MED-Midwest Medical Edition-September/October 2011 by MED- (Midwest Medical Edition)

growing to meet your

healthcare needs New 2011 Avera McKennan Hospital & University Health Center Physicians EMERgENCy MEDiCiNE

Paul Van heukelom, md

nate Johnson, md

NuERosuRgERy

Kelly rhone, md

iNtERNAl MEDiCiNE

nathan miller, md

Joseph rees, do

Joseph seurer, md Avera McGreevy Clinic

PsyCHiAtRy

Avera Brookings Medical Clinic ellen hopper, md Obstetrics & Gynecology

anthony Vaca, md

Avera Dell Rapids Medical Clinic demetre skliris, md Family Medicine Avera Holy Family Health and Estherville Medical Clinic anthony cook, md Family Medicine

Brian Fay, md

oPHtHAlMology

chetan wasekar, md

FAMily MEDiCiNE

amy lindaman, md Avera McGreevy Clinic

henk Klopper, md

RHEuMAtology

Jeffrey stevens, md

Victoria Knudsen, md

samuel schimelpfenig, md Avera Medical Group McGreevy 7th Avenue

Avera Marshall Regional Medical Center chris swanson, md Internal Medicine James hanna, md Pediatrics heather reber, md OBGYN Avera Marshall Regional Medical Center, Emergency Department timothy hindbjorgen, md Family Medicine

Valerie Flynn, md CRitiCAl CARE MEDiCiNE

srinivas gangineni, md oNCology & HEMAtology

PEDiAtRiCs

Jill termaat, md Avera McGreevy Clinic

DERMAtology

Joseph Vogel, md Avera Medical Group McGreevy 7th Avenue

Avera Medical Associates Clinic Bretta olson, md Pediatrics nicole Poppinga, md Internal Medicine/Pediatrics dan rasmussen, do Physical Medicine & Rehabilitation Jessica rasmussen, md Obstetrics & Gynecology Floyd Valley Hospital/ Avera Health maria e. catalan-aquino, md Family Medicine

heidi mcKean, md

Avera Medical group Worthington larry Foster, do Family Medicine raphael Peralta, md Family Medicine Kenneth eldridge, md Internal Medicine Hegg Medical Clinic/ Avera Bradley Kamstra, do Family Medicine

to find an Avera Medical group physician call 1-877-At-AVERA (1-877-282-8372) or go to www.AveraMedicalgroup.org.

Contents Midwest Medical Edition

September / October 2011

Regular Features 2 | 16 |

From Us to You M edicine & the Arts Poet and Nephrologist Richard Jensen, MD

31 |

Then and Now

Urogyn Becomes a Specialty

33 |

Grape Expectations

35 |

N ews & Notes

37 |

L earning Opportunities

Old World vs New World Wines By Heather Taylor Boysen News from around the region Upcoming Symposiums, Conferences and CME Courses

In This Issue

Cover Feature

4 |

Raising the States Sales Tax By Dave Hewett

6 |

Marketing with QR codes By Lindsay Cosimano

8 |

A Matter of Trust By Jessica Beavers and Lisa Macguire

16 |

Feature: Flood of Goodwill Tenacity and Camaraderie Helped Dakota Dunes Healthcare Organizations Carry on ‘Business as Usual’ as the Flood Waters Rose

18 |

Pulmonary Valve Replacement without Surgery

21 |

25 Years of Careflight

22 |

Sanford Announces New World Clinics

29 |

Hands-on Rural Healthcare

34 |

F unctional Job Analysis by Kelly Marshall

In Review

Books by Local Doctors

page

How Robots are Transforming Medicine in the Heartland Science fiction trained us to believe that robots would make us less than human, inspiring more paranoia than peace of mind. But in healthcare, the gentlest touch is sometimes the non- human one. With eyes and hands far sharper and steadier than any surgeon’s, robotics is not a preemptor of human excellence, but an extension of it. Robotic technology has become an extension of the same tools that have saved lives for centuries: A scalpel with a guiding touch of humanity.

page

From Us to You

Staying in Touch with MED

A letter from the VP and Editor

Steffanie Liston-Holtrop

Alex Strauss

t MED, we love a road trip. We were excited to greet many of you in August at the Fall SDMGMA conference in Chamberlain. Our next destination is Rapid City for September’s SDAHO meeting. As the region’s only local business and lifestyle publication for healthcare professionals, MED is committed to understanding and serving the communication needs of our readers and advertisers. If we don’t meet you at a conference, feel free to drop us a line, via phone or email, any time and let us know how we’re doing. Our thanks to the ‘electric doctors’ who shared their experience with robotics for this month’s cover story. Even if robots are not currently a part of your practice, as the technology infiltrates more areas of American life and medicine, there is a good chance they will be a part of your future. We explore some of the places robotics are already enhancing the healthcare experience, for both doctors and patients. Be sure to check out several new books by area doctors in this issue, as well as advice from local professionals on everything from managing your money to marketing your practice. Our wine expert has some picks for your autumn table. And our list of regional Learning Opportunities is bigger than ever. Is there something else you would like to see in the pages of MED? Let us hear from you. Revel in the beauty of autumn on the Great Plains. — Steff & Alex

Publisher

MED Magazine, LLC Sioux Falls, South Dakota

VP Sales & Marketing Editor in Chief Cover Design/Photo Design/Art Direction Web Design

Steffanie Liston-Holtrop Alex Strauss Darrel Fickbohm Corbo Design 5j Design

Contributing Editor

Contributing Writers

Steffanie Liston-Holtrop, VP Sales & Marketing 605-366-1479 Steff@midwestmedicaledition.com Alex Strauss, Editor in Chief 605-759-3295 Alex@midwestmedicaledition.com Fax 605-271-5486 Mailing Address PO Box 90646 Sioux Falls, SD 57109 Website MidwestMedicalEdition.com

2011/12 Advertising / Editorial Deadlines

December Issue November 5

MED Welcomes Dan Heinemann, MD, to the MED Advisory Board Dan Heinemann, MD, is an experienced Family Practice Physician now working in Public Policy, Clinic Administration and Health Services Division. He has 20 years experience in practice in Canton as well as extensive experience in the area of legislative affairs, quality and patient safety. Dr. Heinemann is a lifelong resident of South Dakota and grew up on a family farm in rural Dell Rapids. He enjoys gardening, woodworking, reading, travel, and spending time with his wife Cathy and three adult children.

Jessica Beavers Heather Boysen Stepanie Broderson Lindsay Cosimano Dave Hewett Lisa Maguire Kelly Marshall Thav Thambi-Pillai

Contact Information

November Issue October 5th

Welcome

Darrel Fickbohm

2012 Jan/Feb Issue December 5 March Issue February 5

April/May Issue March 5 June Issue May 5 July/August Issue June 5

Reproduction or use of the contents of this magazine is prohibited.

Write to us!

Don’t forget we want to hear from you.

©2011 Midwest Medical Edition, LLC Midwest Medical Edition (MED Magazine) is committed to bringing our readership of 3500 South Dakota area physicians and healthcare professionals the very latest in regional medical news and information to enhance their lives and practices. MED is published 8 times a year by MED Magazine, LLC and strives to publish only accurate information, however Midwest Medical Edition, LLC cannot be held responsible for consequences resulting from errors or omissions. All material in this magazine is the property of MED Magazine, LLC and cannot be reproduced without permission of the publisher. We welcome article proposals, story suggestions and unsolicited articles and will consider all submissions for publication. Please send your thoughts, ideas and submissions to alex@midwestmedicaledition.com. Magazine feedback and advertising and marketing inquiries, subscription requests and address changes can be sent to steff@midwestmedicaledition.com. MED is produced eight times a year by MED Magazine, LLC which owns the rights to all content.

Midwest Medical Edition

Intensive Care for Newborns

In whose hands will you place her?

Physicians’ Priority Line

1.888.592.7955

When a newborn is critically ill, a single call gives you instant access to our neonatal intensive care specialists and a full range of pediatric and surgical subspecialists, all supported by state-of-the-art technology and equipment. It can also link you to our neonatal transport service team, who will arrange for transport to Children’s Hospital & Medical Center based on the child’s needs. Twenty-four hours a day, seven days a week, one call links you to physician-to-physician consults, referrals and admissions. There’s no problem too large, no child too small. www.ChildrensOmaha.org

Med Mag.Sept., 2011indd 1

8/2/11 2:22 PM

Raising the States Sales Tax

By Dave Hewett, President/CEO, SDAHO

here is a good chance inheritance tax. And during the recession in services and delayed or deferred care. that South Dakota voters other revenue sources have waned. The Those who have expressed early contractors’ excise and the banking franopposition to this initiative have said we will have the opportunity to vote on raising the State’s chise taxes have taken huge hits. Less need to let the current actions have a sales tax as part of the 2012 general people are smoking so tobacco revenues chance to work. The fact is that, at least election. The specific language calls for are at best flat (that’s a victory by the for Medicaid over the past three years, way); gaming has had a similar fate. providers have had their rates frozen for the approximately $175 million in This comes at a time when health care the first two, dramatically reduced in the additional revenue generated by that penny increase to be distributed equally providers are being asked to do more. third, and the prospects for existing revMedicaid enrollments are up because enues growing at a rate to make up for between the State’s Medicaid program and K-12 education. Eighty percent of more people have lost private coverage these years of loss are not materializing. during this recession. And by all So, this is a long-considered decision; the Medicaid distribution would be used to increase provider reimburseaccounts, the Medicaid cuts exacted by one that is not taken lightly and, in fact ment rates which over the past three the Governor and Legislature are taking represents a last resort to preserve adeyears have been frozen for the first two a real toll. Real cuts in physician and quate funding for the programs that acute care reimbursement are being educate our young and care for those and cut over six percent for the current made. At best in health care, the reducwho cannot care for themselves. State Fiscal Year. The remaining 20% tions in Medicaid reimbursement will be Please take the time to sign the petiwould be used to pay for projected passed on to private payers and will show tion that will put this initiated measure increased utilization and enrollment up as de facto tax increases in health on the November 6, 2012, ballot, encourin the Medicaid program. SDAHO supinsurance premiums and out-of-pocket age others to do so as well, and vote YES ports this effort. Quarter Page Horizontal 3.875 x 5.275 DRAFT 2011-05-09_Layout 1 6/8/2011 2:18 PM Page 1 charges. At worst it has meant reductions on Moving South Dakota Forward! ■ So why the sales tax and why now? Certainly, the decision to pursue an initiated measure to raise a state tax is not an option to be taken lightly – in fact it’s At RAS, Workers’ is our primary focus. Together we Compensation can create better outcomes the last option. We know this It’s what we do, and who we are. isn’t the perfect solution. The We have a proven history of solid performance with sales tax is regressive; the Leghealthcare facilities throughout the Midwest. We have islature and the Governor the knowledge and experience to address your unique refused to seriously consider concerns or situations. We have a team approach to this action during this past sesdeliver exceptional service, including: sion. But our analysis shows it to be the best of many difficult n Stay at Work/return to Work ProGraM DeVeLoPMent n LoSS PreVention anD traininG alternatives. First, new taxes n Safe Patient HanDLinG ProGraMS/erGonoMic aSSeSSMentS such as a state income tax or n injury aSSiStance center other tax isn’t supported in n LocaL cLaiMS ManaGeMent anD caSe ManaGeMent South Dakota — in a word, they are nonstarters. Second, the sales tax is a relatively stable source of revenue. In the past several years, we’ve witnessed ww w. r a sc omp an i es.co m Workers’ Compensation. the voters of the State eliminate our Focus. Your opportunity. sm 1.800.732.1486 one source of revenue – the

CONTAINING emplOyee INjury COsTs

Midwest Medical Edition

In tune with pediatric care Medicine is more than just our gig at Sanford Children’s. Backstage, we have the right teams whose expertise, courage and skill delivers the best outcomes, making your patient feel center stage. Our crew focuses on over 70 services and specialties, research to cure rare pediatric diseases and advocacy programs to bring health and wellness to the community. Helping your patients do what they do best: shine like the rock stars they are. That’s the art and science of health care. Only at Sanford Children’s.

childrens.sanfordhealth.org

100-11395-1919 8/11

September / October 2011

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QR Codes Bring messaging directly to users May provide valuable information to healthcare marketers, too By Lindsay Cosimano, APR, PCM

here are 69.5 million smartphone users in the United States, which is enough smartphones to give each South Dakota resident 85 of the mobile gadgets. Using smartphones, users can access QR codes, one of the latest trends to hit the marketing scene. Short for “quick response,” its name says it all. QR codes originally were developed in Japan as a way to manage Toyota’s extensive vehicle and parts inventory. However, the black and white digital barcodes are showing up everywhere from magazine ads, to your favorite packaged food items and even in healthcare.

Increased Health-care Presence ■ QR codes are

How it Works ■ QR codes are arranged in a square

■ Schedule appointments via a mobile-friendly

pattern of black and white pixels that compose an advanced, two-dimensional barcode that can store thousands of letters and numbers in vertical and horizontal fashion. Using a smartphone and barcode scanning application, users scan the bar code and are typically directed online for more information. There are a number of mobile barcode scanners on the market today, many of which are available at no charge.

gaining visibility in healthcare marketing, too. The Society for Healthcare Strategy and Market Development identified QR codes as a “Hot Trend in Healthcare” in their recent Emerging Media Handbook. Nearly half of SHSMD’s survey respondents, 45.2 percent, agree that social technologies are the most important trend they follow. Common healthcare marketing examples integrating QR codes include directing users online to:

■ View patient testimonials ■ Locate urgent care clinics, physician offices, ERs or hospitals via interactive maps

appointment calendar

■ Learn more information about a specific service line like imaging, cancer treatment or women’s health Omaha-based Members.MD, a concierge health-care firm, uses QR codes to help encourage direct mail recipients to view content online. The QR codes enable prospective physicians to quickly view testimonial videos on YouTube without having to log in to their computer.

Not the Final Answer ■ Although QR codes are

Lindsay Cosimano is Vice President of Marketing, Cassling

growing in popularity, there are still a number of users who are unfamiliar or uncomfortable with the concept. Prior to implementing a QR code, marketers should research their target audience to ensure that their preferences and usage align with the goals of the marketing campaign. Because there is no universal bar code scanner or mobile device application, users will likely have different

Midwest Medical Edition

You’re always there for them.

Scan this QR code and see where it takes you.

experiences accessing the same QR code. Marketers are encouraged to test the campaign extensively prior to implementation. QR codes are best used when part of a multi-channel marketing campaign, rather than used as a sole solution. They are an excellent way to drive response rates on direct mail or advertising and can direct users online for additional, more detailed information.

We’re always here for you. We have defended and supported the individual needs of health professionals for more than 30 years. And nobody is more personally committed to protecting you from the risks you face every day. To learn more, call 888-397-3034 or visit MMICGroup.com

Exclusively promoted and recommended by the South Dakota State Medical Association.

Increased Market Intelligence QR codes also give marketers added response-tracking functionality. For example, a healthcare organization can place a registration form on multiple pages within their website. Users can be directed to the online registration forms via:

■ A QR code in a print ad, ■ An article in a patient e-newsletter, or

■ A Direct mail piece. Because users are directed to a specific webpage, marketers can analyze which tactic garnered the highest response rate. QR code users report that they like the quick access to additional information and the technology’s ease of use. If healthcare marketers can keep the content valuable and succinct, they may see increased response rates and the ability to reach a more tech-savvy consumer. ■

MORE EQUIPMENT UPTIME, MORE SERVICE COVERAGE Keeping our customer’s equipment up and running is an important part of what we do every day. That’s why we’re proud that Cassling customers experienced an equipment uptime of 99.88 percent last year. Cassling’s service coverage is unmatched in the industry. Our highly trained service engineers are ready to address your immediate issues and our call center is available for assistance 24 hours a day, seven days a week. Find customer case studies, white papers and upcoming educational events at www.cassling.com.

Contact Shane Slaughter, Cassling Account Executive 605-321-6909 | sslaughter@cassling.com

13808 F St. | Omaha, NE | 800-228-5462 | www.cassling.com

September / October 2011

MidwestMedicalEdition.com

By Jessica Beavers and Lisa Maguire

A Matter of Trust

The Directed Trust Concept

Do you want a trust that keeps sensitive decisions in the hands of your existing investment advisors and other counselors? If so, read on.

n recent years, we have seen an increased interest in the use of Directed Trusts. Families are creating Directed Trusts to maintain control over investments and distributions.

to one particular firm’s investments or theories. The Investment Advisor or Investment Committee’s role is usually given to a client’s family members and/ or close advisors.

What is a Directed Trust?

The second advisor is the Distribution Advisor, which again can be assigned to an individual or a committee. The responsibilities of this advisor/committee are to determine how and when trust distributions should be made and to whom. A Distribution Advisor directs the Administrative Trustee on distributions to trust beneficiaries, thus allowing distribution decisions to remain in the hands of someone with a more intimate knowledge of the beneficiaries and their particular personal and financial situations. Again, typically, family members serve as the Distribution Advisor or serve on the Distribution Committee.

In its current form, a Directed Trust is one in which some of the duties traditionally associated with a trustee are instead vested in either an individual or several advisors. This creates substantial flexibility with regard to how the traditional “trustee” role is filled. In its current form, a South Dakota Directed Trust uses the statutes of our state to set up a trust with as many as three types of advisors: Investment Advisor, Distribution Advisor, and Trust Protector.

Investment Advisor

The first advisor is an Investment Advisor. This position can be held by an individual or a committee. The Investment Advisor directs the Administrative Trustee on all matters relating to trust investments. For instance, the use of an Investment Advisor can allow increased flexibility in investment strategy, as that advisor will not be tied

Distribution Advisor

powers typically given to a Trust Protector can include, but are not limited to, the power to override decisions of certain terms of the Trust Agreement, such as removal and appointment of trustees and advisors, the power to amend the trust, and the power to change the trust’s situs. Not all states have trust protector statutes, but South Dakota’s laws allow for the position of a Trust Protector.

Administrative Trustee

The role of Administrative Trustee, sometimes known as “Directed Trustee,” is usually assumed by a trust company. The Administrative Trustee is directed by the Investment Advisor/ Committee and/or the Distribution

Trust Protector

Finally, a Trust Protector can be used as a neutral party to add an additional layer of protection. This person is usually most familiar with family’s long-term financial and personal goals. A Trust Protector acts to balance the power between the Trust Agreement, the Trustee, the Grantor, and the beneficiaries. The

Jessica Beavers, CTFA, CISP is President of Bankers Trust Company of SD and Lisa Maguire is a Partner with Woods, Fuller, Shultz & Smith P.C .

Midwest Medical Edition

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Advisor/Committee. Hence the title, Directed Trustee. The Administrative Trustee’s duties may include “managing” all administrative aspects of the trust, including document review, distribution review, accounting preparation and review, and tax preparation. The result of this streamline of functions is competitive corporate trustee fees.

The concept of a Directed Trust is particularly attractive to those who: ♦ have close relationships with their current advisors, ♦ own substantial non-traditional assets, such as closelyheld businesses, that they wish to keep in the family, or ♦ are concerned about significant family issues such as spendthrift, substance abuse, or competency. The Directed Trust gives administrative expertise by using a corporate trustee, while still allowing a family’s trusted advisors to assist with investment and distribution decisions. Families are thus able to achieve their goal of keeping decision making close, while the corporate trustee is able to concentrate on properly administering the trust. In essence, it is a win-win situation. ■

September / October 2011

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AMA Offers New Resource for Physicians Considering Hospital Employment CHICAGO –The American Medical Association (AMA) has released a new chapter in its physician resource manual. “ACOs, CO-OPs and other Options: A ‘HowTo’ Manual for Physicians Navigating a PostHealth Reform World” provides an overview of the process and issues to be considered when negotiating a physician-hospital employment agreement. “In the post-health reform world, hospital employment of physicians may become increasingly popular,” said AMA president Peter W. Carmel, M.D. “This new chapter helps physicians who are considering this option fully understand the legal issues surrounding hospital employment so they can avoid pitfalls and negotiate a fair employment contract.” “ACOs, CO-OPs and Other Options: A

‘How-To’ Manual for Physicians Navigating a Post-Health Reform World” was specifically designed to help physicians thrive in the posthealth reform world. Both the new chapter on physician-hospital employment agreements and the full resource manual are available for free on the AMA website. Another AMA resource available for physicians on this topic is the e-book, Annotated Model Physician-Hospital Employment Agreement. This resource addresses the specific needs of physicians and their attorneys who are preparing to negotiate employment contracts with hospitals. AMA members may view the interactive Physician-Hospital Agreement online for free. Non-members may purchase access to the current edition through the AMA Bookstore. ■

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September / October 2011

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Vascular specialist J. Michael Bacharach, MD, of North Central Heart repairs an abdominal aortic aneurysm in a new hybrid vascular lab at Avera Heart Hospital. Â Photo courtesy Avera.

How Robots are Transforming Medicine in the Heartland nce the stuff of science fiction, robots are now a scientific fact. Used in a vast number of human applications, from vehicle manufacturing to household cleaning (think robotic vacuum cleaners), robotic technology has also, not surprisingly, found a growing place in the world of medicine. Rolling robots are streamlining medication management in hospitals; humanoid robots serve as life-like training tools for medical students and EMS workers; and telemedicine-equipped robots are bringing specialists into underserved areas. But perhaps the most profound and far-reaching application for robotics in medicine is inside the operating room.

History of Robotic Surgery The earliest surgical robots were simple. ROBDOC, developed by IBM in 1992, helped surgeons bore holes in the femur for hip replacement. Later, scientists at Stanford, the U.S. Defense Department and NASA combined robotics with telepresence technology so surgeons could operate on distant patients. Intuitive Surgical, Inc., acquired the prototype and, in 2003, after adding a laparoscopic camera holder, introduced the daVinci Surgical System. Sioux Falls hospitals were quick to recognize the potential. Sanford acquired its first daVinci system in 2004 and Avera in 2007. Both hospitals later added a second system. Although Sanford gynecologic oncologist Maria Bell, MD, was among the first doctors in the region to incorporate the robot into her surgical practice, she was skeptical at first. By Alex Strauss 12

Midwest Medical Edition

courtesy Avera

Courtesy Sanford Gynecologic Oncologist Maria Bell, MD

September / October 2011

New Applications

“When I was in training, about 75 % of minimally invasive surgeries were done as straight laparoscopic surgeries and about 25% were done robotically,” recalls Dr. Luis Rojas, MD, gynecologic oncologist, who trained in robotic surgery at the Cleveland Clinic before joining Avera McKennan in 2007. Dr. Rojas’ passion for the technology helped bring it to Avera. “Because the robot allows me to function better as a solo surgeon, I have seen that 75/25 reverse. Here at Avera, we now do about three quarters of our minimally invasive surgeries with the robot.” In South Dakota, gynecologic procedures are the most common robotic procedures followed by urologic surgeries including prostatectomy, where the target site is not only tightly confined but also surrounded by nerves that affect urinary and sexual function. General surgeons in the region have also used the robot for adrenalectomy, Nissen fundoplication, colon and esophageal procedures. While daVinci is not yet being used for mitral valve repair in South Dakota as it is in some centers, a new robotic imaging system is already being used in some vascular cases. “This is essentially an imaging system that uses robotic technology as part of its mainframe,” says J. Michael Bacharach, MD, a vascular medicine MidwestMedicalEdition.com

specialist with North Central Heart Institute in Sioux Falls. Dr. Bacharach uses the new Siemens Artis Zeego flexible robotic imaging system to place stents and perform other vascular procedures. “The robotic assisted positioning of our imaging equipment gives us 3D visualization of vascular anatomy that you couldn’t otherwise see. It reduces the potential for complications, is more ergonomic for the clinician, and reduces the patients’ radiation exposure.” In the Black Hills, Surgeon David Fromm, MD, of Rapid City Medical Center, who trained in pediatric and thoracic robotic surgery at the University of Iowa, is anxious to see a system in place West River. courtesy Sanford

“I had already had success doing many of my procedures with standard laparoscopy, so I wasn’t sure this was something I was going to be able to embrace,” she says. But it did not take long for daVinci, with its super-human maneuverability, precision, and enhanced visualization, to change her mind. Dr. Bell, who has performed more than 700 robotic assisted operations and become an international leader in the field, says she became a convert on her first complex surgery with lymph node dissection. “It was like ‘Honey, I Shrunk the Surgeon!’,” she says. “You’re in there. And you have this incredible 3D panoramic view. Any time you can improve exposure and visualization, you are going to have a better outcome.” Using a stationary ‘docking system’ for the robotic arms and a video console across the room, daVinci integrates 3D high-def video with robotics to virtually extend the surgeon’s eyes and hands. The system is ideal for operating in hard-toreach areas such as the pelvis. Although the docking system precludes shifting easily to another quadrant to operate, doctors who’ve used it say daVinci’s ergonomic design is less fatiguing. In the hands of well-trained surgeons, the robotic system has been shown to reduce surgical trauma, blood loss and pain and result in shorter hospital stays.

Luis Rojas, MD, Gynecologic Oncologist

Surgeon John Lee recently began offering transoral robotic surgery for cancer on the tonsil or base of the tongue.

courtesy Sanford

courtesy Avera Flexible arms on the Artis Zeego robotic imaging system give better views during vascular procedures.

Aethon ‘tug’ robots deliver medications that can’t be sent through the hospital’s pneumatic tube system.

courtesy Avera

“Having a robotic system in place would help us further advance the minimally invasive procedures we already offer,” says Dr. Fromm, who performs a variety of single port surgeries and appreciates the way the robot improves the ability to suture laparoscopically. “Having a robot would allow us to do more complex colorectal cases right away as well as head and neck surgeries and others down the road. It is a matter of thinking outside the box.” Both Black Hills Surgical Hospital and Rapid City Regional Hospital are reportedly evaluating the economic feasibility of installing the $2 million robotic system. In Sioux Falls, Sanford head and neck cancer surgeon John Lee, MD, recently began offering transoral robotic surgery for incision-free excision of tumors in the tonsil or base of the tongue. The FDA recently approved this new application for daVinci, which may reduce radiation

exposure and could help some patients avoid chemotherapy with more complete tumor resection. “I used to have to look through the microscope and use my hands to pull with forceps. It was difficult to get around corners,” explains Dr. Lee, who was among the first surgeons to be certified in the new technique. “Now, I just slip my fingers into the remote control. The robot has a bright light on a high definition camera and it can easily grab tissue with its skinny arms. When you don’t have to cut skin and muscle, patients recover faster and have less pain.”

Other Robots in Action

For the past 2 years at Avera McKennan, rolling Aethon tub robots have distributed medications that can’t be delivered via the pneumatic tube system because of composition, size, weight or other factors. “We wanted to keep technicians in the pharmacy, instead of out delivering medication,” says Jessica Larsen-Gallup, Avera McKennan’s Compliance Manager for Pharmacy. “We input the destination on the robot’s touch screen and send it off. They have laser sensors that allow them to see obstacles and an alarm that sounds to announce the delivery.” More importantly, each robot requires the recipient to input an i.d. to retrieve the delivery – a valuable feature when dealing with medicines like narcotics.

Since 2004, Sanford surgeons have performed nearly 3000 procedures using the daVinci robotic system. Today, close to 30 physicians in gynecology, urology, general surgery and ENT are trained to use the system.

Rolling robotic telemedicine units have been used in South Dakota to bring a specialist’s life-like presence into rural exam rooms. And recently, the state launched new EMS training ambulances featuring humanoid robotic simulators. (see photo, right) Robotic surgery enhancements such as smaller instrumentation, flexible lighting, incorporation of fluorescence, or ability to deploy the system through a single port are already in development, ensuring that robots are likely to be a permanent part of medicine’s future. And by making surgery easier on surgeons, they may even help keep more human doctors in the game longer. “The longevity of surgeons could definitely be lengthened with robotics,” says Dr. Bell. ■ Midwest Medical Edition

Regional HealtH

Recognized for Best Practices

Congratulations!

Several Regional Health employees were selected to share their research and best practices with health care professionals from throughout the United States at the 2011 Premier Breakthroughs Conference and Exhibition in Nashville, TN. Premier Presenters mark Brodin

Vice President of Decision Support

Regional Health – “Safety, Quality & Savings through Regional Collaboration”

Jennifer Gholson

Clinical Analyst

Regional Health – “One System of Care: One Electronic Chart”

randee Handcock

Director of Clinical Integration

Regional Health – “Hospital to Home: A Value-Added Approach to Reducing Readmissions”

James Keegan, mD

Chief Medical Officer, Regional Health; Chief Executive Officer,

Regional Health Physicians – “Implementing Programs that Protect Workers & Patients”

sandra Ogunremi, DHA

Director, Office of Rural and Frontier Health

Regional Health – “ED Diversion: Success on the Pine Ridge Indian Reservation”

scott Peterson

Assistant Director of Pharmacy

Rapid City Regional Hospital – “Achieving Pharmacy Efficiencies in Non-Acute Care Facilities”

Heidi tennyson

Programmer Analyst

Regional Health – “One System of Care: One Electronic Chart”

Courtesy Regional Health

Jody thompson

Blood Bank Supervisor

Rapid City Regional Hospital – “Implementing a Blood Management Program”

Premier POster Presenters tasha Frisinger, rn, Bsn

Director of Clinical Coordination and Staffing

Rapid City Regional Hospital – “Rapid Admissions Unit: An Innovative Approach to Patient Flow”

Kathy Hill, msn, rn

Clinical Quality Coordinator – Stroke

Rapid City Regional Hospital – “Who Ya Gonna Call? Clot Busters!”

Lacey Joens, rn

Director of Emergency Services and Trauma Coordinator Spearfish Regional Hospital – “Behavioral Health in the Northern Hills”

Deonne taylor, rn

Clinical Quality Coordinator-Pneumonia

Rapid City Regional Hospital – “Influence of Antibiotic Stewardship Program for Quality Advisor Pneumonia Outcomes”

Robots as teachers: The SD Department of Health, along with the state’s EMTs and several hospitals and health systems, recently launched Simulation in Motion-South Dakota, a state-of-the-art training vehicle featuring a life-like iStan simulator robot that can bleed, sweat, shake, groan and simulate a heart attack or stroke.

September / October 2011

For more information about the presentations, visit www.regionalhealth.com/premier

15725-0811

Medicine

&Arts

Life is short but art endures — Hippocrates

The fog will slowly burn away. What it reveals, I cannot say. I only know that nothing lasts, when fog-filled mornings wander past. From the poem Fog by Dr. Richard Jensen

Dr. Richard Jensen, Nephrologist By Darrel Fickbohm

he writings of Sioux Falls nephrologist Richard Jensen, MD, seem to reveal that the most profound ideas are often found in the questions that we cannot answer—which is almost a contradiction in the medical profession that is based on a test-and-then-fact protocol. Dr. Jensen has much in common with other artist-doctors. He is quick to see the shared ground between his vocation and his love of writing. When he is asked about the similarities he makes little distinction between the two. “We’re taught to listen in our profession. I’d like to see more doctors write. The practice of medicine makes us so ready to do it. Nothing prepares us for the task better than taking histories and listening to someone tell their story. We learn to pick up on details that can mean so much. Later, when we’re alone we analyze common themes. I find myself alone, many times, still listening” The inclination to be a writer started very early in Dr. Jensen’s life, but the pull of medicine was even stronger. “I helped with the family business, right here in South Dakota. When I left home in 1982, the call of medicine was 16

Poet

definitely there. Now, my practice takes me all over the state and farther. I drive down country roads and have time to listen to myself for a while. Later, I write about those thoughts.” He credits the life of a doctor with giving him discipline and an ongoing quest for knowledge, although the quest can take him into some unknown territory. The task of learning the craft of writing has been a humbling experience for Dr. Jensen. He approached his mentor, “hat in hand,” and asked her to teach him to be a better writer. Later, friends begin to notice that his writing had matured. “What I do is look at the everyday things and try to find what has been missed. It helps to be in contact with people everyday. I think that’s what really gets me going—experiences. In fact, when I finally stop practicing medicine, I’ll have a lot to write about.” The poetry of Dr. Jensen closely follows natural themes that draw spiritual parallels. “I had a Native American practice for a while and it gave me a deepened spiritual sense, I think. I am always drawn to people who are at peace in a world that they cannot change. I am

also inspired by my own family and the simple faith of my grandparents is very much with me when I write.” When asked about the intersection of the spiritual and the scientific in his writing, he warms to the subject easily. “In my book Celestial Dust I see God as a character in the big story, but I’m not afraid to make us be a part of the physical universe, also. You can embrace your religious beliefs and still keep the bigger picture in mind.” When asked why more physicians don’t experiment with writing and the arts, Dr. Jensen is thoughtful and then answers as a poet might answer: “Maybe we just need to have permission.” ■

If you’re interested in the work of Dr. Jensen, please visit www.skydoc310.com to order books or to email for more information.

Midwest Medical Edition

Clinical Spotlight

Pulmonary Valve Replacement without Surgery

h i l dr e n ’s Hospital & M e d i cal Center in Omaha, Nebraska has successfully performed the region’s first transcatheter pulmonary heart valve replacement procedure, a Jeffrey Delaney, M.D. non-surgical alternative to open-heart surgery. The Melody Transcatheter Pulmonary Valve (TPV) is the first medical device of its kind to be approved by the Food and Drug Administration. It is considered a Humanitarian Use Device for the treatment of dysfunctional right ventricular outflow track (RVOT) conduits whose pulmonary valve has become blocked or is leaking. The valve is placed during a minimally-invasive procedure via a catheter that travels through the patient’s blood vessels. The process means a shorter

and 21, spent just one night in the hospital. Both are doing well. In the past, children whose RVOT was affected by congenital heart disease would face a series of open-heart surgeries, first to replace their native pulmonary conduit and valve, then to replace the aging prosthetics that provided the repair. “Once the children had the first surgery, they’d know they would have to go through it again multiple times for the rest of their lives,” Dr. Delaney says. “Each time we operate, we have to penetrate more scar and fibrous tissue than the last time, which means a little higher risk.” The Melody valve procedure illustrates how the pediatric hybrid catheterization lab at Children’s is being utilized to offer heart patients and their families the latest in minimally-invasive cardiac treatments. “The way we can diagnose conditions in the cath lab and also treat them has totally changed the field,” Dr. Delaney says. “There were dire predictions that the numbers for cath labs would go down. And while our diagnostic catheterizations have gone down somewhat, the number of interventional catheterizations to treat these conditions has gone up tremendously. “That means more hope for more kids every day.” ■

“. . . more hope for more kids every day.” hospital stay, minimal pain, and no stitches. “It is a marvelous option for any patient who has had prior pulmonary valve surgery, whose conduit or homograft has since become dysfunctional, and the existing conduit is of appropriate size to accept the Melody valve,” says Jeffrey Delaney, M.D., pediatric cardiologist and medical director of the catheterization lab at Children’s. The valve is a viable option for patients weighing at least 25 kilograms, or about age 8 and older. Children’s is the only approved Melody implantation center in Nebraska, Kansas and the Dakotas. Dr. Delaney and the cath lab medical team underwent training in Minneapolis to learn the procedure. They performed the first implants at Children’s in April 2011. The patients, aged 19

Midwest Medical Edition

In Review What You’re Reading, Watching, Hearing

Author Richard Howard, MD

Beyond A Surgeon’s Journey to Understanding the Transition from This Life to the Next “I looked down at her still open eyes. They continued to shine with that “sparkle” of life, but it faded and disappeared even as I watched. The scientist in me closed her eyes…”

his excerpt from “Beyond: A Surgeon’s Journey to Understanding the Transition from This Life to the Next” by Richard Howard, MD, comes from the story of the 85 year old grandmother, healthy and hard working right up until the day she became seriously ill, who deteriorated quickly and then informed Dr. Howard that she would not recover. He recounts her peacefulness in the face of death.

“I have seen people at death’s door absolutely terrified while others have radiated peace and tranquility,” says Dr. Howard. “I have seen patients die who had virtually all the medical odds in their favor. I have also seen the miracle of patients young and old surviving against all odds.” As a seasoned plastic and reconstructive surgeon, Dr. Howard says he has often been touched by the fragile balance of life and death. The patient stories he shares are complex, moving and provide an intimate glimpse into the life and death struggles experienced every day by those who choose to heal on the front lines. “When I first started this book endeavor, I honestly thought the personal patient stories I felt compelled to tell were common in medicine,” says Dr. Howard.

“I was certain that other doctors and healthcare professionals also experienced the same spiritual journey that I have witnessed over the course of my career. As it turns out, the remarkable patient stories that have been revealed to me are somewhat unique in the medical field.” Dr. Richard Howard is certified by the American Board of Plastic Surgery and is a Fellow of the American College of Surgeons. He is the owner and practicing physician at the Sioux Falls Center for Plastic and Reconstructive Surgery. ■

Author Brad Randall, MD

The LD Chronicles

very year nearly a quarter of a million men are diagnosed with prostate cancer. Forensic pathologist Brad Randall, MD was one of those men, living through the uncertainties that surround a prostate cancer diagnosis. He chose to write about his experience, both from the perspective of a patient and as a physician. The reader of The LD Chronicles will have a very first person look at the trials and tribulations along each step of the prostate cancer path: diagnosis, treatment options, robotic prostatectomy, post-operative care issues, and perhaps September / October 2011

most prominent on the mind of every man dealing with prostate cancer, erectile dysfunction. Dr. Randall not only shares his personal experiences, but also takes the reader behind the physician/hospital curtain to offer a glimpse into the physician-to-physician interplay that most patients never see. Interspersed in the narrative are enough anatomy, physiology, and pathology to facilitate the lay reader’s understanding of the topic without being overdone. But what sets this book apart from others is Dr. Randall’s self-depreciating style that takes a serious topic and makes it humorous. MidwestMedicalEdition.com

This book is a short and easy read that is a must for anyone wanting to look at life beyond a diagnosis of prostate cancer. Dr. Randall is a Professor of Pathology at the USD Sanford School of Medicine. For nearly 30 years he has practiced both general and forensic pathology in Sioux Falls, SD. To order Dr. Randall’s book, please visit Outskirtspress.com and search “Brad Randall.” ■

MRI Safe Pacemaker

Now At Rapid City Regional Hospital

Featuring

ration

y Celeb niversar

20th An

With Special Guest

September 17, 2011 East side of 8th and Railroad Center, Sioux Falls

Gates open at 6:30 pm $10 at the gate

A cardiac pacemaker that is safe for patients who need an MRI scan is now available at Rapid City Regional Hospital. Patients with standard pacemakers are unable to undergo an MRI scan as it can disrupt pacemaker settings or cause wires to overheat, resulting in unintended heart stimulation, device electrical failure, or tissue damage. The new pacemaker, manufactured by Medtronic, has the same function as existing pacemakers but is specifically designed to allow patients to undergo MRI scans under specific conditions. There are some limitations to the new pacemaker: it is only for new pacemaker patients and cannot replace existing pacemakers; it must be implanted for six weeks before receiving an MRI; and it will not work for all types of MRI scans or in all MRI scanners. It is highly recommended that all MRI scans be performed at the same institution where the pacemaker was inserted due to the special training and knowledge required. “Patients with a history of conditions requiring MRI scans such as spinal cord disease, brain tumors, multiple sclerosis, stroke, back problems and some orthopedic problems will greatly benefit from this new technology,” said John Heilman, M.D., a cardiologist with Regional Heart Doctors . “This is an important technological advance and will greatly benefit future patients.” ■

Advance tickets available at Last Stop CD Shop Locations

Ages 21+ Proceeds benefit

Thank you to our sponsors

Sanford Health

plans to build a $360 million,

371-private room Sanford Fargo Medical Center. The new Fargo campus is the largest project of its kind in North Dakota history and will encompass over 100 acres in southwest Fargo. The 704,000 square foot, 11-story facility will house Sanford’s medical and surgical services, emergency medicine, and four out of five Centers of Excellence (heart, children’s, women’s,

More information available at www.southdakota.wish.org

orthopedics/sports medicine). Groundbreaking is expected in 2013, with anticipated completion in 2016. ■

Midwest Medical Edition

Careflight Celebrates

25 Anniversary th

The Careflight air transport program at Avera McKennan Hospital & University Health Center is celebrating its 25th year in service. Francie Miller, assistant vice president for Emergency Services at Avera McKennan, was instrumental in developing the Careflight program in 1986, and served as flight nurse on Careflight’s first flight. “We serve an area that’s largely rural. McKennan Hospital started Careflight because many of our most critical patients in outlying areas didn’t have the same access to critical care,” Miller said. Careflight began with a helicopter

aircraft, providing transport within a 125-mile radius of Sioux Falls from medical facilities or accident scenes. Fixed wing services were added in 1995 to fly at higher speeds and greater distances. The Careflight ambulance is used for ground transportation to and from the airport as an extension to Careflight’s fixed wing and rotor wing aircraft. Having met stringent standards and criteria, Careflight is accredited by CAMTS, the Commission on Accreditation of Medical Transport Services. The Careflight helicopter and fixed wing aircraft are essentially airborne

Intensive Care Units, staffed by professionals trained to handle trauma, obstetrics, pediatrics, medical/surgical care, burns, neurology and neonatology. Avera McKennan updated to a new fixed-wing plane in 2008 and a new helicopter in 2009 in order to incorporate new safety and critical care technology. Careflight averages 1,200 flights a year, with approximately 15 percent of those being flights to the scene of accidents and the other 85 percent transports from area hospitals. Over the past 25 years, Careflight has traveled over 3.1 million miles on more than 17,700 flights. ■

Ribbon Cutting & Open House! Tuesday, September 20, 11-1 p.m. 11:30 Ribbon Cutting

Services Include:

The Children’s Care Hospital & School Rehabilitation Center, Rehabilitation Medical Supply, and the office of Julie Johnson, MD, are celebrating their move to a new, more spacious location at 18th & Grange. Join us for refreshments and a tour. For children: · Physical Therapy · Occupational Therapy · Speech Therapy · Cranial Remolding · Autism Evaluations

For children & adults: · Orthotics/Prosthetics · Wheelchairs/Mobility Devices · Audiology & Hearing Aid Fitting · Assistive Technology · Augmentative & Alternative Communication

REHABILITATION CENTER

For Children with Special and TheirSD Families 1020 W. 18th St.,Needs Sioux Falls, 57104 • www.cchs.org 1020 W. 18th St., Sioux Falls, SD 57104 www.cchs.org

September / October 2011

MidwestMedicalEdition.com

Tenacity and Camaraderie Helped Dakota Dunes Healthcare Organizations Carry on ‘Business as Usual’ as the Flood Waters Rose

hey say that what doesn’t break you makes you stronger. If it is true, then the residents of Dakota Dunes, South Dakota along with residents of the 37 other South Dakota counties declared ‘disaster areas’ in the wake of spring flooding, are now strong enough to weather just about anything. Mike Hurlburt, CEO of the CNOS, PC in Dakota Dunes, was one of an estimated 400 people forced to evacuate their homes shortly after the Missouri River began to rise out of control on Memorial Day weekend. Like his neighbors, Hurlburt went into action, working not only to protect his own property, but to help build levees and sandbag the houses of friends and colleagues, as well as continue to ensure that local residents could still get access to the medical care they needed. “The community, the National Guard, FEMA, the Army Corps of Engineers, private contractors… everyone was working together like they had never worked together before,” recalls Hurlburt. With trucks and equipment running steadily 24-hours a day, the town was able to construct a 4-mile long levee capable of holding back 12 to 15 feet of water in just ten days. “When I saw the way the community began to come

together immediately, I knew that we were going to be OK, regardless of what happened,” Hurlburt says. “What we found was that it was not the flood but our response to the flood that defines us.” As the flood continued, over 600 families temporarily moved from the community. Hurlburt began to regularly blog about his and others’ experiences on the CNOS clinic website, a clinic whose own doctors and staff were hit as hard as anyone by the rising water. Hurlburt estimates that as many as three quarters of the 70+ medical providers in the community were personally impacted by the flood, with as many as half being forced from their homes. One of those doctors was CNOS Neurosurgeon Quentin Durward, MD. Dr. Durward, along with his wife and adult daughter, began evacuating their Dakota Dunes home on Memorial Day weekend. They

Flood lood ooff F Goodwill oodwill G By Alex Strauss

Midwest Medical Edition

put many belongings in storage, moved some in with friends or family, and moved themselves into an apartment further from the river as the threatened neighborhood was walled off by a protective levee. “You really find out how much you have accumulated when you have to start trying to move it all out,” says Dr. Durward. The rising groundwater damaged carpet and drywall in the Durward’s basement but they know it could have been so much worse. Elsewhere in the same neighborhood, the flood water rose many feet high in some basements. Other neighborhoods were, literally, under water. Although the water is finally receding, repairs and renovations will keep the Durwards from going home until at least next spring. Like Hurlburt, Dr. Durward says he was inspired by the support and kindness he experienced throughout the ordeal. “It was really amazing the amount of support we had from all over, not just from the Sioux City area, but even from Sioux Falls, the border patrol, the Army National Guard,” says Dr. Durward. “I would say that the entire Siouxland community showed an enormous amount of positive goodwill.” Hurlburt says it was that goodwill which allowed flood-impacted physicians like Dr. Durward to keep the healthcare wheels spinning in Dakota Dunes, even while their home lives were in upheaval. Although many medical professionals were impacted along with the rest of the community, neither the Siouxland Surgery Center nor any of the 18 medical specialty clinics on the campus had to close, even during the peak of the flooding. General Surgeon Rob Anderson, MD, of Midlands Clinic, whose home is in the Sandy Mead neighborhood, has been

September / October 2011

showering and washing dishes in an RV in his driveway for 3 months because of contaminated water in his house. In his group of ten physicians, only three did not have to move out of their homes. Like Hurlburt and Durward, Dr. Anderson relied on help from dozens of volunteers to keep his life afloat. “I had to build a 6000 sandbag wall around the back of my house to hold back the water,” says Anderson. “It was pretty humbling to see so many volunteers – friends and family and people in the community that we didn’t even know – who came to help.” Mike Hurlburt and other colleagues from the medicine community were among the people who worked to protect Anderson’s house so that he could continue to focus on the surgical needs of patients. It was a pattern repeated throughout the area as community resources were pooled quickly and efficiently to protect vital infrastructure like the medical clinics. “I really credit the physicians and staff member who were able to stay focused and provide for patients, even in the midst of a crisis,” says Hurlburt. “And I have to commend patients, too. In the state of chaos, they were able to continue to support the health services industry here and come receive care. We have a great community, great physicians, and a fantastic patient base that was incredibly understanding.” Many residents, including Dr. Durward, have wondered at the unprecedented length of the flood that has now lasted more than 3 months, but are heartened by the steadily dropping river levels. Water releases from the Gavins Point Dam, which stood at 160,000 cfs at its peak are

MidwestMedicalEdition.com

Dr. Quentin Durward

slated to drop to 40,000 cfs by the end of September. Now that “chaos is the new norm”, Hurlburt has been taking stock of the flood’s broader impact, not just on the community’s buildings and land, but also on its attitude. “The people of this community have been able to take a worst-case scenario and turn it into something positive for businesses, residents and the whole state. The Dakota Dunes Community Improvement District, which is coordinating the rebuilding efforts, has strong working relationships with business. By working together, we have found that our strength is in our unity and that, in our unity, we can handle any disaster that comes at us.” For their parts, Durward and Anderson agree that the disaster did foster a greater sense of community spirit and brought out the best in many people. And while they, too, are optimistic about the area’s future, both are hopeful that there is one thing that future will not include. “I just hope it doesn’t rain like this next May,” says Dr. Anderson. ■

Sanford Doctors

RUGS

The most functional piece of art you will ever own.

Experience Transplant

from a New

Perspective Family Medicine physician Stephanie Broderson, MD, who has had lupus for many years, recently underwent a kidney transplant in Sioux Falls. For Dr. Broderson, it was not only a chance to regain her health, but also a rare opportunity to experience healthcare from an entirely new perspective. For her transplant surgeon Thav Thambi-Pillai, MD, it was also a relatively rare chance to treat a fellow physician â&#x20AC;&#x201C; sometimes said to be the most difficult kind of patient. Now, nearly three months after the successful opera-

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tion, MED invited both doctors to write about the experience.

Midwest Medical Edition

A Patient’s

A Surgeon’s

Perspective

By Stephanie Broderson, MD Sanford Clinic Family Medicine

s a physician undergoing a kidney transplant, I was often asked if I “knew too much.” I don’t think you can ever know too much. I knew a transplant was coming since 1998. I just didn’t know when. Last fall, my labs suddenly worsened and kidney biopsy showed only chronic change left over from the original damage done by lupus nephritis. My nephrologist suggested peritoneal dialysis (PD) due to my active life and work. I felt stable enough to get through the end of the year and contacted the transplant team just after the first of the year. My PD catheter was placed March 5th. Because I am a veteran, I had gotten care through the VA, but they would have to send me to Iowa for transplant. I wanted to stay close to home, so contacted Sanford. My meeting with transplant was March 18 and my husband and stepdaughter, both potential donors, came along. They both began initial testing that same day witha 24 hour urine. To my benefit, my creatinine remained stable at around 5, so I never did have to start dialysis. I understood that dialysis is hard on the body, so people who don’t have to have dialysis prior to transplant tend to do better, and a live donor kidney tends to do better also. A few months later, we got word that my stepdaughter would be the donor and scheduled Surgery. The hospital part was straightforward. I had been told what to expect. I was instructed to “be a good patient.” Apparently physicians generally are not good patients. I promised I would. Every time I saw Dr. Thambi prior to transplant, I requested that he remove my PD catheter during my transplant surgery. He said it needed to stay in for 4-6 weeks after surgery “just in case,” but did end up removing it since it was a potential source of infection. The pain was about as expected. The nursing staff was awesome. They said I was an easy patient because I understood my lab results and medications and they didn’t have to explain everything to me. Although I didn’t like everything I had to do (all the meds, huge amounts of fluids I had to drink, all the blood draws), I understood why it needed to be done. For me, being a physician and having that background knowledge made the whole process easier. ■

September / October 2011

MidwestMedicalEdition.com

By Thav Thambi-Pillai, MD Sanford Transplant Center Surgical Director

n the 21st century, kidney transplant is routine but still complex. As a transplant surgeon, I feel honored and privileged to be placed in a unique position where I’m able to help facilitate the transfer of an organ from one individual to another. Regardless of the number of transplants I’ve done, every single time when I complete a transplant surgery and the kidney pinks up and starts making urine in the operating room, it’s a humbling experience. I never forget even for a moment at what cost each transplant happens especially in the cases of deceased donor transplants. In the case of living donor . . . operating transplants, this is the only time in surgery that we ever operate on a on our patient (in this case a living donor) for the physician benefit of another individual. The stakes are high. Both the recipient and donor colleagues, expect to do well with good outcomes. these effects It’s similar to being in the Obstetric environment where a mother expects to are multiplied deliver a perfect baby every single time. many fold When operating on our physician colleagues, these effects are multiplied many fold. I think it’s like walking on a straight line on the ground vs doing the same thing many feet up in the air! It’s exciting and fun when the surgery goes as planned. Both Andrea’s and Stephanie’s surgeries went smoothly as planned. In fact the transplant kidney made as much as 25 liters of urine in the first 24 hours! In the US, there are over 120,000 people on the national waitlist waiting for an organ transplant and over 95,000 of them for a kidney. In South Dakota, there are about 220 people waiting for an organ transplant. Unfortunately, every day about 18 people die on the waitlist for one reason: lack of transplantable organs. At Sanford, the majority of our transplants are living donor transplants. I’m humbled by the number of people in the upper Midwest region who come forward to donate one of their kidneys to their love ones or even as an altruistic donor to strangers. ■

“

”

Sanford Health announced plans this summer to open several new clinics around the world.

Ghana, Africa

Sanford Announces

Children in the Baja region of Mexico

New World Clinics Through conversations with various world health organizations, Ghana, Africa was identified as an area of need and opportunity for better health care. Sanford will take over operations of an existing primary care clinic in Cape Coast, Ghana currently led by two physicians who are treating 800 patients a week. This location will serve as the hub for several other general health care clinics throughout Ghana and will provide general health care services to area children and adults. Malaria, diarrhea and respiratory health issues are common in the region. Sanford hopes that Ghana’s consistent government and growing economy will allow them to build a model of permanent health infrastructure that can then be parlayed into projects in other parts of the African continent. Two additional clinics are planned for Mankessim, Ghana and Kojokrom, Ghana.

“The venture in Ghana is the beginning of what we hope to be a major change in health care services in Africa,” stated Dave Link, Sanford Health senior executive vice president. “Through a ‘hub and spoke’ model we hope to make an immediate impact on health care in the country and beyond.” At the same time, children in the region of Baja, Mexico will soon have their own Sanford Children’s Clinic. The addition of a permanent general pediatric clinic serves a significant need by guaranteeing health care access to thousands of area children. Half of the growing Baja area population is made up of children, and local health care services are not growing to meet the need. Physicians in the new clinic will be closely connected to a team of pediatric physicians at Sanford Children’s who are specially trained in a wide variety of pediatric subspecialties. In addition, Sanford will partner with a local

hospital to support primary care services with urgent and subspecialty pediatric care. The new clinic is expected to open in 2013. Finally, a third news clinic was announced for the city of Carmiel, Israel. Like other Sanford Children’s Clinics, it will provide general pediatric services to area children and be designed like a castle. A leading provider of health care in Israel, Maccabi Healthcare Services, will partner with Sanford and provide subspecialty pediatric services within the same facility which is expected to open in 2014. The three new clinics are part of a group of seven cinics announced by Sanford as part of the initiatives outlined after a $400 million donation in 2007. Sanford Children’s has already opened pediatric clinics in Duncan, OK and Oceanside, CA. Clinics in Klamath Falls, OR and West Dublin, Ireland are underway. ■

Midwest Medical Edition

Sturgis Rally

Roundup Regional Health releases final numbers

MED article Update

Rapid City Regional Health has released its final patient numbers from this year’s 75th anniversary Sturgis Motorcycle Rally. The rally, which more than doubles the size of Regional’s patient base for two weeks every August, typically brings close to a half million people to the Black Hills. This year, Regional Health physicians treated 643 of them in the emergency rooms at Rapid City Regional Hospital, Custer Regional Hospital, Hans P. Peterson Memorial Hospital in Phillip, Lead-Deadwood Regional Hospital, Spearfish Regional Hospital, Sturgis Regional Hospital and Weston County Health Service in Newcastle, Wyoming. On their busiest day, midway through the 10-day rally, the hospitals treated a total of 87 patients. The busiest day for inpatients was closer to the end of the rally with a total of 39 rally attendees in the hospitals. ■

Hypertension is one

of the most serious health problems in the country. Fortunately, itʼs also one of the easiest to diagnose and treat. You know the classifications and risks. Donʼt assume your patients do. Talk to them about their BP and do it often. Breaking the silence is one of the best ways to fight this silent killer.

September / October 2011

MidwestMedicalEdition.com

“We are proud to offer patients the newest vascular technology in the region.” - J. Michael Bacharach, MD, MPH, FACC, North Central Heart Institute and Tommy R. Reynolds, MD, FACS, North Central Heart Institute

Ten years ago, we opened our doors as the region’s first hospital dedicated solely to the diagnosis and treatment of cardiovascular disease — and we remain the only hospital with that focus. We are excited to offer you the newest technology in our state-of-the-art vascular lab, the first and only in the region. With unmatched positioning and flexibility, we can attain precise images in even complex clinical cases.

state of the art ...with Heart.

See the new technology at www.AveraHeartHospital.com

Midwest Medical Edition

Program Gives Area Medical Students

A Firsthand Look at Rural Healthcare

essington Springs was one of three sites selected in the state as a “Best Practice Model” site for the Rural Experiences for Health Professions Students program. Leonard Wonnenberg, USD Physician Assistant Student from Winner and Beau VanOverschelde, SDSU Pharmacy Student from Letcher were chosen to be part of the 4-week program, which is funded by a 3-year HRSA grant and administered through the Yankton Area Health Education Center. As part of the program, the students have been accompanying the providers at Horizon Health Care, as well as rounding and visiting patients at Avera Weskota Memorial Hospital. They also spent time at Thornton Drug reviewing the pharmacy operation. “The students were able to witness rural emergency response to a trauma accident in the community,” says Hospital CEO Gaea Blue. “EMTs responded and brought the victim into the emergency department where the nurses, ancillary staff and medical providers worked closely with an eEmergency physician and nurse at Avera McKennan’s emergency department. They were intrigued that a patient in a rural area could receive the care and consultation that a patient in a large city would receive.” The students also developed a community project which included free

September / October 2011

Beau VanOverschelde, Pharmacy Student from SDSU, Dr. Keri Orstad and Leonard Wonnenberg, Physician Assistant Student from USD.

healthcare presentations. At some locations they set up informational healthcare booths. They addressed Women’s & Men’s Health at the Senior Center and the Springs Area Community Club, but also took a non-traditional avenue by setting up a booth about treating allergies and the common cold at a local convenience store. “The presentation given by the Medical Students on women’s and men’s health given at our senior center was educational.,” says Donna Larson, RH, Home Care Coordinator for Avera Weskota Memorial Hospital. “There were visual, verbal, and hands on education. I learned some medication and health information I can pass on to my Adult Service clients.” They targeted youth at a Future College Freshmen presentation and went straight to the City Pool armed with sunblock and CPR masks to address sun protection and basic life support. They teamed up with local law enforcement to visit with 4-H youth about first aid and winter survival and created a Scavenger Hunt activity that was used during this year’s Intergenerational Camp at the nursing home involving kindergarten through 6th graders. The goal of the Rural Experiences Program is to increase the number of physicians, physician assistants, certified nurse practitioners and pharmacists who practice in rural communities in South Dakota. ■

MidwestMedicalEdition.com

Leonard Wonnenberg with Melanie Hinricher, Pharmacist.

Medical Students with 4-H Youth.

Avera Transplant Institute Performs First ‘Paired’ Kidney Donation in South Dakota Dr Robert Santella Dr. Tariq Kahn

Nationwide, approximately 75,000 people are on the waiting list for a kidney transplant and approximately 17 people die on the wait list each day. Paired donation is a growing concept in kidney donation that involves two donors and two recipients. Rather than just one person, this concept helps two. The Avera Transplant Institute recently performed its first ever paired donation, and the first paired donation in the state of South Dakota. The region’s longest standing kidney transplant program and only pancreas

transplant program in the state, Avera has performed over 600 organ transplants. Avera was among 21 percent of transplant programs nationally, and one of only two in the Dakotas and Minnesota awarded a medal of honor by the U.S. Department of Health and Human Services’ Health Resources Services Agency’s Division of Transplantation for outcomes meeting or exceeding what is predicted in survival on the kidney waitlist and after transplant, and reduced time on the organ wait list. Contributing to lower time on the organ waitlist is living kidney donation. Here’s how paired donation works: Living kidney transplant usually involves two persons – a healthy kidney donor, and the Lecture with person receiving Valerie Zumbusch the organ. A person with Screening Sessions kidney disease Oct. 18: 9am – 6pm has a friend or Oct. 19: 9am – 3pm family member who is willing to the Absolute Finest in Early Detection. donate a kidney. Often, while For anyone looking for reaffirmation of their health status. medically able to donate, a donor Call Pharmacy Specialties has a blood or today to RSVP and tissue type which make your appointment. is not compatible with the intended

Thermography Screening Oct. 17, 7pm Oct. 18 & 19

recipient. “In these cases, instead of declining the donor who doesn’t match, we can now offer the option of kidney paired donation,” said Dr. Tariq Kahn, transplant surgeon and surgical director of the Avera Transplant Institute. Paired donation matches one donor/ recipient pair with another donor/ recipient pair. The donor in the first pair gives to the recipient in the second pair and vice versa. Even complete strangers can be matched. Paired donor transplants allow more donors to fulfill their wish to help a family member or friend. In addition to paired donor exchange between those on its own waiting list, the Avera Transplant Institute also participates with the United Network for Organ Sharing’s national kidney donor exchange program between multiple transplant centers. The potential for paired donation can extend beyond just two transplants to a larger group of donor/recipient pairs, known as a “paired donor chain.” Dr. Robert Santella, nephrologist and medical director of the Avera Transplant Institute, said living donation is encouraged whenever possible. “Living donation is absolutely the best option,” Dr. Santella said. “It’s safe for the donor, it means a shorter wait time for the recipient, and it’s a healthier and fresher organ to transplant than one from a deceased donor. It’s a win-win for everyone,” Dr. Santella said. “Most living donors will say that it’s the best thing they’ve ever done in their life.” ■

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Midwest Medical Edition

Then & Now Our Changing Medical Landscape

Female Pelvic Medicine and Reconstructive Surgery Gains Recognition as a Medical Subspecialty

or three decades, the specialized area of medicine known as urogyncology or Female Pelvic Medicine and Reconstructive Surgery has existed as an offshoot of other specialties, such as Ob/Gyn. Although fellowship training has been available in the field for twenty years through programs accredited by the American Board of Obstetrics and Gynecology, it has not been recognized as its own separate medical specialty – until now. The American Board of Medical Specialties (ABMS) and the American Council for Graduate Medical Education (ACGME) have now officially recognized FPMRS as a medical subspecialty. Sioux Falls native Matthew Barker, MD, with Avera Medical Group Urogynecology is the state’s first and only fellowship trained urogynecologist. Dr. Barker’s father, John Barker, MD, was one of the state’s first fellowship-trained gastroenterologists when that field became its own specialty area. “It was exciting to leave South Dakota and then bring something back here that has never been offered here before,” says Dr. Barker, a USD graduate who did his Urogynecology fellowship training in Cincinnati, Ohio. Urogynecology combines issues relating to the female pelvis, including difficulties with urination, defecation or sexual intercourse. Pelvic organ prolapse, an issue many women experience, can lead to urinary incontinence, overactive bladder, urgency and frequency, fecal incontinence, constipation,

September / October 2011

pelvic pain, pelvic pressure or painful intercourse. “In the past, medicine has not done a very good job of offering solutions for these patients,” says Dr. Barker. “Part of what the new specialty certification means is that women with these sometimes complex functional issues can get care from someone with high level training in treating the problems they are facing. Physicians will now have to meet certain thresholds of education and training to care for these women. The hope is that we create a universal competency so that you can expect the same standards of care whether you get care in New York or Sioux Falls. Not only does this help the science, but it also helps the patient.” As the subspecialty area has come into its own, treatment options have also evolved. One example is sacral neuromodulation, a technique for treating urinary or fecal incontinence with a pacemaker-like implantable device that stimulates the S-3 nerve root. Other treatment options for pelvic issues may include minimally invasive surgery, medications, biofeedback and physical therapy. “Over half of women will suffer from a urogynecological issue,” says Dr. Barker. “One of the most important aspects of the specialty designation is that it raises awareness that help is available. These women do not have to suffer in silence. As a specialist, it is very gratifying to be able to improve someone’s quality of life and their ability to stay active and age gracefully.” ■

MidwestMedicalEdition.com

Matthew Barker, MD

Do you have a memory or observation on the practice of medicine in our region? How have things changed? What’s improved? What do you miss? Contact us at:

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Sanford Health Advances Breast Cancer Research Edith Sanford Breast Center will be home to new Bio Bank On August 17, Sanford Health officials announced the launch of Edith Sanford Breast Cancer Center today. Named in honor of philanthropist Denny Sanford’s mother who died of breast cancer when he was four years old, Edith Sanford Breast Cancer (ESBC) Center includes a tower between the existing Sanford Health Cancer Center and the VanDemark building at Sanford Health Medical Centers and an expansion in Fargo. ESBC will house a repository for genetic information from women of all ages, medical histories and backgrounds. This bio bank will collect, process and store genetic samples, a library for researchers to accelerate the pace of research. “Our vision is to eradicate breast cancer through personalized medicine,” said Eugene Hoyme, MD, geneticist and Sanford Research president. “With a comprehensive genetic picture, we will know more specifically what treatments will work with each woman, how to prevent disease on an individual basis and ultimately find a cure.” The announcement was made as part of Sanford Health’s gala week celebration to a group of nearly 300 community am 32

bassadors, founding bio bank participants, physicians, researchers, breast cancer advocates, survivors and Sanford Health leaders. Television celebrity and South Dakota native Mary Hart, the former Entertainment Tonight anchor, who will serve as national spokesperson for ESBC and whose mother is a breast cancer survivor, said Sanford Health will unite women across the country. Sanford Health has long been a leader

in cancer treatment and care delivery. One in four breast cancer patients are enrolled in clinical trials, with more than 1,700 total enrollments in cancer research studies over the past five years. Sanford Health was selected by the National Cancer Institute to be one of 30 community cancer centers to participate in the Community Cancer Centers Program designed to help lead the expansion of clinical trials close to home. ■

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Grape Expectations

Old World vs New World Wine By Heather Taylor Boysen

he other day I had a customer come in to the store who wanted to buy a birthday gift for himself. He was like a kid in a candy store and it was my job not to disappoint. I know choosing wine sometimes isn’t rocket science, but his goals were specific and uncommon and I needed to really step up to the plate on this one. He wanted help picking out two red wines that would show him the differences between old world and new world wines. First, thank goodness he called in advance and made an appointment. This was not an easy assignment, but I was up for the challenge! Second, it involved investigating the many wines I have in order to present to him an “apple to apple” comparison. His only parameters were that it must involve Cabernet Sauvignon and one of the wines must be from France. My immediate thought was French Bordeaux and a Bordeaux-style wine from California. Before I go any further, let’s quickly define old world and new world. Old world wines include the wines made in France, Italy, Spain, Portugal and Germany. These are the oldest wine making countries in the world and without a doubt where wine was produced for the world. New world wines basically include everybody else. Some of the more popular are the USA (particularly California), Australia, New Zealand, Chile, Argentina, South Africa and Canada. The largest factor that determines the stylistic differences between old world

September / October 2011

and new world wines is terroir. Terroir, which according to Wikepedia was “originally a French term in wine, coffee and tea used to denote the special characteristics that the geography, geology and climate of a certain place bestowed upon particular varieties. It can be very loosely translated as “a sense of place.” It is the theory that the grape itself doesn’t form the complete structure and flavor of the wine, but rather where its feet (or roots) are planted. Vines absorb flavors from the area around them including soil type, other plants existing around the vineyards, climate, and maritime influences just to name a few. Old world typically sees a shorter growing season with higher levels of humidity, rain and clouds. The fruit is picked earlier hence leading to higher acid content and a much more austere flavor. Lean and mean as I like to say. These wines have a tendency to mimic their terroir and you can really taste the “dust” in the bottle. You will have more earth-like flavors such a minerals, tobacco and even leather. Please don’t take these descriptions to be disparaging, but rather a perspective on what you might smell coming out of the bottle or glass, not necessarily what you will find on your palate while consuming. With new world wines the growing season is longer, the days warmer and sunnier and grapes are left on the vine longer. This translates to higher sugar content when the grapes are harvested meaning the grapes are “fruitier” with higher alcohol content. These are wines with big fruit, big flavor and big

MidwestMedicalEdition.com

structure. “Go big or go home” comes to my mind with this style. The two wines I chose for my client’s comparison were red blends. I chose an old world French Bordeaux from Margeaux made from a blend that consisted primarily of Cabernet Sauvignon, with some Merlot, Petit Verdot and Cabernet Franc blended in. The new world wine was Chalk Hill Estate Red from California. The blend of varietals was very similar in nature, but flavor wise? Certainly they will give my customer what he was looking for as a comparison between worlds. But which one will he like better? Hopefully he also bought himself a nice big juicy steak for the grill and indulged in a something really chocolaty and decadent for dessert to go with his two beautiful wines! I’m still waiting to hear the results, but in the meantime, cheers! ■

Functional Job Analysis

By Kelly Marshall, MS, OTR/L

unctional job analysis is the process of analyzing job tasks in order to objectively identify and measure the physical requirements needed to safely perform the work. To do this, a job analyst goes into the workplace to objectively measure the physical requirements of the essential functions of a job, including: ♦ Grip forces ♦ Pinch forces ♦ Push/pull forces

♦ Distances walked Functional job analysis has a variety of benefits. The product of this analysis can create both a functional job description as well as corresponding functional job test, both created from the objective measurements obtained during the onsite job analysis. Most employers have developed traditional job descriptions; however, they typically do not include the physical requirements necessary to perform the work. If they do include physical requirements, they are typically “guesses,” instead of objective measurements. Thus, new employees may not have gotten a clear picture of the physicality of the work they would be required to perform, which can lead to high turnover and increased recruiting costs for the employer. During the pre-employment screening process, employers benefit from the ability to more accurately match employees to a job that may be a better physical “fit” for that employee. Furthermore, following an employee injury, medical providers are able to utilize the functional job descriptions and tests to communicate with human resources personnel, supervisors and other medical providers to better determine appropriate work restrictions, when necessary. Providers are able to state what an employee can do, instead of what they can’t do. Employers, in turn, benefit from this because they no longer find themselves making decisions about how to place an injured employee; their functional job test defines the job tasks they can safely perform as they return to work! The process of functional job analysis presents the opportunity for a variety of additional benefits. Employers find that a functional job analysis program promotes a culture of safety and understanding among employees. Additional opportunities for improved communication also arise. A new employee gains the ability to understand the physical requirements of a job before he or she even begins work! In a clinical setting, the employee performs physical tasks that are replications of 34

the job to be performed, instead of a generic lifting task that is not based on the job. Injured employees are more likely to be returned to their actual job, instead of performing alternate or off-site duties while they continue to recover. They are able to return to work more quickly and easily since the treating provider understands the requirements of the job and what job tasks the employee is safely able to do. Recent court proceedings support the need for employmentrelated physical testing to be objective and job-specific. Employers are becoming increasingly aware of the importance of these court rulings. Job descriptions with generic measurements and physical requirements are an open door for investigation and litigation. Functional job analysis provides objective, measurable information that can help keep employers on the cutting edge and out of the court of law. ■ Kelly Marshall is a trained occupational therapist and a member and committee chair for the South Dakota Occupational Therapy Association. She is a Job Analysis and Ergonomics Specialist with RAS Companies.

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Midwest Medical Edition

News & Notes Happenings around the region

Prairie Lakes

Dr. Tina Melanson, nephrologist, has joined the medical staff at Prairie Lakes Healthcare System in Watertown, S.D. Dr. Melanson is board certified in Nephrology and Internal Medicine. Prior to joining Prairie Lakes, Dr. Melanson practiced in Sioux Falls and provided outreach services to surrounding communities including Watertown. Dr. Melanson will see patients in the Prairie Lakes Specialty Clinic and Hospital, and in regional dialysis units and outreach clinics. She will also serve as medical director for the Prairie Lakes’ dialysis units located in Watertown, Sisseton, Brookings and Ortonville, Minn.

Avera Avera McKennan Hospital & University Health Center will open Avera Medical Group Dermatology, at 6701 S. Minnesota Ave. in Sioux Falls. The newly constructed facility has 22,000 square feet of usable space – more than twice the size of the former clinic at 69th and Minnesota. Five certified dermatologists are on staff at Avera Medical Group Dermatology, including Drs. Brian Knutson, Douglas Pay, Jana Johnson, Michelle Wanna and Valerie Flynn; as well as one certified nurse practitioner, Heidi Furth.. A sixth dermatologist will join the medical staff in August 2012. The former clinic site at 116 W. 69th St. is now home to Avera Medical Group McGreevy Clinic Pediatrics.

September / October 2011

The Avera Cancer Institute is now offering PROVENGE, a new vaccine for the treatment of certain men with advanced prostate cancer. PROVENGE is the only prostate cancer immunotherapy to be approved by FDA. Avera was the first institution in the state to offer it

Regional

Regional Heart Doctors is pleased to announce the addition of Brion Winston, M.D., an interventional cardiologist, has joined Regional Heart Doctors. Dr. Winston completed his medical degree at State University of New York at Downstate, Brooklyn, N.Y. His residency in internal medicine was completed at New York University and he was fellowship trained in cardiovascular disease at the University of Pittsburgh Medical Center and in interventional cardiology at Brigham and Women’s Hospital in Boston. Dr. Winston’s clinical interests are coronary, peripheral and structural interventions. Weston County Health Services (WCHS) Administrator/CEO Kay Garcia will leave her position to pursue other opportunities. WCHS includes a 22-bed critical access hospital, a 54-bed long-term care facility, and a home health and hospice program. Garcia has been the CEO at Newcastle, Wyo., since April 2009.

Rapid City Regional Hospital has received the Get With The Guidelines-Heart Failure Gold Plus Quality Achievement Award from the American Heart Association for its excellence in the treatment of patients with heart failure. This award is given to hospitals that achieve 85 percent or higher adherence with all Get With The Guidelines-Heart Failure Quality Achievement indicators for two or more consecutive 12-month intervals. Get With The Guidelines is a quality improvement initiative that provides hospital staff with tools that follow evidence-based guidelines and procedures in caring for heart failure patients. The Black Hills community has once again shown great support for the Children’s Miracle Network (CMN), with 17,000 ducks sponsored in the 22nd annual Great Black Hills Duck Race on Sunday, July 31. Approximately $95,000 was raised for CMN. One hundred percent of the funds raised will be used to provide services and equipment for ill and injured children in the Black Hills area served by Rapid City Regional Hospital. The Walking Forward Program, in partnership with Gundersen Lutheran Health System’s Norma J. Vinger Center for Breast Care and Global Partners Program, will offer free cancer education and screening services for Native American women of Pine Ridge. Free mammography exams and clinical breast exams will be available for women older than 40 who are uninsured or underinsured. Appointments are strongly encouraged. All education sessions begin at 8:30 a.m. with mammograms beginning at 10:30 a.m. on the following dates and locations: Sept. 26 – Red Shirt Table School, (605) 407-5047 or (605) 391-7909 Sept. 27-28 – Wanblee Clinic, (605) 462-6155, ext. 6237 Sept. 29 – Batesland School, (605) 407-5047 or (605) 391-7909

MidwestMedicalEdition.com

In an effort to increase patient safety through improved quality measures, Regional Health has moved to a phone satisfaction survey process, rather than the traditional paper survey sent by mail. Phone surveys have also been shown to collect a better representation of all patients rather than those at extremes. The American Heart Association will host the Run Crazy Horse Fast 5K and Kids 1K on Saturday October 1, the day before the Run Crazy Horse Marathon. The 5K will begin at Tracy Hall Park (the Hill City Mickelson Trailhead) at 1 p.m. and the Kids 1K will start at 12:45 p.m. Awards will be given to the first place male and female. Entry fee for the 5K is $25 pre-registered by Sept. 30, or $30 on-site. Runners can register on-line at www. RunCrazyHorse.com or on site the day of the race.

Nancy Nelson, RN, Administrative Director of Patient Care Services at Rapid City Regional Hospital (RCRH), has been appointed to a three-year term on the Board of Nursing by Governor Dennis Daugaard. Nancy is the President of the South Dakota Nurse Executives, a national member of the American Organization of Nurse Executives, belongs to both the South Dakota Nurses Association and the American Nurses Association, and is a member of Sigma Theta Tau.

News & Notes

Happenings around the region

Veronica Schmidt has been selected as the new CEO/ Administrator of Custer Regional Hospital (CRH). Schmidt comes to CRH with more than 15 years of experience in the health care field. During the past four years she has served as the Director of Ancillary Services for Sanford Vermillion Medical Center in Vermillion, S.D.

Vernal Trove has been named the recipient of the 2010 George S. Mickelson Award for Nursing Excellence at Rapid City Regional Hospital (RCRH.) Trove works as a Hospital Coordinator and has been employed at the hospital for 22 years Rapid City Regional Hospital (RCRH) Pharmacy Director Dana Darger has received the South Dakota Pharmacists Association (SDPA) Innovative Pharmacist of the Year Award. Darger credits his team with implementing new and innovative ideas including the first tele-pharmacy in the state at LeadDeadwood Regional Hospital.

Winner Regional Healthcare Center has announced Chris Wortham, RN, as its new CEO. Wortham replaces Gordon Larson who recently accepted a position to lead the new Sanford Health Aberdeen Medical Center. Wortham comes to Winner Regional from Covenant Plainview, a one hundred bed acute care hospital and primary care and specialty physician office in Plainview, TX. He has more than a decade experience in health care leadership positions. Wheaton Community Hospital and Medical Center officially became Sanford Wheaton Medical Center July 1, making its merger complete. All employees will become Sanford employees and no changes are expected in services, with the exception of looking at additional services to offer. Wheaton, population 1,600, is located 93 miles south of FargoMoorhead. Sanford Wheaton Medical Center is a 15-bed critical access hospital established in 1950. Clinic services were added in 2005. Sanford Wheaton Medical Center employs 95 people

Sanford

A study by Sanford physicians and scientists on human papillomavirus (HPV) appears in the June 2011 issue of Gynecologic Oncology. The study -- “Risk factors for HPV infection among American Indian and White women in the Northern Plains” -- is the first epidemiologic survey of cervical cancer risk factors in a population of AI women. Lead author is Sanford Women’s gynecologic oncologist Maria Bell, MD.

Mike Gulseth, Pharm. D, of Sanford USD Medical Center was recently honored as a “fellow” by the American Society of Health System Pharmacists. Thirty-eight health-system pharmacists received the title in recognition of excellence in pharmacy practice. The program has recognized 690 Fellows since it began in 1988. The 2011 Fellows were honored during the ASHP Summer Meeting in Denver, CO.

Over 250 people showed up

Other

this summer to sign a brick that will be used in the construction of Sanford Health’s new Heart Hospital. The brick signing took place in front of the Sanford Health Hospital construction site near the Locken Lobby entrance.

Sanford Research/USD has appointed its current Director of Commercialization, Whitney Robertson, PhD, MBA, as Executive Director of Clinical Research and Commercialization. In this new and expanded role, Dr. Robertson will have administrative and strategic oversight of both the Clinical Research and Commercialization divisions of Sanford Health.

SDSU’s Medical Laboratory Science program recently received a five-year accreditation from the National Accrediting Agency for Clinical Laboratory Science in Rosemont, Ill. As a result, SDSU can place up to 24 majors in clinical practice including Avera McKennan and other regional health networks. Every graduate of the programs first class in 2010 passed the graduates passed the national certification board exam from the American College of Clinical Pathology and found professional positions in their field.

Rochelle Christensen, M.D., board certified in Obstetrics and Gynecology, has started her own medical practice; Rapid City Obstetrics & Gynecology. She’s been practicing in Rapid City since 1997, and was the first female OB/ GYN to practice in the Rapid City area. She’s completed over 2500 surgeries, and delivered over 4000 babies. Dr. Christensen earned her medical degree from Creighton University in Omaha, NE. She completed her OB/GYN residency at the University of Nebraska Medical Center.

Manish Kharche, HealthPOINT’s Clinical Information Technology Specialist, recently received the Donald A.B. Lindberg Award that represents innovation, professionalism, high principles for outstanding work and dedication to the University’s Department of Health Management and Informatics Program. Kharche is a Health Informatics graduate from the University of Missouri.

Midwest Medical Edition

Learning Opportunities Happenings around the region

September / October 2011 September September 16 • 8:30 am – 3:30 pm Chronic Disease Management Conference Location: St. Luke’s Regional Medical Center, Sioux City, IA Information: 712-279-3235 Website: www.stlukes.org/professional-education

September 21 – 23 SDAHO 2011 Annual Convention

October 7 • 8:00 am – 12:00 pm CNOS Foundation Cerebrovascular Disease Symposium Location: River’s Bend Conference Center, Sioux City, IA Registration: http://cnosfoundation.org Contact: Ruth Klein – 605-217-2817 CME and CEU credit available

October 11 Sanford Trauma Symposium

Location: Rapid City Information/Registration: Rhonda.Christensen@sdaho.org

Location: Sioux Falls Information: nikki.terveer@sanfordhealth.org

September 24 • 8 am – 4:00 pm Avera Cancer Institute Symposium – Personalized Treatment: The Future of Cancer Care Location: Avera Prairie Center Information: mckeducation@avera.org, 322-8950 www.AveraMcKennan.org; click on Events Calendar

September 30 • 8:15 am – 4:00 pm Sanford Nursing Research and Evidence-Based Practice Conference Location: Sanford USD Med Center, Schroeder Auditorium Information/Registration: https://south.sanfordhealth.org/EventsClasses/ FallResearchConference/

October October 4 • 8:30 am – 4:00 pm Avera Rural Health Conference Location: Sioux Falls Convention Center Information: events.coordinator@avera.org, 605-322-4645 www.AveraMcKennan.org; click on Events Calendar

October 7 • 8:00 am – 4:00 pm Avera Women’s Conference for the Primary Care Provider Location: Avera Education Center Auditorium Information: mckeducation@avera.org, 322-8950 www.AveraMcKennan.org; click on Events Calendar

October 14 • 10:45 am – 1:30 pm Trends in Transplantation Location: Prairie Center, Sioux Falls, Classroom A Information: mckeducation@avera.org, 322-8950 www.AveraMcKennan.org; click on Events Calendar

October 20 • 8:00 am – 4:45 pm Fundamentals of Oncology Location: Sanford, Carlson Conference Room Information: Roxy Vandendries – 605-328-6378

October 27 – 28 2011 Upper Midwest Regional Pediatric Conference Location: Marina Inn & Conference Center, South Sioux City, NE Website: www.umrpconference.com Information: 712-279-3273

NOVEMBER November 4 Sanford/Mayo Pediatric Symposium Location: Sanford USD Med Center, Schroeder Auditorium CME Credit Information: nikki.terveer@sanfordhealth.org

November 18 • 8:00 am – 4:00 pm 2011 Avera Pediatric Symposium Location: Avera Education Center Auditorium Information: mckeducation@avera.org, 322-8950 www.AveraMcKennan.org; click on Events Calendar

MED reaches more than 3500 doctors and other healthcare professionals across our region 8 times a year. If you know of an upcoming class, seminar, webinar, or other educational event in the region in which these clinicians may want to participate, help us share it in MED. Send your submissions for the Learning Opportunities calendar to the editor at Alex@MidwestMedicalEdition.com. Midwest Medical Edition

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