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January FebruarY

Vol. 6 No. 1

High Tech

Sight Saver

Meaningful Use Milestone

in Watertown



Medical Education

a Team Effort

South Dakota and the Upper Midwest’s Magazine f or Physicians & Healthcare Professionals

One Number Accesses Our Pediatric Surgical Specialists, Any Problem, Anytime.


Your 24-hour link to pediatric specialists for physician-to-physician consults, referrals, admissions and transport service.

Orthopedics Pulmonology Gastroenterology & GI Surgery Cardiology & Heart Surgery

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Midwest Medical Edition

Contents Volume 6, No. 1 ■ ja n ua ry | februa ry 2015


Regular Features

Tech Sight


Jan uaRy Feb Rua Ry

4 | From Us to You

Vol. 6 no. 1

5 |  MED on the Web

Considering Hospice, Pain Management Award, Meaningful Use Penalties

10 | N  ews & Notes


New doctors, certifications, clinics, and more

30 | The Nurses’ Station Magnet Recognition, New USD Degree Program

34 |  Wine Marketplace

By Alex Strauss

Red Wine’s Media Comeback and a Sponsorship Opportunity

35 |  Learning Opportunities

HigH TecH

Upcoming Conferences, Events, and CME Opportunities

In This Issue 6 |  Collections: How to Make a Fair Comparison

SigHT Saver

use Mil Meaningful

n in Water tow

■ By Sara Greff Dannen

13 |



new Ceo

e S Ma ga zin MiD we St’ th e up per ar e pro feS Sio na lS ko ta and Sou th Da cia nS & he alt hc f or ph ySi


Medication Management for Senior Patients: Statistics paint a troubling picture of medication problems in the elderly ■ By Tony Mau

21 |

ucation Medical Ed

rT a Team effo

The South Dakota Lions Eye and Tissue Bank in Sioux Falls is one of only 9 eye banks in the U.S. to offer a rare type of transplant tissue preparation technique that is helping to restore vision in our region and around the world.



Avera Health Partners with Elekta

 Interprofessional Healthcare: More than an

New technology partnership will enhance cancer treatment

expression ■ By Carla Dieter

22 |

S outh Dakota Surgeon Reflects on National Leadership Role

23 |

‘Wall of Heroes’ Honors Organ & Tissue Donors

24 |

P  hysicians Can Fire Patients, Too ■ By Jeremy Wale

26 |

More Research Validates the Benefits of Hospice

28 |

C  linical Spotlight: Gastroenterologists at Children’s Hospital in Omaha are monitoring the researcher on fecal bacteriotherapy research for their pediatric patients

32 |

R  eady for Something Completely Different?


rairie Lakes Healthcare 20 PReaches a Meaningful

Use Milestone The rural hospital is one of only 19% of eligible hospitals in the U.S. to have attested to Stage II meaningful use within the original time period

MED talks with University of Sioux Falls Healthcare MBA graduate and orthopedic surgeon Dr. Walt Carlson about why – and how – he went back to school.

33 |  The History of Citizen Eco-Drive Watches ■ By Randy Hoffman, CMW

New Year, New CEO for Regional Health

On the


From Us to You Staying in Touch with MED


appy New Year! As we head into our sixth year as the region’s most widely distributed publication for the medical community, we want to extend a thank you to the many readers who have helped MED to grow, expand, and become an even more effective communication tool in the last 12 months. Your readership of and the digital edition, your posts in MED’s free online calendar and business directory, and many responses to our first-ever online reader survey tell us you like how we’re using technology. In the last year, MED has:

Publisher MED Magazine, LLC Sioux Falls, South Dakota Steffanie Liston-Holtrop

Vice president

Liston-Holtrop Editor in Chief Alex Strauss

graphic design Corbo Design

1. Grown website readership by 100%

Photographer Kristi Shanks

2. Steadily grown a loyal list of digital edition subscribers

director Jillian Lemons

4. Completed an online/print reader survey

Alex Strauss

Contributing Writers Sara Greff Dannen

5. Grown its list of digital advertisers 6. Partnered with other digital news outlets to expand our coverage Do you have ideas for where we should head next? MED’s responsive local team would love to hear from you. Send your thoughts to Here’s to a peaceful and prosperous new year!

Web Design Locable

digital media

3. Added valuable links to its regular newsletter

—Steff and Alex

And the Winner Is . . . Dr. Scott Dierks, a family practice doctor with Avera Medical Group McGreevy in Sioux Falls, is the winner of a $500 diamond necklace from Riddle’s Jewelry in our first ever MED Reader Survey. Dr. Dierks says he especially appreciates the fact that MED is a regional publication and he likes MED ’s cover stories and feature articles as well as the Learning Opportunities/events calendar. Congratulations, Dr. Dierks!

MED Reader Survey Winner Dr. Scott Dierks shows off his new diamond necklace with Riddle’s Jewelry General Manager David Stensrud and MED’s Steffanie Liston-Holtrop.


Sales & Marketing Steffanie

Staff Writers

Carla Dieter Tony Mau Peter Carrels Jeremy Wale Liz Boyd Caroline Chenault John Knies

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 5000 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 MED is produced eight times a year by MED Magazine, LLC which owns the rights to all content.

MED welcomes reader submissions!

More than a Magazine, A Medical Community Hub

Give yourself a gift!

2015 Advertising Editorial Deadlines

Start your new year of MED a little early! Sign up for advance access to the digital issue and we’ll email you when it is released – up to two weeks earlier than print.

Jan/Feb Issue December 5 March Issue February 5 April/May Issue March 5 June Issue May 5 July/August Issue June 5 Sep/Oct Issue August 5 November Issue October 5 December Issue November 5

Contact Information Steffanie Liston-Holtrop, VP Sales & Marketing 605-366-1479 Alex Strauss, Editor in Chief 605-759-3295

Area Hospital Recognized for Pain Management Find out why this Black Hills hospital attracted the attention of Becker’s Hospital Review.

Avoiding Meaningful Use Penalties February 28 is the attestation deadline for eligible professionals participating in the Medicare EHR Incentive Program. Find a link to everything you need to know on our website.

When to Consider Hospice Hospice of the Hills says many patients wish they had known about hospice sooner. Here’s what you need to know to help empower patients in end-of-life decision-making.

Only on our website! ◆D  ownload the Digital Issue – Want to read a back issue of MED but don’t have it handy? Download it onto your compute, tablet or smartphone in seconds. Find the link on the MED homepage.

◆ L ist Your Practice – For FREE – Add your practice to MED’s growing online business directory and you’ll be searchable by website visitors. Add a link to your website for even more value. It takes just a minute and is completely free.

Fax 605-231-0432 Mailing Address PO Box 90646 Sioux Falls, SD 57109

◆ S earchable Article Archive – It’s easy to reference something you’ve read in MED. Search hundreds of past articles, including many that never appeared in print, by topic, date, and more – right from the MED homepage.




How to Make a Fair Comparison


By Sara Greff Dannen

am sure you’ve heard the phrase “apples-to-apples comparison,” but before you can make a true apples-to-apples comparison, you have to first determine certain facts. Are you looking at a Granny Smith apple, a Fuji, or maybe a Red Delicious? How old are the apples you are comparing? Have you looked at the size of each apple? What about their crispness and sweetness? Why all of the questions about apples? It is simply to illustrate that, although people may think all collections agencies are created equal, there are many variables that need to be taken into consideration in order to make a fair comparison. Even an apples-to-apples comparison is never as simple as it sounds.

Compliance At the top of your comparison factor checklist should always be compliance, especially on the heels of all the security breaches in the news lately. Are the agencies you are

For Sara’s final comparison tips on how your agencies manage and distribute the money they collect, Log on!

working with collecting on your accounts in a compliant manner or are they cutting corners to make the numbers better? Is your data secure with your agencies? How are your patients being treated? What other services make your agency a valuable business partner?

by payer, demographic information, or account age. The best option is an alpha-split by patient last name. For example, A-L would go to one agency and M-Z to the other. All accounts should be approximately the same age in the billing cycle and have run through the same internal processes.

Dividing Accounts

Comparing Programs

Many healthcare facilities use two or more collections agencies. They divide their overdue bills into equal batches, and give each agency one batch. This allows the healthcare facility to monitor collection performance over two to three months and compare which agency produces the best results. While looking at a straight comparison of numbers to see which agency is recovering more dollars is a good practice, it is easy to overlook some important considerations. First, are you sending both agencies similar accounts? To make a fair comparison, be cautious not to make a separation of accounts

Once the accounts are listed with the designated agencies, how do the programs compare? All agencies should have a minimum account standard that all accounts go through. Ask your agencies, what their specific standards are. Do they send one, two, or three letters on every account? How many phone calls do they make on an account? When do they decide to take advanced action on an account? While these programs can be hugely beneficial, they do make it difficult to measure performance and costs if both agencies are not doing the same.

Comparing Time Frames When evaluating results, you need to consider whether or not the agencies are being compared on the same time frame. An agency that has worked with a facility longer may have more accounts, which means more ways to recover funds. However, even if a line in the sand is drawn, an agency with a longer history with a facility will likely have payment arrangements in place on older accounts that would not be included in the comparison time line. It is good practice to make agency comparisons, but all the different variables need to be factored into the equation. There is very little information about fair comparisons on the Internet. Working with your agencies to find a common ground is i always the best practice. ■ Sara Greff Dannen is General Counsel and Compliance Officer with AAA Collections in Sioux Falls.


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Midwest Medical Edition

Interprofessional healthcare — more than an expression By Carla Dieter, EdD, FNP-BC


hat if, instead of a

single healthcare professional focusing on your healthcare needs, a team of skilled professionals from multiple disciplines closely worked together to give you the best possible care? The answer is evident: You’d want a team, and you’d prefer it if that team worked cooperatively, collaboratively, and that each member of the team shared their skills and knowledge with each other to assure a successful outcome. That’s the premise behind interprofessional healthcare, and it is also the reason that the different programs in the University of South Dakota’s School of Health Sciences (SHS), including the school’s Nursing program, are carefully incorporating interprofessional education into their curriculums. We believe our students must be properly prepared to practice interprofessional healthcare. What makes this so important? A landmark 2003 report by the Institute of Medicine titled Health Professions Education: A Bridge to Quality emphasized that one of the five core areas needing focus in educational programs involved developing and maintaining proficiency in working as a part of interdisciplinary teams. USD’s School of Health Sciences and its medical school were instrumental in organizing educators and practice partners from many different colleges, universities and healthcare institutions from across South Dakota in 2013 to develop interprofessional projects intending to advance a concept known as the “Triple Aim”. This concept –Triple Aim – refers to the simultaneous pursuit of improving the patient’s

A USDSM medical student, internal medicine resident, two nursing students, and an instructor attend to a “patient” during a code blue simulation. Photo courtesy USD.

You’d want a team, and you’d prefer it if that team worked cooperatively

experience of care, the overall health of various population groups, and the reduction of healthcare’s per-capita costs. Interprofessionalism will be a key component in meeting those three goals. I am the Chair of the South Dakota Collaborative for Interprofessional Education and Practice, a statewide committee formed in 2013 that is developing projects and implementing strategies to advance inter professionalism in healthcare,

including in the institutions of our state that teach healthcare programs. We are making progress on many fronts. I’m especially proud to report that USD’s School of Health Sciences (SHS) is on the path to fulfill its vision of being a nationallyrecognized leader in interprofessional health sciences’ education. It allows students from multiple disciplines to work together on clinical case simulations to improve patient care and outcomes. ■

Carla Dieter, EdD, FNP-BC, is the Chair of the University of South Dakota School of Nursing.

January / February 2015


Happenings around the region

South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska

News & Notes Avera

Avera Queen of Peace Hospital was one of three Avera hospitals to receive a threeyear accreditation from the Joint Commission and earn “Top Performer on Key Quality Measures” for 2013. Avera

Queen of Peace, along with Avera Sacred Heart and Avera St. Mary’s are featured in the Joint Commission’s “America’s Hospitals: Improving Quality and Safety” annual report, on the Joint Commission website and on the Joint Commission’s Quality Check website. Avera St. Mary’s Hospital in Pierre, South Dakota and the State of South Dakota have negotiated Tier 1 provider pricing for state employees on the state health plan for all orthopedic and gastroenterological procedures at Avera St. Mary’s. The new

pricing is effective immediately and will be retroactive to Nov. 1. Any South Dakota state employees who were provided these services after Nov. 1 will have the lower pricing reflected in their bills. Avera Health joined other state and national rural stakeholders in celebrating National Rural Health Day on November 20 th.

The National Organization of State Offices of Rural Health (NOSORH) created National Rural Health Day as a way to showcase rural America and increase awareness of rural health issues. Plans call for National Rural Health Day to become an annual celebration on the third Thursday of each November.


Avera Sacred Heart Hospital has been awarded a three-year term of accreditation in computed tomography (CT)


as the result of a recent review by the American College of Radiology (ACR).

Black Hills Erica Bestgen, RN, recently passed the International Board Certification of Lactation Consultants

(IBCLC) exam and is the fourth certified Lactation Consultant at Rapid City Regional Hospital. Bestgen has worked in Women and Children’s Services for nearly three years.

Rapid City Regional Hospital has received the Get With

The Guidelines-Stroke Silver Achievement Award from the American Heart Association/ American Stroke Association for its excellence in the medical treatment of patients with stroke. Rapid City Regional Hospital also received the Target: Stroke Honor Roll Award for improving stroke care. Throughout the past 12 months, at least 50 percent of the hospital’s eligible ischemic stroke patients have received tissue plasminogen activator, or tPA, within 60 minutes of arriving at the hospital.

A fixed-wing plane in Dickinson is the newest addition to the Sanford AirMed fleet. Starting

December 15, a King Air B200 fixed-wing plane, along with a team of flight paramedics, flight nurses, pilot and mechanics began serving patients in western North Dakota. Sanford AirMed currently operates a fleet of helicopters and airplanes from bases in Bismarck, Dickinson, Fargo, Sioux Falls and Bemidji. Sanford AirMed is the only Commission on Accreditation of Medical Transport System air medical program in North Dakota. Brett Slingsby, MD, a provider

for Child’s Voice in Sioux Falls, recently received his certification in Child Abuse Pediatrics by the American Board of Pediatrics.

Profile by Sanford is now open in three new locations – Knoxville, Tennessee and Davenport, Iowa and Aberdeen, South Dakota.

The Tennessee and Iowa locations are the first to open in both states. Profile was designed using a large body of clinical research to ensure a sustainable means to healthy weight loss. Profile launched in Sioux Falls, South Dakota, opening its first store front in November 2012. Today, it has 17 locations in six states with more planned openings.

Siouxland Wade Kuehl, LISW, is the new Manager of Behavioral Health Social Services at Mercy Medical Center-Sioux City. Kuehl

received his Bachelor of Science in Psychology and Criminal Justice from the University of South Dakota in 1993 and his Master of Social Work at the University of Nebraska Omaha in 2000. He has been employed at Siouxland Mental Health Center for the past 14 years, the last six of which he has served as their clinical director. In his new role, Kuehl will oversee the outpatient Pathways program as well as the programming on the inpatient behavioral unit.

Stay up-to-date with new medical community news between issues. Log on!

Midwest Medical Edition

Mercy Breast Care Center has been awarded a three-year term of accreditation in stereotactic breast biopsy as the result of a recent review by the American College of Radiology (ACR). Siouxland Paramedics has again received the distinct designation as an Accredited CAAS (Commission on Accreditation of Ambulance Services) ambulance service. There are only two other

paramedic services in the state of Iowa who received this designation –West Des Moines Emergency Medical services and MEDIC EMS in Davenport. This is the third time SPI has received this accreditation which is valid for 3 years.


Make-A-Wish South Dakota has added Dr. Alexandra Schaller to its statewide board of directors. Schaller will

Prairie Lakes Healthcare System has received the American College of Cardiology Foundation’s NCDR ACTION Registry–GWTG Platinum Performance Achievement Award for the second consecutive year.

This award recognizes Prairie Lakes’ commitment and success in implementing a higher standard of care for heart attack patients, and signifies that Prairie Lakes has reached an aggressive goal of treating these patients to standard levels of care as outlined by the American College of Cardiology/ American Heart Association (ACC/ AHA) clinical guidelines and recommendations.

serve a two-year term, which began in September. “Dr. Schaller’s passion for helping children and her desire to help us reach more sick children who may qualify for a wish makes her a valuable addition to our Board,” Paul Krueger, president and CEO said.Dr. Schaller is currently a second year pediatric resident at the University of South Dakota Sanford School of Medicine. Originally hailing from Maple Grove, Minnesota, she graduated medical school from AT Still School of Osteopathic Medicine in Mesa, Arizona. Her four year degree was obtained at South Dakota State University where she also played four years of Division I soccer. The injectable dermal filler formerly known as Artefill has changed its name to Bellafill.

Bellafill is FDA approved for the correction of nasolabial folds. Dr. Lornell E. Hansen, II, owner and medical director of LazaDerm Skincare Centre is the only physician injecting Bellafill in South Dakota.

Xuesheng Feng, MD, neurologist with the Sioux Falls VA Health Care System has recently earned board certification in headache medicine.

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Midwest Medical Edition

Medication Management for Senior Patients By Tony Mau

Statistics paint a troubling picture of medication problems in the elderly


n elderly patient’s arthritic

fingers struggle to grasp the tiny prescription pills, so she frequently drops them on the floor. Sometimes she decides just not to bother with her medications at all. Another senior patient cuts his daily blood pressure tablets in half to save money and still another patient forgets to take her diabetes and cholesterol medications. If she’s not sure whether she took them, she’ll take an extra of each the next day to “catch up.” The wrong medications. The wrong dosage. The wrong timing. Any of these scenarios of skipped medications or taking too much or too little can cause medical complications or even death. The nation’s seniors are particularly at risk for medication-related problems. In fact, some healthcare experts rank medication problems among the top five causes of death for people over 65 and as a significant source of confusion, falls and loss of independence. In a 2013 report on aging and health, the Centers for Disease Control and Prevention reported, “More than a quarter of all Americans and two of three older Americans have multiple chronic conditions, and treatment for this population accounts for 66 percent

of the country’s healthcare budget . . . People with multiple chronic conditions face an increased risk of conflicting medical advice, adverse drug effects, unnecessary and duplicative tests, and avoidable hospitalizations, all of which can further endanger their health.” The more medications a patient takes, the greater likelihood of adverse drug interactions or a mix-up in dosages. A nurses’ handbook available on the National Center for Biotechnology Information website states that seniors discharged from the hospital on more than five drugs are more likely to be readmitted to the hospital within six months after discharge. Medication-related ER trips and hospitalizations may also occur because the elderly absorb medicines at a different rate than younger patients. Drugs taken with certain foods and liquids also can affect absorption and side effects. Staying ahead of complications from medications truly becomes a first line of defense for patients and their caregivers. Properly managing medications is crucial for every individual, especially those with multiple health conditions, and the elderly pose an increased challenge. ■

Common medication problems and prevention tips for older patients: Trouble Reading Labels Seniors with diminished eyesight can be encouraged to ask the pharmacist for large-print labels and instructions.

Memory Impairment Seniors who have dementia and other cognitive issues need specific reminders for timing and dosages. Standard pill box organizers or electronic ones with timers and rescue alerts, or an in-home care professional can help.

Financial Limitations Some seniors on tight budgets will cut prescribed medications in half or skip doses to save money. Generic brands and 90-day supplies help reduce medication costs, and for those who meet income requirements, prescription assistance programs can help. In addition, people on Medicare and U.S. military veterans also may qualify for lower-cost medications.

Swallowing Difficulties Prescribing liquid forms of medications can ease swallowing challenges. Patients should be reminded not to score, crush, chew or mix medications in liquids without first checking with the pharmacist.

Improper Storage Patients may need to be reminded that certain medications require refrigeration (insulin, eye drops, etc.). Tony Mau is the owner of Right at Home in Sioux Falls.

January / February 2015


A donor cornea in Optisol GS, a storage medium, within a corneal viewing chamber.

In 2013, 698 corneal transplants were performed

High Tech

Sight Saver

South Dakota Lions Eye and Tissue Bank Offers Rare Tissue Prep Technique to Restore Vision in Our Region and Around the World 14

By Alex Strauss Midwest Medical Edition


lan Berdahl had known for nine years

innermost portion of the cornea. These cells are responsible

that he would eventually lose his sight to the

for keeping vision clear by wicking away excess moisture

progressive eye disease, Fuch’s corneal endo-

that can cloud the vision. As endothelial cells die, fluid can

thelial dystrophy. It was not just because he

build up and vision worsens. Eventually, the only way to

could no longer see to drive at night or because his vision

restore sight is to replace the damaged endothelium.

was blurry every morning when he woke up. He knew

“In surgery, we take the damaged cells out of the eye

that his vision would continue to deteriorate because his

and replace them with new tissue,” explains Dr. Berdahl,

son, then a first-year ophthalmology resident at Duke,

who performed the procedure on his father in Sioux Falls

told him so.

earlier this year, nine years after diagnosing his condition.

“That was the first time I diagnosed him,” says John

To replace his father’s damaged endothelial cells, Dr.

Berdahl, MD, now an ophthalmologist in Sioux Falls. “He

Berdahl used the most advanced transplant procedure avail-

and my mom had come out to visit me in school in North

able for this condition–a Descemet’s Membrane Endothelial

Carolina and he says ‘Hey, I want to get an eye exam!’ I

Keratoplasty (DMEK). This delicate and minimally invasive

thought that what I was seeing was Fuch’s dystrophy, but

procedure utilizes a specially-prepared endothelial graft

I brought in one of the other docs to confirm and they said,

just 10 to 12 microns thick. The extreme thinness of the

yes, that’s what he’s got.”

graft has been shown to give patients the best chance for

Fuch’s dystrophy is a genetic disease that destroys vision by slowly killing off cells in the endothelium, the critical

clear vision with faster recovery and less chance of rejection than procedures of the past, which used thicker grafts.

from tissue recovered from 425 donors in the South Dakota region.

Delicate Operation Before surgeons like Dr. Berdahl can use DMEK to treat Fuch’s dystrophy, bullous keratopathy, and other causes of poor endothelial function, there is another delicate operation that must take place first. Under microscopic guidance, a specially-trained tissue preparation expert must carefully isolate and remove this miniscule layer of cells from the underside of a donor cornea. Although, DMEK is becoming increasingly popular with surgeons because of the advantages it offers to patients, preparation of such a thin tissue graft for transplantation requires a level of expertise that is not yet widely available. Fortunately for Dr. Berdahl and patients like his father, the South Dakota Lions Eye and Tissue Bank is one of 9 eye banks in the U.S. (out of 79) with the training and experience to prepare DMEK transplants. “The average cornea is about 500 to 600 microns thick and the endothelium (the innermost layer) is absolutely the tiniest portion,” says Marie Bowden, CEBT, CTBS, Clinical Recovery Manager at the SDLETB in Sioux Falls.

January / February 2015

Bowden trained in the DMEK tissue preparation procedure in Portland, Oregon and has been using the process at the SDLETB since last June. Unlike previous generation partial thickness corneal grafts, the ultrathinness of DMEK grafts means they can only be prepared manually. Currently, Bowden is the only local staff member trained in the technique. She says working with the average donor cornea, a piece of non-vascular tissue about 12 millimeters in diameter, is like operating on a soft contact lens. “I use very, very delicate instruments and a surgical microscope,” she explains. “First, I stain the tissue with vision blue and then proceed with scoring and lifting the edges of the endothelium all the way around. Using forceps, I peel it ever so gently and slowly across the entire cornea hoping that nothing tears. It’s trial and error a lot.” The resulting circular graft is approximately 8.25 to 8.5 millimeters in diameter, a mere 10 to 12 microns thick, and the consistency of wet tissue paper. Since Bowden started offering the procedure, the eye bank has been preparing DMEK grafts not only for

South Dakota surgeons like Dr. Berdahl, but also for other surgeons from around the country. “More surgeons want to be as minimally invasive as possible to restore sight,” says Bowden. “Our job is to get the grafts to surgeons that they desire and that their patient needs.” After it is removed from its donor, a cornea only has about a 14-day lifespan, which means the cornea must be recovered, prepped, shipped and used within that timeframe. Bowden says if a corneal graft cannot be placed locally within 5 days, it is made available to surgeons around the country and even the world.

Alternatives to DMEK Not every patient is a candidate for DMEK and many surgeons are still not trained to perform the delicate procedure. For this reason, most eye surgeons still prefer an alternate procedure call Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK). “About 10 years ago was the first time that we began to be able to replace just the inside portion of the cornea and


Alan Berdahl, Clinical Outreach Coordinator for the SDLETB and Fuch’s dystrophy patient, and his son, Sioux Falls ophthalmologist John Berdahl, MD, of Vance Thompson Vision.

that was a major improvement,” says Dr. Berdahl of DSAEK. “It is faster, less risky, vision is generally better, recovery is faster and risk of rejection is lower than full thickness corneal transplant.” The difference is the thickness. DSAEK transplants replace the endothelium with a graft that can range from 80 to 140 microns thick. The greater thickness of the DSAEK tissue makes the procedure more invasive than DMEK but can also make the graft itself easier for surgeons to handle. “DSAEK is very similar to DMEK for the surgeons, but it is different from a processing standpoint,” says Bowden. “To prepare tissue for DSAEK, we get part of the stroma, the Descemet’s membrane, and the endothelium.” Bowden and one of her colleagues do this by cutting through the donor cornea using a microkeratome, a precision surgical instrument with an oscillating blade that is also used to create cornea flaps during LASIK surgery. “These grafts are not perfect because this tissue in the back is about 100 microns thick tends to scatter light a little bit,” says Dr. Berdahl. “There is no question in my mind that people see better with DMEK than with DSAEK. That’s why I did it on my dad and I do it 80 percent of the time with my patients.” Even so, while the demand for DMEK tissue is growing, DSAEK remains the graft of choice for most surgeons. The SDLETB stays busy delivering both.

Generous Donors Once the graft has been scored all the way around, Bowden carefully lifts the Descemet’s membrane to detach it from the cornea.

Corneal tissue preparation is a delicate process. Here, the corneal scleral rim is trimmed to even it out


Fortunately, South Dakota ranks high in the number of people willing to donate their organs and tissues. Bowden estimates that as many as 57 percent of South Dakotans have agreed to be donors. “We have a very giving state,” she says. While not all organs may be suitable for transplantation, especially if the donor was elderly or sick, Bowden says there are very few reasons that the eye bank would have to reject a donor cornea. Even corneas that are not suitable for DMEK, such as those from diabetics or those with cataract scars, may still be suitable for preparation as DSAEK grafts. The eye bank accepts corneas from donors between one and 75 years of age, but even those limits can be expanded when the need is greater. Before recovering donor tissue, SDLETB techs perform a blood draw and a physical exam. Corneas are recovered using sterile techniques and are brought back to the eye bank where they are examined under a slit lamp. Endothelial cells are then counted using a specular microscope and appropriate tissue is designated for DMEK, DSAEK, or full thickness preparation. In 2013, 698 corneal transplants were performed from tissue recovered from 425 donors in the South Dakota region. Bowden says 201 of those transplants went to in-state recipients.

Midwest Medical Edition

Eye on the Future Today, more than 8 months after his DMEK surgeries, Alan Berdahl’s vision has been restored so well that he can continue to do his job, which just happens to be educating the public about the work of the eye bank as its Community Outreach Coordinator. Dr. Berdahl estimates that he now performs 2 to 3 DMEK procedures a week and about 25 DSAEKS and 25 full thickness transplants each year. He sees his dad’s experience with DMEK as evidence that, thanks to advanced tissue preparation techniques, he is offering all of his patients the very best options available anywhere. “I really feel that, in some ways, it is a test of me,” says Dr Berdahl. “I did my dad’s surgery exactly the way I do everyone else. There was no difference. So, it’s really a validation that, when I say that this is the procedure that I would do on my own family member, I really mean it.” Marie Bowden, Clinical Recovery Manager with the SDLETB, scores a corneal graft to find the edge of the Descemet’s membrane during DMEK preparation.

January / February 2015


New Year, New CEO

for Regional Health Pledging to build engagement

Brent R. Phillips

with physicians and employees to improve and simplify patient experience, the new President and Chief Executive Officer of Regional Health began his duties on January first. After an extensive nationwide search, Regional Health announced its selection in November of Brent R. Phillips of Milwaukee, Wisconsin. Phillips succeeds Charles E. Hart, MD, MS, who has served as Regional Health’s President and CEO for 10 years. Dr. Hart announced his intention to retire earlier in 2014. Phillips served as Senior Vice President of Medical Group Operations for Aurora Health Care in

Wisconsin, and later his role expanded to include President — Greater Milwaukee South, overseeing four hospitals for Aurora Health Care. Prior to his role with Aurora Health Care, Phillips served in a senior leadership role with Mayo Clinic in Rochester, Minnesota and as an Administrator and Executive Director with Sentara Healthcare in Norfolk, Virginia. With more than 100 applicants from across the country, Pete Cappa, Regional Health Board of Trustees Chairman and CEO Search Committee Chairman, says Phillips impressed the search committee with his experience and vision for the future. “Brent Phillips is passionate

about building a culture of teamwork and mutual respect among administrators, physicians, caregivers, employees, patients and the community,” says Cappa. “He is focused on excellence in all aspects of healthcare including service, quality, and teamwork as well as making healthcare delivery easier for patients, physicians and caregivers.” Phillips earned his bachelor’s degree in business administration from Idaho State University in Pocatello, and dual master’s degrees in healthcare administration and business administration from the University of Minnesota in Minneapolis. He is a Fellow with the American College of Medical Practice Executives. ■

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of our clients report purchasing unhealthy food to help stretch their weekly budget

Help us provide nutritious meals to hungry families January / February 2015


Photos courtesy Prairie Lakes

Prairie Lakes Reaches Meaningful Use Milestone Prairie Lakes is one of only 19% of eligible hospitals in the nation to have successfully attested to Stage Two within the original time period.



Healthc are

System in Watertown recently became the first healthcare facility in the state of South Dakota to attest for Stage Two Meaningful Use. Prairie Lakes is also one of only 19% of eligible hospitals in the nation to have successfully attested to Stage Two within the original time period. “This milestone is an outcome of Prairie Lakes’ continual improvement of its healthcare services and technologies,” says Jill Fuller, President and CEO of Prairie Lakes. Staff at Prairie Lakes took a team approach to complete the objectives. An interdisciplinary team worked to identify and apply enhanced applications of Prairie Lakes’ EMR system. In addition, attestation required work flow changes, strategies to foster patient engagement, and working with other care providers to set up paths for information exchange and a level


of interoperability for the different EMR systems. In addition, the objectives of Meaningful Use have led to the development of a Patient Portal where patients who have been hospitalized can view their allergies, immunizations, active and inactive medications, health history, and test results. “It was inspiring to watch our team embrace the Meaningful Use challenge and take it ‘head on’,” says Kristi Osthus, Director of Health Information Management. “We were determined to meet our attestation goal for Stage Two Meaningful Use and when we came across an obstacle we were not afraid to take a detour and try a new process.” Shelly Turbak, Chief Nursing Officer added, “Success was realized because of the efforts and problem solving attitude of the interdisciplinary team and the agile change culture at Prairie Lakes. CPSI also provided direction and timely assistance when needed.” But attesting to Stage Two was not without challenges, including a significant culture change. “It didn’t come without major obstacles and daily challenges to

change processes,” says Deb Pederson, Director of CCU and Respiratory Therapy. “Because of teamwork, those processes became a part of our daily practice,” Prairie Lakes staff feel a high sense of accomplishment to be the first hospital in South Dakota. But attestation is just the beginning. Technology is continually changing; Prairie Lakes and all healthcare facilities must be proactive and anticipate those changes. “Maintaining requirements of Meaningful Use does not end with attestation,” says Shelly Turbak. “Prairie Lakes works each day to ensure ongoing compliance. This makes certain we will continue to improve EMR use and interoperability, meet or even exceed Stage Two Meaningful Use requirements, and be in a position to address Stage Three Meaningful Use when those requirements are released by CMS.” Meaningful Use is a nationwide program with three stages of objectives to use certified electronic health records (EHR) technology to improve quality and efficiency of care, engage patients and family, improve care coordination, and improve population health. ■

Midwest Medical Edition

Avera Health Partners with

Elekta Avera Health has announced a new partnership with Elekta, a technology company specializing in cancer treatment. Under the agreement, Avera will deploy Elekta’s MOSAIQ oncology information system across the Avera Cancer Institute. According to Avera, the new partnership will enable the Cancer Institute to implement an integrated oncology health system that spans the full cancer care continuum, from prevention and screening through to palliation and recovery. The agreement includes Elekta linear accelerators (Versa HD, Elekta Infinity), Leksell Gamma Knife Perfexion and brachytherapy solutions, Monaco treatment planning and METRIQ cancer registry software. All of the software will be deployed through a cloud-based solution. “By choosing Elekta as our partner, we will be able to give our patients access to the world’s most advanced technology for treating cancer,” says Michael Peterson, MD,

The Elekta Versa HD radiation therapy system is available in Sioux Falls

Radiation Oncologist with Avera Health. “Having both Versa HD and Perfexion provides superior capabilities for stereotactic treatment delivery, enabling us to perform treatments faster, with even greater precision.” “Through this partnership, Avera will be

able to access a single patient record at any of our cancer centers and outreach locations,” says Dave Flicek, Chief Administrative Officer for Avera Medical Group: This ensures connectivity between cancer providers, chemotherapy, and radiation therapy centers and cancer registries.” ■

Welcome to the

Each year, thousands choose to give the gifts of Sight and Health This season, register to be an Organ, Eye, and Tissue donor at

January / February 2015


South Dakota Surgeon Reflects on

National Leadership Role

By Peter Carrels

Gary has been a terrific leader. He brought stability and strategic thinking to this important position.

— Dr. Patricia Turner

Peter Carrels is Communications Coordinator at the University of South Dakota Sanford School of Medicine.



r. Gary Timmerman’s climb through the leadership ranks of the prestigious American College of Surgeons has been a highly gratifying experience for the Sioux Falls-based surgeon. It has also benefited students at the University of South Dakota Sanford School of Medicine. Timmerman, chair of the University of South Dakota Sanford School of Medicine surgery department, recently concluded a one-year stint as Chairman of the College of Surgeons’ Board of Governors. That appointment – to lead the Board of Governors – followed a twenty-year commitment to the organization that involved an array of demanding and meaningful assignments and positions. The Watertown, South Dakota native had been president of the College of Surgeons’ South Dakota chapter, and had served on numerous regional and national committees. Founded in 1913, the American College of Surgeons’ 85,000 members are from every state in the US, as well as many foreign countries. The ACS is the second largest

organization of physicians in the world, just behind the AMA. The organization is guided by two leadership boards, the Board of Regents and the Board of Governors. Regents formulate policy and direct affairs for the College. The Governors serve as an administrative channel through which various chapters (some 270 of them) and the organization’s many members deliver their concerns and suggestions to the organization. It is the grassroots component of the organization, the activist aspect. “The Board of Governors,” explained Timmerman, “is the voice of the College of Surgeons.” “Gary has been a terrific leader,” said Dr. Patricia Turner, a Chicago-based surgeon who also directs member services for the American College of Surgeons. “He brought stability and strategic thinking to this important position.” Dr. Turner pointed out that Dr. Timmerman was the first South Dakota surgeon to lead the organization’s Board of Governors. A benefit of Dr. Timmerman’s national post is his exposure to and relationships with surgeons

and medical school professors and deans from around the country. That translates into better opportunities for University of South Dakota Sanford School of Medicine graduates seeking surgical residencies. It also translates into greater visibility for the surgical residencies offered by the school of medicine here in South Dakota. The surgical residency program at the University of South Dakota Sanford School of Medicine is in its infancy, and reviewed its second cycle of candidates in fall, 2014. The program has been approved for three residents per year. Dr. Timmerman played a key role in re-establishing the medical school’s surgical residency program, a program that had been discontinued in the 1980s. At his office on the Sanford Hospital campus in Sioux Falls, Dr. Timmerman shared his feelings about ACS experience. “What a humbling experience it’s been. I’ve been able to work with some extraordinary people, and I’ve learned that so many of my colleagues, my fellow surgeons, are dedicated to medicine, surgery, and to the patient.” ■

Midwest Medical Edition

“Wall of Heroes”

Honors Organ & Tissue Donors Avera McKennan Hospital & University Health Center recently dedicated its new Wall of Heroes, honoring individuals and their families who made the courageous choice to donate organs and tissue. The new Wall of Heroes consists of two video screens in “Heritage Hall,” the curved hallway leading from the lobby of Avera McKennan that tells Avera McKennan’s story in pictures and displays. The screens show a photo and short biography of the donors whose families have chosen to honor them this way. Families so far have submitted approximately 100 photos and stories. Among donors recognized on the Wall of Heroes is 16-year-old Andrea Cleveland of Corsica, South Dakota, who died in November 2011 following a car accident. Her parents honored Andrea’s decision to be an organ and tissue donor, which she had proudly marked on her driver’s license. Andrea’s gifts of organ donation saved the lives of five people, and her gifts of tissue donation benefited people across the country. “I am so proud of her for doing this,” said her mother Marlene. “The accident was going to happen whether she marked ‘donor’ or not. If she hadn’t signed up, those people would have gone through the same thing we went through. Because of Andrea, they made it.” A number of hospitals across the United States have “donor walls” but most feature a static display. Avera’s transplant staff received a grant from Avera’s Employee Giving Campaign to create the novel video display, which provides more room to showcase donor stories. Avera partners with LifeSource in the organ donation process. In conjunction with the dedication of the Wall of Heroes in December, Avera presented LifeSource with a check for $10,000 as a community benefit donation and LifeSource presented Avera McKennan with its Workplace for Life award, in recognition of activities that raise awareness for organ donation. The Wall of Heroes will be on display for six months of the year, from October through December and April through June. ■

January / February 2015


Physicians Can Fire Patients, Too


he physician-patient relationship is created by mutual agreement between the physician and the patient. As such, the physician may terminate the relationship for any non-discriminatory reason. Valid reasons may include (but are not limited to) non-compliance with medical advice, combative or threatening behavior, or outstanding medical bills. Patient non-compliance is one of the most common reasons for terminating the physicianpatient relationship. Patients who routinely miss or cancel appointments or refuse to heed medical advice may be considered non-compliant. Non-compliant patients might be your practice’s biggest liability risk. Patients are less likely to get better when they don’t comply with medical advice, placing them at higher risk for adverse outcomes. By properly terminating non-compliant patients, you may help reduce your risk of malpractice claims. It also is appropriate for practices to terminate hostile, aggressive, or verbally abusive patients.

By Jeremy A. Wale, JD

Proper termination is important to help avoid a claim of patient abandonment. While the legal definition of abandonment varies from state to state, the following elements typically exist in a patient abandonment claim: ◆ Termination of a professional relationship between the physician and patient without good reason or at an unreasonable time;

◆ Termination occurred when the patient was in need of continuing medical care;

◆ The patient was not given reasonable notice sufficient to secure an alternate physician; and

◆ The patient was harmed as a result.1 The American Medical Association (AMA) summarizes your responsibility this way: once a physician-patient relationship exists, physicians are ethically obligated to place the patient’s welfare above all other considerations, including the physician’s own self-interest.2

Once you’ve determined it’s prudent to terminate a patient from your practice, lower the risk of a patient’s claim of abandonment or malpractice by: ◆ Evaluating the patient’s condition and rendering stabilizing care, if needed. Avoid discharging a patient during treatment for an acute condition until the treatment is finished or the condition is resolved.

◆ W hen possible, discuss the termination and your reason(s) for termination with the patient. You may conduct the conversation via telephone or in person. We encourage the physician to have this conversation with the patient. Be sure to document this discussion in the patient’s medical record. 24

Midwest Medical Edition

◆ Send a written letter to the patient confirming his or her termination from the practice. We suggest sending the letter by both regular mail and certified mail with return-receipt requested. If you choose to include the reason for termination in the letter, be sure you are objective and tactful in your choice of words.

We suggest you include the following: A specified period of time during which you will continue to provide care. The AMA suggests at least 30

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days’ notice; however, there is at least one state that requires at least 60 days’ notice. Review your state’s laws before you terminate a physician-patient relationship.

A statement encouraging the patient to find another physician as quickly as possible. Referral services to aid the patient in finding another physician. These

services may include the local medical society or the state board of medicine.

Information on how the patient can get a copy of his or her medical record. You may want to consider

including a release-of-records form to make this process easier.

A signature. We encourage the terminating physician to personally sign the letter and retain a copy of the letter in the patient’s medical record. We also encourage you to contact any third-party payer or managed care provider that may be involved in the patient’s care. Some third-party

payers and managed care providers have specific contractual obligations you must follow prior to terminating one of their covered patients. ■

At MMIC, we believe patients get the best care when their doctors feel confident and supported. So we put our energy into creating risk solutions that everyone in your organization can get into. Solutions such as medical liability insurance, clinician well-being, health IT support and patient safety consulting. It’s our own quiet way of revolutionizing health care. To join the Peace of Mind Movement, give us a call at 1.800.328.5532 or visit

1 A merican Medical Association. Ending the patient-physician relationship. 2013. Accessed August 25, 2014. 2A merican Medical Association, Code of Medical Ethics Opinion 10.015. Jeremy Wale is an attorney and Risk Resource Advisor with ProAssurance, a national provider of medical professional liability insurance and risk resource services. Copyright © 2014 ProAssurance Corporation. Used by permission.

January / February 2015


More Research Validates the Benefits of Hospice CMS Urged to Reimburse Providers for Discussing End-of-Life Options New research published

in the Journal of the American Medical Association reinforces the benefits of hospice care for patients with cancer facing a poor prognosis. The study, led by Dr. Ziad Obermeyer, a physician at Brigham and Women’s Hospital in Boston, found cancer patients in hospice are less likely to be hospitalized, to be admitted to the intensive care unit, or to undergo invasive procedures. The study included data from nearly 40,000 Medicare patients with cancer who died in 2011.


The study also concludes that healthcare costs in the last year of life were about $9,000 lower per hospice patient. Furthermore, nearly 75% of non-hospice patients in this study died in hospitals or nursing homes, compared to 14% of hospice patients. The authors say their findings highlight the need for frank discussions between physicians and patients about realistic expectations for care at the end of life. Hospice of Siouxland advocates that physicians have frank discussions with patients about

goals of care for end of life and determining treatment options that best meet their goals. “Documenting end of life wishes through advance directives and communication with family members are extremely important to assure the patient’s goals are known and respected,” says Linda Todd, Executive Director of Hospice of Siouxland. The National Hospice and Palliative Care Organization has long supported reimbursement to physicians for facilitating these kind of advanced planning discussions, which is also a key recommendation from the Institute of Medicine in its report “Dying in America”. NHPCO also advocates for concurrent care, a model of healthcare delivery that would not require patients to forgo all curative treatment in order to access hospice services. “We know that many people access hospice care too late to fully take advantage of all this team-based, patient and family-focused model of care can offer,” says J. Donald Schumacher, PsyD, President and CEO of NHPCO. “While patients with cancer still make up more than a third of all those cared for by hospice providers, their lengths of stay in hospice are among the shortest.  This points to the desperate need for clinicians treating cancer to have conversations about palliative care and hospice.”

The publication of this new research in JAMA follows on the heels of the Institute of Medicine report, “Dying in America” and recommendations from the American Medical Association to the Centers for Medicare and Medicaid Services regarding the activation of reimbursement codes to allow Medicare to pay for such conversations. In recent weeks, CMS indicated that the agency intends to solicit additional comments from the public. In the meantime, advance care planning

This points to the desperate need for clinicians treating cancer to have conversations about palliative care and hospice.

discussions are only reimbursable during the initial ‘Welcome to Medicare’ preventive visit but not for any subsequent annual visit. “The hospice community continues to be disappointed in Medicare’s lack of leadership in this area,” says Schumacher. It defies reason that reimbursement is not available for physicians to take the time for these vital and delicate discussions later on.” ■

Midwest Medical Edition

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SANFORD CANCER CENTER Currently enrolling patients into KEYNOTE 055, a new clinical trial for refractory head and neck cancer. Led by Sanford Health oncologist Steven Powell, MD and otolaryngologist John Lee, MD, KEYNOTE 055 is studying the investigational drug, pembrolizumab (MK-3475). Eligible refractory head and neck cancer patients will receive pembrolizumab every three weeks, and may continue for up to 24 months. Referral consults are available over the phone.


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January / February 2015


Clinical Spotlight

Omaha Gastroenterologists Monitor Pediatric Fecal Bacteriotherapy Research Gastroenterologists at Children’s Hospital & Medical Center in Omaha, Nebraska, are keeping a watchful eye for new research that further demonstrates the specific advantages of fecal bacteriotherapy (transplantation) in treating recurrent Clostridium difficile infections and other bowel disorders in children. “Right now, the pediatric data we have on the therapy is very slim,” says Children’s pediatric gastroenterologist Pablo J. Palomo, MD, Children’s Specialty Physicians and Assistant Professor, Gastroenterology at UNMC College of Medicine. “It’s still one of the new kids on the block.” Clostridium difficile infection (CDI) is a sporeforming, obligate anaerobic, Gram-positive bacillus acquired from the environment or by the fecal-oral route. According to the American Academy of Pediatrics, C. difficile is the most common cause of antimicrobial-associated diarrhea and is a common healthcare-associated pathogen. Clinical symptoms vary from asymptomatic colonization to pseudomembranous colitis with bloody diarrhea, fever and severe abdominal pain. “Bacteria exist in our gut for our state of health and state of disease,” Dr. Palomo says. “When there is an imbalance, our body can be susceptible to illness. C. difficile takes over when there is a significant imbalance in our healthy bacteria.” Some data suggest more children are acquiring C. difficile infection and at an earlier age than previously thought, which Dr. Paloma says makes news of any new treatment — or an application of an existing adult treatment like fecal transplantation — worth monitoring. A study last year in Clinical Infectious Diseases indicates that although CDI in children remains uncommon, the authors noted a more than 12-fold increase in cases from 1991 to 2009.


young child,” the study’s authors wrote. They concluded that fecal transplantation should be reserved for complicated cases of CDI that fail conventional therapy “until randomized studies can confirm the safety and effectiveness of fecal bacteriotherapy in children.” In 2013, the New England Journal of “In treating C. difficile, the first regimen Medicine published the results of a study is antibiotic therapy,” Dr. Palomo says. “In (Duodenal Infusion of Donor Feces for Recurrent Clostridium difficile) conducted the majority of cases, antibiotics work, but on 16 patients with recurrent CDI that found how we deliver them and for how long may fecal transplantation “was significantly more vary and need to be adjusted.” Fecal specimens from healthy donors effective” than the use of vancomycin. “Because the were first used Food and Drug as a treatment C. difficile takes over for adults in when there is a significant Administration has 1958. Delivered issued concerns imbalance in our healthy via enemas, the that fecal bacteriofecal microbiota therapy involves bacteria was administransplanting living organisms into a living recipient, even tered to critically ill adult patients with in adult practices it remains a second-line pseudomembranous colitis caused by C. difficile. A 2010 case report in Pediatrics treatment, not first line,” Dr. Palomo says. (titled Fecal Bacteriotherapy for Relapsing “At this point in time, we are still in the early stages of assessing bacterial therapy and fecal Clostridium difficile Infection in a Child: A Proposed Treatment Protocol) noted success transplantation as pediatric treatments. administering fecal bacteriotherapy via a “In the meantime, I think we will contemporary nasogastric tube to a 2-year-old tinue working toward a greater understanding of how we can modify the immunological child. The case “demonstrated for the first time system and manipulate it to our advantage, that fecal transplantation is practical and rather than hammering it hard and trying to effective for treating relapsing CDI in a suppress it.” ■


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January / February 2015


The Nurses’ Station Nursing News from Around the Region

USD nursing degree to be expanded at Capital University Center

Avera McKennan Earns Prestigious Magnet Recognition Avera McKennan Hospital & University Health Center has again attained Magnet recognition from the American Nurses Credentialing Center. This voluntary credentialing program for hospitals is the highest honor an organization can receive for professional nursing practice. “Our achievement of this credential for the fourth time underscores the

A bachelor of science in nursing degree will be offered by the University of South Dakota at Pierre’s Capital University Center starting in 2016. USD officials say the expanded program corresponds with a growing demand for more highly-trained nurses. “By bringing BSN education to Pierre, USD Nursing is making a statement that the healthcare of rural South Dakota matters,” said Carla Dieter, chair of USD Nursing. USD currently offers a two-year associate nursing degree at CUC and will admit their last associate degree student in fall 2015. CUC and USD Nursing staff will work closely with all current and

future students during the transition. USD Nursing’s BSN degree consists of 120 credits that include theory, laboratory and clinical courses and experience. The curriculum is highlighted by interprofessional preparation, an advanced instruction for nurses and other healthcare students that highlights interaction with other professions. The program was fully accredited in 2012, and other four-year nursing programs are available at the USD campuses in Vermillion, Sioux Falls and Rapid City. For more information, please contact Janelle Toman, Ed.D., CUC Executive Director, (605) 773-3025 or email: ■

foundation of excellence and values that drives our entire staff to strive harder each day to meet the healthcare needs of the people we serve,” said Judy Blauwet, Chief Nursing Officer and Senior Vice President for Hospital Operations at Avera McKennan. Out of 6,000 U.S. hospitals, Avera McKennan is one of 403 to be Magnetrecognized and one of only 26 to be recognized for the fourth consecutive time. In 2001, Avera McKennan was the 36th hospital in the nation to earn Magnet status. Redesignation was earned in 2005, 2010 and now in 2014. ■

Find out how advanced education is putting some nurses on the forefront of primary care. Log on!


The Sanford Children’s Boekelheide Neonatal Intensive Care Unit recently received the DAISY Team award. The team includes Bev Jorgenson, APP-RN, Gail Jamison, Social Worker, Pat Dysthe, CCC, RN, Kathy Schweitzer, DNP, CNP, Director NICU NNP’s, Dr. David Munson, Sheri Fischer, MS, RN Director, NICU, Donna Edwards, CCC, RN, Aimee Brodkorb, RN, and Deanna Stoll, APP-RN. ■

Midwest Medical Edition

Winter DAISies Critical


s ou th dakota sym p h ony orch estra


Jennifer Toates was nominated for the Daisy Award by the family of a 28-year-old woman who was admitted to Sanford for cardiac arrest. The family praised Toates for explaining what she was doing, answering questions, and advocating for the


patient and her family. Her critical care unit teammates call her “a great patient advocate, kind and caring.” Sanford nurse Kori

Peterson, a full time RN in the Brith Place since 2008, was taking a bike ride on in August when she came across a man having a heart attack. Petersen did active CPR until an ambulance could arrive to take over. Due to this successful CPR this man, who is a Sioux Falls city employee, has a great prognosis.

Kyrsten Anderson, RN, BSN, BS, received the October DAISY Award at Rapid City Regional Hospital (RCRH). She has been an RN on the third floor Medical-Surgical/Rapid Admissions Unit for just over one year. The daughter of a patient who has had several lengthy admissions to the hospital in the past year nominated Anderson, saying, “She treated my mom with dignity and Kyrsten’s interactions with physicians only enhanced my

Mozart’s Piano Concerto No. 23 saturday, january 10 at 7:30 pm

Strauss’ Don Quixote saturday, january 24 at 7:30 pm

The Music of Andrew Lloyd Webber, Stephen Sondheim, and More! saturday, february 7 at 7:30 pm sunday, february 8 at 2:30 pm

mom’s care.” DAISY is an acronym for “diseases attacking the immune system.” The DAISY Award has grown into an ongoing recognition program in partnership with healthcare organizations, now in seven countries, celebrating the extraordinary skill and compassion nurses bring to patients and families every day.

January / February 2015

CALL FOR TICKETS (605) 367-6000


Photo courtesy USF Pictured (L-R): Kyle Torkelson, Annette Goettsch and Dr. Walt Carlson.

Ready for Something

Completely Different? If you are like most practicing medical professional, you probably assumed that you were done with school when you completed your medical education. But a growing number of providers are finding out, in this rapidly changing healthcare environment, that additional schooling can give them an edge they need to be more effective in business and in medicine. How does a busy practitioner make it happen? We asked Dr. Walt Carlson, a Sioux Falls orthopedic surgeon who recently completed his Healthcare MBA at the University of Sioux Falls. What prompted you to pursue your MBA? WC: First, I thought it would enhance my skill set. We run our own practice and I have always enjoyed the business side of that. Also, I was asked to serve on a bank board and I realized after the first meeting that I did not really recognize their language as well as I would have wanted to. And finally, I was uncertain what I might do when I am no longer an orthopedic surgeon. So I thought this could open new opportunities for an ‘encore career’ down the road.


What was the biggest challenge of the program for you? WC: Learning the technology was really the most challenging part for me. I was an English minor, but business writing was new to me. For me to get involved in writing and using the computer and technology in a business setting required me to learn a new set of skills there. What would you say was a highlight of the program? WC: One of the biggest highlights for me was the opportunity to get to know my younger classmates. It was fun to hear their thoughts on various issues and I think they enjoyed my approach, as well. The classes are very diverse, so it was a learning experience for all of us. How much time did the program take and how did you fit it in with your practice schedule? WC: I estimate that it probably took about 20 hours a week outside of my normal life to get the work done. Some classes require more time than others and you get out of it what you put into it. I spent many a Saturday and

Sunday doing research and I spent a couple of vacations writing papers. But I think it has real benefit for physicians who want to know more about business and communication. Do you think the program has helped you in your practice? WC: Absolutely. I use things I learned and the insights I gained in this program every single day, in meetings I attend as well as in interactions with patients and staff. My approach to business meetings, and my ability to communicate, is totally different. I used to look at business communication as something that was black and white, but, after going through the program, I now see it in high definition Technicolor.

Editor’s note: Not only did Dr. Carlson complete the USF MBA in Healthcare program, but he was recognized with an Academic Achievement Award. “The old guy did it!” he says. More information can be found on the website at

Midwest Medical Edition

The History of Citizen Eco-Drive Watches The Citizen Eco-Drive movements were introduced into the United States in 1996. A new concept in quartz movements, Eco-Drive is a watch that is fully fueled by both indoor and outdoor lighting. In early designs, a rechargeable cell was mounted under the dial itself, but was visible to the consumer. In 2002, Citizen came up with a dial so opaque that you could no longer see the power cell itself. This was mounted directly under a dial sufficiently translucent to allow energy to be absorbed but no longer visible. The storage capacity on the Eco-Drive when fully charged can run in the dark up to 6 months before a light source is needed to recharge the cell. In the early 2000s, while wristwatch sales declined with the advent of cell phones and their timekeeping capability, demand for Citizen watches in North America remained robust. In 2009, the Citizen model 2011 was introduced under the name of Eco-Drive Satellite Wave. This model has a movement that receives a synchronization signal nightly from GPS satellites, keeping it accurate to the second. By 2011, 80% of the Citizen line was Eco-Drive and, to date, they are every bit as accurate as traditional quartz watches. By Randy Hoffman, CMW

For additional information on available Citizen Eco-Drive Watches, stop in to Riddle’s Jewelry in Sioux Falls.

January / February 2015


Wine ine

Wine Marketplace Som m elier’s cor n er

Red Wine Makes a Media Comeback

Women are drinking more red wine . . . at least the women on TV are. That’s the word from a recent article in the Minneapolis Star Tribune. According to author Bill Ward, “American popular culture always has been awash in alcoholic beverages, but seldom has the drink been wine, red wine in particular. And rarely has it been treated so specifically as a beverage primarily for women, served in oversized goblets and consumed like the after-work cocktails of previous eras.” Ward cites prime time examples from “Scandal”, “The Good Wife”, “Cougar Town” and “House of Cards”. Ward contends that the fact that red wine is used as a prop in pop culture suggests that it is still viewed as “somehow effete, foreign, or, at least, no different from any other alcoholic beverage.” Ward says, in pop culture, reds are seen as less “wimpy” than whites.

Wine Fact Women tend to be better wine testers because women, particularly of reproductive ages, have a better sense of smell than men.

Source: “Real women drink red wine”, December 14, Minneapolis Star Tribune

HIt the (Winery) Trail As you plan your spring activities, South Dakota’s burgeoning wine industry is inviting you to visit what they’re calling the “Winery Trail” for vineyard tours, tastings and special events. Eastern South Dakota distributors and vineyards features in the Winery Trail brochure include:

Prairie Berry, East Bank – Sioux Falls Schadé Vineyard – Volga Strawbale Winery – Renner Tucker’s Walk Vineyard – Garretson Valiant Vineyards Winery at Buffalo Run Resort – Vermillion Wilde Prairie Winery – Brandon

Wine to Watch

Les Hauts de Smith Pessac-Leognan 2011 White Bordeaux Tasting Notes: Smooth and subtle with a stealthy richness. On the palate it’s full of toasted nuts, almonds, brioche, buttered croissants and white flowers. Varietal: Semillon-Sauvignon Blanc Blend Region: Bordeaux, France Food pairings: Lobster, scallops or pasta with crab meat


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Learning Opportunities February — May February 6

Avera Ethics Conference

8:00 am – 5:00 pm

Location: Hilton Garden Inn Downtown, Sioux Falls Information:, 605-322-8987 Registration:

February 7

Nuclear Medicine Conference

8:00 am – 12:30 pm

Location: Prairie Center, Sioux Falls, Classroom A Information: Registration: Begins at 7:30 am March 13

8th Annual Brain & Spine Institute Conference

8:00 am – 4:00 pm

Location: Hilton Garden Inn Downtown, Sioux Falls Information & Registration:

March 26

Perinatal, Neonatal & Women’s Health Conference

7:30 am – 4:30

Location: Sanford USD Medical Center, Schroeder Auditorium Information: March 26

Avera Transplant Symposium

8:15 am – 5:00 pm

Location: Prairie Center, Avera McKennan

March 30 – April 1 USD Center for Disabilities 2015 Spring Symposium Information: Registration: April 8

7:30 am – 4:00 pm

Avera Trauma Symposium Location : Sioux Falls Convention Center

Information: 605-322-8987, Registration: April 24

14th Annual Pediatric Symposium

8:00 am – 5:00 pm

Location: Sr. Colman Room, Prairie Center, Avera McKennan Information:, 605-322-8987 Registration:

April 30

Sanford Kidney Symposium

8:00 am – 4:00 pm

Location: Sanford USD Medical Center, Schroeder Auditorium Information:, 605-328-9290 Registration: Coming soon

May 1

8:30 am – 3:30 pm

Avera Caring Professionals Conference: Nurturing the Caregiver

Do you or your organization have an event for the MED Calendar? Post it online for free through the calendar link on our home page.

Location: Holiday Inn City Centre Sioux Falls Information:, 605-322-8987 Registration:

MED reaches more than 5000 doctors and other healthcare professionals across our region 8 times a year. If you know of an upcoming class, seminar, webinar, or other educational event in the region in which these clinicians may want to participate, help us share it in MED. Send your submissions for the Learning Opportunities calendar to the editor at

The experts at Sanford Limb Preservation Center are here to consult with you regarding patients with diabetes, those at risk for peripheral arterial disease and other factors that place them at risk for amputation. This is the only comprehensive center of its kind in the region.

Our board-certified team of vascular surgeons

Patrick Kelly, MD

Chad Laurich, MD

Angelo Santos, MD

Greg Schultz, MD

JOIN US IN REDUCING AMPUTATIONS. Call (605) 312-7300 or (800) 618-3186 to schedule a consult with a vascular expert.

500-55205-0265 12/14

MED-Midwest Medical Edition-January/February 2015  
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