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September/October December 2017 2009 >> $5 ON ROUNDS Child Psychiatrist Molly M. Gathright Finds Calling Combining Teaching with Clinical Work Gathright Guided Work at UAMS Psychiatric Institute Child Diagnostic Unit It takes a village of healthcare professionals to help take care of a child with profound behavioral or mental health problems, says Molly M. Gathright, MD, a child psychiatrist who Molly Gathright is assistant dean of graduate medical education and an associate professor of psychiatry at the University of Arkansas for Medical Sciences (UAMS) ... 3

Addressing Adolescent Angst in a Digital World

Thousands of Women are Living Longer Through Advances in Oncology

New drugs, hormone blocking agents cutting cancer reoccurrence by 50 percent By BECKY GILLETTE

Two thirds of breast cancers in women are hormone fed. Giving women with this type of breast cancer hormoneblocking agents such as aromatase inhibitors can significantly improve their odds of living ten more years without the cancer reoccurring, said Issam Makhoul, MD, a professor of medicine and director of the Division of Medical Oncology in the Department of Internal Medicine at the University of Arkansas for Medical Sciences (UAMS). “Female hormones feed the fire,” Makhoul said. “You have to cut them off. Hormone blocking agents can cut the risk of reoccurrence by 50 percent. There are some side effects, which can vary. In many cases, side effects are more an inconvenience than complications that are functionally affecting the patients. Some patients get hot flashes, aches and pains, but that is a minority. Side effects are usually transient and patients are advised to continue their treatment.” (CONTINUED ON PAGE 4)

The Truman Show, a satirical 1998 film, followed the everyday life of fictional character Truman Burbank as he grew up in front of millions as the unwitting and unsuspecting Jess. P. Shatkin ‘star’ of a television program ... 5


Trisha Montague Overseeing Launch of Arkansas Children’s Northwest Recruiting 280 employees for $427.7-million facility opening in January

See the Grand Rounds section beginning on page 8 for healthcare spot news from around the Natural State.


SPRINGDALE – Trisha Montague, MSN, RN, NEA-BC, senior vice president and chief administrator for Arkansas Children’s Northwest, has spent her entire 30-year career working in pediatrics. Now she is taking on her biggest job yet, overseeing the construction, staffing and operations for the new $427.7 Arkansas Children’s Northwest scheduled to open in January. “It is an exciting and unique opportunity,” said Montague, who moved from San Antonio, Texas,

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Child Psychiatrist Molly M. Gathright ARKANSAS Finds Calling Combining Teaching SPINE & PAIN (ASAP) with Clinical Work

is Central Arkansas’ leading program for the management, treatment and rehabilitation of spine and sports-related injuries and for pain relief.

Gathright Guided Work at UAMS Psychiatric Institute Child Diagnostic Unit By BECKY GILLETTE

It takes a village of healthcare professionals to help take care of a child with profound behavioral or mental health problems, says Molly M. Gathright, MD, a child psychiatrist who is assistant dean of graduate medical education and an associate professor of psychiatry at the University of Arkansas for Medical Sciences (UAMS). Gathright was recruited to join the faculty of the UAMS Department of Psychiatry to launch an innovative startup of a child psychiatry inpatient unit within the Psychiatric Research Institute (PRI) to address the rising concern within Arkansas regarding the number of children with severe emotional and behavioral disorders. “There were children who were diagnostically puzzling, incurring repeated acute psychiatric hospitalizations and residential treatment, failing outpatient levels of care, and being treated with significant poly-pharmacy,” Gathright said. The job fit Gathright perfectly since she loves working in teams. She headed the team used to establish the Child Diagnostic Unit (CDU) in 2008 to serve children ages 2 to 12. The results have been a measurable success in outcomes for children. “I was fortunate to be integral to the development of the clinical guidelines and administrative protocols that now drive the mission of the CDU to provide child and family-centered care that is collaborative, humane, and trauma sensitive,” said Gathright. “The approach at the CDU utilizes an inter-professional team to produce a comprehensive individualized treatment plan. More specifically, objectives of hospitalization are to clarify psychiatric diagnoses in diagnostically challenging and puzzling children, and create a comprehensive bio-psychosocial formulation, including developmental factors that contribute to presenting psychiatric symptoms of the child and family. Another goal is establishing a rational medication regimen by reducing poly-pharmacy.” Children stay 28 days for comprehensive assessment used to develop an individually-tailored treatment plan that allows them to be integrated into the arkansasmedicalnews


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Spinal Cord Stimulator Fluoroscopy and Ultrasound Guided Injection Therapies Radio Frequency Targeted Vertebral Augmentation | Balloon Kyphoplasty Radio Frequency Nerve Ablation Stellate Ganglion Nerve Blocks Tenex Health TX Minimally Invasive Chronic Tendinitis Treatment Vertebroplasty | Lumbar Radiofrequency | Neurotomy community. A key goal is to address the “revolving door” of repeated psychiatric hospitalizations. “It’s really challenging when you have tried a lot of things and they seem to be making no difference,” Gathright said. “It is important then to step back and see what pieces of an assessment might be missing. Does this child have hearing impairment? Speech and language problems? Motor skills difficulties? What is the family struggling with? We need to hit the pause button, and look up and consider the other assessment pieces.” Part of process was to conduct a medication washout. Children would come in on three to eight medications. They would be slowly tapered off medications to get a baseline view and allow a very well-reasoned approach to using medicines. “Medicines work and there is a place for that,” Gathright said. “The literature supports that. But being thoughtful about how medications were being used and targeted was important. On average, children would leave on one or two medicines. We probably cut the quantity of medicines by half.” A unique inter-professional post-dis(CONTINUED ON PAGE 4)

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Thousands of Women are Living Longer, continued from page 1 If someone can’t tolerate cer. The probability of survival aromatase inhibitors, they can and cure in early stage cancer be prescribed a different class of this type has jumped up to 80 of drugs like tamoxifen, which to 90 percent of women who do also results in saving the lives chemotherapy and antibodies. of many women. “We start with chemo and “Tamoxifen cuts the monoclonal antibodies, then risk of reoccurrence in half,” stop the chemo and continue Makhoul said. “For 100,000 with monoclonal antibodies for women with breast cancer a year,” Makhoul said. “With who have a 40 percent chance stage IV or metastatic breast of reoccurrence, that would cancer of the HER2 positive mean 40,000 cases of breast type, many get complete recancer reduced to only 20,000 mission with no cancer visible cases. That is something subon any scans available. I think stantial when we look at large Gwendolyn Bryant-Smith, MD, director of breast imaging at UAMS, shown above many are cured, but we connumbers of patients. We have reading a mammogram, said multiple research studies have shown that digital breast tinue treatment because we about 240,000 breast can- tomosynthesis (3D mammograms) has been shown to increase the detection of invasive don’t know in case we stop the cers per year in our country. cancer by 41 percent. treatment if the cancer would Considering the fact that two reemerge. The treatment is causing breast swelling, redness and somethirds of those are hormone driven, that well tolerated.” times pain. Chemotherapy before surgery is 158,000 women who will have their risk The most recent development in makes the tumors smaller and makes it of cancer coming back cut in half. We are the treatment of stage IV metastatic hormore possible for surgeons to remove all the changing the natural history of the disease mone driven breast cancer is a new class cancer without leaving anything behind. by providing our patients with these drugs of drugs called cyclin dependent kinase Cutting out less also preserves the breast, and convincing them to take them.” 4/6 (CDK4/6) inhibitors. When added to so you do not have to do a mastectomy.” Getting patients to take the drugs can hormone blocking agents they are likely to Approximately 25 percent of all breast be a challenge. Makhoul said at the time double the time of disease control. cancers carry on the surface of cancer cells the drugs are prescribed, the patients feel There is also great hope for immunoa special protein called Human Epidermal normal and when they start taking the therapy, but Makhoul said that this new Receptor 2 (HER2) that can be targeted drugs they may start having new and anclass of drugs is still in clinical trials and with a new class of drugs such as the mononoying symptoms such as aches and pains nothing is yet ready for prime time. Imclonal antibody trastuzumab (Herceptin®). and\or mood swings, or vaginal dryness. munotherapy in melanoma and lung canMakhoul said that targeting HER2 resulted So they may abandon them. cer has become a part of standard of care. in significant improvement in cure rates This is the wrong move. “However, we do not know yet which whether patients have early stage or ad“It is far better for women to talk to subset of breast cancer patients would vanced stage or even metastatic breast cantheir doctor and find ways to treat the benefit more from this treatment,” he said. side effects, and continue the treatment because that is their life saver, basically,” Check out this article online at for these he said. additional resources: Another advance in chemotherapy is that oncologists are doing neoadjuvant UAMS 3-D Mammograms chemotherapy before surgery. “There are many reasons to do that,” Benefit of 3-D Mammograms Last Over Time Makhoul said. “Sometimes the tumors are Study Results Published in JAMA Conclude that 3D MAMMOGRAPHY™ Exams large, have invaded the chest wall or skin, Outperform Conventional Mammography for Women with Both Dense and have involved a large number of lymph Nondense Breasts nodes, or the patient has inflammatory breast cancer that presents like mastitis

Child Psychiatrist Molly M. Gathright, continued from page 3 charge clinical management program was developed to follow the child for 90 days. “This post discharge management assists in integrating the inter-professional treatment plan with key collaborators, providers and support that exist within a child’s returning community,” Gathright said. Prior to coming to the CDU, 80 percent of the children had some form of inpatient treatment in the previous 90 days—and sometimes more than one. Ninety days post discharge, 80 percent of the children were not being re-admitted to the hospital. “That is really quite great,” Gathright said. “A lot kids are in a revolving door, and keep being re-admitted to the hospital. Reducing that is a good outcome.” Gathright grew up in Searcy, and became interested in medicine at age 7 when her father developed multiple sclerosis. She also had an early interest in teaching. One thing she likes about her current job is she can be both a physician and a 4



teacher. “In that, I have found what I call my life work,” Gathright said. “I am clinician first, but I get to teach not just students, but children and their families.” Gathright became assistant dean of graduate medical education a year and a half ago. UAMS has about 60 different residency and fellowship programs on campus, and about 650 residents. “It was the next step for me to serve the greater good,” said Gathright, who earned a degree in chemistry from Harding University before graduating from UAMS. “I do a lot of administrative work making sure the institution has accreditation standards. We also focus on being innovative in striving for excellence in our programs. I particularly enjoy mentoring the next generation of physicians and junior faculty members in the state.” Even with that many specialties, there are gaps in areas such as pediatric gastroenterology, child psychiatry, neurology,

and infectious diseases. And most specialists in those shortage areas are concentrated in Central Arkansas with a smaller concentration in Northwest Arkansas. “That makes it really difficult for families who don’t live in those areas,” Gathright said. In her spare time, Gathright likes to run. She has run a couple of marathons and half marathons. “I enjoy that,” she said. “I also enjoy cooking and spending times outdoors. My husband, Dr. Ken Gathright, a radiologist, and I like to travel.” Check out this article online at for these additional resources: University of Arkansas for Medical Sciences Psychiatric Research Institute Child Diagnostic Unit

Progress has also been made in access in Arkansas to the gold standard in breast cancer detection, digital Breast tomosynthesis or 3-D mammography. UAMS has had digital breast tomosynthesis since 2014. “Digital breast tomosynthesis (DBT) in multiple research studies has been shown to increase the detection of invasive cancer by 41 percent,” said Gwendolyn Bryant-Smith, MD, director of breast imaging at UAMS. “The really good part about DBT is an overall improvement in finding more invasive breast cancers which are the cancers that are associated with more morbidity and mortality.” Multiple studies have shown 3-D mammograms reduce by 15 percent the number of patients who have to be called back because the first mammogram was inconclusive. “Dense tissue is white and cancer is white,” Bryant-Smith said. “For patients with dense breast tissue, the worry is that the dense tissue might be covering up a cancer. DBT can be very helpful in finding cancer in dense tissue.” An analogy might be a photographer trying to take a picture of a door and having a tree in front of the door. A direct photo shows little detail of the door because the tree is obscuring portions of the door. But if the photographer moves to either side of the tree, more detail of the door can be seen. “DBT helps us see through overlapping structures so we don’t have to call patients back for extra pictures as often,” Bryant-Smith said. “There are cost savings from not having to take extra views.” DBT has the potential to change the entire pathway of breast cancer detection in that it requires fewer callbacks and less confusion about whether it is breast tissue versus a real lesion. “It is really an improvement and we should encourage women to be screened,” Bryant-Smith said. “When breast cancer is found early, there may be less need for aggressive treatment.” More and more sites in Arkansas are getting DBT, although it is not yet available everywhere in the state. Bryant-Smith testified in the Arkansas Senate for legislation which requires all providers in the state to pay for DBT. “That is a significant improvement because that was not the case before Aug. 1 of this year,” she said. “Now this lifesaving test is made more available to the public because it can be covered by insurance companies. Multiple studies have shown it to be a major improvement in breast cancer screening.” Many women in Arkansas fail to get screenings. “Overall, our morbidity and mortality is higher as a result,” she said. “A lot of patients are still not being screened and are coming in with late stage disease. We really push mammography, but still have a lot of work to do and improvements to make in this state. We encourage all healthcare providers to make sure their patients are getting screening mammograms. It does save lives.”



Addressing Adolescent Angst in a Digital World Jess. P. Shatkin, MD, MPH, a member expert of the American Academy of The Truman Show, a satirical 1998 film, Child and Adolescent Psychiatry, noted followed the everyday life of fictional chargrowing up in a digital age is very differacter Truman Burbank as he grew up in ent than what parents and providers exfront of millions as the unwitting and unperienced in their own adolescent years. suspecting ‘star’ of a televiWhether because of more sion program. stressors, improved diagWhen the film denostics or a combination buted, reality television of both, adolescent depreswas still in its infancy. sion and anxiety are on the While there had been a few rise. shows over the years de“Most of our studies picting clips of police stings suggest that about 15-17 or funny videos, Jersey Shore percent of kids will have and Keeping Up with the Karhad a major depressive epdashians were still several isode by the time they hit years away, and Facebook, 18,” said Shatkin, profesTwitter and Instagram sor of Child & Adolescent were unknown commodiPsychiatry and Pediatrics ties. at New York University Today’s teens have Dr. Jess Shatkin, NYU professor and vice chair of Educagrown up as conscious ac- of Child & Adolescent Psychiatry tion for the NYU Child Pediatrics and author of the tors in their own reality and Study Center. upcoming book ‘Born to be Wild.’ shows with carefully culti“Almost a third – 32 vated selfies and no detail percent – of adolescents too small to share and like. Yet, the unrebetween 14 and 18 will meet DSM (Dilenting access comes with its own pitfalls agnostic and Statistical Manual of Mental where cyberbullying can quickly escalate, Disorders) criteria for an anxiety disorand it’s all too easy to believe everyone der,” he continued. “Depression is high, else’s life is picture perfect. but it looks like anxiety is higher … and By CINDY SANDERS

both are troubling.” Shatkin said depression and anxiety have increased with each successive generation since behavioral health professionals began monitoring such statistics at the end of World War II. While he was quick to say data on the effects of social media is still emerging, he noted the larger the audience to witness mistakes and failures, the worse kids are going to feel about those missteps. “We know now that the brain’s pain sensors not only respond to physical pain but also to emotional pain,” he explained.

Teens as Risk-Takers

Shatkin said teens taking risk is part of the natural evolutionary order. For millions of years, he noted, the young utilized their strength, energy, speed and fearlessness to hunt and stay up all night to protect the village from wild animals and other dangers. “Our brains and our bodies evolve much more slowly than our society is moving,” he said of those ingrained risk-taking behaviors necessary for surviving in the wild but not required in today’s modern world. Additionally, Shatkin said societal changes are now happening much more rapidly. “Kids have the opportunity to be

exposed to a lot more than they ever have before,” he pointed out. Shatkin – author of the forthcoming book “Born to Be Wild: Why Teens Take Risks, and How We Can Help Keep Them Safe,” which comes out in early October – explained the adolescent paradox is that despite great strength, teens are also incredibly vulnerable. That hardwired risk-taking coupled with frontal lobes that are still developing can lead to unsafe behaviors that have real-world consequences without the maturity to fully discern the range of outcomes. For example, he continued, “We need to teach our kids media literacy.” Shatkin pointed out how many commercials, television programs and videos sell sex or glorify risky behaviors. “Companies have a right to do it, but we should teach our kids to be savvy,” he stated. “Technology is here to stay,” Shatkin continued. “We’ve given our kids this great opportunity, but it’s like putting kids in a swimming pool with sharks. We have to learn to limit it.”

Early Intervention

Although it’s never too late to talk to teenage patients about safe behaviors, introducing guardians to evidence-based (CONTINUED ON PAGE 6)

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Trisha Montague Overseeing Launch, continued from page 1 to take the job with Arkansas Children’s in 2015. “I have had experience both adding on to significant projects, as well as a complete tear down and rebuild of a children’s hospital on the campus of a vacant adult hospital in San Antonio. This was my last job before moving to Arkansas and was still going on when I left in 2015.” Montague worked for Arkansas Children’s Hospital from 1997 to 2001, so she was familiar with the organization, the mission and the passion for the hospital shown not just by employees and patients, but the people of Arkansas. “The people of this state have always been proud to call Arkansas Children’s their own. When Arkansas Children’s Northwest opens in January, this state will have not one but two children’s hospitals,” Montague said. “That’s unique in a state this size. Thanks to the generous support of this community, Arkansas Children’s Northwest will be able to improve the health of children by bringing pediatric specialist care close to home for the second most populated area in the state.” While being brand new with all the latest technology is a plus, so is being a part of the tradition and culture of the 106-year-old Arkansas Children’s. “We have the gift of standing on the shoulders of the Arkansas Children’s reputation and legacy,” Montague said. “The community is so engaged. This is one of the things that has struck me over and over. The level of engagement, knowledge and support is something I have never seen before. Everyone has a story to tell about someone they know who has been helped by Arkansas Children’s. In addition, people are giving us amazing gifts. We are still in the middle of an active fund-raising campaign, but the generosity has been amazing thus far.” One of the biggest parts of her job currently is recruiting staff. She said it is easiest to recruit someone who is already familiar with the area and its many amenities. With those who live outside the region, she finds if she can get them here to show them how sophisticated and cosmopolitan it is while offering a wealth of outdoor recreational opportunities, the conversation moves to another level. The hospital is working to bring such pediatric subspecialists to the area as emergency, cardiology, ear, nose and

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throat, anesthesiology and hematology/ oncology. These subspecialties are underrepresented in Northwest Arkansas, and will enhance the depth of pediatric care available in Northwest Arkansas. The new hospital also has built-in telemedicine abilities in order to access expert care in an instant. “It is great to start with the ability to do telehealth if needed,” she said. “Technology exists now where a telemedicine specialist can use a stethoscope to do an exam of a child.” Integrated electronic health records will be available on an iPad, which will also allow parents or children to order their dinner, watch a movie or play a game. And within the hospital on the inpatient floor there will be a “family house” with space for a living room, media center, dining area and kitchen. “Children’s hospitals are designed to meet the needs of the entire family, not just the patient,” she said. “This type of amenity allows the entire family to share a meal together when they would like.” The hospital will have 24 in-patient beds, a 30-bed emergency department, an outpatient clinic with 30 exam rooms, and operating room suites with the latest technology. Arkansas Children’s Northwest has been actively recruiting staff and physicians since September 2016. “It is a huge challenge,” Montague said. “We’re in a community that has less than a 3 percent unemployment rate. We have recruited quite a few people and have quite a few more to recruit. Our whole team does a weekly huddle just on

physician recruitment. We need nurses, physical therapists, surgical technicians and child life specialists.” Montague has been interested in nursing since she was a little girl. When she went through the pediatric rotation in nursing school, it was clear pediatrics was where she wanted to be. Her first job was at the Colorado Children’s Hospital in Denver, Colo., one of largest in country. It was at that hospital that she had the opportunity to go into nursing administration, “The great thing about becoming a nursing leader is that you are able to indirectly and directly impact a lot more patients,” she said. “Once I began to understand that, I was hooked.” Two things drive her management style: servant leadership and transformational leadership. “A good leader doesn’t treat everyone the same,” Montague said. “You need to understand what inspires the individual and adapt your style to what works for them. My leadership style is all about creating an environment for people to be the best they can be. I really believe in teamwork, and that by providing an environment of trust, empowerment and knowledge, you can create something

greater than what you actually are.” When Montague started out in her career, nurses rarely were tapped to lead big hospitals and health systems. She has found it rewarding to see the holistic training and organizational skills of nurses being recognized today resulting in nurses being tapped for top administrative jobs. “In my career, I’m starting to see nurses come into their own,” she said. “I feel nothing but privileged to be part of it. I love what I do.” Having benefitted from the assistance of major mentors along the way, she finds it rewarding to get calls for advice from people in different areas of the country where she has worked. “I have tried hard to be the kind of person people trust and ask for advice,” she said. “We took a leap of faith moving up here,” she said. “But we have been nothing but pleasantly surprised. There is a lot to do.” Arkansas Children’s Northwest is being built on 37 acres of land donated by Robin and Gary George, Cathy and David Evans and their families. The campus is located on I-49 between Don Tyson Parkway and Highway 412, across from Arvest Ballpark.

For more information, go online to: Arkansas Children’s Northwest Expansion, Arkansas Children’s Northwest-Job Openings,

Addressing Adolescent Angst, continued from page 5 parenting strategies while children are still young has proven to be most effective. “We know that certain types of parenting work better than others,” pointed out Shatkin. He added providers play a critical role in presenting and reinforcing these concepts. Clinical and developmental psychologist Diana Baumrind outlined three basic types of parenting – authoritarian, authoritative and overly permissive. Shatkin said evidence over time has shown authoritative parenting … the midpoint between overly strict and no rules … produces the best results not only in young children but as those kids grow into teens and begin spending more time with friends. Shatkin said authoritative parents are supportive but also set strong limits. They are warm and affectionate but not overly permissive, use effective communication tools, and try to ‘catch’ their children being good. “Fewer than one in five of our parenting commands should be negative,” Shatkin said. “If there’s one thing we know about kids, and people in general, it’s that we’re motivated by reward … and never is that more true than during our teen and early adult years because of high levels of dopamine,” he explained. While rewards for meeting or exceed-

ing behavior standards are most effective, Shatkin said that doesn’t mean privileges can’t be taken away when needed. The ubiquitous phone offers both carrot and stick. First, he said parents should be very clear when presenting a child with a phone what the expectations and limitations are. “The phone is a reward so you set it up as a reward,” Shatkin said of advice to share with parents. He added it should be clearly communicated that having a phone is a privilege that the adolescent must continue to earn, or it can be taken away for a period of time. However, he continued, it’s most effective if the period is relatively brief and if children have a way to earn back the privilege. Shatkin said if a phone or other privilege is taken away for more than a day, kids forget the ‘why’ of the punishment and just think parents are just being mean, which diminishes the impact of the lesson. “Use these as teasers to get them to the zone where you want them to be,” he said of taking away privileges.

Warning Signals

Pediatricians and other primary care providers are often a first line of defense for young patients feeling anxious or experiencing depression. Shatkin encouraged providers to reach out routinely to

parents and patients to see if there are any red flags that should be addressed. Warning signals include a persistent change in mood, crying or tearfulness, changes in sleep patterns or complaints of not being able to sleep, hanging out with a new group of friends not known to parents, no longer engaging in activities or with people they used to enjoy, expressions of anxiousness, physical changes like weight loss/gain or appearing ‘spaced out,’ and slipping grades. “If a parent is concerned … if a pediatrician feels out of their depth … then absolutely get a consultation with someone trained in child and adolescent psychiatry,” said Shatkin. He praised the movement toward colocation with primary care and behavioral health providers under one roof. However, he also said the increasing need to address emotional and behavioral issues has been coupled with a shortage of child psychiatrists. “From a mental health perspective, there’s a huge workforce issue,” Shatkin noted. He advocated for providing physicians, nurses and therapists with a better grounding in diagnosis and treatment of mental health issues. “The earlier we intervene, the better kids do,” said Shatkin. “We need to catch more in the primary care office.”



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St. Bernards Announces New Physicians JONESBORO – St. Bernards has added new physicians to its medical staff. Dr. Mallory Hurst is seeing patients at the new St. Bernards Dermatology clinic, 800 South Church St., Suite 203. She earned her Medical Degree from Dr. Mallory Hurst the University of Arkansas for Medical Sciences and completed a dermatology residency at the University of Alabama at Birmingham. Prior to that, she completed an internal medicine internship at Louisiana State University in New Orleans. Dr. Hurst is accepting patients of all ages and treating every variety of dermatologic conditions. Her special interests include pediatric dermatology, pigmentary disorders, cutaneous manifestations of systemic disease and skin cancer prevention. Dr. Naveed Younis has joined physicians at St. Bernards Heart & Vascular as an invasive cardiologist. Younis earned his medical degree from Rawalpindi Medical College in Rawalpindi, Pakistan. He came to the Dr. Navveed Younis United States to pursue advanced medical training and completed a residency in internal medicine and pediatrics at the University of Tennessee Health Sciences Center in Memphis and a fellowship in cardiovascular diseases at the University of Texas Health Sciences Center in San Antonio. Younis is board certified in internal medicine/cardiology, internal medicine and pediatrics. He is joining the region’s largest cardiovascular practice – St. Bernards Heart & Vascular. He is one of 19 physicians in that clinic and will see patients in Jonesboro and Wynne.

Tim Hill Named Chief Operating Officer for UAMS Health System LITTLE ROCK — Tim Hill, vice chancellor for Regional Campuses at the University of Arkansas for Medical Sciences (UAMS), has been named chief operating officer for the UAMS Health System. As COO, Hill will serve as a member of Tim Hill the clinical executive leadership team, reporting to Richard Turnage, M.D., senior vice chancellor for clinical programs and CEO of the Medical Center. Hill will continue as vice chancellor for Regional Campuses, re-

porting to the chancellor. Tim has more than 30 years of experience in health care finance and operational management. Before joining UAMS, Tim was president and chief executive officer of Arkansas Heart Hospital. From 1998 to 2009, Hill served as president and CEO of the North Arkansas Regional Medical Center in Harrison. He joined UAMS in 2011 as director of the UAMS Center for Rural Health. He served as director of the UAMS Center for Healthcare Enhancement and Development from 2013-2015. In 2015, he was appointed vice chancellor for Regional Programs (now Regional Campuses). In 1982, Hill earned his bachelor’s degree in business, finance and accounting from St. Cloud State University in St. Cloud, Minnesota. The Arkansas Hospital Association named him Administrator of the Year in 1996 while running Southwest Hospital in Little Rock, and he was named the A. Allen Weintraub recipient in 2009, the highest honor bestowed upon a health care executive.

CARTI Announces Adam Head as New President, CEO LITTLE ROCK - CARTI, the state’s largest not-for-profit multidisciplinary cancer care provider, has named Adam Head as president and chief executive officer (CEO) following a six month national search. With almost 20 years of leadership experience, Adam Head Head has served as the chief operating officer of the Arkansas Heart Hospital in Little Rock since 2013. Head began his career in healthcare in 2004 as a captain in the U.S. Army Medical Service Corps at Martin Army Hospital in Fort Benning, GA. He returned to Arkansas in 2008 as the assistant administrator of the Arkansas Heart Hospital. He also has served as the chief operating officer of HealthSouth Lakeshore Rehabilitation Hospital in Birmingham, AL and of Medical Assets Holding Co. in Little Rock. CARTI is a not-for-profit, multi-disciplinary cancer care provider offering medical and surgical oncology, diagnostic radiology and radiation oncology at locations throughout the state to provide convenient access for cancer patients. Chemotherapy is offered in Little Rock, North Little Rock, Benton, Clinton, Conway, El Dorado, Heber Springs, Russellville and Stuttgart. Radiation therapy is offered in Little Rock, North Little Rock, Conway, Mountain Home and Searcy. Medical News is pleased to provide space for press releases by providers in our Grand Rounds section. Content and accuracy of the releases is the sole responsibility of the issuer.



GrandRounds UAMS Names New Department Chairs LITTLE ROCK — The University of Arkansas for Medical Sciences (UAMS) has named two new Department Chairmen. Frederick “Rick” E. Barr, M.D., was named chair of the Department of Pediatrics and associate dean for child health in the UAMS College of Medicine, as well as pediatricianin-chief for Arkansas Children’s, effective Oct. 1. Barr succeeds Dr. Rick Barr Richard F. Jacobs, M.D., who retired June 30 after 35 years of service on the faculty at UAMS and Arkansas Children’s, including 11 years as chair of the Department of Pediatrics. Steve Schexnayder, M.D., professor and chief of the Critical Care Medicine Section, will continue serving as interim chair until Barr’s arrival. Barr called Jacobs a leader in the field and said he considers Jacobs a mentor. Barr, a pediatric critical care specialist, is currently the Suzan B. Thames endowed professor, chair of the Department of Pediatrics and senior associate dean for Graduate Medical Education at the University of Mississippi Medical Center in Jackson, Mississippi. He is also physician-in-chief at Children’s of Mississippi/Batson Children’s Hospital, where he has served since 2011. Barr is also principal investigator for the Mississippi Pediatric Clinical Trials Center, one of 17 sites in the IDeA States Pediatric Clinical Trials Network, the National Institutes of Health initiative being overseen by the Data Coordinating and Operations Center established through a $41.8 million grant to UAMS in September. Barr previously served on the faculty at Vanderbilt University from 1995 to 2010. He was chief of the Division of Pediatric Critical Care from 2007 to 2010. He also served as co-director of Vanderbilt University Master’s in Clinical Investigation Program, a component of Vanderbilt’s National Institutes of Health Clinical and Translational Science Award (CTSA). In 2010-2011 he was an endowed professor of Pediatric Critical Care and director of the Clinical and Translational Research Center, a CTSA-funded program at Cincinnati Children’s Hospital and the University of Cincinnati. Barr received his undergraduate degree in animal and veterinary science at West Virginia University in 1984 and his medical degree from the University of Virginia in 1988. He completed his residency in pediatrics at Vanderbilt. Barr continued his training with a clinical fellowship in pediatric critical care at the University of California San Francisco, where he was also a research fellow in arkansasmedicalnews


the Cardiovascular Research Institute. While on the faculty at Vanderbilt in 2002 he obtained a Master’s of Science in clinical investigation. Robert L. “Lee” Archer, M.D., was named chair of the Department of Neurology in the College of Medicine at (UAMS), effective Aug. 1. Archer, who has lead the department on an interim basis since July 2016, has served on the UAMS Dr. Lee Archer faculty for more than 30 years, providing world-class care for Arkansans with multiple sclerosis (MS), while teaching and mentoring many future neurologists. He has earned the admiration of his patients, students, residents and colleagues. Archer also will focus on strengthening ties with the basic science faculty at UAMS, particularly in bioinformatics, to fully take advantage of research, education and collaboration opportunities. He will advance the department’s research into amyotrophic lateral sclerosis (ALS) by filling two endowed chair positions in association with the Department of Pharmacology and Toxicology. He will continue to work closely with the UAMS Department of Neurosurgery to ensure patients receive seamless care from diagnosis to surgery to follow-up care. Archer, who is highly regarded in the MS patient community, will continue to spend about half of his time on patient care. He has trained and hired a second physician, Carolyn Mehaffey, M.D., to continue to serve MS patients in Arkansas and allow the UAMS MS clinic to accept new patients. Archer received his medical degree from the College of Medicine in 1982. He completed his residency at UAMS, joined the faculty in 1986 and has held the rank of professor since 2008. He founded UAMS’ Multiple Sclerosis Service in 1987 and co-directed the Muscular Dystrophy Association Clinic at UAMS from 1989 to 2003. Archer is president-elect of the Arkansas Medical Society. He is also active in the National Multiple Sclerosis Society and several civic organizations. He has served on the Board of Directors for the Arkansas Regional Organ Recovery Association (ARORA) since 2005 and chaired the organization in 2014-2016. Among many honors, Archer was invested in 2007 as the inaugural holder of the Major and Ruth Nodini Chair in Neurology, which was established with $1 million in donations to support his clinical care, research into MS and educational programs. One initiative partially funded by the endowment is the MS Fellowship developed and led by Archer, which graduated its first fellow — new faculty member Mehaffey — this past June. Graduating College of Medicine seniors have awarded Archer three Gold

Sash and numerous Red Sash awards for his teaching. He received the Distinguished Faculty Award from the College of Medicine Alumni Association in 2007. In 1999 he received the inaugural Humanism in Medicine Award for faculty in the college. He received the UAMS Helen May Compassionate Care Award in 2015 and was honored later that year as the Physician of the Year in the Arkansas Business Health Care Heroes ceremony. Among many “Best Doctors” recognitions he was voted in 2010 as the Best Neurologist in Arkansas and featured on the cover of the Arkansas Times. Archer has been married to his wife, Nancy, for 40 years.

Conway Regional, surgeon forming Center for Orthopaedics and Sports Medicine CONWAY - Tom Roberts, MD, has joined Conway Regional Health System as Medical Director of a new Sports Medcine Program as part of the formation of the Conway Regional Center for Orthopaedics and Sports Medicine. In his role and in partnership with other physicians on staff at Conway Regional, Dr. Roberts will help to oversee six full time athletic trainers across Faulkner County. Dr. Roberts will see patients in the center which is located in the Medical Tower of Conway Regional Medical Center. Dr. Roberts has practiced as an orthopaedic surgeon in Conway for more than 25 years and also teaches orthopaedic surgery at the University of Arkansas for Medical Sciences and at the Veterans Administration Medical Center. Dr. Roberts completed his orthopaedics residency and internship at UAMS followed by a fellowship at the LSU Knee and Sports Medicine Clinic. He also holds a medical degree from the LSU School of Medicine in Shreveport. Board certified in both orthopaedic surgery and sports medicine, he serves as team orthopedic surgeon for UCA, Hendrix College, and Central Baptist College, as well as various area high schools. Orthopaedic surgeons are trained in the care of musculoskeletal problems, Sports Medicine physicians are additionally trained in the non-musculoskeletal aspects of sports health. Common examples include: concussions, exercise-induced asthma, overtraining and fatigue, return to play issues after being sick or injured, nutrition, training and conditioning. Orthopaedists who specialize in sports medicine complete a fellowship focused on the comprehensive care of the athlete’s orthopedic, medical and nutritional needs. While they perform orthopaedic surgery, sports medicine physicians can also be found in training rooms and onsite at numerous athletic events. Dr. Roberts is married to the former Joanie Thiels and has two sons. They all currently reside in Conway.

Two Named to Executive Leadership Team at Washington Regional FAYETTEVILLE – Washington Regional Medical System is pleased to announce 2 new additions to it’s executive leadership team. Rob Bomstad has been named Senior Vice President of Outreach Services and Business Development. Bomstad’ s Rob Bomstad areas of responsibility will include Physician Enterprise, North Hills Surgery Center and Dialysis Centers of Northwest Arkansas, where he will remain as a member of the board of directors. A Dialysis CenMeredith Green ters administrator is expected to be hired and will report to him. Bomstad graduated from the University of Arkansas with both a Master of Health Science in healthcare administration and a Bachelor of Science in business administration. A registered nurse, he also earned an associate’s degree in nursing from North Iowa Area Community College. Bomstad has been with Washington Regional for 20 years. Meredith Green, MSN, APRN, AGCNS-BC, has assumed the role of Senior Vice President and Chief Nursing Officer. An executive search was initiated in June when Washington Regional’s Senior Vice President and Chief Nursing Officer Beverly Winney announced her intention to retire in October. Green has been with Washington Regional for more than 10 years, most recently as Administrative Director in Women and Infants Services. She played an integral role in the planning, design and staffing of the Women and Infants Center that opened in December 2016. An Advanced Practice Registered Nurse, Green earned both a master’s degree and a bachelor’s degree in nursing at the University of Arkansas and received credentialing as a Clinical Nurse Specialist in Adult and Geriatric Health. She has served in various leadership roles including clinical director and educator and was selected by her peers as Director of the Year in 2017 and 2016, and as Nurse of the Year in Women’s Services in 2009. She also received the ANGELS Award for Outstanding Service to Obstetrical Nursing from the University of Arkansas for Medical Sciences.

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GrandRounds Governor Signs “Emerging Therapies Act of 2017”

LITTLE ROCK - The Emerging Therapies Act of 2017, signed into law by Governor Asa Hutchinson, grants pilot access to state employees and teachers’ health plans to Regenerative Injection Therapies (RIT) as treatment of orthopedic conditions. “This could potentially save the state $100 Million using regenerative medicine (RM) as an alternative to surgery or pharmaceuticals,” said Morgan Pile, who worked with HB2014 sponsors to pass the law. In the amended bill, the Employee Benefits Division will conduct a pilot study for state employees and teachers’ health plans. At the end of 2018, the full study results will be reviewed with a goal of providing all insured Arkansans access to these therapies. Dr. David L. Harshfield, Jr., a pioneer in regenerative cellular therapy, believes that (RM) allows us to move away from the existing Allopathic medicine model. Instead, RM is leading the “correction of medicine” by focusing on safe, effective and less costly patient centered regenerative solutions. With the transition to a value-based healthcare model, RM will continue to grow. If we can fix our health care system, we will positively impact the health of Americans, and take pressure off our country’s struggling economy. RM can treat both acute and chronic problems and is safe and effective at a fraction of the cost of the existing “standard of care.” Until now, there have been no financial incentives for wellness care. The current iteration of RM is based on safe, effective procedures, in most cases eliminating pharmaceuticals and unnecessary surgical procedures. The State of Arkansas will now give patients a choice beyond drugs or surgery. With RM, physicians can help patients restore their health by utilizing the natural healing responses within the body. Dr. Harshfield, an Interventional Radiologist and Medical Director for the Arkansas Institute of Regenerative Medicine, has been exploring autologous adult stem cells since graduating from UAMS in 1981.

Immediately after signing of the bill into law in the Governor’s office at the Arkansas State Capitol, left to right, State Representative Joe Ferrer, Arkansas Governor Asa Hutchinson, Morgan Pile, and Dr. David Harshfield M.D. (Medical Director Arkansas Institute of Regenerative Medicine, Chairman International Cellular Medicine Society IRB and member AAOM Board of Directors).




CARTI Announces Gynecologic Oncology MultiDisciplinary Clinic LITTLE ROCK - Dr. Joseph Ivy will begin seeing patients twice a month as part of a new multI-disciplinary clinic for gynecologic oncology patients at the CARTI Cancer Center in Little Rock. A graduate of the Dr. Joseph Ivy University of Arkansas for Medical Sciences, Ivy performed his residency at Louisiana State University before completing a Galloway Fellowship at Memorial Sloane Kettering Cancer Center. After practicing for three years as a pelvic surgeon, Ivy went on to complete a gynecologic oncology fellowship at the University of Minnesota. Ivy is the founder of Ivy Women’s Cancer Care in Rogers, where he also practices with Highland Oncology Group. Appointments or referrals for Ivy’s twice monthly gynecologic oncology clinic at the CARTI Cancer Center in Little Rock can be made by calling 1-479878-5464

CHI St. Vincent Names New Chief Nursing Executive LITTLE ROCK -- CHI St. Vincent has named Nancy Brown as its chief nursing executive and as senior vice president

of patient care services for CHI St. Vincent hospitals in Little Rock, Sherwood and Morrilton. Brown will direct patient care operations for the first Nancy Brown hospital in Arkansas named as a Magnet hospital by the American Nurses Credentialing Center. As a Magnet hospital, CHI St. Vincent Infirmary in Little Rock is considered a leading hospital for nursing excellence and patient care. A native of Pine Bluff, Brown returns to Arkansas from Norman, Oklahoma, where she served as chief nursing officer at Norman Regional Health System. While in Oklahoma, Brown provided oversight for quality functions, helping the health care system demonstrate significant improvement in quality, safety and patient experience measures. She also was a key leader during the aftermath of a tornado that destroyed a hospital that was part of the Norman Regional Health System. Before working in Oklahoma, she was vice president of patient care services at Jefferson Regional Medical Center in Pine Bluff from 1995 to 2003 and was chief nursing officer at St. Edward Mercy Medical Center in Fort Smith. Brown has degrees from the University of Arkansas-Pine Bluff and the University of Arkansas for Medical Sciences.

Sparks Physicians Team Up With UA Fort Smith Athletics FORT SMITH – Primary care physicians, Salahuddin Kaddoura, M.D., and Thanh Le, M.D., have teamed up with the Sports Medicine Department at the University of Arkansas - Fort Smith to provide care to student athletes. This month the physicians conducted sports physicals for male and female student athletes participating in basketball, baseball, golf, tennis, volleyball, cross country, cheerleading and dance. The physicians will also be able to provide follow-up care to the students throughout the school year. Most organized sports leagues require a student, even as young as elementary school age, to have a preparticipation physical examination (PPE) prior to playing. And while many parents think it may be unnecessary for their healthy child, this physical can help ensure your child is not only in good shape to play, but also possibly detect any conditions that may be life threatening. Your family doctor and nurse practitioner can conduct PPEs in the office. The goal of the PPE is to assess a student’s general health and current fitness level. But often the physical can assess and detect health conditions that require immediate attention, such as: • Medical or orthopedic problems that predispose the student to injuries • Existing injuries that may impair the athlete’s ability to perform • Current size and developmental maturation, as well as fitness level • Congenital anomalies that increase the student’s risk of injury • Poor pre-participation conditioning that may put the child at increased risk Dr. Le practices medicine at Alma Family Medical Clinic, while Dr. Kaddoura sees patients at Sparks Plaza Family Practice in Fort Smith.

Diana McDaniel, FACMPE, Named Vice President of Operations, Arkansas Children’s Northwest LITTLE ROCK/SPRINGDALE - Arkansas Children’s has named Diana McDaniel, FACMPE, vice president of operations for Arkansas Children’s Northwest (ACNW). McDaniel most recently served as the executive director of Medical AdministraDiana McDaniel tion for Arkansas Children’s Hospital (ACH), overseeing physician workforce planning, contract administration and credentialing for more than 500 medical staff providers. McDaniel completed her undergraduate degree in international relations at the University of Arkansas in 2005 and went on to complete a Master of Public Administration at the University of Arkansas at Little Rock in 2007. She became a Fellow of the American College of Medical Practice Executives, Medical Group Management Association in 2012.

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Kathy’s elbow was shattered in an accident. We made sure her life wasn’t. Kathy was moving to a new home when she accidentally dropped a firearm that went off, shattering her elbow. She was airlifted to UAMS, where the orthopaedic team was waiting. Surgeons worked together to rebuild the bone and graft a nerve to restore movement to her arm. As the state’s only academic health sciences center, our orthopaedic doctors are among the nation’s best for diagnosis, treatment and rehabilitation of the most complex cases. Our expertise kept an unfortunate accident from changing Kathy’s life forever.

we here with advanced orthopaedic care Get Kathy’s full story at

Kathy | Oxford, AR

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Sept.-Oct. 2017 Arkansas Medical News  

Arkansas Medical News Sept.-Oct. 2017