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FOCUS TOPICS UROLOGY • ORTHOPEDICS/SPORTS MEDICINE

July/August December 2019 2009 >> $5 ON ROUNDS

Expanded Diagnostic and Treatment Options Needed to Overcome Stage Migration of Prostate Cancer Prostate cancer is one of the most common cancer diagnoses, affecting an estimated 1 in 9 men in America, primarily occurring in men 65 and older, and in African Americans. Some people may be less concerned about a diagnosis of prostate cancer today because for most, it is slow growing and not fatal. But it is still the second leading cause of cancer deaths in men ... 3

Hip Labral Tears Benefiting from Lessons Learned with Shoulder Tears Improved treatments include OATS, meniscus transplants and platelet rich plasma By BECKY GILLETTE

Improvements in surgical and rehabilitation techniques used in sports medicine are allowing athletes to recover faster and get back in the game. “A big thing in sports medicine is improvements in arthroscopic surgery for labral tears,” said Lawrence (Larry) O’Malley, MD, a sports medicine specialist with the University of Arkansas for Medical Sciences (UAMS) Orthopedic Clinic in Little Rock and Conway. “Internal impingement can cause labral tears and also cartilage injuries. We have been doing arthroscopic surgery for labral tears in the shoulder for multiple years. Now we are also seeing a lot of success fixing labral tears in the hips. Arthroscopy for labral tears is a large portion of my practice. We are able to perform more repairs than we could previously.” In terms of cartilage restoration, there is now a whole gamut of options including the Osteoarticular Transfer System (OATS), osteochondral allografts or MACI, where a surgical procedure is used to transplant cartilage from either a cadaver or from a nonweight bearing, undamaged area of the joint to the damaged area of the joint. (CONTINUED ON PAGE 4)

Larry O’Malley

HealthcareLeader

Medical Center of South Arkansas CEO Overseeing Destination Healthcare Efforts

See the Grand Rounds section beginning on page 5 for healthcare spot news from around the Natural State.

By BECKY GILLETTE

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Scott M. Street

EL DORADO - “People don’t want to travel long distances for healthcare,” said Medical Center of South Arkansas (MCSA) CEO, Scott M. Street, who took his present position in October 2017. “We want those patients in south Arkansas to be able to get specialty care near home. Our vision is to provide a destination for healthcare services by creating alliances, opening new services and expanding existing services.” In an era of hospital closures across the country, especially in smaller cities, Street said while (CONTINUED ON PAGE 6)

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PhysicianSpotlight

Expanded Diagnostic and Treatment Options Needed to Overcome Stage Migration of Prostate Cancer Urologist Robbie Hurtt says flawed USPTF data on testing created problem By BECKY GILLETTE

Prostate cancer is one of the most common cancer diagnoses, affecting an estimated 1 in 9 men in America, primarily occurring in men 65 and older, and in African Americans. Some people may be less concerned about a diagnosis of prostate cancer today because for most, it is slow growing and not fatal. But it is still the second leading cause of cancer deaths in men. Robbie Hurtt, MD, a urologist based at the Arkansas Urology Conway clinic, said while there are certainly slowgrowing prostate cancers, there are also fast-growing, aggressive prostate cancers that tend to metastasize, ending men’s lives earlier than expected. “And as one would expect, there are many prostate cancers in between,” said Hurtt. “We now have more tools available than ever to help us differentiate these different tumor behaviors. While a simple blood test called a PSA (prostate specific antigen) and digital rectal exam (DRE) can help identify patients at risk for prostate cancer, the diagnostic capabilities available to us now far exceed PSA and DRE alone.” Hurtt said he can’t think of another area of urology that is evolving as fast as prostate cancer. This applies to men who have yet to be diagnosed to those with advanced, metastatic prostate cancer. “The diagnostic capabilities and therapeutic treatments continue to expand year-to-year which is exciting for us as urologists and great for our patients dealing with this malignancy,” Hurtt said. The PSA test for prostate cancer has been controversial in recent years. But Hurtt said the PSA test is still an extremely useful part of identifying men at risk for prostate cancer, as well as a way of following patients who have been treated for prostate cancer to rule out recurrence of the disease. “PSA’s reputation, so to speak, took a hit in 2012 when the U.S. Preventive Task Force (USPTF) recommended against PSA screening,” Hurtt said. “While no prostate cancer expert sat on the panel which made the recommendation, the results have changed practice patterns in our country. The recommenarkansasmedicalnews

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Robbie and Megan Hurtt

dation against the PSA test is contradicted the American Urologic Association (AUA) and experts in the field of urology and prostate cancer. We felt the data the USPTF used to make their recommendations was flawed. Fortunately, they eventually agreed and removed their prior

recommendation against PSA.” The USPTF position now is that the decision about PSA screening should be between the patient and their physician. “PSA certainly has its limitations, and we know that,” Hurtt said. “We can augment PSA’s shortcoming with molecular testing, MRI and other cuttingedge options now available. The AUA guidelines state men aged 40-70 years old with risk factors for prostate cancer such as family history or African American descent should consider prostate cancer screening, and average risk men should consider screening from age 55-70.” The recommendation against PSA may have backfired. Since the initial USPTF recommendation in 2012 against PSA, a stage migration has been seen in prostate cancer. “This means more patients are coming to the urologist in 2019 with higher stage, metastatic prostate cancer than 10 years ago,” Hurtt said. “Metastatic prostate cancer is incurable. Why has this happened? We have better and more treatment options now than ever. This stage migration has occurred due to less PSA screening. While USPTF removed their recommendation

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against PSA screening, practice patterns take time to change.” Hurtt strongly encourages any healthcare provider throughout the state who is not talking to their male patients about prostate cancer have that conversation. “We would be happy to have a discussion with any of those patients, as well,” he said. “An elevated PSA does not guarantee that a patient needs a biopsy or will have treatment, but it starts a dialogue and a closer follow-up to ensure we aren’t missing these patients at high risk for morbidity and mortality from prostate cancer.” Arkansas Urology is in the process of building a state-of-the-art facility in Conway. Hurtt said they are hopeful to be in that space by the end of the year. “As leaders in the state in urologic care, this investment in Conway is a big step forward for our patients in Faulkner County and beyond,” he said. Hurtt grew up in Salem, a small town in North Arkansas near Mountain Home, and was valedictorian of Salem High School in 2004. He graduated summa cum laude with a degree in biology from the University of Arkansas, Fayetteville, in 2008. He received his Medical Degree from the University of Arkansas for Medical Sciences in 2012, and did a general surgery internship followed by a urology (CONTINUED ON PAGE 6)

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Hip Labral Tears Benefiting from Lessons Learned, continued from page 1 “You can also transplant knee meniscus from someone else,” O’Malley said. “Associated with that are alignment procedures – making sure there are no alignment issues affecting the cartilage wear. We try to preserve the knee so the patient won’t need a replacement. These are for people with isolated defects versus someone with global arthritis, and global cartilage loss. It is important to pick the right patients who have isolated lesions. These are many younger patients, often 45 and under.” Another option is Platelet Rich Plasma (PRP), which uses the patient’s own blood to stimulate growth in injured tissues. Evidence is increasing that PRP may be effective in managing pain associated with knee osteoarthritis. “Studies have shown PRP can be helpful, but that is not growing new cartilage,” said O’Malley, who is also an assistant professor in the UAMS College of

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Medicine’s Department of Orthopaedic Surgery. “The best way to replace cartilage is to transplant cartilage from someone else or the patients themselves.” Anterior Cruciate Ligament (ACL) injuries in athletes are very common, and for years orthopedic surgeons have been doing reconstruction using a graft to replace the ligament. O’Malley said that a quadriceps tendon graft is an excellent option instead of doing a hamstring or patella tendon graft. “There is also Anterolateral Ligament Reconstruction where an extra articular ligament is used to supplement for someone who has had an ACL reconstruction that has failed,” O’Malley said. “We are adding the ALL to protect the rotation forces on the ACL. Hopefully, it is a way to reduce the risk of ACL re-tears. It is a newer procedure we are doing more often. We are still trying to study it to see who needs it and who doesn’t need it. I will do it depending on the patient’s needs.” In terms of rehab, some therapy centers in the state, including those at UAMS, are using an anti-gravity device originally developed using NASA technology called the AlterG® Anti-Gravity Treadmill. This is used to reduce body weight to 20 percent so patients can get up walking and running earlier after knee and hip surgeries. “It is a great option that allows us to get patients back to health more quickly,”

he said. “Another great tool is blood flow restriction. A special blood pressure cuff is used to provide 80 percent constriction so the patient works at 20 percent of normal mass. For example: they used to leg press 200 pounds. With blood flow restriction, they now leg press 40 pounds, but get the results of 200 pounds. This rebuilds muscle in areas that have previously been injured. “The NBA has used it the past four or five years to help athletes recover while building muscle. A lot of the therapy clinics around the state have been getting these machines and it is really helping patients get back to functioning quicker. After you take that tourniquet off, you get a rush of blood that enhances tissue growth.” Wearable telematic devices are increasingly being used as prices have come down. O’Malley said these are useful for determining an athlete’s performance before and after treatments. Are they back to baseline or are they still having issues? “Out on the field, the athlete may not be as good as we expect, or may be better than expected,” O’Malley said. “This information can help decide how much to allow the athlete to practice. The problem is the cost; not everyone can afford these. But they can be extremely helpful in terms of monitoring athletes and getting them back to full activity. O’Malley said he loves working with

For more information, go online to: UAMS sports medicine, https://uamshealth.com/ sportsmedicineservices2/

athletes, who are usually very motivated to get well so they can get back playing the game they love. “What I like about my job is most of the time you fix them, and they are back to where they were and are able to meet their goals and aspirations,” O’Malley said. “That is something I really enjoy seeing. Unfortunately, with ACL, recovery can take 6 to 12 months.” While the surgeries take only a short period of time, O’Malley’s job is not done after the surgery. “The great part of my job is the encouragement aspect of getting them back to their previous level of competition or perhaps even getting them better than they were before,” he said. The UAMS Sports Medicine Clinic takes care of athletes at the University of Arkansas Little Rock, Philander Smith College, Arkansas Baptist College, and the University of Arkansas Monticello. O’Malley takes care of athletes at North Little Rock High School. “As of this point, we continue to expand taking care of more and more colleges,” he said. “It takes time to develop those relationships.”

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GrandRounds Washington Regional Medical Foundation Announces 2019 Eagle Award Winners​ FAYETTEVILLE - Three Eagle Award recipients were formally recognized during Washington Regional​ Medical Foundation’s Gala at Walton Arts Center. Established in 1994,​the Eagle Award for Outstanding Health Leadership is given to individuals or organizations that make​outstanding contributions to the improvement of healthcare in Northwest Arkansas. This year’s recipients​are Dr. Scott A. Bailey, Dr. J. Thaddeus Beck and Dr. Hugh B. Higginbotham.​ Dr. Scott Bailey, a Bentonville native, received his medical degree from the University of Arkansas for​Medical Sciences in Little Rock and completed an OB/ GYN residency at Memorial Medical Center in​Savannah, Georgia. He is board-certified Scott Bailey by the American Board of Obstetrics & Gynecology.​ Dr. Bailey launched his career at the Parkhill Clinic for Women in 1988. He was the first robotic certified​physician in Northwest Arkansas and performed the first robotic hysterectomy in the state. Dr. Bailey​played a critical role in the establishment of the Beau Foundation to support the Community Clinic’s​ Prenatal Pathways program, demonstrating his commitment to all patients, but more specifically, those who​ are uninsured and in need.​ Dr. Bailey currently serves as president of Parkhill Clinic for Women. He served as chief of staff at Willow​Creek Women’s Hospital for over a decade and on the Board of Directors of Willow Creek Women’s​Hospital and the Arkansas Perinatal Association. Dr. Bailey is active in medical staff leadership at​Washington Regional, having served as chairman of the OB/GYN and surgery departments. He is a Fellow​of the American College of Obstetrics and Gynecology and a member of the Arkansas Medical Society.​ Dr. Bailey was Celebrate Arkansas’ 2016 Best OB/GYN and received the 2011 Hawks-Workman Award​from UAMS for outstanding contributions to the health and welfare of mothers and babies in Arkansas.​ Dr. Bailey enjoys spending time and traveling with Leslie, his wife of 33 years, and his three children,​Bridgette Pardo, Kate, Thomas and granddaughter Waverly.​ Dr. Thad Beck received his medical degree and completed residency in internal medicine at the University of Arkansas for Medical Sciences Thad Beck in Little Rock. He obarkansasmedicalnews

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tained his fellowship in hematology and oncology at Duke University Medical Center and is board-certified in internal medicine, medical oncology and hematology from the American Board of Internal Medicine.​ Dr. Beck, along with Drs. Daniel Bradford and Malcolm Hayward, started the Highlands Oncology Group, PA in June of 1996, transforming the practice of oncology medicine throughout Northwest Arkansas. He is an accredited author of over 90 papers and abstracts and played a part in launching

Highlands Oncology’s Clinical Trials Program. This unique program includes 21 full-time staff and 35 open protocols with approximately 80 active patients who likely would have no alternatives if these trials didn’t exist. Since 2000, Dr. Beck has been the Principal Investigator (PI) in 288 studies and sub-PI in another 52 studies. The trials program has gained the trust of many drug developers, giving Highlands access to some of the most promising developmental therapies.​ Dr. Beck and his wife Melanie were

recognized as the 2018 Philanthropists of the Year by the NWA Association of Fundraising Professionals. In addition, Dr. Beck has served as a board member for Susan G. Komen Ozark, was a founder of Hope Cancer Resources and was a 2010 Gentleman of Distinction for Hope.​ Dr. Hugh Higginbotham earned his medical degree and completed residency in internal medicine at the University of Missouri Columbia School of Medicine, as well as a residency in cardiology with the American Heart Association. (continued on page 6)

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Medical Center of South Arkansas CEO, continued from page 1 El Dorado is a midsize town, it has a big heart for the future. City leaders are actively supporting growth in entertainment, jobs, education, and healthcare. “These are the essential elements for a quality lifestyle,” he said. “MCSA is proving successful in growing its footprint in Union County. We have created alliances with the Arkansas Heart Hospital, Arkansas Children’s Hospital, the University of Arkansas for Medical Sciences, Arkansas Urology and the Landmark Cancer Center to bring certain services back to El Dorado.” Street, with the support of the MCSA Board of Trustees and Leadership, worked to start crafting a vision for destination healthcare soon after arriving at MCSA. “We went into our market, talked to stakeholders in the community, and asked what they want from us as healthcare providers,” Street said. “We got a lot of input, and responded by working to bring services here that the region hasn’t had in the past, like behavioral health – psychiatric services – and a full, comprehensive cancer center. We are also working to bring back the Arkansas Health Education Center (AHEC) 12-physician residency program.” The program is currently under design, and a clinic facility is planned to house the program. The first class is expected to start in the fall of 2022. Street said one of the advantages of the residency program is that if the hospital system builds a rapport with residents for three years, they are more likely to want to stay when their residency is up. That helps with the vital need for adequate numbers of physicians to serve the region. “If someone has ties in the region, or within Arkansas, that is always helpful,” he said. “If you can recruit locally, that is a huge hurdle you are able to get over. We start recruiting in high school and college looking not just for quality, but stability. If a physician is here for a couple of years, builds rapport with patients and families, and then leaves, it is unfortunate for those who live here. We are aggressively recruiting for subspecialists. We have eight active searches right now for subspecialists.” As is the trend in healthcare today, MCSA is finding success in recruiting specialists by jointly recruiting with organizations like Arkansas Heart Hospital. An interventional cardiologist, for example, could live in El Dorado and be employed jointly by MCSA and Arkansas Heart Hospital, allowing the physician to be part of a group based in Little Rock with about 30 heart specialists. They currently have a joint employment arrangement in Arkan-

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sas Heart Hospital and are planning such an alliance with Arkansas Urology, as well. “That model is part of the plan,” Street said. “We think that is key to some of the subspecialties we need here. This will work for us currently, and as we grow our service lines down the road. For other staff needs such as nurses, we work with South Arkansas University, South Arkansas Community College and other allied programs. South Arkansas University has a strong nursing program and other allied programs. They do an impressive job training those we recruit and hire, and who are hired by other healthcare providers throughout the region.” MCSA, which has 166 beds, is currently in the process of modernizing the second, third and fourth-floor rooms in its patient tower. The hospital has added a new café and bistro, remodeled the entrance lobby, and built a conference center. Through a partnership, they are adding a three-level medical office building, new medical service lines, and physician specialties. “These are fairly short-term goals,” Street said. “We are serving all of South Arkansas, not just Union County, which we are excited about. We are always challenging ourselves. We strive to create a better healthcare experience for our patients. With our goal to bring extensive healthcare service lines to the citizens of south Arkansas, they will no longer have to make a long drive for most of their medical care.” In addition to the main hospital, MCSA has an imaging center, and multiple primary and specialty clinics throughout El Dorado. Street, who has been in healthcare

administration for 29 years, grew up in Cherokee Village in North Arkansas. His interest in a healthcare career surfaced in an eight grade English class. When the students were asked what they wanted to become, most classmates wanted to be astronauts and firemen. Street stood up and said he wanted to be a hospital administrator. His uncle, Steve Morris, CEO of a large hospital system, and father, Gene Street, a businessman, had a big influence on his career choice. Street obtained a bachelor’s in business administration from Ouachita Baptist University in Arkadelphia before earning a master’s degree in healthcare administration from the University of Missouri, Columbia, MO. His first job after graduation was working for Baptist Health in Little Rock. “Baptist invited me to do a residency and I spent the first ten years of my career with them,” Street said. “Baptist Health is a good organization and I valued my time with them.” Prior to El Dorado, Street worked in Oklahoma and Texas. When the opportunity was presented to lead MCSA, the Streets were excited about the opportunity to return to Arkansas. “We had two sons at Ouachita Baptist University, which is the college my wife, Christine, and I graduated from,” Street said. “So, we wanted to get back to Arkansas. We thought this was a great location. Community Health Systems, the operator of the hospital, was looking for a leader with a passion for this area. And I can’t overemphasize the location is great for my wife and our four children.” Their son Jacob is a freshman and

Expanded Diagnostic and Treatment Options, continued from page 3 residency at the University of Mississippi Medical Center in Jackson, finishing up in 2017. He has been employed by Arkansas Urology, the largest urology practice in the state, since 2017. Hurtt was selected for the Prostate Cancer Academy, Denver, CO, in September 2016, and received the T Leon Howard Imaging Conference presentation award from The Southeast Section of the American Urologic Association in 2016. He received the 2009-2012 Robert L Kerr Medical Student Scholarship, and the 2004-2008 Chancellor’s Scholarship and Governor’s Distinguished Scholarship from UAMS. He has done a number of podium presentations and published research papers including: A pilot study of telemedicine for post-operative urologic care in children. Stephen Canon, Hurtt et al. Journal of Telemedicine and Telecare, October 2014. Hurtt and his wife, Megan, are very passionate about adopting and foster care. “My wife is intimately involved with many organizations related to this (The Call, Soaring Wings, Little Rock Angels), and she is a CASA (court appointed special advocate) for a foster child in Faulkner

County,” he said. “We are also very involved in our church, New Life Church.” In July, the couple went back to Peru for about 3 weeks for medical and outreach missions in the Amazon. They are also diehard Razorback fans. “We enjoy going to games there, and we have also become fans of our local colleges in Conway since moving there,” Hurtt said. From the age of 10, he has had an interest in old cars and has restored multiple muscle cars. “It was working on old cars and ‘diagnosing’ their ‘diseases’ that sparked my interest in medicine,” he said. “I also think that’s really what drew me to surgery. Tools, albeit more expensive, such as high definition endoscopes, robots, and scalpels, seemed like a natural fit for me given my experience with working with other simpler tools on cars over the years.” For more information, go online to: Arkansas Urology, http:// www.arkansasurology.com/.

a member of the basketball team at Ouachita, and their son Zach, recently graduated from there. An older son, Nathan, and his wife, Kasey, live in Little Rock, and daughter Samantha and her husband, Caleb Akers, live in Rogers. Street describes his leadership style as service oriented and vision driven. “I was originally drawn into healthcare and am still in healthcare today because of the opportunity and privilege to serve,” Street said. “We have an opportunity to do that in this day and time in healthcare. Our goal is to always provide quality care and create a positive patient experience.” The Streets say their greatest passion is raising their children and make it a top priority to spend time with them. They are also both very involved with their church and their alma mater, where Street is on the Ouachita Baptist University Board of Directors. Street played football in college, and they also participate in fundraisers for Ouachita Athletics. For more information, go online to Medical Center of South Arkansas, https://www.themedcenter.net/

Washington Regional, continued from page 5

Dr. Higginbotham obtained a fellowship in cardiology from the Barnes Hospital Fellowship Program. He served as a cardiologist in the US Army during the Vietnam War, and Hugh after his military service Higginbotham at Fort Leonard Wood, moved to Fayetteville and became the fourth member of the Fayetteville Diagnostic Clinic.​ As a former Eagle Scout and prior to his medical career, he was an avid canoer and fisherman but did not have much time to pursue those interests during his 60-year medical career. After a brief “retirement” from private practice in 1998, Dr. Higginbotham served another 14 years reading EKG’s and providing personalized follow-up with his colleagues.​ Following his most recent retirement, he is spending time with his wife of 38 years, Donna, and focusing on his health. He enjoys time with his family and his two Yorkshire Terriers, Maggie and Mollie.​ The Gala will include a cocktail reception, awards ceremony and entertainment provided by Piano Men: A Tribute to Elton John & Billy Joel starring Craig A. Meyer and Gregory Scott. An after-party will take place in the Walton Arts Center atrium featuring the local favorite dance band, Full House. The 2019 Gala proceeds will be dedicated to support construction of a new Cancer Support Home in Fayetteville.

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GrandRounds APRN joins Conway Regional Surgical Associates CONWAY - Brooke Keith, APRN, has joined Conway Regional Surgical Associates to practice alongside Doctors Michael Stanton, Brock King and Tony Manning. The practice provides general, vascular and bariatric surgery services. Brooke Keith Brooke completed her Master’s of Science in Nursing degree from the University of Central Arkansas in December of 2018 after working as a registered nurse since 2004. In addition, she is board certified by the American Academy of Nurse Practitioners. Brooke will see patients at Conway Regional Medical Center and Conway Regional Surgical Associates located at 525 Western Avenue, Suite 203. For more information, the clinic can be reached at 501-327-4828.

U.S. News & World Report Ranks 5 Arkansas Children’s Hospital Specialties LITTLE ROCK - U.S. News & World Report has ranked Arkansas Children’s Hospital in five specialties in the new 2019-20 Best Children’s Hospitals rankings published online. The state’s only pediatric health sys-

tem is proud to have the following programs ranked among the national list: • Cardiology & Heart Surgery • Neurology & Neurosurgery • Nephrology • Orthopedics • Pulmonology The 13th annual Best Children’s Hospitals rankings recognize the top 50 pediatric facilities across the U.S. in 10 pediatric specialties: cancer, cardiology and heart surgery, diabetes and endocrinology, gastroenterology and gastrointestinal surgery, neonatology, nephrology, neurology and neurosurgery, orthopedics, pulmonology and lung surgery, and urology. U.S. News introduced the Best Children’s Hospitals rankings in 2007 to help families of children with rare or lifethreatening illnesses find the best medical care available. The rankings are the most comprehensive source of qualityrelated information on U.S. pediatric hospitals. The U.S. News Best Children’s Hospitals rankings rely on clinical data and on an annual survey of pediatric specialists. The rankings methodology factors in patient outcomes, such as mortality and infection rates, as well as available clinical resources and compliance with best practices. This year’s rankings will be published in U.S. News & World Report’s “Best Hospitals 2020” guidebook.

CHI St. Vincent Infirmary Appoints Megan Roberts as First Director of Orthopedics LITTLE ROCK – CHI St. Vincent has appointed Megan Roberts as Director of Orthopedics for CHI St. Vincent Infirmary. In this newly created administrative role, Roberts will align timely resources and solutions to support CHI St. Vincent’s orthopedic patients, nurses and physicians Megan Roberts to ensure they receive the highest possible quality of care. During her time at CHI St. Vincent, Roberts spearheaded the Leadership Development Institute Planning committee, co-authored the 2016 Community Health Needs Assessment and organized multidisciplinary project teams to support the planning and implementation of initiatives under the Orthopedic Co-Management Agreement. She has served as a planning analyst with CHI St. Vincent’s Strategy and Business Development team since 2016. Roberts earned her Master of Health Administration from Cornell University and currently represents CHI St Vincent in Leadership Greater Little Rock Class XXXIV and in CommonSpirit’s Emerging Leader Program. The orthopedic program at CHI St. Vincent emphasizes a multidisciplinary

approach to help patients return to and maintain a life free of pain. The team of highly specialized physicians and patient care staff offer state-of-the-art procedures and treatments for a full range of orthopedic conditions, providing a comprehensive continuum of care. For more information, visit: CHIStVincent.com/orthopedics

Conway Regional GI Clinic Welcomes APRN CONWAY - Lindsey Sierra of Conway, an advanced practice registered nurse, has joined the Conway Regional Gastroenterology Center. She is practicing alongside Drs. Martin Moix, Owen Maat and O.T. Gordon as well as Brandy Eason, APRN. Sierra achieved her Master of Science in Lindsey Sierra Nursing degree from the University of Central Arkansas in 2015 and worked as an advance practice registered nurse at Gastro Arkansas since 2016. Prior to achieving her advanced practice degree, Sierra worked as a registered nurse in intensive care units at the University of Arkansas for Medical Sciences and at NEA Baptist Memorial Hospital in Jonesboro. She was also a member of the adjunct nursing faculty at UCA.

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GrandRounds CHI St. Vincent Advances the International Field of Neurosurgery with Completion of the New Research and Education Center LITTLE ROCK - CHI St. Vincent announces the grand opening of the new Arkansas Neuroscience Institute (ANI) Research and Education Center. The new facility will work to improve treatment outcomes for patients, map the human brain and provide training for neurosurgeons to deAli Krisht velop the skills necessary to tackle the most complex cases. The center is the culmination of a $30-million project to develop new neurosurgery, education and research facilities in central Arkansas. ANI Director Dr. Ali Krisht says the center will be a beacon to neurosurgeons around the world because it will become an oasis for all the thinkers and people who deal with neurosurgery to come learn and contribute knowledge. The center includes the M.G. Yasargil Neurosurgical Research and Education Center and O. Al-Mefty Microneurosurgery Laboratory, named after two of Dr. Krisht’s mentors and fellow recipients of the prestigious international Herbert Olivecrona Award for

contributions to the field of neurosurgery. The laboratory features the only existing space where neurosurgeons can train using The Aboud Model: The Live Cadaver. Created by ANI’s Dr. Emad Aboud, The Aboud Model circulates blood-like perfusate through a cadaver using a cardiac pump to simulate life-like conditions in terms of bleeding, pulsation and softness of tissue, providing surgeons the advanced training they need without the enhanced pressure of operating on a live patient. The 150-seat Margaret Clark Auditorium is equipped with three large projectors using a combination of 3D and laser technologies to live stream neurosurgical procedures from the microscopic camera navigating areas of a patient’s brain in the operating room. The resource allows students and fellow neurosurgeons to fully witness a surgery and see how the world’s best neurosurgeons conduct procedures or address unexpected discoveries. Construction of the ANI Research and Education Center was made possible in part thanks to $4-million in donations to the CHI St. Vincent Foundation. The project also included major renovations to CHI St. Vincent North, including four state of the art surgery rooms, advanced imaging resources, a helipad to reduce the transportation time for patients in need of immediate care and an expanded Intensive Care Unit to pro-

vide for the unique needs of neurosurgery patients. ANI currently treats patients from all 75 Arkansas counties, 38 states and countries around the world. An international symposium on The Future of Microneurosurgery will immediately follow the grand opening with presentations by experts in the field of ultra-microsurgery from 25 nations. The ANI Research and Education Center was developed and designed by the NexCore Group and architects at Taggart Inc in coordination with the CHI Real Estate and Planning Office. The center was built by Clark Contractors.

Veterans Affairs Benefit Now Available at Baptist Health Urgent Care LITTLE ROCK – Baptist Health Urgent Care is now an Authorized VA Urgent Care Provider as part of the VA MISSION Act. Passed by Congress last year, this act now allows eligible veterans to visit participating urgent care centers for their urgent care needs without preauthorization or an appointment. All six Baptist Health Urgent Care centers are open seven days a week. Baptist Health Urgent Care centers are located in Benton, Bryant, Cabot, Jacksonville, Little Rock and North Little Rock. Walk-ins are welcome or for added convenience, patients can schedule a same day or next day appointment online with Hold My Spot.

Veterans can learn more about the program and eligibility by visiting MissionAct.Va.Gov. Also visit UrgentCareBaptistHealth.com to view all health care services offered.

Baptist Health Neurosurgery Arkansas Welcomes Dr. PB Simpson Jr. Editor’s note: We wanted to repeat this announcement from our May-June issue to correct the photo of Dr. Simpson. LITTLE ROCK - Dr. PB Simpson Jr., who has been in practice for more than 40 years, has joined Baptist Health Neurosurgery Arkansas on the campus of Baptist Health-Little Rock. Simpson received his medical degree from the University of Mississippi and is board PB Simpson Jr. certified in neurosurgery. He has a conservative practice philosophy, believing that surgery should only be an option if the benefits outweigh the risks. Baptist Health Neurosurgery Arkansas, established in 2004 as a multidisciplinary approach to the treatment of brain and spine disorders in the state, is open Monday through Friday from 8 a.m. to 5 p.m. in Medical Towers I, Suite 750, 9601 Baptist Health Drive.

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GrandRounds ROGERS – Several providers recently joined Mercy Hospital and Mercy Clinic in Northwest Arkansas. Andrew Ebers, MD, joined Mercy Clinic Infectious Disease – Physicians Plaza. Dr. Ebers earned a Doctor of Medicine from the University of Texas Houston Medical School. He completed a residency at the University of Virginia Department of Internal Medicine and a fellowship at University of Virginia Department of Infectious Disease and Global Health. He is board certified in internal medicine and infectious disease. Steven Moon, MD, joined Mercy Clinic Neurology – Physicians Plaza. Dr. Moon earned a Doctor of Medicine from the University of Oklahoma Health Sciences Center and master’s in public health from the University of Oklahoma College of Public Health. His postgraduate work includes an internship in psychiatry at the United States Air Force Hospital and a residency in psychiatry from the University of Kansas Medical Center. He completed a residency in preventive medicine at the University of Kentucky Medical Center and a residency in internal medicine at the University of Oklahoma. He completed a residency in neurology at the University of Kansas Medical Center. Prior to joining Mercy, he has practiced neurology in Northwest Arkansas for 28 years. He

is board certified in neurology and neuroimaging. Mitchell Preston, MD, joined Mercy Clinic Family Medicine – Downtown Rogers. Dr. Preston earned a Doctor of Medicine from the University of Oklahoma School of Medicine. He completed a family medicine residency at Louisiana State University Medical Center and an internship in family medicine at the University of Oklahoma. Prior to joining Mercy, Dr. Preston practiced family medicine at clinics in Arizona, Texas and Oklahoma for 22 years. In addition, he practiced emer-

gency medicine 1999 to 2006. He is board certified in family medicine. Jennifer Jennings, family nurse practitioner, joined Mercy Clinic Primary Care – Bella Vista. She earned a Bachelor of Science in nursing from Abilene Christian University and a Master of Nursing Science from the University of Arkansas for Medical Sciences. She completed a Doctor of Nursing Practice at the University of Arkansas. Prior to joining Mercy, she worked as a registered nurse for more than a decade and as a family nurse practitioner for seven

years. She is board certified by the American Nurses Credentialing Center. Rhonda Pauls, advance practice nurse, joined Mercy Clinic Rheumatology – 52nd Street. She holds a Bachelor of Science in Health Science from Wichita State University and a Bachelor of Science in nursing from Kansas Newman College. She earned a Master of Science in nursing from the family nurse practitioner program at Indiana State University. Prior to joining Mercy, she worked for 23 years in nursing, including six years as an advance practice nurse.

Mercy Hospital Fort Smith Adds Obstetric Hospitalists FORT SMITH – Mercy Hospital Fort Smith has added a new service to ensure that pregnant women have access to the care they need. Mercy Hospital Fort Smith is launching an obstetric hospitalist program that will provide an experienced team of board-certified obstetricians 24 hours a day, seven days a week. • Providing care in times of emergency prior to the arrival of a patient’s physician. • Supporting the care of high-risk pregnancy patients. • Delivering babies for patients who don’t have an obstetrician. As part of the program, Mercy Childbirth Center in the Labor & Delivery building on the main hospital campus will have an Obstetric Emergency Department with four rooms dedicated to emergency care at any gestational age. Eight OB hospitalists have been hired. The program, not intended to replace a woman’s reguDr. Andrew Riché, a board-certified OB-GYN and chief of staff for Mercy Hospital Fort Smith, at far right, is shown with four lar obstetrician, is offered in partnership with the OB Hospiof the eight OB hospitalists. talist Group, which staffs and manages programs throughout the United States.

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GrandRounds UAMS Chancellor Cam Patterson, M.D., MBA, Invested in Harry P. Ward Chancellor’s Distinguished Chair LITTLE ROCK — Cam Patterson, M.D., MBA, chancellor of the University of Arkansas for Medical Sciences (UAMS), was invested June 3 as the third recipient of the Harry P. Ward Chancellor’s Distinguished Chair. Created in 2005, the Ward chair became the first chancellor’s chair endowed at an Arkansas university. I. Dodd Wilson, M.D., who succeeded Harry P. Ward as chancellor in 2000, was the inaugural recipient, followed by Daniel W. Rahn, M.D., who succeeded Wilson in 2009. Patterson has served as chancellor since June 1, 2018. Gov. Asa Hutchinson praised Patterson’s accomplishments since he joined UAMS. Patterson thanked Gov. Hutchinson, who attended with his wife, Susan, as well as University of Arkansas System President Donald R. Bobbitt, Ph.D., for bringing him and his family to Arkansas. Patterson thanked his wife, Kris Patterson, M.D., their children Celia, Anna and

Graham, and his mother Audrey, who were seated in the front row. He also thanked a host of mentors, friends, extended family members, legislators, the UA Board of Trustees and each of his predecessors as chancellor. Bobbitt presided over the investi-

ture ceremony, held in the Fred W. Smith Conference Center at the UAMS Jackson T. Stephens Spine & Neurosciences Institute. Bobbitt and John Goodson, chairman of the University of Arkansas Board of Trustees, presented Patterson with the chair medallion. In a video message, Nancy DeMore, M.D., professor of surgery and medical director of the breast program at the

Medical University of South Carolina, credited Patterson as a strong mentor who helped advance her career as a physician scientist. Friend and mentor Michael E. Mendelsohn, M.D., executive chairman of Cardurion Pharmaceuticals and adjunct professor of medicine at Tufts University School of Medicine, offered his congratulations to Patterson and UAMS. The chair is named for Harry P. Ward, M.D., UAMS chancellor from 1979 to 2000, who is remembered as a giant in the history of health care and higher education in Arkansas. Ward led UAMS’ transformation from a small medical school with a charity hospital into a health sciences university and research leader, with an annual economic impact in Arkansas of more than $4.5 billion. His wife, Betty Jo, attended Patterson’s investiture. An endowed chair is among the highest academic honors a university can bestow on a faculty member. A distinguished chair is established with gifts of at least $1.5 million, which are invested and the interest proceeds used to support the educational, research and clini-

cal activities of the chair holder. Those named to a chair are among the most highly regarded scientists, physicians and professors in their fields. The Willard and Pat Walker Charitable Foundation provided the lead gift of $1 million for the chancellor’s distinguished chair, with support from other donors reaching $2.5 million. The chair provides funding for the UAMS chancellor to use in recruiting faculty and administrators of the greatest possible caliber and vision. In his first year as chancellor, Patterson led efforts to trim a potential $72 million deficit to produce a balanced budget. In February, UAMS established the Institute for Digital Health & Innovation to increase health care access across the state through technology, one of Patterson’s key priorities. Patterson has also worked alongside the governor and the Arkansas General Assembly to receive a commitment of at least $10 million in annual state support in UAMS’ quest for National Cancer Institute designation for the Winthrop P. Rockefeller Cancer Institute. A renowned cardiologist, Patterson earned his Bachelor of Arts in psychology from Vanderbilt University, his medical degree from Emory University School of Medicine and his Master of Business Administration from the University of North Carolina Kenan-Flagler School of Business.

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GrandRounds Candra Ray, APRN, Joins Renal Specialists of NWA FAYETTEVILLE - Candra Ray, APRN, recently joined Washington Regional and Renal Specialists of Northwest Arkansas where she is part of the physician team. Her primary responsibility is caring for dialysis patients. Ray earned both a Master of Science and Candra Ray Bachelor of Science in Nursing from UAMS and an Associate of Applied Science in Nursing from Northwest Arkansas Community College. She is a certified Family Nurse Practitioner.

UAMS Orthopaedics Dedicates One-Stop Clinic for Upper Extremity Amputees LITTLE ROCK - Patients with amputations to their fingers, hands and arms can receive care from a specialized physician, occupational therapist and prosthetist all under one roof at the University of

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Arkansas for Medical Sciences (UAMS) Autumn Road Orthopaedics Clinic. Once a month, this multidisciplinary team will focus on upper extremity amputations so patients can be seen by a doctor, have their needs assessed by an occupational therapist, and be fitted for a wide range of the latest available prosthetics, streamlining their need to make multiple trips. Fellowship-trained upper extremity surgeons Mark Tait, M.D., and John W. Bracey, M.D., are part of the team, along with occupational therapist Angela Green and an upper extremity prosthetist who will fly in from out of state. Together, they will provide a level of upper extremity care unique in Arkansas. The clinic is for anyone with an upper limb amputation, including: multiple fingers, partial hand, full hand, below the elbow, above the elbow and into the shoulder. The amputation could be recent or several years or decades in the past. The occupational therapist will assess the patient’s needs and provide referrals for any necessary follow-up therapy close to the patient’s hometown. The prosthetist will provide information on a range of options that might be best suited for the patient’s goals. These include myoelectric-controlled prostheses, which allow the wearer to control the prosthetic device by using muscle contractions in the residual arm, and body-powered prostheses, which function by using movements elsewhere in the body to allow the patient to extend the arm or grasp an object, for example.

Kindred Healthcare, Mercy Fort Smith Announce Plans for Inpatient Rehabilitation Hospital FORT SMITH - Rehabilitation services in the Fort Smith region are about to get a major upgrade. Kindred Healthcare, LLC and Mercy announced that they have signed a definitive agreement and created a joint venture to construct and operate a 40bed inpatient rehabilitation hospital. Groundbreaking is expected in the fall, subject to regulatory and other approvals, with construction expected to take 12 to 13 months. A location is being determined for the facility projected to be 49,000 square feet and cost $23 million. Kindred will manage day-to-day operations of Mercy Rehabilitation Hospital Fort Smith. The new hospital will care for adults recovering from conditions such as stroke, neurological disease, injury to the brain or spinal cord and other debilitating illnesses or injuries. Kindred and Mercy are also partners for rehab hospitals in Oklahoma City, St. Louis and Springfield, Missouri. Currently, Mercy operates an inpatient rehab facility within Mercy Hospital Fort Smith. Mercy also offers a full complement of outpatient rehab services.

OFFICE FOR CIVIL RIGHTS OFFERS CLARIFICATION OF DIRECT LIABILITY FOR BUSINESS ASSOCIATES UNDER HIPAA On May 24, 2019, the Department of Health and Human Services (HHS)’s Office for Civil Rights (OCR) issued clarification on all instances through which a business associate can be held directly liable for compliance with certain requirements of the HIPAA Privacy, Security, Breach Notification, and Enforcement Rules (“HIPAA Rules”). The HIPAA Privacy Rule and Business Associates A business associate is a person or organization, other than a member of a covered entity’s workforce that performs certain functions or activities on behalf of, or provides certain services to, a covered entity that involves the use or disclosure of protected health information (PHI). Business associate services to a covered entity are limited to legal, actuarial, accounting, consulting, data aggregation, manageThe Authors: ment, administrative, accreditation, or financial services. However, persons or organizations are not considered business associates if their functions or services do not involve the use or disclosure of protected health information, and where any access to protected health information by such persons would be incidental, if at all. When a covered entity engages with a business associate, the Privacy Rule requires that the covered entity include certain protections for the information in a business associate agreement. In the business associate agreement, a covered entity must impose specified written safeguards on the individually identifiable health information used or disclosed by its business associates.

Lynda M. Johnson, Partner

Direct Business Associate Liability Under HIPAA Rules Congress enacted the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, making business associates of covered entities directly liable for compliance with certain requirements of the HIPAA Rules. As directed in HITECH, OCR issued a final rule in 2013 to modify the HIPAA Rules to add provisions that apply directly to business associates. This new factsheet is a clarification of these provisions. As set forth in the HITECH Act and OCR’s 2013 Final Rule, OCR has authority to take enforcement action against business associates only for those requirements and prohibitions of the HIPAA Rules as set forth below.

Timothy C. Ezell, Partner

1. Failure to provide the Secretary with records and compliance reports; cooperate with complaint investigations and compliance reviews; and permit access by the Secretary to information, including PHI, pertinent to determining compliance. 2. Taking any retaliatory action against any individual or other person for filing a HIPAA complaint, participating in an investigation or other enforcement process, or opposing an act or practice that is unlawful under the HIPAA Rules.

Amie K. Alexander, Associate

3. Failure to comply with the requirements of the Security Rule. 4. Failure to provide breach notification to a covered entity or another business associate. 5. Impermissible uses and disclosures of PHI. 6. Failure to disclose a copy of electronic PHI to either the covered entity, the individual, or the individual’s designee (whichever is specified in the business associate agreement) to satisfy a covered entity’s obligations regarding the form and format, and the time and manner of access under HIPAA Rules. 7. Failure to make reasonable efforts to limit PHI to the minimum necessary to accomplish the intended purpose of the use, disclosure, or request. 8. Failure, in certain circumstances, to provide an accounting of disclosures. 9. Failure to enter into business associate agreements with subcontractors that create or receive PHI on their behalf, and failure to comply with the implementation specifications for such agreements. 10. Failure to take reasonable steps to address a material breach or violation of the subcontractor’s business associate agreement. Enforcement actions against business associates by OCR has been on the rise. Since direct liability for business associates was established and extended in the 2013 Final Rule, there was little clarity as to whether OCR would pursue actions against the business associate, covered entity, or both for violations, and if so, the types of violations OCR would enforce against business associates. This guidance from OCR serves as an important tool to business associates to avoid potential liability under the HIPAA Rules by complying with and documenting the requirements outlined above.

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