Residents of the Montezuma County Hospital District will choose among six candidates for three positions on the MCHD board on the May 2 special district election. Seeking four-year terms are incumbents Rick Beisel and Lois Rutledge and challengers Remigio Candelaria, Keith Domerese, Marvin Smith and Sheila Wilson. The seventh candidate, Jeanette Hart, has dropped out of the race, although her name will appear on the ballot.

Today the Cortez Journal profiles Domerese and Rutledge. Smith and Candelaria, will be featured in the Tuesday edition, and Wilson and Beisel will be featured in the Thursday edition.

"There is a lot at stake for the community health services, and to be able to play a hand in keeping what we do have alive and growing from that point is something that I want to see and be a part of. Because I am involved with the health-care system as director of Hospice of Montezuma, I can’t help to want to be more involved to make sure it works."

"I feel that in the past two years we have made progress in getting our medical facilities stabilized. In spite of the fact that many people have said two boards can’t work together, I feel that we are working together very well now. We have updated the hospital with the ER expansion and the utility-plant upgrade, and so I want that mode to continue.

"The role of the MCHD board is to monitor SHS’s activities and to provide help when we can; and to provide suggestions and our own theories of what might be helpful and what might not work."

"My first thought would be to make a thorough assessment of where we are and what the board’s role is. From there, I would recommend changes as a team player. I have two ears and one mouth, so my goal is to be a listener and then build from that. I strongly believe that a lot more can be accomplished if we approach it as a team. But that also means respecting those who have been in the trenches, whether you agree with them or not.

"My focus would be not so much the internal affairs of the hospital, but more the role the hospital plays in the community, such as its interaction with the health department, or home health, or hospice, or the senior center. The hospital is not just an entity in and of itself; rather it is part of a community-wide health network."

"A crucial need at the hospital is additional space, so I would work toward that aspect in addition to ensuring that equipment is kept updated. We are the landlord of the operation so we give our input regarding operations to SHS. In the future I would like to see a clinic be established here; however I feel like our first priority is the medical facilities we already have."

Has the 1996 reorganization at Southwest, which put operations in the hands of a private corporation (South-west Health System), been good for the hospital?

"They take care of day-to-day operations, but it is too soon to judge. That will take more time to determine. I believe that the MCHD board is more responsible for guidance and setting the pace for the hospital, while SHS is more the pacemaker. A lot of it is learning more of the specifics, and I look forward to that."

"Once the hospital needs are met we can turn to the health-care needs of the entire district. After this is up to speed and SHS is more financially solvent, then other things should be looked into. But we need to give SHS a chance to work — they have not had enough time."

"I was an employee with Vista Grande as a LPN five years ago. Financially the world is a lot different than it was back then. The constraints that (the industry) has to deal with paint a different picture now. As long as Vista Grande is physically part of the hospital there is an inherent relationship there that is also between both boards, and I think this is an asset that not many nursing homes have. If you have a neighbor that is close enough to pass the salt shaker between windows then there needs to be involvement. In the past that has worked."

"I not sure that MCHD should try and operate it, because we are governed by the Taxpayer Bill of Rights law (TABOR) on the amount of revenue that we can take in. At the moment we only have two options regarding what will happen under the Vista Grande lease with (the management company) Continuum: Either allow them to build a new one on campus or agree to a long-term lease at the current building. Trying to circumvent that contract, then we definitely are liable for a lawsuit, and as a taxpayer I do not want my tax dollars defending a lawsuit. I think that the community would agree."

There has been criticism that executive sessions held by the MCHD board are keeping the public out of the loop on issues regarding taxpayer assets. What should executive sessions be used for?Would you pledge to keep them to a minimum?, and would you comply with the open meetings law regarding executive sessions?

"It’s a tough question because sometimes a public forum can work against forward movement yet it is good to have the public involved for their feedback. So I think that that process needs to be open because if you want to buy into the public, you must have the public buy into you first. The public is the stakeholder, if they are not involved then it breeds secrets and rumors and causes dysfunction. What the public believes, the employees will adopt; what the public thinks of Southwest will be the way Southwest defines itself. We do not want to move forward in reckless abandon, but move forward at a pace the people choose. There will be times for executive sessions, but yes (I’ll keep them to a minimum.) If it is a law, then I think it should not be changed."

"I have complied with the open meetings law, and executive sessions are only called on necessity, such as protecting hospital personnel issues, or contract negotiations where the information cannot be made public. I do pledge to keep them to a minimum because the community needs to be informed of what is going on, even if it is controversial. Kelly (McCabe) is very good at reminding us to keep within the parameters during the executive sessions that we do have."

In the last few years there has been talk of the need for a low-cost community health clinic. What are your thoughts on that?

"There is a need, particularly for the seniors, but also for the children. Nationally 6 percent of children have no health insurance and here I would say it is a lot higher. I think that if you polled the physicians on that they would say that we are not doing ourselves a service by having nothing of that nature."

"Many in Montezuma county need this type of affordable care, and the hospital’s financials indicate that there is a lot indigent-care write-offs. It is more costly for a hospital to take in a patient who does not require anything more than a prescription, than it would cost that person through a clinic. Plus the majority of people who cannot pay put off going to a doctor for as long as they can and this is not good either. Then it costs them much more to get them well, while a clinic could offer more preventative care that avoids this situation."

"In this case I would use my two ears to find out where the key players would want that to go toward. As a new member it is more important to listen than to speak at first. So right now it is too early for me to tell where it should go."

"We need to help those who cannot afford insurance; this mill levy is their money and this is a need many have, so it makes sense to spend it on a clinic if it turns out to be doable."

Residents of the Montezuma County Hospital District will choose among six candidates for three positions on the MCHD board on the May 2 special district election. Seeking four-year terms are incumbents Rick Beisel and Lois Rutledge and challengers Remigio Candelaria, Keith Domerese, Marvin Smith and Sheila Wilson. The seventh candidate, Jeanette Hart, has dropped out of the race, although her name will appear on the ballot.

Today the Cortez Journal profiles Beisel and Smith. Domerese and Rutledge were featured in the Saturday edition, and Candelaria and Wilson will be featured in the Thursday edition.

"I feel like I bring a sense of balance to the MCHD board. As a boardmember for the last four years, I have a knowledge of the issues and I understand how we got to where we are and why those decisions were made. So this is helpful to remind people what we have been doing and where we need to be going."

"Civic duty and because those health care facilities are a very important aspect that need to be supported by the monies of the special district. A lot of people put a lot of work time and money into building this hospital; it is theirs and it is to remain theirs.

"The district board oversees the assets for the community, and the district has a fiduciary duty to make sure the hospital and the (Vista Grande) nursing home do not deteriorate or de-value and are useful. I think that the district needs to keep to the charge laid out in the special-district service plan, which is to support those facilities."

"I would like to put the nursing home issue behind us. The issue has clouded what we as the district board need to be doing, which is to leave the operations with Southwest Health System and to move forward with decisions that need to be made on how to help the status of health-care in the community. One area I’m interested in going back to is figuring out what services are now being provided and what gaps need to be filled, because we have never made definitive conclusions on that."

"The way it is going now I feel that the (hospital operation) should be handed back to the district and I would work toward that if it continues as it is. By the numbers it is not working — there used to be thousands of patients per year, now the patient census is very low. Combine that with high-priced, unneeded management and it becomes just outrageous. The outpatient cost per-person is too high so I would also look into the reasons contributing to that. Right now the price is going up, which means the demand is going down, and unless this is changed we may face failure. Also there is a lot of mistrust right now, and many patients are going to Mercy or Farmington, so that needs to change.

"Some things need to be changed, such as the MRI should not be external to the hospital. Right now it is sitting in a modular and patients are wheeled outside to get to it. The administrative staff should be outside in the double-wide, not the medical equipment. That’s unacceptable."

"Some of the reasons for the restructuring are still viable reasons, so in that regard I think it is working. In another regard it is not working because we are not letting it work, but it is an evolving situation. Take the ER expansion; the district board provided funds for a facility that will help health care in the community, so getting that accomplished has been a good thing and shows there can be cooperation between the two boards. Having leased the facility to SHS in 1996, the district was in the middle of trying to determine what we needed to do and how that could be accomplished when the controversy over the professional office building rose. Those issues impaired the process of deciding on other issues that needed to be addressed. I think that we are back to that point where we as a district board can not only make sure that SHS operates the hospital in an appropriate fashion, but also start addressing other community health needs."

"It has not been working and it impedes progress because there are too many cooks in the kitchen; there is no SHS accountability and the law requires it — that’s the essence of fiduciary law. This has led to a lack of integrity in the work force, and employees are constantly worrying where they will be next week. I have problems with it because it is too management top heavy and this creates a high overhead. They have structural inconsistencies within management that are not being addressed and I do not think they will. As such, failure is determined. I do not want the district to lose because of this. The district handed SHS $3 million in cash, $9 million in accounts receivable; the cash is gone, the accounts receivable is down to $3 million — what is going on? But as a private corporation they do not like to be asked that. An oligarchy type of government, which is the case at the hospital, has never been a performer and that is why it was thoroughly rejected by the framers of the constitution."

"Vista Grande is leased to a management company, and that lease was assigned to SHS during the reorganization along with conditions that certain standards be met. That lease was drawn up before my tenure as a boardmember because the hospital considered it a financial drain for them to do it. Maybe that has changed, but it doesn’t really matter because the district does not have the choice to manage it now. We have two options under the lease with Continuum: either we give them a long-term lease or negotiate for them to build a new one, and building a new one is what the board has decided on pursuing in the negotiations with Continuum, given the circumstances."

"It should be managed by the hospital board because that is the law. It is a district asset and it is the board’s responsibility. It needs to be taken back and I have some ideas on how to do that. If the district was running Vista Grande there would be no corners cut for profit, things would be done strictly for the benefit of the residents. If the state health department finds something wrong, then it is seriously wrong. The tip of the iceberg that they found shows it needs correction."

"Yes and yes on those last two. I can understand why people would be critical of executive sessions; however, we as a board have never conducted an executive session that was not allowed for under the law, or done so for the purpose of hiding anything. There are good reasons for the exceptions allowed under that statute: basically that there are certain areas where it is in the public’s interest for the board to maintain a degree of confidentiality on certain issues. The most common are for personnel issues and contract negotiations. When the board represents one side of a business negotiation, it is not in the best interest for the other side to know what you are thinking or doing. Giving the other side an advantage in the negotiations in the end becomes a disadvantageous to the public. Of course ultimate decisions are not made in executive sessions, that is always done in the public forum."

"Use of executive session is clearly outlined in the law, and that is all I would use it for. I would get up and walk out if it was anything else. If the law is not followed then it brings mistrust in the community. The economics of the hospital is the public’s business."

"This idea has a high degree of merit and would probably be a good thing for the community. There are some issues there that need to be addressed about it competing with the hospital and private physicians, and also how it would be funded. We were in the middle of that when these other controversial issues intervened and we never completed that process. When you look at some of the statistics from the health department, for example, there is a large segment of women who don’t get prenatal care because they are low-income or not insured. So certainly that is where a community health clinic is needed, to take care of children at risk. Also members of the community and different groups have indicated that there is a large segment of our community that is not getting care because they cannot afford it, or uninsured, or unaware. So part of it is an educational aspect."

"This could be done as an outpatient service in-hospital. I would probably support this because it is the right thing to do and it is part of the job of the district where the community subsidizes health care. There is a need; many people do not have insurance and so the cost per patient needs to go down so they can come in for the care they need."

"Again we had been discussing what we could use this for before all of the controversy. What we were learning was that (a recent) court’s decision specified that those mill-levy funds could only be utilized for a health-related facility. Poudre Valley Hospital in Fort Collins, which is set up similarly to us, tried to use those funds for educational programs and were sued by a taxpayer for illegal use of tax money. The courts ruled that tax-funds had to be used for a facility, and educational programs did not constitute a facility. Even though educational programs are an important need for the community, I do not know if we as a district can help to fund them. There may be ways around it, and that is where the board, along with community input, should work to focus their efforts on, but we have never established what those parameters are."

"It should strictly be used to subsidize the operations and maintenance of the hospital and nursing home."

Residents of the Montezuma County Hospital District will choose among six candidates for three positions on the MCHD board in the special district election, to be held Tuesday. Seeking four-year terms are incumbents Rick Beisel and Lois Rutledge and challengers Remigio Candelaria, Keith Domerese, Marvin Smith and Sheila Wilson. The seventh candidate, Jeanette Hart, has dropped out of the race, alth-ough her name will appear on the ballot.

Today the Cortez Journal profiles Candelaria and Wilson. Domerese and Rutledge were featured in last Saturday’s edition, and Beisel and Smith were featured in the Tuesday edition.

"Basically because I think that they need a director that is going to show concern for the entire county’s health-care needs. Right now the board is concentrating on the nursing home and the hospital, but they are neglecting other health-care issues that are the responsibility of the district. Other problems need to be looked into: senior citizens without health insurance, single mothers with kids without insurance, the immunization problem, teenage pregnancy problem, and so on. Putting money into the hospital was needed, but I think that it was too much one-sided — there are other county needs too. A lot of residents do not use the hospital because they do not have insurance."

"To serve the people, and because I feel very strongly that there will not be enough representation for the people during the negotiations on the nursing home lease. In other words, I feel that negotiations on many things are not slanted toward the peoplebest interest and I would like to help to change that around. Since (former board member) Jo Tipton left office, the people have not been served as well as they deserve; on the other hand for some on the board, special interests take precedence over the people.

"We the people have no idea what is going on unless we listen through the window."

"The primary role I would work toward is the overall health-care needs of the county, not just the hospital and nursing home. There is a mentality of ‘us against them’ on the board. The constant politics and division needs to end and I would promote that change. I feel that everyone should have an adequate shot at obtaining health care. We have a great system here, but not everyone is getting the care they need. Doing this collaboratively reigns in the cost, too, because more than one or two groups that are sharing the work and costs. We make a mistake by narrowing defining health care as just what goes on in the hospital and nursing home. All of the meetings that I have gone to in the last seven years have addressed either the crisis at the hospital or nursing home."

"One of my priorities is to find out where our hands are tied with Continuum. The public needs to know what Continuum is demanding of the hospital board. I’m not saying all of the hospital board, but when you have four members who are ready to give Continuum everything, then it is not balanced, and I think we need more balance.

"I would like to see SHS become a non-entity and return the assets and operations back under MCHD governance. Then, the very good and experienced people on the SHS board now could run for positions on the MCHD board next time around. Also I want to protect that land on the campus, and I am concerned that a part of it will be granted to a private physician for his use to a private practice. This is not right, because the land belongs to the people of the district, not special interests. Also, I would like to see more communication between the district and the Medical Society. The doctors, nurses and technicians know what needs to be done to make a better hospital."

"With the current SHS board it runs quite well. I think that they have basically got the organization out of the red, are meeting the financial ratios, and have managed to save $2 million in investments which has not happened before, so it shows good fiscal responsibility. I can’t say the same for the district board; they had tax dollars but never did anything with it until the hospital needed it for the expansion.

"With two boards there is great opportunity right now. There are things that SHS can do that the district board can’t and vice versa. With SHS responsible for the hospital operations, the district board has a better opportunity to address the other health issues in the county, which they have neglected to do."

"It has not been working, and the reasons it was formed are not valid today. The hospital operations and leased assets need to be returned to the control of the MCHD board as a base of the hospital. SHS does a fair job of running the hospital, but let’s put it this way: if both the SHS and MCHD boards are represented by a single string, it is easy to break one or the other. Intertwine those two strings as the one entity it was before, and it becomes much more difficult to break.

"The intent of SHS forming in the first place was to take advantage of a special district loophole that allowed SHS to utilize the district assets and land to back up a revenue obligation bond that they wanted to float in order to build a medical office building. As we all know, that plan was shot down by the community and the county commissioners because it was irresponsible. SHS is supposed to improve the hospital, but they do not have the money so they come to the district for funding so it seems that they are unnecessary."

"One of the prime directives of the district board is to see that the nursing home is managed right, and that the residents have a safe, healthy environment. I do not see that there would be any loss in revenue to the hospital if SHS were to run Vista Grande. Again, we could shore up the money we may lose from not managing it ourselves with more community partnerships that would help satisfy the needs of those residents. My concern is for those residents, not whether or not the money is leaving the community."

"First off, the nursing home should have never been leased. There should have been a management contract, and the MCHD board should have always been in control. Profits going out of the nursing home could have been well spent in this community by going back into the nursing home. A management contract is preferable to a lease because it keeps Vista Grande in the public eye. A lease contract with a private, for-profit group closes down the avenues for information concerning that taxpayer asset."

"The reasons for going into executive session are very specific, and I would adhere to those rules. There are a lot of issues that you probably could go into executive session for but you really do not need to do so, and that is the criteria I would use. I think that the MCHD board have used executive sessions a little too liberally because they do not want, in some instances, to have companies like (Vista Grande management company) Continuum to know what our cards are. Sensitive contract negotiations and being sued are pretty much the only reasons to ever go into a closed door session."

"Executive sessions were enacted for personnel problems, or for sensitive contract negotiations. The road easement request across taxpayer land by a private physician that I wrote to the editor about should have been put out in front of the people. There are too many executive session being called with the MCHD board. There is no need for most of those closed-door sessions. I feel that many of these executive sessions are simply gab fests. Ironically, I can get more information going to an SHS board meeting, a private corporation, than I can from the public MCHD board. The MCHD have even denied the people who want their letters to the board about a concern read in open session. If the people want it read in public, they have a right to have that happen. It hurts the community members ... it is like a slug in the gut."

"The health clinic probably is not economically feasible, but there are ways to fill the gap by tapping into available programs and organizations, private and public, that already exist to help. You have got to incorporate existing entities that are willing to help do this."

"A community indigent clinic would be a very good thing that needs to be looked into. I think it would work. There are people who need help in this county because they fall between the cracks. Let’s give back to them."

"On a periodic basis, a certain percentage should be taken out of that and put toward upgrading equipment. Or the board should enter into partnerships with the county health department to help start a immunization project for kids, or for an early screening program, or for programs involving the school health. There should be a concerted effort between both boards to put that money toward making health care more available for those in the county who need it, but can’t afford it. This takes the pressure off of the ER, which is often the last resort for those who do not have access to care. I am not saying it should be free, but it should be affordable and available based on what people can pay, and it would also help get into programs that also help defer some of those costs."