Page 1




Celebrated for Service








Vol. 8 No. 7

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


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

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Contents VOLUME 8, NO. 7 ■ N OV EM B ER 2017


From Us to You

5 | MED on the Web Best and Worst States for Healthcare, Hazards in the Medical Workplace

31 |

Learning Opportunities


10 | New USD Study Finds “Concerning Differences” in Healthcare Between Germany’s Black Forest and the Black Hills 13 | Study Ranks Sioux Falls Among the Least “Stressed” Cities 19 | Spearfish Surgeons Now Offering Same Day Outpatient Total Joint Procedures

24 | Pierre Physician Honored by SD’s American College of Physicians Chapter 24 |

New Data Project Could Impact Patient Care

22 Sanford’s New Imagenetics Building Offers Space for Education, Clinical Care, and Research An interview with Catherine Hajek, MD, Director, Clinical Services & Education

26 Long-Time Siouxland Physician Couple Celebrated for Service

Sanford collaborates to apply the lessons of big data at the bedside.

25 | Groundbreaking Lung Cancer Trial Uses Innovative Tri-Drug Approach 26 |

New Skilled Nursing Unit Opens at Mercy

27 | Concussion Guidelines Evolve as More is Learned Pediatric sports medicine experts say it may be safe to return to activities earlier than once thought.

28 | Physician Profile: Shahid Ahmad, MD, Hospitalist, Regional Health Rapid City Hospital 30 | New Toolkit Helps Tribes Take More Control of Research ■ By Alex Strauss

Vol. 8 No. 7

■ By Alex Strauss

■ By Alex Strauss

21 | Regional Health Kicks Off Transformation of Rapid City Hospital

Celebrated for Servi ce

Rapid City Medical Center Brings 3D Mammography to the Black Hills

busy meeting and greeting at regional medical events. Here’s how to protect your neck, back, and hands ■ By Jeff Roach





6 | MED on the Road MED’s staff has been 8 | Smartphone Ergonomics:




Here’s what’s happening around the region

Liver Transplantation Fits Perfectly Into Avera’s Transplant Program


14 | News & Notes






By Alex Strauss

Not long ago, many patients in our region with advanced liver disease never even made it onto a transplant list. The reason? Liver transplantation was not available locally. Some were referred out of the area, but that was the exception rather than the rule. Today, the picture is very different. With Avera’s liver transplant program firmly in place, more patients are being offered this potentially life-saving choice. On the Cover: (Left to right) Avera transplant surgeons Christopher Auvenshine, DO, Jeffery Steers, MD, and Hector S. Crespo, MD. Photo courtesy Avera.



From Us to You Staying in Touch with MED



Medical Edition (MED), the premier business


publication for healthcare professionals in the

Sioux Falls, South Dakota

South Dakota region. This month, we are excited

to bring you an issue packed with news, information, and, we believe, plenty of personality. In fact, in every issue of MED, you’ll not only find the most up-to-date information about happenings

Liston-Holtrop Steffanie Liston-Holtrop

in our wide and diverse medical community, but you’ll also find articles that help you get to know the people behind them. A couple of cases in point are articles in this issue on high



doctors doing cutting edge research or advancing transplant care

in Sioux Falls, a talk with the people who have helped bring 3D


DIRECTOR Jaclyn Small

mammography to the Black Hills, and a profile of a young Rapid Speaking of people in the profession...we have been gratified

PHOTOGRAPHER studiofotografie

honors for physicians in Pierre and Sioux City, interviews with

City doctor who’s a favorite with medical students.



MARKETING DIRECTOR Erika Tufton Alex Strauss


to meet so many of you in person at events throughout the region


this fall. (See “MED on the Road” for the photos!) YOU are the

WRITER Jeff Roach

reason we do what we do and we are continually proud to keep

the human element front and center in every issue of MED. Are you a medical professional with something to share? We want to talk to you! Reach us any time with comments, suggestions, and story ideas at Now, grab a warm beverage of your choice and settle in with your new issue of MED. We really hope you enjoy it!


EDITOR Virginia Olson STAFF WRITERS Virginia Olson Liz Boyd Caroline Chenault John Knies

—Alex and Steff Reproduction or use of the contents of this magazine is prohibited.

©2017 Midwest Medical Edition, LLC

Next Issue: December 2017 Next Contribution deadline November 1 Next Advertising deadline November 5

Midwest Medical Edition (MED Magazine) is committed to bringing our readership of 5,000 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 Magazine feedback and advertising and marketing inquiries, subscription requests and address changes can be sent to MED is produced eight times a year by MED Magazine, LLC which owns the rights to all content.



There is even

Steffanie Liston-Holtrop VP Sales & Marketing 605-366-1479 Alex Strauss Editor in Chief 605-759-3295 MAILING ADDRESS PO Box 90646 Sioux Falls, SD 57109 WEBSITE

MED welcomes reader submissions! 2018 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

more online!

Maximize your digital marketing! List your practice or business, including contact information and links to your website, in MED’s popular online business directory for free. Add your listing in just minutes at businesses/search.

This month only on the Web

The Prairie Center as Cultural Art Museum

Blood on Board

Mercy Air Care is readier than ever for trauma patients

Sep/Oct Issue August 1 November Issue October 1 December Issue November 1


Stay up-to-date between issues. Sign up for previews of upcoming articles and advance notice of the next digital edition of

On the Road AUGUST 16 – Kyra Torgerson (MED), Sheila Anderson (RAS), Steff, Bobbi Nelson (Novak Sanitary), and Cathy Luke (All American Gymnastics) at the Sioux Empire United Way WomenUnite Event.

SEPTEMBER 21 – Steff, this year’s SDAHMPR (PR arm of SDAHO) president, with fellow board members (l to r) Julia Yoder of Brookings Health System, Jennifer Bender of Prairie Lakes Healthcare System, and Paige Baskerville of Avera Health.

OCTOBER 12 – Erica Knippling (SDHIMSS),Mandi Atkins (Health Link), and Kevin Atkins (HealthPOINT) at the 4th Annual SD Health Link Fall Forum in Sioux Falls. MED was a sponsor of the event.

SEPTEMBER 21 – Brooking Health System CEO (and self-proclaimed MED fan!) Jason Merkley poses with Steff and Alex at the 91st annual SDAHO Annual Convention in Rapid City.


AUGUST 24 – MED staff member Kyra Torgerson (right of the MED banner) with the SDMGMA board of directors: (l to r) Robyn Ewalt , Mark Hatting, Justin Garry, Patty Tlustos, Jon Pociask at MED’s conference display.

SEPTEMBER 27 – Steff with Sanford clinical geneticist Dr. Catherine Hajek, director for clinical services and education, at the Imagenetics ribbon cutting. sponsor of the event.

SEPTEMBER 29 – Sanford cardiologists Dr. Tom Stys and Dr. Kelly Steffen at the Go Red for Women Breakfast in Sioux Falls.

It has been a whirlwind late summer/early fall for MED. Our staff has been on the road, taking an active role in events from Sioux Falls to Rapid City. In August, VP Steff Liston-Holtrop and MED’s business development coordinator, Kyra Torgerson, took part in the Sioux Empire United Way’s WomenUnite fundraising event which attracted more than 850 attendees and raised close to $20,000 for PATH, a mental health organization that providers counselors in area schools. Kyra also represented MED at the South Dakota Medical Group Managers Association fall conference in Oacoma. In September, Steff and MED Editor Alex Strauss spent time with MED fans, sharpened their digital media knowledge, and made some new friends at the South Dakota Association of Healthcare Organizations 91st Annual Convention in Rapid City. In late September, Steff attended the American Heart Association’s GoRed for Women Breakfast in Sioux Falls, the official kickoff of fundraising for January’s Go Red for Women event. MED is once again a sponsor of the Go Red Event and Steff is the 2018 Chair. Finally, we were excited to get a peek inside Sanford’s new Imagenetics building at its official ribbon cutting ceremony in October.

November 2017



Ergonomics Here’s how to protect your neck, back, and hands By Jeff Roach



smartphone users worldwide. According to the Pew Research Center, approximately three-fourths (77%) of US adults say they own a smartphone. With more people now owning a smartphone, along with increased use of the devices for both work and leisure activities, it is not surprising to see ergonomic issues develop. The most common issues include muscle strain from awkward neck flexion and rounded posture, repetitive and awkward motion of one or both thumbs, and awkward static wrist posture. Also, design trends of larger phones with larger screens have added risk for thumb overuse due to the increased distance the thumbs need to travel. The science of ergonomics considers both the mental and physical capabilities of people when designing products. In the case of smartphone usage, problems can arise when people demand a better experience with screen size, but still want the functionality of a hand held mobile device. At a certain point, the size of the average human hand will not properly match the size of the smartphone being demanded. To better manage these ergonomic issues, some tips are included below to help prevent pain or injury from using smartphones.

See a graphic representation of the evolution of tech usage on the website.



 or those who need to occasionally F use their smartphone one handed, make sure you can hold the phone securely and still be able to tap with the thumb on all tap targets without strain.

 o improve neck and back posture, hold T the smartphone near chest level rather than waist level. This should help to maintain the natural curves in the spine and reduce neck flexion.

 void cradling the phone between your A ear and shoulder. This can cause upper back and neck strain.

 olding the phone to your ear with H your hand can also cause fatigue so use a Bluetooth headset instead.

 ary the way the smartphone is held V occupational therapist and a member of the and alternate between using the thumbs South Dakota Occupational Therapy and the fingers when tapping. Association and the American Occupational

 ollow the same advice for those with F sitting jobs – take breaks and change positions.

 se a protective case that improves U grip, which can decrease grip forces.

 eep the wrists straight when holding K and tapping.

 se features including predictive text U or auto complete tools to reduce typing or tapping frequency.

 hoose a smartphone that fits C your hands properly.

Also, always be aware of your surroundings when using your smartphone when walking. We have all seen video of people walking into traffic, into poles, or falling into pools. Don’t be the next smartphone fail on YouTube. ■ Jeff Roach, MS, OTR/L, CEES, is an

Therapy Association. He is an Ergonomics and Loss Control Specialist with RAS.

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Healthcare on the move 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

d Therap y?



pist, a highl CHT, knew y-specializ occupation ed and highl that she want al thera ed to be py, from y-competiti had been a hand her first disabled ve subsp encou nter “This patie by a strok ecialt y area ■ Joint with a patie e. nt had been of replaceme the opera nt whos a seamstress nt and e hand s ■ Carp for al tunne recalls Harm had had some high certified l syndrome end jobs,” ■ Strok s. hand thera e-related as she broug “I remember sittin pists world of six in Sioux contractur g with her ht ■ Posto wide and es Falls. As perative of the beaut out a book of pictu one Clinic at rehabilitati part of the res of some iful gown Orthopedic on Hand s that she she began Instit with “Our traini had made another ute, Harm to cry, realiz ng is from hand thera and s be able to ing that she all the way therapist, pist, an occup work perform may never down, althou the cervical spine and OI surge that ation part difficult al gh we typic To achie tional use of her life ons to resto shoulders ve certifi ally leave to hand s again.” re functo our physi cation, a must work says Harm impacted such as hand thera cal thera in by cond s. “Any pists,” pist itions before sittin the field for at least cond ition the uppe r extremitie that affec g for an exam which five years ts has just s should certified ■ Rheu a 40 perce hand thera be seen historicall matoid arthr by nt pass pist. We y OT by evalu ation itis ■ Cong rate. Harm have an exten a backgrou enital defor process s, an nd, is one sive to deter therapy mities ■ Traum of just mine if could help atic ampu 5,300 hand them.” tations or ■ Woun Her patie injuries ds and infec nts range elderly and tions from infan 8 are typic ts to the ally matologist s, pediatricia referred by rheuns, chiro practors and R/L,

9:43 AM



d 8


The new Prairie Lakes Specialty Clinic will eventually be home to many services already offered by Prairie Lakes Healthcare System but will also add much-needed space for future growth. Prairie Lakes has grown from one employed specialty physician in 2003 to 21 in 2016. Today, Prairie Lakes physicians operate 17 outreach clinics in surrounding communities. “Many of our services, like dermatology and interventional cardiology, are rare to find in our type of service area,” says President and CEO, Jill Fuller. “Prairie Lakes Healthcare System needs additional space to accommodate service growth. The Specialty Clinic building will be a great addition to our campus.” The helipad will also relocate to the roof of the clinic, which will be adjacent to the emergency department and radiology services. The new clinic is expected to be complete by the Fall of 2018. ■

Community Center Gets New Name



9:43 AM

“Prairie Lakes Healthcare System has been a long-standing partner to the Watertown community, providing funds to initiatives that support a healthy population,” said Steve Thorson, Mayor of Watertown. “The City Council and I are so pleased to have been able to work out an agreement with Watertown’s regional healthcare provider, to help fund a facility that will serve the recreational and fitness needs of our citizens for decades to come.” ■



● Making all current patient rooms private

and care units

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

The Watertown Community

Center will officially be called the Prairie Lakes Wellness Center under a newly-announced naming rights agreement.

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


The Prairie Lakes Healthcare System Board of Directors agreed to finalize a naming rights transaction for the Watertown Community Center in April 2016. The parties agreed to a purchase price of $2.2 million for a term of 25-years. Five annual payments will be made in the first five years of the term to complete the transaction. The funds will be used by the City to support capital costs of the center. Prairie Lakes will receive sponsorship benefits.

Brookings Opens New Medical Plaza

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.

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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.

“The biggest influence on the health of our community now and into the future will be the lifestyles we lead,” said Jill Fuller, CEO of Prairie Lakes. “With this partnership, we see an opportunity to improve the health and wellbeing of the community as a whole for years to come.” The Prairie Lakes Wellness Center will feature an open concept space including a walking track, leisure pool, racquetball and basketball courts, expanded cardio and weight area, larger fitness class space, and a social area with fireplaces for members. Four full-size courts and the eight-lane pool will be able to accommodate competitive events and spectators. Participants will have access to these facilities through a separate entrance.

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 surgery and podiatry services from the 400 Twenty-Second Avenue clinic into the new building. The Medical Plaza’s second floor is available for lease. Intentionally built as an open shell, the second floor may be set up to accommodate the needs of tenants. “The second floor of the Medical Plaza will accommodate those provider office space needs well into the future,” says Merkley. “The building even contains infrastructure to add on a third floor if the demand for space exceeds the second floor capacity.” With the Medical Plaza open for business, construction continues on the rest of Brookings Health System’s campus. Once the east hospital expansion is completed, remodeling will start inside the original 1964 building. The entire project is slated for completion Summer 2017.

24 Midwest Medical Edition

November 2016


To submit or suggest an article, share and idea, or offer a news item, November 2017 email us at or call 605-366-1479.


Study co-authors Kim Cleveland (center back in orange sweater) and Carole South-Winter (center in scarf and sunglasses) with USD student researchers in Germany’s Black Forest.


New USD Study Finds “Concerning Differences” in Healthcare Between Germany’s Black Forest and the Black Hills.

The study and results are available on our website.



ESEARCHERS AT THE University of South Dakota’s Beacom School of Business say there are “concerning differences” between healthcare cost, quality and access in comparable towns in Germany and the Midwest. Dr. Carole South-Winter, Assistant Professor in USD’s Beacom School of Business, and Kimberly Cleveland, MBA in Health Services Administration, Beacom School of Business, recently completed a comparative research study including 235 Germans and 219 Americans. Students who participated in a faculty-led program to study healthcare in Germany surveyed German residents on their perceptions of healthcare. Specifically, participants were asked to rate the quality of healthcare in their community, how easy it is to access, and how the cost compares to the value for patients. A similar survey was also conducted in a comparable town in the Midwestern US. “German respondents consistently scored their health care system much higher than American participants in these categories,” write South-Winter and Cleveland. “These differences may be attributed to fundamental political platform differences and most recent economic factors.” Germans, says the report, tend to embrace socialistic views of both healthcare and

education. Workers and employers contribute to a social insurance system through a payroll tax proportionate to income. Many Americans, on the other hand, are seeing their costs increase even as their employer-based healthcare coverage decreases. In addition, while efficient public transportation ensures that even most rural Germans can readily access healthcare, the challenges can be greater for American patients, especially in rural communities where both transportation and services are often lacking. Finally, at least some of the difficulties that American patients face are attributed to a lack of understanding of the complex US healthcare system. “Some argue this is a result of corporation’s profit margin mentality or the result of the American capitalistic political platform,” states the report. The study concludes that the significant differences between otherwise similar towns (many citizens of which are descendants of common ancestors in the Black Forest and the Black Hills) suggests that the US system might “glean insight” from Germany’s system. The study, entitled “Health Care Cost, Quality, and Access Comparison of Germany and United States: Two University Cities” is currently in the journal submission process. ■

Midwest Medical Edition

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Rapid City Medical Center Brings 3D Mammography to the Black Hills By Alex Strauss

“I went to my board and said ‘We need to do this because women are dying and they don’t have access to this technology’”


APID CITY MEDICAL Center has become the first institution in the Black Hills to offer area women access to 3D mammography services. RCMC examined its first patients with the new technology last month–coincidently, just in time for national Breast Cancer Awareness month. “I care a great deal about women’s health and I saw this as a wonderful opportunity to make some significant changes from the inside,” says RCMC CEO Jennifer Trucano, a healthcare lawyer who took the helm of the facility two years ago. “I went to my board and said ‘We need to do this because women are dying and they don’t have access to this technology.’” 3D mammography has been shown to detect breast cancer 15 months earlier and detect 41% more invasive cancers than conventional mammography. It also reduces unnecessary callbacks by 40%, especially in younger women.. “At 40, a woman’s breast is still so dense that it is hard to see through. So these women get called back. That is not just additional stress and anxiety but also more cost.,” says RCMC Ob/Gyn Marcia Beshara, MD. Because 3D mammography takes multiple image “slices” through the breast, it makes it easier to see around these densities. “I think the only reason we did not have it here in our region is that no one had asked about it,” says. Dr. Beshara who adds that she knows Black Hills women who have driven to smaller eastern SD cities just to get 3D mammograms. The introduction of 3D mammography at RCMC includes a remodel of the mammography area to create a more soothing, spa-like environment. “We want patients to go away not only feeling like they had the best exam possible but that they also had a positive experience,” says Dr. Beshara. “I’m proud of Dr. Beshara and of the board for doing what’s right for the community and our patients,” says Trucano. ■

Jennifer Trucano


Dr. Marcia Beshara

Midwest Medical Edition

Study Ranks Sioux Falls Among

the Least “Stressed” Cities

See the website to access the full report.

THE PERSONAL FINANCIAL website WalletHub has named Sioux Falls as one of the least stressed cities in America. In order to determine where Americans cope best with stress, WalletHub compared 150 of the largest cities using 30 key metrics. Sioux Falls was the 5th least stressed city in the study surpassing Omaha and Lincoln, Nebraska, Minneapolis and St. Paul, Minnesota, and Des Moines, Iowa. Researchers showed Sioux Falls was lowest in poverty (133rd), percentage of adults facing poor health (106th), and divorce rates (121st) but ranked 38th highest when it came to the number of hours people work and 57th highest in job security. The data set ranges from average weekly work hours to debt load to divorce and suicide rates. Newark, New Jersey was ranked as the most stressed city in the survey while Fremont, California, was the least stressed city. ■

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November 2017


Happenings around the region

South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska

News & Notes AVERA


Avera Medical Group announced Infectious Disease Specialists, PC, of Sioux Falls and its physicians have joined

Local Walmart and Sam’s Club stores in the Black Hills joined forces again this year to raise

Avera and came under its ownership September 1. The name of the practice is now Avera Medical Group Infectious Disease Specialists. The physicians in the practice include Jawad Nazir, MD, FACP, Fares Masannat, MD, Brian Pepito, MD, Robert Kessler, MD, and Asma Syed, MD. All are board certified in infectious disease.

Avera Health has rebranded its orthopedics and sports medicine programs under a new name: Avera Orthopedics.

The Avera team of orthopedic physicians includes 33 doctors in addition to 20 advance practice providers. In Sioux Falls, Avera Orthopedics includes the region’s first orthopedic trauma group to cover the emergency department 24/7 for complex fractures. Avera eCARE Pharmacy has gone live with its 100th site, Fall River Health Services, in Hot Springs, South Dakota.

Part of Avera eCARE, Avera’s telehealth network, Avera eCARE Pharmacy began in 2008. The remote pharmacy program provides a broad range of clinical and consultative services including pharmaceutical order entry, review, and verification.

money for Regional Health during the annual Children’s Miracle Network 2017 campaign. This year’s ‘register campaign’ — where customers can donate $1 or more when checking out at any Black Hills area Walmart or Sam’s Club — ran through October 29. Last year’s campaign raised $48,000 for CMN at Regional Health. Justin Steinert, MD, has joined Regional Health’s team of orthopedic surgeons and sports medicine specialists in Rapid City. Dr.

Steinert earned his medical degree from the University of Kansas School of Medicine in Kansas City and went on to complete his residency at Florida’s Orlando Regional Medical Center where he received extensive experience caring for trauma and total joint arthroplasty cases.

Regional Health Rapid City Hospital received a Kohl’s Cares grant of more than $80,000 for KidShape, a children’s healthy living education program. KidShape

is designed for children ages six to 12 who are overweight or wish to maintain a healthy lifestyle.


“ 14

A cheerful frame of mind, reinforced by relaxation... is the medicine that puts all ghosts of fear on the run. —―George Matthew Adams

Regional Health Rapid City Hospital nurse Bekka Pierce, RN, and Dan Warnke, RN, were recognized as DAISY Award Winners. Pierce

was nominated by the mother of a pediatric patient for her compassion and care. Warnke was nominated by the wife of an ICU patient who recognized the nurse for his patience and empathy. Ten Rapid City Hospital VolunTeens received $2000 scholarships from the hospital’s volunteer auxiliary.

Recipients include: Alana Brown, Isabella Glissendorf, Grace Wittenberg and Sophia Gomez from St. Thomas More; Abby Grismer, Christina Delzer, Janna Hagen, McKenna Haas and Tayla Bahr from Stevens High School; and Seth Papenfuss from Sturgis High School.

SANFORD Efrat Feldman, MD, has joined Sanford Health as a neurologist at the Sanford Brain & Spine Center in Sioux

Sanford Health has earned full accreditation in human research from the Association for the Accreditation of Human Research Protection Program (AAHRPP). AAHRPP

has accredited 247 organizations. Sanford Health is the only fully AAHRPP-accredited healthcare system in Sioux Falls and all of North Dakota.

Stephen Grove, MD, has joined Sanford Health as an emergency medicine specialist at Sanford USD Medical Center in Sioux Falls.

Dr. Grove graduated from the University of Nebraska Medical Center in Omaha. He completed his emergency medicine residency at Beaumont Health System in Royal Oak, Michigan. Donella Herman, MD, has joined Sanford Health as a primary care sports medicine physician at Sanford Orthopedic & Sports Medicine in Sioux Falls. Dr. Herman

graduated from the Sanford USD School of Medicine in Vermillion. She completed her residency at the Center for Family Medicine in Sioux Falls as well as a fellowship at Duke University in Durham, North Carolina.

Falls. Dr. Feldman graduated from medical school at Semmelweis University School of Medicine in Budapest, Hungary, and completed her residency at the University of Maryland Medical Center in Baltimore.

Midwest Medical Edition

Sanford Health has created a Department of Veterans and Military Services to streamline and bolster services to veterans.

Paul Weckman, a 26-year veteran and retired captain in the US Navy, will lead the department. The new department will help veterans and military personnel obtain healthcare services, navigate care and insurance coverage, identify wellness services, and search for employment opportunities. Sanford Health’s first adiposederived stem cell clinical trial has reached full enrollment.

The trial is the first in the United States to offer an FDA-approved adipose-derived stem cell trial for shoulder injuries. Sanford’s Mark Lundeen, MD, of Fargo and Jason Hurd, MD, who is based in Sioux Falls, are the study’s principal investigators.

Valentina Joseph, MD, has joined Sanford Health as a neurologist at the Sanford Brain and Spine Center in Sioux Falls.

Dr. Joseph graduated from medical school at MBBS, PSG Institute of Medical Sciences & Research in Tamil Nadu, India, and completed her neurology residency at the University of Toledo Medical Center in Ohio. Her areas of expertise include sleep disorders in adults and children. Sanford USD Medical Center has attained Magnet recognition from the American Nurses Credentialing Center’s Magnet Recognition Program for the fourth time. Magnet recognition

distinguishes healthcare organizations that meet rigorous standards for nursing excellence and is the highest national honor for professional nursing practice.

The Population Health Group at Sanford Health has been awarded $11.33 million to study health outcomes and disparities as they relate to public health.

The five-year study will focus on rural and American Indian health. Sanford Health was one of 20 institutions to receive three Centers of Biomedical Research Excellence grants from the National Institutes of Health. Profile by Sanford, the nutrition and lifestyle coaching service developed by Sanford Health, opened in stores in Evansville, Illinois, Cedar Rapids and Ankeny, Iowa, and Colorado Springs. Profile is headquartered

in Sioux Falls and has physical locations in 14 states. It opened its first location in 2012 has helped members lose more than 1.25 million pounds. The Sioux City location was recently named Profile franchise of the year.

Sanford Health nurses Jami Jacobson, RN, and Ruth Kaiser, RN, recently received DAISY awards for nursing excellence.

Jacobson works in the NICU and is described as friendly, knowledgeable, and compassionate. Kaiser has been called respectful, calm, and kind. She works in inpatient-rehab. Sanford Health celebrated its top employees this summer at its annual Employees of the Year presentation in July. This

year, 22 winners in the Sioux Falls region received awards in various departments ranging from The Birthplace, communications, NICU, and radiology to IT, security, and payroll.

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November 2017


Happenings around the region

South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska

News & Notes SIOUXLAND Cathleen and Chris McGowan of Sioux City are the chairs of the Mercy Medical Center Foundation’s Fall Gala November 4 at the Delta by Marriott. The annual

Mercy Medical Center–Sioux City hosted a Retreat and Refresh Stroke camp the weekend of September 15 at Inspiration Hills Camp in Inwood, Iowa. The goal of the

camp is to help stroke survivors and caregivers improve their quality of life and connect with others in similar circumstances and hopefully gain strength.

fundraiser helps provide the financial resources needed to further Mercy’s mission of hope and caring. Since its inception, the Gala has raised $3.5 million to improve healthcare for Siouxlanders.

Douglas Powell, DO, a vascular and interventional radiologist, joined Mercy Medical Center in September. Dr.

Powell’s specialty training will expand Mercy’s interventional radiology services. A Michigan native and graduate of Michigan State University College of Osteopathic Medicine, Dr. Powell completed his residency in diagnostic radiology at MSU and Oklahoma State University in Tulsa. He received his fellowship training in Interventional Radiology at Case Western Reserve University in Cleveland and at the Cleveland clinic.

Mercy Home Care in Sioux City, Iowa which provides in-home nursing and therapy for people recovering from illness or surgery, launched Home Care Connect. The integrated

care program empowers patients to stay in their homes. Using a tablet patients self-report such things a blood pressure, weight and current health symptoms. Mercy Home Care’s Vital Care Center nurses monitor the data 24/7. There is no cost to patients for Home Care Connect.

Anyone can register to be an organ, eye and tissue donor. NUMBER




Every ten minutes, someone is added to the national transplant waiting list.


On average, 22 people die each day while waiting for a transplant.



One person can save and heal up to 75 lives through organ, eye and tissue donation. 16

Midwest Medical Edition


There is no medicine like hope, no incentive so great, and no tonic so powerful as expectation of something tomorrow. —―Orison Swett Marden

recognition, the clinic successfully demonstrated excellence in care management, patient-focused huddles, setting patient goals and identifying barriers along with chart preparation and charting rooming standards.

As part of National Child Passenger Safety Month in September, Safe Kids Woodbury County hosted a car seat check September 23. The Safe Kids

program also conducted a “walk to school” and a bike safety program. Karin Ward and Amy Scarmon of Mercy’s Child Advocacy Center serve as coordinators of Safe Kids Woodbury County. Mercy Medical Center has announced the appointment of Shelby Reed and Jennifer Blackmore as hospital liaisons.

In this role, the two will work to strengthen relationships between Mercy Medical Center and other area hospitals, primary care physicians, and specialty providers as well as recruitment, retention and orientation of new physicians.

November 2017


Craig Severtson, founder of the non-profit Helping Kids Round First (HKRF), was honored in September by the South Dakota Association of Healthcare Organizations with the 2017

Healthcare Hero Distinguished Service Award. HKRF improved access to quality healthcare services to the poorest regions of Nicaragua by delivering donated hospital equipment. Severtson farms and ranches near Flandreau and founded HKRF in 2009. Laura McNaughton, MD, has joined Midlands Clinic, PC, in Dakota Dunes, South Dakota as a plastic surgeon. Dr. McNaughton

received her Doctorate from the USD Sanford School of Medicine and completed her plastic surgery residency at the University of Missouri-Columbia. She has published research in cosmetic breast surgery and craniofacial reconstruction and is the recipient of the 2017 “Best Emerging Author Paper” in Plastic and Reconstructive Surgery.

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By Alex Strauss

A Good Match Liver Transplantation Fits Seamlessly Into Avera’s Transplant Program


T HAS BEEN NEARLY A YEAR SINCE South Dakota medicine reached a major milestone

when Avera Transplant Institute performed the region’s first-ever liver transplant in Sioux Falls. Since that time, Avera surgeons have performed seven life-saving liver transplants in the culmination of an evolution that began in 1993 with the region’s first kidney transplant. Avera Transplant Institute has also established the region’s only pancreas and bone marrow transplant programs. In total, they have performed more than 1,000 transplant operations. “Just as with kidney’s, we were always aware that there were patients in our area who could benefit from liver transplant,” says transplant surgeon, Jeffrey Steers, MD, who joined Avera in 2012 and helped to build the liver transplant team. “Historically, many of these patients were never referred for transplant at all. Some were lucky enough to get referred to places like Minnesota or Nebraska. Having local access to the service means more people are going to benefit.”

THE EVOLUTION OF A LIVER PROGRAM Over the course of time, Steers says, Avera developed an extensive hepatology program, including four full-time hepatologists. As the number of patients with cirrhosis and end-stage liver disease grew, so did the number of physicians and allied health professionals needed to support them. The program’s integrated team now includes nurses, surgeons, anesthesia and critical care specialists, pathologists, nephrologists, and others–all with expertise in the special care of liver patients. Liver transplantation was the natural next step. “Liver transplant is part of the spectrum of care for patients with liver diseases and liver cancer,” says Dr. Steers. “We see ourselves and our expertise as caring for all patients with liver diseases, whether they need a transplant or another option. We now have the capacity to provide anything a patient with liver disease would need.”


“Administration has also been a strong component in the program’s success,” adds fellow transplant surgeon Christopher Auvenshine, DO. “My colleagues in other hospitals have nightmare stories of their administration’s inability to stay focused on a common goal. In contrast, our administration has stayed steadfast in their support.”

LACK OF ORGANS KEEPS SOME ON WAITING LIST With the team in place, the requirements met for active status with the United Network for Organ Sharing, and the administration firmly on board, Steers says the only thing now standing in the way of the program’s continued growth is the availability of donor livers. LifeSource, the region’s organ procurement organization, does well in this altruistic part of the country, but organs are shared over a large multistate area and there are never enough to meet the need. “We could probably do 30 to 40 liver transplants [the number of people added to the waiting list in the state each year] if we had enough donors,” says Steers. “In our area, there are a lot of people on the transplant waiting list. Unfortunately, patients have to get pretty sick to get to the top of the list.” Seeing these sicker patients safely through a transplant operation can be especially challenging. “Liver transplant is a much bigger and riskier operation than kidney transplant, which is not especially physiologically stressful,” says Steers. “But we recently had a liver transplant candidate who was in the ICU here for a month and somewhere else before that. If they are healthy, they might bounce back in a week, but most of our patients have been extremely ill.” Even so, all of Avera’s liver transplant patients have done well, to date, reflecting a national trend. Nationwide, there is now an 80 to 90 percent survival rate a year after liver transplant, compared to just 60 percent in the 1990s.

Midwest Medical Edition



■ First kidney transplant 1993 ■P  atients on the kidney transplant waiting list 243 ■ First bone marrow transplant 2000 ■ First pancreas transplant 2003 ■ First liver transplant 2017 ■ Physicians with transplant fellowship credentials on Avera campus –more than 12 Dr, Jeffrey Steers, Transplant Surgeon

NEW OPTIONS MAY GROW THE PROGRAM “We all expect the program to grow,” says Steers’ colleague, nephrologist Robert Santella, MD, who has been with Avera’s transplant program since the beginning. “Eventually, we would expect to be doing up to 40 to 50 kidneys a year and probably 20 livers.” Living donor livers might help them get there. Living donor liver donation involves removing a portion of the liver from the donor and transplanting it into the patient whose liver has failed. But there is a downside. While the risk associated with living donor kidney donation has dropped steadily, thanks to minimally invasive techniques, the risk of living donor liver transplantation is much higher, for both recipient and donor. Another option may be a liver support device, now in development. The machine would contain liver cells and may have the potential to help keep patients alive while waiting for a transplant or may support people whose livers could recover without a transplant. Steers say such a device might even be an alternative to transplantation for people who are not good candidates, and he is hopeful that Avera could be involved in any clinical trials. ■

November 2017

Dr. Auvenshine

Dr. Santella

Dr. Steers

Dr, Jeffrey Steers, Transplant Surgeon


Spearfish Surgeons Now Offering Same Day Outpatient Total Joint Procedures By Alex Strauss

Dr. Gould

Dr. Jensen

Dr. Little



HREE ORTHOPEDIC surgeons with Regional Health Orthopedics in Spearfish, South Dakota have begun replacing hips, knees, and shoulder joints on an outpatient basis in select patients. “An outpatient joint replacement is much like having a knee or shoulder scope in that you come in at 6 or 6:30 in the morning and you leave shortly after noon,” says Kipp Gould, DO, who specializes in hip and knee replacements at Regional Health Spearfish Hospital. Along with his colleagues Ray Jensen, DO, and Richard Little, MD, Dr. Gould has been offering the outpatient option to patients younger than 65 for about six months. “If you are over 65, Medicare requires that we keep you overnight,” says Dr. Gould. “Otherwise, interested

patients are sent to our surgical clearance physician for a workup of their heart and lungs.” Those who are deemed to be healthy enough for a same day total joint procedure attend a presurgical joint camp the week before. “The more you know about the procedure you’re going to have, the less trepidation you have and the better you are likely to do,” says Dr. Gould. In addition to careful patient screening and preparation, Dr. Gould says improved surgical techniques and a powerful, long-acting interoperative pain medication called Exparel have made it possible to cut length of stay from just over a day (already better than many other institutions) to just a few hours. “This is an injection that we do

during the procedure which lasts for about 72 hours,” says Gould. “Before we started using this, our first ambulation was about 30 feet. Now it’s 300 feet. So that has been a big factor.” Although Gould says same day total joint replacements are on the rise around the country, they are more often offered at private surgery centers. “It is unique that we are able to do this in a hospital setting. Usually, it is difficult to get the administration on board, but ours has been very supportive. I would be shocked if there were other hospitals our size in a rural setting offering this.” As more people become aware of the availability of these procedures in Spearfish, Dr. Gould says he expects about 30 percent of his total joint patients to choose the outpatient option. ■

Midwest Medical Edition

Artist’s rendering of the lobby and exterior (below) of the renovated Regional Health Rapid City Hospital. Photos courtesy Regional Health

Regional Health Kicks Off Transformation of Rapid City Hospital THE TRANSFORMATION OF

Regional Health Rapid City Hospital is now in full swing. The hospital kicked off a major expansion project and also celebrated the Phase 1 completion of its multi-story covered parking structure. The full project will encompass a new three-story front entrance, a larger and more efficient emergency department, as well as additional space for patient beds and medical offices. Other components include space for clinics and

future growth, along with Phase 2 of the parking structure. When fully complete in 2020, the $200 million project will add 266,000 sq. feet of internal space and 1,296 parking stalls, with 665 of them covered. The three-story, glass front entrance will be accessed from Fifth Street and face south, connecting to the new parking ramps and surrounding hills. It will enclose a large commons area with community spaces, dining, spirit ual healing spaces, a waiting lounge, home

medical equipment, and retail shops. The new 36,000-square-foot ED will be half again as large as the current one, with 34 private exam rooms, five stateof-the-art trauma exam rooms, and three resuscitation rooms. An enclosed drive-through ambulance garage will have space for up to six ambulances. The current department has 26 exam rooms, including six trauma rooms, and the enclosed garage has space for three ambulances.

The new Emergency Department will have an integrated clinical decision unit with 12 rooms and future growth space for an additional six. Interventional Cardiologist Joseph Tuma, MD, welcomes the addition of clinical space built in tandem with emergency services. The new 30,333 square foot cardiac intermediate unit will be 40 percent larger than the existing CIU. THe Heart and Vascular Institute outpatient/clinic offices will be relocated to a space two floors above the ED. â–

Check out our website for a comprehensive look at the complete renovation and expansion project.

November 2017


Photos courtesy Sanford Health.

Sanford’s New Imagenetics Building Offers Space for Education, Clinical Care, and Research Sanford Health opened the doors on the new Imagenetics building on the Sanford USD Medical Center Campus in Sioux Falls in October. Construction of the 103,000 square foot building began in October, 2015. The building houses clinical, research, and education spaces dedicated to integrating genetic medicine into everyday primary care. As Director for Clinical Services and Education, Sanford clinical geneticist Catherine Hajek, MD, helped to bring the new space to fruition. MED recently spoke to her about the building and the next stage of Imagenetics.

MED: Beyond a striking new building, what is Imagenetics? CH: Imagenetics is the marriage of internal medicine and genetics. Primary care physicians are at the front line of caring for patients. They are the first ones to address it if a patient has a genetic concern. Sanford decided to pursue this initiative when it became clear that genetics will continue to play a larger role in healthcare.

MED: How will the new building support the goals of Imagenetics? CH: All of the internal medicine physicians from Medical Building 2 will be in the new building along with clinical geneticists and genetic counselors. Having


Midwest Medical Edition

Go online for more photos inside the new Imagenetics building.

these specialists and physicians co-located increases access to genetic medicine. We also have our molecular genetics and cytogenetics labs right on site. A close relationship between the laboratory geneticists and the genetic counselors is key to getting patients the appropriate test and getting a good, accurate interpretation of results.

MED: Education is another major component of Imagenetics. How will the new space facilitate that? CH: The space between the two sides of the building is entirely dedicated to public education. We have two kiosks with a ton of interactive information. These interact with the light sculpture, which offers a unique way to engage people. We also have a social stairway with a drop-down screen for a community lecture series. We also have classroom space for our clinical staff and others. There are a lot of people who haven’t been exposed to genetics in their training, so some of this is very new. â–

November 2017

Ask ur tO Abou dge Lo e! g Packa


New Data Project Could Impact Patient Care STUDENTS AND RESEARCHERS at four

universities and Sanford Research have released the findings from their study of real-time patient data. It includes information that may impact the way patients are cared for at Sanford in the future. The data, which is stripped of private information, was made available as part of the Sanford Data Collaborative, which gathered statistics from thousands of patient visits to Sanford facilities and allowed the selected academic institutions to study it for trends and insights. The study began in February. “We had 20 applications from seven institutions,” says population health scientist Emily Griese, PhD, Director of Collaborative Research with Sanford’s health services division. “These were 20 truly multidisciplinary applications from the health services world, the business world,

the behavioral health world, and others.” Griese says sharing de-identified data with other institutions brings broader perspective to issues faced by patients, providers and systems. Although the original plan was to accept only three to five projects, they ultimately selected six. “We considered a number of variables in deciding which projects to accept,” Griese told MED. “We were looking for projects with a population-level focus. We wanted these to be things that would impact a big part of the Sanford footprint. The other piece was whether or not the data that they wanted to use was actually available.” “The other piece is that they needed to be able to come back to us and demonstrate how this could be used in clinical care.”

Among the projects chosen for the collaborative were a readmission risk algorithm for heart surgery patients developed by USD, an algorithm to predict unplanned medical visits for diabetics from the University of North Dakota, and a patient engagement score designed to decrease ED visits created by researchers at SDSU. “Typically, a hospital will share data with an academic institution that they are a part of,” says Griese. “This is unique because we are not part of an academic institution. So for us, this is a good partnership. It is one of the first of its kind in the nation.” The 2017-18 project RFP was released in September. ■ See a graphic representation of the evolution of tech usage on the website.


Robert Allison, MD, FACP, is the recipient of the 2017 Laureate Award from the South Dakota Chapter of the American College of Physicians. The honor recognizes fellows or masters of the ACP who demonstrate by example and conduct an abiding commitment to excellence in medical care, education, research, or in service to their community, their chapter, or the ACP. Dr. Allison has worked at Avera St. Mary’s Hospital and Avera Medical Group Pierre for more than two decades, serving as chair of the South Dakota ACP’s committee focused on health and public policy from 2003-2011, and again from 2014 to the present. He received the 2015 Neubauer Advocate for Internal Medicine Award, a national ACP honor given to a member who demonstrates excellence in state and national advocacy. He earned his ACP fellowship in 2002. “The ACP has been important to me and a part of my professional life since

State Medical Association’s Alternate Delegate to the American Medical Associamedical school,” says Allison. In addition to his contributions to the tion. He is also past ACP, Dr. Allison is a member of the South president of the South Dakota Governor’s Primary Care Task Force Dakota State Medical AssoMEDAd201711 v2_Layout 10/13/2017 2:30 PM Page■1 and currently serves as the1 South Dakota ciation.

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Midwest Medical Edition


first site in the United States to launch a clinical trial using a genetically-engineered VSV virus that aims to destroy therapy-resistant solid tumors. The Phase I immunotherapy trial will focus on adults with metastatic solid tumors that have not responded to standard treatments. The treatment involves injecting a genetically altered oncolytic virus — vesicular stomatitis virus (VSV) — directly

into a tumor. The virus is engineered to grow in cancer cells, destroy these tumors, and then spread to other cancer sites. During this process, it recruits the immune system to the area with the goal of triggering an immune response. The virus, commonly known as VSV, can infect cattle, but it rarely causes serious infections in humans. For the new treatment, it has been altered by adding two genes. The first is a human

interferon beta gene, a natural antiviral protein, to protect healthy cells against infection. The second gene makes the NIS protein found in the thyroid gland, which allows the researchers to track the virus as it spreads to tumor sites. Vyriad, a biopharmaceutical company in Rochester, Minnesota, developed the technology. “Oncolytic viruses are the next wave of promising cancer immunotherapy treatments,” says oncologist

Groundbreaking Lung Cancer Trial Uses Innovative Tri-Drug Approach AVERA WILL BE ONE OF eight sites in the world participating in

a groundbreaking new clinical trial for first-line treatment of metastatic non-small cell lung cancer. The clinical trial is part of the Worldwide Innovative Networking (WIN) Consortium and recently received U.S. Food and Drug Administration (FDA) approval. It is the latest in several planned trials to be offered at Avera, which will improve patient access to cutting edge clinical research in the Sioux Falls region. “This win for Sioux Falls is two-fold: it’s a good opportunity for patients who have advanced lung cancer but is also a sign of hope for the future. What we learn from these studies can be very important for treatments down the road,” says oncologist Benjamin Solomon, MD, the lead investigator for the study at Avera. In the Survival Prolongation by Rationale Innovative Genomics (SPRING) trial, patients will be provided a three-drug protocol that incorporates immunotherapy (avelumab) and two other therapies (palbociclib and axitinib). These three targeted drugs used in combination are expected to be highly potent but must be carefully tailored to the patient. The trial will further results from WIN’s first clinical trial and validate a novel algorithm SIMS (Simplified Interventional Mapping System) developed to match each patient’s tumor biology to a specific drug combination. SPRING’s investigator-initiated research will be launched in five countries and eight WIN member sites, including two in the US. “Avera must have a high level of expertise to perform these studies,” Solomon said. “This is a testament to the level of ingenuity and knowledge Avera patients have access to. This is not something that can be done everywhere.” The SPRING trial will start with a Phase I portion to explore the safety of the combination and determine the optimal doses for Phase II that will explore the efficacy of this tri-therapy regimen in first-line treatment of metastatic non-small cell lung cancer. The trial will have strict eligibility criteria and limited enrollment. ■

November 2017

Steven Powell, MD, who collaborated with Vyriad on the development of the clinical trial. Interventional radiologist Shannon Peck, MD, oversees the viral injection procedures. Enrollees in the trial are given a one-time injection and then are followed for 43 days to evaluate for safety and clinical benefit. After this 43-day period, chemotherapy, immunotherapy or targeted therapy can be restarted. ■


The aim of medicine is to prevent disease and prolong life, the ideal of medicine is to eliminate the need of a physician. —―Albert Camus


Photo courtesy Mercy Medical Center.

Long-Time Siouxland Physcian Couple Celebrated for Service

Drs. Askar and Fahima Qalbani.

DRS. ASKAR AND FAHIMA QALBANI, longtime married physicians in the Siouxland area, are this year’s recipients of the Mercy Medical Center Foundation’s annual George G. Spellman Service Award. The Qalbanis have served the Siouxland community for a combined 80 years. The award will presented at the 2017 Mercy Fall Gala on November 4, 2017. The Qalbani’s both are graduates of Liaquat Medical College in Iamshoro, Pakistan and have been on Mercy’s medical staff for 40 years. Askar, a pathologist, went on to his residency at Mt. Sinai Hospital in Elmhurst, NY, and a Fellowship at MD Anderson in Houston. Fahima, who is a radiologist, completed her residency at Christ Hospital in New Jersey. Dr. Askar Qalbani has served as the Director of Pathology, a member of the Medical Executive Committee and as President of the Medical Staff at Mercy Medical Center. Dr. Fahima Qalbani has been an integral part of improving the detection and treatment of cancer in the region. Together the Qalbani’s have touched and saved thousands of lives. The couple has three grown sons, and three grandchildren. Named after the late Dr. George G. Spellman, a longtime Sioux City physician, the Spellman award recognizes community members or groups whose generosity with their time, talent and treasure exemplifies the values of Mercy Medical Center. The award, which is now in its 15th year, was presented to the Qalbanis at the 2017 Mercy Fall Gala in Sioux City. ■

Photo courtesy Mercy Medical Center.

New Skilled Nursing Unit Opens at Mercy

The staff of Mercy's Skilled Unit, l-r: Sara Gerke, Office Coordinator; Wendy Olson, MDS Coordinator; Patti DeMoss, Floor Nurse; Chris Severson, Administrator; and Kari Lofflin, Social Worker.

MERCY MEDICAL CENTER HAS OPENED A NEW SKILLED NURSING UNIT on the 7th Floor in the North Building. The work to convert the area to the skilled unit has recently been completed and they are seeing new patients. The unit includes 20 private patient rooms, as well as staff offices, a dining room, kitchenette, television area, exercise room, and much more. Skilled Nursing Units provide services to individuals with disabilities or medical problems requiring daily therapy, nursing intervention or observation, but who do not require the specialized care of a hospital setting. The average length of stay is 14 – 21 days. “Patients are offered a quick transition from hospital to skilled care with a supportive living environment,” said Chris Severson, Mercy Skilled Care Administrator. “The nursing staff is monitoring medical needs, watching for changes and early warning signs, and communicating with physicians.” ■

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Midwest Medical Edition

Concussion Guidelines Evolve as More is Learned MUCH MORE THAN A BUMP to the head,

Moffat says recommendations regarding the resumption of physical activity after a a concussion is a traumatic brain injury that concussion also have evolved. “The new causes one or more serious symptoms. As practice patterns call for a couple of days of more is learned about the human brain rest, then the resumption of light cardiovasand the effect concussions have on it, especular activities, as long as those activities cially a child’s developing brain, medical don’t significantly worsen any lingering guidelines are adjusted to reflect the latest symptoms. It’s almost as if the exercise knowledge and research. “Years ago, the initial becomes the child’s meditreatment concept called cine,” Dr. Moffat says. “It is now deemed for total rest,” says Kody However, a child who important to get kids Moffat t, M D, has suffered a concussion, back into school, even whether the injury is medical director of the Sports Medicine clinic for partial school days.” sports-related or not, — Dr Moffatt at Children’s Hospital & should recover enough to Medical Center in Omaha resume full curricular and an associate professor of Pediatrics at activities before resuming extracurricular Creighton University School of Medicine. activities. “Despite any pressure to do “In some cases, that was taken to the extreme, otherwise, a child who can’t go back to school to the point of keeping the child in a darkened shouldn’t be playing football,” Dr. Moffat room with no cell phone, television or books; says. almost like solitary confinement.” At Children’s Sports Medicine Clinic, Dr. Moffat says that was an especially Dr. Moffatt and his fellow medical profesdifficult prescription for adolescents whose sionals implement a two-phase concussion lives revolve around social media. “Rather recovery protocol. “Return to Learn” is a process of returning to school according to than relax the child, we created a bunch of a plan developed specifically for that child. anxious and depressed teenagers,” he says. The most recent guidelines call for early The child moves through the plan at his recognition of symptoms and rest, especially or her own pace. during the first two days following the injury. “Taking two days out of school seems to be the optimal length of time to allow for initial brain rest,” says Dr. Moffatt. “After those two days, it is now deemed important to get kids back into school, even for partial school days.”

November 2017

The second phase is “Return to Play”. By law, after suffering a concussion, students will not be allowed to participate in any organized team activities (practice or games) until they have been evaluated by a licensed healthcare professional and have received written, signed clearance and written permission from parents or guardians, and submitted that material to the school or team. The newer concussion guidelines are a more realistic reflection of how children and adolescents respond and recover, Dr. Moffatt says. “A lot of the kids I see are athletes,” he says. “They’re active all the time, conditioning for their sports for months on end. To order them to completely shut down until every symptom is gone affects them not only physically, but emotionally as well.” ■


Physician Profile:

Shahid Ahmad, MD Hospitalist, Regional Health Rapid City Hospital of Arizona Medical School. Family physicians entrust these specialists “My father felt that was the real way to with the care of their patients during give back to medicine,” Ahmad said. It was hospitalization. Families entrust them with something the son only understood after he himself attended medical school. “It’s a conloved ones. Without trust, everything stops, tribution. I owe it to this profession.” says Shahid Ahmad, MD, a hospitalist at Athleticism and a diverse background Regional Health Rapid City Hospital. It is has made Ahmad approachable and his Ahmad’s ability to teach life lessons like shifting fortunes have given him perspective. this that has made him a favorite among Ahmad now splits his time between work in medical students undergoing rotation at Rapid City and a life in Arizona, where his Rapid City Hospital. parents live. He also coaches his brother’s “There’s so much more to being a good doctor than just knowing the medicine,” Little League team and gives to his comAhmad says. munity in other ways. After visiting Rapid Last spring, Dr. Ahmad received the City as a traveling doctor, he found that he liked the friendliness of the Midwest and Anton Hyden Award from USD Sanford asked for a permanent position. School of Medicine, an award given to a professor who inspires, supports, and men“I wanted to really commit to what I was doing,” says Ahmad, who admires the tors students during their clinical rotations. purposefulness of the Japanese Samurai. Ahmad, 33, says he works hard not to limit the teacher-student They awoke every day and relationship as he helps “There's so much more recommitted themselves to students prepare for to being a good doctor perfecting their role in sociboard reviews and find ety, he says. than just knowing their fit among the As a hospitalist, Ahmad the medicine.” many medical specialneeds to quickly connect ties. He also provides instruction on with patients, earn their trust, and respond to complex acute care issues. Hospitalists delivering bad news, having been on the like Ahmad have become common in receiving end after a sports injury in his youth. American hospitals over the past generation “You just talk like you’re friends and as care has grown more complex and physifamily – not like a stranger,” Ahmad said. cians have realized they need a balanced life. “It’s not about the doctor; this is not his “The mistake we make in this profession moment. This moment belongs to the patient sometimes is we let medicine consume us,” or family. There’s no actual right way.” says Ahmad. “We lose our identity. People Ahmad’s family came to the United forget they are people. I think trying to avoid States from India so his father could finish that actually makes us a better doctor. It a doctorate. They brought along few belongmakes us a better person.” ings and young Ahmad worked to contribute, His quest for a complete life fits with his learning the value of demonstrating respect name Shahid, which means “the witness” and kindness, even when it wasn’t reciproand refers to God’s ability to witness all. “I’m very blessed,” Ahmad said. “Life can be cated. After Ahmad’s father completed his doctorate, he began teaching medical glorious. I want to help people be a part of students as a professor at the University something great.” ■ TRUST IS CRUCIAL FOR A HOSPITALIST.


Midwest Medical Edition

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New Toolkit Helps Tribes Take More Control of Research


MERICAN INDIAN tribes have

long been a popular focus for population research studies. Too often, however, the findings are never even shared with the tribe, let alone used to improve tribal health. But an initiative called The Collaborative Research Center for American Indian Health (CRCAIH), a project funded through the NIH since 2012, is designed to change that. In addition to funding a research coordinator for each tribe, the group, which includes representatives from Sanford Health and six tribal partners, has developed an Institutional Review Board (IRB) “tool kit” that tribes can use to take more control of health research. “The original goal of CRCAIH [pronounced “ker-kuh”], was to help build tribal research infrastructure with the long term goal of reducing health disparities over time,” explains Jyoti Angal with CRCAIH. As Angal explains, there are three “cores” to CRCAIH: a regulatory knowledge core, a culture, science, and bioethics core, and a methodology core. She directs the regulatory knowledge core which put together the new toolkit. “There is a history of research abuse in native communities largely because they were not actively involved in that research,” says Angal. “The tribe never felt as though

they had ownership or governance.” But these days, Angal says, tribes are more interested in taking an active role in what is being studied and in how it might be used to benefit tribal members. Based on feedback from their tribal partners (each of which had a different level of sophistication around research), the free CRCAIH IRB toolkit contains templates, forms, and how-to documents for setting up a tribal IRB and reviewing research proposals. It is free and available online. Before the Sisseton Wahpeton Oyate (formerly the Sisseton Wahpeton Sioux Tribe) in Flandreau, South Dakota began using the toolkit two years ago, they had few rules to govern research. “Some of the protocols would go to our human services board, but they didn’t have any knowledge of regulations surrounding research,” says Heather Larsen, the tribe’s Research Specialist and IRB Coordinator. “A lot of times a research project would be approved and the researcher would conduct their research and just never come back. Our tribe wouldn’t hear any of the findings or be able to use the findings or anything like that.” It’s no wonder, says Larsen, that research has a negative reputation in Indian country. “We call them ‘helicopter researchers’ who

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come in and do their study and get what they need and then leave right away,” she says. But thanks to CRCAIH, attitudes and actions are changing. The Sisseton Wahpeton Oyate now has its own IRB and a Research Review Board which has been meeting monthly since 2014. With their IRB in place, have even been able to obtain a grant to conduct their own research on services they provide to parents of newborns. “For decades, research has been conducted on us but not by us,” says Larsen, who says she is now frequently contacted by other tribes for advice on research. “There is beginning to be a shift now and they are beginning to take ownership and see the value of research and in the data that we are collecting ourselves.” “The unique thing about the CRCAIH toolkit is that it factors in the role of the community and the impact on the community,” says Angal. “It has created buzz around the fact that research is important and that research regulation is necessary.” The CRCAIH toolkit has even caught the attention of the NIH and its developers were invited to present on it at the 2015 Native Research Network Conference. “I think it will have a long term impact on tribal health,” says Larsen. ■



By Alex Strauss

Midwest Medical Edition

Learning Opportunities

November 2017 November 6 9:00 am - 4:00 pm Clinical Documentation for Psychiatry and Mental Health Care Professional Conference Location: UnityPoint Health - St. Luke’s Auditorium Information and Registration:

November 7 8:30 am - 3:30 pm Avera Palliative Medicine Symposium Location: Hilton Garden Inn, Sioux Falls Information and Registration:, 605-322-7879

November 27 12:00 pm Sanford Imagenetics Lecture Series: Frontiers in Genetic Medicine Location: Sanford USD Medical Center, Sioux Falls Registration:, keyword “Frontiers”.

November 28 9:00 am - 4:00 pm Avera and Hazelden Betty Ford Symposium Location: Sr. Colman Room, Prairie Center, Sioux Falls Information and Registration:, 605-322-7879

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