Holy Cross staff, former employees and Taos residents laid into Holy Cross Hospital’s administration before the Taos County Commission Tuesday (July 10).
Their angry comments unveiled publicly some simmering resentment that’s built quietly over the last several months against the financially beleaguered hospital, the only one in the county, and its CEO Bill Patten.
Beginning in 2016, one year into Patten’s time at Holy Cross, “some devastating changes were beginning to take place in staffing at our hospital,” said Linda Friedman, a nurse at the hospital for nearly 40 years who retired in 2017. “This resulted in the exodus of many long-term nurses from the community.”
She told the commission that at least one-third of the nurses in the hospital's labor and delivery department have resigned in the last couple of years leaving open positions, “only to be filled by traveling nurses who make three times what our local nurses are paid. As a result, we’ve lost a valuable service.
“I think this sends a terrible message to our community,” Friedman added. “It undermines the fact that this is a local hospital, owned by the county.”
While Taos County owns the hospital grounds and buildings, which were built through bonds approved by taxpayers, the medical facility is managed by Taos Health Systems, a locally controlled nonprofit organization. Patten is the CEO for the group.
“We are literally fighting for our jobs in the emergency department. Cuts are phenomenal,” Martha Miller, a certified nurse practitoner at the Holy Cross ER for eight years, told the commission.
Beginning in October, the hospital ran into tight financial straits and began laying off some staff. Several challenges hit the hospital simultaneously: a new billing system wasn’t working correctly and caused a delay in payments, a switch to a new Medicare model caused more revenue delays and an unexpected bill from Medicaid for hundreds of thousands of dollars in overpayments dating to before Patten’s time. Patten says bad luck and too many system changes that unintentionally landed at once led to the financial problems and staff cuts a few months ago.
Bea Balsamo, a physician assistant and nurse at the hospital for years, told the commission the billing system has been in place for a year and there are still problems. “People in the billing department were not trained,” Balsamo said. “I think there are thousands of unpaid bills out there.
“I think the revenue problems at the hospital have been caused in part by the administration and some very bad decisions made over the last few years,” she said. “I’m hoping our hospital can recover.”
One commissioner who’s dealt recently with delayed billing at the hospital added his concerns to the chorus of voices.
“When you start hearing from employees and staff at the hospital, when you start hearing from the community about what the current CEO is doing, that hurts the very core of Taos,” said commissioner Gabriel J. Romero following public comments. “We need to show the community that we own this hospital and we care about it.”
Patten disagrees with some of the criticism, such as cuts in staffing affecting hospital services.
“The overall staffing ratios have not been significantly changed,” Patten said in an email Wednesday (July 11). “We recently changed our day-shift CNA (Certified Nurse Assistant) ratio to match national standards,” he said. “We have had a lot of turnover for a variety of reasons. While we look for permanent staff, we do hire travelers who cost us about double what a normal nurse gets (and we have to pay for travel and housing). We are not unique in that respect. St. Vincent’s (a hospital in Santa Fe) is currently using a huge number of traveling nurses. There is a national shortage.”
County manager Leandro Cordova said he will be sitting in with the hospital’s governing board as an ex-officio nonvoting member to stay better informed about the issues at the medical facility.
“We are creating a formal liaison position between the county and the board,” Patten said. “Leandro will fill this liaison position and can attend the finance committee meetings, board meetings and executive sessions that have to do with finances. This is an effort to improve the communication between the county and Holy Cross.”
The recent problems aren’t new for the hospital. Under prior management, more than once the relationship among the hospital administration, the staff and the community has soured. A few years ago, the county launched a citizens committee to meet on a regular basis and attempt to resolve issues with Holy Cross administrators.
Many of the financial problems facing Holy Cross are familiar to rural hospitals across the country due to rising costs and an inability to meet those costs with revenues. Across the United States, 83 rural hospitals have closed in the last eight years, according to a study by the University of North Carolina. Commissioners and the community don’t want Taos to be added to that list.
But longtime former employees fear that’s the direction it is headed.
“The hospital I knew as a young pharmacist, that taught me how to be an exceptional pharmacist and allowed me to develop a clinical program, is deteriorating,” said Leslie Ingham, who worked as a pharmacist at Holy Cross for 30 years. “I think a lot of the financial problems are caused by bad management.”
Taos County Manager Cordova told the commission many of the concerns they had heard regarding financial problems at the hospital are accurate. He said at the beginning of May the hospital was still operating on a negative budget and at the end of May had only enough cash to cover 10 days.
He said the hospital board told management to go back to the drawing board, make more cuts and come back with a balanced budget. That included cuts to the compensation package of upper management like Patten.
“I believe that is a step in the right direction,” Cordova said.
Clarification: Linda Friedman said one-third of nurses in labor and delivery had left the hospital in the last couple of years. The original version of this story did not specify the nurses were from one department.