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					                                                 MAYOR’S TALK SHOW
                                                                November 20, 2009


Tom: Hello, welcome to another mayor‟s talk show. My name is Tom Swisstack. My
special guest today is Clay Holderman, the administrator for the new Rio Rancho
Presbyterian Hospital. We‟ll be back in just a moment.

[music]

Tom: Clay, welcome. It‟s really a pleasure to have you here today and I guess I want
to make a few comments and then try to ask you some questions so that we can
provide information to the public. I know it‟s kind of interesting, we‟ve had some hard
times in our country right now, and even our state‟s beginning to see some of those
hard times, but Rio Rancho seems to be moving in a progression fashion and one of
the major milestones or cornerstones in our city‟s history, though Presbyterian‟s
been around for a long time in our community, is building a full service hospital in our
community. Maybe you can take some time and kind of elaborate about that
hospital. Where do we stand? Is it six years away from now? What is it going to look
like? How many beds?

Clay: Mayor, I‟m delighted to say it‟s not six years from now, it is happening today.
Presbyterian is full steam ahead with the construction of the Presbyterian Rio
Rancho Medical Center. It‟s at the corner of Unser and Black Arroyo and if you drive
by the site today you‟ll see a beehive of activity. In fact, as we record this they‟re
assembling the drilling rig that will put the… the piers in the ground that will anchor
the hospital to the…to the mesa and by January you‟ll see construction vertically up
out of the ground and begin to really dominate the skyline for that part of Rio
Rancho. We will open by October of 2011, so we‟re 23 months away from being able
to treat patients and in this economy it‟s exciting to see construction crews, as many
2500 jobs, bustling about in Rio Rancho, cranes moving, concrete pouring and steel
being delivered.

Tom: Clay, you know, Presbyterian‟s been in our city how long now?

Clay: Twenty years. We were the first healthcare provider to come to… to Rio
Rancho just six or seven years after its inception as a city.

Tom: Talk a little bit about the hospital. It‟s… how big is it going to be, how many
beds? And I guess you‟re doing some high end technology and the state-of-the-art
rooms. Could you talk a little bit about those?

Clay: Sure. We‟ll talk about two phases: so day one when we open in October of
2011, we‟ll open a 66 bed hospital. And just to size that, there… there… today are

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54 Rio Rancho residents who are hospitalized at Pres hospital, so that‟s really just to
take care of the patient need for today. That bed tower will also have a floor that will
allow 24 additional beds to be built, with very little notice, taking us up to 90 beds,
but the hospital from day one is being built so that eventually, in 30 years when the
population of Rio Rancho and west Albuquerque exceeds the population east of the
river, this will be the new center of Presbyterian‟s central New Mexico operations. So
the ultimate site plan allows for three patient towers, three physician office buildings,
multiple garages, and all of the technology you can imagine.

Tom: The expansion capability are for beds, okay? What is that capability?

Clay: Well, on day one, as I said, we‟ll open 66 beds on four floors of the patient
tower, we‟ll open for operating suites and a full cardiac catherization lab where we‟ll
be able to do cardiac cath and stint placement, we‟ll open a full service emergency
department, full imaging department with MRI, CT scan, all of the high end
technology. We‟ll also be delivering babies day one and we‟ll be able to take care of
the most premature of babies with a ten bed neonatal intensive care unit. So
everything from broken hips and hip replacements to heart... heart catherizations,
this will be a full service hospital that will be treating Rio Rancho citizens very well.

Tom: So let me see if I understand you, you… you just finished indicating a plethora
of services that the hospital‟s going to provide, so I‟m understanding you, if my
mother was to get injured or needed a hip replacement, and there is nothing
extraordinary with her heart or anything of this nature here, she could actually have
that done in the Rio Rancho Presbyterian Hospital and I will be able to visit her
without having to drive all the way to Albuquerque? Is that reasonably…?

Clay: Absolutely. From day one will be doing minimally invasive surgery, we‟ll be
doing GYN surgery, we‟ll be doing orthopedic surgery and general surgery, urologic
surgery, so there‟ll be a broad… a broad array of specialties and if your mother
breaks her hip or is you need a knee replacement, Tom, we‟ll be able to take care of
you from the first day we open.

Tom: I have to tell you I feel good because the way I‟m moving lately here, you
never know. I may need that knee replacement. Rooms, 66, you mentioned that. Is it
double occupancy? Is it single? Is it a dorm?

Clay: So the days of roommates are over. We are… we are building 100% private
beds but more important than private beds, there‟s a lot of thought that‟s gone into
what a hospital room looks like and it‟s taking over a century of what we‟ve learned

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at Presbyterian, it‟s combining it with some research that‟s been done by over 40
healthcare systems around the country that are collaborating as they build to find
out, how does the room and how does the environment improve your healing and
decrease the chance of someone making a mistake while you‟re in a hospital? So
we‟ve got some renderings that are on our website at phs.org or on our Facebook
page, but the interior room looks nothing like rooms that you‟ve been in today with a
curtain between two beds. These rooms have a family zone where families are
supplied to a computer that links to healthcare information, information about their
account, they‟re supplied with a couch and it folds out to a bed, and a sitting area,
and all of that is located where it doesn‟t get in the way of caregivers, they don‟t
have to get up and leave the room when caregivers come in, a full wall of natural
light that decreases the use of pain medications by about 20%, and a… sorry about
my phone.

Tom: Happens all the time to me.

Clay: And… and… and other features to absorb sound to increase the quality of
sleep, the bathroom doors are engineered such that they slide along the outside of
the wall instead of coming out and interfering with IV poles and walkers and
preventing falls. It‟s an amazing amount of research that‟s gone into something as
simple as a hospital room.

Tom: Well, explain a little bit, if I‟m a nurse, what does this mean for me as a nurse
or what does this mean for me as a doctor? I‟m assuming you‟ve done some
research on time it may save, and I know this is critical time if something was to
happen.

Clay: Nursing shortage across the nation has been a big issue and so we‟ve been
doing a lot of research on how do we… how do we reduce fatigue of a nurse during
a shift, how do we... how do we reduce the travel time and travel distances and how
do we keep the things that doctors, nurses and other caregivers need directly at
hand, near the patient? So part of what we‟re doing is applying what manufacturing
and Toyota learned a long time ago about just videotaping and studying our motions
and pulling commonly used supplies closer to the work, but in the way we designed
the layout of our floor we were able to eliminate 45 minutes a day of walking from a
nurses‟ shift. That‟s the equivalent of a nurse walking to Gallup and back every year.

Tom: Wow! That‟s interesting the way you put that. Presbyterian, talk a little bit about
Presbyterian. They‟re been around for what… 100 years or so?


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Clay: Presbyterian is 101 years old this year and we‟ve been in Rio Ranch for two
decades.

Tom: So you have different services in Rio Rancho, right? What are some of them
that you provide right now today?

Clay: I think most people may be surprised to know that we‟re in three locations in
Rio Rancho, two on High Resort and one at Southern, and in those three locations
we‟ve got a payroll of Rio Rancho employees of over $28 million. It‟s 368 employees
here. Probably more important, though, is what we do for the citizens of Rio Rancho.
Last year we had 211,000 patient visits in those three locations.

Tom: Wow! I didn‟t realize that myself.

Clay: So 211,000 times last year somebody didn‟t get in a car and cross a bridge,
and hopefully what would have been a half day trip across town and trying to find
parking that doesn‟t exist at our downtown facility, they were able to come, park near
the facility and hopefully get in and out quickly.

Tom: The new hospital that is being built will open in 2011. How many employees
will that have?

Clay: In addition to the 360 somewhat employees that we have here today, we
project that the new hospital will begin with an additional 400 employees. So
bringing us to over 700 employees total and we‟ll add about another 40 million to our
payroll, so we‟ll be looking at a 68 to 70 million dollar payroll in 2011.

Tom: Clay, and forgive me because I think this is a very… a piece of critical
information, you‟ll have… you have right now 300 and how many employees?

Clay: 368.

Tom: 368. In 2011, as we mount up to 2011, you‟re talking about another 400 jobs in
our community and a payroll of about 40 million in the hospital alone?

Clay: Correct.

Tom: Where do I sign up?

[laughing]

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Tom: I guess I‟m also kind of interested because there‟s been a number of people
who have talked to me about triaging, especially when it comes to car accidents. I
have to tell you honestly I‟m very impressed about the services that you‟re going to
be providing there and before we get to the car accident issue, why are you able to
provide those services right now, or at least in 2011 when you‟re talking about the
hips or… or the prenatal? What‟s allowing you to do that quicker?

Clay: Well, I think the easy answer is what the citizens of Sandoval county did in
voting a mil levy to support hospital development. Most people don‟t realize that
those mil levy dollars are not being released today. They‟re being held in escrow by
the Sandoval county commission until a contracted hospital is operating, treating
patients, and licensed by Medicare. And those… those mil levy dollars don‟t help us
to construct a hospital. What they do is they help us to provide services that the
community might not be able to support otherwise. So an excellent example of that
is the neonatal intensive care unit that I told you about. It‟s an intensive care unit for
premature babies or babies born with birth defects, so if a baby stays 10 days, two
weeks, six weeks, in a neonatal intensive care unit, everyday that family wants to be
a part of that care and it‟s easier if they don‟t have an hour and a half roundtrip
commute to add onto the time they want to spend with their new baby.

Tom: Clay, let me ask a question because you‟re saying it‟s being held in escrow.
And how do you respond to this because I‟m assuming you have to bring doctors
and look for doctors and nurses. Why couldn‟t that tax been implemented maybe
sooner or later as the hospital was getting ready to open their doors?

Clay: Well, you alluded to it quite well. There are immense startup costs, not…
outside of construction, which is 165 million in straight construction and purchase of
furniture and equipment, but there are other immense startup costs in creating a
staff. We can‟t recruit 150 physicians in the month before the hospital opens. It‟ll
take us all of the 23 months between now and then to slowly bring those physicians
on, add them to other clinics, rent space for those physicians, and during the first
year to two years of a physician‟s practice they don‟t have the patient base to help
pay for their salary. Likewise with specialized staff. They don‟t appear in New Mexico
looking for jobs, often we have to partner with UNM college of nursing, with CNM,
with Apollo, with PIMA, to create the radiation technologists, the nurses, the
pharmacists, the physical therapists, that we need, and we have to work with them
to get graduating classes in advance so that not everyone we start with on day one
is new.


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Tom: You know, that‟s a good answer because I think sometimes we forget that, that
there‟s a process and you‟re trying to recruit people. They may not all live here and
you‟re having to work with other institutions so I appreciate that. Let me go back to
my triage. Tom Swisstack‟s driving in a car, I‟m actually doing the speed limit today,
and then all of a sudden somebody else comes along and hits me head on. And I
break my leg. My heart‟s still good, I don‟t have any contusions where my whole
chest is opened up or anything. Is Presbyterian in the position today, and will
Presbyterian be in the position in 2011 when the hospital opens up, to triage kind of
car accidents where maybe you don‟t have the trauma or you have heart damage or
things of this nature?

Clay: So the answer‟s a resounding yes but there‟s a qualifier.

Tom: Okay.

Clay: So today we do everyday receive car accidents from both rescue, Sandoval
county and Rio Rancho city rescue and from Albuquerque Ambulance which is an
affiliate of Presbyterian. So everyday those come into our Rio Rancho emergency
center, are treated and released. But there‟s a large amount of professional
judgment that the paramedic in the rig needs to make and unfortunately our bodies
don‟t have a diagnostic computer like your car, so they‟re making a judgment call
and if they see a bruise on your chest they may say, “you know, I just want to be
sure that I‟ve got a pulmonologist right there in case there‟s a breathing issue,” or “I
want to be sure there might be some issue with a concussion or neurological
problem,” so trauma, as it‟s designated, that goes to our only trauma center in
central New Mexico which is the university hospital downtown. All other car
accidents can go to any of the emergency departments in town including Rio
Rancho emergency department.

Tom: That‟s kind of exciting because I‟m assuming, Clay, I know you‟re the
administrator, that that first contact is really critical. Now, what does this do, if you
can kind of maybe elaborate about this here, if I am in an accident or something
critical happening, what does it mean to have a hospital in basically your city without
having to drive on a good day maybe 40 minutes to get to Presbyterian, unless
you‟re air lifted, obviously that‟s different, but I‟m talking basically now ambulance
service?

Clay: So on the front end, time is critical. Whether you‟re talking about stroke where
there‟s a three hour window that they consider the golden halo where treatment can
really be effective, versus really dealing with the aftermath, or whether you‟re talking

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about heart attack where minutes mean damage to heart muscle, the 45-minute
commute across the bridge is devastating in some cases. So… so time is critical on
the front end, but I don‟t want to overlook on the back end either. If you‟re going to
spend a few days in the hospital, having family support, family involvement in your
care, family understanding what medications you‟re getting, being able to ask their
own questions of your care team, that‟s critical as well. And your outcomes are
somewhat determined by the people who are going to take care of you once you
leave the hospital. So if they don‟t have to drive an hour and a half roundtrip and
they‟re able to visit you and be a part of your care, then that‟s an amazing thing.

Tom: Now Clay, it sounds to me in your talking, because you even talked about the
rooms in this way, it almost seems that family contact and that the environment of
this particular hospital, at least, maybe I‟m reading this, helps in the healing
process?

Clay: That… that is not an opinion or assumption or a misread, that‟s backed up by
years of research and lots of studies. When Presbyterian first envisioned building
this hospital, before I was there, they contacted a group called the Pebble Group, 40
other systems that are building hospitals, and they all said, “let‟s pool our resources,
let‟s pool our research, and let‟s really figure out all of the things we‟ve heard about
how the environment affects care and let‟s see if we can prove them using the
scientific method.”

Tom: Clay, the jobs that will possibly occur at the new hospital, not possibly, are
occurring, they range from what to what? I mean, what… what‟s the opportunities
that exist for future people, our young kids in high school that go to college at UNM
and CNM, how do you fit into that process?

Clay: So that‟s an excellent question because most people don‟t realize that a
hospital is like a small municipality of its own. We‟re required, because of the nature
of what we do to be able to be completely self-sufficient from any external utilities
for up to three days, as we all learned from hurricane Katrina. So we have complex
engineering departments and great engineering jobs, biomechanical jobs, we have
administrative jobs from clerical to registration to financial counselors. We have
clinical jobs from radiation technologists to pharmacists to physical therapists to
what we all think of which is nurses and doctors, surgical techs. So the span of
salaries, the span of opportunities, the span of… of interests is… is really unlimited
in a hospital environment. There‟s something that mirrors almost every job in our
economy. Now how do we link up with the institutions that are training our children
and are hopefully keeping our children here in Rio Rancho instead of sending them

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out of state and there‟s a number of ways but we are partners with every community
college and the University of New Mexico college of nursing as a preceptor site of
care. And you‟ve heard that although we have a nursing shortage in this state,
there‟s a waiting list to get into nursing school. And one of the reasons for that is
because we have to have experienced nurses treating real patients, in real clinical
settings, to be able to complete the training of nursing students. It can‟t be done in a
classroom or a laboratory, even with the advanced simulators we have today, so this
will provide another site where radiation technologists and pharmacists and
therapists and… and surgical techs and nursing students can get that clinical hands-
on experience and it‟ll allow our partners in education to increase the number of
spots that they can offer for their students.

Tom: Now Clay, it‟s kind of interesting because I see some of the administrators,
people working with your hospital, already getting involved, and I know they‟ve been
because they‟ve been here for 20 years but even the people that are beginning to
take a little bit more control over the new hospital that‟s being built, getting more
involved in our respective community, and I think that‟s pretty exciting because it just
talks about your character as a hospital, as a healthcare industry, about your
commitment to the community. A couple more things, I guess, „cause I‟m kind of
intrigued about this over here, so my mother, let‟s go back to her, and hopefully
she‟s not watching because she‟ll pick on me, she‟s 84-years-old, she‟s walking
along, she breaks her hip, she calls, okay? And the ambulance comes and picks her
up, this is 2012 now, or 2011 at the end of 2011. My mom who‟s 84-years-old,
unless there‟s something else that they make a determination, is in a position right
now to go to your hospital, the new Presbyterian hospital that will open up in 2011.
She goes to the emergency room and immediately you have a team that starts
working on those issues. I have to tell my mother that her taxes are being well-spent
right now.

Clay: Absolutely. As you know, Tom, I live in Cabazon so I‟m paying those taxes and
I have children and a mother-in-law here. What better investment could there be
than to provide a hospital to the largest center in the United States that does not
have its own medical care? And all you have to do is try to commute on a day that
there‟s a bicycle accident on Paseo, or a motorcycle accident on Montano, and you
realize that all of our access to those downtown hospitals is shut off for an hour and
a half, two hours, three hours. In a real disaster it‟s unthinkable that we as a city of
80,000, as a service area of 120,000 on the west side of the river here, don‟t have
better access to medical care. So nobody likes to pay the extra $300 that came up
on my tax bill, but what a better use of funds could there be than to provide
healthcare that‟ll be there for the next 100 years?

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Tom: You know, it‟s interesting you made that comment because a couple weeks
ago that‟s exactly what happened and I was absolutely amazed on how long it took
me just to get from Rio Rancho across Alameda to go to the other side for a
meeting, and it was literally a better part of two hours, just sitting in traffic, so God
forbid we should have somebody from our community or the west side, needing
those services. What‟s… is there multiplier affects? What I mean by multiplier
affects, so you have this hospital and we… we kind of say, okay, that hospital‟s
going to help bring other businesses, what traditionally kind of happens in your
experience? I‟m not saying necessarily what happened here, but what happens in
your experience about when a hospital starts to build, what comes around it?

Clay: So you„ve got direct multipliers which means every dollar that a hospital
spends has… rotates two and a half times in a community according to the
American Hospital Association, for purchasing our supplies and hiring our vendors,
but you‟re already seeing it start here. And mayor, you saw that with the
announcement last week of X-ray Associates and the medical plaza they‟re creating
across the street from us, Petroglyph Medical Plaza. That plaza wouldn‟t exist if
there wasn‟t a hospital across the street to anchor it. You‟ve already seen it with
Walgreen‟s who‟s taking a position on every corner on Unser.

Tom: They have actually.

Clay: And what wouldn‟t exist if there weren‟t a hospital and medical offices that
were coming there that would be writing the prescriptions. So you see first durable
medical equipment providers, you see prescription providers, you see other medical
office complexes. Then all of the people who work there, they need restaurants to
eat in, they need places to shop, so we already have the rooftops here, that‟s never
been a problem for Rio Rancho. What you‟re going to see is the services that this is
an anchor tenant for a lot of services.

Tom: I understand, and you may be part of these conversations that the University of
New Mexico and that CNM are working extremely close on this west side as they‟re
building their campuses and part of it, and I talked to Dr. Winegrad the other day,
too, that CMN… CNM is really expanding their healthcare profession of their
classes. Do you see that as a good thing for Presbyterian Hospital, for its future, and
you kind of alluded to this earlier about interfacing with them to get the required
people that you need, have you been part of that conversation, what they‟re looking
for?


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Clay: We‟re having parallel conversations so we‟ve not been part of… I think there‟s
a level of integration that UNM and CNM are talking about because of their proximity
as neighbors in a the city center, about sharing classroom space. Where we fit in is
two-fold. First in sharing proctors and clinical space for those... those final year
nursing students and technology students and then in providing jobs for those
students who‟ve gone through and proven themselves and… and keeping our
students here.

Tom: Clay, we‟ve got a couple more minutes here. Is there anything that you may
want to add that I may have missed? It‟s… I have to tell you and I‟ll just say this as
the mayor of the city of Rio Rancho, I‟m extremely excited, I appreciate what
Presbyterian is about to do in raising the quality of life in our community, so I‟ll just
say that. Are there any comments you‟d like to make?

Clay: No, I… we‟re extremely pleased and… and Presbyterian is betting big on the
city of Rio Rancho. This is the largest project in 101 years of Presbyterian‟s
existence and this is what we fully believe will be the center of our delivery system in
the next 30 years. So our belief is probably best symbolized by the amount of land
that we purchased here. As you know, the plan was to build a hospital on High
Resort across from our existing buildings, but we decided 17 acres was not
adequate because of our belief about the future of this city. So 66 acres, twice the
size of our downtown campus, is what we‟ve secured in Rio Rancho and we believe
that that will sustain us for the next 100 years.

Tom: Clay, thank you very much for being a part of this show. Thank you very much
for being part of this community. And I‟m probably going to call my mother after I
leave here and remind her, “mom, hold on, we have services that are coming.”

Clay: Thank you very much.

Tom: I really appreciate it. Thank you very much. On behalf of myself, Tom
Swisstack, and my very special guest, Clay Holderman, the administrator for
Presbyterian Hospital, we look forward to seeing you again. Thank you.

[music]




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