March 2023 MED Magazine

Page 1



Medical Documention: What Really Matters?

Community Health Workers in SD

Remarkable Recovery at Sanford Children’s

VOL. 14 NO. 2 2023 MARCH



4940 5th Street, Rapid City, SD 57701 605-755-4100


Spearfish Clinic

1445 North Avenue, Spearfish, SD 57783 605-644-4170

Jay W. White D.O., MS, HCA Rapid City Robert Burgess M.D. Rapid City Loren Jones M.D. Spearfish Jeanette Carlson CNP Spearfish
Richard Bowen M.D. Rapid City Now accepting patients in Rapid City.
Stacie Collins CNP Rapid City WELCOME TO THE TEAM RAPID CITY: Audiology & Ear, Nose and Throat

1.855.850.KIDS (5437) is your 24-hour link to pediatric specialists for physician-to-physician consults, referrals, admissions and transport.

One number is all you need to connect with the the very best newborn specialists.

Telemedicine in Motion

First Of-Its-Kind Program Keeps EMS Workers Connected in the Field

The state of South Dakota is leading the way in rural telemedicine with a $1.7 million initiative designed to connect EMS workers and emergency specialists. We explore how the program is likely to impact both patient health and the health of EMS companies.


Teen Commits to Recovery After UTV Crash

The remarkable recovery story of a young man whose legs were saved after an accident by the comprehensive care he received at Sanford Children's.

PAGE 8 | This Month Online GoRed brings in $80K for heart care, the importance of telehealth for cardiac patients, top employee awards, exclusive online articles, and upcoming spring events.


Orthopedic Surgeon Q & A: No, the Robot Doesn’t Take Over During Surgery Are your patients confused about the ins and outs of robotic surgery? In this feature, a Sioux Falls orthopedic surgeon weighs in on exactly how to talk about it.


PAGE 19 | USD School of Health Sciences Success Spotlight: Adam Ladwig, DPT

PAGE 21 | Medical Documentation

That Matters: Separating the “Signal” from the “Noise” in EHR Documentation

■ By Alan Lembitz, MD


Community Health Workers: Making A Difference Across the State


The pandemic posed significant challenges for healthcare. But it also brought with it a few gifts. The rise in acceptance of telemedicine, improvements in telehealth tech and workflows, and innovative programs like the one we are featuring on this month′s cover, are prime examples.

Other features in this issue include a deeper dive into the growing importance of community health workers to fill healthcare gaps, a local orthopedic surgeon busts some popular myths about robotic surgery, and a remarkable recovery story after an accident threatened to cost a teenager his legs.

As always, we bring you a comprehensive wrap-up of all the news from around the region in recent weeks. To see your news and announcements in this print & digital issue, as well as on, our social media channels, and in our bi-monthly digital newsletters, email us any time at

Be sure to subscribe to the VIP list at to download the digital version of this issue (and access all the past issues, too!).

All the Best,



VP Sales & Marketing



Sioux Falls, South Dakota

Vice President Sales & Marketing


Editor in Chief / ALEX STRAUSS

Staff Writer / KIM LEE

Graphic Design / CORBO DESIGN


Digital Media Director / ALYSSA MCGINNIS



Editor in Chief





PO Box 90646, Sioux Falls, SD 57109

MARCH 2023
Nov 10
10 APRIL/MAY March 10 JUNE
NEXT ISSUE Editorial contributions due March 5 Ads due March
Cover Photo Alex Rodriguez, EMT, with Dell Rapids Community Ambulance Service, the first pilot site for Telemedicine in Motion. Photos courtesy Avel eCare.


MARCH Midwest Medical Edition 5

Teen Commits to Recovery After UTV Crash

T WAS MEMORIAL DAY WEEKEND in 2021 when Landyn

His parents, Judd and Daisy Keiser, recall what happened that day in their hometown of Fordyce, Nebraska.

“He had taken our UTV, it had tipped over into a gulley, (Landyn) fell out and the roll bars pinned him face down behind his knees,” Landyn’s mom Daisy Keiser explained.

Landyn, 13, lay there for 45 minutes before she could find him.

“I’m a nurse,” she explained. “But I was panicking as I was trying to be in mom mode, not nurse mode.”

A medical helicopter was dispatched to their farm and based on the extent of his injuries, emergency crews determined Landyn would need more advanced care to include orthopedics and

“We met the helicopter, Sanford Health and Dr. Jared Daniel

“Landyn, unfortunately, developed compartment syndrome in both of his lower extremities,” Jared Daniel, M.D., says. “It’s one of those orthopedic emergencies where, to help preserve life and limb, you have to do something immediately.” 6


Right away, Dr. Daniel, a surgeon specializing in pediatric orthopedic trauma at Sanford Children’s Hospital in Sioux Falls, South Dakota, took Landyn to the operating room to try and treat his compartment syndrome with a fasciotomy.

“Compartment syndrome is a condition where the circulation, muscles and nerve are affected. So you want to give them more room to give them overall better function. That was just the start,” Dr. Daniel said.

With Landyn’s injuries and more than a dozen procedures came an immense amount of pain and a large collaborative team of providers.


“He was dealing with surgeries, pain from a severe infection, and nerve pain from all of the inflammation in his legs as well,” said Daniel Mark, M.D.

Dr. Mark is a specialist in Children’s Palliative Care, who helps Landyn and his family manage his pain and try to keep him as comfortable as possible.

“This pain would be something that would last for a while. So I was involved as a request to see if I could come up with some sort of plan for him that was more effective and something he could do at home,” Dr. Mark said.

“There were lots of heavy discussions. It was heart-wrenching to see his family go through all of that,” said Sarah Dorr, CPNP.

Dorr, a pediatric wound care specialist, coordinated much of Landyn’s care from the very beginning.

Landyn and his family faced their hardest decision yet: whether to salvage his legs or move forward with an amputation.

“They were very much on board with trying to do limb salvage which is our number one goal,” Dr. Daniel added.

“We got him to the point of being able to salvage his legs with the understanding that he lost most of the muscle — the muscle that could have died. That muscle doesn’t grow back. The muscle remaining can be conditioned and can be built up, but what’s gone is never coming back again,” Daisy explained.

Landyn is a big sports fan and competitive athlete in baseball, basketball and football.


His care team knew nothing was going to stop him from pushing forward.

“One of the biggest goals when I first met him was how are we gonna get him back to playing sports,” Dr. Daniel said.

“He’s a kid that would push through almost any tough situation,” Dr. Mark added.

Today, his journey continues with Sanford Sports physical therapist Josie Stockland.

“Things we’re working with through Josie are building up strength, range of motion of joints that are stiff and tight,” Dr. Daniel said.

“Are there certain orthotic devices, braces, to help with management, to help with overall function or anything in the future from a surgical perspective to improve his overall function.”

“I can see where he was to where he is now and it blows my mind what he can do compared to what the alternative could have been,” Daisy said.

“He’s walking independently, he continues to work with therapies, plays basketball, football and goes golfing with his dad,” Dorr said.


Every step of Landyn’s journey is stronger thanks to his team’s collaboration for care.

“We as surgeons are a small portion of the team. We know there’s a bigger picture. That’s the beauty of having a children’s hospital with those resources at your disposal at all times. Not every institution is as lucky as we are to have resources like that,” Dr. Daniel said.

The Keiser family is grateful for that.

“Someone was always there for us, to guide us, and we never felt alone,” Daisy said.

“Landyn operates on the philosophy of ‘can’t stop, won’t stop’, and got that from the University of Nebraska football team,” Dorr explained. “It’s something I’ve carried with me in the patients I take care of. There’s always a little piece of Landyn that walks around this castle every day.”

“Seeing the difference you can make, when everyone works together, shows you what Sanford Children’s is all about,” said Dorr. ❖

To refer a patient for specialty children’s care at Sanford Children’s, call (844) 851-1515.

Midwest Medical Edition MARCH 7


Upcoming EVENTS

March 24 - 25

SD Society of Medical Assistants State Convention Location: Sioux Falls

March 25

Prairie Lakes BASH (Building a Superior Health System) Gala, Location: Watertown

March 31 - April 1

South Dakota Society of Health-System Pharmacists Annual Conference Location: Sioux Falls

April 18

Speaking of Health: David Ansell, MD, author of The Death Gap: How Inequality Kills Location: Sioux Falls

April 19

Critical Access Hospital Conference 2023

Location: Omaha

April 20 - 22

SD Counseling Association Conference Sioux Falls

April 25 - 28

MPECC - Medicare Provider Enrollment Compliance Conference

Location: Phoenix, AZ

May 23 - 24

Telehealth Everywhere 2023 Conference Location: Minneapolis


Exclusive Online Articles

Avera Wound Care Team Adds Surgical Approach to Help Slow-Healing Wounds

Helping diabetic patients with slow-healing wounds. That’s what the Avera McKennan Hospital & University Health Center’s multidisciplinary wound-care team has done for years. This year, they added a podiatrist, Peter Bellezza, DPM, whose surgical approaches provide new options for patients with slow-healing wounds. Read all the details in this article only on the website.

Does You Practice Need an Administrative Check-up?

Eide Bailly says every office needs revenue cycle assessments and feasibility studies. Find out why is this exclusive onilne article.

Go Red Raises $80K+ for Heart Health

MED was proud to once again be a Media Sponsor of the American Heart Association’s Go Red for Women event, which took place in Sioux Falls on February 3rd. MED’s own Steffanie Holtrop, a Circle of Red member, was co-chair of this year’s event, which attracted 270 people and raised over $80,000 to support heart health initiatives in the region. This is the 19th year for the Go Red event in Sioux Falls.

Highlighting content and opportunities available exclusively at 8
Steff with (l to r) Dr. Josh Crabtree, VP of Sioux Falls Region Clinics; Dr. Tom Stys, Sanford Cardiology Medical Director & Interventional Cardiologist; Dr. Adam Stys, Interventional Cardiologist; Dr. Richard Clark, Cardiologist, and Dr. Marian Petrasko, Interventional Cardiologist Dr. Angelo Santos, Dr. Gregory Nissen, & Dr. Benjamin Jorgensen of Dakota Vascular. Dr. Thekla Bacharach, Sanford Vascular Surgery


(and other Exceptional People)

Danielle Longwell, RN Monument Health Rapid City Hospital ONS


Kathy Roti, RN Home Health & Hospice, Huron Regional Medical Center DAISY Award


Telehealth 38 Times More Common Post-Pandemic

T HE COVID-19 PANDEMIC radically changed the way healthcare professionals serve their patients. Over the past two years, a larger proportion of care has shifted to the virtual landscape as clinicians and patients search for a safe, reliable way to receive needed care.

A recent scientific statement from the American Heart Association found that the benefits of telehealth — namely, reduced costs, improved access and increased quality and patient satisfaction — are especially important for those with cardiovascular disease, which disproportionately affects people in underrepresented groups who often face barriers to healthcare access. However, the statement also noted that limitations remain on using telehealth to serve those in rural and under-resourced communities.

Jenny Reimer Huron Regional Medical Center –February Exceptional Employee

Pam Shoultz, RN Director of Surgical Services, Huron Regional Medical Center

2nd Annual Ubuntu Award

VanBuskirk, CNP Physicians Clinic 2022 Spirit of Caring Award

As telehealth use continues at levels 38 times higher than before the pandemic, the American Heart Association, the world’s leading voluntary organization focused on heart and brain health, is aiming to help healthcare professionals demonstrate their commitment to telehealth through its professional education offerings.

“Evidence suggests telehealth can transform the healthcare system, making healthcare more effective, accessible and efficient, particularly for those who otherwise lack access to quality healthcare,” says Edwin Takahashi, MD, lead author of the scientific statement and a specialist in vascular and interventional radiology and cardiac imaging at Mayo Clinic. “In addition, telehealth can help mitigate physician burnout by reducing clinicians’ drive times and allowing more time for direct patient care.”

For more about the American Heart Association’s extensive telehealth training portfolio including the CORE Concepts in Telehealth certification, Go Online to read the full article

9 Scan the QR code on this page or visit TO JOIN THE VIP LIST. FOLLOW US!


“No, the Robot Doesn’t Take Over During Surgery”


Many surgeons only use it on a case-by-case basis.


Robots might have an added benefit for younger and more active patients. However, an older adult with lower physical demands may have just as good an outcome with a traditional joint replacement surgery.

Experts of Avera Orthopedics use the latest technology and procedures to relieve ongoing knee, hip or shoulder pain. Joint replacement surgery is often supported by 3-D software and robotic-arm technology to help plan and perform surgery.

Travis Liddell, MD, orthopedic surgeon and Clinical Vice President of Avera’s Orthopedic Service Line, answers questions about 3-D and robotic technology.


The technology builds a 3-D model of the joint, helping us choose the right size of implant and plan the implant’s position within the joint. We virtually plan the surgery and maneuver around any bone deformity or defect before the patient comes in for the actual procedure.


The robotic arm is a precise cutting tool the surgeon manually operates during surgery.


Robotic technology aids in the patient’s journey by personalizing their treatment plan, enhancing the surgery-planning process, cutting smaller and more precise incisions, and reducing recovery times. However, there’s no replacement for a skilled surgeon. A good surgeon supported by the newest technology will potentially lead to the best outcome possible.


The robot is a hyper-precise instrument that makes cuts exactly where we have planned out. It’s a great tool to enhance the outcome of a patient candidate.


No, the surgeon is still the one doing the surgery. People have a perception that I’m in a back room with a joystick. No, I’m doing the surgery, scrubbed in and in the operating room.


Facing any surgery can be overwhelming, with or without robots. It’s most important to focus on expertise and experience. Here at Avera Orthopedics — with our incredible team of surgeons, surgical techs and nurses —surgery is what we’re trained to do. ❖ 10
[ SPONSORED ] Learn more about our technology and services at
11 ORTHOPEDIC CARE IS ABOUT GETTING BACK TO THE THINGS YOU LOVE. If you need orthopedic care or are trying to relieve ongoing pain, our compassionate team of experts use the most advanced technology to give you personalized, precise and minimally invasive care.
EXPERT HANDS Trust the region’s leaders in orthopedic care to keep you moving forward. The future of orthopedic care is here. Robotic-Assisted Surgery ExactechGPS® O-arm/StealthStationTM Navigation Integration Orthobiologics EOS Imaging Moving Health Forward. Call to schedule an appointment today at 605-504-1100 or visit to learn more.

PUTTING TELEMEDICINE First-of-its-Kind Program Keeps

but the technology just wasn’t there,” says Sioux Falls emergency medicine physician Tyler Price, MD, Medical Director of Emergency at Avel eCare. “But the technology has really come along. When the state announced this initiative, we felt strongly that, with our history in eEmergency, this was a natural fit. We had the infrastructure in place.”


Last November, Dell Rapids Community Ambulance Service became the first pilot test site for the new program. A smaller department with a staff of just 25, Dell Rapids Ambulance responds to about 500 calls a year in and around northern Minnehaha County and the communities of Dell Rapids, Baltic, Colton, Lyons and Crooks.

TELEMEDICINE HAS BEEN AN INCREASINGLY important part of healthcare delivery in recent years, especially in rural areas. But the pandemic catapulted the technology to new heights. The ability for physicians to connect with patients remotely, and for specialists to connect with providers in far-flung locations has truly been a game-changer.

But one group of healthcare workers in South Dakota have traditionally been unable to access the benefits of telemedicine. Emergency Medical Services, which often deal with the direst of health situations in the remotest parts of the region, were excluded from access simply because of the mobile nature of their work and the limitations of the technology.

Now, a new $1.7 million state program is changing that. Launched late last year, Telemedicine in Motion is a South Dakota Department of Health initiative in partnership with Sioux Falls-based telemedicine provider, Avel eCare. The program enables participating EMS companies to get roundthe-clock virtual access to Avel’s team of board-certified emergency physicians and nurses in real time, in the field.

“This has been something that has been discussed internally for years. People have talked about teleEMS

“We are mostly an ALS (Advanced Life Support) service, staffed by paramedics rather than EMTs,” says Director Ryan Sittig. Sittig has been a paramedic in Dell Rapids for 24 years and has served as director for half that time. He says one of the biggest benefits for a small operation like his is simply the ability to reach a physician when their own medical director is unavailable.

“In a small community in rural South Dakota, it is not always easy to connect with your medical director. That person can’t be available all the time,” says Sittig. “We have had a few cases where it has really been nice for the providers to be able to communicate with an ED physician and have a question answered, an order received, or just the confirmation that what they’re doing is correct.”

At any time, a participating EMS company can request a dispatcher to connect them with Avel EMS. Within seconds, a provider at Avel’s eHub in Sioux Falls can dial directly into a dedicated iPad installed in the back of the ambulance to connect with a live audio and video feed.

“The speaker is mounted in the rig where they prefer to have it and an iPad is mounted right inside and to the right so that we can see the patient and the crew,” says Dr. Price. “The goal is to give them access to an ER nurse or an ER physician during that first ‘golden hour’ because time is tissue.”

That access can reduce the time workers have to spend on the scene, allowing for faster transport. If it looks like a transport to a larger trauma center is needed, Avel can coordinate that, too, speeding up the process while 12
(l to r) Kate Mahmutovic, Emergency RN, Avel eCare, Becky McManus Hexom, Emergency RN, Avel eCare, & Tyler Price, MD, Medical Director of Emergency Avel eCare in the Avel eHub in Sioux Falls.

TELEMEDICINE IN MOTION Keeps EMS Connected in the Field

freeing first responders to focus on the patient. They can even provide interpretive services if there is a language barrier.

“For us on our side, this is going to give us the ability to take more complex or critical calls” says Sittig.


In phase one of the rollout, the Telemedicine in Motion initiative will outfit an ambulance at 60 of the state’s 122 EMS providers with a cabin-mounted telehealth tablet, microphones, speakers, antennas, and cellular boosters by June. Avel teams go to each site to install the technology and spend a few hours training each team to use it.

“We want to be there with them to teach the workflow and to answer questions so that everything runs smoothly when they go live,” says Dr. Price. Price remembers the frustration of working in a trauma center himself under the “old” model of eCare, trying to field emergency calls from outlying facilities while tending to his own critically ill patients.

“Now, I can actually see the people I’m working with and their patients,” he says. “It has been a marked transformation. It really feels like we are doing something that is truly affecting patient care. This is pioneering telemedicine and it’s exciting.”


To call the initiative “pioneering” is no exaggeration. Telemedicine in Motion is the first program of its kind in the country. With 16 sites connected as of mid-February and 80 calls under their belt,

both the program and the tech appear to be working as expected. Although they have briefly lost video signal for a few moments in very remote locales, Price says they have yet to lose audio.

More importantly, the program is saving time and increasing efficiency for EMS workers on the ground.

“We used it recently on a post cardiac arrest call with 40 minutes transport time to Pierre,” says Matthew Hardwick, Oper ations Supervisor at American Medical Response in Pierre, one of the largest com panies taking part in the program. Hardwick and his EMS colleagues cover a territory of more than 2,000 square miles in central South Dakota.

“We were able to reduce our time at the scene to less than five minutes and do more things in route because we had that extra set of eyes and ears and the ability to bounce ideas off of someone else,” says Hardwick, who has been a paramedic since 2008.

With dwindling numbers of volunteers and even paid staff, Hardwick predicts that response times statewide will increase, making that kind of efficiency even more important for positive patient outcomes. Additionally, the hope is that, by helping first responders feel more supported in the field, the program will also help with recruitment and retention and ensure a healthy future for South Dakota’s EMS companies.

“You can only train people so long,” says Hardwick. “You can’t be with them all the time. This provides that extra level of support, especially for newer medics. I definitely think it’s something that is going to stick around and grow.” ❖

❱ Learn more about the Telemedicine in Motion initiative on our website

Midwest Medical Edition MARCH 13
iPads installed near the ceiling in the back of the ambulance provide a full view of what's happening inside. EMS personnel can request a video call from Avel within seconds of arrival on the scene. Responders know they are not alone with support available 24/7.

News & Notes


Avera Gregory Hospital is opening a new health campus on 12 acres of land east of Gregory on U.S. Highway 18, about one mile east of the existing campus. This $39.4 million project integrates a 17-bed hospital, 30-bed long-term care center and Avera Medical Group clinic with 20 exam rooms and two procedure rooms to accommodate local providers and visiting outreach specialists. With 88,000 square feet, the new building doubles current space and accommodates the latest technology, including the hospital’s first MRI.


Barnes, MD, is the new President Elect of the American College of Physician Advisors Board of Directors. Dr. Barnes is the Lead Physician Advisor in Clinical Documentation Integrity and Utilization Review for Avera McKennan Hospital and University Health Center. She is also a system-level Physician Advisor for Avera Health and a Clinical Professor for the University of South Dakota Sanford School of Medicine as well as a practicing internist and hospitalist. Dr. Barnes has previously been the Vice President of Member Engagement for the American College of Physician Advisors.

For the fourth consecutive year, Avera Foundation was recognized by the Association of Healthcare Philanthropy (AHP) with the High Performer distinction for 2022. AHP recognizes high performance based on organizations that fall within the top 75th percentile in net returns from fundraising efforts, minus expenses. For data based on fiscal year 2021, being a High Performer in the Overall category means that Avera Foundation raised more than $23.6 million among all U.S. respondents to the AHP’s Report on Giving. Thanks to more than 18,000 benefactors, the Avera Foundation reported giving of more than $40 million in FY2021 and $46 million in FY2022.



Avera has received a $100,000 grant through the South Dakota Community Foundation’s Beyond Idea Grant (BIG) Program to further integrate behavioral health services into primary care visits in Brookings County. Brookings County is a federally designated Mental Health–Health Shortage Professional Area. Suicidality increased in 2022 to exceed the 10-year average of suicide attempts.The grant will allow training for clinicians to increase their ability to identify and refer behavioral health concerns. The grant also provides for equity training to support cultural sensitivity and referrals for Hispanic and Native American patients.

Steven Maser, MD, has been named Vice President of Medical Affairs of Monument Health Rapid City Hospital. Dr. Maser has been serving as the interim Vice President of Medical Affairs since last August. Dr. Maser is a board certified orthopedic surgeon specializing in surgery of the hand. He has been with Monument Health since January 2019 serving as Vice President and Executive Medical Director of the Monument Health Orthopedic and Specialty Hospital.

South Dakota | Southwest Minnesota | Northwest
Iowa | Northeast Nebraska
Happenings around the region 14


Robert Santa-Cruz, MD, Urologist with Monument Health Rapid City Clinic, recently reached a major milestone after he performed his 1,500th

procedure using the da Vinci robotic surgical system. Intuitive, the company that produces the da Vinci robot, presented him with an award for his achievement. Dr. Santa-Cruz had frequently used the robotic platform before he joined Monument Health and hit the ground running when he arrived in 2019. Santa-Cruz says about 80 percent of his patients who have robotic procedures go home the same day, even for major surgeries. He performed more than 240 procedures in 2022.

Monument Health recently announced three changes to its executive leadership team:

Patrick Woodard, MHA, MD, joins Monument Health as the Chief Healthcare Information Officer. Dr. Woodard is an innovative healthcare leader and board-certified internal medicine physician. He most recently served as the Vice President, Chief Digital Officer for Methodist Le Bonheur Healthcare in Memphis, Tennessee.

Robin Zebroski, MBA, has been promoted to Chief Brand Officer. She has been with Monument Health for six years. In this time she has successfully led the health system’s strategic marketing, internal and external communications, community relations and philanthropic efforts.

Tasha Frisinger, MSN, RN, CNML, has been promoted to Vice President of Nursing in the Rapid City Market. Tasha has been with the organization for 24 years, working in various leadership roles, including most recently as an Associate Chief Nursing Officer in the Rapid City Market.

Monument Health is now offering Ear, Nose and Throat services to the Rapid City community. Monument Health Audiology and ENT is located on 5th Street at the former location of Advanced ENT and Allergy Center of the Black Hills, and includes providers Jay W. White, DO, Robert Burgess, MD, Stacie Collins, CNP, and Merrill Hill, AuD. New to the ENT team are V. Richard Bowen, MD, and Mark Guy, MD.

Surgical Hospital has been ranked as the #1 Hospital in the Nation for Major Orthopedic lence by CareChex patient mortality,

patient safety, inpatient service and surgical quality, when compared to nearly 5,000 U.S. hospitals. BHSH’s orthopedic services include a Hip and Knee Center, nurse navigators, a total joint robotics program featuring Mako SmartRobotics, and minimally invasive spine surgery.


The Spine Center at Black Hills Orthopedics is celebrating the addition of two new care providers to their Rapid City and Mitchell, South Dakota locations. Joining the practice are board-certified neurosurgeons Drs. Troy Gust and Bryan Wellman, both of whom have been serving South Dakota patients for over a decade each. Dr. Gust earned his medical degree at the University of South Dakota Sanford School of Medicine and completed a general surgery internship and neurosurgery residency at The University of Kansas Medical Center. Dr. Wellman earned his medical degree from the University of Pennsylvania and completed his neurosurgical residency at the University of Iowa.



Chioma Osemwegie, MD, has joined Sanford Worthington Clinic as a pediatrician. Dr. Osemwegie attended medical school at the University of Nigeria in Enugu. She continued her education with her residency at Woodhull Medical & Mental Health Center in New York and is board certified by the American Board of Pediatrics. She specializes in newborn care, well child exams, sports physicals, minor respiratory and gastrointestinal illnesses, and pediatric asthma.

• Happenings around the region MARCH 15 News & Notes Midwest Medical Edition


Tom Clark, the new president Clark brings multiple system operations. Clark most recently served as the Chief Strategy & Growth Officer for Avera Health in Sioux Falls, South Dakota. Prior to his promotion to that role, he served as the regional president and Chief Executive Officer of the Avera Queen of Peace Hospital and the region’s four other hospitals. Before joining Avera, he held the CEO position at Bluffton Regional Medical Center and Wells Community Hospital in Bluffton, Indiana.

MercyOne opened the first and only full service urgent care in Dakota Dunes, South Dakota, on February 20. MercyOne

Dakota Dunes Urgent Care is located Just off of I-29 next to MercyOne Dakota Dunes Breast Care Center. The new urgent care offers in-person walk-in appointments, extended hours two nights a week, and weekend hours. Telehealth appointments are also available.

MercyOne Dakota Dunes Urgent Care is MercyOne’s second urgent care location. The first is located in Singing Hills. The new facility is closed on Thursdays.


The CNOS Clinic in Dakota Dunes has added occupa tional medicine to its list of service offerings with the addition of occupational medicine specialist Dr. Douglas Martin and Physician Assistant Sarah Plueger. Dr. Martin is serving as the 2022-2023 President of the American College of Occupational and Environmental Medicine and will be practicing at the Dakota Dunes Clinic location. Plueger has 10 years of experience in the market and will be practicing at the Sioux City, Iowa Clinic locations.


Adams State University and a master’s degree in Nursing in Healthcare Administration and Leadership from Capella University. She has eight years of nursing experience and first learned of Watertown in 2020 when she was a travel nurse assigned to the Cardiac Cath Lab at Prairie Lakes. Bluel replaces Leah Le, who was the Director of Cardiology for the past 10 years and is transitioning to the Director of Specialty Clinic.

Prairie Lakes Healthcare System (PLHS) was recently named one of the top 20 rural and community hospitals in the country. This is the sixth time PLHS has received this recognition since it was introduced by The National Rural Health Association (NRHA) seven years ago. The determining factors for the top 20 rural and community hospitals are based on eight indices: inpatient market share, outpatient market share, quality, outcomes, patient perspective, cost, charge, and finance.


John Allen has been named President and CEO of Prairie Lakes Healthcare System in Watertown. Allen replaces Paul Macek, who was hired in August 2021 as Interim CEO to assist with the recruitment of a permanent CEO. After earning his BA from Concordia College in Moorhead, Minnesota, Allen went on to complete an MBA with a focus in finance from the University of Minnesota Carlson School of Management. Allen is relocating to Watertown from Boise, Idaho, where he served as the System Vice President, Enterprise Planning and Decision Support for St. Luke’s Health System, the largest not for profit health system in Idaho, incorporating eight adult and pediatric hospitals.

Gilbertson who was recently appointed to the Vice President of Human Resources. Bruning holds an MBA from the University of South Dakota and has been with Prairie Lakes for the past six years serving as an accountant for three years and most recently as the Payroll and Benefits Specialist within the HR Department. A native of Watertown, Bruning worked as the Clinic Administrator at Prairie Eye Clinic in Vermillion for 17 years prior to coming to Prairie Lakes.

Happenings around the region 16


Prairie Lakes Healthcare System has named Jan Hansen as the new Director of Dialysis for the Watertown, Sisseton, and Ortonville Kidney Dialysis Units. Hansen grew up in Mitchell and earned her nursing degree at SDSU. Hansen has more than 20 years of nursing experience with eight of them being in dialysis and five of them being in leadership roles.


Prairie Lakes Dermatology is now providing outreach to Sanford Health Brookings Clinic in Brookings twice a month. Prairie Lakes Dermatology specialists, Dr. Jeffrey Smith and Abby Gietzen, PA-C, specialize in general dermatology, surgical dermatology, cosmetic and laser treatments, and contact dermatitis. In addition to seeing patients at the Prairie Lakes Specialty Clinic in Watertown and Sanford Health Brookings Clinic, they also provide outreach services to Huron and Milbank.

astigmatism up to 1.5 diopters. It can help correct astigmatism and irregular astigmatism and is also an option for patients with other corneal conditions, such as keratoconus.


Vance Thompson Vision will expand its services with the addition of fellowship-trained ophthalmologists Jed Assam and Zachary Keenum. As an expert in the retina, Dr. Assam can treat macular degeneration, retinal detachment, diabetic retinopathy, and all other conditions that decrease retinal function. Dr. Keenum is a specialist in oculoplastics for the eyelids, eyebrows, forehead, cheeks, orbit, or lacrimal system. Both doctors will join the surgical team this summer.

❱ Intrigued by something you’ve read here? Want to go deeper? Read the full versions of these and other recent news items on our website.


In just one 3 oz. cooked serving, you’re getting 10 essential nutrients including protein, zinc, iron and B vitamins. Scan here to learn more about beef’s nutritional benefits.

• Happenings around the region 17 News & Notes Midwest Medical Edition
C M Y CM MY CY CMY K ai1673551746105_MARCH MED approve.pdf 1 1/12/2023 12:29:09 PM

Now Offering

Occupational Medicine

Exams, Consultations and Evaluations

CNOS is excited to welcome Dr. Douglas Martin and Sarah Plueger, Physician Assistant to our team. The additions expand CNOS’s list of health services to best serve the workers and workforce of Siouxland.

Four nurses from Spencer Hospital in Spencer, Iowa are among the 78 nurses from across the state who are being recognized as 2023 Great Iowa Nurses for their contributions to the nursing profession.

the basis of demonstrated service to patients, leadership, and mentoring or serving as a role model. The four nurses recognized this year are Birth Center nurse Roxanne Warburton , Med/ Surg nurse Lindsey Kelleher, Clinical Educator Kylee Zinn , Jessica Dirks in Clinical Informatics.



Deepali Shah, MD, Internal Medicine, and PA-C Miranda Nygaard are new providers at Brown Clinic.


• Injury Care Consultations

• Social Security Disability Evaluations

• Specialty Physicals (Immigration, FAA, FMCSA)

• Post-Job Offer Evaluations

• Independent Medical Exams

• 2nd Opinion Evaluations

• OSHA-required Regulatory Exams

• Fitness for Duty Evaluations

We’re excited to add Occupational Medicine to our care line and welcome physician referrals, workplace referrals and new patients.

REFER TO 605-217-2667, OPTION 7. CNOS.NET

received her BS degree at The University of Toronto and was awarded her MD from the Avalon University School of Medicine in Curacao. Her residency in Internal Medicine was completed at Howard University Hospital in Washington, D.C., where she also did her residency.

Miranda Nygaard, PA-C , earned her Bachelor of Science in Health Sciences from the University of South Dakota and her Master of Science in Physician Assistant Studies in 2022 from the University of North Dakota.

Happenings around the region 18
Douglas Martin, MD Sarah Plueger, PA-C Warburton Zinn Kelleher Dirks

Brown Clinic recently enhanced their overall imaging services at the Northridge Clinic location with the addition of a Canon Advantage Orian MRI. This cutting-edge technology will offer patients an improved patient experience with reduced noise, a wider bore aperture for enhanced comfort, and increased resolution

Adam Ladwig, DPT

Degree: PhD In Health Sciences

Current Position:

Assistant Professor, USD Department of Physical Therapy

Huron Regional Medical Center has launched a new Healthcare Information Technology apprenticeship program. The Healthcare IT apprenticeship is designed to teach the major disciplines of IT that specifically pertain to a hospital. Apprentices will complete four cycles of paid, on-the-job training within the information systems department, working alongside current experienced employees. HRMC has established registered apprenticeship programs in nursing, surgical technologist, youth certified nursing assistant, and respiratory therapy. HRMC added the healthcare IT apprenticeship thanks to a $10,000 grant from the Department of Labor and Regulation.

Even before DPT Adam Ladwig started school to become a physical therapist, he knew that he wanted to eventually teach. Getting offered a position in the Department of Physical Therapy at the University of South Dakota School of Health Sciences was not only a dream come true, but it was also the impetus he needed to take his education to the next level.

“When I joined the faculty at USD, I knew I needed to up my game,” says Ladwig. “It’s not a requirement to have a PhD but it can open doors. It gives you an experience that can translate into being a better teacher.”

As the father of four small children (one of whom was born while he was working on his dissertation), Ladwig knew he needed a highly flexible program, but one that would also challenge him and help him hone his skills as a scholar and researcher. The School of Health Sciences PhD in Health Sciences program proved to be the perfect choice.

“Without a doubt, my understanding of research and scholarship improved tremendously,” says Ladwig. “But what surprised me the most was the impact that this program had on my leadership skills. I didn’t expect those classes to challenge the way I think of myself as a leader but they absolutely did.”

When the pandemic hit in the middle of his program, Ladwig elected to focus his dissertation on adult education through the lens of online learning. He has now published two studies on the subject and has submitted a third for publication.

“The PhD program really helped me realize what my strengths are and understand how to capitalize on those in the way I act as a leader and the way I teach our young adults here,” he says.

Huron Regional Medical Center is building a $2.45 million dialysis expansion project. The project will relocate HRMC dialysis to an easy-to-access, one-level treatment unit at 142 Third Street SE when complete. The renovated unit will increase the capacity from seven to twelve treatment chairs. The new unit will also feature a water system with an automatic backup to ensure that dialysis can continue locally if part of the system fails. The project is expected to be complete this summer.

This SUCCESS SPOTLIGHT brought to you by:

• Happenings around the region MARCH 19 News & Notes Midwest Medical Edition

Brookings Health System’s Wound Center invited the public to participate in a sock drive in February. Wound experts say numerous health problems can result from not having or wearing socks, including friction, frostbite, and neuropathy. “Socks are one of the most requested items in the winter for those less fortunate,” said Katie Jones, CNP, one of the medical providers at Brookings Health System’s Wound Center. Socks donated during the “Every Sole Deserves a Sock” drive were donated to the Salvation Army of Brookings.

Brookings Health System’s rehabilitative services now offers blood flow restriction (BFR) therapy, a rehabilitative technique that helps patients repair and strengthen muscle and bone while performing low-intensity exercises. BFR uses a specialized tourniquet cuff that restricts blood flow by 50 to 80% to create a positive muscle growth response in a leg or arm. BFR works well for patients who cannot bear weight after surgery or an injury as well as patients with limitations due to chronic weakness or osteoarthritis.


Avel eCare, a provider of clinician-to-clinician telemedicine services, has acquired NightWatch, a West Virginia-based company that provides remote pharmacy services to hospitals, clinics and nursing homes throughout the Midwest and mid-Atlantic region. During the past few years, Avel eCare has witnessed an increase in demand for remote service across all service lines, including pharmacy. With a team of U.S.-based, hospital-trained pharmacists available around the clock, NightWatch delivers a reliable solution to help alleviate the pressure on pharmacists by filling gaps in coverage and providing other critical support to hospitals, outpatient pharmacies and hospice facilities.


As your premier medical liability insurance carrier, you can trust us to put our expertise and agility to work on your behalf. Our claims support helps you confidently manage unexpected outcomes and preserve patient relationships. We protect and guide you each step of the way. That’s Value Beyond Coverage.

The University of South Dakota’s nursing graduates rank higher than most in South Dakota and the United States when it comes to board exam pass rates. 94.12% of USD’s nursing students taking the 2022 NCLEX (National Council Licensure Examination) passed, which is the second-highest average among BSN programs in the state and the highest from a public university. According to the South Dakota Board of Nursing, the average NCLEX pass rate of all nursing program graduates in South Dakota was 86.7% in 2022, compared to the national average of 79.9%. USD Nursing graduates have consistently tested above the national average, with pass rates between 90.57% and 95.38% over the past four years and enjoyed a 100% job placement rate in 2021.

Happenings around the region 20 CALLCOPIC.COM | 800.421.1834

Medical Documentation That Matters

Separating the “Signal” from the “Noise” in EHR Documentation

In the last 20 years with the institution of electronic health records (EHRs), the time it takes to complete medical documentation has gotten longer and longer. It’s not unusual to see a short and routine emergency department visit for an ankle sprain result in a multi-page note.

But more documentation isn’t necessarily better. In fact, studies demonstrate how current medical documentation includes a lot of “noise,” without necessarily identifying the key “signal” that is important.

There are several reasons for medical documentation, but this article will focus on the following:

Documenting the services, thought processes, and recommendations to determine that the provider was practicing within a reasonable scope of practice when complaints at the licensing board or legal liability actions arise.


Detailed documentation of informal and curbside consultations by both the requester of the consultation and the provider of it are often missing or inadequate. The documentation should include the information conveyed, the decisions made, and who was assigned responsibility for the patient’s

care, now and in subsequent follow-up.

Incidental findings require someone to “close the loop” with the patient about the nature of the abnormality, including why the recommended follow-up is important and the risks of not following up.

Trusting the next clinician to provide the necessary follow-up on the incidental finding is often inadequate. Informing the patient and documenting the critical elements greatly adds to the defense when the patient alleges they were never told, and so suffered an adverse outcome such as a delayed diagnosis of a now more advanced malignancy.

When you receive critical lab, imaging, and other diagnostic findings, document what you did and what was communicated, including referring the patient for further immediate care. In legal cases viewed retrospectively, families and patients often allege that they stated something completely different than what the clinician or clinical team heard.

One documentation strategy is to specifically state the patient’s chief concerns and chief complaints verbatim and in quotes; such as “patient states (or chief complaint or chief concern)…” Recall that a chief concern is different from a chief complaint, but can provide insight into what the patient or family believes to be occurring. When their chief concern turns out to be accurate, and it was dismissed, ignored, or never heard, it can be difficult to defend the care. ❖

Midwest Medical Edition MARCH 21
Go online to read the full version of this article, including Dr.
recommendations on critical documentation for your best defense.

COMMUNITY HEALTH WORKERS (CHWS) Making A Difference Across the State

community. Moses Idris, a CHW, lived in an Ethiopian refugee camp for 10 years and his experiences have given him perspective and empathy for others. “The CHW program has a great potential to help people live a healthier life and be productive members of our community,” said Moses.

When Benny Medrano joined the Sanford Chamberlain Clinic as a CHW, he quickly completed training and integrated into the care team. Through conducting home visits, Benny has been able to be the “eyes and ears” of the home environment and shares his findings with the healthcare team. Additionally, Benny is able to address social determinants of health needs for patients, such as finding food, transportation, and even furniture.

From supporting rural patients in Chamberlain to connecting the homeless with resources in downtown Sioux Falls, to interpreting and assisting refugees and immigrants, Community Health Workers (CHWs) are making an impact across South Dakota.

As one of the last states to introduce the CHW role, there has been tremendous growth within this role across South Dakota. Within the last year, over 120 CHWs have completed training and are currently working in clinics, hospitals, and community-based organizations.

A CHW is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the worker to bridge the gap between

communities and health/social service systems and improve the quality and cultural competence of service delivery.

The Avera Community Health Resource Center hired and trained 6 CHWs to help clients connect to jobs, as well as healthcare and other social services in the Sioux Falls

At Union Gospel Mission, Rochelle Williams, CHW, assists clients in navigating the complex process of finding affordable housing in the Sioux Falls Area. She works with clients to navigate the process of applying for housing and works with clients to address other social determinants of needs as they navigate from being homeless to housed.

These CHWs join over 85 Community Health Representatives (CHRs) located in 10 different tribal sites where they have worked in a similar capacity for decades. CHRs play a vital role by providing transportation for medical appointments, distributing food boxes, medication deliveries, and home visits for tribal members.

More information about CHWs, CHRs, Medicaid reimbursement, and the developing workforce can be found by accessing 22 [ SPONSORED ]
“The CHW program has a great potential to help people live a healthier life and be productive members of our community.”
—Moses Idris

Working Hand in Hand: The Value of Community Health Workers (CHWs)

A Community Health Worker is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served This trusting relationship enables the worker to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery

– American Public Health Association, 2022


Health system navigation and resource coordination,

Health promotion and coaching,

Health education to teach or promote methods and measures that have been proven effective in avoiding illness and/or lessening its effects

Learn more by visiting www chwsd org

Midwest Medical Edition MARCH 23


6th Annual Monument Health

6th Annual Monument Health


Friday, March 31, 2023

Friday, March 31, 2023

8 a.m. - 5 p.m.

8 a.m. - 5 p.m.

The Monument - Rushmore Hall | Rapid City, SD

The Monument - Rushmore Hall | Rapid City, SD



This symposium will contain content beneficial to physicians/providers, athletic trainers, physical therapists, occupational therapists, chiropractors, strength and conditioning coaches, personal trainers, sport coaches and other specialty providers. Medical providers CME and CEU(s) available.

This symposium will contain content beneficial to physicians/providers, athletic trainers, physical therapists, occupational therapists, chiropractors, strength and conditioning coaches, personal trainers, sport coaches and other specialty providers. Medical providers CME and CEU(s) available.

BOC: Credits coming soon.

BOC: Credits coming soon.

CME: Credits coming soon.

CME: Credits coming soon.

NSCA: Credits coming soon.

NSCA: Credits coming soon.


Visit for event updates and information about the agenda, accommodations and registration. for event updates and information about the agenda, accommodations and registration.

Turn static files into dynamic content formats.

Create a flipbook
Issuu converts static files into: digital portfolios, online yearbooks, online catalogs, digital photo albums and more. Sign up and create your flipbook.