Fresh Air 2023

freshAIR

Caring teams

A closer look at those who care for our patients

The journey home

Stricken with pneumonia and Covid-19, Wanda fought the long fight to get back home

freshAir Magazine is published each Fall and is distributed to respiratory care residents statewide. Rockcastle Regional Hospital and Respiratory Care Center, Inc. is a family-oriented team of healthcare professionals dedicated to delivering the highest quality of care to those we serve.

We extend our thanks to the residents, volunteers and staff who allowed us to share their stories of hope and accomplishment.

For more information about our services

Carolyn Browning BSW, Admissions Coordinator

Phone: 606-256-7757

Email: c.browning@rhrcc.org

Foreword

The irreplaceable value of the human connection

Stephen A. Estes President & CEO Rockcastle Regional Hospital and Respiratory Care Center

If you know anything at all about our Respiratory Care Center, you know that we treat our patients as if they were family, and that caring spirit is reciprocated.

Take Wanda Correa, for example, who is featured on page 5 of this freshAir magazine. She had suffered from both Covid-19 and pneumonia and was transferred to our care after three months at another facility. Her prognosis was bleak, but we were able to provide the high-quality medical care she needed, and she fully recovered.

She was so grateful that she not only cooked an entire meal for some of our staff towards the end of her stay, but she also came back after being released and coordinated a baby shower for one of her caregivers.

Time and again, we are part of success stories that not only herald the technical skill and institutional knowledge we’ve built over the last four decades, but also illustrate the irreplaceable value of the human connection.

For this and a multitude of other reasons, I’m as proud of our team as I’ve ever been, especially given the challenges brought on by the pandemic over the last couple of years.

In this issue, we’ve highlighted some of the professions that are so central to a facility such as ours. Our nurses and respiratory therapists are the backbone of the Respiratory Care Center, and we obviously couldn’t function properly without the valuable contributions of laboratory services, just to mention a few.

I invite you to turn the page and read more about the compelling work we are doing. You’ll get a sense of the professionalism our team brings to work and the compassion that shines through every day, all for the sake of our family of patients.

Cerri Harbison, RN, chats with patient Jordanna Little at the Respiratory Care Center, which delivers high-quality care to patients who depend on mechanical ventilators to breathe.

freshAIR

ROCKCASTLE REGIONAL HOSPITAL AND RESPIRATORY CARE CENTER COMPLIES WITH APPLICABLE FEDERAL CIVIL RIGHTS LAWS AND DOES NOT DISCRIMINATE ON THE BASIS OF RACE, COLOR, NATIONAL ORIGIN, AGE, DISABILITY, OR SEX.

Español (Spanish)

ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-606-256-2195 (TTY: 1-606-256-0556).

繁體中文 (Chinese)

注意：如果您使用繁體中文 您可以免費獲得語言援助服務。請致電

1-606-256-2195 (TTY: 1-606-256-0556)。

Deutsch (German)

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-606-2562195 (TTY: 1-606-256-0556)

Tiếng Việt (Vietnamese)

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-606-256-2195 (TTY: 1-606-256-0556)

ﺔﱠﻴﺑﺮﻌﻟﺍ (Arabic)

Srpsko-hrvatski (Serbo-Croatian)

OBAVJEŠTENJE: Ako govorite srpsko-hrvatski, usluge jezičke pomoći dostupne su vam besplatno. Nazovite 1-606-256-2195 2195 (TTY: 1-606-256-0556)

日本語 (Japanese)

注意事項：日本語を話される場合、無料の言語支援をご利用いただ

けます。1-606-256-2195 (TTY: 1-606-256-0556)

Français (French)

ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-606-256-2195 (TTY: 1-606-256-0556)

한국어 (Korean)

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로

이용하실 수 있습니다 1-606-256-2195 (TTY: 1-606-256-0556)

Deitsch (Pennsylvania Dutch)

Wann du [Deitsch (Pennsylvania German / Dutch)] schwetzscht, kannscht du mitaus Koschte ebber gricke, ass dihr helft mit die englisch Schprooch. Ruf selli Nummer uff: Call 1-606-256-2195 (TTY: 1-606-256-0556)

नेपाल� (Nepali)

ध्या �दाहोस: तपयइ�ले ाेपयल� बोलाहुन भा तपयइ�को �ािमत भयषय सहय्तय

1-606-256-2195 (TTY: 1-606-256-0556)

Oroomiffa (Cushite - Oromo)

XIYYEEFFANNAA: Afaan dubbattu Oroomiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama. Bilbilaa 1-606-256-2195 (TTY: 1-606-2560556)

Русский (Russian)

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-606-256-2195 (TTY: 1-606256-0556)

Tagalog (Philipino)

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-606-256-2195 (TTY: 1-606-256-0556)

Ikirundi (Bantu - Kirundi)

ICITONDERWA: Nimba uvuga Ikirundi, uzohabwa serivisi zo gufasha mu ndimi, ku buntu Woterefona 1-606-256-2195 (TTY: 1-606-256-0556)

CONTENTS

IT STARTS WITH A THOROUGH

PAGE 4

‘The

Wanda’s long road to recovery Building

to get him well’

4

PAGE 6

Expanding our reach

winning team The central role of RTs Having

Communication

Sobesity, cancer and oral health are among the top health concerns in Rockcastle County, we found in our 2016 Community Health Needs Assessment (CHNA).

PAGE 10

Team stays with patients every step of the way

The study, conducted every three years, sought input from the community mainly through a questionnaire that was mailed to every household as well as a series of community focus group discussions. It combined that input with other research to present a comprehensive overview of health and healthcare in Rockcastle County.

Two-hundred, eighty three of 406 survey respondents listed cancer as one of their top five concerns, while 262 identified substance abuse.

Caring that goes both ways

The document also outlines the hospital’s priorities and strategic implementation plan developed in light of the assessment. Cancer care and prevention and health education are among those priorities.

A link to the full 65-page study can be found on the front page of the hospital’s website (rockcastleregional.org).

PAGE 16

Writer/Editor: Dwain Harris

Photography: Lee Thomas Photography

The assessment was completed by the Southern KY Area Health Education Center (AHEC), which is hosted by Rockcastle Regional, with the help of Rockcastle County community partners.

Graphic Design: Cathryn Hahn

On the road again

tenacity

On the day she was released from Rockcastle Regional, Wanda Correa shares some special memories with some of the staff who cared for her.

In September of 2021, the height of the pandemic’s Omicron wave, Wanda Correa was living a normal life in Central Kentucky when she fell ill, and before she knew it, was in serious trouble. “One day, I couldn’t breathe.”

Wanda would be diagnosed with both Covid-19 and pneumonia. She was hospitalized and then sent to a long-term care facility, where she would remain for three months as her condition deteriorated.

“I woke up one day, and my eyes were heavy, and I began to panic,” she recalled. “I couldn’t move my legs or arms. I could only move my head.”

That’s when she was transferred to the Respiratory Care Center at Rockcastle Regional Hospital.

Immediately she felt more comfortable with her treatment because her care team, led by Dr. Karen Saylor, “explained to me what was going on,” she recalled. They told her what they were doing and why they were doing it, and they offered encouragement and support. But they also challenged her.

“You need to fight,” she recalls hearing from them, “and we’re here to help you.” Her long road back had begun.

“I said I want to fight because I want to see my kids and family again,” Wanda said. “I want to fight, and fight, and fight.”

The care team would say to her, “‘I know you can do it,’ and then I would do it.”

She would need all the determination she could muster, because the fight was going to be long. Days turned into weeks, weeks to months.

She remembers milestones such as the day therapists capped her tracheostomy, a surgically created hole through the front of the neck and into the windpipe, enabling her to talk for the first time in months.

It was an emotional moment. “When I heard my voice, I almost cried.”

Gradually, respiratory therapists began taking her off the ventilator to allow her to breath on her own for increasing periods of time.

With each day, her time on the ventilator dwindled, and her appreciation for the care she was receiving grew. They once aroused her fighting spirit; now that fight was giving way to gratefulness.

As she continued to recover, Wanda, who is originally from Puerto Rico, made an authentic Puerto Rican meal – including chicken, rice, shrimp, and mofongo – for the staff she’d grown to see as family.

She cried when in May of 2022, after nearly five months, she heard this from unit secretary Krystal Thompson: “Wanda, I’ve got your papers. We’re going to send you home.”

In September, she even returned to Rockcastle to organize a baby shower for one of the Rockcastle team. “She planned the whole thing,” Thompson said.

Now she is fully recovered, getting good reports from her pulmonologist, and continuing to surprise those around her, including her family physician, with her progress.

“When my family doctor first saw me after I was discharged, she started crying and hugging me. She said she didn’t expect to see me again.

‘You need to fight, and we’re here to help you.’

Nursing roles at RHRCC

Registered Nurse: includes Associate and Bachelor prepared nurses (2-4 yrs. of college education).

Unit Secretaries: requires a HS diploma for employment and entails on-the-job training.

Licensed Practical Nurse (LPN): requires approximately 13 months of college education.

SRNA (State Registered Nursing Assistant): 4-month in-house training followed by state certification test. Requires a HS diploma or GED prior to acceptance into the program.

Restorative Aides: SRNAs who assist with enhancing patients’ range of motion and assist with activities of daily living.

CO-OP students: high school students who are employed to get exposure and experience in the healthcare field.

Angela Roberts, Associate Director of Nursing, BSN, RN, leads the nursing team at Rockcastle Regional’s Respiratory Care Center. Pictured are some of the nursing staff. From left, Austin Hubbard, SRNA; Anna Eversole, LPN; Roberts; Jessica McFerron, BSN, RN, WCC; Cerri Harbison, RN; Kimberly Lawson, LPN.

Communication, compassion are keys to successful nurse team

After 11 years at Rockcastle Regional, Angela Roberts BSN, RN, became the associate director of nursing in September of 2022. She leads a team of 81 nursing staff on the long-term ventilator care unit. We asked her about her new position, her team, and what it’s like to work for Rockcastle Regional; her answers are below.

What do you think nurses like about working on the ventilator unit?

Our ventilator units have a tight-knit structure to them. Our nurses work cohesively and enjoy the family atmosphere we have with our patients. The nurses receive our residents at a vulnerable time in their lives and develop an attachment to them and their family members.

What is some of your most important advice/ guidance for nurses who are new, or are new to the ventilator unit?

My most important advice is to take advantage of your resources and ask lots of questions! Communication is key to the success of the team and ultimately the patient, so never hesitate to ask for help when needed.

What are the keys to success in being a good nurse?

The keys to success in being a good nurse lie in good communication skills, compassion, and advocating for your patients.

Describe the work environment at Rockcastle Regional?

I have worked various roles throughout my nursing profession and encountered various work atmospheres. I value developing close relationships with my patients, their families, and my staff. Rockcastle provides a work environment that supports us professionally and personally. You cannot find this perfect blend just anywhere, but we all support each other here and function like a family.

What are the most rewarding and challenging parts of your new position, so far?

The most rewarding part of my new job so far is building a supportive team that really collaborates with each other to improve patient outcomes. Sharing my experience and knowledge to the newer generation of nurses is extremely rewarding, and it allows me to be a part of developing the nursing workforce for future success. When nurses succeed and excel at their roles, patient outcomes and experiences improve, as well. It generates a win-win!

The most challenging aspect so far has been staffing, something every healthcare facility currently faces. However, we are making great strides in that area and look forward to this next year together – we have begun implementing several projects to improve staff recognition and developing more of a “learning together” atmosphere.

Rockcastle Regional has developed an internal float pool program to attract more nursing talent:

• 12-week contract in which the nurse works three 12-hour shifts per week where the greatest staffing needs are.

• Generous rate of pay.

• Experience and insight into our organization with potential to become a permanent employee.

Interested in working at Rockcastle Regional’s Respiratory Care Center? Call 606-256-2195.

Angela Roberts with patient Teddy Fulton. “When nurses succeed and excel at their roles,” Roberts said, “patient outcomes and experiences improve as well.”

According to the U.S. Bureau of Labor Statistics, the “Employment of respiratory therapists is projected to grow 23 percent from 2016 to 2026, much faster than average for all occupations.”

Respiratory therapists Heather Wilson & Jennifer Cervney on a recent shift at the Respiratory Care Center.

Lab technician Lindsay Bays on a recent morning at Rockcastle Regional.

From day one

Respiratory therapists work to wean patients from ventilator care

As one might expect, a health profession that is central to the care provided at Rockcastle Regional’s Respiratory Care Center is the respiratory therapist, or RT.

Fifty-five respiratory therapists currently staff the center, which at 143 beds is the largest freestanding ventilator care center in the nation. Its patients, due to illness or injury, depend on mechanical ventilators to breathe.

At a long-term care center such as Rockcastle’s, one of a respiratory therapist’s main duties is to manage those ventilators, a task for which they are clinically and didactically trained. They determine the appropriate settings on the ventilator to keep the patient breathing, and they play a critical role in the weaning process.

“Weaning is the goal,” said Jeff Smithern, director of respiratory therapy at Rockcastle. “That’s what we are always striving for, and it starts as soon as they come in the door.”

When patients are admitted, RTs evaluate patients’ ability to generate sufficient pressure for deep breathing and airway clearance, and they do studies to measure oxygen, pH, and carbon dioxide levels in the bloodstream.

If a patient is determined to be a candidate for weaning, RTs are there every step of the way, gradually allowing the patient to breathe independently for increasing periods of time each day.

They also assist with intubations, extubations, and are a critical part of the care team that responds to emergencies such as cardiac or respiratory arrest.

Increased demand for therapists during the pandemic has highlighted a shortage that has persisted for years.

“Recruiting enough RTs to staff the facility is one of our biggest challenges right now,” Smithern said. “We could use as many as 25 more RTs right now.”

Respiratory therapists must have a minimum of an associate degree from an accredited respiratory therapy education program, and many go on to earn a bachelor’s degree.

RTs must pass the Certified Respiratory Therapist (CRT) exam, and most go on to earn their Registered Respiratory Therapist (RRT) credential.

The nearest RT programs are at KCTCS located in London, KY and Bluegrass Community & Technical College in Lexington.

The laboratory’s vital role in patient care

Rockcastle Regional’s laboratory provides a vital service to the Respiratory Care Center. Phlebotomists draw patients’ blood for testing while lab technicians are responsible for testing and analyzing specimens. A pathologist diagnoses and characterizes health conditions by examining those specimens. Rockcastle Regional’s laboratory staff of 24 provides daily services to the Respiratory Care Center. The lab recently underwent renovation and equipment upgrades.

In these photos

1. Activities Assistant Elizabeth Doan gives a makeover to resident Debbie Snow.

2. The residents enjoying a game of 21 during Casino Day.

3. Resident Martha Naylor breaks beans during Garden Day.

4. Residents Jordanna Little and Tina Jenkins basking in the sunshine on one of many Outside Days.

5. Resident Catherine Fannin enjoys Outside Day.

6. Residents in the facility chapel for weekly Bible Study with Brother Luther Allen.

SAY CHEESE!

Residents enjoy a variety of activities from Casino Day in the activity room to Garden Day

COMPASSIONATE?

Want to make a difference?

Rockcastle Regional Hospital and Respiratory Care Center is looking for dedicated professionals to help us maintain and continue our tradition of delivering exceptional care. We are the largest freestanding ventilator unit in the nation, and we need top talent to join our team. It’s a tough job, but be advised that there are days that are almost unbearably rewarding.

We are seeking:

• Licensed Practical Nurses

• Registered Nurses

• Respiratory Therapists

• State-Registered Nursing Assistants

Some of our benefits:

• Employee wellness program (get paid to exercise)

• On-site daycare

• Matching 401K

• Competitive salary

• Scholarships/tuition reimbursement programs

• Attractive health & dental benefits

Apply online at rockcastleregional.com/careers

Brian Richard Knoops, 44 of Mt. Vernon, Kentucky formerly of Evergreen Park, Illinois passed from this life on Saturday, August 20, 2022, after an extended illness.

Brian had been a patient at Rockcastle Regional’s Respiratory Care Center, beloved by staff and fellow patients, since July of 2007.

He was born on March 5, 1978 in Oak Lawn, Illinois, son of John R. Knoops and Barbara Dykstra Knoops. Brian graduated from Faith Heritage School, Syracuse, NY and furthered his education at Calvin College, Grand Rapids, MI where he earned his Bachelor’s Degree in Business Administration.

He was a dedicated Customer Account Representative until his health failed. Brian was loved for his upbeat and positive outlook and shining personality. He was smart, witty and compassionate. Brian was an avid collector of baseball cards, coins, and all things Star Wars, and he loved chocolate. He will be sadly missed by those who knew and loved him. Brian was of the Christian Reformed faith, and he loved the Lord.

BRIAN KNOOPS

March 5, 1978 – Aug. 20, 2022

Brian had a profound effect on those he knew. A few comments from the staff of Rockcastle Regional:

“Brian was absolutely one of a kind. He was one of the kindest, most humble souls I have ever known. He was an absolute joy to be around … he had the greatest sense of humor, the best stories and life experiences, and was so full of knowledge and wisdom. He was always so appreciative of every little thing that anyone did for him … he was the biggest advocate for the organization and OUR biggest cheerleader. He genuinely loved and cared about the staff, our families, and this community. He was a friend to all (residents and staff alike) and is missed beyond measure. He definitely made his mark on this world, had such a positive impact on our lives and we will remember him forever.

A Celebration of Life Service was held at the facility on Thursday, September 22, 2022.

We are

ROCKCASTLE REGIONAL HOSPITAL & RESPIRATORY CARE CENTER

CHIEF OF STAFF

Karen B. Saylor, MD

VICE CHIEF OF STAFF

M. Kevin Rowe, MD

SECRETARY

David S. Bullock, MD

ROCKCASTLE MEDICAL STAFF

William Bakhos, MD, General Surgery

David Brabon, MD, Plastic Surgery

David Bullock, MD, Family Medicine

Lura Cash, DMD, Dentistry

Eduardo Gomez, MD, Diagnostic Radiology

Michael D. Hamilton, MD, Emergency Medicine

Angela DeBord Isaacs, DO, Family Medicine

Mary Saylor Joenborg, MD, Family Medicine

Kelsey Ladd, MD, Psychiatry

Sarah C. Oliver, MD, Pediatrics

M. Kevin Rowe, MD, Family Medicine

Karen B. Saylor, MD, Internal Medicine & Pediatrics

Callie Shaffer, MD, Pediatrics

Justin Williams, DO, Hematology/Oncology

CONSULTING MEDICAL STAFF

Tarek Ali, MD, Neurology

Michael I. Anstead, MD, Pediatric Pulmonology

Azhar Aslam, MD, Cardiology

Taha Ayach, MD, Nephrology

Joshua C. Bailey, MD, Pain Management

Charles Barton, MD, Gynecology

Daniel Beineke, MD, Radiology

Karim Benrajab, MD, Gastroenterology

William Beuerlein, MD, Pathology

Lee Cain, MD, Optometry

Jason A. Clark, MD, Pathology

Jordan Clay, MD, Neurology

Chad Cooper, DPM, Podiatry

Saurav Das, MD, Neurology

Ann Davis, DPM, Podiatry

Daron Davis, MD, Pathology

Ima M. Ebong, MD, Neurology

David A. Escalante, MD, Endocrinology

Suhas Gangadhara, MD, Neurology

Filip Garrett, DO, Pathology

Bradley Gibson, MD, Pathology

Bethanie Hammond, MD, Diagnostic Radiology

Autumn Hammonds, MD, Pathology

Phillip Hasler, DPM, Podiatry

Aaron Hesselson, MD, Cardiology

Jessica Howard, DO, Pathology

Wallace Huff, MD, Orthopaedics

James G. Huffman, MD, Ophthalmology

Mark D. Huffman, MD, Ophthalmology

Malik Khurram Khan, MD, Pulmonary

George Kim, MD, Pathology

Christian Knecht, MD, General Surgery

Vishakhadatta Mathur Kumaraswamy, MD, Neurology

Nathan Kusterer, MD, Cardiology

John Leigh, MD, Cardiology

Iraklis Livas, MD, Allergy/Immunology

Richard Lozano, MD, Pathology

Zabeen Mahuwala, MD, Neurology

Rick McClure, MD, Cardiology

Thomas Mechas, MD, Gynecology

Naoki Misumida, MD, FACC, FSCAI, Cardiology

David J. Moliterno, MD, Cardiology

Jason Mull, MD, Pathology

Fred L. Picklesimer, MD, Pathology

Khalil Rahman, MD, Nephrology

Navin Rajagopalan, MD, Cardiology

Faizal Ramdial, MD, Pediatric Pulmonary

Callie Rzasa, MD, Pediatric Cardiology

Mandakini Sadhir, MD, Adolescent Medicine

Amanda Saltzman, MD, Pediatric Urology

Douglas Schneider, MD, Pediatric Cardiology

Parijat Sen, MD, Pulmonary

Hammad Siddiqui, MD, Nephrology

Stephanie Stockburger, MD, Adolescent Medicine

Michelle Sykes, MD, Pediatric Cardiology

Nimish Thakral, MD, Gastroenterology (Hepatology)

Andrew Tompkins, DPM, Podiatry

Rudolph Tovar, MD, Gynecology

Sarah Williams, MD, Pathology

Denis Yalkut, MD, Urology

ROCKCASTLE ADVANCED PRACTITIONERS

Courtney Browning, APRN, Pediatrics

Jessica Carpenter, APRN, Family Practice

Jennifer Cash, APRN, Family Practice

Vicki Chapman, APRN, Endocrinology

Jenny Collier, Professional Counselor

Chasity Frakes, APRN, Behavioral Health

Deana Gabbard, MPAS, PA-C, QuickCare

Brent Hasty, Professional Counselor

Latoya Lamb, APRN, QuickCare

Chelsen Larkey, Professional Counselor

Virginia Mink-Cash, APRN, Family Practice

Alicia Myers, MPAS, PA-C, Family Practice

Kacey Scoggin Nicely, APRN, QuickCare

Nancy Owens, APRN, QuickCare

Angela Parsons-Woods, MPAS, PA-C, Family Practice

Tiffany Patrick, CRNA, General Surgery

Brittany Perkins-Saylor, MPAS, PA-C, Family Practice

Megan Taylor Pittman, APRN, Pediatrics

Barbara Prather, APRN, Family Practice

Terry Puckett, CRNA, General Surgery

Brislyn Saylor, MPAS, PA-C, QuickCare

Jordan Whitaker, MPAS, PA-C, QuickCare

Colyn Wright, MPAS, PA-C, QuickCare

CONSULTING ADVANCED PRACTITIONERS

Dee A. Abrams, MPAS, PA-C, Cardiology

Sara Ackerman, MPAS, PA-C, Allergy/Immunology

Doris Adams, APRN, Cardiology

Michael Blackburn, MPAS, PA-C, Orthopaedics

Susan F. Grubbs, APRN, Nephrology

Lynsey Henderson, APRN, Cardiology

Nedda Hughes, MPAS, PA-C, Nephrology

Jessica Kendrick, MPAS, PA-C, Cardiology

Rana Lindsey-Rahman, APRN, Cardiology

Caroline Little, MPAS, PA-C, Cardiology

William “Dan” Manning, MPAS, PA-C, Cardiology

Kimberly McLaughlin, MPAS, PA-C, Nephrology

Katherine Moore, MPAS, PA-C, Cardiology

Heather Oaks, APRN, Cardiology

Rose Y. Pierson, APRN, Allergy/Immunology

Hannah L. Puntney, APRN, Pediatric Urology

Kathy Tincher, RN, Cardiology

Carol Yaden, APRN, Cardiology

EMERGENCY MEDICAL STAFF

Michael Hamilton, MD, Director

Olayinka Aina, MD

David Bullock, MD

Brandon Cowan, MD

Tariq Mirza, MD

M. Kevin Rowe, MD

Mohamed Sadek, MD

John Sasinouski, DO

Dan Sotingeanu, MD

Gregory Spears, DO

Bernard Williams, MD