The Nevada Regional Medical Center (NRMC) Board of Directors held their regular monthly meeting Tuesday evening.

In his CEO report, Jason Anglin spoke about the hospital's request of the Vernon County Commission for American Rescue Plan Act (ARPA) funds. The funds would go towards three planned projects, which include the following:

Nevada Regional Medical Center provides surgical services to include general, urology, ENT, OB/GYN, and ophthalmology surgical interventions. In 1996, the hospital completed and expansion of surgery to include a large state of the art chiller system. The surgery suites are below street level which provides benefits and problems related to humidity control.

Surgery regulations have been made more stringent since the construction of these surgery suites. Now, temperature and humidity must be maintained and monitored for both infection prevention and patient safety standards. The existing chiller and controls are unable to meet these expectations during the temperature swings that Missouri is known for. When this occurs, surgery must be delayed in order to bring in bulky portable air conditioners to remove humidity and control temperature.

Regulations specifically require a temperature between 68 to 75 degrees and when the temperature spikes to 100 to 105 degrees outside, this system can't handle the load. Humidity must be controlled at 30 to 60 percent and with daytime highs in Missouri averaging 90 percent humidity, the chiller can't keep up. This can cause serious safety concerns.

Currently, NRMC does not offer orthopedic services. The current state of the chiller impacts the hospital's ability to provide the ideal environment for those procedures. A doctor who provides orthopedic services is on the hospital's plan for recruitment.

Anglin noted that it is critical to the hospital's existence to provide obstetric services, including c-sections, which also allows NRMC to receive Disproportionate Share Hospital funding (DSH) and 340B funding through the services the it provides to Medicaid patients. Without the patients in obstetrics, the hospital would lose significant funding.

In fiscal year 2021, the hospital received approximately $3.7 million for DSH and $1.5 million in 340B funding. "These monies are vital to our continued mission," noted Anglin.

Phase two allows NRMC to reuse the chiller from the north tower to replace a 1960s chiller.

The cost of Phase One of Project One would be $539,500 and Phase Two would be $73,500. This would make the project have a total cost of $$613,000.

Project Two — Roof for Med Arts Building

In 1937, Nevada City Hospital opened on Adams Street to provide care for the community. The original building still exists on South Adams Street and NRMC would like to continue to use this building to its fullest potential and preserve the hospital's historical legacy. This original building has been used throughout the years as a hospital, nursing home, clinic, home health and hospice, office space for billing and quality, along with staff and community education.

In the last few years, the roof has failed and NRMC has been unable to divert funding from operations to allow for a new roof. All occupants have been forced to move from this space to other tightly packed spaces within the hospital and other clinics that need to be used for patient care space in the future. This building houses the generator, heating and air conditioning, main electrical incoming utilities and medical supplies.

Operational resources have been diverted to address continued high salary costs due to staff shortages and continued elevated supply expenses, and to provide necessary clinic space which to vital to services in the community.

The cost of Project Two would be $145,877.50

Project Three — Digital Portable X-Ray Machine

Nevada Regional has a long history of providing emergency and inpatient care at the bedside. Bedside portable x-ray is necessary to doctors to provide this care to patients. Currently, the hospital has a portable x-ray machine that was purchased new in 1996. The machines last a long time and it is expected that a new machine would get years of service.

Digital portable imaging reduces wait time on vital exams such as IV line in the chest placement, fractures, heart failure, and pneumonia. This technology helps maintain the sterile field by having the images viewable right on the portable unit after exposure. This also allows the doctor to adjust more quickly since the image is viewable at the point of care, including sterile procedures and bone fracture reductions.

A new digital portable x-ray unit would help reduce risk with COVID-19 as the patient would not have to be moved around the hospital, exposing others. It would also help with continued services even when there is a power outage as the doctor can see the images on the portable unit.

The cost of Project Three would be $140,000. The hospital is requesting $898,877.50 in ARPA funding from the County Commission.

In approval items, the board considered the following:

• InterQual: Medical necessity software. Change in vendor resulting in cost changes. With a budget of $180,000 (five years), the cost of this would be $74,857 (three years). With a motion, and a second, the board unanimously approved.

• Two Lab Chemistry Analyzers Service Contract: Siemens service contract for remainder of lease life of analyzers. With a budget of $90,000 the cost of this would be $90,050 (three years). With a motion, and a second, the board unanimously approved.

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