MED-Midwest Medical Edition-November 2016

2016

NOVEMBER

Vol. 7 No. 7

Expansion

in Rapid City & Watertown Your Guide to

CHARITABLE GIVING Taking the Pain Out of Office Purchasing

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Hearts in the Hills

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MIDWEST MEDICAL EDITION

Contents

Healing

Hearts in

VOLUME 7, NO. 7 ■ N OV EM B ER 2016

the Hills

REGULAR FEATURES 4 | From Us to You 5 | MED on the Web

IMPORTANT "FIRSTS" FOR RAPID CITY CARDIOLOGISTS

Life after injury, Does valet parking improve patient care?, Free digital promotion for your practice

6 | New! Hometown Advantage - Featuring area physicians

ON THE COVER

who’ve come "home" to practice

10 | N ews & Notes

New providers, awards, accreditations and more

39 | Learning Opportunities Upcoming Winter CME opportunities and conferences

IN THIS ISSUE

6

8 | Five Reasons to Update Your Estate Plan Before the New Year

Smart Giving:

■ By Jeana Goosmann

How charitable gifts can enrich your community and your financial plan ■ By Nathan Quello

20 | Elderly Patients and Informed Consent

■ By Jeremy Wale

22 | Task Force Explores Models for Rural Healthcare

■ By Scott A. Duke

23 | Coyote Clinic reaches ten-year milestone

19 New Cloud-Based Purchasing Solution Makes it Easier to Manage Your Office Spending

■ By Peter Carrels

24 | Regional Health to Expand and Renovate in Rapid City

25 | Brookings Opens New Medical Plaza 26 | Sanford Forms Pediatric Genomic Consortium

Sponsored Feature

27 | Thaemert to Offer New Non-Surgical Weight Loss Procedure

■ By Alex Strauss

24

28 | A cquisition and Expansion

Changes for Watertown: Prairie Lakes Breaks Ground on New Specialty Clinic

for Sioux Falls Specialty Hospital

30 | Understanding the Stages of Substance Use

■ By Chris Sandvig

32 | Dakota Lions Sight &

Health Celebrates 25 Years

Sponsored Feature

34 | The Right Prescription: Pharmacist Earns Healthcare MBA in Record Time

By Peter Carrels

■

By Alex Strauss

36 | Small Changes, Big Payoff: How making some simple changes to the way we eat can ward off Holiday weight gain

■

page

16

By Alex Strauss

As Regional Health prepares for major expansion, the cardiologists of Regional Heart Doctors in Rapid City are quietly celebrating some significant firsts in cardiac care for the region. They were recently first in the area to implant the world’s smallest pacemaker and first to use a catheter-based heart pump in the right ventricle. We’ll meet them and find out where they hope to go from here as they continue to advance cardiac care in this month’s cover feature.

page

14

By Corey Howard

Cover photo by Kevin Eilbeck Photography

Zahir Rashid, MD, Kelly Airey, MD, and Bhaskar Purushottam, MD of Regional Heart Doctors in Rapid City.

From Us to You Staying in Touch with MED

PUBLISHER MED Magazine, LLC Sioux Falls, South Dakota

VICE PRESIDENT SALES & MARKETING Steffanie

Liston-Holtrop

EDITOR IN CHIEF Alex Strauss

GRAPHIC DESIGN Corbo Design

PHOTOGRAPHER studiofotografie

ce, Oc tober hnology Conferen Golden West Tec Conway, rah Sa r: Pic tured l to 2016, Rapid Cit y.

Holtrop, ton Lis nie ffa Ste ge, Tracy Manning-Eg Bobbi Wells.

Jamie Miller and

I

4

SDAHO Annu al Convention Golf Tournam September 20 ent, 16 in Sioux Fa lls Pic tured l to Mark Schlueter, r: Ritch Noble, St ef fanie Liston Holtrop, Butch Hanssen.

CONTRIBUTORS: Scott A. Duke

t has been a busy Fall for MED Magazine! As part of our

commitment to be active participants in our wide and diverse medical community, MED VP Steffanie Liston Holtrop has been criss-crossing South Dakota, meeting MED readers and clients at a variety of events and conferences. Got an event you think MED should be a part of? Steff has her bag packed and is ready to go. Let us know!

In this issue, we are excited to feature some significant firsts in cardiology in our region happening at Regional Heart Doctors. Technology is getting smaller and it is having a big impact on patient outcomes.

Also in this issue, our expert contributors weigh in on a range of topics from informed consent and elderly patients to estate planning, charitable giving, and simpler eating habits. Of course, we also bring you all the latest news including expansions and new construction across the region. Be sure to let us know about your end-of-the-year news and events to be a part of the December issue.

Until then, we are giving thanks for all of you! —Alex and Steff

WEB DESIGN Locable

DIGITAL MEDIA DIRECTOR Jillian Lemons

Jeana Goosmann Corey Howard Nathan Quello Chris Sandvig Jeremy Wale

STAFF WRITERS Liz Boyd

Caroline Chenault John Knies

NEWS & NOTES EDITOR Kari Anderson

ADMINISTRATIVE ASSISTANT Erika Tufton

SDMGMA Fall Conference August 2016 at Cedar Shore Resort in Chamberlain.

Pictured l to r: Steffanie Liston Holtrop, Jill Heyden, Abby Munro, Robyn Ewalt.

MED fans Jody Sternberg, Director of Patient Care Services, and Roxanne Summerville, Material Director, Platte Health Center Avera at the SDAHO Convention.

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

Š2011 Midwest Medical Edition, LLC Midwest Medical Edition (MED Magazine) is committed to bringing our readership of 5000 South Dakota area physicians and healthcare professionals the very latest in regional medical news and information to enhance their lives and practices. MED is published 8 times a year by MED Magazine, LLC and strives to publish only accurate information, however Midwest Medical Edition, LLC cannot be held responsible for consequences resulting from errors or omissions. All material in this magazine is the property of MED Magazine, LLC and cannot be reproduced without permission of the publisher. We welcome article proposals, story suggestions and unsolicited articles and will consider all submissions for publication. Please send your thoughts, ideas and submissions to alex@ midwestmedicaledition.com. Magazine feedback and advertising and marketing inquiries, subscription requests and address changes can be sent to steff@ midwestmedicaledition.com.

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

CONTACT INFORMATION Steffanie Liston-Holtrop VP Sales & Marketing 605-366-1479 Steff@MidwestMedicalEdition.com Alex Strauss Editor in Chief 605-759-3295 Alex@MidwestMedicalEdition.com Fax 605-231-0432 MAILING ADDRESS PO Box 90646 Sioux Falls, SD 57109 WEBSITE MidwestMedicalEdition.com

MED welcomes reader submissions!

2016 Advertising EDITORIAL DEADLINES Jan/Feb Issue December 1 March Issue February 1 April/May Issue March 1 June Issue May 1 July/August Issue June 1 Sep/Oct Issue August 1 November Issue October 1 December Issue November 1

Digital Marketing Made Easy Need to promote your website and your services online but aren’t sure where to start? MED can help. With custom content opportunities, free calendar and business listings, and web links for advertisers, we’ll design a digital plan to meet your goals and your budget. Contact us to learn more.

On the Website this month Life After Injury Injuries disrupt normal life routines. But research demonstrates that time away from regular life activity can derail recovery. Occupational Therapist Lori Berdahl explains how to help break the vicious cycle

Case Study: Does Valet Parking Matter?

See how the addition of valet parking at the front entrance has impacted how one Midwestern hospital cares for its patients.

Promote Your Business for FREE It’s always free and take just a minute to list your business in MED’s interactive online business directory and be seen by thousands of MED website readers.

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Contact us at Info@MidwestMedicalEdition.com to learn more.

Smart Giving appreciation, a relatively small investment made years ago could have a large impact on a charitable organization today, while significantly reducing your tax liability.

kids” can leave the kids with less than you’d expect. Estate and income taxes can greatly reduce the value of your assets, leaving your beneficiaries with a heavy tax burden and a fraction of your estate’s worth.

Setting aside a portion of your estate for the purpose of charitable giving greatly increases its value to the recipient organization and reduces the impact of estate taxes on your beneficiaries. With the right planning, you can leave a legacy of generous community support while providing for your loved ones long after you’re gone.

DONOR-ADVISED FUNDS

WHERE TO GIVE

How charitable gifts can enrich your community and your financial plan

By Nathan Quello

T

HERE IS MORE TO GOOD

financial planning than simply providing for you and your loved ones. An attentive financial advisor will not only protect your assets, but also help you establish a legacy of giving.

Incorporating strategic charitable giving into your financial plan can positively impact your community while efficiently managing your estate.

But before you open your checkbook, ask your financial advisor about how the following considerations can help you make the most out of your gift.

APPRECIATED ASSETS One of the most efficient ways you can give to a non-profit organization is with an appreciated asset. A stock that has increased in value often makes a better gift than cash. Depending on the level of

A donor-advised fund is a great opportunity to target tax efficiency into the year that is most beneficial to the taxpayer. Whether you’re selling a business or receiving a large bonus, this type of fund maximizes your giving while minimizing your tax burden.

Establishing a donor-advised fund allows you to make one large gift that can be distributed to a variety of organizations, or to a single organization over a longer period of time. When properly managed, it is literally a gift that keeps on giving.

Part of the beauty of charitable giving is the opportunity it provides us to reflect on what we value most. Take some time to think about the issues, programs, and services that mean the most to you and your community. Then talk to your financial advisor about how you can help. Regardless of what organizations you support—from religious and human services to education and the arts—there is no end to the good you can do with a well-considered charitable gift. ■

LEGACY AND ESTATE PLANNING

Nathan Quello is a Certified Financial Planner

Sometimes “leaving everything to the

with Loft Advisors in Sioux Falls.

HOMETOWN ADVANTAGE What brings physicians back to the region to practice?

When

STEVEN JOYCE

finished high school in Sioux City, he was bound for greener pastures.

“When you are 18, you think you want to explore the world and certainly aren’t going to come back to your home town to live,” says Dr. Joyce. “Everybody wants to go bigger, somewhere with more things to do and see.”

After completing medical school at the University of Iowa, Joyce trained in internal medicine and pediatrics at the University of Rochester in New York. He married a woman from Menno, South Dakota

6

and the couple settled in Rochester for four years. But as the Joyces’ family grew, they began to think about home.

“If you had asked me in 1988 if I would ever move back to Sioux City, it would have been a resounding no,” he says.

But the economic boost provided by companies like Gateway computers, as well as a growing number of entertainment and lifestyle options, strong schools, and a low cost of living convinced the

Joyces to take a second look at the Sioux City area.

“I love practicing here,”

says Dr. Joyce, who is now the Chief Primary Care Officer for Mercy Medical Center. “It’s a challenge to practice everywhere. More is asked of physicians than ever before. But here I have the satisfaction of knowing that many people like and trust me. That doesn’t exist everywhere, that bond.”

“Respect and cordiality are definitely benefits of practicing here.”

Midwest Medical Edition

Beckenhauer Construction has been providing high quality construction service to its clients for 138 years and counting. Beckenhauer Construction is a family owned general contracting firm specializing in healthcare construction and is now being directed by the fifth generation of family ownership.

Safety of the staff, the patients, visitors, and crews is always at the top of our list to control. We do so by continual training, monitoring, providing the best of equipment to assist us, and constant communication with the client so they are aware of our every move. We go above and beyond the industry standard requirements when it comes to protecting employees, client staff, patients, and visitors. If you are not already one of Beckenhauer Construction’s clients we urge you to visit with any of our past or current clients to see what they have to say about doing business “The Beckenhauer Way”.

Five Reasons to

Update Your Estate Plan

Before the New Year

By Jeana Goosmann

A

S THE NEW YEAR APPROACHES, many people will find themselves contemplating the successes and challenges of the past year. However, many people will fail to consider one important detail – how the past year’s events might have impacted their estate plan.

RELOCATION Estate plans stipulate how and when the distribution of a person’s assets will take place. If skillfully drafted, they can help individuals avoid unnecessary fees, taxes, and stress in addition to ensuring peace of mind. But estate plans can’t work effectively if they fail to reflect the changes that have occurred within a person’s life.

If you have experienced any of the following five events since you formulated your estate plan, contact an estate planning attorney. He or she can update your plan so that you can head into 2017 confident that your assets are protected.

MARRIAGE, DIVORCE, OR DEATH OF A SPOUSE Marriage, remarriage, divorce, and death all significantly impact how you wish to distribute your estate. However, your estate plan does not update automatically when any of these events occur, so you will need to change it to reflect your new situation. An attorney can assist you by reviewing the situation’s impact on your finances, updating your beneficiary designations, and more.

FINANCIAL CHANGES If you’ve experienced a substantial change in financial status, you may need to revisit your estate plan as well. Financial changes can increase or decrease the different estate planning opportunities available to you. An attorney can ensure you obtain the best tax and inheritance benefits accessible to you in your situation.

BIRTH OR ADOPTION OF A CHILD / GRANDCHILD If the birth or adoption of a child or grandchild has occurred, you will need to update your estate plan if you wish to designate him/ her as a beneficiary. In addition, an attorney can you help create all necessary Gifting

8

BIRTH OR ADOPTION

MARRIAGE

Trusts, 529 education plans, gifting plans, and UGMA / UTMA (Uniform Gifts to Minors Act / Uniform Transfers to Minors Act) accounts. You should also consider if you would like to designate a legal guardian for the child/grandchild in your plan.

RELOCATION TO A NEW STATE If you’ve relocated, your estate plan may not be in compliance with your new state’s laws.

Laws concerning medical directives, last will and testaments, living trusts, property power of attorney, and IRA’s all differ from state to state.

OTHER LIFE CHANGES Many other life changes can impact your estate plan. Have an estate planning attorney review your situation and determine necessary estate plan updates if any of the following occur:

● Your children or grandchildren reach adulthood

● Your relationship status

Estate Planning

LIFE CHANGES

FINANCIAL CHANGES

● Guardians, executors, or trustees are no longer able (or no longer desire) to serve as such

● A beneficiary becomes disabled and therefore requires a special needs trust

● Your children’s designated guardian moves or becomes unable to act as a guardian for any reason

A NEW YEAR’S RESOLUTION WORTH HAVING Estate plans can be powerful tools. If you want to safeguard your assets and ensure they are distributed according to your wishes, an estate plan is not only recommended, but necessary. As you think back on the last year, be sure to consider how all of life’s changes could potentially impact your estate plan.

And if any of the above has occurred, make contacting an attorney and updating your estate plan a priority. Possessing an up-todate estate plan can only make your New Year more happy and peaceful. ■

changes in any way

● Your beneficiaries develop addictions which could impact their ability to handle your estate

Jeana Goosmann is CEO & Managing Partner, Goosmann Law Firm

Midwest Medical Edition

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Happenings around the region

South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska

News & Notes AVERA Avera Queen of Peace is opening a new pediatric therapy facility in Mitchell. At

the Avera Therapy and Integrated Therapy Services center, therapists use a collaborative team approach to help children function independently. Before the center was built at the former urgent care facility, children were having to go out of town for care in Occupational, Physical, and Speech Therapy.

Avera Health has announced that their participation with Sanford Health Plan Provider Network will terminate as of January 1, 2017. Only South

Dakota Hospitals will be removed from the Sanford Health Plan, but Avera Behavioral and Avera-employed Behavioral Health physicians will stay in-network.

Avera Health Plans announced that they will donate $25,000 in support of the Great Plains Education Foundation. The

Foundation is a 501c(3) scholarship granting organization based in Aberdeen.

SANFORD The National Institutes of Health (NIH) has distributed $157 million in awards for the fiscal year 2016 as part of a seven-year initiative called Environmental Influences on Child Health Outcomes (ECHO). Sanford Research

received a grant for nearly $4.5 million from ECHO for their ongoing research project called Safe Passage. Safe Passage investigates the role of prenatal alcohol in sudden infant death syndrome and stillbirths.

NIH also distributed a grant to the Cancer Biology Research Center at Sanford Research under their Centers of Biomedical Research Excellence (CoBRE) program.

The grant was for 11.7 million to translate laboratory research into clinical trials for head and neck and pediatric cancers.

Avera Cancer Institute in the Prairie Center hosted the Lakota Emergence Exhibit during the month of October.

Avera was the first host of the traveling version of the exhibit.

The exhibit was in honor of Native American Day, which fell on October 10 this year.

10

Steven Powell, MD, and Sam Milanovich, MD, are leading a new study called COMPASS.

COMPASS follows Sanford Research’s GEMMA trial and explores how genomic profiling might help improve treatment options for patients. Both pediatric and adult patients with advanced stage cancers or cancers with no established treatments can participate.

USD Sanford School of Medicine Interventional Cardiology Fellowship Program has received initial accreditation from ACGME.

The fellowship program will begin training on July 1, 2017.

Sanford Health Oncologist and Researcher, Steven Powell, MD, accepted for Sanford Cancer Center the 2016 ICLIO Innovator Award at the ICLIO National Conference in early October. Sanford Cancer Center

was selected for this award for its advanced research program, its multidisciplinary approach, and efforts to provide immunotherapy options to its patients.

Sanford Health now offers patients of Family Medicine and Children’s Medicine all day walk-in hours from 8am–5pm.

SIOUXLAND UnityPoint Health-St. Luke’s Foundation is pleased to announce that Rebecca Brown, Rocky Welker, and Jessica Wheeler will be joining their staff. Ms. Brown

and Mr. Welker have accepted positions as Development Directors. Ms. Wheeler will be the Development Coordinator for St. Luke’s Children’s Miracle Network.

Sanford Acute Care hours are from 5pm–9pm. “We’re always looking for new ways to better serve our patients,” said Clayton Van Balen, MD, enterprise medical director of employee health services for Sanford Health and Acute Care Physicians.

Marilyn Haiar is the newest DAISY Award recipient for outstanding nurses. Ms. Haiar

works at Sanford Children’s Specialty Clinic. She had multiple submissions from patients stating she was prompt returning their calls, answered their questions, and was compassionate and caring to family members and patients.

St. Luke’s College–UnityPoint Health is now offering a continuing education opportunity for working healthcare professionals that is 100% online. These bachelor

degree programs also allow the flexibility of transferring credits from previous education programs. For more information visit www.stlukescollege.edu or call (712) 279-3149.

Midwest Medical Edition

Mercy Medical Center would like to announce the appointments of Alicia Held and Kari Kirchmeier to the position of inpatient clinical nurse educators.

Ms. Held and Ms. Kirchmeier have both been on staff at Mercy for several years and in their new positions will be educating nurses to integrate evidence-based practices that will promote the high standards of patient care at Mercy.

Stroke survivors and their caregivers were able to attend a retreat held by Mercy Medical Center at Inspirational Hills during the weekend of September 16. The camp’s goal

was to bring together Stroke Survivors and improve their quality of life. It allowed people of similar circumstances and their caregivers to interact outside of the hospital setting.

Mercy Medical Center hosted Siouxland’s first Birth Expo on Saturday, October 29. It was

held at the Sioux City Convention Center. There were mini sessions on child safety from the City Fire Department, CPR instructors, SIDS Foundation and Poison Control Center.

Midlands Clinic is now offering ORBERA™, an Intragastric Balloon, to assist adult patients suffering from obesity.

ORBERA™ is a weight loss solution with 20 years of global results.

BLACK HILLS Spearfish Regional Hospital (SPRH) Hospice of the Northern Hills invited Barry Baines, MD, to their facility for a conference presenting “Honoring Patients’ Choices”. The conference took

place on September 27. Dr. Baines is a nationally-recognized expert, researcher and speaker on patients’ choices and is boardcertified in Hospice and Palliative Medicine, and Family Medicine.

info@voa-dakotas.org

(605) 334-1414

November 2016

MidwestMedicalEdition.com

11

Happenings around the region

South Dakota Southwest Minnesota Northwest Iowa

Northeast Nebraska

News & Notes

WATERTOWN

Spearfish Regional Hospital was recently recognized by HealthStream for an Excellence Through Insight Award for the Most Improved in Home Care.

The award was for the 2015 calendar year and was presented at the Awards Luncheon during the HealthStream Summit in Nashville on October 27.

Rapid City native, Dr. Brett Lawlor, volunteered to accompany the United States Men’s U-18 National Soccer Team to the Czech Republic.

Dr. Lawlor is a member of the Black Hills Sports Medicine Institute, a collaboration of specialized healthcare experts that provides the same high level of coordinated care found at National levels to the Black Hills region.

The Medical Center of Spearfish and Black Hills Urgent Care participated in a Spearfish Chamber of Commerce Ribbon Cutting Ceremony on Thursday, September 29. Black Hills

The American Heart Association (AHA) and the American Stroke Association (ASA) recognized both Mercy Medical Center and Regional Health with awards that showed they have reached aggressive compliance goals as outlined by the AHA/ASA.

Mercy received the Get With The Guidelines-Heart Failure Silver Quality Achievement Award.

Regional received Get with the Guidelines- Stroke Gold Plus Quality Achievement Award, Mission: Lifeline Receiving Center Bronze Plus Recognition Award, and the National Cardiovascular Data Registry ACTION Registry- Get with the Guidelines Platinum Performance Achievement Award.

Regional Health is pleased to welcome Travis Menge, MD, to their orthopedic surgery team.

Urgent Care opened its doors to the Northern Hills on September 1.

Regional Health was among four healthcare organizations to receive the ASCEND Peak Performance Award at the 2016 Breakthrough Conference and Exhibition recently held in National Harbor, Maryland.

They were selected for the award for their devotion to the ASCEND programs.

Dr. Menge went to Medical School in Colorado and graduated an Alpha Omega Alpha Honor Medical Society Member. Dr. Menge will be seeing patients at Regional Orthopedics.

MED QUOTES

12

“

Prairie Lakes Dermatology Clinic in Watertown is pleased to welcome Jeffery Smith, MD.

Dr. Smith received his medical degree from Texas Tech University School of Medicine and did his residency in dermatology at New York Presbyterian Hospital where he achieved Chief Resident.

Prairie Lakes Healthcare Systems has named Sara Spilde, PharmD, the new Director of Pharmacy.

Dr. Spilde has been serving as the Interim Pharmacy Directory since June 6. Spilde holds a Doctor of Pharmacy degree from SDSU and has worked at Prairie Lakes for 9 years in the Pharmacy Department.

Prairie Lakes Healthcare Systems is pleased to welcome to Prairie Lakes Rehabilitation Services Physical Therapist Karen Skogstad. Skogstad

OTHER Make-A-Wish of South Dakota is pleased to welcome Doug Ekeren and Dr. Kimmy Hart to its Board of Directors.

Mr. Ekeren is the regional president and chief executive officer of Avera Sacred Heart Hospital in Yankton. Dr. Hart is a pediatric resident at Sanford Children’s Hospital— Sanford School of Medicine, University of South Dakota, Sioux Falls.

The VA Black Hills Care System has appointed Jo-Ann Ginsberg to the position of Director of the Marion VA Medical Center. Ms. Ginsberg is

currently the Associate Director of Patient Care Services. The Marion VAMC is one of seven VISN 15 healthcare systems of excellence covering six states: Kansas, Missouri, Illinois, Indiana, Arkansas, and Kentucky.

serves patients through Prairie Lakes Home Health. Skogstad has twenty-four years experience as a physical therapist.

Happiness is nothing more than good health and a bad memory.

—Albert Schweitzer

”

Midwest Medical Edition

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By Alex Strauss

Healing Hearts in the Hills Regional Heart Doctors Achieve Important “Firsts” in Cardiac Care

AS

THE BLACK HILLS regions’ largest group of cardiovascular specialists, Regional Heart Doctors, a department of Regional Health's Rapid City Regional Hospital, continues to push the envelope to advance comprehensive cardiac care for the communities they serve.

In recent months, several RHD physicians have performed notable “firsts”, bringing world-class new techniques and technology to heart patients in Western South Dakota.

Dr. Bhaskar Purushottam

The Impella RP from Abiomed

November 2016

When cardiologist Bhaskar Purushottam, MD, was completing his fellowship training in Endovascular & Structural Interventional Cardiology at Mount Sinai Medical Center in New York in 2015, he never imagined that, less than a year later, he would be the first to bring an important new cardiac advance to the state of South Dakota.

But this spring, Dr. Purushottam, who had joined Regional Heart Doctors just eight months earlier, became the first physician in the Dakotas to implant the world’s smallest heart pump, Abiomed’s Impella RP, into the right ventricle of a Rapid City patient. Even the Mayo Clinic had not yet offered this procedure when Dr. Purushottam performed it at RCRH in May. “The patient came in with a blocked artery and in a critical state. He was sent for an emergency bypass but in the meantime went into cardiac arrest and had

MidwestMedicalEdition.com

to be resuscitated,” recalls Dr. Purushottam.

“After the bypass, he wasn’t doing well. He was on vasopressors to get his blood pressure up, but the right side of the heart was just so inflated that it wasn’t working.”

Right heart failure typically carries a mortality rate of 60 to 70 percent and the situation had, indeed, begun to look grim for Dr. Purushottam’s patient. Jaundice had set in as his liver and kidneys shut down from lack of adequate blood supply.

The damaged right ventricle was not healing on its own and the team was running out of options and time.

Fortunately for the patient, during his cardiology fellowship at Einstein Medical Center in Philadelphia, Dr. Purushottam had been trained in the use of an advanced new device designed to take the burden off a damaged right ventricle for up to 14 days to facilitate healing.

15

Photos by Kevin Eilbeck Photography

Right Place, Right Time

The Impella RP catheter device sits across the right ventricle and delivers blood from an inlet in the inferior vena cava to an opening near the tip of the catheter in the pulmonary artery. The pump, which was granted a Humanitarian Device Exemption by the FDA in 2015, can be deployed through a standard catheterization procedure through the femoral vein without the need for an incision.

Dr. Purushottam was convinced that the procedure was his patient’s best hope and Regional’s administration quickly agreed.

The final hurdle was to convince Abiomed.

“The device is still in its baby stages, so if there are too many negative outcomes, it might jeopardize its chances for approval,” says Dr. Purushottam. “I called the company and told them that I had a patient that I thought could truly benefit and was not improving with medication, that I had had experience with the device, and that I would appreciate it if they would let me do this. This was a huge decision but, thankfully, it was approved very quickly, which made all the difference.”

The device was shipped to RCRH overnight and, in 24 hours, Dr. Purushottam was taking his patient into the cath lab with an Abiomed representative at his side. Within three days, it was clear that it had been the right call.

“This was enough time for the heart to shrink in size and let the healing happen,” says Dr. Purushottam. “We were able to take him off the blood pressure medicine and he is doing phenomenally well. I have trained in big centers like Mount Sinai and this patient’s story is miraculous. To put it in layman’s terms, he kissed death and came back.”

Although there are other pumping options for right heart failure, the Impella RP’s tiny size means that it can be inserted without incision, minimizing the risk of complications and setting a new standard for minimally invasive heart care.

“For patients on whom we had nearly given up, this tool gives us a new hope,” says Dr. Purushottam.

Dr. Kelly Airey

Pacemaking Without Leads Just three months after Dr. Purushottam implanted the region’s first Impella RP in his patient’s right ventricle, his colleague, cardiologist/electrophysiologist Kelly Airey, MD, who joined the practice in April of 2014, performed a first of her own. On August 23rd, Dr. Airey became the first in the Dakota’s to implant the world’s smallest minimally invasive pacemaker, the Micra Transcatheter Pacing System from Medtronic, which was FDA-approved last April.

At less than two grams, the system is a tenth of the size of a conventional pacemaker–about the size of a large vitamin tablet–making it easier and quicker to implant than a traditional system. The entire 1-inchlong system is completely self-contained within the heart, including the battery, and attaches to the heart wall with small tines.

But Dr. Airey says what may be even more important about the Micra is the fact that it uses no leads.

“The problem with leads is that they can wear over time because of constant stress,”

says Dr. Airey, who did fellowship training in Cardiovascular Diseases at the University of Nebraska Medical Center and in Clinical Cardiac Electrophysiology at the University of Utah. “They can wear down in ten to 15 years. It is possible to extract them, but that is risky. The more leads a patient has, the more likely they are to develop an infection.

And, because these are foreign bodies they can become encapsulated by scar tissue and even occlude blood vessels.”

In the case of the region’s first Micra Pacemaker recipient, the leads were indeed the problem. The 94-year-old patient’s leads had failed. Dr. Airey had tried to remove one of the leads a year early but could not get a lead across the patient’s tricuspid valve.

“The only other option was to put the lead on top of his heart and tunnel it through his chest wall up to the pacemaker in his shoulder,” says Dr. Airey. Dr. Airey had tried to place a new lead from the chest a year earlier but could not get a lead across the patient’s artificial tricuspid valve from that angle.

Without the need to create a pocket to hold the pacemaker, the procedure is faster

Medtronic's Micra Transcatheter Pacing System

16

Midwest Medical Edition

Physician photos by Kevin Eilbeck Photography

with Medtronic to help bring the procedure to RCRH. “Another great thing about this procedure is that patients can go home the same day,” she says. “With a standard pacemaker, we typically keep them overnight.”

Dr. Airey says miniaturization is likely to be the future of pacemaking technology.

The Micra is one result of Medtronic’s decade-long commitment to what it calls “deep miniaturization”, an effort to reduce medical device sizes by up to 90 percent. The company is currently developing technology similar to the Micra for the atrium.

A New Direction for Heart Surgery

Dr. Zahir Rashid

and easier on both doctor and patient. And because there is no incision to heal, the Micra reduces the need for restricted activity after implantation. It also reduces the risk of inadvertently collapsing a lung while attempting to run leads across the lung to the heart from the shoulder area. The device self-adjusts to match heart rate with activity level.

According to Medtronic, the Micra Pacemaker is indicated for patients with symptomatic paroxysmal or permanent high grade AV block in the presence of atrial fibrillation, or in the absence of AF as an alternative to dual chamber pacing when atrial lead placement is considered difficult, risky or unnecessary. Patients with symptomatic bradycardia-tachycardia syndrome or sinus node dysfunction may also be candidates.

The initial trial of about 700 patients who received Micra Pacemakers demonstrated a 48 percent reduction in complications compared to a similar transvenous pacemaker with leads.

Dr. Airey, who estimates that she sees one or two patients a month in her practice who could benefit from the Micra, worked closely

Cardiothoracic surgeon Zahir Rashid, MD, has been a part of Regional Heart Doctors for just seven months but, already, he has introduced several new approaches to the surgical treatment of heart patients at RCRH. One of the most notable is the ability to perform mitral valve and aortic valve replacements through small incisions between the ribs, eliminating the need for sternotomy in certain patients and dramatically reducing risk, pain, and recovery time.

“Mitral valve operations have been done with small incisions in the right chest for years,” says Dr. Rashid, who was fellowship trained in Thoracic & Cardiovascular Surgery at the Medical College of Wisconsin in Milwaukee. “The difference now is that the incision is even smaller. The technology is better and we have improved the technique.

Now, anything on the right side of the heart like a tricuspid valve or the removal of a tumor from the right or left atrium, we can do without a sternotomy.”

Dr. Rashid was the first to perform a minimally invasive procedure to replace a patient’s diseased aortic valve through the right chest at RCRH and says this surgical technique may be particularly appealing to women and younger patients since the tiny scar can easily be hidden under the bra line. For patients suffering from atrial fibrillation, Dr. Rashid offers the Maze ablation procedure through a small incision on the right side.

New technology has also made the left

side of the heart more accessible. Another first for Dr. Rashid at RCRH is minimally invasive coronary artery bypass from the left side of the chest, a procedure that may be recommended when there are blockages in one or two coronary arteries, usually in the front of the heart.

For certain heart patients, the availability of minimally invasive cardiac surgery locally is about more than faster recovery and smaller scars. “The biggest benefit is for people at highest risk such as those with multiple comorbidities, people who have had a previous sternotomy, or elderly people with a condition like COPD or emphysema,” says Dr. Rashid. “With a minimally invasive approach, we don’t compromise lung function with a big incision.”

National figures show sternotomy patients spend 5 to 10 days in the hospital and do not return to work for two or three months. In contrast, patients who undergo minimally invasive cardiac surgery stay in the hospital only three to five days and can usually resume normal activities in four to six weeks. Recently, an 83-year-old female patient of Dr. Rashid went home just three days after undergoing minimally invasive bypass surgery.

“Hospital stays for me and my partner are down. We are trying to change the culture and show that people can go home earlier,” he says.

Although minimally invasive cardiac techniques present more challenges for the surgeon than sternotomy, it seems apparent that the region was ready for the new surgical options RHD is offering, RCRH’s volume of heart cases climbed by 40 percent over the previous year during the first quarter after he joined the practice.

“I think we are making good progress,” he says. “Everyone has a role to play in making it happen.”

In addition to the team of board certified physicians, Regional Heart Doctors includes Certified Nurse Practitioners, a Certified Physician Assistant, and an extensive support staff. Many team members are involved in cardiovascular research and the group works closely with a nationally accredited laboratory which is also located on site. ■

MED will have more on some of the new thoracic surgeries Dr. Rashid has brought to the region in the December issue.

November 2016

MidwestMedicalEdition.com

17

step up. extends beyond your medical practice,

If your vision of success

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18

Midwest Medical Edition

New

Cloud-Based Purchasing Solution

MAKES IT EASIER TO MANAGE YOUR OFFICE SPENDING

$

$

Every medical practice, no matter how large or small, needs to manage its spending. A computer or tablet may need to be replaced, new stationary ordered, or advertising created.

There will also be the need to update medical equipment.

For each expenditure, there must also be a way to organize and track it, including who requested the upgrade, who placed the order, and who signed off on it. Having the ability to quickly see any anomalies in spending is also important to prevent fraud or theft.

Unfortunately, although it’s essential, this need for tracking can also create a cumbersome paper trail and can slow the whole buying process down, right when time may be of the essence.

Some organizations use the Purchase Order Module to keep track of spending but the system’s reliance on stock and “product codes” can be frustrating. Others make do with spreadsheets, Word documents or plain old paper with a physical signature.

Regardless of what module is used, the office not only needs a way to track the original order, but to manage and record it, and easily reorder later, if needed.

Fortunately, there is now a new breed of purchasing solution available designed to make the whole process easier, faster, and more efficient. One example is the new Zahara Purchase Order &

$

Sponsored Feature

Requisition System, an online tool to quickly and simply create purchase orders, track them, organize them, and reorder without the hassle.

Zahara integrates seamlessly with FileDirector, a document management and workflow system, marketed locally by Sioux Falls-based Active Data Solutions.

“This product is incredibly robust and, with a cloud version, is extremely competitive,” says Ritch Noble, CEO of Active Data Systems.

“ADS FileDIrector Document Management System with our Sahara PRS cloud module is an exciting opportunity and a much-needed solution.”

With the Zahara system, there is nothing to install, so an office can be up and running in minutes. After an account is created, the organization can add as many users as needed, assigning roles like “buyers” or “finance managers”. The site even lets users create departments such as “Marketing”, “Operations”, and “Finance” and provides all the expected cost codes. Anyone with the login information and permission can use the system to quickly generate a purchase order. Zahara’s

MidwestMedicalEdition.com

elegant design and simple user interface means there is no need for extensive training, keeping staff happier and the wheels turning smoothly.

“One thing we really like about Zahara is its customizable approval process for purchases,” explains Noble.

“That means you can easily approve or reject a new purchase request right from your cell phone or tablet. You can even go into the system and explain why you are accepting or rejecting a particular request.”

Zahara integrates with existing accounting systems using open standard, making it easier to add suppliers and invoices. The system even features a spending analysis tool which provides a quick snapshot of who is spending what in the organizations and how much money could be saved by shaving even 1 or 2 percent off the bottom line.

For a demonstration and more information on how Zahara may be able to simplify your life and business, contact Ritch Noble at Active Data Systems at 605-335-5906 or by email at ritchn@ activedatasystems.com.

19

Elderly Patients and

Informed Consent

E

By Jeremy Wale

LDERLY PATIENTS MAY NOT

always have the capacity to make informed consent—and if recurring treatment is required, there are special issues. A patient’s absolute right to make informed decisions regarding his or her medical care is the foundation of informed consent. The American Medical Association states, “Physicians should sensitively and respectfully disclose all relevant medical information to patients. The quantity and specificity of this information

20

should be tailored to meet the preferences and needs of individual patients.”

First, some history on informed consent.

It began in earnest as a legal requirement with a New York lawsuit back in the early 1900s.

Justice Cardozo of the New York Court of Appeals stated, “[e]very human being of adult years and sound mind has a right to determine what shall be done with his own body…”1 This Appeals Court decision laid the framework for our modern-day informed consent laws and rules.

Over the years, case law relating to informed consent has evolved—with some states introducing statutes governing consent requirements for healthcare providers.

Informed consent laws differ by state in the amount of information a healthcare provider is required to disclose to the patient.

Some states employ a “reasonable physician” standard, meaning a healthcare provider must provide the amount of information a reasonably prudent physician would provide in the same or similar circumstances.2 Other

Midwest Medical Edition

states use a “reasonable patient” standard, requiring that a physician provide information that a reasonable patient would need to make an informed decision.3 Generally speaking, physicians do well to provide patients with enough information to be able to make a fully informed decision about medical care.

Exceptions to the informed consent requirement can be made for emergencies where the patient is unconscious and arrives at a facility needing a life-saving procedure. Be sure to check state laws so you know what is required for your informed consent discussions with patients.

RECURRING TREATMENTS Illnesses that require recurring treatments present unique challenges for physicians obtaining informed consent. Elderly patients are more likely to require recurring treatments such as dialysis, radiation, and chemotherapy. When a patient agrees to undergo these types of treatment, the initial informed consent process ideally covers the entire course of treatment.

Patients are told they may question the treatment process, as well as each individual treatment. Informed consent may require more than one conversation, especially in the case of chemotherapy, radiation, or dialysis.

Consider having an in-depth, detailed informed consent discussion with each patient before you begin recurring treatments.

Have the patient sign an informed consent document acknowledging that discussion and the patient’s consent to the course of treatment. Verifying

November 2016

with the patient at each visit that he or she wishes to continue the course of treatment is a good idea—as is noting that verification in the medical record.

ISSUES ASSOCIATED WITH AGING Elderly patients also are more likely to present you with consent issues related to powers of attorney (POA), guardianships, mental competence, etc. Who, if not the patient, do you need to obtain consent from for an elderly patient’s medical care?

Powers of attorney come in various forms; limited, general, durable, and healthcare are the most common. A POA is a document where a “principal” names an attorney-in-fact (“agent”) to act on his or her behalf. The POA will usually outline the breadth of the agent’s decisionmaking authority. Depending on how it is drafted and the type of POA, the agent may have very limited or virtually unlimited authority to make decisions on behalf of the principal.

The type of POA provided to your practice will have a large impact on whether the individual named in the POA has the authority to make healthcare decisions on behalf of the patient.

A healthcare POA is the most straight-forward type of POA. This document specifically outlines healthcare decision-making authority granted to the agent by the principal. We encourage you to read healthcare POAs carefully to determine the authority granted to the agent.

Non-healthcare POAs typically do not give the agent the authority to make healthcare decisions. Exceptions exist. Outside of a healthcare POA, if healthcare decision-making

authority is not specifically granted within a POA, do not make presumptions.

You also may encounter patients who lack the mental capacity to continue to make healthcare decisions. Patients with dementia or Alzheimer’s present consent issues you should be ready to address. You may be confronted with family disputes, court orders, conflicting POAs, or other documents that cloud the consent issue for a mentally incapacitated patient.

One of the best ways to avoid the confusion of consent for an elderly patient is to establish consent when the patient is of sound mind. Ask your elderly patients if they have executed any type of POA, living will, or other document outlining who has decision-making authority in the event they become

incapacitated or otherwise unable to make decisions.

Request a copy of documentation outlining decision-making authority for your patients.

Maintain this documentation in the medical record. And consider reviewing this with the patient periodically to ensure it is still current.

Consent can be a difficult topic to discuss. If you have any questions, please call your healthcare professional liability insurer. ■ Jeremy Wale, JD, is a Risk Resource Advisor with ProAssurance Group 1 Schloendorff v. Society of New York Hospital, 211 N.Y. 125, 129 (1914).

2 T haw v. North Shore Univ. Hosp., 129 A.D.3d 937, 939 (2015).

3 Janusauskas v. Fichman, 264 Conn. 796, 810 (2003).

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21

Task force explores models for

Rural Healthcare

By Scott A. Duke

H

OSPITALS, HEALTH systems, and post-acute

care providers from across the nation are committed to improving the access and delivery of essential healthcare services, but facilities operating in rural and frontier communities face numerous challenges in fulfilling their missions.

Excessive federal regulations and obsolete financing mechanisms add an extras level of stress on rural and frontier healthcare providers, whose workforce and finances are already limited by factors such as socioeconomic and demographic challenges. Communities experiencing multiple vulnerability characteristics are susceptible to a cumulative vulnerability risk that endangers the sustainability of quality healthcare services for more than 450,000 individuals – half of our state – living in rural and frontier South Dakota.

To proactively address these issues, the South Dakota Association of Healthcare Organizations (SDAHO) Board of Trustees last fall created the Task Force on Ensuring Access in Vulnerable Communities (VCTF) Rural and Frontier.

The 17-member group, which followed a construct established by the American Hospital Association (AHA), identified the characteristics and parameters of a vulnerable rural or frontier community in South Dakota and studied opportunities for innovation and emerging strategies, delivery and payment models. The task force also explored what state and federal government can do to create a climate for transition to these different models.

Residents of rural and frontier communities should have access to essential healthcare services, which include primary care, emergency services, behavioral health, dental services, transportation, diagnostics needs, prenatal care, referral and coordination resources and long-term services and community supports. Access to these services is critical for overall physical, mental and social needs, the prevention, detection and treatment of illness. They provide a quality of life and boost life expectancy.

The task force determined that a sustainable rural healthcare delivery system should focus on the Triple Aim of

22

improving the patient experience, improving the health of populations and reducing the per capita cost of healthcare for the population served. It should also encompass:

● Prevention, primary care, chronic disease management, and emergency services

● Coordination of the care continuum from wellness to home and community-based services too acute and post-acute

● Providing access to essential health services within a reasonable distance and timeframe

● Encouraging collaboration ● Pursuing technology ● Patient safety and quality ● Fair financing mechanisms by federal, state and local resources, private payers and patients The task force concluded that the current Critical Access Hospitals (CAH) model is vitally important to maintaining access to high-quality healthcare services in rural/frontier communities, but a “one size fits all” approach or solution is not advisable, and a number of models have the potential to help ensure access.

The task force recently released its findings in a report that is available at http://www.sdaho.com/vctf.pdf. Healthcare and community leaders are encouraged to discuss the information with a broad coalition of stakeholders in a “call to action” to engage conversations about the future healthcare needs in their communities and throughout the state. SDAHO will share the findings with national partners such as AHA, Leading Age and others in an effort to identify opportunities to influence public policy and legislation that supports positive changes in rural/frontier healthcare delivery models. ■ Scott Duke is President/CEO of the South Dakota Association of Healthcare Organizations.

COYOTE CLINIC REACHES TEN-YEAR MILESTONE

By Peter Carrels

A

FREE

PUBLIC

clinic in downtown Sioux Falls staffed by medical students from the University of South Dakota Sanford School of Medicine is celebrating its tenth year of service.

Coyote Clinic, located at 300 N. Dakota Avenue, offers fee-free consults and care by students with oversight by volunteer physicians.

The clinic facility is operated by Avera Health, and is run as a regular clinic during daytime hours. Coyote Clinic opens its doors two Tuesday evenings each month. Avera donates use of the clinic space, as well as contributes two on-site nurses, a receptionist, and a clinical manager to the student-run enterprise.

The clinic offers medical students an opportunity to engage in hands-on practice. Older students mentor younger students, and established physicians serve as ultimate decision-makers in all cases. Patients are encouraged to call the clinic and make an appointment, as the 12 appointments available during the two hours the clinic is open during each evening session are often taken.

The clinic also offers Spanish interpreters, as some 40 percent of the patients speak Spanish, and cannot speak English.

Student leaders decided earlier this year to double the clinic’s hours, from one Tuesday evening to two Tuesday evenings per month. This provides more opportunities for more students to work with more patients, and also

November 2016

provides for better continuum of care.

Third-year medical student Courtnee Heyduk is part of the steering committee that manages the clinic. She is elated at the recent schedule expansion. “Students gain valuable experience here,” she explained, “but our patients also benefit.” Because of the expanded schedule Heydukdescribed students working in the clinic are better able to track the impact of medications, and they can judge the progress of a patient following an initial exam.

For many medical students Coyote Clinic offers their first opportunity to interview and assess a patient. On a Tuesday night in late September first-year student Taylor Den Hartog was preparing to see his first-ever patient. “I do have butterflies,” Den Hartog admitted. “I’ve barely started medical school, and here I am getting ready to meet a real patient.”

Moments later Den Hartog and third-year student Sarvesh Kaushk entered the exam room accompanied by a Spanish interpreter. Not only would this be Den Hartog’s first patient, the interaction between the student and patient would be complicated by the fact that the patient cannot speak English.

Fifteen minutes later the two students emerged and Den Hartog provided limited information about the patient, to protect her privacy. But he smiled and described his first patient experience as satisfactory. Fellow

student Kaushik praised Den Hartog’s performance. “I am impressed.” said Kaushik, “He handled himself very well.”

The two students then went to another room to consult about the patient with Dr. Kevin Whittle, a Sioux Falls physician who volunteers his time to help at the clinic.

Whittle uses the conversation

to not only guide the patient’s treatment and prognosis, but to teach the students about their profession.

Coyote Clinic successfully blends public service and experience-based training for medical students, and after ten years this combination of benefits seems as relevant and meaningful as ever. ■

Medical students Sarvesh Kaushik (center) and Taylor Den Hartog (right) consult with physician Dr. Kevin Whittle at the Coyote Clinic in downtown Sioux Falls.

Coyote Clinic is run by medical students from the University of South Dakota Sanford School of Medicine, and operates as a free public clinic that is open two Tuesday evenings each month. The clinic exists in Avera Health’s downtown Sioux Falls clinic location.

MidwestMedicalEdition.com

23

Healthcare on the move Regional Health to Expand and Renovate in Rapid City

services within one location with a team of providers and caregivers coordinating and working together,” says Regional Health Chief Operating Officer Paulette Davidson.

The institute will also include a performance and athletic enhancement center. The initiatives are a part of Regional Health’s system-wide master space planning process and represent the largest expansion and renovation project in the system’s history.

The construction manager for the project is Layton/Gustafson, a joint venture between Layton Construction of Salt Lake City and Rapid City-based Gustafson Builders.

Local officials and business leaders, including Rapid City Mayor Steve Allender and Rapid City Area Chamber of Commerce President and CEO Linda Rabe, were among those who celebrated the news with Regional Health executives, physicians, and caregivers at an unveiling ceremony last month. ■

Changes for Watertown Regional Health has announced a multi-year, phased project to expand and renovate Rapid City Regional Hospital (RCRH) and construct an Advanced Orthopedic and Sports Medicine Institute at the Buffalo Crossing development in Rapid City.

PRELIMINARY PLANS FOR REGIONAL HOSPITAL INCLUDE:

● Making all current patient rooms private and adding additional private patient care units

● Expansion of the emergency department ● A new main entrance ● A new hospital office building for specialty services attached to the hospital

● New parking structures, including covered parking The announced expansion project also includes the construction of a new medical facility specializing in orthopedics, sports medicine and rehabilitation. The Advanced Orthopedic and Sports Medicine Institute will be built on 10 acres at the Buffalo Crossing development, located at the southeast corner of Catron Boulevard and Highway 16, in Rapid City.

“Our goal is to have all orthopedic, sports medicine, podiatric, spine, pain management, rehabilitation, and integrative medicine

24

Prairie Lakes Breaks Ground on New Specialty Clinic Prairie Lakes Healthcare System has broken ground on a new specialty clinic set to open in two years. The clinic is the result of a decision made by the Board of DIrectors more than a decade ago to build specialty medical and surgical services in Watertown.

Midwest Medical Edition

The new Prairie Lakes Specialty Clinic will eventually be home

The Prairie Lakes Healthcare System Board of Directors agreed

to many services already offered by Prairie Lakes Healthcare System

to finalize a naming rights transaction for the Watertown

but will also add much-needed space for future growth. Prairie

Community Center in April 2016. The parties agreed to a purchase

Lakes has grown from one employed specialty physician in 2003

price of $2.2 million for a term of 25-years. Five annual payments

to 21 in 2016. Today, Prairie Lakes physicians operate 17 outreach

will be made in the first five years of the term to complete the

clinics in surrounding communities.

transaction. The funds will be used by the City to support capital

“Many of our services, like dermatology and interventional cardiology, are rare to find in our type of service area,” says

costs of the center. Prairie Lakes will receive sponsorship benefits.

President and CEO, Jill Fuller. “Prairie Lakes Healthcare System

“Prairie Lakes Healthcare System has been a long-standing

needs additional space to accommodate service growth. The

partner to the Watertown community, providing funds to initia-

Specialty Clinic building will be a great addition to our campus.”

tives that support a healthy population,” said Steve Thorson,

The helipad will also relocate to the roof of the clinic, which

Mayor of Watertown. “The City Council and I are so pleased to

will be adjacent to the emergency department and radiology

have been able to work out an agreement with Watertown’s

services. The new clinic is expected to be complete by the

regional healthcare provider, to help fund a facility that will

Fall of 2018. ■

serve the recreational and fitness needs of our citizens for decades to come.” ■

Community Center Gets New Name

Brookings Opens New Medical Plaza Brookings Health System officially opened the newly constructed Medical Plaza building last month, completing the first leg of the health system’s hospital expansion and renovation project. Brookings Health System CEO Jason Merkley expects the new facility to help the community recruit and retain new doctors.

The Medical Plaza’s first floor tenant, Avera Medical Group Specialty Care clinic, includes familiar Brookings faces. Avera Medical Group recently moved its obstetrics/gynecology, general

The Watertown Community Center will officially be

surgery and podiatry services from the 400 Twenty-Second

called the Prairie Lakes Wellness Center under a newly-announced

Avenue clinic into the new building.

naming rights agreement.

The Medical Plaza’s second floor is available for lease. Inten-

“The biggest influence on the health of our community now and into the future will be the lifestyles we lead,” said Jill Fuller,

tionally built as an open shell, the second floor may be set up to accommodate the needs of tenants.

CEO of Prairie Lakes. “With this partnership, we see an opportunity

“The second floor of the Medical Plaza will accommodate

to improve the health and wellbeing of the community as a whole

those provider office space needs well into the future,” says

for years to come.”

Merkley. “The building even contains infrastructure to add on a

The Prairie Lakes Wellness Center will feature an open concept space including a walking track, leisure pool, racquetball and bas-

third floor if the demand for space exceeds the second floor capacity.”

ketball courts, expanded cardio and weight area, larger fitness

With the Medical Plaza open for business, construction

class space, and a social area with fireplaces for members. Four

continues on the rest of Brookings Health System’s campus. Once

full-size courts and the eight-lane pool will be able to accommodate

the east hospital expansion is completed, remodeling will start

competitive events and spectators. Participants will have access to

inside the original 1964 building. The entire project is slated

these facilities through a separate entrance.

November 2016

for completion Summer 2017. ■

MidwestMedicalEdition.com

25

Sanford Forms Pediatric Genomic Consortium SIX CHILDREN’S HOSPITALS have signed an agreement to form the Sanford

Children’s Genomic Medicine Consortium, a cutting-edge collaboration of children’s hospitals committed to integrating genomic medicine into pediatric care.

“This groundbreaking collaboration . . . will help set the standard for sharing resources and collaborating in research and education in personalized medicine for children,” says Gene Hoyme, MD, chief of genetics and genomic medicine at Sanford Health and medical director for the new consortium.

The consortium is intended to improve pediatric care through joint research programs and genomic healthcare workforce development. The expectation is that the combined research capabilities of the member hospitals will expedite genetic and genomic discovery through economies of scale and access to a large and racially and ethnically diverse population.

Founding members include Sanford Children’s; Children’s Hospital Los Angeles; Rady Children’s Hospital-San Diego; Children’s Hospital Colorado; Children’s Hospitals and Clinics of Minnesota; and Banner Children’s at Diamond Children’s Medical Center, Tucson, Arizona.

The consortium has also established an external scientific advisory board with representation from the American Academy of Pediatrics, the American College of Medical Genetics and Genomics and the National Human Genome Research Institute. Sanford Health is providing administrative staffing for the consortium. ■

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DISSOLVING HEART STENT NOW AVAILABLE AT SANFORD SANFORD HEART HOSPITAL in Sioux

Falls has been selected as one of the first 35 locations in the United States to offer a naturally dissolving heart stent, made of material similar to that of dissolving sutures.

The Heart Hospital is the first facility in a six-state-radius to offer Abbott’s Absorb stent.

“Traditionally, we’d treat a patient with coronary artery disease with a metal stent, and it would stay with them for the rest of their life,” said Sanford interventional cardiologist Tom Stys, MD. “Now, just like a doctor treating someone for a broken bone would remove a cast when the injury is healed, we’re able to use a stent that naturally dissolves after the artery is healed. This leaves the artery with the ability to pulse and flex naturally.”

Sanford Heart Hospital has been a clinical trial site for the Absorb bioresorbable vascular scaffold device for the past three years. It was FDA approved this summer and Sanford’s interventional cardiology team has undergone extensive training to be certified to perform the surgery. Sanford plans to eventually offer the technology outside of Sioux Falls, as well. ■

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“

Our greatest happiness does not depend on the condition of life in which chance has placed us, but is always the result of a good conscience, good health, occupation, and freedom in all just pursuits.

—Thomas Jefferson

”

Midwest Medical Edition

Thaemert to Offer New Non-Surgical Weight Loss Procedure

O

V ERW EI G H T PAT I EN T S

who aren’t heavy enough to warrant surgery but still need help to achieve significant weight loss now have a new option in the Sioux Falls area.

Surgeon Bradley Thaemert, MD, with Surgical Institute of South Dakota is one of only a handful of surgeons in the country trained to use the OverStitch suturing device from Apollo Endosurgery in endoscopic sleeve gastroplasty.

Thaemert, who has been using the device in other applications–such as closing holes in the bowel–for several years, was

November 2016

among a group of nine surgeons invited to train on the sleeve gastroplasty procedure in Houston in September.

The procedure works on the same principal as the sleeve gastrectomy, which achieves weight loss by removing up to 80 percent of the stomach. In non-surgical sleeve gastroplasty, Dr. Thaemert operates through the mouth, using the compact OverStitch device to place sutures in the stomach, sealing off about 70 percent of it.

“This procedure is meant for people with a BMI range of 30 to 40,” Dr. Thaemert told MED. “It is best for people who need to lose about 50 pounds, which is pretty challenging to do with diet and exercise. With this nonsurgical procedure, we are still having good success after about two years.”

As with other weight loss procedures,

MidwestMedicalEdition.com

By Alex Strauss

patients who undergo sleeve gastroplasty also have to undergo significant changes in their diets and exercise routines. At $14,000, the procedure is about twice as expensive as gastric balloon placement, which Dr. Thaemert also does, but can last at least four times longer. The gastric balloon comes out after six months.

The endoscopic sleeve gastroplasty procedure requires no incisions and leaves no scars and has the added advantage of being potentially reversible, should the need arise.

Dr. Thaemert says the closest center offering the same procedure is Mayo Clinic in Rochester. ■

27

ACQUISITION AND EXPANSION FOR SIOUX FALLS SPECIALTY HOSPITAL It has been a busy Fall for Sioux Falls Specialty Hospital. In the last few months, the independent facility in Sioux Falls has:

● Installed and began using a

●

larger cases. “Although the total number of suites will only increase by one, our goal with this project was to create larger, state-of-the-art OR suites that will better serve the needs of our patients and will be more efficient for our doctors,” Sioux Falls Specialty Hospital Director of Operations, Jon Crow told MED. The new suites are expected to be complete by February, 2017.

new GE Revolution EVO 64-slice CT scanner. The new CT scanner will make a number of new options available to patients at the hospital including CT-guided renal cryoablations. ● F inalized the purchase of Prairie States Surgical Started construction on a Center, an independent major expansion and ambulatory surgery center renovation of its existing OR suites. By adding four new on 26th Street in Sioux Falls. The Surgical Center suites and modifying several was previously owned by existing suites, the hospital the physicians of CORE will have a total of 14 surgical Orthopedics, who recently suites and will be better parted ways with Avera equipped to accommodate

Medical Group. “From our standpoint, we want to give our patients as many choices as possible, whether that is in the physicians they see or the facility they want to go to,” says Crow. “Acquiring Prairie States allows us to offer more choice in both areas as the need for orthopedic services continues to grow.” The physicians of CORE remain independent but Prairie States Surgical Center is now a division of Sioux Falls Specialty Hospital.

● Selected a developer for its planned Urgent Care clinic. The clinic, which is projected to open next November, will be located at 85th and Minnesota Avenue.

Architectural drawings of the new facility are expected to be released after the first of the year.

● Received another 5-Star Rating from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) for 2016.

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1020 W. 18th St., Sioux Falls, SD 57104 www.LifeScapeSD.org

Midwest Medical Edition

SDAHO RECOGNIZES

Photos courtesy SDAHO

“Distinguished Service”

TWO NURSES, A PUBLIC AFFAIRS OFFICER, A CLINICAL INFORMATICS SPECIALIST AND A HEALTHCARE EDUCATOR are among nine people honored with distinguished service awards at the South Dakota Association of Healthcare Organizations (SDAHO) 90th Annual Convention in Sioux Falls in September.

Obstetrics nurse Mary Schwaegerl, RN, a 34-year veteran of Brookings Health System and it’s OB director since 2009, was honored with the Distinguished Service Award, Health Care Professional. Schwaegerl has led patient-centered change in maternity care practices and advocated for positive breastfeeding policies within her community and state.

Kerri Lutjens, RN, with Avera St. Benedict Hospital in Parkston and Shirley Redmond, Public Affairs Officer for the Sioux Falls VA Health Care System in Sioux Falls, were both recipients of the Distinguished Service Award, Health Care Hero.

Lutjens has been closely involved in an outreach program that brings health basics such as healthy eating, immunizations and communicable disease prevention to eight Hutterite colonies surrounding Parkston.

She logs an average of 2,100 miles a month all within a 60-mile radius of Parkston.

Redmond, the VA’s public affairs officer since 2005, has the “innate ability to empathize with veterans and their families”,

November 2016

and has worked to ensure dignified and respectful treatment for all veterans. She has served as a coach and mentor of other rising leaders at the VA and has served as the Native American Veteran Activities Coordinator and liaison to Native American Veterans.

The Distinguished Service Award, Young Professional went to Erica Knippling, clinical informatics specialist with Brookings Health System. Knippling is responsible for the design, implementation, protection and continuing successful operation of computer, information and interfaced technologies. Knippling has been a member of the South Dakota Chapter of Healthcare Information and Management Systems Society (SDHIMSS) for the past four years and is currently its president elect.

Cindy Senger with Avera@Home received the Distinguished Service Award, Post-Acute Care Champion. Senger, vice president of innovation for Avera@Home, has more than 27 years of leadership experience in the hospital and education fields and has been visionary in thinking of new ways to deliver home- and communitybased services. She has helped lead the charge to bring Avera’s home health and hospice agencies under one leader and enterprise to strengthen services and expand service areas. ■

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Photo Left: Distinguished Service Award winner Kerri Lutjens, center, with Avera St. Benedict Health Center Chief Financial Officer Rita Blasius, left, and CEO Gale Walker, right.

Photo Right: Distinguished Service Award winner Shirley Redmond, center, with SDAHO President CEO Scott A. Duke, left, and Sioux Falls VA Health System Associate Director Sara Ackert.

See our website for a complete list of Award Winners from this year’s SDAHO convention.

29

Understanding the Stages

of Substance Use

By Chris Sandvig

P

ARENTS WILL OFTEN ask about the sig ns and sy mptoms of alcohol and d r ug use in their children. Substance abuse counselors will explore nine critical life areas to assess the progression of the client’s substance use. These critical life areas include Physical, Psychological, Family, Education, Social, Employment, Financial, Spiritual and Legal.

The more substance use-related problems the individual has in any of these nine areas, the farther their substance use has progressed. Parents and healthcare professionals should look for any significant

changes in behavior by the child. This may include falling grades, a change in friends, dropping out of extracurricular activities, disappearance of money or valuables, withdrawal from family, lying, escalation of conflicts at home and a change in appearance or hygiene.

Typically, experts refer to four stages of substance use. These include Experimentation, Regular Use, Risky Use/Abuse, and Addiction.

During the Experimentation stage of substance use, teens are voluntarily using chemicals without experiencing any

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negative issues in any of the nine critical life areas. Often during this stage the individual has little to no desire to continue the use of that particular drug. At this time the teen is just using the drug to have “fun” and has control of his/her use.

During the Regular Use stage, teens typically are still able to stop their chemical use on their own. The substance use greatly increases during this stage. The teen starts to engage in risky behaviors such as fighting or driving under the influence. They also may demonstrate symptoms of depression, anxiety or anger.

During the Risky Use/ Abuse stage, the teen is continuing to use substances despite multiple consequences within the nine critical life areas. Their chemical use has started to become their primary focus in their life. This is the stage where many teens start to see their legal issues increase.

Parents may see an escalation in problems in the home environment. The teen may start to crave drugs/alcohol, experience some minor withdrawal symptoms and changes in mood when they are not using the drug.

During the Addiction stage, the teen experiences physical dependence of the drug, including an increase in withdrawal symptoms and cravings for the drug. The problems related to their substance use will continue to spread through the nine critical life areas. The teen will be more likely to go against their own value system during this stage. The risks of accidental death or injury, suicide and incarceration greatly increase during this stage.

Midwest Medical Edition

While a parent can seek help for their teen at any point during these stages of substance use, the earlier a parent or healthcare provider recognizes the warning signs and seeks help for their teen the better the chances of the teen discontinuing their substance use. Prevention and Education classes may be sufficient for teens in the Experimentation and Regular Use stages, whereas outpatient or inpatient substance abuse treatment may be required for teens in the Risky Use/Abuse and Addiction stages of substance use. ■ Chris Sandvig, a commissioned minister, has been working with at risk youth since 1995, and is currently employed at Volunteers of America, Dakotas as a Licensed Addictions Counselor

For a complete bulleted rundown of the common progression of alcohol and drug-related behaviors, see an expanded version of this article on our website.

November 2016

Intervention is Key to Treating Significant Anxiety Determining when pediatric anxiety is serious enough to take action begins by identifying what behavior is ageappropriate and what is problematic.

“Untreated anxiety can lead to depression for some children,” says Loren P. Conaway, PhD, licensed clinical psychologist with Children’s Hospital & Medical Center Behavioral Health in Omaha.

“If their anxiety is significant, they are not going to grow out of it. They need tools to manage it.”

According to Dr. Conaway, for children ages 3 to 6, fears tend to be imagination-based.

“Ghosts, monsters and things that go bump in the dark,” she says. “They worry about the scary things that hide under the bed or in the closet.”

For school-age children, the fears become more reality-based. “They have worries about physical injuries, school performance, world events or illness, and not

MidwestMedicalEdition.com

just worry for themselves but also for their parents or siblings,” she says. “At this age, they also become socially aware and begin to fear rejection or embarrassment.”

Dr. Conaway says the difference between ageappropriate anxiety and anxiety disorders requiring therapy is the significance of the anxiety and whether or not it disrupts the child’s daily functioning.

Primary care physicians and parents should watch for changes in behavior or adjustment, such as problems with friendships, changes in grades, eating changes, withdrawal from activities, sleep difficulties or increased clinginess or dependence on parents.

Primary care physicians may also see physical symptoms rooted in anxiety.

“Chronic stomach aches, headaches, nausea or difficulty eating, or panic symptoms (sudden onset

crying, sweating, shakiness or dizziness), these could be a result of anxiety,” Dr. Conaway explains. “Lots of trips to the nurse’s office at school for these same symptoms are also an indication.”

If primary care physicians suspect an anxiety disorder or depression, Dr. Conaway says they have the option of educating parents on strategies, referring to a behavioral health specialist or both. She says a decision to refer may depend on how stressed the child is, how stressed the child’s parents are and how seriously the anxiety is interfering with the child’s life.

Typically, the behavioral health specialists at Children’s will attempt therapy before employing medication. “We have many evidence-based treatments, therapies and strategies that work,” Dr. Conaway says. “Although pediatric anxiety is on the rise, our knowledge is on the rise, as well.” ■

31

Dakota Lions Sight & Health

Photos courtesy DLSH

Celebrates 25Years The original headquarters of the South Dakota Lions Eye Bank in Sioux Falls.

32

The Corporate Headquarters of Dakota Lions Sight & Health in Sioux Falls

Sponsored Feature

Photos courtesy DLSH

EMS Teams from Sanford Health and Avera Health pose for a photograph outside the Dakota Lions Sight & Health Sioux Falls Office

T

HIS YEAR, Dakota Lions Sight &

corneas for transplant per year with satellite

Heath celebrates a significant mile-

offices in Rapid City, Bismarck, and Fargo. DLSH

stone in their journey marking 25 years

is proud to continue this incredible momentum

of helping to “restore of the gifts of sight and

marked by an increased number of eye and

health” in our region and beyond.

tissue donations and transplants, state-of-the-

It is hard to believe that the diversified organization that exists today began with just a handful of Lions Clubs members who had a vision of sponsoring a “Lions Eye Bank.”

Alan Berdahl evaluates a cornea in a viewing chamber using a slit lamp microscope

hospital and recovery partnerships.

As DLSH continues to grow and expand, the organization remains dedicated to its mission

Prior to the establishment of the region’s

of helping those affected to overcome corneal

first eye bank, ophthalmologists like Dr. Thomas

blindness and to heal disabling injuries. The task

White of Sioux Falls and Dr. Paul Wright of Rapid

is not always easy. DLSH staff work daily to con-

City, were identifying and recovering corneas

tinue to improve quality and build relationships

themselves, specifically for their own patients.

that support donor families, donors, recipients,

But Lions Club members in both South

and donation partners.

Dakota and North Dakota had a dream inspired

From the moment a call is received, an enor-

by the Lions Club International Foundation and

mous amount of coordination with the donor

the work of Helen Keller to create centralized

family, healthcare providers, coroners, funeral

eye banks to meet an even greater demand for

homes, and other recovery agencies begins. This

corneal tissue nationally and internationally.

work requires dedication, compassion, and

That vision led to the establishment of the South

attention to detail. Ultimately, the work of DLSH

Dakota Lions Eye Bank which officially opened

represented just the first ink in a chain that

on February 14, 1991.

culminates in the surgery to restore sight, ease

The first base of operations was in a small lab

pain, restore mobility, and in some cases, save

located in the lower level of Sioux Valley Hospital

a life. Of course, none of this is possible without

(later renamed Sanford Health) and later moved

the selfless gift of donation.

into a house-turned-office across the street. A

Throughout 2017, DLSH will be remembering

satellite facility was established in Rapid City to

and celebrating the organization’s roots, its

serve the needs on that end of the state.

achievements, and its plans for the future. The

As the organization developed and grew, a

organization expects to see 1,200 corneas trans-

new building was constructed specifically for

planted in 2017. Thousands more will be

the Eye Bank.This building opened in August

impacted by the gifts of tissue and research

2010 in Sioux Falls and still serves as the orga-

donation.

nization’s corporate headquarters.

As the only eye and tissue bank based in

In 2014, another satellite facility opened in

both South and North Dakota, DLSH is devoted

Bismarck, ND and in 2015 the South Dakota Lions

to continuing its important mission and creating

Eye & Tissue Bank and the Lions Eye Bank of

a culture that values relationships, donor fami-

North Dakota, affiliated to form a unified orga-

lies, and donors. They have plans to expand the

nization known as Dakota Lions Sight & Health.

new facilities in North Dakota to provide addi-

Today, DLSH is a nationally-recognized and

tional corneal processing and look forward to

accredited eye bank, providing nearly 1,000

November 2016

art tissue preparation technology, and new

MidwestMedicalEdition.com

another great 25 years. ■

33

The Right

Prescription Pharmacist Earns Healthcare MBA in Record Time

By Alex Strauss

E

RICA BUKOVICH spent years working as a retail pharmacist before she began moving into the managed care space, first at Cigna and then at Health Management Partners, a Sioux Falls-based health management company.

“Most people think of a pharmacist as someone that they get their medicines from, but my role is different. I don’t dispense medicine,” explains Bukovich who works with nurses, health coaches and medical directors on the pharmaceutical aspects of case management as HMP’s Director of Pharmacy “There has been growth in roles like mine, but it is still less traditional.”

It was during her time at Cigna that Bukovich, a graduate of South Dakota State University’s pharmacy program, first heard about the University of Sioux Falls Healthcare MBA program and was curious.

“At Cigna, two of the pharmacists I worked with had gone through this program and I just really started to think that maybe it would be a good idea for me, too,” she says.

“I was very, very well prepared for the clinical aspects of my pharmacy work. But when I started managing people, there were

34

other aspects of my role that I thought the MBA might be beneficial.”

Bukovich entered the USF MBA program with a concentration in healthcare in September of 2015. Although it is typically a 2-year program, Bukovich says the school worked with her to come up with a way for her finish faster by taking a combination of live and online classes. As a result, Bukovich will finish her coursework this Fall and says the customization was just what she needed.

“Honestly, balancing work and a family and all the other aspects of my life, it just worked better for me to focus on this for a shorter period of time,” she says.

But the arrangement did more than just help Bukovich earn her MBA faster. As part of her healthcare cohort on campus, she was able to explore business issues unique to healthcare. At the same time, through her online classes–many of which were made up of students who were not in the healthcare industry–Bukovich says she gained

valuable new perspectives, as well.

“I feel like this curriculum really prepared me for working with all kinds of people,” says Bukovich. “I still interact with people with varied backgrounds. My classes required us to collaborate and coordinate and that is exactly what I do in my work.”

“The professors understand that all of us work and they make a point to make things relevant,” Bukovich adds. “There were so many times when we would discuss something in class and then I would go to work and something relevant would happen.”

In addition to supporting her continued personal development and understanding of the business aspects of her own job, Bukovich says her USF Healthcare MBA has given her the tools to be an even more valuable part of the management team.

“The program has made me better at presenting my ideas and contributing to our business strategy as we continue to grow and evolve our business,” says Bukovich. “I like being able to be part of that discussion.” ■

I feel like this curriculum really prepared me for working with all kinds of people.

Midwest Medical Edition

Small Changes,

Big Payoff How making some simple changes to the way we eat can ward off Holiday weight gain

By Corey Howard

I

N THE WORDS OF JOHN SNOW, “WINTER IS COMING.”

In the health and fitness industry that means it’s the season for high calorie meals and sugary snacks. Especially if you have spent the warmer months being physically active and eating healthfully, you may not want the wheels to come off the wagon now just because your friends, family, and office staff may be pushing sugar laden treats your way. Or maybe you haven’t started your fitness program yet, but you just don’t

want to gain ten pounds over the Holidays.

First, some good news. If you’ve spent the summer being physically active and eating better, you should be just fine during the cold, dark, food-filled winter months because you’ve established some daily habits. However, if you’re just getting started on the road to a healthier lifestyle, you may need to make some small adjustments to your current eating habits before you begin a new diet. Your habits will dictate your success.

HABIT #1:

Eat slower.

It take 20 minutes for the brain to recognize that the stomach is full. By slowing down, you will naturally eat less since you’re allowing your stomach to process the food and send signals to the brain that you are full.

You’ll also feel less bloated after a meal. Try putting your fork down in between each bite, or take a breath or sip of water in between bites. Eating while conversing with a friend can also help.

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Midwest Medical Edition

While doctors search for new cures, we’re finding new ways to minimize risk.

HABIT #2:

Stop when you’re 80% full.

This one can be hard, but remember that it’s OK to have leftovers. if you’re eating slower, you should be able to recognize when you’ve eaten just enough to feel satisfied. If you stop at 80% you’ll have more energy after your meal and you won’t feel lethargic and bloated. Eat enough so that you’ll be hungry again in a couple hours.

HABIT #3:

Eat protein at every meal.

Protein is the single most important macronutrient you can eat. It’s responsible for repairing and rebuilding all of our damaged human tissues. Did you know you can’t overeat protein? Your body always has amino acids (protein molecules) in the blood floating around rebuilding tissues, cellular activities and helping with your basal metabolism. My clients live by the rule; it’s not a meal if there isn’t any protein.

Implementing these three simple habits will not only help prevent you from gaining ten pounds over the winter, but may even help you shed ten pounds between now and March. Imagine if you just did these three small things, cleaned up your diet, and started a light workout program. Ultimately, it’s the small daily habits that add up to the most significant changes. ■

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Corey Howard is the owner of Results Personal Training in Sioux Falls.

November 2016

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Learning Opportunities Winter 2016

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Most institutions avoid planning educational opportunities during the holiday season, but it’s not too late to start planning for the Spring. If you or your organization has an event you’d like us to list in the December or January/February issues of MED (and in our popular and free online calendar), please let us know right away. Contact us at Info@MidwestMedical Edition.com or add your event directly to our calendar at Midwest MedicalEdition.com.

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

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