What form of management and oversight is best for Sierra Vista Hospital?

by Lee Ungnade | December 14, 2020
3 min read

As a person new to Sierra County, I am very interested to learn about the issues surrounding health care and the Sierra Vista Hospital.  Kathleen Sloan has done a wonderful job of giving a summary of the history and an overview of current proposals before the public.

It is ironic that the community I am moving from has approximately the same population, is rural, and has had a very similar health care situation. The local hospital system there does have a health district board (five members), as well as a governing board (five members), and has struggled for years.

Almost three years ago, the hospital and its clinics were within days of being permanently closed due to mismanagement and a) over-expansion of clinics and services, b) inflated loans to pay off, due to enormous remodeling projects of the hospital, and c) excessive staff—all issues missed by the two boards. In a sudden move, a small group of people approached the governing board to express concerns, and the board ultimately fired the top three administrators and then contracted with a management company based in Texas.

The management company brought in its own administration and, through consolidation, good financial management and streamlining services, the health care system slowly became financially viable.

Health care in the 21st century is a specialized business that requires oversight and management with expertise in billing/insurance reimbursement, provider retention in rural areas, networking with specialized providers, accountability, quality assurance and risk management—all of which makes providing rural health care a big challenge for even the most experienced administrative staff.

This community may want to consider some of the following questions:

1. What are the benefits of having two boards? List them.

2. What qualifications are necessary for board members, keeping in mind that oversight and accountability of healthcare management is their most important responsibility?

3. What are the benefits of turning over management to a larger New Mexico-based health care entity such as (just for example) Presbyterian Healthcare Services that has decades of experience managing a variety of facilities, providers, nurses and a varieties of staff members on a statewide scale.

4.  Some health care institutions have patient/family advisory boards that meet with administration and act as liaisons with the community. What if the members of the current boards retained interest, influence and ideas by becoming an advisory board to the management administration?

Thank you to the Sierra County Sun for providing a platform for discussion and for covering vitally important news. With more than four decades of health care experience working in communities in New Mexico, Utah and Colorado as a paramedic, intensive care nurse, quality assurance manager, risk manager, HIPPA compliance officer, and legal nurse consultant, I care deeply that the health care system of Sierra County succeeds in providing the best quality health care.

Lee Ungnade, BSN, RN, LNC
Truth or Consequences

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Understanding New Mexico's proposed new social studies standards for K-12 students

“The primary purpose of social studies is to help young people develop the ability to make informed and reasoned decisions for the public good as citizens of a culturally diverse, democratic society in an interdependent world.”
—National Council for the Social Studies 

Reader Michael L. Hayes of Las Cruces commented: What impresses me is that both the proposed standards and some of the criticisms of them are equally grotesque. I make this bold statement on the basis of my experience as a peripatetic high school and college English teacher for 45 years in many states with many students differing in race, religion, gender and socioeconomic background, and as a civic activist (PTA) in public education (My career, however, was as an independent consultant mainly in defense, energy and the environment.)

The proposed social studies standards are conceptually and instructionally flawed. For starters, a “performance standard” is not a standard at all; it is a task. Asking someone to explain something is not unlike asking someone to water the lawn. Nothing measures the performance, but without a measure, there is no standard. The teacher’s subjective judgment will be all that matters, and almost anything will count as satisfying a “performance standard,” even just trying. Students will be left to wonder “what is on the teacher’s mind?” or “have I sucked up enough.”

Four other quick criticisms of the performance standards. One, they are nearly unintelligible because they are written in jargon. PED’s use of jargon in a document intended for the public is worrisome. Bureaucrats often use jargon to confuse or conceal something uninformed, wrong or unworthy. As a result, most parents, some school board members and more than a few teachers do not understand them.

Two, the performance standards are so vague that they fail to define the education which teachers are supposed to teach, students are supposed to learn, and parents are supposed to understand. PED does not define words like “explain” or “describe” so that teachers can apply “standards” consistently and fairly. The standards do not indicate what teachers are supposed to know in order to teach or specify what students are supposed to learn. Supervisors cannot know whether teachers are teaching social studies well or poorly. The standards are so vague that the public, especially parents or guardians, cannot know the content of public education.

Three, many performance standards are simply unrealistic, especially at grade level. Under “Ethnic, Cultural and Identity Performance Standards”; then under “Diversity and Identity”; then under “Kindergarten,” one such standard is: “Identify how their family does things both the same as and different from how other people do things.” Do six-year-olds know how other people do things? Do they know whether these things are relevant to diversity and identity? Or another standard: “Describe their family history, culture, and past to current contributions of people in their main identity groups.” (A proficient writer would have hyphenated the compound adjective to avoid confusing the reader.) Do six-year-olds know so much about these things in relation to their “identity group”? Since teachers obviously do not teach them about these other people and have not taught them about these groups, why are these and similar items in the curriculum; or do teachers assign them to go home and collect this information?

Point four follows from “three”; some information relevant to some performance measures requires a disclosure of personal or family matters. The younger the students, the easier it is for teachers to invade their privacy and not only their privacy, but also the privacy of their parents or guardians, or neighbors, who may never be aware of these disclosures or not become aware of them until afterward. PED has no right to design a curriculum which requires teachers to ask students for information about themselves, parents or guardians, or neighbors, or puts teachers on the spot if the disclosures reveal criminal conduct. (Bill says Jeff’s father plays games in bed with his daughter. Lila says Angelo’s mother gives herself shots in the arm.) Since teacher-student communications have no legal protection to ensure privacy, those disclosures may become public accidentally or deliberately. The effect of these proposal standards is to turn New Mexico schools and teachers into investigative agents of the state and students into little informants or spies.

This PED proposal for social studies standards is a travesty of education despite its appeals to purportedly enlightened principles. It constitutes a clear and present danger to individual liberty and civil liberties. It should be repudiated; its development, investigated; its PED perpetrators, dismissed. No state curriculum should encourage or require the disclosure of private personal information.

I am equally outraged by the comments of some of T or C’s school board members: Christine LaFont and Julianne Stroup, two white Christian women, who belong to one of the larger minorities in America and assume white and Christian privileges. In different terms but for essentially the same reason, both oppose an education which includes lessons about historical events and trends, and social movements and developments, of other minorities. They object to the proposal for the new social studies standards because of its emphasis on individual and group identities not white or Christian. I am not going to reply with specific objections; they are too numerous and too pointed.

Ms. LaFont urges: “It’s better to address what’s similar with all Americans. It’s not good to differentiate.” Ms. Stroup adds: “Our country is not a racist country. We have to teach to respect each other. We have civil rights laws that protect everyone from discrimination. We need to teach civics, love and respect. We need to teach how to be color blind.”

Their desires for unity and homogeneity, and for mutual respect, are a contradiction and an impossibility. Aside from a shared citizenship, which implies acceptance of the Constitution, the rule of law and equality under the law, little else defines Americans. We are additionally defined by our race, religion, national origin, etc. So mutual respect requires individuals to respect others different from themselves. Disrespect desires blacks, Jews or Palestinians to assimilate or to suppress or conceal racial, religious or national origin aspects of their identity. The only people who want erasure of nonwhite, non-Christian, non-American origin aspects of identity are bigots. Ms. LaFont and Ms. Stroud want standards which, by stressing similarities and eliding differences, desire the erasure of such aspects. What they want will result in a social studies curriculum that enables white, Christian, native-born children to grow up to be bigots and all others to be their victims. This would be the academic equivalent of ethnic cleansing.


This postmortem of a case involving a 75-year-old women who went missing from her home in Hillsboro last September sheds light on the bounds of law enforcement’s capacity to respond, especially in large rural jurisdictions such as Sierra County, and underscores the critical role the public, as well as concerned family and friends, can play in assisting a missing person’s search.

Reader Jane Debrott of Hillsboro commented: Thank you for your article on the tragic loss of Betsey. I am a resident of Hillsboro, a friend of Rick and Betsey, and a member of H.E.L.P. The thing that most distresses me now, is the emphasis on Rick’s mis-naming of the color of their car. I fear that this fact will cause Rick to feel that if he had only gotten the facts right, Betsey may have been rescued before it was too late. The incident was a series of unavoidable events, out of everyone’s control, and we will never know what place the correct color of her car may have had in the outcome. It breaks my heart to think that Rick has had one more thing added to his “what ifs” concerning this incident.

Diana Tittle responded: Dear Jane, the Sun undertook this investigation at the request of a Hillsboro resident concerned about the town’s inability to mount a prompt, coordinated response to the disappearance of a neighbor. From the beginning, I shared your concern about how our findings might affect Betsy’s family and friends. After I completed my research and began writing, I weighed each detail I eventually chose to include against my desire to cause no pain and the public’s right to know about the strengths and limitations of law enforcement’s response and the public’s need to know about how to be of meaningful assistance.

There was information I withheld about the state police investigation and the recovery. But I decided to include the issue of the car’s color because the individuals who spotted Betsy’s car emphasized how its color had been key to their identification of it as the vehicle described in Betsy’s Silver Alert. Because the misinformation was corrected within a couple of hours, I also included in this story the following editorial comment meant to put the error in perspective: “The fact that law enforcement throughout the state was on the lookout in the crucial early hours after Betsy’s disappearance for an elderly woman driving a “light blue” instead of a “silver” Accord would, in retrospect, likely not have changed the outcome of the search” [emphasis added].

I would also point to the story’s overarching conclusion about the inadvisability of assigning blame for what happened: “In this case, a perfect storm of unfortunate circumstances, many of them beyond human control, hindered the search that it would fall to Hamilton’s department to lead.”

It is my hope that any pain caused by my reporting will eventually be outweighed by its contribution to a better community understanding of what it will take in the future to mount a successful missing person’s search in rural Sierra County.

2 thoughts on “What form of management and oversight is best for Sierra Vista Hospital?”

  1. I found Ms. Ungnade’s comments and suggestions pertinent and valuable. I am curious what community she lived in prior to moving here and what particular hospital she is referring to. It might be useful in evaluating her thoughts about the value of an outside management company.

  2. Good morning Dave:

    Thank you for responding to my comments about health care management.

    At this point in time, I’m reluctant to say more about a particular system as I left their employment only a year ago and do not want to in any way appear negative toward them or to the management firm the boards hired.

    What I’d like to emphasize is that a tried-and-true New Mexico health care system such as Presbyterian has decades of success, positive customer service and knows/understands the care needs of rural New Mexico such as close-by Socorro General Hospital.

    Presbyterian is the largest health care system in New Mexico and can provide trained professionals and a highly credentialed Services Board of Directors.

    The Board’s credentials are amazing, as can be seen on the website: https://www.phs.org/community/legacy-of-caring/leadership/Pages/phs-board-of-directors.aspx

    The current boards in Sierra County could provide excellent information about the specific needs of their communities and work in concert with the professionals.

    Turning over control is never an easy process, certainly one that produces anxiety, but it would be a worthwhile effort to at least discuss possible benefits.

    Best wishes to you and Sierra County residents for a safe and healthy holiday season.


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