial park?

Elizabeth Teeters said yes. So, our focus actually has been on those infrastructure gaps and so the congressional earmarks if they come through or if we get the EDA

Grant that is where we would like to use the funds because that is what is actually going to bring the business in. The overlay zone is for when they actually decide to locate here and to start working on their facility and it is going to be whether these businesses are coming in have to build those sidewalks or not or whether we feel they need to. That is kind of two different conversations. It is getting them here which is the infrastructure gaps and then once they are here what do we want to require that they

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have to put in when they locate here.

Mayor Enriquez said I agree with staff’s recommendations that the sidewalks be used on one side and then it varies depending on the businesses on what is coming in and how it is going to be used but thank you for the presentation.

4. ADJOURNMENT 4.1 Councilor Johana Bencomo moved, seconded by Councilor Yvonne Flores, to

Adjourn at 3:57 p.m.

MOVER: Councilor Johana Bencomo

SECONDER: Councilor Yvonne Flores

Graham, Mayor Eric Enriquez, Councilor Cassie McClure, and Councilor

William Mattiace

ABSENT: Councilor Becky Corran

Mayor

City Clerk

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