Meeting the Growing Need for Behavior Analysts in SD A Leap Forward for Lung Cancer Diagnostics at Sanford
Six Ways to Minimize Medical Liability Risk Meeting the Growing Need for Behavior Analysts in SD
LISTENING, LEARNING, and LEADING A Leap Forward for Lung Cancer Diagnostics at Sanford
Bill Gassen, CEO, Sanford Health
THE SOUTH DAKOTA REGION’S PREMIER PUBLICATION FOR HEALTHCARE PROFESSIONALS
MARCH
Six Ways to Minimize Medical Liability Risk
VOL. 12 NO. 2
2021
When one number connects you to the region’s best pediatric specialists, Anything can be. 1.855.850.KIDS (5437) is your 24-hour link to pediatric specialists for physician-to-physician consults, referrals, admissions and transport.
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TAKE CONTROL. WHEN IT’S TIME TO TAKE CONTROL OF YOUR HEALTH, CONSIDER ...
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VO LU M E 12 , N O. 2 ■ M A R C H 2021
Inside This Issue
CONTENTS PAGE 6 | Six Ways to Minimize Medical Liability Risk By COPIC’s Patient Safety and Risk Management Department PAGE 8 | This Month Online
New lung cancer diagnostic technology in Sioux Falls and 8 reasons to be a MED VIP PAGE 12 | News & Notes
[ on the cover ]
LISTENING, LEARNING, AND LEADING:
BILL GASSEN, CEO, SANFORD HEALTH
■ By Alex Strauss
Sanford CEO Bill Gassen takes the helm at the health system at one of the most challenging times in its history. Here is what he has learned from listening to his employees, and how he plans to lead them into the future. PAGE
10
A comprehensive roundup of medical community news including new staff members, certifications, awards, expansions, and more. PAGE 18 | Putting the 'Success' in
Succession Planning Without a succession plan, one unforeseen event could derail your plans to sell your business. PAGE 19 | Sioux Falls Physician Diagnoses Autoimmune Hepatitis in Association with COVID-19 Sanford doctor is first to document rare and unusual post-COVID condition PAGE 20 | New Behavior Analyst Program Will FIll a Care Gap in South Dakota New BCBA program has been a long time coming. PAGE 22 | Prairie Lakes Healthcare System Opens Walk-In Clinic for Young Athletes
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wenty-twenty was a year of major change for everyone in healthcare and nowhere more so than at Sanford Health. The health system not only faced the challenges of providing care during a global pandemic, but they also faced major changes in leadership. For this month’s cover feature, we sat down (virtually, of course) with Sanford’s new CEO Bill Gassen to discuss his new role, his goals for Sanford, and leading the way in uncharted waters. Also in this issue, we talk to the people behind South Dakota’s new behavior analyst certification program, which aims to fill a major gap in behavioral healthcare for the state. We also have a Sanford doctor’s case report of a rare secondary illness in a COVID-19 patient and a new clinic for young athletes in Watertown. Remember, to read every issue of MED Magazine weeks before it comes out in print, join the VIP Email list for free at MidwestMedicalEdition.com. Until next month, Alex and Steff
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Six Ways to Minimize Medical Liability Risk BY COPIC’S PATIENT SAFETY AND RISK MANAGEMENT DEPARTMENT
W
HEN IT COMES TO MEDICAL LIABILITY
and the next provider to see the person, as well as any
risks, you can never overemphasize preven-
personnel responsible for discharge (if it’s at a hospital).
tion. The best way to avoid adverse outcomes
In addition, make sure your EHR system enables noti-
is implementing measures that prevent them
fications for any abnormal findings, so that every
from happening in the first place. Read on for a list of
member of a patient’s care team will receive an alert
six ways to be proactive and minimize your liability.
when opening the patient’s medical record.
1. E RR ON THE SIDE OF OVER-COMMUNICATION WITH PATIENTS
PRACTICE PROVIDERS (APPS)
Physicians should understand supervisory require-
A common culprit of adverse outcomes can be insuffi-
ments, such as what qualifications need to be reviewed
cient communication. For example, some medical
and how often, as well as what documentation needs
liability lawsuits allege that significant incidental find-
to be in place. One recommendation is to create a spe-
ings never got communicated to patients. Always make
cific list for which treatments and procedures require
sure to directly communicate to patients the results of
direct oversight and which don’t. It’s important to
any image or test, as well as any recommended fol-
review this list on a regular basis, making sure to
low-up. Take the time to determine the patient’s
include and account for new technology and medical
expectations and desired outcome, summarize the
advances. And since state licensing boards for APPs
conversation, and assess the patient’s understanding.
dictate rules and regulations for compliance, make sure
In addition, make sure to conduct those conversations
to stay apprised of your state’s policies.
yourself, instead of assuming that the discharge nurse or another staffer will do it.
2. ENSURE EFFECTIVE PATIENT HANDOFFS
6
3. A PPROPRIATELY SUPERVISE ADVANCED
4. T HOROUGHLY DOCUMENT PATIENT COMMUNICATION IN THE MEDICAL RECORD
When you’re busy and moving from one interaction to
To avoid miscommunication in patient handoffs, adopt
the next, making the time to note everything important
two critical habits. First, if you come across anything
is one of the biggest challenges of modern medicine.
notable in an examination or test, make sure to assume
In the effort to keep up, it’s easy to forget to include one
the responsibility for telling the patient’s care team
of the most crucial pieces of any case: the why. Not only
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do you need to capture what you recommended, said, or did, but you also need to document why you recommended, said, or did it. Always remember to include your thought process when you’re updating a patient’s medical record.
5. U SE BEST PRACTICES FOR DEALING WITH NON-ADHERENT PATIENTS
When patients seem resistant to following your advice, try to find out where they’re coming from in a curious, non-judgmental way. Do they not understand the reason for what you’re recommending? Have they heard bad things about it? The more you can understand, the better chance you have of influencing their thought process and their likelihood of being proactive about their health. Since nonadherence can open you up to liability in certain cases, also make sure to take these steps to protect yourself: Note in the medical chart whenever you discuss a recommended action or treatment, why you recommended it, and any objections that the patient voiced (do this whether you’re communicating via phone or in-person). In the case of a test result that triggers a treatment recommendation or further action, explain the risk of not following through. If a patient decides against the recommended course of action in spite of that risk, consider using an “againstmedical-advice-informed refusal” form to document that a patient has arrived at a decision after thorough discussion, no coercion, and a full understanding of the risks and benefits.
By your side, and moving
FORWARD.
6. MAKE SURE YOUR ELECTRONIC HEALTH RECORD (EHR) TELLS A STORY
All too often, EHRs—with their series of click boxes and drop-down menus—provide a fragmented account of a patient’s treatment and medical status, as opposed to a clear, summarized story. Before EHRs, healthcare professionals would dictate a summary of the patient’s story and what they were thinking to share with a colleague. Now, you have to make sure that’s coming through in the boxes and drop-down
We wake up every day to serve in the towns and places you call home. We’ve expanded our innovative care, expertise and access to always keep your patients moving. Because forward is the only direction we know.
REFER TO 605-217-2667, OPTION 7. CNOS.NET
selections of whichever EHR you use. Make relevant notes wherever there’s a comment box and review each record to make sure the most important information is clear. In addition, be judicious when using “copy” and/or “paste” and carefully edit and remove irrelevant or unintended content. ❖
March 2021
7
THIS MONTH ONLINE Highlighting content and opportunities available exclusively at MidwestMedicalEdition.com
Exclusive online articles Preeclampsia May Double a Woman’s Chances for Later Heart Failure Pregnant women with preeclampsia are far more likely to develop heart failure later in life than those who don’t have blood pressure-related pregnancy complications, especially if it occurs during more than one pregnancy, new research finds.
Proper Air Flow: More Than a Comfort Issue
Protecting Your Assets with Long Term Care Insurance
Proper airflow is much more than a comfort issue. Especially in healthcare facilities, where the need to slow the spread of pathogens is a critical safety concern. See if your facility makes the grade.
Long term care is one of those topics that is easy to put into the “someday” category. After all, if you are healthy and plan to stay that way, you may never need it, right? However, the facts suggest there is a good chance that you will
Paul Berger III, DO, on the Monarch Robotic Navigational Bronchoscopy Platform Recognizing that early diagnosis is the key to lung cancer survival, Sanford Health recently began using the most advanced lung cancer diagnostic technology yet, the Monarch Platform robot assisted navigational bronchoscopy. MED asked lung cancer specialist Paul Berger, III, DO, to tell us more about the new technology. MED: What was your first
reaction to getting the Monarch Platform? PB: I grew up a ‘Trekkie’, a big fan of Star Trek, and I played my share of early video games like Atari. For a guy like me, any time you can throw a robot into the equation, how cool is that? Everything those science fiction shows predicted, we are slowly moving into.
MED: How does it help with lung cancer diagnosis?
MED: How does this compare to prior robotic technology?
PB: Compared to our traditional manual bronchoscopy that we have been doing for decades, or more invasive procedures such as CT-guided biopsy through the chest wall, Monarch allows us to reach the smallest and hardest-toreach lung nodules without an incision in the chest wall.
PB: With some other non-robotic platforms, you are still basing your bronchoscopy ability on a CT, but you have no visualization and very limited control during the procedure. When I was using a different navigational bronchoscopy platform, my diagnostic yield was about 47 percent. That is for lung nodules greater than 1 cm.
MED: What makes the Monarch system so precise? PB: Not only is it robotic, but you perform the procedure after taking CT images and creating a 3D image. That image is used to guide the robotics. I have continuous vision throughout the procedure thanks to a fantastically innovative telescoping endoscope and I can see what the lung tissue actually looks like.
With Monarch, I’m able to go out into the periphery of the lung for a nodule 6 mm or greater in size and have near 100 percent diagnostic accuracy. This is an absolute game changer for patients with lung diseases that require culture or tissue for diagnosis.
the rest of our discussion of Monarch with Dr. Berger on our website. READ MORE Read
8
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9
Listening, Learning,
B
BY ALEX STRAUSS
ILL GASSEN began his career at Sanford Health in
Later, as a lawyer in Sioux Falls, I
2012 as corporate counsel and transitioned to the human
had the chance to represent hospitals
resources department two years later as vice president of
and physicians groups and eventually
human resource integration and eventually became the chief
became in-house counsel at Sanford.
human resources officer. In 2019, he was promoted to chief
That has given me a very well-rounded
administrative officer with oversight of human resources,
understanding of all facets of the
technology solutions, legal, facilities, business development
organization — clinical, non-clinical,
and the Sanford Sports Complex. He took the helm in December at a time of unprecedented challenges for the
whole blueprint. I’m also married to a
healthcare system as a whole and for its more than 48,000 workers. As he settles
physician assistant.
into his new role, Gassen wants those workers - from the front lines to the back
MED: You have spent a lot of time
offices — to know that he’s listening to them, working to understand their continued struggles, and committed to finding ways to address those struggles as an organization. We caught up with him in late January to find out how it’s going. MED: Your professional background is in the legal field. How did you get connected to healthcare and how has that influenced how you lead?
BG: My mom was a nurse. So, early in my life I got a real appreciation for what it means to serve in healthcare and especially the significance and importance of nursing. I saw the passion my mom had for her job, but I also saw firsthand what it meant for her family. My dad was in the Air Force so my mom worked straight nights so that she could be home with us kids during the day. So I really understand that our people don’t stop caregiving when they leave work.
10
hospitals, rural healthcare, and our
listening to Sanford employees in the last couple of months. What have you learned?
BG: Our caregivers have been through more this past year than at any time in history. The things that they have stepped up to do — often disregarding their own safety and wellbeing — have taken a toll on them. For much of last year, no one had any assurance as to
and Leading
Bill Gassen, CEO, Sanford Health
when a vaccine would be coming or
by our actions that we care. That is
the opportunity to move COVID-
what interventions were going to
critically important.
positive patients to locations where
work or whether we were going to
Another thing that we have heard
we could provide the best possible
see hospitalizations and death tolls
is that our employees have a desire
care for them and reserve ICU space
rising. That was emotionally draining.
to serve in their communities and
for those who needed it most. It reaf-
And they still dealt with the same
be seen as good stewards. So we
firms for me the need to be even more
challenges that the rest of us did at
recently rolled out a paid day of
rightly integrated.
home. Challenges of having sick loved
service opportunity. Every Sanford
ones, getting sick yourself, distance
employee will have an opportunity
learning for children, job loss.
to step way from their job once a year
MED: From what you have heard, what are some things that could help these workers going forward?
BG: Beyond things like mental and behavioral health services to support them while they are still in this battle,
and lean into their passions and
MED: What lasting impact do you think the pandemic will have on Sanford as an organization?
interests and serve in the community
BG: I think it will definitely change
on any day of their choosing.
us for the better as we move forward.
MED: What is one thing that the pandemic has taught the organization?
It highlighted both the things we were doing well and the things we need to do better. It showed us that there is very little margin for not being pre-
one thing that they really need is
BG: I think it has reinforced for us
pared or not being in a position to be
simply to be acknowledged and rec-
the strength of being an integrated
prepared quickly. And it has forced us
ognized and appreciated for the
system. It allowed us to bring together
to keep in mind that, when it comes
incredible work that they do. They’re
the whole sum of our resources and
to our employees, we have to take care
not asking for more money. They just
leadership to benefit the whole com-
of the whole person. We have to be
want us to know that we understand
pany. It allowed us, for instance, to
mindful that when they come in every
what they’ve gone through. And,
provide sufficient PPE to Good Samar-
day, they bring with them their respon-
when there are opportunities, they
itan Society facilities when other
sibilities outside the workplace. ❖
need us to be responsible and show
facilities were struggling. It gave us
11
Happenings around the region
News & Notes
South Dakota | Southwest Minnesota | Northwest Iowa | Northeast Nebraska
AVERA CLARISSA BARNES
The Avera Research Institute Center for Pediatric & Community Research continues to expand its exploration and impacts on communities in need with two new programs. Systems of Native Community Health (SYNCH) has been underway for three years and focuses on health disparities within complex problems such as behavioral health issues, trauma and violence, addiction, substance abuse and poverty. The second program, which goes by NOSH, began recruiting in January, is a behavioral intervention focused on reducing high blood pressure in adults. Both programs focus on populations in the Rapid City area.
12
Sioux Falls physician Clarissa Barnes, MD, is the newest member of the American College of Physician Advisors Board of Directors. Dr. Barnes is a board-certified internist who works as a hospitalist and Physician Advisor in Clinical Documentation Integrity and Utilization Review at Avera McKennan. She is also a system-level Physician Advisor for Avera Health. Barnes will serve as the ACPA’s Vice President of Member Engagement. Freeman native and nurse Courtney Unruh has been named the new CEO of Freeman Regional Health Services. Unruh earned a BS in nursing from South Dakota State University and MS in nursing from the University of WisconsinEau Claire. Prior to joining the team in Freeman five years ago, she worked as a board certified adult gerontology clinical nurse specialist at HealthEast Care System in St. Paul, Minnesota.
Freeman Regional Health Services (FRHS) and Salem Mennonite Home (SMH) have entered into a cooperative arrangement to plan for the construction and development of new healthcare facilities in Freeman, SD. Both FRHS and SMH provide affiliated senior care services. SMH delivers assisted living care and independent living. FRHS serves individuals who require skilled nursing, long-term care and congregate independent living.
TERAH SCHOENFISH Freeman Regional Health Services Surgical Coordinator Terah Schoenfish has earned her Trauma Certified Registered Nurse designation through the Board of Certification for Emergency Nursing. According to BCEN, there are only 6,074 nurses who have earned this specialty designation that recognizes the highest level of emergency nursing. Schoenfish has been with FRHS, an Avera Affiliate, for four years.
BRUK KAMMERMAN Bruk Kammerman has been named Senior Vice President/Chief Information Officer for Avera. He holds a BS in Business IT Management from Western Governors University in Salt Lake City and will complete his MBA soon.Working with senior leadership, Kammerman will play an integral role in enabling a data-driven organization and supporting strategies to improve the consumer experience through the implementation and utilization of digital technology. The following Avera McKennan nurses are recent recipients of DAISY awards: Cindy Stevens, BSN, RN Women’s Center 3 (Labor and Delivery)
Lexie Klimisch, BSN, RN Behavioral Health Center
Lauren Hill, BSN, RN Women’s Center 3 (Labor and Delivery)
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Photo caption: Mike Latour, Director of Musculoskeletal Care and Sports Medicine for Monument Health, Dr. Randy Rhine, President of Chadron State College, Mark Longacre, Vice President of Operations at Monument Health Rapid City Hospital, and Joel Smith, Athletic Director for Chadron State College.
MONUMENT
SANFORD
Monument Health and Chadron State College in Chadron, Nebraska,have created a new partnership that makes Monument Health the official sports medicine provider for the college’s athletic programs. Under the partnership, Monument Health will employ one strength-and-conditioning coach and two certified athletic trainers to work at Chadron State College. Monument Health will also provide a team physician, Brian Shelmadine, DO, to examine and treat athletic injuries. Dr. Shelmadine will also hold onsite clinic days to provide better access for the student athletes. These services will be provided at no cost to Chadron State College.
Profile by Sanford, a nutrition and lifestyle coaching brand, in collaboration with Entercom Communications, last month announced its partnership with a celebrity lineup featuring Lady A, Meghan Trainor and Emmitt Smith. The partnership includes special offers for Profile members like private virtual concerts and Q/A’s with the talent.
TRINA ALLEN Trina Allen has been promoted to Vice President of Human Resources for Monument Health. Allen holds an MS in Higher Education from Iowa State University and a BA in Public Relations and Communications from the University of Northern Iowa. She is certified by the Society for Human Resource Management and the Human Resource Certification Institute. Allen will lead a division that meets the human resource needs of approximately 5,000 physicians and caregivers at five hospitals and more than 30 clinics and specialty centers across the region.
March 2021
BHASKAR PURUSHOTTAM A research paper written by Bhaskar Purushottam, MD, FACC, FSCAI, an Interventional Cardiologist and Vascular Specialist at Monument Health Heart and Vascular Institute in Rapid City, was recently published in the Journal of Vascular and Endovascular Therapy. The paper, titled “Novel Technique to Cross Infrapopliteal Artery Chronic Total Occlusions,” discussed Dr. Purushottam’s innovative technique to open lower extremity arterial blockages in a timely and economical way.
Construction will begin on the Viborg Medical Clinic to have two separate clinic entrance lobbies and check-in areas. A separate entrance will be made for the Hospital and Ambulatory entrance, as well. Renovations are also beginning in the Nursing Home dining room area to have a more open floor plan, which will improve the flow of traffic through the Dining Room with a second main entry. The final project will be a new exit to the outside courtyard which will allow for outside private access for all skilled care residents.
LINNÉ CURTIS
JAMI SCHULTZ Two new providers have joined the team at Sanford Brandon Family Medicine and Children’s Clinic. Linné Curtis, MD, received her MD from the University of Texas in Galveston and completed her residency in pediatrics at the University of California San Francisco. Jami Schultz, CNP, moved to the Brandon clinic after serving Sanford patients at the 49th and Oxbow clinic in Sioux Falls for several years. She graduated from Clarkson College in Omaha and holds certification from the American Academy of Nurse Practitioners. Sanford Health has a new option for patients diagnosed with locally advanced breast cancer. The I-SPY 2 TRIAL (Investigation of Serial studies to Predict Your Therapeutic Response with Imaging and molecular anaLysis 2), is an adaptive platform clinical trial, created to identify successful treatments for Stage II/III breast cancer while minimizing the number of required participants and time required to evaluate the treatments. I-SPY 2 is available at Sanford USD Medical Center in Sioux Falls and 20 other leading US cancer centers.
13
• Happenings around the region
News & Notes
Happenings around the region
Manny Ohonme, founder of Samaritan’s Feet and champion for global health, has been named chair of the nine-member Sanford International Board. Ohonme moves to chair of the board after serving as vice chair for the past two years. Erin Fujimoto, the co-founder and head of merchandising for Tommy John, and Micah Aberson, executive vice president of Sanford Health, have been named to the board.
O u r F a v o r i t e S p r i n g
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UnityPoint Clinic Pediatrics–Sunnybrook is celebrating one year of service in Siouxland. UnityPoint Clinic is part of UnityPoint Health which also includes UnityPoint Health–St. Luke’s and UnityPoint at Home. Since opening in January 2020, UnityPoint Clinic Pediatrics has expanded to welcome Ashley Knapp, PA, to the team. Knapp, along with Drs. Jeremy and Sandra Granger, provides care to patients from birth to 18 in the Sunnybrook Medical Plaza near Target in Sioux City.
winetimeonmain.com
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UnityPoint Accountable Care, a subsidiary of UnityPoint Health and one of the largest accountable care organizations in the US, earned $41.9 million in shared savings for calendar year 2019. This result stems from UAC’s quality and cost performance in the Medicare Next Generation Accountable Care Model, administered by the Centers for Medicare and Medicaid Services Innovation Center initiative.
MidwestMedicalEdition.com
KELLY DELANEY-NELSON
ROSA MARQUEZ
JAMES HEGVIK
CNOS recently welcomed two new staff members. Kelly Delaney-Nelson, MD, is a fellowshiptrained rheumatologist and a board-certified internist. A native of North Sioux City, she earned her medical degree from the University of South Dakota Sanford School of Medicine. Dr. Delaney-Nelson completed her internal medicine residency at the Gundersen Health System in La Crosse, Wisconsin, where she also served as Chief Resident for one year. In 2020, Dr. Delaney-Nelson completed her Rheumatology Fellowship from the University of Missouri.
Rosa Marquez, PA-C also grew up in Siouxland. She attended Briar Cliff University and moved to Omaha to pursue a Masters in Health Sciences and Physician Assistant Studies. Marquez works with Drs. Brian Johnson and Kelly Delaney-Nelson.
James Hegvik, MD, is joining the weight loss surgery program at Midlands Clinic in January. Dr. Hegvik joined Midlands Clinic General Surgery in 2019 and has been specializing in weight loss surgery since his residency at Iowa Methodist Medical Center in 2014. Since joining Midlands Clinic, Dr. Hegvik has been working within the established bariatric program at Midlands Clinic alongside Drs. Keith Vollstedt and William Rizk.
The CNOS clinic in Dakota Dunes has a new MRI Suite with a variety of patient-centered enhancements. The new GE Wide Bore MRI promises to “humanize” the MRI experience. The design allows patients to choose the hue of their light, pick music, and even watch a movie on a large screen. The new design also features GE’s exclusive Silent Scan technology to reduce MR scanner noise to ambient sound levels and improve a patient’s MRI exam experience.
March 2021
THOMAS JACOBSON
ROBERT WISCO
Thomas Jacobson, MD, and Robert Wisco, MD, have both retired from CNOS in recent months. Dr. Jacobson is a board-certified Orthopaedic surgeon who was part of the founding team of doctors who merged to form CNOS. He is a well known face providing care on the sidelines of high school and college sporting events in the region. Dr. Wisco is a board-certified rheumatologist and graduate of the University of Iowa medical school. He was with CNOS for nearly 20 years. MercyOne Medical Center raised its minimum wage to $15 per hour in December. Staff members in environmental services, nutritional care and other support services are the most likely to be impacted by the change.
MercyOne Siouxland Heart and Vascular Center was honored with seven awards, distinctions, and certifications in 2020. Honors include recognition from US News and World Report for heart failure care and three distinctions from the American Heart Association. MercyOne also received the Platinum Performance Achievement Award from the National Cardiovascular Data Registry and two certifications, one from the Intersocietal Accreditation Commission for Echocardiography and another from the American Association of Cardiovascular and Pulmonary Rehabilitation.
15
• Happenings around the region
News & Notes
MercyOne Siouxland Medical Center recently held a Catholic blessing of its new MercyOne Air Med helicopter. Father Gus Peter blessed the Bell 429 and its crew with holy water and crew members were presented with Saint Christopher medals.The new, two-engine helicopter is larger and faster than the Bell 407 it replaces, allowing more efficient in-flight care by Air Med flight nurses for the 33-county region they serve.
INDEPENDENTS AND OTHERS The University of South Dakota was among 10 colleges and universities nationwide to receive a $1 million gift as part of TikTok’s Health Heroes initiative launched in response to the COVID-19 pandemic.The gift from the global social media company is intended to support healthcare-related scholarships benefitting enrolled tribal members and other students, as well as programming to study and promote health and wellbeing in impoverished or marginalized South Dakota communities.
SHAWN BARTEL Shawn Bartel, MD, a board-certified pediatric and internal medicine physician, has joined the staff at Huron Regional Medical Center. Dr. Bartel graduated from Huron High School and earned his MD at the USD Sanford School of Medicine. He completed his internship and residency in internal medicine and pediatrics at the Medical College of Wisconsin in Milwaukee. Dr. Bartel provides care for newborns to geriatric but has a special love of pediatrics and caring for families.
BRYAN BECKEDAHL Bryan Beckedahl is the new Director of Radiology at PLHS. Beckedahl received his Radiology Technology degree from the University of Mary in Bismarck. He earned his Registered Diagnostic Medical Sonographer and Registered Diagnostic Cardiac Sonographer Ultrasound degrees at the Health Sciences Centre in Winnipeg and received his Registered Vascular Technologist degree while working at Mayo Clinic. Beckedahl also has a Master’s Degree in Management and Health and Human Services from St. Mary’s University in Minneapolis.
16
VIJAY RAO Prairie Lakes Healthcare System (PLHS) recently welcomed board certified oncologist and hematologist Vijay Rao, MD. Dr. Rao completed his internal medicine residency and hematology/oncology fellowship at the University of Arkansas for Medical Sciences in Little Rock. He joins Bipin Amin, MD, Jeffrey Brindle, MD, and Kristina Rieffenberger, CNP, at Prairie Lakes Cancer Center.
BONNIE CORDELL Bonnie Cordell is the new Director of Finance at PLHS. Cordell is a graduate of the University of South Dakota where she earned a joint Bachelor of Business Administration in Accounting and Master of Professional Accountancy in 2009. She is a Certified Cost Report Specialist and a member of the American Institute of Healthcare Compliance. She has eleven years accounting experience and moves into her new position after being a part of the team at PLHS for three years.
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Claudia Berrondo, MD, Children's Hospital & Medical Center
Children’s Hospital & Medical Center in Omaha recently added a new DaVinci Xi surgical robot to its operating room. The DaVinci Xi is the first surgical robot in Omaha to be used in the pediatric setting. The robot allows for minimallyinvasive procedures using smaller incisions which results in quicker recovery times for young patients. Children’s pediatric urologist Claudia Berrondo, MD, recently completed the first surgical robot case. Children’s plans to expand its robotic surgical program to incorporate additional specialties.
MARTHA HOLSTEIN Med-peds physician Martha Holstein, MD, of Yankton Medical Clinic has earned board certification in pediatrics. Dr. Holstein is a graduate of the USD Sanford School of Medicine and did her residency at the University of Nebraska Medical Center in Omaha. Dr. Holstein chose to practice a dual specialty after having great experiences in both specialties during medical school. She joined YMC last September.
Black Hills Orthopedic & Spine Center and Black Hills Neurosurgery & Spine have joined to form The Spine Center at Black Hills Orthopedics. The 20 doctors of the newly combined practice will provide specialized treatment for all bone, joint, muscle and nerve-related needs, with specialists in every area of musculoskeletal care. The merger also combines ProMotion Physical Therapy with Black Hills Orthopedics Physical Therapy, so patients now have access to more therapy options throughout Rapid City.
Yankton Medical Clinic cardiovascular laboratory has been granted a three-year term of accreditation by the Intersocietal Accreditation Commission in echocardiography in adult transthoracic and adult stress. Accredited since 2003, this latest accreditation demonstrates the facility’s ongoing commitment to quality echocardiography services. Yankton Medical Clinic cardiovascular laboratory has been granted a three-year term of accreditation by the Intersocietal Accreditation Commission in echocardiography in adult transthoracic and adult stress. Accredited since 2003, this latest accreditation demonstrates the facility’s ongoing commitment to quality echocardiography services.
March 2021
17
Putting the ‘Success’ in Succession Planning
Y
OU MAY HAVE SPENT decades building
where they can pass on the business, but they still want
your private practice or another business
to continue to work there and add value to the business
and banking on a comfy retirement on the
as long as they are able.”
proceeds from an eventual sale. But without
The best way to ensure that things play out the way
a succession plan in place, one unforeseen event could
you want them to, says Popkes, is to be proactive. That
quickly derail those plans.
starts with knowing your own vision.
“It is a balancing act,” says Gary Popkes of Frontier
If your business is a family-owned business, do you
Bank. “You want to sell your business when it has max-
want to keep it in the family? If not, are there employees
imum value. Not too early, but not too late. The more you
capable of buying you out and taking over? Will you finance
can plan and set up ahead of time, the more time you
the buy-out yourself? In the case of a medical practice, do
have to analyze a number of scenarios.”
you want to sell to a larger healthcare system, or ensure
As a Certified Financial Planner and Wealth Advisor with nearly 30 years experience, Popkes helps his clients run through those scenarios and come up with succession plans that work for their lives and their businesses.
that the practice stays independent? Other critical considerations are your health and your age. “What you don’t want is to end up in the hospital and be forced to sell your business quickly,” says Popkes. “That
“There is no cookie cutter approach. Every situation is
is the kind of situation that attracts vultures. If your busi-
unique,” says Popkes. “Some people want to be able to
ness was worth $500,000 when you went into the hospital,
retire completely. Others would rather set up a structure
after two months, someone might offer you $250,000.” ❖
❱ Read more of Popkes’ insights into succession planning in the complete version of this article on our website.
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18
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SIOUX FALLS PHYSICIAN DIAGNOSES AUTOIMMUNE HEPATITIS IN ASSOCIATION WITH COVID-19
H
E PATO L O G I S T
“Even though she recovered
A week later at her outpa-
Govarthanan
from COVID-19, her liver mani-
tient follow-up appointment,
Rajendiran, MD,
festation persisted for several
her transaminase levels were
at Sanford Health
weeks. We wanted to present her
still elevated. She still had
is the first physi-
case study so that the medical
abdominal pain, poor appetite,
cian to diagnose
community could be aware and
dark urine, light-colored stools,
a patient with autoimmune
see if it is something that may
and pruritus. The woman was
hepatitis in association with
need to be looked into further.”
transferred to the Sanford USD
Autoimmune problems
Medical Center in Sioux Falls
Nearly a year into the pan-
have also been documented in
where a liver biopsy confirmed
demic, medical experts and
severely ill COVID patients. In
a diagnosis of autoimmune
researchers are still learning
one report, critically ill patients
hepatitis.
about the severe acute respira-
w it h C OV I D -1 9 d i s pl ay e d
Three milligrams of the oral
tory syndrome coronavirus 2
hallmarks of extrafollicular
steroid budesonide three times
(SARS-CoV-2) and its short-
B-cell responses similar to those
a day resolved her symptoms
and long-term effects. Hepatic
reported in autoimmune set-
within six weeks and at eight
involvement had been widely
tings.2 Another author reported
weeks, the patient’s liver test was
reported. Typically, however,
autoantibodies against multiple
normal again.
liver injury only occurs in the
targets, including phospholipids
“We don’t know if this will
sickest of patients and is usually
and type-I interferons, that were
happen again but we did want to
temporary.
linked to COVID-19.3
document that COVID-19 can
COVID-19 infection.1
“Our patient’s case is rare and unique,” says Dr. Rajendiran.
A NEW CASE REPORT
be associated with autoimmune hepatitis presentation and let
Rajendiran’s 38-year-old female
other physicians know that, in
patient, who had no risk factors
our experience, budesonide is
for chronic liver disease, devel-
safe to use in a COVID-19 setting,”
oped
says Dr. Rajendiran. ❖
jaundice,
right-sided
abdominal pain, abnormal urinary discoloration, and markedly elevated liver enzymes a few weeks after testing positive for the COVID-19 infection. She had taken acetaminophen for fever and body aches but not for at least a week before the onset of liver enzyme elevation. N-acetylcysteine treatment was administered at the local hospital without significant liver test improvement. She was discharged with recommended monitoring of symptoms at home.
March 2021
References: 1 Rajendiran G, Brice C, Erickson K, Oliver T, Manatsathit W. Autoimmune Hepatitis Associated with COVID-19 Infection – A Diagnostic and Therapeutic Dilemma. S D Med. 2020 Nov;73(11);528 -532. 2 Woodruff, MC, Ramonell, RP, Nguyen, DC et al. Extrafollicular B cell responses correlate with neutralizing antibodies and morbidity in COVID-19. Nat Immunol 21, 1506–1516 (2020). https://doi.org/10.1038/ s41590-020-00814-z 3 Woodruff MC, Ramonell RP, Lee EH, Sanz I. Clinically identifiable autoreactivity is common in severe SARS-CoV-2 infection. medRxiv 2020.10.21.20216192. Under review.
19
USD and LifeScape Launch SD’s First BCBA Program
Eric Kurtz
T
Kimberly Marso
Ryan Groenweg
HE UNIVERSITY OF
increasing need for these profession-
provide instructors and clinical
South Dakota School
als in all age groups.
supervision for the new program in
of Health Sciences’
“As a BCBA, you can work with
the hope that BCBAs trained in South
Department of Public
anyone at any age,” says Marso.
Dakota will be more likely to stay in
Health and Health Sciences in
“BCBAs can specialize in areas such
the state to practice.
conjunction with the USD Center
as traumatic brain injury, gerontology,
“We have had a workforce need
for Disabilities and LifeScape are
or substance use disorders. There
for years and this has long been a goal
partnering to offer the state’s first
are many subspecialties in addition
of ours,” says Marso. “We have waiting
certification
to autism.”
lists of families who need services. I
program
for
Board
Certified Behavior Analysts (BCBA)
Marso says demand for BCBAs
this fall. Eric Kurtz, PhD, Executive
nationally has grown by nearly 2,000
“This program is long overdue,”
Director of the Center for Disabili-
percent in the last decade and the
agrees Ryan Groeneweg, EdS, BCBA,
ties, says the new program will have
trend is continuing. LifeScape will
Director of Community Education at
can’t hire enough BCBAs.”
far-reaching implications for healthcare organizations and patients throughout the region. “The program is going to fill a major gap in care in our state,” says Dr. Kurtz. “The prevalence of autism and related developmental disabilities is continuing to rise and there are not enough professionals available to serve them. The evidence-based treatments that improve outcomes for those individuals throughout their lives is rooted in applied behavior analysis (ABA) therapy.” Board-Certified Behavior Analysts assess and treat problematic behaviors in children and adults. Although BCBAs are often associated with the treatment of autism in children, LifeScape Chief Operating Officer Kimberly Marso, RhD, BCBA-D, says there is an
20
LifeScape BCBA Noelle Jacobs working with a young client in Rapid City.
MidwestMedicalEdition.com
USD School of Medicine. Groeneweg will serve as Director of the new program and will be
PROUD TO BE RECOGNIZED AS A
one of its instructors. He was one of only five BCBAs in the state when he started working ten years ago. A decade later, South Dakota still needs more BCBAs. Groeneweg says fewer than 50 of these professionals are credentialed in South Dakota and some of them work in surrounding states. Most are concentrated in the largest cities and primarily work with children with disabilities. “We should have BCBAs in places like
RFG CIRCLE OF EXCELLENCE
CERTIFIED DEALERSHIP
2021
schools, clinical settings, prisons, and substance abuse programs,” says Kurtz. “We are hopeful that this program is going to allow us to really expand the settings in which these people are working.” Kurtz says several steps had to happen before the state could start its own BCBA program. The first occurred in 2016 when the state legislature approved limited insurance coverage for BCBA services. The second necessary step was the establishment of a state licensing and regulatory body for BCBAs. USD’s School of Health Sciences then developed the educational program. LifeScape’s willingness to provide supervision for the required 2,000 hours of field work made the last step —the educational program— possible. The result is an interprofessional BCBA program with a lifetime focus and a clear path to clinical supervision before students even start, something that is unique among BCBA programs. “This new educational program results from collaboration and cooperation with our partners in the state,” said Haifa Samra, dean of USD’s School of Health Sciences. “It builds around a common goal to meet a critical healthcare need for South Dakota families while also creating a mechanism for health professions students and practicing healthcare professionals to advance their career opportunities and practice in South Dakota.” The program will accept both current graduate students in a masters level or higher program and practicing professionals in related fields such as psychology, speech language pathology, and special education. The first five to ten students will start the program this fall. It can be completed in two years. ❖
March 2021
CONTACT US:
1-800-477-2425 ABBUSINESS.COM 21
PRAIRIE LAKES HEALTHCARE SYSTEM OPENS WALK-IN CLINIC FOR YOUNG ATHLETES PRAIRIE LAKES HEALTHCARE SYSTEM has opened a walk-in clinic for young Michelle Leitheiser
athletes. The Young Athlete Walk-in Clinic is a free clinic to screen student athletes with sports injuries and concerns. Elementary through high school aged students can receive a free athletic screening for orthopedic injuries or concerns by Jeff Haufschild and Michelle Leitheiser, Certified Athletic Trainers and Certified Strength and Conditioning Specialists. The Young Athlete Walk-in Clinic opened February 22 and no appointments are needed. The clinic is held weekly on Mondays from 11 am to 1 pm in Prairie Lakes Rehab located on the lower level of the Prairie Lakes Specialty Clinic. Severe sports injuries, such as a head injury, high pain, or bone fracture, should be seen in the ER immediately. Jeff Haufschild and Michelle Leitheiser with Prairie Lakes Sports Medicine serve student athletes full time and are supported by Physical Therapists at
Jeff Haufschild
Prairie Lakes. At the Young Athlete Walk-in Clinic, Haufschild and Leitheiser will give student athletes and the athlete’s parent(s) their recommendations to begin recovery or prevent injury. ❖
22
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2021
HVAC Healthcare Symposium
May 25-26 • Sioux Falls, SD
ion t a r t Regis g Soon in Open CElements.com HVA www.
Conserving Energy, Saving Money and Enhancing Patient Experience Inviting all Healthcare CEOs, CFOs, Facility Engineers, Directors & Managers, Architects, Mechancal Engineers & Contractors
Congenital Cytomegalovirus (CMV) is one of the leading causes of childhood hearing loss. 1 in 3 pregnant women infected with CMV will pass the virus to their child in utero. CMV is the most common condition present at birth, but it’s one of the least well-known conditions among those in the United States. Cannon et al., 2012; Muldoon, 2020; Centers for Disease Control & Prevention
Want to learn more?
Get involved today at ehdi136.com or find us on Facebook @SouthDakotaEHDICollaborative
March 2021
23
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