MED-Midwest Medical Edition-April/May 2011 by MED- (Midwest Medical Edition)

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Contents Midwest Medical Edition

April / May 2011

Cover Feature

Regular Features 2 |

VP, Sales & Marketing /Editor’s Page

14 |

edicine & the Arts M Violinist Shirley Kunkel

27 |

30 |

32 |

Hometown Healthcare

Grape Expectations The Nose Knows By Heather Taylor Boysen

News & Notes News from around the region

Learning Opportunities Upcoming Symposiums, Conferences and CME Courses

4 |

Reduced Readmissions: “The Next Big Thing!” By Dave Hewett

5 |

New Chief at JAMA

13 |

Technology: MRI-safe pacemaker Healthpoint: DSU Program helps with rural EMR

By Alex Strauss

65 Years of Progressive Care

22 | Feature: Navigating the Spine at CNOS 28 |

Splinting at Work: Pt. 2 by Stan Kulzerx

In Review BIOGRAPHY

specialty training in pediatrics and the new field of medicine, medical genetics. For twenty-eight years, he was on staff at a clinic that supervised the medical care of a genetic disorder, hemophilia. This book is based upon his experiences. Now retired, he lives in Oregon.

The events in this story do not take place in the “ dark old days.” The setting is during the times of modern medicine in the 1980s and 1990s. Events in Brent’s life are set down as he would have described them if he had lived a few more years. Experiences related are real, although exact conversations, Brent’s intimate thoughts, and details of events may not be completely factual. Some of the names of places and living persons have been changed.

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After finishing medical school, Everett Winslow Lovrien, MD completed

Doctor Guilt?

Written by Everett Winslow Lovrien, M. D Through his treatment, Brent met other youths and men, not exactly like him, but who had the same medical disorder and required similar medical care. He met men and boys in the clinic where he was cared for—as well as at summer camp. Some of the events in their lives are also described in this story. He also met medical doctors, nurses, physical therapists, social workers, and a list of persons who served him in the clinic. Brent had a close family and loving relatives.

The medical condition Brent lived with, hemophilia, was treatable but not curable, and it required frequent infusions of medicine into his veins. Modern treatment with a revolutionary medicine brightened his life. But the medicine he received for treatment also led to his early death.

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Photo by Kristi Shanks

In This Issue

Yankton

Don’t let its size fools you. Yankton may have only 13,000 residents, but this South Dakota community is home to a dynamic and growing multi-specialty clinic that brings in patients from more than 65 miles away. The Yankton Medical Clinic’s past, present and future at the focus on this month’s MED Cover Feature.

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At six months of age, his parents were alarmed when they discovered bruises on his chest which led to the discovery of hemophilia. From that moment forward, he received frequent intravenous infusions of Concentrate to treat recurrent bleeding episodes. Infusions of the medicine relieved pain and suffering from bleeding. His life seemed normal. Unexpectedly, Brent’s life changed after the discovery of HIV contamination of the medicine. The medicine was manufactured from the plasma of paid blood donors. Unbeknownst to Brent, the plasma was polluted with HIV. The SIV in chimpanzees changed to become HIV in humans. But the chimpanzees were not the cause of the transfer of SIV in animals to HIV in humans. The change from SIV in animals to HIV in humans was the result of human activity. The change came about with the production of the hepatitis B vaccine.

Who was responsible for the pollution of the hemophilia medicine with HIV and hepatitis viruses? Was Brent’s death preventable?

page

From Us to You

Staying in Touch with MED

A letter from the VP

his issue marks the one-year anniversary of MED magazine and we want to extend a heartfelt thanks to those of you whose readership, contributions Steffanie Liston-Holtrop (far right) and advertising dollars have helped to make it at the Go Red event a success. MED, with all of its regional news, features and commentaries, comes to you free thanks to the support of our advertisers. When you let them know that you saw them in MED, that helps to keep this publication vibrant. It was great to see many of you at the American Heart Association’s annual ‘Go Red for Women’ Event in February. I was amazed by the show of support from the medical community. I am looking forward to spending some time West River at the SDMGMA conference April 18th-20th in Deadwood and hope those of you who are there will take the time to stop by our booth. (As an extra incentive, you could win wine from Good Spirits Fine Wine in Sioux Falls!) Does your organization have a conference or other event coming up that MED can help you promote? Or is your practice using new technology that you would like to share with your colleagues? MED is here to help serve your communication needs. Let me know how I can help. —Steffanie

A letter from the Editor

s a writer, I try to avoid overused phrases. But, when talking about the Yankton Medical Clinic, it is hard not to use the words ‘well kept secret’. Physicians who work in South Dakota’s largest communities may have little call to interact with this independent practice, which quietly continues to thrive. But, for those who live in and around the Yankton area, the Alex Strauss 65-year-old multi-specialty clinic is no secret at all. Yankton residents, as well as those much farther afield, have long depended on this group’s progressive and comprehensive approach to healthcare. This innovative clinic is the subject of this month’s MED cover feature. It was Hippocrates himself, one of the most outstanding figures in the history of medicine, who declared “Vita brevis, ars longa” – Life is short but art endures. At MED, we agree. This month, we continue our look at the artistic endeavors of medical professionals in our new Medicine & the Arts column. As with In Review and Then & Now, the success of Medicine & the Arts relies on your suggestions and contributions. Are you a surgeon with the soul of a poet? A dermatologist with a penchant for painting? Let us know how you access the artist in you and we may feature it in an upcoming to us! column. Drop me a brief email telling me about your art and let Don’t forget we me know how to get in touch. No writing required. As always, want to hear from you. I look forward to hearing from you. —Alex

Write

Publisher

MED Magazine, LLC Sioux Falls, South Dakota

Steffanie Liston-Holtrop Alex Strauss

VP Sales & Marketing Editor in Chief

Cover Design Darrel Fickbohm Design/Art Direction Corbo Design Web Design 5j Design

Contributing Editor Darrel Fickbohm

Contributing Writers Heather Boysen Dave Hewett Stan Kulzer Advisory Board John Berdahl, MD Mary Berg, MD Michelle L. Daffer, MD James M. Keegan, MD Timothy Metz, MD Patty Peters, MD Juliann Reiland-Smith, MD Luis A. Rojas, MD Daniel W. Todd, MD

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

2011 AD / Editorial Deadlines June Issue May 5th July/August Issue June 5th

Sept/Oct Issue August 5th

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

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

Written by Everett Winslow Lovrien, M. D

FDA-Approved for MRI Use The First and Only Pacing System to Break the Image Barrier Introducing the Revo MRITM Pacing System engineered with SureScan® Technology – the only pacing system to provide proven cardiac care that’s designed to be used safely with MRI.

www.medtronic.com The Revo MRI SureScan pacing system is MR Conditional designed to allow patients to undergo MRI under the specified conditions for use. A complete system, consisting of a Medtronic Revo MRI SureScan IPG implanted with two CapSureFix MRI® SureScan leads is required for use in the MRI environment.

The Revo MRI™ SureScan® pacing system is MR Conditional and as such is designed to allow patients to undergo MRI under the specified conditions for use. Indications The Revo MRI SureScan Model RVDR01 IPG is indicated for use as a system consisting of a Medtronic Revo MRI SureScan IPG implanted with two CapSureFix MRI® SureScan 5086MRI leads. A complete system is required for use in the MRI environment. The Revo MRI SureScan Model RVDR01 IPG is indicated for the following: • Rate adaptive pacing in patients who may benefit from increased pacing rates concurrent with increases in activity • Accepted patient conditions warranting chronic cardiac pacing include: – Symptomatic paroxysmal or permanent second- or third-degree AV block – Symptomatic bilateral bundle branch block – Symptomatic paroxysmal or transient sinus node dysfunctions with or without associated AV conduction disorders – Bradycardia-tachycardia syndrome to prevent symptomatic bradycardia or some forms of symptomatic tachyarrhythmias The device is also indicated for dual chamber and atrial tracking modes in patients who may benefit from maintenance of AV synchrony. Dual chamber modes are specifically indicated for treatment of conduction disorders that require restoration of both rate and AV synchrony, which include: • Various degrees of AV block to maintain the atrial contribution to cardiac output • VVI intolerance (for example, pacemaker syndrome) in the presence of persistent sinus rhythm

Antitachycardia pacing (ATP) is indicated for termination of atrial tachyarrhythmias in bradycardia patients with one or more of the above pacing indications. Atrial rhythm management features such as Atrial Rate Stabilization (ARS), Atrial Preference Pacing (APP), and Post Mode Switch Overdrive Pacing (PMOP) are indicated for the suppression of atrial tachyarrhythmias in bradycardia patients with atrial septal lead placement and one or more of the above pacing indications. The device has been designed for the MRI environment when used with the specified MR Conditions of Use. Contraindications The device is contraindicated for: • Implantation with unipolar pacing leads • Concomitant implantation with another bradycardia device • Concomitant implantation with an implantable cardioverter defibrillator There are no known contraindications for the use of pacing as a therapeutic modality to control heart rate. The patient’s age and medical condition, however, may dictate the particular pacing system, mode of operation, and implantation procedure used by the physician. • Rate responsive modes may be contraindicated in those patients who cannot tolerate pacing rates above the programmed Lower Rate • Dual chamber sequential pacing is contraindicated in patients with chronic or persistent supraventricular tachycardias, including atrial fibrillation or flutter • Single chamber atrial pacing is contraindicated in patients with an AV conduction disturbance • ATP therapy is contraindicated in patients with an accessory antegrade pathway

Warnings and Precautions Changes in a patient’s disease and/or medications may alter the efficacy of the device’s programmed parameters. Patients should avoid sources of magnetic and electromagnetic radiation to avoid possible underdetection, inappropriate sensing and/or therapy delivery, tissue damage, induction of an arrhythmia, device electrical reset, or device damage. Do not place transthoracic defibrillation paddles directly over the device. Use of the device should not change the application of established anticoagulation protocols. Do not scan the following patients: • Patients who do not have a complete Revo MRI SureScan pacing system, consisting of a SureScan device and two SureScan leads • Patients who have previously implanted devices, or broken or intermittent leads • Patients who have a lead impedance value of < 200 Ω or > 1,500 Ω • Patients with a Revo MRI SureScan pacing system implanted in sites other than the left and right pectoral region • Patients positioned such that the isocenter (center of MRI bore) is inferior to C1 vertebra and superior to the T12 vertebra See the device manuals before performing an MRI Scan for detailed information regarding the implant procedure, indications, MRI conditions of use, contraindications, warnings, precautions, and potential complications/adverse events. For further information, call Medtronic at 1 (800) 328-2518 and/or consult Medtronic’s website at www.medtronic.com. Caution: Federal law (USA) restricts this device to sale by or on the order of a physician.

www.medtronic.com World Headquarters Medtronic, Inc. 710 Medtronic Parkway Minneapolis, MN 55432-5604 USA Tel: (763) 514-4000 April / May 2011 Fax: (763) 514-4879

Medtronic USA, Inc. Toll-free: 1 (800) 328-2518 (24-hour technical support for physicians and medical professionals)

Patient Line: Tel: 1 (800) 551-5544 7:00 am to 6:00 pm CT M-F Fax: (763) 514-1855 24-hour information available MidwestMedicalEdition.com on www.medtronic.com

Brief Statement

Reduced Readmissions:

The Next Big Thing

By Dave Hewett, President/CEO, SDAHO

he first three months of 2011 have focused primarily on State Medicaid funding. And while the scars of that debate have yet to be fully appreciated, we need to ask the question “So, where do we go now?” For physicians, I would suggest that it is related to implementation of various aspects of federal health care reform. Doctors take an oath to “do no harm,” How can you extend and amplify that action in the face of reform in a different way? Due to declining reimbursement, physicians continue to work harder yet get paid less every year. So how can you work more efficiently and economically? Quality and transparency are the two places to start. These can be addressed through two simple words: reduced readmissions. According to the Dartmouth Atlas, South Dakota is a high quality, low cost state relative to the amount of Medicare spending per beneficiary. This correlates to where SD sits with readmissions as well. An April 2009 New England Journal of Medicine study found that nearly one in every five Medicare patients admitted to a hospital in a year is readmitted within 30 days of discharge. In 2007, the cost to Medicare of these readmissions alone was $18 billion. In order to reduce readmissions, partnerships and collaborative efforts must develop outside of the hospital and clinic setting. Stakeholders including nursing facilities and home health agencies with the common goal of reducing rehospitalizations should assemble to reduce readmissions. Secondly, the discharge process should be considered as more of 4

a “transitional process.” This concept also applies to the transition to a short term rehabilitation facility or long term care center. In addition, case management for those individuals who are at high risk for readmission will allow for better patient care, better outcomes, and lower costs. Physician payments will become more closely linked to value with the launch of a physician value-based payment system and implementation of a “value-modifier” rewarding physicians who deliver better care. This is estimated to reduce Medicare costs by more than $1.9 billion over the next 10 years. The Affordable Care Act includes a range of provisions to reduce waste, fraud and abuse, such as expanding Recovery Audit Contractors (RAC), requiring faceto-face encounters with physicians before reimbursing for certain services, such as home care, and requiring greater data matching capabilities. This is expected to save $5 billion over 10 years. Extending the program to reduce hospital-acquired infections would save $3.2 billion. South Dakota hospitals are working with SDAHO to reduce central line associated blood stream infections (CLABSI) through participation in the CUSP Program. The challenge to reduce readmissions is everyone’s job. Readmission rates are measurable and will impact reimbursement positively and negatively. A team approach that includes physicians, hospital administration and health care professionals, long term care, and home care will be necessary to ensure South Dakota remains the “low cost / high quality” state that we are so very proud of. ■

AMA Welcome Court Validation of ‘Red Flags’ Rule WASHINGTON-A federal appeals court issued a decision Friday that further validates the American Medical Association’s long-standing argument to the Federal Trade Commission (FTC) that physicians who bill after rendering services are not subject to the red flags rule as creditors. The United States Court of Appeals for the District of Columbia Circuit found the present regulations of the FTC invalid in light of the Red Flag Program Clarification Act of 2010, passed by Congress last December to shed much needed light on who is considered a creditor under the red flags rule. The court issued the judgment in a lawsuit filed by the American Bar Association challenging the application of the red flags rule to attorneys. According to the court’s opinion, “…the Clarification Act makes it plain that the granting of a right to ‘purchase property or services and defer payment therefore’ is no longer enough to make a person or firm subject to the FTC’s red flags rule – there must now be an explicit advancement of funds. In other words, the FTC’s assertion that the term ‘creditor,’ as used in the red flags rule and the FACT Act, includes ‘all entities that regularly permit deferred payments for goods or services,’ including professionals ‘such as lawyers or health care providers, who bill their clients after services are rendered,’…is no longer viable.” ■

Midwest Medical Edition

March 9, 2011

Pediatrics Professor Named

New Chief at JAMA CHICAGO – Howard C. Bauchner, M.D., from Boston University School of Medicine, will become the next JAMA Editor-in-Chief on July 1, 2011. Dr. Bauchner will be the 16th editor in the journal’s 127-year history. Dr. Bauchner is currently the editorin-chief of the Archives of Disease in Childhood, the official publication of the Royal College of Paediatrics and Child Health in the United Kingdom. He is the first U.S.-based editor of that journal and has held that position since 2003. He is a professor of pediatrics and community health sciences at Boston University Schools of Medicine (BUSM) and Public Health. He is also the vice chairman of the department of pediatrics and assistant dean, alumni affairs and continuing medical education at BUSM. He has

served on many editorial boards, including currently for the British Medical Journal and Journal Watch. Dr. Bauchner is also an accomplished researcher. He has published more than 125 papers in peer-reviewed journals. His research interests include health promotion, clinical trials and quality improvement. As Editor-in-Chief, Dr. Bauchner will have editorial oversight of JAMA and the nine Archives journals, the specialty medical journals published by the AMA. Dr. Bauchner was chosen after an international search conducted by a committee comprised of members of the Journal Oversight Committee, JAMA Editorial Board, the AMA’s Board of Trustees and senior management and with help from the executive search firm, Russell

Reynolds Associates. Dr. Bauchner is following Catherine D. DeAngelis, M.D., M.P.H., who is leaving the post after 11 years to return to Johns Hopkins School of Medicine in Baltimore. “I have tremendous respect for JAMA and the prestige and stature it has achieved under Dr. DeAngelis,” Dr. Bauchner said. “JAMA is among the elite medical journals in the world and I am excited and honored by the opportunity to be its new editor.” ■

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Hometown Healthcare

65 Years of Progressive Care in

Yankton By Alex Strauss

or 65 years, the residents of Yankton have

enjoyed the benefits of dynamic ‘hometown healthcare’. Formed by the merger of two separate clinics, the Medical Clinic and the Yankton Clinic, both of which were estab-

lished in 1946, the Yankton Medical Clinic, P.C. opened in its new incarnation in 1982 and has looked forward ever since. Physically, the clinic still stands on the same spot at the corner of Jackson and 8th Streets where it was established 29 years ago, but with continued growth and expansion of both building and staff, and the addition of new technology and services, this clinic can never be said to have stood still. “Yankton has a long tradition of having very progressive health care,” says board-certified dermatologist James Young, DO, FAOCD who joined the Yankton Medical Clinic 13 years ago. Not only did the clinic bring his and other specialties to town, but it also opened the first Ambulatory Surgical Center there in the late 1980’s. “It is important that we try to be very comprehensive, not only to serve patients in the Yankton area, but also because 25 percent of our patients come from more than 65 miles away,” explains Dr. Young, past President of the American Osteopathic College of Dermatology who now serves as president of the Yankton Medical Clinic Board. 6

History of Growth

he Yankton Medical Clinic took up 55,000 square feet when it opened in 1982. In 2006, the clinic increased its size by half, adding an additional 27,000 square feet. In addition to expanded office space to accommodate the growing staff of physicians and physician assistants, the expansion included two new operating suites for ambulatory surgery and a state-of-the-art infusion center. “It was the vision of our board many years ago to try to make this clinic as comprehensive as possible,” says Dr. Young. “It behooves an organization like ours to be very complete if we want to stay viable.” What began with just a handful of primary care physicians has grown into a regional practice of 39 primary care doctors and specialists and 5 physician assistants. These providers represent more than 16 areas of expertise, including primary care – family medicine, internal medicine, ob/gyn and pediatrics – and medical and surgical specialties. Comprehensive diagnostic imaging, including MRI and other ancillary services such as an onsite pharmacy owned and operated by the clinic have helped to make the Yankton Medical Clinic a ‘one stop shop’ for healthcare. By carefully controlling their debt and investing only in technology that they believe shows a clear benefit for patients, the Yankton Medical Clinic has continued to stand on its own – an increasingly rare situation for small-town clinics, especially in a challenging economy. “For a town of 13,000, this is quite unique,” says Daniel Megard, MD, a board-certified Internal Medicine physician who joined the clinic 19 years ago. Dr. Megard, who sits on the clinic’s Physician Recruitment and Retention Committee, says the clinic’s independent status makes it possible for providers to work seamlessly with all area clinics and hospitals when necessary.

The Medical Clinic

The Yankton Clinic April / May 2011

photos by Kristi Shanks

Outpatient surgery in one of YMCâ&#x20AC;&#x2122;s newly constructed surgical suites. The clinic was the first to open an Ambulatory Surgery Center in Yankton.

Yankton Med 8

Variety of Services

Dawn Larson, MD, FAAP, Board Certified Pediatrician Tavaya Griffth

Max Farver, MD, Board Certified in Internal Medicine, Specializing in Oncology/ Hematology-Patient Robert Novak

Daniel Megard, MD, Board Certified Internal Medicine Physician, Member of YMC’s Recruitment Committee-Patient James “Jim” Snow

he Yankton Medical Clinic offers the gamut of primary care and specialty services. Allergy sufferers can get evaluation, skin testing and allergy shots. Comprehensive Audiology services include audiologic testing, dizziness evaluation, hearing aid fitting and follow-up, and an OSHA hearing conservation program. Chemotherapy can be prepared and administered on site in the clinic’s new infusion center, which also offers hydration and administration of other IV medications. In addition to digital X-ray capabilities, the clinic’s diagnostic imaging services include a 16-slice CT scanner and a new Achieva 1.5T MRI, which can produce high resolution images in less than 30 minutes. State-of-the-art digital fluoroscopy provides exceptional image quality, particularly for exams of the stomach and colon. Digital Mammography, breast ultrasound, breast MRI and a digital stereotactic unit for breast biopsies are central features of the ACR-accredited Comprehensive Breast Care Center. “Women’s health is a very high priority for us,” says Dr. Young. “We have recently implemented a dedicated phone number (664-PINK) that women can use to quickly schedule mammograms.” Mammograms are read by the clinic’s board-certified radiologist. Ob/Gyn diagnostic services include state-of-theart 3D/4D ultrasound. The clinic has two hematologist/oncologists. Non-invasive testing of the heart,

arteries and veins, including contrast echocardiography with harmonics, are conducted in the Cardiovascular Lab. The stress echo lab is equipped with advanced technology and all vascular and cardiac sonographers are certified by the ARDMS. Over 500,000 lab tests are performed each year in the Yankton Medical Clinic laboratory. The clinic also supports area employers with Occupational Medicine services ranging from accident/injury treatment and pre-placement exams to drug and alcohol testing, CPR and first aid courses. The newly-constructed Ambulatory Surgery Center features fully-equipped operating rooms in which surgeons perform outpatient procedures such as ear tubes and tonsillectomies, colonoscopy and flexible sigmoidoscopy, hernia repair, breast, prostate and skin biopsies, laparoscopic cholecystectomy, appendectomy, vasectomy and a number of ob/ gyn procedures. In an effort to accommodate busy young families and working professionals, the clinic implemented ‘ConvenientCare’ in 1996. Designed to be an alternative to the emergency room for after-hours health concerns, ‘ConvenientCare’ provides care for acute, non-emergency ailments such as sore throats, earaches, sprains, strains and broken bones that can be treated without the higher costs associated or needed with ER visits. ConvenientCare is available on weekday evenings until 9 and on weekends from noon to 5 pm to walk-in patients.

dical Clinic 9

photo by Kristi Shanks

Photo courtesy YMC

Jeremy Kudera, MD, Board Eligible Orthopedic Surgeon and Jim Frerk, PA-C

Moving into the Future

s the clinic’s patient load continues to increase, plans are in the works to add seven new physicians to the existing team of 39 doctors. An Internal medicine specialist, an Ob/Gyn, a nephrologist, a cardiologist, a family medicine physician, and a rheumatologist will join the practice within the next two years. In addition, the group plans to implement the area’s first hospitalist program to serve patients at Avera Sacred Heart Hospital, beginning in early 2012. “We are having a real recruiting boom right now,” says Dr. Megard. “In the last five years we have recruited a variety of young doctors including

a radiologist and an orthopedic surgeon, neither of which we had. The rheumatologist, nephrologist and hospitalist who are coming also represent new specialty areas for us.”

“The progr am is a benefit not only to students, but also to us as physicians . . . It forces you to understand disease processes better. It keeps you on your toes.”

Dr. Megard credits the ‘recruiting boom’ to Yankton’s good schools, high quality of life, mix of new and established physicians (about two-thirds have been with the clinic ten years or more), and the clinic’s close involvement with the Sanford School of Medicine. The Yankton Medical Clinic helps train about a dozen 3rd year medical students each year through the 20-year-old Yankton Ambulatory Program, a program that allows students to sample multiple specialties at one time, instead of doing separate rotations. “The program is a benefit not only to students, but also to us as physicians,” says Dr. Megard, who, like many of the clinic colleagues, is also an Associate

Yankton Med 10

Dr. Young

YMC’s expansion included new patient care areas, more office space, and additional surgical suites

Clinical Professor with the Sanford School of Medicine. “When you are part of a teaching program, it forces you to understand disease processes better. It keeps you on your toes. And, by giving us the chance to observe and start getting to know these students early, we can begin early to start recruiting those that we think would be good additions to our practice.” Building on the Yankton model, the Vermillion Clinic, opened in 1982, is served by three primary care providers and two physician assistants and offers specialty services including dermatology, ob/gyn, ENT, pulmonology, urology and orthopedic surgery. In addition to Vermillion, Yankton Medical Clinic

physicians routinely offer outreach services to clinics in Tyndall, Wagner, Gregory, Freeman, and Parkston, South Dakota and in the rural Nebraska communities of O’Neill, Creighton, Norfolk, Osmond, Plainview and Santee. “Because of the nature of South Dakota, you have to offer the services when and where people need them,” explains Dr. Young. The clinic plans to continue to expand its outreach services as more physicians come on board. “It would not work for us to just be a behemoth and just sit here and make people come to us.” Dr. Young says the hope is that the clinic’s fiscal responsibility combined with a commitment to convenient, cost

Dr. Megard

effective care will help keep the Yankton Medical Clinic operating for another 65 years. “I am really hoping that my son, who just got accepted to medical school will consider coming here to practice,” says Dr. Young. “That is how excited I am about the future of the Yankton Medical Clinic.” “Medicine is likely to look a lot different ten years from now,” adds Dr. Megard. “But if we have a good business model, don’t overextend ourselves, and recruit good physicians, we are confident that we are going to be able to continue to serve the needs of patients in this region well into the future.” ■

dical Clinic 11

Avera clinic names are changing to reflect a growing emphasis on Avera Medical Group. For example, Avera Medical Group McGreevy 69th and Western.

Avera streamlines

Hospital and Clinic names Avera is streamlining the names of hospitals and clinics throughout the region in an effort to improve identification of Avera facilities and medical specialties. These changes began to take place on April 1. The name of Avera McKennan Hospital & University Health Center in Sioux Falls remains the same. However, names of Avera regional hospitals will change to Avera (Community Name) Hospital. For example, Avera Gregory Healthcare Center will change to Avera Gregory Hospital. Avera clinic names are changing to reflect a growing emphasis on Avera Medical Group, an association of Avera physicians and mid-level providers. Avera clinics will all take on the name “Avera Medical Group” followed by the specialty and/or location. For example, Avera Medical Group Internal Medicine Sioux Falls, or Avera Medical Group Gregory. Avera Medical Group has grown by nearly 200 percent since its inception

three years ago, and is now 545 members strong. Avera Medical Group now has 130 locations in more than 50 communities throughout a five-state region. Changes are also taking place on Avera McKennan’s main campus in Sioux Falls to simplify building names, and also to reflect a South Cliff Avenue address. This, along with new signage, is aimed at helping visitors find their way around easier. Campus building names and addresses are as follows:

conventions will enable our patients and communities to have a clearer picture of our offerings and our wide variety of specialties,” says Michelle Lavallee, senior vice president for Strategic Marketing and Communication at Avera McKennan. “This change is also designed to help our physicians and patients feel connected to the entire Avera system”. ■

Avera McKennan Hospital & University Health Center Plaza 1 (formerly Avera Doctor’s Plaza 1) 1417 S. Cliff Ave. Plaza 2 (formerly Avera Doctor’s Plaza 2) 1301 S. Cliff Ave. Plaza 3 (former Avera Cancer Institute) 1315 S. Cliff Ave. “In our evolution as a regional health care provider, this change is a more uniform approach to our identity across the entire system. New naming

Avera will change names of its community hospitals to Avera (Community Name) Hospital. For example, Avera Gregory Healthcare Center will change to Avera Gregory Hospital

Midwest Medical Edition

MRI Safe Pacemaker Now Available at Sanford Heart Hospital in Sioux Falls Sanford Heart Hospital is now offering a new pacemaker option for patients who may also need magnetic resonance imaging (MRI). The Revo MRI™ SureScan® pacing system is the first MR-Conditional pacing system designed, tested and FDA approved for use in the MRI environment. Prior to the Revo MRI SureScan pacing system, MRI procedures for patients with implanted pacemakers were not recommended because these patients might face serious complications, such as interference with pacemaker operation, damage to system components, lead or pacemaker dislodgement or change in pacing capture threshold. “The device offers flexibility for the patients who may need MRI scans for their care in the future and it’s safe,” said Scott Pham, MD, Cardiac Electrophysiologist with Sanford Heart Hospital. Sanford Heart Hospital recently became the first in South Dakota, North Dakota, Iowa and Nebraska to implant the new MRI-safe pacemaker. MRI is often a preferred imaging modality because it provides a level of detail and clarity not offered by other imaging modalities. “It is federally approved, and I suspect we’ll be using the device more often for the right patient,” added Pham. “For those patients who clearly don’t need an MRI or are not likely to, we’ll still be using the more conventional pacemakers.”

April / May 2011

Scott Pham, MD

The Revo MRI SureScan pacing system was designed to address safety concerns around MRI procedures for patients who have implanted pacemakers. MRI scanners may cause traditional pacemakers to misinterpret MRI-generated electrical noise and withhold pacing therapy or deliver unnecessary pacing therapy. When programmed prior to an MRI scan,

the Revo MRI pacing system is designed to be used safely in the MRI environment. “Medical imaging and electronic implantable devices such as pacemakers are important technological advances, particularly for older people,” said Dr. Pham. “We encourage our patients to talk to their doctor about which pacing system is right for them.” ■

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Medicine

&Arts

Life is short but art endures — Hippocrates

Dr. Shirley Kunkel,

&Violinist

retired OBGYN MED: Tell us a little about your history with the violin

Dr. Kunkel: I started violin when I was eleven, and I continued until I was a sophomore in high school. I played in a little college orchestra when I was in pre med, as well as the Purdue Symphony orchestra. While I was in practice, I played very minimally—once a year with the Augustana or community orchestra just to keep my hand in. I’d play once or twice a year on piano. Then when I was a resident in Rochester I didn’t play at all. It was just too busy as a doctor. And that’s how life was for me. It was an eighty-hour work week and I had kids. Now, I’m “Interview and photo by Darrel Fickbohm high-energy, but I had to sleep sometime. I just always thought that there would be a time in my life when I’d get back to it. We’ve always had a piano in the house, but I’ve always liked the violin better. When I had in-house call (24 hours), I’d actually take the violin into the clinic with me, sometimes, and play. I wouldn’t do that at home because I had the kids at home so there was just no quiet time. MED: When you restarted the violin, how long did it take to get your chops up. Dr. Kunkel: First I thought, “I’m way too old for this.” I was a wreck. I was really nervous for the symphony audition. It all came back much slower than I thought it would, but twenty-five years is a long time for a talent to rest. Luckily, I was retired by that time so I finally had some time to practice. I think my field of OBGYN is also a field of art, more so than science. There’s a lot of human contact and more than one way to skin a cat—more than one way to solve a problem. It’s creative. Now, when I’m in surgery, I’m not exactly weaving designs, but otherwise there’s a lot of creation going on. I think they are both the same kind of discipline. To be able to excel in music or in medicine you have to be dedicated and willing to put in the time. They go together. ■ 14

‘Big Grape’ Wine Tasting

Benefit set for April 14 The Big Grape Reserve, a premier wine and food tasting event to benefit pediatric patients and their families, will take place 6:30-9:30 p.m. Thursday, April 14 at the Museum of Visual Materials in Sioux Falls. This event is designed as an elite wine and food tasting experience, which also raises awareness and funds in support of pediatric patients’ needs. Live music and a silent auction are also part of the event. Proceeds and donations benefit children and their families at Avera Children’s Hospital & Clinics through equipment acquisition, staff education, training, and charitable health care. Among programs supported through Big Grape funds are pediatric social workers, Child Life Specialists, the Avera Children’s Champion program. Avera Children’s is a “hospital within a hospital” comprised of 114 beds devoted to the care of infants, children and adolescents in Avera Children’s Level III Neonatal Intensive Care Unit (NICU), newborn nursery, Pediatric Unit, and Pediatric Intensive Care Unit (PICU), as well as the child and adolescent units at the Avera Behavioral Health Center. Along with the Avera McKennan Foundation, presenting sponsors of the event are JJ’s Wine, Spirits & Cigars; Cadillac of Sioux Falls; and Republic National Distributing Company. For more information call (605) 3228900 or visit www.TheBigGrape.org. ■

Midwest Medical Edition

Local Physicians take Center Stage at annual

Doctors in Concert fundraiser

Dr. Wilson Asfora

photos by Reistroffer Design

By Darrel Fickbohm

The Crabgrass Crew Dr. Ron Rossing

he stage was set on Saturday March 12th, as the Washington Pavilion in Sioux Falls hosted the 8th annual Doctors in Concert benefit event for Children’s Care Hospital & School. The concert and silent auction were jointly sponsored by Avera and Sanford. An estimated 800 people attended the event, which raised nearly $30,000. Children’s Care President and CEO Dianna Rajski said of the evening, “It’s really fun for people to see their doctors in this totally different role—on stage performing musically. We’re lucky these busy professionals agree to do this for our kids.” Jack Billion, MD, retired orthopedic surgeon and CCHS board member, was the evening’s emcee. His easy-going manner with the audience and performers set a comfortable mood in the Great Hall for a musical program that featured a walk through a range of styles and instruments. First on the program was a piano trio by Joseph Hayden performed by Marian Petrasko, MD, Chris Carlisle, MD and Carlisle’s son, Gabriel. The piece was given a fresh sound by Dr. Petrasko’s assertive piano style. Singer Ronald Rossing, MD, then performed selections ranging from Frank Sinatra standards to gospel. Later, the stage brought sounds of the flute and harp duo of Dennis Knutson, MD, and Erin Holland. Dr. Knutson’s flute trilled out some Celtic sounds in an especially beautiful trio of songs. The classical guitar of neurosurgeon Wilson Asfora, MD, was next with several pieces that seemed to hang in the rich acoustics of the Great Hall. One selection, Childhood Memories, was especially touching during an evening that would benefit the children of CCHS. Although the evening’s proceeds support CCHS, this year’s event was also dedicated to Scott Schoppert of Schoppert Piano Gallery (formerly Schmitt Music) of Sioux Falls, who contacted April / May 2011

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Children’s Care in 2003 with the idea for this event. Schoppert is seriously ill with cancer. The night ended with a a rollicking survey of American popular and country music that featured the Crab Grass Crew, a collection of string players that included doctors Lisa LaFollette, MD, Tom Weisbecker, DDS, and Richard Barnette, OD. ■

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A new associate agreement between RiverView Health and Sanford Health will give Riverview patients access to an integrated, state-of-the-art Electronic Medical Record (EMR) system. RiverView Health is an independent, community-owned health care organization headquartered in Crookston, Minnesota. RiverView consists of a 25-bed critical access hospital, a 70-bed long-term care facility, a 52-bed chemical dependency treatment center, home care, laboratory services, rehabilitation, community outreach, and a number of primary and specialty care clinics. They system has entered into the associate agreement with Sanford in February. The EMR system will allow nurses, doctors and other medical professionals to seamlessly collect, store, and access a patientâ&#x20AC;&#x2122;s medical information in the safest way possible. Patients will

Midwest Medical Edition

Avera McKennan Assumes Ownership of Avera Flandreau Medical Center Avera Flandreau Medical Center is now an owned facility of Avera McKennan Hospital & University Health Center in Sioux Falls. The change in ownership, effective March 1, results from an agreement reached between Avera McKennan and the City of Flandreau. The city gifted the hospital buildings and property to Avera McKennan in exchange for Avera’s agreement to expand and renovate the facility. Avera McKennan has had a healthcare presence in Flandreau for 18 years. The hospital came under McKennan management in 1993, and became an Avera McKennan leased facility in 1999. “We have appreciated Flandreau’s partnership with us in innovative projects like Avera eICU® CARE, eConsult, eEmergency, ePharmacy, Electronic Medical Records, and more,” said Dr. David Kapaska, CEO and regional president of Avera McKennan. “Avera Flandreau is known for making progressive decisions to ensure that local health care remains strong, so area residents have access to high quality care right in their home community.” ■

also be given the opportunity to utilize a secure Internet based portal to schedule appointments, access lab test results, and communicate with their care team. “As an organization, Sanford Health takes an integrated approach to health care. Working with other health systems to share the same electronic medical records is a catalyst for providing that integrated care,” said Dennis Hofer, vice president for Sanford Health Information Technology. Sanford Health has several levels of relationships with area hospitals. These relationships range from associate, managed, leased and owned status. An associate agreement with Sanford Health allows RiverView Health access to the EMR system, which is expected to be installed by the fall of 2012. ■

April / May 2011

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New Study Validates Efforts of Dakota State University Health IT Initiative

A study completed by the Office of the National Coordinator for Health Information Technology (ONC) and published in the journal Health Affairs finds growing evidence of the benefits of health information technology (HIT). The new study finds that 92 percent of articles on HIT reached conclusions that showed overall positive effects of HIT on key aspects of care including quality and efficiency of health care. In addition, the study also finds increasing evidence of benefits for all health care providers, not just the larger health IT “leader” organizations (i.e. early adopters of HIT). HealthPOINT, part of Dakota State University which works with the ONC as South Dakota’s Regional Extension Center, launched their Member Services

last summer to all state healthcare providers with a special focus on the rural and independent providers. HealthPOINT Member Services offers students, consumers, and healthcare professionals an opportunity to engage in a South Dakota health IT community through its specialized content, including online webinars and regional workshops. Through a network of Health IT Professionals in every corner of the state, HealthPOINT assists healthcare providers in rural South Dakota communities with vendor selection, change management, workflow optimization, and project management. “What this study demonstrates is at the very core of our mission,” said Kevin Boyum, Operations Manager for HealthPOINT. “Electronic Health

Record (EHR) adoption is vital to improving healthcare in all settings, both large and small.” “This article brings us much more up-to-date, both in our confidence regarding the overwhelming evidence of the benefits of adoption and use of HIT, and also in our understanding of problem areas that still need to be addressed,” said David Blumenthal, M.D., the national coordinator for HIT and one of the authors of the review. “This review is important because it helps us correct for the lag in evidence that occurs naturally in the dynamic HIT field, where changes in technology and accelerating adoption cause the old literature to become quickly outdated.” The review reflected a new balance of evidence between HIT “leader”

South Dakota Medical Group Management Association Spring Conference

Improving the Odds for

Success

April 18-20, 2011

The Lodge | Deadwood, South Dakota

Featuring: Frank Cohen

Principal and Senior Analyst, The Frank Cohen Group, LLC

Elizabeth Woodcock

Principal, Woodcock & Associates

David A. Westergaard Executive Vice President/CFO, Riddle’s Group Inc.

Barry Carlson

President, Carlson & Associates

For the full schedule or to register, visit our website at

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Midwest Medical Edition

organizations and other entities, especially smaller medical practices. In previous years, much evidence has come from the “leaders.” The current review shows increased evidence of benefits for others as well. Under the Health Information Technology for Economic and Clinical Health Act (HITECH), part of the American Recovery and Reinvestment Act of 2009, as much as $27 billion Medicare and Medicaid incentive payments will be available to eligible professionals, eligible hospitals, and critical access hospitals when they adopt certified EHR technology and successfully demonstrate “meaningful use” of the technology in ways that improve quality, safety, and effectiveness of patient-centered care. Positive results highlighted in the article include: One study found that at three New York City dialysis centers, patient mortality decreased by as much as 48 percent while nurse staffing decreased by 25 percent in the three years following implementation of EHRs. In an inpatient study, a clinical decision support tool designed to decrease unnecessary red blood cell transfusions reduced both transfusions and costs, with no increase in patient length-of-stay or mortality. Another study addressing HIT in 41 Texas hospitals found that hospitals with more advanced HIT had fewer complications, lower mortality and lower costs than hospitals with less advanced HIT. The nation’s 62 Regional Extension Centers (REC)s have enrolled over 50,000 providers nationwide. HealthPOINT continues to assist providers with the adoption and meaningful use of EHRs. To date, HealthPOINT has enrolled over 40% of the state’s primary care providers for their services, putting them above the national average. If you are a provider considering an EHR adoption or would like more information, please visit http://www.healthpoint.dsu.edu. ■ April / May 2011

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Make-A-Wish Foundation® of South Dakota www.southdakota.wish.org 800-640-9198

Spotlight on Nonprofit American Cancer Society

Now Taking Applications for Research Grants Focusing on Cancer Health Disparities

The American Cancer Society is inviting researchers in South Dakota to apply for grant funding for community based research projects focused on reducing cancer health disparities. Funding is available up to $100,000 for two years of study.

Make-A-Wish Spreads

Hope,

Strength and Joy

in South Dakota A letter from President & CEO Paul Krueger Experiencing a wish firsthand is the best way to understand our mission. I saw it in the huge smile and eyes of 6-year-old Karley from Yankton when her mom pushed her wheelchair up the new ramp into the family’s refurbished van for the first time. I saw at it on the faces of her parents who don’t have to lift her growing body out of her wheelchair each time they want to travel somewhere as a family. I saw it on the faces of her grandparents and family members who came to celebrate with her that day. And I saw it in the faces and tears of those who helped make the wish possible as sponsors. Hope, strength and joy – it’s what we offer to children facing life-threatening medical conditions. It is what we do best. We rely on you, the medical community, to refer children to us. We want to make sure every eligible child, like Karley, receives a wish. For more information, visit www.southdakota. wish.org or call 800.640.9198 statewide or 605.335.8000.

To be eligible, research must: ■ be done with suitable experts (those within colleges, universities, public health and professional schools, scientific and professional organizations, government agencies, community hospitals, or cancer centers) ■ be done with nonprofit or government organizations outside of the American Cancer Society (health and social service organizations, faith-based organizations, voluntary associations, civic and citizen groups, or federally-recognized Indian tribal governments, tribes, or tribal organizations) The American Cancer Society currently funds two research projects in South Dakota. A $50,000 grant was awarded to Delf Schmidt Grimminger, MD at the Avera Research Institute in cooperation with the University of South Dakota Sanford School of Medicine to increase awareness and prevention of cervical cancer among the Northern Plains American Indians. A second grant of $50,000 was awarded to Nancy Fahrenwald, PhD, at South Dakota State University to determine factors that influence rural women’s decision-making in breast cancer treatment in order to generate a decision support intervention. For more information on applying for grants, visit the American Cancer Society online at www.cancer.org. ■ Midwest Medical Edition

Prevention. Diagnosis. Treatment.

Whether your patient is a child with spinal deformities or fractures, a competitive/recreational athlete with a sports injury or active adults exhibiting signs of chronic musculoskeletal disease, the physicians at Sanford Orthopedics & Sports Medicine take a multidisciplinary approach to surgery, research and clinical consultations. • Total Joint Replacement • Anterior Approach Total Hip Replacement Surgery • Sports Medicine • Upper Extremity • Lower Extremity • Pediatric Orthopedics • Foot care Get stronger. Play smarter. Return to performance.

Visit Sanford Orthopedics & Sports Medicine Walk-in Clinic, Monday-Friday 8:00 a.m.- 4:30 p.m. For an appointment at Sanford Orthopedics & Sports Medicine call (605) 328-2663.

100-11395-1276 1/11

photo by Kristi Shanks

By Alex Strauss Detailed 3D images are produced by combining preoperative CT scans with interoperative x-rays.

Navigating the Spine New technology helps spine doctors improve fusion surgery

ust as ‘all roads lead to Rome’, many of the body’s most complex neuromuscular or skeletal problems can be traced directly to the spine. Nerve pathways converge here, in the center of the body, and the column of 2 dozen delicate vertebral bones provides the vital support structure for the entire skeletal system. “The spine is the area of the body that really brings us all together,” says Neurosurgeon Quentin Durward, MD, of CNOS in Dakota Dunes, where a team of nearly 30 neurologists, neurosurgeons and orthopedic surgeons as well as a rheumatologist and therapists, take a team approach to spine cases. Dr. Durward explains, “There are bones, joints and nerves in the spine. When patients come in with conditions that affect the spine, such as pain, deformity, numbness, weakness or sciatica, our different areas of expertise mean that these 22

conditions can be handled from many different directions at once, all in the same building. I don’t know of any other clinic that manages such cases the way we do.”

S p ina l E x p e r t ise : D i f f e r en t Pat h s When approaching spinal cases, CNOS neurologists, including William Andrews, MD, John Grudem, MD, Mei He, MD, James Case, MD Luis Pary, MD and Jennifer Pary, MD use a variety of state-of-the-art diagnostic tools to pinpoint common problems such as disc herniation and nerve impingement. If non-surgical intervention cannot provide relief, the clinic’s five board-certified neurosurgeons, including Dr. Durward, Ralph Reeder, Jr., MD, Grant Shumaker, MD, Thorir Ragnarsson, MD and Matthew Johnson, MD, look for ways to surgically remove the structures that may be putting Midwest Medical Edition

photo by Kristi Shanks

photo by Kristi Shanks CNOS spine surgeons will use the new stereotactic navigation technology to assist them in the precise placement of fixation devices during spine fusion.

pressure on spinal nerves and causing pain. Three of CNOS’ 13 orthopedic surgeons – Steven Meyer, MD, Wade Jensen, MD and Michael Espiritu, MD – also have spinal expertise and focus on surgical methods for relieving joint pain. Not only are these physicians available to consult with each other, but neurosurgeons and orthopedic surgeons – who rarely work together in other markets – may even perform the most complex spinal procedures, such as deformities or extensive nerve compression, in tandem to ensure optimal patient outcomes.

S p ina l F u sion One of the most common procedures designed to relieve spinal pain while increasing the spine’s strength and stability is spinal fusion. Spinal fusion may be indicated for a variety of conditions Studies have shown that it is often an effective option for spondylolisthesis, in which a fracture occurs in a vertebrae causing it to slip forward over the bone below. Fusion of the unstable vertebrae to a stable one holds the bone in place and prevents it from putting pressure on spinal nerves. Fusion may also be considered for curvature of the spine (scoliosis) and certain kinds of degenerative disc disease. A typical spinal fusion procedure involves placement of bone graft material between adjacent vertebrae. Often surgical implants, such as screws or plates, are used to hold the vertebrae April / May 2011

Orthopaedic spine surgeon, Dr. Wade Jensen discusses a spinal fusion case with Physician Assistant Batzi Mutize, PA-C.

stable and the bone graft in place until the bones naturally fuse. The result is a less flexible but stronger and less painful spine. Although fusion can be highly effective at stabilizing and relieving pain, the procedure is complex and requires a thorough knowledge of the delicate structure of the spine. “It is extremely important to position the screws so that they are completely within the bone and don’t impinge won the nerves in any way,” explains Dr. Durward. Experience and an understanding of spinal anatomy, as well as well-designed surgical screws, are crucial for patient safety. Surgeons may also use a combination of CT images, x-rays, and intraoperative neuromonitoring techniques to aid them in precise placement.

N av i g at in g t h e S p ine Now, in addition to these tools, CNOS surgeons are also utilizing an advanced new imaging system to make spinal fusion more accurate and safe. Stereotactic navigation combines preoperative CT scans with intraoperative x-rays to provide even more detailed, 3D guiding images. “With the stereotactic navigation system, we have one more way to make sure that we have been accurate with the placement of screws during fusion surgery,” explains Dr. Durward. “We are able to ascertain that everything we have done during surgery is going to be effective and safe.” MidwestMedicalEdition.com

Functioning similar to a car’s GPS system, the stereotactic navigation system gives surgeons a detailed, 3 dimensional view inside the spine in real time. The image can even be adjusted during surgery, to provide a constant flow of information that allows for continuous refining of the treatment. The ability to place surgical screws more precisely means that not only is successful fusion more likely, but also that complications can be minimized. In a study of the technology conducted at the Cleveland Clinic and published in Neurosurgical Focus, the authors observed, “Although conventional intraoperative imaging techniques such as fluoroscopy have proven useful, they provide only two-dimensional imaging of a complex 3D structure. Consequently, the surgeon is required to extrapolate thethird dimension based on an interpretation of the images and knowledge of the pertinent anatomy. . . Image-guided spinal navigation minimizes much of the guess work associated with complex spinal surgery.” Although the stereotactic navigation technology is currently being used primarily to assist with fusion surgeries at CNOS, it may eventually have applications for certain types of minimally invasive spine procedures. These procedures, as well as new techniques such as the lateral surgical approach to the spine now being offered at CNOS, continue to secure the clinic’s place as a regional leader in spine treatment. ■ 23

Lead-Deadwood Regional Hospital CEO Receives National American Hospital Association

Award

DEADWOOD, SD – Sherry Bea Smith, Chief Executive Officer at Lead-Deadwood Regional Hospital, was recently named the American Hospital Association’s South Dakota 2010 Grassroots Champion. The Grassroots Champion award singles out one hospital leader from each state who, over the previous year, effectively delivered the hospital message to elected officials; helped broaden the base of community support for hospitals; and advocated tirelessly on behalf of patients, hospitals, and the community served by those hospitals. “Sherry Bea Smith is a highly respected and trusted employee of Regional Health,” said Tim Sughrue, CEO of Regional Health Network and COO of Regional Health. “She is richly deserving of this award and recognition as she is totally dedicated to advancing health care and improving the common good.” Smith will be honored at the sixth annual “Breakfast of Grassroots Champions” April 12 in Washington, D.C. “I’m honored and invigorated to continue my involvement in health policy, since it has significant impact on all that we serve,” said Smith. ■ 24

Rapid City Doctor Named SDAFP

Doctor of the Year

RAPID CITY, SD – Kurt Stone, M.D., Medical Director at Rapid City Regional Hospital (RCRH) Family Medicine Residency Clinic was recently named the South Dakota Academy of Family Physicians (SDAFP) 2011 Family Doctor of the Year. Stone has been practicing in the Rapid City area since 1993 working as a flight surgeon and Chief of Hospital Services at Ellsworth Air Force Base, Medical Director of Community Health Center and Medical Director of the RCRH Family Medicine Residency Clinic, a position he has held since 1995. He is valued by many family medicine residents, staff, faculty, and patients as a teacher, physician, mentor, clinic director, community servant, and friend. Stone is also active in clinical research and is currently serving as the principal investigator of several studies. The SDAFP’s mission is to improve the health of patients, families and communities by serving the needs of members with professionalism and creativity. ■

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Grape Expectations

The Nose Knows By Heather Taylor Boysen

s human beings we rely on our hearing, sight, smell, taste and touch to experience our own existence. While all of us place our own importance on each of these senses, I firmly believe that for me smell and taste are two senses that when indulging in my passion for wine I would be bereft without. Wine is sensual, playful and sometimes mysterious. If I couldn’t smell it or taste it my world would just seem a little less bright. Studies have shown that when you taste wine it is really 70-80% smell and contrary to popular belief, smells are not registered in the nose, but at olfactory receptors located behind the nose and between the eyes and brain. Our palate or tongue can only perceive 5 basic tastes: sweet, salty, sour, bitter and umami, a Japanese word for the savory character in food and drink. And if any of you can identify umami, I suggest a sommelier course is in your future. In order to smell your wine it is important to first release its aroma. Simply swirling the wine your glass will intensify a wine’s odor because it causes some of the alcohol in the wine to evaporate. As it evaporates it brings with it

the particular scents that were trapped in the wine. If you are not a “swirler” then you may want to practice a little before you attempt this in public. The easiest way to swirl is to leave your glass on the table and gently rotate the base of the wine glass in small circles to create a tornado effect in the glass. This will also concentrate the aromas of the wine in the center of the glass. After a few seconds of swirling immediately put your nose in the glass and take several short, aggressive sniffs. Don’t be shy – putting your nose two inches above the glass will not work! I like to close my eyes when I sniff. It is my way of concentrating fully on what it is in the glass and the smells that are galloping up my nose. I also might quietly hum so as to block out the environment around me just a little. And, yes, I have had people give me funny looks while I’m tasting wine. Maybe that’s why I close my eyes? Don’t over think it at this point. What is the first smell that comes to mind? I actually tasted a Zinfandel the other night and my first thought was Double Bubble Bubble Gum. I’m not kidding and after I mentioned it to other tasters they concurred. This was not the smell I was looking for in that particular wine and it ruined the tasting experience for me. I wanted an exuberant Zinfandel with flavors of raspberries, black pepper and baking spices. I want vanilla in my Chardonnay and lemon grass in my Sauvignon Blanc. I am a fan of fresh

MidwestMedicalEdition.com

turned dirt in my Pinot Noir and green apples in my Pinot Gris. I do not want green peppers in my Chilean Cabernets! Usually after another swirl and several deep whiffs, I let a small amount of the wine hit my lips and tongue. I like to slurp a little and let wine and air enter my mouth at the same time. This does take practice, but it allows even more olfactory participation and pleasure. Make sure you taste at least twice before making a decision about the wine. The first sip is only to prepare your palate, the second sip is to savor and enjoy. The third sip will give you even more information and hopefully open your senses to a full throttle enjoyment of what is in your glass. You will not be disappointed unless you get bubble gum when you were least expecting it! ■

Splinting At Work part 2 In the January/February issue of MED, Stan Kulzer addressed some of the challenges related to splinting for relief of work-related hand and wrist conditions. He explores the issue further in this second part of that article.

By Stan Kulzer, OTR/L, CEES

he intention of a work splint is to provide rest to the muscles and tendons around the wrist and to prevent further motion that may worsen symptoms. It sounds pretty simple.

What Really Happens Three things may happen while wearing a wrist splint at work: The splint provides support and reminds the individual to avoid awkward wrist posturing. They get better. The employee continues to use the same awkward wrist postures while working and actually bends the wrist against the resistance of the splint. They may get worse. The splint succeeds in preventing the unwanted wrist motion but to complete the job, the motion is performed by another joint thereby placing it at risk. The wrist feels better but they file a claim for overuse of the shoulder. Example Tack welding in the posture shown in photo number 1 (above) demonstrated without welding glove for clarity, 7.5 hours a day, created numbness and 28

tingling in the fingers, wrist tendonitis, and forearm muscle spasm. A wrist splint was applied, as shown in photo number 2, which prevented the employee from flexing the wrist. This reduced symptoms, but the employee began to have complaints of shoulder discomfort. The motion needed to turn the wand to the correct orientation was transferred to the left shoulder. The shoulder is now in abduction and internal rotation which is often associated with rotator cuff pathology. Problem Solving Photo number 3 shows the result of ergonomic problem solving. The employee now allows the wand to turn in his hand – instead of turning the wand with his hand – and activates the trigger with his thumb instead of his index finger. The other hand assists. The result is neutral wrist and shoulder posture. The strain in both joints was eliminated with this method. In fact, the splint was no longer needed because neutral wrist positioning is built into the new technique. Other Factors If you’re not problem solving onsite, you’ll also miss the weight of the cable extending from the welding wand. The wrist and hand continually fight the resistance of the cable which adds to the overall fatigue and discomfort. Overhead tool balancers can hold the cable slack and remove the resistance. The cable can also be secured to a hook worn off the employee’s belt to allow slack.

Final Thoughts It’s nearly impossible to anticipate the issues created by splint wear in the workplace without seeing the actual work. Most often, we find that a splint is not needed at all. In addition, there are likely other issues that require problem solving and correction before an employee with a musculoskeletal injury will see results. The splint alone will not fix everything and may actually be in the way. Using ergonomic specialists – qualified occupational therapists, physical therapists, human factors engineers, etc. – can significantly reduce recovery time and help avoid unnecessary complications for workers with musculoskeletal disorders. ■ Stan Kulzer is an Ergonomic and Loss Control Specialist with RAS, a provider of workers’ compensation in the upper midwest, headquartered in Sioux Falls, SD.

Midwest Medical Edition

In Review What You’re Reading, Watching, Hearing

Written by Everett Winslow Lovrien, M. D

Doctor Guilt? When patients die, who’s to blame? Retired doctor examines guilt in AIDS-related patient deaths BIOGRAPHY

Winslow Lovrien, MD completed

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Through his treatment, Brent met other youths and men, not exactly like him, but who had the same medical disorder and required similar medical care. He met men and boys in the clinic where he was cared for—as well as at summer camp. Some of the events in their lives are also described in this story. He also met medical doctors, nurses, physical therapists, social workers, and a list of persons who served him in the clinic. Brent had a close family and loving relatives.

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March 2011

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controversial topics such as capitalism, free marketing, cost controls and greed when drug companies sacrificed safety for profitability. “I have felt guilty of bringing harm to innocent young persons who trusted me as their doctor,” Lovrien confesses. “I intended to relieve them from suffering and disability and prolong their lives instead they died from the medicine that I prescribed. Am I guilty? Or was I just wrong?” ■

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ho’s to blame for the thousands of hemophilia patients who received medication for their condition that was unknowingly infected with HIV? Who’s to blame for their subsequent deaths from HIV/AIDS? Are the blood donors guilty? The drug companies that didn’t test the medicine? The doctors who prescribed it? The Center for Disease Control in 2008 reported that the cumulative number of persons in the U. S. that developed AIDS in hemophilia from medicine contaminated with HIV totaled 13,083. So who’s to blame? Everett Winslow Lovrien, M. D., a retired pediatrician and medical geneticist, examines this dilemma in his book, Doctor Guilt?. The book is inspired by his experiences as director of a hemophilia clinic for 28 years, during which nearly 90 of his patients died of liver failure from hepatitis or AIDS from HIV contamination of the medicine he prescribed to treat them. Doctor Guilt? follows Brent, a hemophilia patient given a new medication that would allow him to live a normal life despite his disorder. The medication is unexpectedly discovered to be contaminated with HIV, causing him to die of AIDS at age 17. “All forms of medical treatment include risks,” says Dr. Lovrien. “Because of the saturation of the media by pharmaceutical advertising, doctors to us! and patients must use critical Do you have a thinking when comparing the media review? benefits with the hazards of A book, film, or article? medical treatment. The impact How about an opinion of human activities are not always on a current event? apparent at the time of an event.” Write to us at: Alex@MidwestMedicalEdition.com Lovrien also discusses the origin of HIV, including where it came from and how it came to cause AIDS, a man-made disease. In addition, the book delves into

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Brent admired the chimpanzee he sketched at the zoo. He regarded the animal as contemplative. He was unaware that similar animals in the wilds of Africa were the source of a virus that would lead to his death from AIDS. Brent became infected with HIV from the medicine he infused to treat his hemophilia. At six months of age, his parents were alarmed when they discovered bruises on his chest which led to the discovery of hemophilia. From that moment forward, he received frequent intravenous infusions of Concentrate to treat recurrent bleeding episodes. Infusions of the medicine relieved pain and suffering from bleeding. His life seemed normal. Unexpectedly, Brent’s life changed after the discovery of HIV contamination of the medicine. The medicine was manufactured from the plasma of paid blood donors. Unbeknownst to Brent, the plasma was polluted with HIV. The SIV in chimpanzees changed to become HIV in humans. But the chimpanzees were not the cause of the transfer of SIV in animals to HIV in humans. The change from SIV in animals to HIV in humans was the result of human activity. The change came about with the production of the hepatitis B vaccine. Who was responsible for the pollution of the hemophilia medicine with HIV and hepatitis viruses? Was Brent’s death preventable?

News & Notes

Happenings around the region

Avera Avera McKennan Hospital & University Health Center will open Avera Medical Group Ophthalmology in May in Sioux Falls. The clinic’s medical providers will be Dr. Victoria Knudsen, retinal specialist and Dr. Jeffrey Stevens, general ophthalmologist. Dr. Jeff Stevens received his medical degree from Drexel University College of Medicine in Philadelphia in 2006 and completed the ophthalmology residency there in 2010. Dr. Knudsen received her medical degree from Yale University in 2000, completed an ophthalmology residency at the University of California in San Diego in 2004, and completed a fellowship in vitreoretinal surgery at the University of California in San Diego in 2006.

Dr. Tarek Mahrous, Interventional Cardiologist at North Central Heart Institute in Sioux Falls, South Dakota was recently awarded Fellowship in the American College of Cardiology. Candidates for fellowship must be Board Certified in Internal Medicine and Cardiology and demonstrate that more than 75% of current practice is related to cardiovascular medicine. Dr. Mahrous received professional recommendations in support of ACC fellowship from his peers and training director. He has also been appointed as a Clinical Assistant Professor of Medicine with the Sanford USD School of Medicine.

Sanford

The 23rd annual Avera Race Against Breast Cancer will be Saturday, May 7, at the Avera McKennan Fitness Center in Sioux Falls. The Avera Race Against Breast Cancer includes a 10K run, 5K run, 3 mile walk and 1.5 mile family fun walk. Online registration for all events is $30. The 5K and 10K runs are competitive, official chip-timed events. Registration for the 5K/10K runs will close on Friday, May 6 at 6 p.m. Runners who register on race day may participate, but will not be timed. Last year’s event broke records with more than 5,000 participants who hit the pavement to raise more than $305,000.

Jim E. Mitchell, MD has been appointed Vice President of Research, Fargo Division for Sanford Research. Dr. Mitchell is a long-time member of the Fargo community. In addition to this new role for Sanford Research, he will continue in his current leadership positions as President and Scientific Director of the Neuropsychiatric Research Institute, Chairman of the Department of Clinical Neuroscience and NRI/Lee A. Christoferson, MD Professor at the University of North Dakota School of Medicine and Health Sciences. Dr. Mitchell will lead the development of programs that increase Sanford Research’s capabilities.

Becker’s Hospital Review has named Sanford USD Medical Center among the top 50 best hospitals in America. The list included a wide spectrum of facilities including well-known academic centers and lesser known community hospitals. The Becker’s Hospital Review editorial team analyzed, scored and weighted data from outside sources on factors including patient safety, clinical outcomes and reputation.

North Country Health Services (NCHS) and Sanford Health have finalized the contract bringing the two organizations together. NCHS and Sanford Bemidji Clinic have worked closely for decades. This is the first step in the integration of the two Bemidji-based organizations. Plans are underway to expand the areas of heart, cancer, orthopedics & sports medicine and women’s health, as well as research and education. As part of the affiliation, Sanford will invest $70 million in resources over the next ten years and will immediately make a $5 million gift to the NCHS Foundation.

Sanford Chamberlain Care Center has received a high ranking of five stars overall in U.S. News & World Report’s 2011 Best Nursing Homes, available online at www. usnews.com/nursinghomes. U.S. News’s Best Nursing Homes profiles more than 15,000 facilities and ranks them by state, using data and quality ratings from the federal government. The rankings are updated quarterly.

Regional Rapid City Regional Hospital (RCRH) is now providing the latest in high-tech digital mammography. RCRH hosted an open house on March 9 to display the new technology. Other Regional Health facilities currently offering digital mammography services include Buffalo Regional Medical Clinic, Custer Regional Hospital, Spearfish Regional Hospital, and Sturgis Regional Hospital. Queen City Regional Medical Clinic, in Spearfish, will provide the service in the summer of 2011. The Lead-Deadwood Regional Hospital (LDRH) diabetes program was recently accredited by the American Association of Diabetes Educators (AADE). The AADE’s Diabetes Education Accreditation Program is based on ten national standards for diabetes selfmanagement education. In honor of former Hospice patient Edna Roth, Frank and Penny Darling asked artist Richard Dubois to create a painting. They donated the painting to the Hospice House in Rapid City and it now hangs in the Great Room. Edna Roth was the mother of Frank Darling. Mona Elsayed, M.D., Hospitalist at Rapid City Regional Hospital was recently certified in Hospital Medicine. This certification complements her Board Certification in Internal Medicine, which she has held since 2001. Elsayed joined Rapid City Regional Hospital’s Hospitalist program in November 2010. She is also an active clinical instructor for the Sanford School of Medicine, Internal Medicine Department. Midwest Medical Edition

You’re always there for them.

Other Lori A. Hansen, MD, FACP, FACCP, Yankton Medical Clinic, P.C. Board Certified Pulmonologist, was announced as the as the 2011 Woman of Distinction Professional Service Award winner during a luncheon on February 21 at the Roncalli Center at Mount Marty College in Yankton, SD. Dr. Hansen was recognized for inspiring, mentoring, and supporting other women in our community in professional endeavors.

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

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

Medical-Based Camps for Children with Special Needs Power Mobility Camps

Augmentative & Alternative Communication Camps

• Session 1: June 7-8 & 13-15 Session 2: July 26-27 & August 1-3 9:00 a.m. - Noon The latest technology in power mobility in a fun and functional setting. Children learn mobility skills for different terrains and situations using their own chair or one from the Children’s Care fleet.

• August 8-11 & August 15-18 8:00 - 10:00 a.m. Children with speech challenges learn to communicate with voice output devices through games and outings to the zoo, a restaurant, and the Sertoma Butterfly House. Led by Speech-Language Pathologists.

Breakfast Club

Helping Hands: Constraint-Induced Camps

• June 6-30, Mondays & Thursdays 7:45 - 9:00 a.m. For children with food aversions, sensory or oral motor difficulties, those transitioning from tube-feeding or who are picky eaters. Led by an Occupational Therapist and Speech-Language Pathologist.

• Call for scheduling Children with hemiplegia practice using both upper extremities for everyday activities, including dressing, feeding, play, and arts & crafts. Led by Occupational Therapists with after-camp follow-up. Medical direction by physiatrist Julie Johnson, M.D.

Call (605) 782-2400 for camp details and screening appointments.

Plus, Children’s Care is now offering free developmental screenings the first Wednesday of each month. By appointment 7:30 - 9:30 a.m.

REHABILITATION CENTER

1100 W. 41st St., Sioux Falls, SD 57105 April / May 2011

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Learning Opportunities Happenings around the region

April / May 2011 April 5

2011 Urology Conference Location: Sanford, Schroeder Auditorium Registration is available on SanfordLearn – course code ci-1028. If you have questions, please contact Kathleen at 605.328.6359.

April 11-12

SDHFMA Medicare HFMA Boot Camp Location: Sioux Falls, SD Contact: Renae Tisdall Contact Email: rtisdall@primecare.org Website: www.sdhfma.org/meetings.htm

April 12 7:45 am – 5:45 pm

Advanced AWHONN Fetal Heart Monitor Location: Avera Education Center, Classroom 1

Information: 605-322-8950

April 13 Living with Grief: Spirituality and End-of-Life Care 12:30 – 3:30 pm Location: Avera Education Center Auditorium Continuing Education credits available through Hospital Foundation of America Registration online at: www.averamckennan.org/conferences

Just for fun

April 14 6:30-9:30 p.m.

The Big Grape Reserve, Wine Tasting Benefit Location: Museum of Visual Materials, Sioux Falls. Information: (605) 322-8900 or visit www.TheBigGrape.org.

April 14-15

SDHIMA Spring Meeting and Coding Roundtable Location: Chamberlain, SD Contact: Laura Moller Contact Email: laura.moller@dsu.edu Website: http://www.cvent.com/events/sdhima-spring-conference/eventsummary-d3933ce9118d49c8a80b245dde7bf10d.aspx

April 18 – 20

SDMGMA Spring Conference Location: The Lodge in Deadwood Website: www.SDMGMA.org

April 20-21

SDAHO Continuing Care Conference Location: Sioux Falls, SD Contact: Wendy Mead Contact Email: wendy.mead@sdaho.org Website: www.sdaho.org

May 6 - 7 7:00 am – 5:15 pm

5th Annual Sanford Sports Medicine Symposium Location: Ramkota Hotel Information: Nikki Terveer, 605-328-6353

May 9 8:30 am – 4:30 pm

Neonatal Resuscitation Program, Sanford Employees Location: Sanford Center for Learning & Innovation

May 18 – 19

South Dakota Workers’ Compensation Summit Location: Ramkota Hotel Sponsor: Howalt-McDowell insurance

May 20, 2011 8:00 am – 5:00 pm

16th Annual North Central Heart Vascular Symposium Location: Sioux Falls Convention Center Credits Offered: CME and CNE Information: 605-977-5316 or www.northcentralheart.com

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

ORTHOPEDICS Medical Group

Intensive Care for Newborns

In whose hands will you place her?

Physicians’ Priority Line

1.888.592.7955

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

www.ChildrensOmaha.org

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