MED-Midwest Medical Edition-September/October 2016

2016

SEPTEMBER OCTOBER

Vol. 7 No. 6

BEST vs RECOMMENDED Cybersecurity Practices

Med Ed from the

Prairie to Persia Functional Movement Screening

Family Bonds,

Healthcare Benefits Conversations About Growing Up in Medicine on the Northern Plains

THE SOUTH DAKOTA REGION’S PRE M IER PUBLICATION FOR HEALTHCARE PROFESSIONALS

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MIDWEST MEDICAL EDITION

Contents

Family

Bonds,

VOLUME 7, NO. 6 ■ SEP T EM B ER / O C TO B ER 2016

REGULAR FEATURES

Healthcare

4 | From Us to You 5 | MED on the Web Cardiac MRI, Invitation to post your events, archived issues 10 | N ews & Notes New providers, awards, accreditations and more 46 | Learning Opportunities Upcoming Fall and Winter CME opportunities and conferences

Expert advice

on saving for retirement and college ■ By Mark Schuleter

24 | The Fair Labor Standards Act

Will you be in compliance with new updates by the December 1st deadline? ■ By Morgan Brekke

25 | Children and Informed Consent

■ By Jeremy Wale

7

Your CyberSecurity: Best Practices vs. Recommended Practices

■ By Jerry

Sponsored Feature

Odom

26 | The Tricky Business of Being a Doctor

16

What Most Medical Professionals Aren’t Taught About Financial Planning Could Fill a Textbook

30 | McGowan to Receive Mercy’s 2016 Spellman Award 31 | Avera to Build Cancer Center in Pierre 32 | Record Turnout for International Rural Nursing Conference in Rapid City

34 | Study Finds Genetic Profiling Increases Cancer Treatment Options

From the Prairie to Persia A local doctor shares his experience with medical education in Iran ■ By Mark Huntington

Sponsored Feature

37 | H ow G & R Controls Helped Take the Heat Off Prairie Lakes Making the switch to direct digital environmental controls is saving the rural hospital $90K a year

42 | Beef for Sleep Quality and Physical Function New research highlights potential health benefits of consuming more protein from foods like beef ■ By Holly Swee

43 | H elp for the Front-line Physician and Opioid Dependent Chronic Pain Patient

■ By Craig Uthe

44 | Exploring the Black Hills: Why One Night is Not Enough

■ By Carmella Biesiot

41 Functional Movement Screening for Pain-free Exercise

■ By Corey

Howard

2016

8 | Tax-Advantaged Savings Vehicles

By Peter Carrels SEPTEMBER OCTOBER

IN THIS ISSUE

ON THE COVER

Benefits Vol. 7 No. 6

BEST vs RECOMMENDED Cybersecurity Practices

Med Ed from the

Prairie to Persia Functional Movement Screening

Family Bonds,

Healthcare page 16 Benefi ts Conversations About Growing Up in Medicine on the Northern Plains

THE SOUTH DAKOTA REGION’S PRE M IER PUBLICATION FOR HEALTHCARE PROFESSIONALS

By Alex Strauss

At a time when many doctors are steering the younger generation away from medical careers, we found many physicians in our region who were happy to recommend the same path to their children. The result not only creates a special kind of family bond but also benefits healthcare across the Northern Plains. We talk with some of these families for this first part of a series.

page

18

On the cover: Ronald Anderson, MD, and his daughter Breanne Anderson Mueller, MD

From Us to You Staying in Touch with MED

AT

MED, Fall is one of our favorite seasons.

Along with cooler temperatures and changing leaves, we love having the opportunity to connect with hundreds of MED readers, advertisers, and contributors at Fall SDAHO and SDMGMA conferences.

We also love bringing you to the biggest, most valuepacked issue of the year. This year’s September/October issue has surpassed even our expectations, with a lineup of fascinating expert columns and timely news stories too numerous to mention. We hope that you find it a valuable and enjoyable accompaniment to your favorite warming Autumn beverage! (As always, we welcome your submissions and suggestions. Special thanks to Dr. Mark Huntington for sharing his Iran trip experience with the MED community!)

The tradition of children following their parents into a profession has largely disappeared in the US. But here in the Midwest, where family farms and hardware stores still pass from one generation to the next, it’s alive and well. In fact, it’s happening in medicine, more than you might think. In this first installment of a series, we explore the similarities and differences in medicine–from one generation to the next–through the eyes of six pairs of parent/child doctors from across our region. Our great thanks to all of them for their participation and for our marketing partners and schedulers who helped us to pull it off!

See you in November!

PUBLISHER MED Magazine, LLC Sioux Falls, South Dakota

VICE PRESIDENT SALES & MARKETING Steffanie

Liston-Holtrop

Steffanie Liston-Holtrop

EDITOR IN CHIEF Alex Strauss

GRAPHIC DESIGN Corbo Design

PHOTOGRAPHER studiofotografie

WEB DESIGN Locable

DIGITAL MEDIA DIRECTOR Jillian Lemons

CONTRIBUTORS: Carmella Biesiot

Alex Strauss

Morgan Brekke Corey Howard Mark Huntington Jerry Odom Mark Schlueter Holly Swee Craig Uthe Jeremy Wale

STAFF WRITERS Liz Boyd

Caroline Chenault John Knies

NEWS & NOTES EDITOR Kari Anderson

ADMINISTRATIVE ASSISTANT Erika Tufton

—Alex and Steff

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

MED was a proud sponsor of this year’s SDAHMPR (South Dakota Association of Healthcare Marketing and Public Relations) annual convention in Sioux Falls in June. Our own Steffanie Liston-Holtrop is a member of the SDAHMPR board.

SDAHMPR Board Members left to right: Julia Yoder, Brookings Health System, Pam Stillman-Rokusek, Independent Marketing Consultant, Steffanie Liston-Holtrop, MED Magazine, Jennifer Devine Bender, Prairie Lakes Healthcare System

©2011 Midwest Medical Edition, LLC Midwest Medical Edition (MED Magazine) is committed to bringing our readership of 5000 South Dakota area physicians and healthcare professionals the very latest in regional medical news and information to enhance their lives and practices. MED is published 8 times a year by MED Magazine, LLC and strives to publish only accurate information, however Midwest Medical Edition, LLC cannot be held responsible for consequences resulting from errors or omissions. All material in this magazine is the property of MED Magazine, LLC and cannot be reproduced without permission of the publisher. We welcome article proposals, story suggestions and unsolicited articles and will consider all submissions for publication. Please send your thoughts, ideas and submissions to alex@ midwestmedicaledition.com. Magazine feedback and advertising and marketing inquiries, subscription requests and address changes can be sent to 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 Ergonomics in the Medical Workplace From the exam room to the front desk, find out how applying ergonomics principles can preserve your health and your bottom line.

What does “Lean” Construction Really Mean?

If you’ve heard of “lean construction” and wondered what it really meant (and how it might apply to your next building project), here’s your chance to learn from a local expert. This article from Beckenhauer Construction explains in layman’s terms how “lean” initiatives add value and eliminate waste to reduce costs and improve the entire construction experience.

Promote Your Fall/Winter Events - FREE It’s always free and takes just a minute to list your event in MED's interactive online calendar and be seen by thousands of MED digital readers.

MORE than a

MAGAZINE A Medical Community

HUB

For a Limited Time!

CLAIM A SITE SPONSORSHIP FOR HALF PRICE — Become a MED website sponsor for a fraction of the cost this fall and enjoy the perks all year long. For a low monthly fee, your logo will appear on every page of the MED website, on MED’s widely-distributed digital newsletter, here on the ‘MED on the Web’ page, and more. Plus, enjoy special opportunities to submit website content and link it to your own site.

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

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”.

Your CyberSecurity

Best Practices vs. Recommended Practices

By Jerry Odom

W

HEN IT COMES to technology, do you ever wonder where the concept of “best” comes from when someone tells you that there is a “best practice” for their approach?

Does it come from years of industry -standard experience and successful implementations across a variety of clients, or does it come from an IT magazine or blog as the current catchphrase? The word “best” traditionally implies a mastery of a given subject. Given the vastness of information technology and the speed at which it evolves, the term “best” may be questionable.

Rarely is a “one-size-fits-all” approach actually right for all. It often results in many unforeseen challenges given the vast differences between organizations across the spectrum. What makes more sense is to look at the practices of companies who have successfully delivered IT solutions globally to every household name in the world.

One such company is Microsoft Services Consulting division. Instead of trying to fit everyone into a box called “best practices”, they employ a series of recommended practices that are applied to many different environments or infrastructures. A recommendation to follow certain industry standards or guidelines offers flexibility and allows a repeatable process to be implemented across an organization to fulfill its needs.

Top of mind for most business and IT professionals is CyberSecurity. For most, the puzzle of cybersecurity is overwhelming. But, by following recommended practices, you can simplify the overall process.

7

Seven recommended practices that will yield great benefits towards bettering your IT CyberSecurity:

1

S tandardization of software operating system baselines for desktops and tablets as well as security standards for mobile devices.

2 3

I mplement end-user technology use agreements and network policies and procedures to your business.

4

estrict access from the outside by allowing your R firewall to block all nonessential inbound traffic and tightly control any remote access.

5

L everage technology to decipher SSL traffic to filter virus, malware, and other undesirable content from entering your network.

6 7

E ducate end-users on how to protect themselves from viruses, malware, and social engineering attacks.

irus and malware protection on the client side as V well as the firewall. ontrol of the network infrastructure using 802.1x C on all internal use wireless networks.

A key point to understand is that the most secure networks are not the ones with the best IT staff. The most secure networks are the ones with solid processes in place that are run by the smart IT staff. You can have the best IT staff in the world, but if they are not following a recommended practice that is repeatable, proven and tested, then your infrastructure will fail.

These basic steps will go a long way toward making your cybersecurity as good as it can be. There is no such thing as a bulletproof network; however, all networks can better their cybersecurity by implementing recommended practices. Risk mitigation and adapting to evolving threats is the name of the game. ■ Jerry Odom is a Solutions Architect at Golden West Technologies.

September / October 2016

MidwestMedicalEdition.com

7

Tax-Advantaged Savings Vehicles for retirement and/or college

By Mark Schlueter

O

NE OF THE BEST WAYS to accumulate funds for

retirement or any other investment objective is to use tax-advantaged (i.e., tax-deferred or tax-free) savings vehicles when appropriate.

Tax deferred is not the same as tax free. “Tax deferred” means

that the payment of taxes is delayed, while “tax free” means that no income taxes are due at all. For example, with a Roth IRA, after-tax dollars are contributed, but qualified distributions (those satisfying

a five-year holding period and made after age 59½ or after becoming disabled) are free from federal income tax.

Saving vehicles for retirement TRADITIONAL IRAS Anyone under age 70½ who earns income or is married to someone with earned income can contribute to an IRA. Depending upon your income and whether you’re covered by an employer-sponsored retirement plan, you may or may not be able to deduct your contributions to a traditional IRA, but your contributions always grow tax deferred. However, you’ll owe income taxes when you make a withdrawal.* You can contribute up to $5,500 (for 2015 and 2016) to an IRA, and individuals age 50 and older can contribute an additional $1,000 (for 2015 and 2016).

ROTH IRAS Roth IRAs are open only to individuals with incomes below certain limits. Your contributions

are made with after-tax dollars but will grow tax deferred, and qualified distributions will be tax free when you withdraw them. The amount you can contribute is the same as for traditional IRAs. Total combined contributions to Roth and traditional IRAs can’t exceed $5,500 (for 2015 and 2016) for individuals under age 50.

SIMPLE IRAs and SIMPLE 401(k)s These plans are generally associated with small businesses. As with traditional IRAs, your contributions grow tax deferred, but you’ll owe income taxes when you make a withdrawal.* You can contribute up to $12,500 (for 2015 and 2016) to one of these plans; individuals age 50 and older can contribute an additional $3,000 (for 2015 and 2016). (SIMPLE 401(k) plans can also allow Roth contributions.)

EMPLOYER-SPONSORED PLANS (401(K)S, 403(B)S, 457 PLANS) Contributions to these types of plans grow tax deferred, but you’ll owe income taxes when you make a withdrawal.* You can contribute up to $18,000 (for 2015 and 2016) to one of these plans; individuals age 50 and older can contribute an additional $6,000 (for 2015 and 2016). Employers can generally allow employees to make after-tax Roth contributions, in which case qualifying distributions will be tax free.

ANNUITIES You pay money to an annuity issuer (an insurance company), and the issuer promises to pay principal and earnings back to you or your named beneficiary in the future (you’ll be subject to fees and expenses that you’ll need to understand and consider). Most annuities have surrender charges that are assessed if the contract owner surrenders the annuity.

Annuities generally allow you to elect to receive an income stream for life (subject to the financial strength and claims-paying ability of the issuer). There’s no limit to how much you can invest, and your contributions grow tax deferred. However, you’ll owe income taxes on the earnings when you start receiving distributions.*

Tax-advantaged savings vehicles for college 529 PLANS College savings plans and prepaid tuition plans let you set aside money for college that will grow tax deferred and be tax free at withdrawal at the federal level if the funds are used for qualified education expenses. These plans are open to anyone regardless of income level. Contribution limits are high—typically over $300,000—but vary by plan.

COVERDELL EDUCATION SAVINGS ACCOUNTS Coverdell accounts are open only to individuals with incomes below certain limits, but if you qualify, you can contribute up to $2,000 per year, per beneficiary. Your contributions will grow tax deferred and be tax free at withdrawal at the federal level if the funds are used for qualified education expenses.

SERIES EE BONDS The interest earned on Series EE savings bonds grows tax deferred. But if you meet income limits (and a few other requirements) at the time you redeem the bonds for college, the interest will be free from federal income tax too (it’s always exempt from state tax).

*Withdrawals prior to age 59½ may be subject to a 10% federal income tax penalty unless an exception applies.

8

Midwest Medical Edition

Taxes make a big difference Let's assume two people have $5,000 to invest every year for a period of 30 years. One person invests in a tax-free account like a Roth 401(k) that earns 6% per year, and the other person invests in a taxable account that also earns 6% each year. Assuming a tax rate of 28%, in 30 years the tax-free account will be worth $395,291, while the taxable account will be worth $295,896. That's a difference of $99,395.

Note: This hypothetical example is for illustrative purposes only, and its results are not representative of any specific investment or mix of investments. Actual results will vary. â–

Mark A Schlueter, CFP, CLTC, FIC, is a Financial Consultant with Thrivent Financial in Sioux Falls.

Ask ur tO Abou dge Lo e! g Packa

For a more in-depth look at tax-advantaged savings vehicles, see the extended version of this article on our website.

September / October 2016

MidwestMedicalEdition.com

9

Happenings around the region

South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska

News & Notes AVERA The National Rural Health Association (NHRA) gave Avera Weskota Memorial Hospital the designation as a Top 20 Best Practices in Patient Satisfaction.

All the honored facilities will be recognized at the Critical Access Conference on September 23 in Kansas City.

Mandi Greenway, MD, Jesse Barondeau, MD, FAAP, and Megan Kippes, DO have joined Avera Medical Group Family Health Center on Avera Grassland Health Campus in Mitchell.

Drs. Greenway and Barondeau graduated from the University of South Dakota Sanford School of Medicine.

Dr. Greenway went on to be certified in dermatology.

Dr. Barondeau went on to be certified in both pediatrics and adolescent medicine. Dr. Kippes is a graduate of Des Moines University and is board certified in internal medicine.

10

Avera Health welcomes these new appointments to its Board of Directors, which began July 1st:

Current board member, Daniel D. Eisenbraun has been named the new board chair, Sr. Debra Kolecka has been named vice chair, and Dr. Charlie Hart joined the board. Ken Karels and Mark Buche both retired.

Avera Health recently earned more than $1 million in grants from two federal agencies.

USDA Rural Utilities Service Distance Learning and Telemedicine Program provided a grant to be used for Pyxis Automated Dispensing Machines in 18 rural locations. Other funded projects include “Before Baby: Avera Remote Gestational Diabetes Monitoring Project” at Avera Queen of Peace Hospital and the Rural Pharmacy Connections Project to expand ePharmacy services.

BLACK HILLS “Helping Kids, One Duck at a Time” was the theme of the 27th annual Great Black Hills Duck Race on July 31st. The

community showed its support to the Children’s Miracle Network Hospitals (CMNH) at Regional Health by sponsoring some 17,000 ducks in the race. One hundred percent of the funds raised from the race went toward helping local ill and injured children by providing programs, services, and medical equipment at Regional Health Hospitals.

Rapid City Regional Health has began a multiphase parking lot project. In phase one they will

expand an existing lot south of the hospital and put in a new lot at 5th and Elk. In the future, the hospital plans to put in a three-story parking deck. They hope to make things more convenient for their patients, visitors, and staff.

Lead-Deadwood Regional Hospital hosted a Digital Mammography Open House on July 19th. The event was held at

the hospital, where community members were invited to meet the team members and learn about the benefits of digital mammography.

Regional Health is offering the National Diabetes Prevention Program (NDPP) at seven sites across the Black Hills to help adults at risk for type 2 diabetes prevent or delay the disease by making lifestyle changes that also promote weight loss. New classes begin in

September. Participants must be at least 18 and meet criteria that demonstrate diabetes risk. People in one recent program hosted by Regional Health lost an average of 11 percent of excess body weight, with improvements in glucose, lipid, and blood pressure levels.

The American Congress of Obstetricians and Gynecologists awarded Sanford Women’s a three year certification in Outpatient Practice Excellence (SCOPE). This was the first in

Sioux Falls, as well as the tri-state region. SCOPE’s primary focus is enhancing the safety environment in the office setting.

The National Association of Occupational Health has given Sanford Health’s Occupational Medicine Program a perfect score in their certification.

Sanford OccMed is the largest franchise-based occupational medicine program in the country to achieve this certification.

Former family medicine physician Timothy Donelan, MD, is now the new vice president and medical officer and Timothy Byrne is the new vice president of operations for Sanford Health Plan. Dr. Donelan

has practiced with Sanford for more than 20 years.

Byrne is a native of Ghent, Minnesota and has worked in leadership roles in several insurance groups including UnitedHealth Group. Byrne started at Sanford in early July.

The 18th Annual Health Care’s Most Wired survey named Sanford Health a Most Wired Hospital for the sixth year in a row. As a Most Wired

Hospital, Sanford Health fills in the gap physicians and pharmacists are unavailable to fulfill using telehealth to give their patients 24-hour service.

Electronic access to the patient’s care team improves efficiency of care delivery, creates a new dynamic in patient interactions, and expands access to medical specialists.

Midwest Medical Edition

Sanford Heart Hospital in Sioux Falls has received the Mission: Lifeline Receiving

Center – Gold Plus Level Recognition Award. The American Heart Association program recognizes hospitals that quickly and appropriately treat heart attack patients.This is the seventh consecutive year Sanford Heart Hospital has received this award.

A group of experts led by Sanford Health’s Eugene Hoyme, MD, has developed

proposed updated clinical guidelines for diagnosing fetal alcohol spectrum disorders based on an analysis of 10,000 individuals involved in studies of prenatal alcohol exposure.

The study was organized, endorsed and funded by the National Institutes of Health’s National Institute on Alcohol Abuse and Alcoholism and appears online in Pediatrics.The study is titled “Updated clinical guidelines for diagnosing fetal alcohol spectrum disorders.”

September / October 2016

Sanford oncologist/ researcher, Steven Powell, MD, collaborated with a team of researchers to discover that the drug Olanzapine significantly improves nausea prevention in patients undergoing chemotherapy. Olanzapine

is FDA approved as an antipsychotic agent, however researchers noted significant relief for study patients using the drug. The study is published in the New England Journal of Medicine and was funded by the National Cancer Institute.

SIOUXLAND iVantage Healthstrong recently named Cherokee Regional Medical Center (CRMC) a Top 100 Critical

Access Hospital for the third year in a row. CRMC is affiliated with UnityPoint Health. iVantage’s results show that critical access hospitals such as CRMC can provide a safety net for rural communities across America.

l to r: Breanna Daniels, RN, Matthew Robertson, RN and Marsha Henn, MSN, RNC-MNN

Three pediatric nurses at UnityPoint Health – St. Luke’s received the 2016 Innovations in Patient Care Award from the Iowa Organization of Nurse Leaders (IONL) for their work in reducing pediatric patient distress. Studies show

that pediatric patients’ primary source of pain was related to having blood drawn. The trio conducted a study that showed a significant drop in patient anxiety when using an existing IV catheter to draw blood, rather than drawing blood traditionally.

As a result, this type of blood draw has become standard practice in the pediatric department at St. Luke’s.

MidwestMedicalEdition.com

UnityPoint Health-St Luke’s recognizes the following employees who have committed themselves to advancing their education:

Renee Grell, Courtney Ott, and Becky Haafke received Bachelors of Science in Nursing.

In addition, these employees have worked towards new certifications: Lesleigh Ailts, Paula Emerson, Kristen Nelson, Megan Berens, Faye Tompkins, Corina Anema, and Benita Triplett.

11

Happenings around the region

South Dakota Southwest Minnesota Northwest Iowa

Northeast Nebraska

News & Notes UnityPoint Health-St. Luke’s has been named a “Most Wired” hospital by the AHA for the fifth year in a row.

Grundy County Memorial Hospital, a UnityPoint Health Community Network Hospital, has also received the honor.

The Mercy Medical Center Foundation Fall Gala is set to be chaired by Dr. Julie and Chris Lohr. The Foundation’s

Gala will be held on November 5th. This year’s proceeds will be directed to Mercy’s Child Advocacy Center.

The American College of Radiology has designated Mercy Breast Care Center a Center of Excellence.

In addition, Mercy Radiology has received a three year accreditation in breast MRI, along with other accreditations in breast care modalities.

Breast MRI is now available at Mercy Medical Center and can impart valuable information to radiologists which is not available through other imaging modalities.

MED QUOTES

“

12

Kindness is just love with its workboots on.

—Unknown

”

Father Anthony Nwudah has joined the Spiritual Care Team at Mercy Medical Center.

Father Anthony completed his Clinical Pastoral education (CPE) at Seton Medical Center in Austin, Texas. He is board certified with the National Association of Catholic Chaplains as of 2014. Father Anthony started at Mercy in June.

Internist and pediatrician, Steven Joyce, MD, and surgeon, Lawrence Volz, MD, will now also serve as Chief Primary Care Officer and Chief Medical Officer respectively for Mercy Medical Center, effective immediately. The two physicians

will continue in their current practices. Mercy President and CEO Jim Fitzpatrick says that the half-time roles place the two doctors close to the work, which is an important perspective in their roles.

Mercy Medical Center provided Operation Heat Relief again this summer during days where temperatures went above 90 degrees. Mercy provided cool

drinks in their cafeteria for people without adequate shelter or cooling in their homes.

Physicians at Mercy’s Emergency Department say that heat-induced illnesses can be life threatening if residents do not stay inside during warm days and drink plenty of water.

The American Heart Association/American Stroke Association awarded the Get With the GuidelinesStroke Gold Plus Quality Achievement Award with Target: Stroke Honor Roll to Mercy Medical Center. Mercy

also met specific qualification guidelines to qualify as a Joint Commission Primary Stroke Center. These guidelines feature a comprehensive system of rapid diagnosis and treatment for stroke patients in the emergency room.

The AHA has also awarded Mercy with the Mission: Lifeline STEMI Silver Achievement Award. As a

participant in Mission: Lifeline, Mercy commits itself to the best practice guidelines of the AHA in treating heart patients.

OTHER Clinical DIetitian Sara Berreth has joined Prairie Lakes Nutritional Services. Berreth is a native of Volga. As a

Nutritionist, her interests are with employee health, fad diets, nutritional support, and malnutrition. Berreth will assess and work with patients in the hospital and can also accept appointments for one on one or group sessions.

Marcy Dimond, CEBT, CTBS, Chief Executive Officer of Dakota Lions Sight and Health

(formerly the South Dakota Lions Eye and Tissue Bank) has been elected to the Board of Directors of the Eye Bank Association of America.

Sioux Falls based Vance Thompson Vision has expanded to Fargo, North Dakota with the opening of a new clinic there August 1.

Jamestown, ND native Mike Greenwood, MD, a graduate of UND Medical School, will return to his home state to run the new clinic. Dr. Greenwood completed his ophthalmology residency at Case Western Reserve in Ohio and did a one-year fellowship at Vance Thompson Vision’s Sioux Falls clinic. Dr. Greenwood will offer treatment for diseases of the cornea, glaucoma, and cataracts as well as complex intraocular lens implants and LASIK surgery. The two offices will be linked via a direct-wired video system.

D1 Sports Training & Therapy, an athletic-based training facility jointly owned by Orthopedic Institute, Kyle Vanden Bosch and Tyler Starr, opened in Sioux Falls in July.

The facility features over 14,000 square feet of training space and a full-service physical therapy clinic. D1 will offer a variety of services focusing on strength, agility, injury prevention, weight loss and general health and fitness for ages 7 through adult.

Archana Chatterjee, MD, PhD, chair of pediatrics at at the USD Sanford School of Medicine, is

chair-elect of the American Association of Medical Colleges (AAMC) Group on Women in Medicine and Science.The AAMC Group on Women in Medicine and Science advocates for the advancement of women within the field of academic medicine, including the nation’s medical schools.

Midwest Medical Edition

September / October 2016

MidwestMedicalEdition.com

13

Pouring concrete into the gaps to improve the stability of the home during earthquakes

At the dedication ceremony for the finished house (The door and roof would be added later)

MED Builds Hope

in Nicaragua

With help from generous sponsors, MED Editor Alex Strauss learns house construction with Habitat for Humanity

Alex and Danis, the new homeowner’s 17-year-old daughter

Some Nicaraguan friends in San Cayetano

W

ITH HER WORK BOOTS, gloves, and sunscreen packed, Strauss, her

husband, and teenaged daughter left in mid-June for a 10-day building project in the Nicaraguan coastal village of San Cayetano. Nicaragua has one of the highest housing deficits in Central America. Along with a team of 8, Strauss made and poured concrete, mixed and laid mortar (for which she and her teammates each earned the title of Albañil), hauled and stacked cinder blocks, and built friendships in the 95-degree heat as they built a home for a family of four.

Like their neighbors, this family lives on less than $2 a day, earning most of their money from their small tortilla business. Replacing the family’s former tin and wood home, the 800 square meter “seed home” is built to withstand the region’s frequent tremors and designed to be expandable by the family. The new home project also included the family’s first-ever flushable toilet and shower. Strauss says the work was the most physically demanding but also some of the most rewarding she has ever done and has broadened her perspective of what it means to be of service in the world.

Strauss, her family, and her new Nicaraguan friends wish to extend their sincere thanks to the following sponsors who helped to make this trip possible.

MMIC (Marian Hagerman) • Right at Home, SE South Dakota (Tony Mau) Dr. Paul Amundson • Carla Campbell • Corbo Design • Wendy Phillips Steve Kuiper

14

Midwest Medical Edition

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15

Shah Abdol Azim Shrine, Tehran, from the 9th century.

From the Prairie

I

to

Persia

N APRIL 2016, along with Dr.

Stephen Schultz of the University of Rochester (NY), I traveled to the Islamic Republic of Iran at the invitation of the Ministry of Health and Medical Education as consultants on the development of graduate medical education in Family Medicine in the country.

Iran has a primary health system based upon community health workers (behvarz) that has made significant strides in improving the public health of the nation over the past quarter century. At the next level of care, the healthcare system was organized in the mid-1980s to fully integrate healthcare with medical education, stressing that

16

By Mark Huntington, MD, PhD

“community needs must be given primary consideration in the context of training medical manpower.”

Though Iran has well-established physician subspecialty training programs, historically, a majority of care has been provided by “general practice physicians”, i.e. medical school graduates without postgraduate residency training.

The Iranian health system faces many of the same challenges as the US system: lack of access, technology-driven rising costs, fragmentation of care, and a focus on episodic disease-centered care rather than continuity and prevention. In an effort to address these challenges, the development

of Family Medicine as a specialty has begun. After studying a variety of models of Family Medicine around the world, the Ministry determined that the US model of the discipline best met their national needs.

This spring, eight Family Medicine residency programs, enrolling a total of 60 physicians, were started.

We were asked to present a day-long workshop as part of the annual National Medical Education Congress. We also visited several of the new residency programs in Tehran and Isfahan, meeting with faculty and resident physicians.

Discussions were held with Ministry officials tasked with the development of

Midwest Medical Edition

National Medical Education Congress special session on Family Medicine.

Dr. Huntington is under the white background flag.

the educational program, and a final meeting was held with the Deputy Minister.

During these sessions, a wide range of topics were addressed. This included current Family Medicine graduate medical education practices in the US (both the more urbanfocused in NY and the more rural-focused in SD), ranging from curriculum and faculty development to recruiting and pedagogical methods. Current experiences and historical lessons from the establishment of Family Medicine as a specialty in the US on issues such as certification exams and maintenance of certification, “grandfathering” mechanisms, continuing professional development, financing of graduate education, and others were presented.

Ongoing consultation is planned, including return trips to Iran and visits by faculty of the Iranian residency programs to US residency programs to see first-hand the logistics of training Family physicians.

In addition to the consulting work, we were taken to see some of the cultural, religious, and historical sites of the nation, including the National Carpet Museum (Iran is where Persian rugs originate), palaces of the former kings of Persia/Iran, and several religious shrines. As a history buff,

it was fascinating to experience a nation with such a long and rich history (and one which has preserved its heritage following the 1979 collapse of their 2500 year old, multiple dynastic monarchy).

What was most delightful about the trip were the people of Iran. In stark contrast to what is often portrayed by our media and politicians, the Iranians were very warm and welcoming. Grand hospitality is an integral part of the culture, and we certainly benefitted from that! The professional colleagues and governmental officials with whom we met were extraordinarily gracious and appreciative; the random people we met on the street reacted with pleasure when they heard we were from the US. We left the country having made many new friends. ■

Mark K. Huntington, MD, PhD, FAAFP, is Director of the Center for Family Medicine and the Sioux Falls Family Medicine Residency Program, and Professor at USD Sanford School of Medicine. He has been involved in global health and medical education for many years and serves on the Advisory Board for the American Academy of Family Physicians’ Center for Global Health Initiatives.

Additional photos from both Alex Strauss’ Nicaragua trip and Dr. Huntington’s Iran trip can be seen on our website.

September / October 2016

Meeting with Dr. Bagher Larijani, Deputy Minister (far right)

MidwestMedicalEdition.com

Ali Qapu Palace at Naqsh-e Jahan Square (Imam Square), Isfahan. Imam Square is the second largest public square in the world (Tiananmen Square in China is larger), dating to 1597.

17

Q

By Alex Strauss

Family Bonds,

Healthcare Benefits Conversations About Growing Up in Medicine on the Northern Plains

F

rom family farms to family-owned diners, hardware stores, and insurance companies, there is a long tradition across the Northern Plains of passing on passion for a special line of work from one generation to the next. It turns out that the passion for the medical profession is no exception. While national surveys find fewer than half of today’s doctors would recommend the same path to a young person, we found many notable exceptions - and their physician offspring - in our region. In the first installment of a series, we explore these medical family bonds and the ways in which the profession is changing.

Fahima Qalbani, MD, Radiologist, and her son, Adnan Qalbani, MD, Radiologist Mercy Breast Care Center, Dakota Dunes, South Dakota Dr. Fahima Qalbani and her husband, pathologist Askar Qalbani, MD, were new Pakistani immigrants and new doctors when they met during their training in New Jersey. When their son Adnan was just 3, the couple settled in the Siouxland area where Dr. Fahima founded the Mercy Breast Care Center. Dr. Adnan Qalbani is a graduate of the University of Iowa Medical School and completed a breast imaging fellowship at the University of Chicago. Although he started his career in Denver, he began practicing with his mother while waiting Fahima Qalbani, MD, and her son, Adnan Qalbani, MD,

18

for his Colorado medical license.

: How do you think Adnan’s upbringing impacted his decision to go into medicine?

DR. FAHIMA: I think it just happened. He was good in science and math and he would accompany me to radiology meetings sometimes. At first, I discouraged him from going into radiology because of the lack of patient contact, but after the Breast Center opened, that was different.

DR. ADNAN: I grew up with a lot of friends whose parents were doctors. A lot of docs tell their kids not to go into medicine but my parents never told me that. To some extent, that may be cultural. It is a big thing in the Indian and Pakistani community to go into medicine. I was not forced or pushed so much as much influenced. I didn’t really know much else when I went to college, so I definitely sensed a sort of inevitability about it.

As far as choosing radiology, when I was growing up, there was a lot of discussion about cancer cases before I even went to college. So this was something I was comfortable and familiar with.

Q

: How do you think your experience of medicine will differ from that of your parent/child?

DR. ADNAN: In the 80’s, doctors had a lot more freedom.

Their challenges were more about transition to a different kind of system. The challenge for my generation is about finding professionalism and meaning in those changes.

Doctors my age and younger don’t have the same set of

Midwest Medical Edition

expectations about how much money they’ll make or how much career control they’ll have.

Another generational difference is that we don’t think of our careers as static.

Technology is changing rapidly and radiology will almost certainly not look the same in ten years. It may change the way we have to practice or even what we are doing from day to day.

David Munson MD

Patrick Munson MD

David Munson, MD, Pediatrician/ Neonatologist, and his son Patrick Munson, MD, Pediatric Ear Nose and Throat Specialist

DR. FAHIMA: This

Sanford Health, Sioux Falls

generation is more into lifestyle. My son likes to ski and be outdoors. I think there will be less chance of burnout and suicide among younger physicians because of this. They are willing to make less money if they have to in order to have the lifestyle they want and this is a good thing.

On the other hand, they have to worry a lot more about reimbursement, whereas that is something that we did not really even have to think about. It never occurred to us that we might not always be doing as well as we did.

After graduating from the University of Minnesota medical

Q

: What is it like to work with your mom?

DR. ADNAN: She has the perspective of experience and I have the recently-educated perspective, so I think patients benefit from that. In school, they teach you how to read films but they don’t necessarily teach you how to interact with patients, so I have really benefitted from her experience there.

September / October 2016

school, David Munson, MD, started in pediatrics as an intern at the former Sioux Valley Hospital in SIoux Falls. After seven years at Central Plains Clinic, he completed a fellowship in neonatology back in Minnesota and returned to Sioux Falls to raise his young family. Early on, Patrick showed a passion for science and people. After an ENT fellowship at Arkansas Children’s he became Sioux Falls’ first pediatric ENT.

Q

: What was said about medicine as a career when Patrick was growing up?

DR. DAVID: I told my kids they should follow what their hearts tell them to do, what they feel called to do. Pat is the kind of person who is very sensitive. He enjoys working with people. He is very concerned about people and what is going on with them.

He is kind of a servant guy with a good heart so I think the personal aspects of medicine appealed to him.

I used to talk to the kids a lot about what I did, but I did not either promote or discourage medicine. They could see that I liked my job, although I didn’t always like my hours. I told them that if you go into medicine for the right reasons, it is an enjoyable field to be in.

DR. PATRICK: I vividly remember people coming up to my dad in the community and saying ‘Hey, Dr. Munson, this is my daughter that you took care of five years ago.’ I am now seeing patients whose parents were NICU babies that my dad took care of.

I loved science and I felt that medicine offered both the intellectual and personal side of things. You care for people and really invest in their lives.

Q

: How do you think your experience of medicine will differ from that of your parent/child?

DR. PATRICK: The quality of life as a physician in easier now than when my dad was first working. He had to be in the hospital at all times and couldn’t leave, but now we have more ancillary helpers to offload the work burden. On

MidwestMedicalEdition.com

the down side, there is a lot more regulation and bureaucracy now, which is something that he did not have to deal with as much in the past.

But I still feel like medicine is a fantastic field. I have four boys and I wouldn’t hesitate to recommend it to any of them if they felt called to it.

DR. DAVID: When I came out of school, there were a lot more private practices. You were able to work more independently.

Now, medicine as a whole has become more large-group focused so we are more likely to be employed by an organization. But the changes also allow for much better work-life balance. We overdid it and our families suffered. This generation has learned to put things in better perspective.

Q

: Do you ever work together?

What’s that like?

DR. DAVID: He does consults with some of my patients in the NICU and I have the opportunity to work alongside him and see what he does. That has been rewarding for me. I really enjoy the collegiality of working with one of my kids. I also get secondary rewards from all the good things that he does!

DR. PATRICK: The fact that our practices could overlap was a big part of my decision to come back and work in this area.

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Dermatologists Roger Knutsen, MD, and his daughter Siri Knutsen-Larson, MD West River Dermatology, Rapid City Dr. Roger Knutsen was on track for a career in cardiology when he suddenly decided to change course and pursue dermatology instead. A graduate of the USD School of Medicine, Dr. Knutsen trained under the famed surgeon Dr. Frederic Mohs at the University of Wisconsin. After a locum tenens in the ER in Rapid City, he opened his own practice. Siri Knutsen also attended USD for medical school and made a similar course correction after a year as an ObGyn resident at the Roger Knutsen, MD, and Siri Knutsen-Larson, MD

University of Colorado.

Q

: How do you think Siri’s upbringing impacted her career choice?

DR. ROGER: The only thing I ever told her is that medicine is the best job in the world. But I never said you should go into medicine. I could see that she was above average intelligence and could get into medical school if she wanted to.

DR. SIRI: I feel like I was always very encouraged to pursue the path into medicine.

There was never any ‘maybe you should think twice about this’. I have done everything in the office from cleaning toilets when I was young to filing charts in high school to being a medical assistant in college and now being a physician. So it has definitely been a

progression and it has been fun to come back and work with a lot of same people who have been here since the beginning and saw me initially as a child.

Q

: What about the decision to pursue dermatology?

DR. ROGER: I never told her to go into dermatology. But I did tell her that there are few decisions in one’s life where you have no regrets at all and going into dermatology was one of those decisions for me.

It has rewarded me in ways I’d never dreamed of.

DR. SIRI: At first I said that I would never be a dermatologist and that I would never come back to South Dakota.

I thought dermatology was

boring. But I realized just a few weeks into my ObGyn residency that it wasn’t going to be for me so I switched to dermatology. I am the kind of person that no one can tell me something, I have to figure out things for myself. He was very supportive and did not try to sway me.

Q

: How do you think your experience of medicine is different from that of your parent/child?

DR. ROGER: She is definitely going to have to deal with managed care more often than I have. But on the other hand she has been trained in different treatment modalities and with different drugs than I have. And she gets to work with a lot of new technology.

And because she is acclimated to EMR, the learning curve was not as steep for her.

DR. SIRI: There are a lot more hoops to jump through now. It is no longer that the doctor just does what's best.

Now we have so many other things we have to take into consideration - insurance companies dictating what procedures are appropriate and what we can and cannot prescribe. There is also more government oversight dictating what things have to go on the patient record.

Sometimes, I watch my dad trying to adjust to some of this and I think yeah, we have all these new-fangled systems, but not all of them are better than what came before.

Ronald Anderson, MD, ObGyn, and his daughter Breanne Anderson Mueller, MD, ObGyn Sanford Health, Mitchell and Sanford Aberdeen Medical Center In many ways, Dr. Ronald Anderson’s medical journey and that of his daughter Breanne Mueller mirror each other. A South Dakota native and a graduate of USD School of Medicine, Dr. Anderson followed his older brother into ObGyn, completing a residency in Minneapolis before coming back home to South Dakota to raise his family. Dr. Mueller also attended USD Sanford School of Medicine. She followed her dad’s example and chose ObGyn, completing a residency at Mercy Hospital in St. Louis before coming back to South Dakota to practice.

Ronald Anderson, MD, and Breanne Anderson Mueller, MD

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Midwest Medical Edition

Q

: What messages do you think Breanne got from you that may have influenced her decision to go into medicine?

DR. ANDERSON: She picked up the joy I had in my job. She also understood the lifestyle. You miss some Christmases and birthdays, but it’s also a rewarding practice.

I let her decision unfold naturally. She said she wanted to do pre-med and I told her what to take in college. That was an advantage.

The other thing when you’re interviewing for medical school, they want to make sure you can handle the workload.

They also want to know that you know what you’re getting into. If your dad has been in medicine and you have seen that all the way through, they can feel confident that you really understand the kinds of sacrifices you have to make and that carries some weight, too.

DR. MUELLER: When I went to college, I found that, of all the things I tried, I liked medicine the most. Even then, my dad never said ‘You should do ObGyn’. In fact, both of my parents suggested that I try something that doesn’t have night call. But this was the only specialty that really made me happy. As my dad says, this was the specialty where people are usually happy to be coming to the hospital.

In medical school, if I would get called in the night for a diabetic ketoacidosis or an asthma attack, it was always hard to get up. But when I got called in the middle of the night for a delivery, it just didn’t bother me.

September / October 2016

Q

: How do you think your experience of medicine is different from that of your parent/child?

DR. MUELLER: I’m really used to the computer and I think he hates the computer.

I also think that he was very busy and missed a lot of things when we were growing up. I have purposely structured my career so that someone else can manage the business part of things so that I don’t have to work quite as hard as he did.

Eldon Becker, MD, General Surgeon and his son, General Surgeon Brandt Becker, MD Avera Medical Group Pierre Brandt Becker, MD, and Eldon Becker, MD

Dr. Eldon Becker grew up along the Missouri River in North

DR. ANDERSON:

Dakota. A biomedical engineering major, he turned to

ObGyn has changed quite a bit. I was trained using forceps and vacuums and they didn’t even teach Breanne those things in her residency. That’s an art that is going away.

On the other hand, her laparoscopic skills are way above mine. She did a lot of robotics in her residency.

When I was training, you did all of your surgeries vaginally.

It wasn’t until three to five years after my residency that we started doing laparoscopic vaginal hysterectomies.

medicine after deciding that big city living wasn’t for him.

Q

: You two operate together once a month when Dr. Anderson comes up to Aberdeen.

What is that like?

DR. MUELLER: It’s fun to see your parent in a whole new light. He’s been running the show for many years, but it’s gotten easier as I have become more assertive. I definitely defer to him, more because he has 20+ years of experience rather than because he’s my parent.

We have a good time playing ‘Name that Tune’ in the OR!

After completing medical school and surgical residency in North Dakota, the Beckers settled in Pierre, South Dakota where Brandt was born. Brandt stayed in South Dakota to attend medical school at USD and did his surgical training at Hennepin County Hospital in Minneapolis.

Q

: How do you think Brandt’s upbringing impacted his career choice?

DR. ELDON: I had a great relationship with my own dad, who was a farmer, and I had always hoped to farm with him. But that was the 70s and there were substantial hardships. I just couldn’t see returning to the farm. But I could see that the family farm was not the only place where collaboration and idea exchange could happen. It was possible in medical care, too.

Brandt has worked at the hospital and the clinic nearly as long as I have. If he wasn’t outside, he was at my office or a partner’s office. He got to see what life was like as a surgeon. I never gave him advice other than to make a wise decision.

MidwestMedicalEdition.com

DR. BRANDT: I mowed the lawn at the clinic when I was 8 years old. So it made me comfortable with medicine and with the other docs. It’s always been there as part of my life. I think it’s really not that different from passing on the family farm or local hardware store. That whole gerations thing.

DR. ELDON: It started as a dream but over time became a reality. It’s pretty amazing that it worked out. If not this, our path would have been family farming.

Q

: What are some ways that medicine has changed between the time that you two trained?

DR. BRANDT: Medicine is becoming more and more specialized. As a surgeon, it used to be that there would be 35 or 40 procedures you

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were comfortable with. Now it’s paired down to 5. The generation before dad, we had GPs that did c-sections and took out appendixes and they have gone by the wayside. The good thing is that you have specialists doing what they’re good at.

The other change I see is a move toward a shift work mentality as a way to limit hours. This is a change from the idea of one provider taking care of one patient.

DR. ELDON: Here in mid South Dakota, trying to meet the emergency needs of our community (Pierre) acutely and provide the same depth of services found in Sioux Falls and strike a balance is difficult.

This will be more apparent in his practice than in mine.

Q

: What are the plusses and minuses of working together?

DR. BRANDT: One big advantage is not having to feel out your partner because we already know how each other thinks. I have always enjoyed running cases by him that were interesting or challenging. That still continues 15 years later.

DR. ELDON: One difficulty is that, because there are only three of us, when I am playing, he has to work and when he is playing, I have to work. Also, fishing and operating with the same person day in and day out is not always satisfying but my son has been very tolerant.

David Daniels, MD, Internal Medicine, and his son, Urologist David Daniels, Jr., MD UnityPoint Clinic Family and Internal Medicine Sunnybrook, Sioux City, Iowa and Siouxland Urology Associates, Dakota Dunes, South Dakota Dr. David Daniels, a graduate of Georgetown University School of Medicine, was practicing in Chicago where he had done an Internal Medicine residency at Northwestern when his namesake was born. David, Jr. was about 10 years old when the family relocated to Sioux City.

David, Jr would go on to medical school at the University of Iowa and a residency at Indiana University.

Q

: At what point did either of you you think David might be destined for a career in medicine?

DR. DANIELS, SR.: The first inkling I had was during a family vacation about 20 years ago. We went to Big Sky and Yellowstone and David was attending a wilderness medicine conference with me. On one of the days, we learned about using fishing line to suture a cut on the scalp. About two days later, we were in a store and David’s youngest sibling was running around and slipped and cut her scalp. So he got some fishing line and he tied it together!

DR. DANIELS, JR.: My dad always encouraged me to follow my dreams. I remember making rounds with my dad as a kid. It was profound. I couldn’t believe how appreciative people were of the services he provided. I didn’t know at the time exactly what he did for them, but I could tell by his patients’ gratitude that it must have been something special. That was cool to see, even as a kid.

David Daniels MD

Then, on my first day of college, I listened to a lecture from a biology professor who dedicated his life to the study of an exotic crayfish species.

I decided at that moment that I’d rather use my love of science in a career dedicated to helping people.

Q

: How do you think your experience of medicine is different from that of your parent/child?

DR. DANIELS, SR.: There was a lot less government intrusion when I started.

Now there is a lot more governmental regulation.

Also, I was the oldest kid and the first doctor in the family.

So, in a sense, I was paving the way and was not as well informed as my son. He knew the board scores needed to get into every program. And they knew exactly what programs were offered where. He went into everything with a great knowledge base.

DR. DANIELS, JR.: I entered medicine in the age of computers, significantly increasing regulations and rules. While it is the only

David Daniels, Jr MD

experience I know, I often hear my dad talk about when one could spend a lot more time actually caring for the patient instead of working through the minutia of new regulations and requirements.

The patients are still wonderful, the problems challenging, and the work rewarding.

I don’t think that will ever change.

Q

: What are your thoughts on working together?

DR. DANIELS, JR.: It’s fun to collaborate as professionals at work and have a personal relationship outside of work. I think the patients benefit, too, as we keep an excellent line of communication open between us.

DR. DANIELS, SR.: Sometimes, when we are both seeing the same patient, it’s hard for people to know which David Daniels to send the records to. I have asked him to change his name but he respectfully declined. Otherwise, it’s great! ■

To read about the father son team at Sioux Falls Center for Plastic & Reconstructive Surgery that was our inspiration for this article, see MidwestMedicalEdition.com.

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Midwest Medical Edition

LifeScape Welcomes

Licensed Clinical Psychologist Jaime Hudson, PhD

Joining Dr. Aimee Deliramich, Jamie will provide outpatient psychotherapy to children, teens, adults, and families.

She specializes in Cognitive Behavioral Therapy and has six years of experience in a wide range of diagnoses and backgrounds, both with individual and group therapy with children and adults.

For appointments with either of our psychologists, call 605.444.9700.

September / October 2016

MidwestMedicalEdition.com

23

The Fair Labor Standards Act

Will You Be in Compliance with New Updates by December 1st?

By Morgan Brekke

A

MONG its various functions,

the Fair Labor Standards Act (“FLSA”) establishes minimum wage and overtime pay requirements that apply to employees in the private sector and in Federal, State, and local governments. See 29 U.S.C. § 201, et seq. Under the FLSA, covered employees are entitled to be paid at least the Federal minimum wage, which currently is set at $7.25 per hour, and at least one and one-half times their regular rates of pay for all hours worked over forty in a workweek, unless an exemption applies.

Some of the primary exemptions from the FLSA’s minimum wage and overtime pay requirements are available for individuals employed in bona fide executive, administrative, or professional capacities or as outside sales or computer employees (“white collar exemptions”).

To qualify for one of these exemptions, an employee must meet the requirements set forth in the Department of Labor’s regulations implementing the FLSA, which include the following main requirements: (1) the employee must be paid a predetermined and fixed salary that is not subject to reduction based on variations in the quality or quantity of work performed (“salary basis test”); (2) the salary amount paid to the employee must meet a minimum specified amount (“salary level test”); and (3) the employee’s job duties must primarily involve executive, administrative, or professional duties or the duties

of an outside sales or computer employee as defined by the regulations (“duties test”).

See 29 C.F.R. § 541, et seq. The FLSA also includes an exemption for highly compensated employees, i.e., those employees who receive an annual compensation that is equal to or exceeds the minimum amount specified by the Department of Labor and who customarily and regularly perform any one or more of the exempt duties or responsibilities of an executive, administrative or professional employee.

In 2014, President Barack Obama directed the Department of Labor to update and modernize the regulations implementing the white collar exemptions and the highly compensated employee exemption. Prior to receiving this order, the Department of Labor had last revised these regulations in 2004, at which time it set the weekly salary level requirement for the white collar exemptions at $455.00 ($23,000.00 annually) and set the total annual compensation requirement for the highly compensated employee exemption at $100,000.00. Since 2014, the Department of Labor has complied with the President’s order by proposing revised regulations, considering comments to its proposed revisions, and ultimately issuing its Final Rule on May 23, 2016.

The most notable changes under the Final Rule pertain to increases in the salary amount needed under the white collar exemptions and the compensation amount required for the highly compensated

employee exemption. Specifically, the Final Rule sets the minimum salary level for the white collar exemptions at $913 per week ($47,476 annually) and the total annual compensation for the highly compensated employee exemption at $134,004.00. It also establishes a mechanism for automatically updating the salary and compensation levels every three years in order to ensure that they continue to provide useful and effective tests for exemption. Moreover, the Final Rule amends the salary basis test in a manner that now allows employers to use nondiscretionary bonuses and incentive payments (including commissions) to satisfy up to ten percent of the new salary level, so long as those amounts are paid on a quarterly basis. The Final Rule, however, makes no changes to the duties tests of the various white collar exemptions or to the highly compensated employee exemption.

Regardless of how an employer chooses to implement the requirements of the Final Rule within its organization, employers must comply with the Final Rule by December 1, 2016. ■ Morgan Brekke is an attorney at Woods, Fuller, Shultz & Smith P.C. She focuses primarily on employment and health law matters.

Find out how to review employee salaries to ensure compliance with the Final Rule in the extended version of this article on our website.

1 Employers should be aware, however, that individual states and cities may adopt minimum wage or overtime laws that provide higher standards than the FLSA. In situations where an employee is subject to both the state and federal minimum wage or overtime laws, the employee is entitled to minimum wage or overtime pay according to the higher standard, i.e., the standard that is most beneficial to the employee.

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Midwest Medical Edition

CHILDREN AND

INFORMED CONSENT

By Jeremy Wale

C

HILDREN PRESENT unique

challenges to healthcare providers, particularly regarding consent. A patient’s absolute right to make informed decisions regarding his or her medical care is the foundation of informed consent, yet children are not able to make informed decisions. The American Medical Association states, “Physicians should sensitively and respectfully disclose all relevant medical information to patients.

The quantity and specificity of this information should be tailored to meet the preferences and needs of individual patients.”

Let’s first examine some background information on informed consent. As a legal requirement, it began in earnest 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

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 your state’s laws so you know what is required for your informed consent discussions with patients.

Now back to children and informed consent. A parent may consent to treatment for his or her own child. There are certain instances where a minor (under age 18) may consent to his or her own treatment.

These instances differ by state, but generally include treatment for drugs/alcohol abuse, sexually transmitted diseases, HIV/AIDS testing, and reproductive health. Check state laws before allowing a minor to be treated without parental consent.

A common question is what to do in situations of children with divorced parents.

Typically, each parent maintains his or her right to consent to medical treatment for the child.

When you encounter a divorce decree granting full legal and/or physical custody to one parent, he or she has the sole right to make healthcare decisions for the

child. If one parent has sole physical custody but legal custody is shared, then both parents maintain the right to make healthcare decisions for their child. These guidelines may not hold true in all situations. Consult an attorney when you have questions regarding the ability of a divorced parent to consent to treatment for a child.

You also may encounter situations where a parent’s rights have been terminated by the court. Then the guardian of the child will have related documentation. It can be helpful to keep a copy of this documentation in the patient’s record so healthcare providers with access to the record know who is allowed to consent to treatment for the child.

Consent issues related to the treatment of minors can be complex. Call your healthcare liability insurer for assistance when you have questions. ■ 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 Thaw v. North Shore Univ. Hosp., 129 A.D.3d 937, 939 (2015).

3 Janusauskas v. Fichman, 264 Conn. 796, 810 (2003).beneficial to the employee.

September / October 2016

1 Schloendorff v. Society of New York Hospital, 211 N.Y. 125, 129 (1914).

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

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

25

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28

Midwest Medical Edition

Early Identification is Key to Effective Treatment of Eating Disorders ENSURING THE MOST FAVORABLE OUTCOME in children with eating disorders begins

with early identification. The first line of defense is the child’s pediatrician, who can recognize if the child is at risk for an eating disorder. Children’s Hospital & Medical Center in Omaha, which runs the region’s only fully-pediatric day treatment program for eating disorders, offers the following diagnostic tips:

Eating disorders can be difficult to uncover.

Possible symptoms include:

● Dramatic changes in eating patterns or weight

● E xcessive focus or concern about body size

●U nrealistic physical self-image ● E xcessive exercising ● Fatigue/tiredness ● Insomnia/sleeping too much ● Dizziness/fainting ● Brittle hair/nails, loss of hair ● Weakness/loss of muscle mass

September / October 2016

Over time, eating disorders can also result in:

● S ocial withdrawal ● Mood shifts ● Anxiety ● Lack of interest in activities ● Loss of menstrual cycle ● Dental problems

MidwestMedicalEdition.com

“We’re not seeing the percentage of patients we should be seeing.,” says Michael Vance, PhD., director of Children’s Behavioral Health, Children’s Hospital & Medical Center. “A lot of these kids are being dismissed as picky eaters or anxious kids. Too often, they’re not being referred until they’ve hit the point of pretty severe malnutrition,” Offering a Partial Hospitalization Program (PHP) level of care, Children’s Eating Disorders Program utilizes a multidisciplinary approach to treat patients with eating disorders and ancillary problems such as depression, anxiety and substance abuse.

Group therapy, pet therapy and family sessions are facilitated by a psychologist or a mental health practitioner. Dietitians supervise the nutritional components of the program and a recreation therapist will oversee the recreation therapy/exercise education group. An on-staff educator works with students to help them stay on pace with homework and tests. Referring physicians are kept apprised of progress to the degree they have indicated.

“There are a lot of fine points and intricacies to be aware of.,” says Martin Harrington, MD, medical director of Children’s Eating Disorders Program. “By having a team, it helps make sure you’re covering all your bases.” ■

29

Gerald McGowan to Receive Mercy’s Prestigious

2016 Spellman Award

LONGTIME SIOUXLAND PHYSICIAN

Dr. Gerald McGowan will be the recipient of the prestigious Dr. George G. Spellman Annual Service Award. The award recognizes community members or groups whose generosity with their time, talent and treasure exemplifies the values of Mercy Medical Center. It will be presented to Dr. McGowan at the Mercy Foundation’s annual gala on Saturday, November 5 at the Marina Inn and Conference Center in South Sioux City.

A native of Fonda, Iowa, Dr. McGowan earned his MD at the University of Iowa College of Medicine in Iowa City, completed an internship at good Samaritan Hospital in Phoenix, and did his surgical residency at Maricopa County General Hospital in Phoenix. McGowan began his career in 1965 in private practice in Sioux City.

From 1968 to 1969, McGowan was a flight surgeon with the US Air Force in Phu Cat, South Vietnam. McGowan rose to the rank of Major and treated soldiers as well as

visited orphanages which were run by nuns during his time in Vietnam.

McGowan then returned to Siouxland and helped with the founding of the Siouxland Medical Education Foundation, Inc., which is the Family Practice Residency Program for Siouxland. He served as the program Director until 1991, and as the Medical Director of the Program from 1992-2000.

McGowan served as a clinical Assistant Professor for the University of Iowa as well as clinical faculty for the University of South Dakota Sanford School of Medicine.

“Dr. McGowan’s impact on the Siouxland medical community is unmatched in the depth and breadth of the medical professionals he has trained, educated, and mentored,” says Mercy President and CEO FitzPatrick. “Hundreds of family practice physicians have been the beneficiary of his dedication, experience and expertise.

Dr. McGowan worked along-side Dr. Spellman so it is very fitting that he is the recipient of this honor. “

The Spellman Award is now in its fourteenth year and was created by the Mercy Medical Center Foundation in recognition of Dr. George Spellman, one of Sioux City’s pioneering physicians who established a reputation as an advocate for the poor and underserved. Dr. Spellman passed away in 2002 and he and his wife Carol were the recipients of the first award named in his honor. ■

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Midwest Medical Edition

New Transitional Care Unit Will Fill Unmet Need in Sioux Falls

Avera to Build Cancer Center in Pierre AVERA HEALTH HAS ANNOUNCED

plans to build a new Avera Cancer Institute in Pierre. The project is being made possible by up to $10 million in grant funding from The Leona M. and Harry B. Helmsley Charitable Trust and will be called the Helmsley Center. The center will offer state-of-the-art cancer care as well as clinic space for primary and specialty care.

Walter Panzirer, Trustee for the Helmsley Charitable Trust, announced a donation of $7.5 million that will go toward construction of the new building, plus a new linear accelerator for radiation treatment, specialized infusion chairs, and a TUG robot that delivers medications including chemotherapy to care units in the hospital and cancer center.

The Helmsley Charitable Trust also announced a $2.5 million dollar-for-dollar challenge matching grant. The Avera St. Mary’s Foundation will launch a fundraising campaign in 15 counties in central South Dakota to meet the $2.5 million challenge through donations from individuals, families and businesses. This is the first time the Helmsley Charitable Trust has offered a challenge match in South Dakota.

Local residents and stakeholders

September / October 2016

identified cancer care as one of the three prominent needs in the 2016 Community Health Assessment conducted by Avera St. Mary’s, alongside chronic conditions associated with obesity and mental health. The new Helmsley Center will be constructed between Avera St. Mary’s Hospital and Avera Medical Group buildings. Construction is planned to begin next summer, with an estimated opening date of late fall 2018.

“Pierre is unique in that it is our state capital and an important city in our state, and yet its geographical location isolates it from more populated areas by hundreds of miles,” Panzirer says. “We see bringing a cutting-edge cancer center to Pierre as a very worthy project that will help improve the future health of this community and the surrounding area.”

The Rural Healthcare Program of the Helmsley Charitable Trust has funded over $296 million in grants throughout the upper Midwest. Other Avera projects funded by the Helmsley Charitable Trust include Avera eCARE telemedicine program that reaches 263 sites; radiation oncology technology in Sioux Falls, Aberdeen and Mitchell; digital mammography equipment; CT scanners; and more. ■

MidwestMedicalEdition.com

AVERA HAS ANNOUNCED that it will open a Transitional Care Unit at Avera Prince of Peace Retirement Community campus in Sioux Falls.

The the Beacom/Reischl Transitional Care Unit is designed to be a post-hospital discharge option for patients who no longer need acute hospital care but still have medical needs too great for a small hospital or traditional nursing home.

Avera Prince of Peace responded to a request for proposal from the South Dakota Department of Health for a unit to care for patients with specialized medical needs, including bariatric patients, patients with cognitive disabilities and other chronic medical conditions. These patients often require a higher level of care, specialized equipment and greater staffing.

The unit, open as of early September, is housed in remodeled space at the former Avera Prince of Peace long-term care center, which has been replaced by a newly constructed building. Cost of the project is $3 million for upgrades to patient rooms, which will all be private, and improved dining and physical therapy space. The unit will employ 42 people, including nurses, certified nursing assistants, social workers, therapists and activities personnel and includes 24 long-term care beds.

“We appreciate the South Dakota Department of Health identifying the need to better serve patients who often have a difficult time finding this level of care,” says Justin Hinker, Administrator of Avera Prince of Peace.

The transitional care unit is supported by a significant gift from Miles and Lisa Beacom of Sioux Falls in honor of the Beacom and Reischl families. ■

31

Record Turnout for International

Rural Nursing Conference in Rapid City RURAL HEALTHCARE advocates from 35 states and 9 countries gathered in July in Rapid City to attend and contribute to the International Rural Nursing Conference.

Attendance exceeded 250, dramatically surpassing expectations. A special emphasis of the conference was describing, examining and proposing solutions for the unmet nursing and healthcare needs in rural areas and on Native American reservations.

Primary sponsors for the event included nursing programs at the University of South Dakota and South Dakota State University, the Rural Nursing Organization, and the Matson Halverson Christiansen Hamilton Foundation (MHCH). MHCH, a South Dakota-based foundation interested in enhancing rural healthcare and economies, also funded the conference, which was almost two years in the making.

“Hosting the international rural nursing conference in South Dakota was a rare opportunity for South Dakota nurses to come together in their own backyard with nurses from around the world to discuss the challenges, opportunities, and strengths of rural nurses to contribute fully to the health of rural communities.,” said Dr. Carla Dieter, recently retired as chair of nursing at the University of South Dakota, and now professor emeritus of nursing at that institution.

Dieter helped plan the conference.

According to Corey Kilgore, MHCH executive director, a highlight for the group was hearing from Dr. Donald Warne, one of

32

five keynote speakers at the conference.

Warne, a member of the Oglala Sioux Tribe from the Pine Ridge Reservation and chair of the department of public health at North Dakota State University, addressed the topic of “historical trauma”, and how this condition includes a combination of circumstances – including 500 years of oppression and suffering- that impact existing health conditions on Native American reservations.

“Dr. Warne’s solution to historical trauma revolves around a so-called balance wheel,” says Kilgore. “This balance wheel involves

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treating Native American patients in a holistic way, and being cognizant of historic trauma as a part of a treatment plan. This is vital information for nurses serving Native American populations.”

Because nurses are on the frontline of rural healthcare, and because the healthcare needs of rural areas, including reservations and small communities where an elderly population presents a host of special needs, Kilgore says nurses serving these populations need training that prepares them for specific needs. ■

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Midwest Medical Edition

Study Finds Genetic Profiling Increases Cancer Treatment Options GENETIC PROFILING OF CANCER tumors

provides new avenues for treatment of the disease, according to a study conducted by Sanford Health and recognized by the American Society of Clinical Oncology.

In 2014, Sanford developed and launched the Genetic Exploration of the Molecular Basis of Malignancy in Adults, or GEMMA, to determine if evaluating genetic information could help customize treatment options for adult patients whose cancer had progressed after the first line of treatment or was too rare for standard treatment. DNA was extracted from tumor samples and tested to identify targets for treatment.

Oncologist and cancer researcher Steven Powell, MD, and his team used next-generation gene sequencing technology to analyze tumor samples for more than 100 Steven Powell, MD patients. More than 90 percent of those patients had gene mutations that could impact their treatment, Powell reported. Some patients, for example, discovered they were eligible for a clinical trial or might benefit

from other personalized medicine therapies.

Nearly 40 percent of these patients were able to be treated with personalized therapies as a result of their testing. Many were treated on clinical trials with new drugs that previously would not have been available to them in this region.

“Molecular profiling programs like GEMMA don’t typically experience this degree of success,” says Powell. “Sixteen percent of our patients were able to go on clinical trials matching them to a personalized therapy. Many academic centers are only able to do this five percent of the time.

Our numbers indicate that the development of a molecular profiling program in a community setting in the Midwest is not only feasible but effective in getting patients access to the newest treatments.”

Enrollment concluded in late 2015, and results of GEMMA were outlined in an abstract published in conjunction with this year’s American Society of Clinical Oncology Annual Meeting held in Chicago last month. The published abstract can be found on the ASCO website.

Later this year, Sanford will begin the second version of GEMMA, which will integrate molecular profiling as part of

standard cancer care. The study is called Community Oncology Use of Molecular Profiling to Personalize the Approach to Specialized Cancer Treatment at Sanford, or COMPASS. Sanford experts will analyze treatment plans based on molecular profiling to determine if outcomes improve. As part of GEMMA and COMPASS, the Sanford team has brought in more than 60 different personalized therapy options for patients through clinical trials in the past two years. ■ Dr. Megan Landsverk, director of the Sanford Clinical Molecular Genetics Laboratory

INNOVATIVE CARE Prairie Lakes Healthcare System in Watertown recently installed a Toshiba Aquilion Prime 80, 128 slice equivalent CT Scanner.

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34

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Midwest Medical Edition

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NIH AWARDS NEW INDIAN HEALTH PROJECT GRANTS THE NATIONAL INSTITUTES OF HEALTH has selected two new

projects for funding as part of the Collaborative Research Center for American Indian Health and its pilot grants program.

Now in its fourth year, the CRCAIH’s pilot grant program was created to fund cutting-edge transdisciplinary research addressing health disparities experienced by American Indians in South Dakota, North Dakota and Minnesota.

Sanford Research and a broad base of partners in 2012 received a $13.5 million grant from the National Institute on Minority Health and Disparities to create CRCAIH. The research center has now supported a total of 15 pilot grant awards across the region to explore how social determinants of health impact American Indians.

The pilot projects were selected based on five major scoring criteria, including purpose, priorities and significance; scientific approach; innovation and potential for future funding; investigators and environment; and collaborative relationships.

This past April in Fort Totten, North Dakota, findings from the second round of pilot grants awarded in 2014 were presented at the CRCAIH Annual Summit. A pilot grant study authored

by Jessica Hanson, PhD, was published in Qualitative Health Research. ■

September / October 2016

THE FOLLOWING PROJECTS WERE SELECTED FOR FUNDING:

Wac’in Yeya: The Hope Project Jacqueline Gray, PhD, University of North Dakota

We RISE (Raising Income, Supporting Education) Project on the Cheyenne River Sioux Reservation Lacey Arneson McCormack, PhD, MPH, RD, LN, ACSM Ep-C, South Dakota State University Rae O’Leary, RN, RRT, AE-C, Missouri Breaks Industries Research, Inc. CRCAIH is made up of the following organizations: Sanford Research; Oglala Sioux Tribe; Turtle Mountain Band of Chippewa Indians/Tribal Nations Research Group; Fond du Lac Band of Lake Superior Chippewa; Sisseton-Wahpeton Oyate of the Lake Traverse Reservation; Cankdeska Cikana Community College/Spirit Lake Nation; Children’s Hospitals and Clinics of Minnesota; Missouri Breaks Industries Research, Inc.; North Dakota State University; Oglala Lakota College; Rapid City Regional; Rosebud Sioux Tribe; Sanford Health; South Dakota State University; Turtle Mountain Community College; the University of North Dakota; and the University of South Dakota.

MidwestMedicalEdition.com

35

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Midwest Medical Edition

The team at Sioux Falls-based G & R Controls is committed to ensuring safe, comfortable, and efficient work environments.

The Problem In the summer of 2015, Prairie Lakes Healthcare System in Watertown, a long time dynamic model for rural healthcare in South Dakota and western Minnesota, found itself in some hot water.

“We were at capacity on our chiller and we almost reached crisis points a few times during some 90 degree days,” recalls Prairie Lakes CEO Jill Fuller. “That is unacceptable in a healthcare facility.”

An independent healthcare system, Prairie Lakes provides primary and specialty care for a service area of 87,000 people.

As the healthcare need has grown in the region, the hospital has grown, too, implementing multiple building additions and renovations since 1949 in order to accommodate new technology and services. Although the HVAC systems had undergone their own share of renovations, by the summer of 2014, the 800 ton chiller simply couldn’t keep up.

CASE STUDY:

SWITCH TO DIRECT DIGITAL CONTROLS SAVES RURAL HOSPITAL $90K A YEAR

How G & R Controls Helped Take the Heat Off Prairie Lakes

“When I took this position, this place was running at 100 percent cooling,” says Prairie Lakes Director of Facilities Management, Rick Masloski. “I didn’t want to be the first director in the state to have the hospital loose cooling. So I priced a new chiller.”

Unfortunately, the news wasn’t good. A new cooling unit of the size Prairie Lakes needed was going to set them back more than $2 million dollars. With significant expansion projects pending, the timing could not have been worse. In hopes of finding an alternative solution, the hospital turned to an old friend: Sioux Falls-based G & R Controls.

The Relationship As a Siemens Independent Field Office, G & R Controls installs, services and maintains HVAC systems, specializing in automatic temperature controls, energy management solutions. security systems, and hydronic heating and cooling equipment, replacement parts, and pumps. Their expertise and sensitivity to the special challenges of working in healthcare environments, has made G & R Controls Prairie Lakes’ go-to choice for its HVAC needs for more than a decade.

“We did a complete cooling retrofit for Prairie Lakes in 2007, consolidating its 28 DX systems into a single 800 ton cooling system,” says Dave Heibult, Sales Engineer of G & R Controls.

Not only was the final cooling system more efficient, saving the healthcare system an estimated $60,000 to $100,000 annually, but, like other air handling improvements and mechanical systems upgrades G & R Controls had done for Prairie Lakes, the project was completed without ever compromising the hospital’s ability to provide quality patient care.

“This time, we were looking at having to add additional cooling equipment but we knew they didn’t want to spend that money with new hospital additions coming,” says Heibult. “Especially since we didn’t know what size the equipment would need to be. So we needed to help them find an affordable alternative.”

Sponsored Feature

37

The Solution The solution G & R Controls offered was an ambitious project that would not only allow the hospital to delay replacing its cooling system for the foreseeable future, but would also shave a significant amount of money off of its operating budget.

“They started by doing a complete physical analysis,” recalls Masloski. “They looked in every closet and nook and corner to determine how we could maximize our efficiency. Not only did we find little things that were broken, such as dampers that weren’t letting enough air through, but we also discovered that there were storage rooms you could practically hang meat in. At the same time, there were other areas with people in them that you could never get cool enough.”

Although some of the problems had straightforward

solutions,

other

inefficiencies that G & R Controls

uncovered

at

Prairie Lakes appeared to be unavoidable, given the hospital’s fluctuating census.

“It’s crazy,” says Masloski.

“You can be full to capacity one week and the next week, you can be at 50 percent. But

The new wall-mounted thermostats feature a single button that allows the user to quickly designate a room as “occupied” or “unoccupied”.

your rooms are still being heated or cooled like someone is in them.”

After a thorough analysis of the entire facility, the experts at G & R Controls suggested that Prairie Lakes exchange the existing pneumatic temperature controls for programmable direct digital controls. The exchange would give the hospital far more control over its heating and cooling while also maximizing the efficiency of the existing equipment.

“There is no reason to keep a hallway at 72 degrees in the summer when it’s just a passthrough. They don’t want people hanging out in hallways anyway,” says Heibult. The same could be said for storage rooms and empty administrative offices after hours. “So we said let’s Before G & G Controls installed direct digital controls at Prairie Lakes, there were storage areas in the hospital that were unnecessarily cold while some patient care areas could never get cool enough.

limit cooling in those kinds of areas so that we can make sure the patient care areas, ORs, etc. can stay where they need to be.”

“Usually you look at labor and productivity for cost savings,” says Fuller. “Temperature control was something we had overlooked in the past. Our priority is always the patient care areas, but we realized that there were office spaces, for instance, that could be handled differently.”

38

Sponsored Feature

Midwest Medical Edition

G & R Controls created custom graphics for the hospital that allow a user to see an entire patient wing. From any computer workstation in the hospital (such as the ER), a room can be designated as “occupied” with a single click so that it will be comfortable and ready when the patient arrives.

The Process The plan made practical sense to Fuller and her team at Prairie Lakes.

And with a pricetag of $500,000, it also made financial sense. But both G & R Controls and the hospital administration knew that getting the rest of the organization on board would require some finesse. They also knew that the plan would not work without staff buy-in. To make sure they had it, the G & R Controls team started by listening. Their goal was to learn as much as they could about the needs and schedules of the hospital’s various user groups.

“These were extensive meetings with groups such as pharmacy, sleep study, oncology, orthopedics,” says Heibult. “We needed to know what hours they worked, what they liked and didn’t like, what temperatures they preferred, what was necessary, and what they were willing to live with.”

G & R Controls’ task also included a heavy dose of staff education. “It wasn’t just about using the new system. We had to help teach people how to be better energy users overall, cognizant of things like doors that were open unnecessarily. You may not think

“We were at capacity on our chiller and we almost reached crisis points a few times during some 90 degree days,” says Prairie Lakes CEO Jill Fuller. “That is unacceptable in a healthcare facility.”

that shutting a door is a big deal, but if you have hundreds of doors, going to be admitted, people in those areas can bring up the custom

it becomes a big deal.”

As the different groups weighed in on their needs and wants,

graphics right on their screen and hit ‘occupied’ to start getting that

G & R Controls used the new digital controls to establish automatic

room prepared with cooling,” says Masloski. “The layout is so simple

time-based temperature set-points. For areas, such as patient rooms,

that it takes little or no training to understand it.”

that were continually being heated or cooled even when they were

“Even the best system in the world is of no use if they don’t

empty, G & R Controls developed custom computer graphics that

know how to use it,” says Heibult. “Our job was to make this as

allow a nurse anywhere in the hospital to quickly designate a room

easy as possible on everyone. The nursing staff tell us that they

as “occupied” or “unoccupied” with a single tap.

don’t even think about it now. That really is the beauty of Siemens

“For instance, if an ER patient or a Same Day Surgery patient is

September / October 2016

and G & R Controls. We are able to customize like no one else can.”

MidwestMedicalEdition.com

39

With an energy cost savings of close to $90,000 annually, the G & R Controls project at Prairie Lakes is expected to pay for itself is about five years.

The Results G & R Controls’ comprehensive analysis of Prairie Lakes’ heating and cooling system and the installation of direct digital controls created both expected and unexpected benefits for the hospital.

By automating temperature settings where possible, making it easier to adjust temperature when needed, and educating the staff on the impact of their own behaviors, the project dramatically improved efficiency at Prairie Lakes. That improved efficiency has not only made the hospital’s physical environment more comfortable and reliable for patients, physicians, and staff, but has also had a direct impact on the bottom line.

“It was about a fifth of the price of a second chiller and saves

As a Siemens Solution Partner, G & R Controls uses the latest technology and resources to manage any building’s environmental needs - even a building as complex as a hospital.

about 90 thousand dollars in energy costs annually, just by controlling temperature according to when spaces need to be heated

energy usage. “We had to take a very hard look at what we were

and cooled,” says Fuller. “We are looking to be able to pay off this

doing. And we are starting to ask ourselves questions like ‘Do we

investment in about five years.”

really need this area to be this temperature right now?’,” she says.

Beyond the cost savings created by the technology itself, Fuller

The project also helped buy the hospital the time it needed to

says G & R Controls’ approach to the project made the entire orga-

evaluate and budget for its future heating and cooling requirements

nization more efficient, more responsible, and more aware of their

in light of planned expansions. And, as Rick Masloski observes, it has created other kinds of savings, as well.

“By taking stress off of the equipment, the direct digital control upgrade has added life to our current equipment,” says Masloski.

“Not only does that save in equipment costs but it also turns into labor savings when we don’t have to be working on air handlers because they are worn out.”

“The installation of direct digital controls offers so much more flexibility, saves them a ton of energy, helped them put off a major capital decision and maximized their existing equipment,” says Heibult. “We are very proud of the results we have been able to achieve for Prairie Lakes with this project.”

“I think we are always trying to find ways to cut costs in healthcare today,” says Fuller. “This project was exactly what we needed

According to CEO Jill Fuller, the experts at G & R Controls helped make the entire organization more efficient, more responsible, and more aware of their energy usage.

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when we needed it and I would highly recommend this approach to other hospitals.” ■

Midwest Medical Edition

Functional Movement Screening for Pain-free Exercise

By Corey Howard

M

ANY PEOPLE WHO WANT

t o i mprove their strength and flexibility or improve their game choose to work with a personal trainer. Maybe you are one of them or perhaps you have patients who are. But when was the last time a personal trainer ran you through a movement screen, scored you, and found your weak points to determine what exercises you should or shouldn’t be doing?

Has your trainer looked at your score to prescribe corrective drills that will make you more resilient? Believe it or not, such a screening does exist.

Screening is an integral part of maintaining a healthy body.

Every physician knows that regular screening for things like cholesterol levels, certain cancers, and vision can help find problems early, potentially heading off more serious issues later on. Functional Movement Screening is designed to do much the same thing.

Several years ago, I had the opportunity to spend four days with Physical Therapist Grey Cook, one of the founders and creators of Functional Movement Screening. I learned that early on in his career, Cook discovered a problem endemic to both physical therapy and personal training.

In an effort to address a particular muscle that might be causing pain, a physical therapist will often fail to look at the entire

September / October 2016

movement pattern. Similarly, personal trainers may try to help clients strengthen muscle groups, rather than addressing movements. For example, if a person’s knee is collapsing inward during a squat, a physical therapist may say the glute needs to be strengthened to create more stability in the hip. A personal trainer might put the client on a leg extension machine to strengthen the quads.

In this case, neither has looked at the client’s ankle, which is tight and lacks the mobility to allow the leg to properly track over the foot. In that case, it’s a mobility issue, not a stability or strength issue.

Sticking with this example, imagine if the client is a runner.

By following the advice of the trainer and therapist, the client has created more stability in a hip that didn’t require it, and a stronger quad in a knee that is already under a tremendous amount of pressure. That person is then sent out to run on a foot that doesn’t flex like it needs to for the safest most efficient performance. If six times one’s body weight is the amount of pressure that a leg absorbs every time the foot plants during a run, there is a good chance that this person is going to eventually meet an orthopedic surgeon. A Functional Movement Screen (FMS) would likely have detected the ankle issue and allowed them to avoid that scenario.

Grey Cook’s Functional Movement Screen includes

seven basic human movement patterns that assess the risk for injury. All seven movements were created from patterns established in childhood. As we age and people start telling us how to run or move, we humans tend to unconsciously alter our intrinsic patterns.

So imagine if you or your patient went in for a session with a trainer and received a screening, followed by a workout specifically created to help lower the risk of injury. Just as it makes sense to check the cholesterol and the vision regularly, movement scoring makes practical

MidwestMedicalEdition.com

sense. Most of us would not walk around complaining of chest pain or continually walk into walls because we cannot see them. Yet many fitness-minded people unnecessary continue to run with knee pain or bench press with shoulder pain. Getting an FMS done can make them more resilient. ■ Corey Howard is the owner of Results Personal Training in Sioux Falls and specializes in helping clients overcome limitations and get into stronger, healthier physical condition. As a father himself, he also enjoys helping his clients stay ahead of their children.

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Beef for Sleep Quality and Physical Function New research highlights potential health benefits of consuming more protein from foods like beef

R

By Holly Swee ECENT RESEARCH on diet

suggests that eating more high-quality

lower in protein. The researchers used com-

and sleep quality conducted

protein from foods like lean beef, as part of

monly available lean beef cuts such as lean

at Purdue University suggests

a reduced-calorie diet, can help obese

ground beef and flank steak. ■

that eating more protein

older adults–even those with limited ability

from foods like beef, as part of a reduced-

to exercise–achieve increased physical

Holly Swee, RD, LN, is Director of Nutrition

calorie diet, may help overweight and

function during weight loss.

moderately obese adults improve sleep

In this study, conducted by researchers

quality during weight loss. This research is

at Duke University, obese older adults who

especially interesting because, while many

ate a reduced-calorie diet higher in protein

previous studies have explored the impact

(at least 30 g of lean, high-quality protein

of sleep upon appetite and dietary choices,

at breakfast, lunch and dinner) had greater

this one reverses the two to examine the

gains in physical function (i.e., balance,

potential impact of the diet on sleep.

lower-body strength, and walking speed)

A second recently published study

compared to those who ate a similar diet

& Consumer Information at the South Dakota Beef Industry Council.

References 1 Zhou, J, et al. Higher-protein diets improve indexes of sleep in energy-restricted overweight and obese adults: results from 2 randomized controlled trials.

March 2016, Am J Clin Nutr 2016103(3):766-74.

2 Porter Starr K, et al. Improved function with enhanced protein intake per meal: A pilot study of weight reduction in frail, obese older adults, January 2016,. J Gerontol A Biol Sci Med Sci

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42

Information info@MidwestMedicalEdition.com

MPA Factbook 2013/2014

Midwest Medical Edition

Help for the Front-Line Physician and Opioid Dependent Chronic Pain Patient

By Craig Uthe, MD

M

any physicians are looking for direction and guidance for an evidence-based treatment model to address the challenging and complex needs of the opioid-dependent chronic pain patient. There is help; help for the patient and resources for the doctor.

First, patients are becoming more aware of the grave consequences of opioid misuse and abuse. Health campaigns have effectively warned the public that more Americans are dying of unintended opioid overdose on a daily basis than are dying in motor vehicle accidents.

Thus, patients are increasingly visiting physician offices asking to be taken off pain medications.

Personal awareness and desire to succeed is the first and most important step to recovery.

Second, the SD Prescription Drug Monitoring Profile has become a resource that allows for standardized tracking of ongoing patient prescription shopping.

Third, the pendulum has swung away from the obligation for physicians to prescribe opioids to treat pain as a vital sign.

The focus to “function over pain” is a new direction that is leading patients in a direction where success is more realistically achievable.

September / October 2016

Fourth, guidelines, checklists and plans of action published and promoted by the CDC in early 2016 are very useful resources for health teams, physicians and patients that provide practical direction and guidance in developing treatment plans and boundaries.

Complementing and highlighting some of the content in these resources are some general points to remember:

1

2

3 4

O pioid overdose is life-threatening; opioid withdrawal is not life-threatening.

If your patient is at a dangerous MME (milligrams of morphine equivalent) dosage, work reduce the dosage to a non-lethal daily dosage.

I n general, sole benzodiazepine overdose is not life-threatening; benzodiazepine withdrawal is life-threatening.

If uncertain, it is generally safer to provide a patient an appropriate benzodiazepine dosage rather than deny the drug.

void prescribing A the combination of opioids and benzodiazepines.

A patient concurrently taking this drug combination is at significantly greater risk for an unintended overdose death.

E mphasize the avoidance of alcohol consumption to the patient who is taking an opioid or benzodiazepine.

Alcohol remains the most commonly abused substance in the US and its consumption while on an opioid and/ or a benzodiazepine increases the risk for unintended opioid overdose deaths.

Caring for and treating the opioid-dependent chronic pain patient is not easy. But then, how much of what is done in medicine is considered easy?

Building mutual trust and respect between the physician and patient is of utmost value.

Making him or her aware that the path of addressing and treating opioid dependence will be difficult but can be rewarding with high functioning and controlled pain.

MidwestMedicalEdition.com

Inviting, encouraging and even challenging the patient into that journey with reassurance that you will provide support and guidance along the way is time-consuming and demanding for the physician. Assembling a team of support with necessary resources will help. More nonopioid pain treatment resources are becoming available. Waiting for the patient to get into a comprehensive, multi-disciplined pain clinic with easy access and availability is not likely to occur in the immediate future.

Until then, the physician can follow these resources to help some patients out of this dangerous condition.

Ultimately, the health care team can only help create a safe environment for the patient to most likely succeed.

The rest is up to the patient.

Let’s see if we have the resolve and discernment to help the patient out of risk and into a safe place. ■ Dr. Craig Uthe is the medical consultant for Midwest Health Management Services.

You can find inks to download and print the CDC resources mentioned in the article on our website.

43

Exploring the Black Hills Why One Night is Not Enough

By Carmella Biesiot

T

HE BLACK HILLS attracts families, history buffs, and adventure-seeking enthusiasts from all over the world each year. These breathtaking hills feature two parts — the Northern Hills and the Southern Hills.

The Southern Black Hills is home to Mount Rushmore and Crazy Horse, Rapid City, Hill City (home of the popular Prairie Berry Winery), Custer State Park, and many other internationally-recognized attractions. However, it is the Northern Black Hills that can offer you a surprisingly unique vacation experience. Visit these 5 destinations and learn why your trip to the Northern Black Hills is worth more than just one night in a hotel.

Find your inner outlaw in Deadwood.

Deadwood, a national historic landmark, features historic Main Street, several upscale gaming resorts, and entertainment for the entire family. Nestled between Sturgis and Spearfish, this exciting place offers something for everyone-gaming for those who seek the thrill of winning, fine dining for foodies, high end retail, museums and guided tours, excellent fly fishing at Whitewood Creek, and for those looking to stay active on their trip, be sure to hike Mount Roosevelt to the Friendship Tower, and don’t forget hit up the exalted Mickelson Trail which begins in Deadwood-take

44

a run or walk, or rent a bike and take the ride of your life on the most beautiful trail in the country!

Spearfish Canyon is a must-see destination in the Black Hills. This, nearly 20 mile drive, features a bird watcher’s paradise, ample rock climbing opportunities, diverse plant life, breathtaking waterfalls including Roughlock Falls (hailed as one of the most beautiful attractions in the Black Hills), and hiking at Devil’s Bathtub, the most scenic and recognizable hike in the area. Consider your Black Hills holiday inadequate without this picturesque drive.

Named after the ancient Greek placer workings on the River Pactolus, Pactola Reservoir, located 11 miles north of Hill City, mixes history and recreation! Pactola actually used to be an old town. When the Pactola Dam was built in 1956, the town flooded permanently and Pactola Lake was born. At least a half day, if not an entire day, is recommended to explore the reservoir. And don’t worry if you don’t own a boat. The Pactola Lake Marina offers speed boats, ski boats, sailboats, fishing boats, and pontoons for daily rental. Don’t forget your camera. Pactola is one of the most stunning destinations in the area.

Spearfish, South Dakota was once named one of the best small towns to live in in America. Home to Black Hills

State University, this town provides a “Boulder-esque” experience in the heart of the Northern Black Hills. With its stellar views, unique shops, its own brewery named after the local summit, Crow Peak, and a trendy downtown that stays active with community events, it’s impossible for even the town’s residents to get bored!

Be sure to visit the DC Booth Fish Hatchery at the gorgeous Spearfish Park.

This is a free attraction that even the locals love. If you have children, love nature, or are just looking for a stroll in the park, the fish hatchery will suit your fancy. Make time for one of the prettiest towns in South Dakota.

Monuments, shopping, and maybe a little gambling mixed with some history are just a few reasons why one night in the Northern Black Hills is never enough.

So as you make your Fall travel plans, we who live in and love this area invite you to unpack that suitcase, kick up your feet, and stay awhile. ■ Carmella Biesiot is Director of Hotel Sales and Marketing at The Lodge at Deadwood.

For timely advice on visiting Devil’s Tower, one of the most unique and spiritual destination in the Black Hills, see the extended version of this article on our website.

Midwest Medical Edition

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Learning Opportunities Fall/Winter 2016 September 8 4th Annual Avera & Hazelden Symposium 9:00 am – 4:00 pm

September 21 - 23 SDAHO Annual Convention 8:00 am – 5:00 pm

Location: Ramkota Hotel, Sioux Falls Information:605-322-7879 AveraEducationEvents@avera.org Registration: Avera.org/conferences

Location: Sioux Falls Convention Center Information:SDAHO.com/events/sdaho-90th-annual-convention/

September 9 5th Annual Sanford Imagenetics Genomic Medicine Consortium 7:50 am – 4:30 pm Location: Sanford USD Medical Center, Shroeder Auditorium Information:605-312-6513 norma.eie@SanfordHealth.org Registration: SanfordHealth.csod.com

September 12 Dialectical Behavior Therapy: A Day with Marsha Linehan 8:30 am – 2:00 pm Location: Ramkota Hotel, Sioux Falls Information:605-322-7879 AveraEducationEvents@avera.org Registration: Avera.org/conferences

September 12 Mercy Infectious Disease Conference 7:15 am – 3:30 pm Location: Sioux City Convention Center Registration and Information: www.mercysiouxcity.com, click on professional education

September 23 Avera Pulmonary & Critical Care Symposium 8:00 am – 4:30 pm Location: Holiday Inn City Centre, Sioux Falls Information:605-322-7879 AveraEducationEvents@avera.org Registration: Avera.org/conferences

September 29-30 17th Annual Oncology Symposium Location: Prairie Center, Avera McKennan Hospital Information:605-322-7879 AveraEducationEvents@avera.org Registration: Avera.org/conferences

October 7 16th Annual Community Response to Child Abuse Conference 8:00 am – 5:00 pm Location: SIoux Falls Convention Center Information and Registration: SanfordHealth.csod.com

October 19 UnityPoint Health 32nd Annual Cardiology Conference Location: Sioux City Convention Center Information and Registration: UnityPoint.org/siouxcity/services-professional-education.aspx

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.

While doctors search for new cures, we’re finding October 26 8th Annual Avera/SDSU Research Symposium 8:30 am – 4:00 pm

new ways to minimize risk.

Information: 605-322-7879 AveraEducationEvents@avera.org, Registration: Avera.org/conferences

October 28 Avera Ethics Conference 8:00 am – 4:00 pm Location: Hilton Garden Inn, Sioux Falls Information: 605-322-7879 AveraEducationEvents@avera.org Registration: Avera.org/conferences

November 4 34th Annual North Central Heart Cardiac Symposium 8:00 am – 5:00 pm Location: Sioux Falls Convention Center Information: 605-977-5122 marilyn.paddock@avera.org Registration: Avera.org/conferences

November 9 Avera Palliative Medicine Symposium 8:30 am – 4:00 pm Location: Hilton Garden Inn, Sioux Falls Information: 605-322-7879 AveraEducationEvents@avera.org Registration: Avera.org/conferences

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