Miller talks about hospital, mill levy
The parking lot was full at the Los Lunas administration building and the council room was packed to with a standing-room-only crowd Tuesday for a question-and-answer session with Darin Miller of Miller Architects about the proposed Los Lunas hospital.
After an hour in Los Lunas, Miller traveled south to the Del Rio Community Center in Rio Communities, where he spoke before and took questions from an audience of nearly two dozen people.
At both forums, Miller did a bit of a backtrack of his previous statements that the taxpayer-generated mill levy was not critical to the development of the Los Lunas project.
Miller said the firm’s study on needed medical services in Valencia County was greater than he initially anticipated, and therefore the support of the mill levy money is needed more than he originally thought.
On Sept. 19, Valencia County Commissioners signed a joint powers agreement with the city of Belen, obligating the mill levy to the development of “what appears to be a county owned, taxpayer-supported hospital in Belen,” rather than going with a completely privately invested hospital, Miller said.
“They have made it impossible to immediately proceed with the facility we have outlined in this presentation,” he said.
County Manager Bruce Swingle took Miller to task at the Los Lunas meeting, reminding him of previous statements about not needing the mill levy and pointing out that Miller never approached the full commission with his project.
“I’m shocked with much of your presentation,” said Swingle. “I was told on two occasions you didn’t need the (mill levy) money, you weren’t interested in the money, and as far as your staying out of politics, since I’ve been here, which is five months, this has been nothing but politics, on everybody’s part … none of you came to me and talked to me about it.”
Swingle said he went to Los Lunas Village Administrator Greg Martin to find out about Miller’s hospital plans, and suggested to Miller that if he and the village want cooperation and the mill levy money, they should inform county officials.
“The commissioners that voted against the Los Lunas site have other issues, because they represent this community, this region of the county, and there’s a lot more dynamics involved,” Swingle said.
Miller responded, saying he personally met with three of the commissioners, and that the village had sent a letter to the commissioners last April. He said he had sent the project presentation to each of the commissioners after his Sept. 12 presentation to the Los Lunas council.
In an interview on Thursday, Swingle said the Miller presentation was sent to him and he passed on copies to all the commissioners.
“There have been a lot politics. So much so, the governing bodies haven’t been able hear everyone out,” he said. “It’s my impression that the three who voted for the JPA felt left out of the process.”
At their Sept. 19 meeting, commissioners Donald Holliday, Mary Andersen and Georgia Otero-Kirkham voted for the agreement, while commissioners Ron Gentry and Lawrence Romero voted against.
According to the JPA, the county needs to acknowledge that the Belen site is feasible, either by an internal review or by hiring a professional consultant, then go through the process of issuing a request for proposal for a developer/provider for the project. Once a developer/provider is selected, both entities must approve a contract with the company.
Commission Chairman Holliday said there were still details to work out before the study is validated. However, he indicated the commission wouldn’t have the “final word” on the matter.
“We will have a third party study it, and it will be paid for through the bonding at no extra cost to the taxpayers,” Holliday said Friday. “We don’t want to let out the RFP if the site isn’t right. We will get together a board of trustees and have them review this. The commission shouldn’t do it; that’s what gives us the problems.
“This whole thing has been a mess since the beginning. The people never should never been taxed before we had a plan. That’s what they were told back in 2006, 2007.”
Reading from a prepared statement at the meetings on Tuesday, Miller said the decision by the commission has sent a clear message to Miller’s individual and institutional financing sources, health care operations partner and physicians that the Valencia County Commissioners and their constituents do not support a privately-funded facility … but instead want a facility developed and supported by local taxpayers.
Miller said he is still committed to pursuing a county medical center, and believes most community members support his plans.
“But at a time when there is so much upheaval and uncertainty in the world of health care, you can hardly blame our company, financial sources, health care operators and providers from shying away from a full scale commitment to a project that local elected officials and citizens appear to oppose,” Miller said.
“We will continue to push forward with our efforts to bring a much needed medical center to Valencia County, but until the people of Valencia County can persuade their elected officials to act in their best financial and health care interest and support the Valencia Regional Medical Center, it is unthinkable to ask Miller and our partners to invest their time and treasure no matter how noble the cause.”
He and his partners want a chance for county residents to decided which facility they want, and appropriate the mill levy funds to the VCRMC if that is their choice, Miller said.
“We also personally received assurances by the majority of the county commissioners that we would have a chance to present our approach prior to them making any decisions concerning the mill levy funds,” Miller said.
During an interview on Thursday, Miller said he did not make a public presentation of the project to the county commissioners in an effort to stay out of county politics.
“We initially began without wanting to get involved with county politics,” he said. “It has caused problems in the past, so we were trying to separate ourselves from that. We were trying to look at this just building.”
During the six month study of the county’s medical needs, Miller said the evolution of the process led them to realize there were some very expensive needs in the county.
“For instance, there is the need to have babies in the community. That is a very expensive part of a hospital and is not popular with start up hospitals,” he said. “As we start to put the pieces together, we can put a hospital together that we want but we need support from the community.”
Also during the six-month study period, Miller said he met with commissioners Gentry, Romero and Holliday, as was assured the commission would not vote on the JPA until his company presented the findings of the study.
He also noted that Commissioner Andersen was at the Los Lunas meeting in March when the village approved its exclusive agreement with Miller.
“For the commissioners to say they didn’t know about the project is disingenuous,” he said.
The Sept. 12 presentation to the village council was well within the time line Miller laid out for the study, he said.
“Unbeknownst to us, a week later, they approved the JPA. Within a week, our commitment to present to the commission dissolved without any comment,” Miller said.
Holliday said he met with Gentry, Miller and project consultant Bob Davey in July to hear information about the Los Lunas project. The chairman said the trio presented a very rapid time line, promising a “big announcement in two weeks,” quickly followed by a ground breaking.
“They said we can build in Los Lunas and do not need the mill levy money,” Holliday said. “They indicated that if they had the money, it could enhance operations of hospital. I understand that — if you have free money, you could do a lot with it.”
Holliday said he ended the meeting with his assurance that the commission would hold off on a decision on the JPA for a month to see what Miller’s big announcement was.
“This was after Los Lunas asked us to wait 180 days. I was willing to honor that,” he said. “I thought this was fantastic, I was on board. But I told them if they were not ready, Belen was ready to rock and I would go with Belen.”
Holliday said he hasn’t heard from Miller or Davey since that meeting.
“Personally, I think this is nothing more than a snow job to get people fighting before the election,” he said. “If the election goes the way they want, there will be big news again that they are going to build in Rio Communities.”
Miller says he has no “beef” with the city of Belen and is only asking for a “level playing field.”
“We are not looking for the commission to overturn its decision and obligate all the funds to us,” he said. “But if our project is eligible for those funds, if they are able to help us fulfill our mission, we want to be able to compete for them”
When pressed on what exactly would happen to the Los Lunas project if Miller did not receive support from the mill levy, he said there was an alternative plan.
“It’s not the facility we want to do, but that’s not going to deter me. If this doesn’t work, we will still build a hospital but it will be difficult,” he said. “What I’m saying is, we don’t want to do option two. It’s the last resort and is not going to fulfill the needs of Valencia County. It’s a business deal, a business approach. And because we are committed to continuing, the Belen feasibility study needs to acknowledge that.”
One of the questions posed to Miller by audience members as why his firm was tracking the VCRMC project through the Los Lunas government. He said it was only a means to make arrangements to communicate with county citizens, Miller said.
“Again, we ask for no incentives, no payment in return for our work,” he said. “We believe that we have a clear alternative and approach to developing a hospital that is privately funded within this community.”
One audience member asked if the village or county are offering tax subsidies as incentives to build the hospital.
“I think I answered that,” Miller said. “There’s no plan for the village to offer tax subsidies to our project.”
Another question asked about the funding sources for the project, and were they proposing tax exempt insured or government bonds?
All of the funding is 100 percent from private individuals and institutions as well as the Miller Architectural business, Miller said.
“We are not proposing any tax exempt or government guaranteed loans,” he said.
A woman in the audience asked if residents would still have to go to Albuquerque for medical services being provided to indigent people at no cost. He said anyone going to the emergency room would have to be provided care and cannot be turned away.
He said that is also why the mill levy money is important to his project, and later, Davy said there is $2.7 million indigent care funds that come through a portion of the county gross receipts taxes that are for indigent care.
“I think it’s important that you care for the entire population and not just the few who can afford to pay for the service,” Miller said.
If Belen builds and keeps the mill levy, someone wanted to know how that would affect Miller’s plans.
Miller said his firm is committed to the VCRMC, but would not disclose how his firm would alter its plans, saying only that it would affect the plans.
“Darin, you seem to be saying that the feasibility of the project is dependent on tax subsides from the county long term,” said Charles Murray from the Jubilee housing development. “Is that true?”
“Our project is not dependent on long term mill levy funds,” Miller said. “Our project that we propose, and the components of the project, some of those would benefit from the support of current mill levy funds, not the extension of those funds.”
The mill levy funds, that expire in 2014, would be used in the first year of operations for services primarily for indigent care, such as birthing services and wellness care, he said, adding that the mill levy money would be utilized through a contract commitment with a health care provider and not just dumped into Miller Architect’s coffers.
“There would be no commitment by the county to support the operations of this facility,” Miller said.
Even if the privately owned hospital took a loss one year, because of mismanagement, it couldn’t go to the county to ask for more money, he said.
Taxpayer exposure is limited, when the current mill levy runs out, the hospital would be on its own.
Los Lunas resident James Taylor wanted to know how seniors with different HMOs would be affected, and would VCRMC be able to affiliate with those HMOs.
“It is our intention to affiliate with those who will affiliate with us,” Miller said.
Miller could not answer questions about services for veterans, but promised to answer them.
“We need a hospital in this county,” said Mary Merrell, who, with her husband, Mike, own Belen-based Ambercare. “People have to quit trying to own something, and just figure out what the best thing is. Let’s just build it.
“We need health care here in Valencia County regardless of where it goes or who does it, but we need it,” she said. “I don’t think anybody would say no.”
Rio Communities Association President Mark Gwinn pointed out that the University of New Mexico-Valencia Campus had a nursing program, as well as several other health care oriented programs.
“Will your facility provide our kids the opportunity to train instead of competing with students in Albuquerque and Santa Fe?,” Gwinn asked
Miller said they were open to any partnership that would help them recruit good employees.
Bill Brown pointed out that in the last 10 years, there has been repeated lobbying of the county commission to get a transport license so that county-run EMS units could charge to transport patients to a hospital.
“How are you going improve and expand ambulance services given the fact we don’t have a transport certificate and it’s $1,000 through the private service, Living Cross?” Brown asked.
Miller said in preliminary discussions with the hospital’s operating partner, they believed they have relationships with other operators that can partner with and expand service in the county.
A woman in the audience said what Miller presented was fabulous, but she was still concerned because no one knew how it would be paid for.
“That’s why the mill levy is such a big stinking deal, right? The county has a large percentage of indigent and uninsured,” she said. “I’m concerned right now that we’ll get something here built but mill levy isn’t even going to be a minor percentage you need for support, especially with the high population of indigent and uninsured.”
Miller said the county had more needs than what revenue was based on.
“We can leave out all the things that don’t make money. But we’ve agreed for some of those activities, the mill levy could support those who can’t afford care,” he said.
Miller said because the Los Lunas project is privately funded, it would be “on our dime if we produce something we can’t afford. We are asking, under state statute, to be a contractor with county. The mill levy funds can pay for things not profitable.”
The woman argued that Miller was talking about operating costs and hospitals didn’t calculate their budget based on what departments were profitable versus those that lost money. Miller disagreed, saying in his experience it was.
Another woman asked about behavioral health services, pointing out that they were included in Miller’s plans. He said that wasn’t something he had discussed with the provider partner, but said it could be worked into the plan, either as part of the main hospital or in a satellite facility.