20160808 bend bulletin news projects pulse august 2016

PULSE H I G H

D E S E R T

Healthy Living in Central Oregon

SUMMER / FALL 2016

Healthy eating: What’s your perfect cooking oil match?

Memory care: Standards for facilities get a closer look Get ready: Find a kayaking style that floats your boat

• Drugs for hepatitis C have improved but remain out of reach for many with deteriorating livers

SUMMER / FALL 2016 VOLUME 9, NO.2

How to reach us • Editor Jody Lawrence-Turner, 541-383-0308, jlawrence-turner@bendbulletin.com • Reporting Tara Bannow, 541-383-0304, tbannow@bendbulletin.com Kevin Duke, 541-617-7868, kduke@bendbulletin.com Peter Madsen, 541-617-7816, pmadsen@bendbulletin.com Kathleen McLaughlin, 541-617-7860, kmclaughlin@bendbulletin.com Sheila Miller, 541-617-7831, smiller@bendbulletin.com Mark Morical, 541-383-0318, mmorical@bendbulletin.com • Design / Production Jeff Caspersen, Greg Cross, Carli Krueger • Photography Ryan Brennecke, Joe Kline, Jarod Opperman, Andy Tullis • Corrections High Desert Pulse’s primary concern is that all stories are accurate. If you know of an error in a story, call us at 541-383-0308 or email pulse@bendbulletin.com.

• Advertising Susan Simpson, health & medical account executive, 541-617-7842, ssimpson@bendbulletin.com • On the Web: www.bendbulletin.com/pulse

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Published: 8/8/2016

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Contents | HIGH DESERT PULSE

COVER STORY

4

HEPATITIS C: BARRIERS TO CARE Exorbitant costs and insurance obstacles are making it hard to obtain new, more effective drugs.

FEATURE

22

MEMORY CARE UNDER THE MICROSCOPE Memory care facilities in Oregon kept investigators busy last year, intensifying the scrutiny on standards for staffing and oversight.

4

HEPATITIS C: BARRIERS TO CARE

12

GET READY

18

WATCHING YOUR SLEEP

22

MEMORY CARE UNDER THE MICROSCOPE

DEPARTMENTS

10 12

GET GEAR Upgrade your game with the latest in golf tech.

15 17

TIPS Raising active kids who stay active into adulthood

18

JOB Sleep technologists: Armed with electrodes and monitors, their job is to observe your slumber.

26

PROFILE Mind, body, medicine and mountain biking: Yoga and outdoor activities bring balance to this physician assistant’s life.

28

HEALTHY EATING Canola, olive, peanut, safflower, grapeseed: With so many options, which oil is right for you?

30 55

SNAPSHOT It’s a popular time of year to slog up South Sister.

GET READY Whether the roar of whitewater or tranquility of flat water floats your boat, this guide will get you started.

POP QUIZ Insomnia: the causes, consequences and possible remedies

ESSAY Year of the Pullup: building arm strength to fulfill a personal fitness challenge

COVER ILLUSTRATION: Carli Krueger CONTENTS PHOTOS, FROM TOP: JOE KLINE; JAROD OPPERMAN (2); ANDY TULLIS

SUMMER / FALL 2016 • HIGH DESERT PULSE

Page 3

Cover story | HEP C: BARRIERS TO CARE

HEPATITIS C: Is the path to treatment too restrictive?

Although new drugs are more effective than ever, prohibitive costs and insurance coverage barriers are blocking treatment

BY TARA BANNOW PHOTOS BY JOE KLINE

A

fter a routine physical, Randy Cox’s doctor fast-tracked him to a specialist in Springfield, who insisted he bring his wife or not bother to show up at all. It was February.

“When’s Randy’s birthday?” the specialist had asked Cox’s wife. She told him it was in June. “Don’t plan a party,” he replied.

Maricela Chavez, pictured at her home in Madras, expected to die from hepatitis C after the first medications she tried made her even sicker. A newer regimen that included Sovaldi, however, rid her of the virus. “I’m walking out of the dead,” she says.

Page 4

The doctor instructed Cox to take his shirt off, and inspected under his arms, noting the unmistakable yellow tint of his skin. It was around his hair. The color had also seeped into his eyes.

The doctor diagnosed Cox with hepatitis C, a viral liver infection that can ultimately lead to liver failure or liver cancer. At the time, the drugs that were available didn’t work for most people.

Cox was already too sick for one of them, anyway. The doctor told him he’d contracted the virus about a decade earlier.

“I honestly thought I was going to die,” said Cox, now 65. Recently recalling the ordeal that would color his world in fear for more than two decades, he started to choke up. Sitting in a Bend diner on Third Street not far from his house, he took his hands off his coffee mug so he could slowly remove his glasses, wipe his eyes and continue his story. “Until about a month ago, I thought I was going to die.”

Within the past three years, new drugs with cure rates surpassing 90 percent have come on SUMMER / FALL 2016 • HIGH DESERT PULSE

Army veteran Randy Cox, pictured outside his home in Bend, recently obtained hepatitis C treatment through the U.S. Department of Veterans. His doctor told him he’s cured. “I’m amazed that I get to turn 65 years old,” he says.

the market that have dramatically changed the conversation for hepatitis C patients like Cox. The results are like nothing doctors had seen before: patients’ bodies being effectively rid of the virus within just a few months, rather than living with it for decades.

But the drugs’ exorbitant prices keep them out of reach for lots of people. Some private insurers and government programs for low-income individuals require patients be very sick before they’ll pay for treatment.

Nearly 20,000 deaths in the U.S. were tied to hepatitis C infections in 2014 — more than any year in history, according to the federal government. That number is expected to increase, as the thousands if not millions of cases that have gone undiagnosed for decades erupt into liver scarring or cancer.

Oregon’s Medicaid program is taking especially intense criticism, not only from hepatitis C patients, advocates and physicians, but from the federal government itself, which says the state’s strict treatment criteria is not in line with federal law.

State officials, hesitant to speak on the issue in recent months, promise to revisit their guidelines in September. Advocates argue that’s not soon enough.

As lawsuits force other state Medicaid programs, including WashSUMMER / FALL 2016 • HIGH DESERT PULSE

ington’s, to drop their restrictions, a legal battle appears increasingly likely in Oregon.

“I don’t want to impute bad motives on the part of insurers,” said Robert Greenwald, a clinical law professor at Harvard Law School and faculty director of its Center for Health Law and Policy Innovation, “but I do think they feel more comfortable than they should about basically condemning a population and many people within that population to sickness, ill health and ultimately, for some, death, for having these kinds of restrictions.”

‘It’s quiet’ Before hepatitis C was first identified in 1989, an estimated 300,000 were infected with the virus each year, primarily through injecting illegal drugs and from receiving blood transfusions in medical settings, according to the Centers for Disease Control and Prevention.

In 1992, researchers developed a blood test that removed the virus from the blood supply used in blood transfusions.

Roughly 80 percent of the chronic or longstanding cases of hepatitis C afflict baby boomers, people born between 1945 and 1965. If the infections develop into cirrhosis, late-stage scarring of the liver, it happens decades — sometimes 30 years — after the initial infection.

Page 5

Cover story | HEP C: BARRIERS TO CARE

Many of the infected are just finding out.

For the rest of that time, there can be virtually no symptoms.

“It’s quiet,” said Maricela Chavez, a 52-yearold Madras resident who was diagnosed in 2002. A doctor told her four years ago that she had probably had the virus for 30 years.

“You don’t feel no pain, you just feel tired. It’s scary.”

The worst is yet to come, according to numerous projections. The CDC believes the prevalence of hepatitis C-related end-stage cirrhosis, liver cancer and deaths will peak in the late 2020s to early 2030s. It now recommends all baby boomers get a one-time screening for hepatitis C, even if they don’t have risk factors. The federal government estimates 3.5 million Americans have hepatitis C, but only half know it.

“Because the most common risk factor is injection drug use, I think people would like to dismiss it as a city drug user problem, but it’s not,” said Dr. Ann Thomas, a public health physician with the Oregon Health Authority. “It’s everywhere.”

Dr. Glenn Koteen, a gastroenterologist with Gastroenterology of Central Oregon, has learned not to be surprised by the people he diagnoses. Hepatitis C doesn’t stick to one creed, gender or race, he said.

“Everyone from CEOs who make a million dollars a year and snorted cocaine in the past to the homeless drug addicts and heroin addicts who shoot up all the time,” Koteen said. “It’s across the board.”

Some research has shown hepatitis C can also be transmitted through the straws or rolled up dollar bills used to snort cocaine, if tiny droplets of blood from one person come in contact with another user.

Oregon’s death rate from hepatitis C was double the national average in 2011. It’s unclear why. The rate of chronic infections tends to be high in Oregon’s rural counties.

Jefferson County had the state’s highest rate of chronic infections between 2009 and 2013: 252 cases per 100,000 residents, according to a 2015 Oregon Health Authority report. Second was Malheur County in southeastern Oregon.

Prisons tend to skew the rates, which could help explain what’s happening in Jefferson and Malheur counties, homes of the Page 6

Hepatitis C death rates per 100,000 people Oregon’s hepatitis C mortality rate was nearly double the national average in 2011. An average of 400 Oregonians died of hepatitis C each year between 2009 and 2013. Nationally, deaths associated with hepatitis C reached an all-time high of 19,659 in 2014, according to the Centers for Disease Control and Prevention.

12 9.88

10 7.81

8 6

Oregon 4

3 2.89

2

4.58

5.01*

National

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

* Data not available for Oregon in 2015 Source: Centers for Disease Control and Prevention

Deer Ridge and Snake River correctional institutions, respectively.

The prevalence in rural areas could also be because that’s where there is a large proportion of retirees, said Dr. Mark Loveless, an infectious disease physician in Portland who is a member of an Oregon Health Authority steering committee on hepatitis.

The most common way of getting hepatitis C is through sharing needles during injection drug abuse. Before 1992, many people got it in medical settings, through blood transfusions, organ transplants or needlestick injuries. Being born to a mother with the virus is another mode of transmission, as is getting a tattoo from someone with unsanitary practices, or sexual contact.

Because of the drug abuse connection, many people don’t like to admit they have the virus. Many advocates believe today’s treatment restrictions come from the belief that people who used drugs don’t deserve treatment.

Laurie Hubbard, a communicable disease nurse in Deschutes County who investigates new hepatitis C cases, said she thinks the treatment restrictions for people with hepatitis C is connected to that stigma.

CARLI KRUEGER

“It doesn’t matter how the disease is contracted in terms of worthiness for care,” she said. “It’s a disease. It’s an infection. As a humane population, we would love to see people with disease and infection have access to care.”

The early days of treatment Koteen got to work treating hepatitis C when it all started in the mid-’90s, and it was “miserable” work.

Back then, patients received three injections per week of a drug called interferon for 48 weeks. The chances of that getting rid of the virus were only about 16 percent, according to a 2012 study in the journal Clinical Liver Disease. When another drug called ribavirin was added to the mix, the cure rate grew to about 34 percent.

When the number of injections patients needed went down to one per week, the cure rate grew again, this time to about 55 percent, according to the 2012 study.

The drugs’ side effects were so severe, few patients could see their regimens through. People felt like they had the flu: nausea, vomiting and many couldn’t work during the treatment.

SUMMER / FALL 2016 • HIGH DESERT PULSE

Maricela Chavez said she didn’t feel any pain when she was diagnosed with hepatitis C, even though she had likely had the virus for decades. “It’s quiet,” says Chavez, pictured with her grandson, 14-year-old Casper Cadena, at her home in Madras.

Chavez said some days she couldn’t even get out of bed. She was tired. She threw up. Her hair fell out. She developed blisters on her lips, tongue and even in her throat. It hurt to eat. She developed anemia, a common side effect of ribavirin.

She watched a friend with cancer die during her chemotherapy treatments, and said the feelings her friend described were exactly what she was experiencing.

“It was very, very bad,” she said.

Even after all that, the drugs didn’t rid Chavez of the virus. In fact, her doctor told her she was worse off than when they had started.

Initially, the drugs were so bad, doctors didn’t treat every patient they diagnosed, Koteen said. For many of them, the slim likelihood of being cured wouldn’t have been worth the unbearable side effects, he said.

That was the case for Cox. By the time the Bend man was diagnosed, he was too sick to take interferon. Instead, the doctor gave him ribavirin, but the odds of that working alone without being combined with interferon were low, a fact the doctor made clear.

“He was upfront about it from the beginning,” Cox said. “He said, ‘You know, there’s a lot of people that their body won’t take this.’”

That was the same doctor who warned Cox’s wife (they’ve since divorced) not to plan a birthday party. It turned out, he’d been right. For weeks, Cox said he was SUMMER / FALL 2016 • HIGH DESERT PULSE

too sick to do anything. In addition to the nausea, he developed rashes all over his body, including on his head.

“Those drugs are so poisonous,” he said.

The doctor stopped the treatment and — out of options — did something that’s typically frowned upon in mainstream medicine: He sent Cox to a naturopathic physician. She whipped up solutions that tasted terrible, but Cox said he eventually felt better again and went back to work.

The yellow tint left his eyes.

It seemed this would keep his illness at bay — at least for a while.

Many of Koteen’s hepatitis C patients dealt with severe depression and anxiety even before treatment. Unfortunately, the early medications exacerbated those conditions. Suddenly, they were angry, too.

Irritable. They couldn’t get along with their children or spouses. They couldn’t sleep.

Coupled with the physical symptoms, many simply couldn’t continue treatment.

At the time, it was common for doctors to pick and choose which patients they treated, Koteen said. Doctors, hearing rumblings of better drugs on the horizon, told patients to wait.

“Since it’s a disease that can take 20 or 30 years, what’s another one or two years?” Koteen said. “All these patients would be waiting in the wings, like airplanes lined up at an airport.”

Dr. Kent Benner, a gastroenterologist with The Oregon Clinic in Portland, said Page 7

Cover story | HEP C: BARRIERS TO CARE

once he got done going over the medications’ side effects — flulike symptoms, depression, all for a small chance of getting cured — many decided to skip it.

“They look at you and they go, ‘Doc, why would I want to take that?’” he said. “‘I’m going to wait for the new drug you’re telling me is coming out in a few years.’ A lot of patients were on the sidelines.”

Given her previous experience, Chavez was nervous when a doctor told her about the new medications. With the help of a patient assistance foundation, she was able to get a regimen that included Solvaldi for about $30 a bottle. Within three months, her doctor told her she was cured.

“I’m walking out of the dead,” Chavez said. “I’m a survivor.”

New drugs, still out of reach At the end of 2013, it seemed the wait was over.

That’s when the FDA approved a new drug, Sovaldi, that was showing cure rates around 90 percent. The drug’s treatment regimen — 12 weeks — was much shorter than the drugs of the day, and, best of all, the side effects were minimal. In fall 2014, Harvoni, another drug with an equally impressive cure rate hit the market.

“It’s like taking candy compared to taking toxins in the old days — for the doctor and the patient,” Koteen said.

Dr. Laurie D’Avignon, an infectious disease physician with Bend Memorial Clinic who sees new hepatitis C patients every week, said she was initially skeptical of the high cure rates the drugs’ manufacturer, Gilead Sciences Inc., was reporting. The drugs she’d been giving patients for years had such horrific side effects, most patients couldn’t see the regimens through, much less be cured.

But once she started prescribing the drugs for her patients, D’Avignon realized the side effects were so minimal, patients had no problem seeing the regimens through, and almost all who took them were cured.

“They say, ‘Are you sure it’s working? I don’t feel anything,’” she said.

But the drugs carried an enormous price tag for a 12-week course: $84,000 for Sovaldi and $94,500 for Harvoni.

Suddenly, the problem shifted from the treatments not existing to the treatments being so expensive, they were out of reach for those who needed them.

Oregon’s Medicaid program, the Oregon Health Plan, initially restricted access to Sovaldi to patients with cirrhosis. Eligibility determinations are primarily based on patients’ fibrosis scores, the progression of scarring on their livers. Fibrosis scores range from one — the least severe — to four, the final stage before liver failure, also known as cirrhosis.

Between June and December 2014, OHP was among only four state Medicaid programs that restricted access to Sovaldi to stage 4 fibrosis.

Meanwhile, Gilead reported in July 2014 it had made $3.48 billion on Sovaldi. In the first quarter of 2016, the company said it made about $4 billion on its hepatitis C drugs.

Today, private insurers in Oregon restrict not only which medications they pay for, but the proportion of the total bill they cover.

An analysis of 2016 silver-tier policies in Oregon by the Center for Page 8

Health Law and Policy Innovation at Harvard Law School found that 22 percent cover only two of the available hepatitis C medications, while 8 percent cover only Sovaldi. Silver policies offered by Atrio, Kaiser Permanente, Moda Health Plans, PacificSource Health Plans, Providence Health Plan, Trillium Community Health Plan and most of those offered by BridgeSpan require members pay for half of the cost of the medications.

More than 90 percent of private silver policies in Oregon require prior authorization for the hepatitis C medications. That means after determining the patient needs the medication, the doctor’s office has to send a request to the insurer, which then determines whether the patient meets its criteria.

Prior authorizations are very time consuming for doctors and their staff. Asked whether she has experienced this, D’Avignon, of BMC, laughed.

“The physical act of them completing the treatment — that’s the easy part,” she said. “I think the most challenging part is getting through all of the paperwork.”

Some insurers require that patients prove they haven’t used drugs or alcohol for at least six months before they’ll be approved for treatment.

Using alcohol hastens the progression toward cirrhosis, so D’Avignon said she always recommends her hepatitis C patients abstain from drinking. At the same time, she said she thinks it’s unfair to restrict somebody who has had a few drinks within the past six months from treatment.

“I think it’s really unfortunate when someone comes in and is like, SUMMER / FALL 2016• HIGH DESERT PULSE

“‘You’re not sick enough. You don’t meet the criteria.’ I think they hope that you’re dead or something, that you die.”

— Kandice Conry, on her repeated attempts to get hepatitis C treatment covered by insurance After her insurer denied hepatitis C treatment four times, 36-yearold Kandice Conry, pictured outside of her Redmond home, bought inexpensive medications online. Her doctor confirmed she was cured in three months. urine screen in patients without histories of alcohol or drug use at least six months prior to approval is “draconian,” he said.

“That is totally unnecessary,” he said. “It’s just a barrier to care.”

Dallas Buyers Club for Hep C

‘Oh my gosh, a month ago I had a couple glasses of wine with dinner,’ and then to have to say, ‘Well, we need to wait six months from that point until we can submit you for treatment,’” she said. “That seems a little overkill.”

It should be the doctor’s job to determine whether the patient’s drug or alcohol use would interfere with their treatment, Benner, the Portland gastroenterologist, said. In any case, requiring a negative

Kandice Conry was among those who passed on interferon when she was diagnosed in 2003.

At the time, Conry, who is being identified by her mother’s maiden name to protect her family’s privacy, was 23 years old and living in San Francisco. She didn’t fully understand the gravity of hepatitis C. That coupled with the horror stories she’d heard about the drug made the decision easy.

“I just knew if it ever came to that point, that I would never try that,” she said. “If it’s going to make me worse, why even do that?”

Around a decade later, Conry, in her mid-30s and raising three kids, decided she couldn’t wait any longer. The disease was making her tired all the time.

“I was exhausted,” she said. “I would sit there on the couch and my Continued on Page 33

GOLF Get gear | GOLF TECH

gadgetry

From the latest and greatest in GPS to drivers, bags and gloves, manufacturers are taking technology to new heights in 2016

BY KEVIN DUKE PHOTOS BY JOE KLINE

T

echnology is a major player for golf equipment in 2016, whether it’s the newest in GPS systems for the golf course, drivers, carry bags or gloves.

From course maps and distances right on your wrist to carbon fiber heads on drivers to new materials used for carry bags and gloves, golf equipment manufacturers are taking technology to new

heights with this year’s offerings.

With a promise that the latest and greatest gadget will improve a golfer’s game and enjoyment, players are snapping up the most advanced products despite high price tags. For those looking to save a little money, golf equipment sales for this year’s new merchandise typically begin in the fall.

TaylorMade M2 Driver • $400 The “M” stands for multimaterial, and that’s exactly what the latest driver from TaylorMade offers, a carbon composite head with a massive sweet spot that promises forgiveness and, of course, extra distance.

“There’s no metal in it,” said Andy Heinly, the owner at Pro Golf in Bend. “There are a lot of good drivers out, but this is just one of them that’s kind of unique.”

TaylorMade took out some of the adjustment capabilities (for draw and fade bias) from its M1 driver in order to create a lighter head.

“It’s almost the exact same head (as the M1), it just doesn’t have the same adjustability, so it’s really lightweight,” Heinly said.

The carbon composite creates a different sound from most drivers on the market.

“It’s solid, and the sound is just better,” Heinly said.

“You’ve got to like the sound, because the sound equates to feel. If you like the way something sounds, it’s going to feel better to you.”

Heinly said he has had the M2 back-ordered since it came out at the end of last year.

SUMMER / FALL 2016 • HIGH DESERT PULSE

Sun Mountain 2Five • $200 Made for golfers who love to walk, the 2Five carry bag from Sun Mountain uses lightweight material for a bag that is strong but weighs in at 2.5 pounds.

“They use aerospace plastic and the lightweight material, so it’s just incredibly light,” Heinly said.

“For somebody that wants to pack their bag and carry their clubs comfortably, it’s a great bag.”

Other features include carbon fiber legs for the bag stand, four pockets and Sun Mountain’s twostrap system to make carrying easier.

While light, the 2Five still has plenty of room for all the clubs, balls and equipment golfers need to carry on the course, Heinly said.

The bag was named as a Golf Digest Editors’ Choice in April and, at its retail price of $200, it’s about $50 higher than most carry bags.

Garmin Approach S6 (at left) • $350 The latest in GPS systems on the course, the S6 does everything a hand-held device does (yardages, hole layouts and more) with the convenience of not having to carry it around.

The S6 is about the size of a normal watch and features full-color course views for more than 40,000 golf courses around the world, with distances prominently displayed for layups and to the front, middle and back of the greens.

Additionally, the watch offers touch-screen control, can measure your swing tempo and speed, and can help golfers with the TempoTraining feature, which provides an upswing-to-downswing ratio with audible tones to help train golfers to achieve a more consistent swing tempo.

“We brought Garmin in because people were asking for it all the time and they’re simple to use,” Heinly said.

Other features include stat tracking for number of putts, greens in regulation and fairways hit. The S6 also offers touch-screen operation and links up to your smartphone for notifications of emails, texts, alerts and more. While the S6 retails for $350, less expensive watches from Garmin are also available.

“It’s $350 for the high-end watch, but they go down to $200 for the watches with less bells and whistles,” Heinly said.

Gloves • $10 to $15 The newest gloves from Zero Friction use a lycra material to create the first one-size-fits-all glove.

No more looking for that medium-cadet size that always seems hard to find.

“I was skeptical at first,” Heinly said. “But when I tried it on and others (with different size hands) have tried it on, it fit great.”

The gloves combine both synthetic material and cabretta leather with the stretchable lycra, and come in a variety of colors. •

Page 11

Get ready | KAYAKING Flat water, whitewater?

Playboating, recreational boating, tour boating? What you need to know to make a go of kayaking

Be ready

BY MARK MORICAL PHOTOS BY JAROD OPPERMAN

F

rom long stretches of serene flat water to roaring white waterfalls, kayaking options abound in Central Oregon.

Still, it can be hard for a beginner to know just

how to get involved in the sport.

For starters, it helps to understand the different styles of kayaking.

Whitewater kayaking options, for instance, include playboating, river running and creek boating. Flat-water kayaking styles include recreational boating, tour boating and sea kayaking.

According to Austin Bunn, a kayaking instructor for Tumalo Creek Kayak & Canoe in Bend, playboating involves various technical moves performed in one spot, the style of kayaking popular at the Bend Whitewater Park. River running is traveling the length of a river section of whitewater, and creek boating is a more expert-level discipline that includes smaller tributaries and bigger drops.

Recreational boating is the basic beginner level in flat-water kayaking. Tour boating and sea kayaking involve longer, narrower boats that can hold lots of gear and allow for a multiday expedition.

So what if somebody wants a boat that is suitable for both flat water and whitewater? The answer, according to Bunn, is a crossover kayak. These boats have the design of a whitewater boat but are a little more stretched out, with a drop-down skeg — an extension of the boat that helps with steering — that allows the boat to track in a straight line.

“Those boats are really great for flat-water rivers, and when you pull out that skeg you have the outfitting of a whitewater boat, which gives you the control to be able to surf and play around in the waves here at the whitewater park,” Bunn said.

“So the crossover boat is kind of that connection between rivers, flat water, and being able to surf and play in whitewater as well. So that’s a great boat for someone who wants to dabble in whitewater but still have that same boat to take downriver and be able to go up to the lakes.”

Other gear necessary for whitewater kayaking includes a

Page 12

Kayaking resources • Deschutes Paddle Trail: deschutespaddletrail.info • Bend Paddle Trail Alliance: bendpaddletrailalliance.org • Bend Whitewater Park info: bendparksandrec.org

spray skirt, a personal flotation device, a paddle and a whistle. All that is necessary for flat-water recreation boating is a boat, a paddle and a whistle. Clothing options for kayakers vary, including dry suits and wet suits.

“Make sure you have plenty of layers,” Bunn said. “It’s better to have too many and not use it than not have enough to stay warm. When you combine water, wind and other elements, you can get quite cold quickly.”

A novice kayaker will not want to immediately attempt expert whitewater like Benham Falls or Dillon Falls. To find calmer stretches along the

for the river (or sea or lake)

Kayakers paddle down a flat-water stretch of the Deschutes River south of the Old Mill. Navigating the maze of kayaking styles and equipment options can be a challenge for newbies.

Deschutes River, a good resource is the Deschutes Paddle Trail at deschutespaddletrail.info.

The Deschutes Paddle Trail includes the navigable sections of the Deschutes and Little Deschutes rivers, as well as the nine largest Cascades Lakes in Deschutes County. The Deschutes Paddle Trail River Guide includes nine sections of Class I water — safe for inex-

perienced whitewater paddlers — ranging from about 2 to 10 miles long on the Upper Deschutes.

Also, the flat-water portions of the Deschutes that run through Bend, including the Old Mill section from Bill Healy Memorial Bridge to the Colorado Avenue Bridge and the section downstream of the whitewater park to Mirror Pond, are ideal stretches for the beginner

SUMMER / FALL 2016 • HIGH DESERT PULSE

Get ready | KAYAKING

Flat-water kayaking Styles: recreational boating, tour boating, sea kayaking What you’ll need:

• Boat • Paddle • Whistle

A kayaker takes a break while riding Bend’s whitewater park.

Whitewater kayaking Styles: playboating, river running, creek boating What you’ll need:

to practice paddling.

The Cascades Lake Guide of the Deschutes Paddle Trail provides maps of the most prominent Cascades Lakes along with the access points and campgrounds. The included lakes are Wickiup, Crane Prairie, Cultus, Lava, Hosmer, Elk, Sparks, Paulina and East.

The Deschutes Paddle Trail was established by the Bend Paddle Trail Alliance (bendpaddletrailalliance.org), which spearheaded the effort for the Bend Whitewater Park and is an invaluable resource for kayakers in Central Oregon.

“Someone new getting into kayaking can go connect with the people in that group (BPTA),” said Colleen McNally, marketing manager for the Bend Park & Recreation District, which oversees the Bend Whitewater Park and conducts classes in kayaking. “We offer basic skills kayaking and half-day and full-day tours through Tumalo Creek Kayak & Canoe. There’s basic skills and whitewater classes, so there’s some progression.”

More information on the Bend Whitewater Park, including a whitewater guide and water and wave conditions, can be found atbendparksandrec.org.

Bunn has been a kayaking instructor for eight years, and he said the biggest deterrent for many prospective kayakers is a fear of flipping the boat and believing they must know how to roll their boat before they attempt whitewater.

“Which isn’t true,” Bunn said. “We do a full-immersion class, with paddle skills, whitewater-reading skills and safety aspects. We don’t even teach the roll in that class, because in reality you can paddle up to Class II without a roll. You might just swim. When you get to Class III to Class V, that’s when you need to start being able to right that boat, because the dangers are more extreme.”

Users of the Bend Whitewater Park include surfers, stand-up paddleboarders, kayakers and bodyboarders.

Bunn estimated that the numbers of surfers and kayakers at the whitewater park are about even. Kayakers use whitewater playboats Page 14

• Boat • Spray skirt • Personal flotation device • Paddle • Whistle

to perform tricks on the wave that is farthest downstream.

The center wave is more smooth and oceanlike and is used by surfers, Bunn noted.

“Surfers,” he said, “are looking for a different style of wave than the kayakers.”

A sign on the bridge at the whitewater park reads “experts only,” so kayakers should practice elsewhere before venturing into the park. Just because the wave is man-made does not mean it is without potential danger.

“They need to gain the appropriate skills, and have a respect and understanding of water and self-rescue,” Bunn said. “Or go out with someone who is knowledgeable.” • SUMMER / FALL 2016 • HIGH DESERT PULSE

Tips | ESTABLISHING HEALTHY FITNESS HABITS

RYAN BRENNECKE

A group of children make their way up the climbing wall as their parents watch at The Pavilion in Bend this summer. Introducing a number of different athletic activities is one bit of advice experts offer parents trying to teach their children healthy fitness habits. “It’s important to try lots of things and find your niche,” says Sue Glenn, recreation services manager at the Bend Park & Recreation District.

Raising active kids who grow into active adults Experts: Practice, setting a good example, introducing a variety of sports and emphasizing fun are among the ways parents can promote activity

BY KATHLEEN MCLAUGHLIN

A

growing body of medical research shows chronic conditions such as high blood pressure and Type 2 diabetes have their roots in childhood and adolescence.

The National Institutes of Health points out children today weigh more and have a higher body

mass index than they did just a generation ago, and 17 percent of all children are obese.

A decline in physical activity, along with poor nutrition and stress, are often cited as culprits. The Centers SUMMER / FALL 2016 • HIGH DESERT PULSE

Page 15

Tips | ESTABLISHING HEALTHY FITNESS HABITS

for Disease Control and Prevention has found most into adulthood? children fail to engage in vigorous or moderate-intensity activity for at least 60 minutes a day.

Experts from a variety of disciplines offered advice that goes beyond that first season of team sports.

So how do you raise active kids who stay active Here’s what they said.

Be a role model St. Charles Family Medicine Dr. Peter Leavitt said parents’ eating and exercise habits are the most important factor in whether their kids are overweight. When he sees overweight kids in his practice, the parents are usually overweight or inactive and have poor eating habits themselves.

Looking to whip the whole family into shape? Bend Park & Recreation District’s Juniper Swim & Fitness Center recognizes parents are the primary role model, and for that reason provides several ways kids can use the facility, says Monica McClain-Smith, fitness coordinator.

Fit Kids classes for ages 4 to 11 are scheduled during an adult group-exercise class during after-school hours, she said. The kids have a healthy snack and then do an activity like yoga or dance. Juniper’s treadmill and weight room permits kids as young as 11 to work out with adult supervision, and teens can work out on their own after they take an orientation, McClain-Smith said. The rules are similar at many commercial gyms.

Insist on ‘physical literacy’ If a skill such as running, jumping, throwing or catching doesn’t come easily to your child, practice it, said John O’Sullivan, a youth sports consultant and speaker who lives in Bend. “If your 6-year-old struggled with reading, you wouldn’t say, ‘He’s just not a reader. We’ll move on to something else.’ We know reading’s an essential life skill.”

Kids who have mastered fundamental physical, coordination skills will feel more confident, which helps them stay engaged in sports, O’Sullivan said.

Mastery of sports skills are tied to a child’s natural growth and development, so if you’re wondering how well the average 5-year-old should be able to catch a ball, read up. Pediatrician Paul Stricker, author of “Sports Success Rx,” writes that fewer than one-third of 2- to 5-year-olds are effective at throwing and catching.

Mix it up “It’s important to try lots of things and find your niche,” said Sue Glenn, recreation services manager at Bend Park & Recreation.

Most parents begin by exposing their kids to the activities they themselves know and love, but what if those efforts fall flat? Time to try something new.

Bend Park & Recreation is trying to make it easier for families to experiment with Open Play at The Pavilion in summer and early fall, Glenn said. During Open Play, kids and their parents can try climbing, skateboarding, racket sports and futsal ball, which is a small-court variation on soccer.

The district also offers a program for kids ages 10 to 14 called Girls and Guys Get Fit, which is a sampler of outdoor activities and indoor fitness classes, including cycling and Zumba. McClain-Smith said the program is geared toward introducing kids — and their parents — to group exercise. When kids find an activity that clicks, they’re welcome to keep it up through the regular

Page 16

group exercise schedule, she said. “Oftentimes, when they do that, they bring mom and dad with them.”

It’s important to maintain variety within activities like swimming, said McClain-Smith. That’s why kids who participate in Juniper’s swim teams learn the competition strokes, plus water polo and open-water swimming.

Talented athletes could be encouraged to specialize in one sport as young as age 9, but O’Sullivan believes the emphasis up to age 12 should be on trying new things. If your child has already narrowed the field, O’Sullivan recommends ensuring that he or she continues to participate in a variety of informal activities like riding bikes.

Emphasize fun Kids like winning, but O’Sullivan maintains it’s not what keeps them coming back every week for practice. Learning, playing and being treated with respect are more important, he said. To steer clear of win-obsessed teams, O’Sullivan recommends a recognizance visit before signing up. “Observe the behavior of coaches, observe the behavior of parents on the sideline,” he said.

“Is that a situation I want my kid to be in?”

Outside of organized sports, O’Sullivan recommends taking a cue from the video game-makers, who constantly ask their customers how they could improve the gaming experience. Let kids have a say in the family activity, he said, and then, “Don’t be afraid to ask your kids, ‘What would make this experience fun, so you’ll do more of it?’”

Avoid middle school dropout The middle school years are a crossroads for kids in terms of physical activity, Glenn said. That’s when organized sports become more competitive and kids become aware of their own abilities in relation to their peers. “They realize trying really hard doesn’t translate to being good at something. It’s a real shift. It’s a reason kids drop out.”

Parks and recreation agencies across the country have realized there’s a huge need to keep middle school-age children engaged, she said, and they’re offering team-sport alternatives such as martial arts and less competitive sports programs in which kids can just participate and be with their friends, which is the main motivator for any activity at this age.

Because of the demand from parents of middle school kids, for the first time this year, Juniper’s swim teams will continue to meet through the winter months, rather than take a break, said aquatics coordinator Shannon Gilman.

“There’s not a lot of middle school sports in the schools,” she said. “They don’t find that there’s much for them to do in the winter.”

O’Sullivan said there’s no way to predict how kids will stay active later in life. A former pre-professional soccer player, O’Sullivan now avoids running at all costs, but he loves telemark skiing. “Your job as a parent isn’t necessarily to determine what your kids should be passionate about, but it is to help them find the things they’re passionate about.” •

SUMMER / FALL 2016 • HIGH DESERT PULSE

Body of knowledge | POP QUIZ

Test your

insomnia

IQ

ILLUSTRATION BY GREG CROSS

BY JODY LAWRENCE-TURNER

A

good night’s sleep can make all the difference in how you eat, think and feel.

When efforts to achieve a decent slumber are thwarted on one, two, maybe three nights, or every night, it’s normal to ponder the cause, consequences and possible remedies.

Nearly 1 in 3 people suffer from some form of insomnia, according to the National Sleep Foundation. Take the quiz and find out how much you know about the condition.

1.

What are the top three causes of insomnia?

A) Depression, medication, alcohol B) Caffeine, environmental changes, chronic pain C) Irregular sleep schedule, eating too late, anxiety D) Anxiety, depression, stress

2.

What action do experts recommend is best if a person can’t sleep?

A) Get out of bed B) Practice a breathing exercise C) Turn on a fan or noise machine D) Drink warm milk

3.

How many hours of sleep is recommended for people ages 26-64?

A) 4-6 B) 6-8 C) 7-9 D) 5-7

SUMMER / FALL 2016 • HIGH DESERT PULSE

4.

8.

5.

6.

Insomnia can be diagnosed.

True or False

9.

What other health problems can be triggered by insomnia?

A) Obesity B) Heart disease C) Diabetes D) Anxiety E) All of the above

10.

Does alcohol help a person get a good night’s sleep?

Yes or No

7.

Which of these is not a remedy for insomnia?

A) Meditation B) Medication C) Watching TV D) Natural herbs

Which gender is more likely to suffer insomnia?

Male or Female How many hours of sleep does a person with chronic insomnia get on bad nights?

A) 2-4 B) 1-2 C) 3-4 D) 4-5 Can insomnia be cured?

Yes or No

Answers: 1. D. 2. A. 3. C. 4. No. 5. True. 6. E. 7. C. 8. Female. 9. C. 10. Yes. SOURCES: MAYO CLINIC, NATIONAL SLEEP FOUNDATION, WEBMD

Page 17

On the job | SLEEP TECHNOLOGIST

Sleep technologist Ryan Vesely applies electrodes to Shanda Wyrez’s face and head during a sleep study at the St. Charles Sleep Center in Bend. Sleep technologists apply each electrode and watch monitors during the course of sleep studies, which at St. Charles last an average of eight hours.

Watching your sleep Sleep technologists perform studies used to diagnose sleep apnea, insomnia

BY TARA BANNOW PHOTOS BY JAROD OPPERMAN

I

f your sleep is bad, chances are other aspects of your health are, too.

“It’s got its fingers in everything,” said Jacob Espinoza, a sleep technologist and manager of clinical operations for St. Charles Health System’s Sleep Center in Bend and Redmond. “We affect cardiology, primary care, pulmonology, behavioral health, orthopedic surgeries — we’re there.”

Ever-accumulating research is warning people about the dangers of a lack of quality sleep. While the effects on mood and mental

Page 18

ability are perhaps more obvious, it’s more difficult to perceive on a day-to-day basis poor sleep’s ability to put people at risk of serious chronic conditions like obesity and heart disease.

“If we can get sleep treated, then patients tend to do much better in all other aspects,” he said.

That’s where medical professionals called sleep technologists, also known as polysomnographic technologists, come in. They’re the ones who perform sleep studies on patients. Most people who see a sleep physician, like the ones at St. Charles Sleep Center, are SUMMER / FALL 2016 • HIGH DESERT PULSE

referred for a sleep study, which typically requires spending a night at the sleep center hooked up to a plethora of monitors.

Although the doctor is the one who interprets test results and slaps on a diagnosis, sleep technologists are the ones who actually perform the sleep study. They painstakingly apply each electrode and watch monitors throughout the night (or during the day, if the patient works at night). That’s no small task; sleep studies at St. Charles last an average of eight hours, and a minimum of six.

“We want to make sure that the patient goes through enough sleep stages so we can really know what’s going on,” said Espinoza, who no longer performs the sleep studies himself and instead oversees St. Charles’ 10 other sleep technologists.

Espinoza said he views his role as being an extension of the physician. Once the study is complete, the night sleep technologist prepares the report and hands it over to the day sleep technologist, who checks it over to make sure nothing was missed before it goes to the physician. Only a physician who is board-certified in sleep medicine can interpret a sleep study.

During the sleep study itself, the patient is monitored on several fronts to try to learn what’s causing the sleep problems.

First off, sleep technologists measure heart signals using an electrocardiogram, or EKG. That’s to measure whether the patient has an abnormal heart rhythm, such as be-

Sleep technologist Ryan Vesely attaches electrodes to Shanda Wyrez during a sleep study at the St. Charles Sleep Center in Bend. The information collected by sleep technologists during sleep studies is interpreted by a physician who is board-certified in sleep medicine.

ing abnormally fast or slow. In a conventional EKG, 12 electrodes are placed on the body, but it’s usually fewer than that during a sleep study, Espinoza said. St. Charles’ technologists are required to use a minimum of two electrodes, or leads, during its studies, he said.

In rare cases, Espinoza said, his clinics have uncovered serious heart rhythm issues that required the patients to be sent to the emergency room.

Sleep technologists also monitor patients’ breathing, both the temperature and the pressure. Pressure is measured using a de-

vice technologists jokingly call the “fake mustache.” It’s essentially a sensor placed above the patient’s upper lip.

Another aspect of breathing is called “abdominal efforts.” To learn about that, Espinoza said technologists wrap belts around patients’ chests to measure the correlation between work the diaphragm and the lungs are doing.

Additional sensors are placed on patients’ legs to rule out restless leg syndrome, a nervous system disorder that causes uncomfortable sensations in the legs. For some patients, technologists will also measure ac-

On the job | SLEEP TECHNOLOGIST

tivity in their arms, especially if they’re trying to rule out a condition like sleepwalking.

Oxygen intake is another important measure of sleep. For some patients, especially kids, technologists also measure carbon dioxide levels, but that’s not always the case, Espinoza said.

Most sleep studies take place in the sleep lab, but St. Charles also has sleep study equipment patients can use at home if their cases aren’t as serious. Patients who take the equipment home are first trained to use it. The problem with the home studies is they don’t measure everything technologists would in the lab, such as brain activity or carbon dioxide levels, Espinoza said.

Home sleep studies are generally for people who likely have sleep apnea, a common sleep disorder that’s believed to affect more than 18 million American adults, according to the National Sleep Foundation. Sleep apnea is characterized by pauses in breathing during sleep.

If the patient has other serious conditions in addition to their sleep problem or if they’re under 18 years old, they always go to the lab for the study, Espinoza said.

When home tests for sleep apnea hit the market in 2013, it initially caused demand for sleep technologists to drop, said Laura Linley, a sleep technologist in Dallas and president of the American Association of Sleep Technologists.

Nowadays, she said demand has improved as sleep technologists

Page 20

Jacob Espinoza, manager of clinical operations at the St. Charles Sleep Center, said he’s seen the demand for sleep studies surge nationwide over the past decade. “It makes sense, right?” he says. “One-third of our life is spent sleeping. It’s how we recover our bodies.” expand their job duties from only tending to monitors and preparing reports to helping patients manage their conditions. That means they now have to understand how patients’ other disorders, such as heart disease, pulmonary disease or diabetes, affect their sleep disorder, and help them manage that.

Sleep technologists also partner with doctors to help patients understand their treatment plans and make sure they’re able to stick with them, Linley said. Often that means making sure patients can use

SUMMER / FALL 2016 • HIGH DESERT PULSE

their CPAP — continuous positive airway pressure — machines, which treat sleep apnea by pushing air into the back of the throat.

“We have to stay relevant,” Linley said.

The American Board of Sleep Medicine certifies sleep technologists to practice once they’ve completed training and passed its exam. Training can include either a six- to 18-month certificate program or an associate degree, Linley said. The certificate option is being phased out, however, so in the future the associate degree will be the only option, she said.

The Board of Registered Polysomnographic Technologists also offers credentials for sleep technologists.

Training programs encompass how to set up and use the many different pieces of equipment necessary for a sleep test. Students also learn how to score the data from the tests to prepare the report that goes to the physician.

Sleep apnea is the most common diagnosis the St. Charles Sleep Center uncovers during a sleep study, Espinoza said. Insomnia is another big one, although patients suspected of having insomnia typically don’t undergo a sleep study, Espinoza said. Instead, a physician diagnoses insomnia based on symptoms, such as an inability to fall asleep, waking up constantly and racing thoughts at night.

Restless leg syndrome and narcolepsy are other common diagnoses for the center.

SUMMER / FALL2016 • HIGH DESERT PULSE

Most of the patients who need sleep studies, especially if they have conditions like sleep apnea or narcolepsy, don’t have problems falling asleep, Linley said. That means they don’t tend to have trouble falling asleep in the sleep lab, either.

“It’s amazing to me,” she said.

There is that “first night experience effect” of being in a different environment surrounded by sensors, but almost everyone falls asleep, Espinoza said. He’s been a sleep technologist for nine years and has had only one patient who didn’t sleep the entire night.

“For the most part, everyone kind of falls asleep eventually,” he said.

Espinoza even tried it for himself once and said it took him about 15 minutes to fall asleep. The only thing that bugged him was the oxygen monitor, a tiny device that’s placed like a bandage over the tip of one finger. It had a red light on it.

“I felt like ET,” he said, laughing. “I was trying to put that under the cover so I wouldn’t see it.”

Most of St. Charles’ sleep study patients are over 50 years of age.

Males are more likely to have sleep issues than females.

Espinoza said he’s watched the demand for sleep studies nationwide grow rapidly over the past decade, especially as research increasingly links poor sleep to a host of health conditions.

“It makes sense, right? One-third of our life is spent sleeping,” he said. “It’s how we recover our bodies.” •

Page 21

Feature | STANDARDS UNDER SCRUTINY

Memory care under After tales of neglect, advocates are giving standards a closer look

BY KATHLEEN MCLAUGHLIN

C

arol Dickerson placed her late husband, James, at Aspen Ridge Memory Care in

March 2015 because the progression of his Lewy body dementia began to affect her own health.

The decision brought 72-year-old Dickerson relief from caregiving chores, but she remained her hus-

band’s constant companion. She visited twice a day, every day. James needed her especially during the evening, when people with dementia tend to become anxious, a syndrome known as sundowners.

“Some are crying. Some are yelling out. Some are pushing. It’s horrid,” Dickerson recalled.

Page 22

Very attuned to his surroundings, James would become anxious, too. So after dinner, Carol would take him into his room and read aloud until bedtime, while other residents continued to wander about in an agitated

state. “Sometimes I had to stand up against the door so the people wouldn’t barge in,” Dickerson said.

She always thought Aspen Ridge caregivers could use another set of hands to deal SUMMER / FALL 2016 • HIGH DESERT PULSE

the microscope THINKSTOCK ILLUSTRATION

“Some are crying. Some are yelling out. Some are pushing. It’s horrid. … Sometimes I had to stand up against the door so the people wouldn’t barge in.”

— Carol Dickerson, recalling her evening visits to Aspen Ridge Memory Care to see her husband James, who had Lewy body dementia. At night, people with dementia tend to become anxious, a syndrome known as sundowners.

While looking through her husband James’ things at her Bend home, Carol Dickerson holds up a picture from a deer hunt on their property in Marcola.

ANDY TULLIS

with the evening period. The help didn’t materialize, at least not during the seven months that her husband, who died in October, lived there.

Dickerson’s time at Aspen Ridge in northeast Bend overlapped with multiple investigations by Adult Protective Services, an agenSUMMER / FALL 2016 • HIGH DESERT PULSE

cy within the Oregon Department of Human Services, of abuse or neglect and a licensing survey that resulted in a four-month ban on new admissions. Portland-based Frontier Management, which also owns Mt. Bachelor Memory Care in Bend and 50 other memory care facilities in 11 states, addressed all of the deficiencies identified in the license inspection and was allowed to admit new residents in December.

In Oregon, long-term care facilities that advertise a specialty in dementia must meet a set of minimum standards for building design including features such as locking doors that can be opened from an electronic keypad, plus staff training in different forms of dementia and accompanying behavior. For the state as well as self-paying residents, memory care costs more than standard residential care and assisted living, but the facilities are not required to provide a prescribed level of staffing, nor are the aides required to obtain licenses.

Aspen Ridge is one of several memory care facilities in Oregon that kept licensing inspectors and Adult Protective Services investigators busy last year, and the scrutiny remains. Prompted by problems at a Coos Bay memory care facility the Oregon Department of Human Services threatened with closure, an informal work group of legislators and advocates for the elderly are examining the stanPage 23

Feature | STANDARDS UNDER SCRUTINY

The problems at Baycrest and other facilities have come to light largely because of a husband and wife, both registered nurses, who spent hours each day with Dot Wright, a Baycrest resident who died in January at age 90. Her daughter, Kathy Wright, told legislators she witnessed people sitting for hours at a time without moving and aides who lacked fundamental understanding of dementia and how its symptoms can be heightened by physical problems such as urinary-tract infections.

Wright said she was most dismayed by the impersonal care. Aides would walk past a person asking for help, not look their way and as-

dards for memory care.

Rep. Alissa Keny-Guyer, D-Portland, thinks standards around staffing and training are too lax, and the vulnerable residents of memory care could use more help from the Long-Term Care Ombudsman’s office. As chairwoman of the House Committee on Human Services and Housing, she heard testimony about Baycrest Memory Care in Coos Bay but thinks facilities around the state are failing to live up to the Oregon standard of “person-directed” care, which promotes each resident’s dignity, independence and comfort. “I think there’s a really big problem,” she said.

Abuse and neglect found in dementia care

Total beds*

LEGEND

These Oregon residential care facilities had the highest number of abuse and neglect complaints, subsantiated by a state investigation from Jan. 1, 2015 through June 1, 2016.

Substantiated abuse and neglect cases

STATEWIDE Fern Gardens Memory Care Medford

Baycrest Memory Care Coos Bay

Elderberry Square Community Florence

Brookdale Eugene Alpine Court Memory Care Eugene

Bridgecreek Memory Care Community Lebanon

84

55

48

64

58

23

16

16

12

31 Ashley Manor-Shasta** Burns

15

Aspen Ridge Memory Care Bend

The Gardens Lincoln City

42

43

15

11

10

9

11

Ashley ManorHomedale** Klamath Falls

CENTRAL OREGON Aspen Ridge Memory Care Bend

42

11 Brookdale Redmond Clare Bridge Redmond

Ashley ManorConnors** Bend

15

3

Brookdale Bend Bend

32

59

2

2

Source: Department of Human Services, Long-Term Care Ombudsman

Page 24

Prairie House Memory Care Community La Pine

18

2

Ashley ManorRimrock** Redmond

15

1

Ashley ManorOak** Madras

15

1

*Facility occupancy could be lower **Does not have memory care endorsement Note: Statewide average, based on 109 facilities with complaints in this time period, is 3.

Residential-care facilities not listed did not have substantiated complaints during 2015 or the first five months of this year.

KATHLEEN MCLAUGHLIN, GREG CROSS

SUMMER / FALL 2016 • HIGH DESERT PULSE

sure them with a generic term of endearment, such as “sweetie.” Wright said people in memory care should be called by their names. “By the time they get there, they have two things left that is theirs,” she said. “That is their name and their feelings.

Both of these things are often ignored in these facilities.”

Oregon last revised its standards for the so-called memory care endorsement in 2011, but memory care is now the fastest-growing segment of long-term care in the state and nationwide, according to an annual report by Portland State University. There are 160 long-term care facilities in Oregon that have the memory care endorsement in addition to an operating license. The vast majority of memory care units are part of or encompassing a residential-care facility, where housing is like a dormitory in which people usually share rooms and dining. Medical care is overseen, though not necessarily in person, by a registered nurse and carried out by aides, most of whom are not licensed in a health care field.

Memory care also accounts for most of the substantiated abuse and neglect complaints from Oregon‘s 282 residential-care facilities, The Bulletin found by examining Department of Human Services’ online database, which is available to the public.

During 2015 and the first five months of this year, Adult Protective Services substantiated one or more complaints at 109 residential-care facilities, according to the DHS database. Of those, 75 also are authorized to specialize in dementia care.

Eight of those memory care facilities, including Aspen Ridge, saw 10 or more complaints during the 17-month period examined by The Bulletin. At Fern Gardens Memory Care in Medford, Adult Protective Services substantiated 31 reports of abuse or neglect, and at Baycrest in Coos Bay, there were 23 substantiated reports.

Long-term care facilities are required by law to report incidents of potential abuse or neglect, even when no one is seriously injured, and many of the incidents in memory care are resident-to-resident altercations. But Oregon’s memory care standards aim to prevent those situations.

Page 25

JOE KLINE

Katelyn Nottingham, a caregiver, walks with residents down the hall between activities at Aspen Ridge Memory Care in Bend.

Facilities must provide “meaningful activity” and a supportive environment, including an accessible, secure outdoor courtyard. Staff members are to be trained in dementia-relat-

ed topics, including effective interventions to challenging behavior.

The average memory care patient is 82 Continued on Page 51

He’ll always remember this summer vacation.

It’s when he got his skin cancer.

One in five Americans will develop skin cancer in their lifetime. Don’t let your child be the one.

Before you take kids out in the sun, make sure they’re wearing sunscreen and are covered up.

Prevent Skin Cancer NOW OPEN IN BEND

Gerald Peters, MD, FAAD, FACMS • Ann Reitan, MHS, PA-C 541-323-SKIN (7546) • www.petersderm.com 2041 NE Williamson Court, Suite B (located on the corner of Neff Rd. and Purcell Blvd.)

Profile | KEITH BELL

MEDICINE, MIND, BODY & MOUNTAIN BIKING Physician assistant applies background in yoga to his approach to medicine

BY PETER MADSEN PHOTOS BY JAROD OPPERMAN

K

eith Bell, a yoga teacher and an avid mountain biker, sat meditating. A “wholesome curiosity” had led Bell to attend a 10-day Buddhist-inspired meditation retreat in Ashland. During one of the 14-hour daily silent sessions of Vipassana, he had an epiphany: He needed to fulfill his long-term goal of becoming a physician assistant.

“I realized I needed to return to my true life path. When I got into teaching yoga, I lost sight of that,” said Bell, 45, of his experience 11 years ago. “Those 10 days of stillness and quiet allowed me to go back to my inner voice, to distill it. I knew I needed to go to PA school.”

Now a seven-year physician assistant at Mosaic Medical Center, Bell marries the hard science of medicine with a visceral understanding of the mind and body. This combined approach helps Bell connect with the 10 to 18 patients he sees each day. Bell listens for what the patient values — which sometimes isn’t healthiness so much as being free from pain — and works causally from there.

“I try to use my meditation and yoga to create the art of relationPage 26

ships so I can present medicine that is a successful motivator toward health for each patient,” he said, adding that it is an approach that is becoming more prevalent in patient-centered care.

As a physician assistant focusing on family practice, Bell has 1,000 patients. He also staffs a mini specialty clinic where he performs joint injections, skin biopsies and cyst removals.

A dose of one’s own medicine Yoga and outdoor activities have always been effective remedies in Bell’s “pillbox.” On a recent afternoon, Bell and his wife Rebecca took their two sons mountain biking at Phil’s Trail complex. Liam, 10, and Emmett, 7, both wearing helmets with face protection, made sure their shoelaces were tied before taking to the pyramids and slopes of the slalom course. Keith Bell, who fell in love with bike riding when he was his sons’ age in his native Rochester, New York, tore ahead, pumping the bumps and lofting airs with a grace won from years in SUMMER / FALL 2016 • HIGH DESERT PULSE

As a physician assistant, Keith Bell (pictured at right giving a patient a shot of cortisone) said he’s found an ideal work-life balance. Mountain biking is a Bell family pastime. Top right, Bell mountain-bikes with his son Emmett, 7, near Phil’s Trailhead. Yoga is also a pillar of Bell’s family life: Above, Bell participates with his two sons, Liam, 10, left, and Emmett, right, in a yoga class led by his wife, Rebecca Bell.

the saddle. Rebecca, equipped with her own dual-suspension bike, pumped along. In talking about their climbing and trekking adventures together, Rebecca flashed her wedding band, engraved with the mountains of Nepal’s Khumbu region. Keith proposed to Rebecca at Mount Everest’s base camp, where they had ended up after a 27day hike. Nearby, Liam, who won his age division in the 2015 Oregon Enduro Series, a mountain bike race, toppled over on his bike. “I’m all right!” he assured his mother. “I just hit an oversized rock!”

Rebecca grinned. “‘I’m all right’ has become a mantra in our family,” she said.

A karmic call to service Liam was born in 2006, two months premature. At one point, he had to be resuscitated, and his parents worried whether he had suffered brain damage. The Bells were living in Chicago, where Keith was taking his prerequisite classes to apply for PA school while working full time as a yoga teacher and massage therapist. The couple had health insurance, yet when Rebecca got pregnant, they learned their insurance didn’t cover maternity. The Bells were spared the $110,000 SUMMER / FALL 2016 • HIGH DESERT PULSE

hospital bill. That same year, Illinois saw the passage of the Covering All Kids Health Insurance Act, a bill championed by then-U.S. Sen. Barack Obama, making children covered by Medicare.

Keith said, “I would have had to drop out of school to pay for that.”

Once Bell received his Master of Science from the University of New England’s physician assistant program in 2009, he felt a strong call to public service. Mosaic Medical, a Central Oregon nonprofit community health center system, was a good fit. It serves individuals and families regardless of income or insurance status, according to its website.

When he applied, Mosaic was expanding the clinic and hiring new staff using funding from a federal stimulus package signed into effect by President Obama.

“I’m somehow karmically tied to Obama,” Bell joked.

Base camp Bend A longtime climber, Bell passed through Bend in 1997 on his way to Smith Rock. He met Rebecca at a Cup of Magic, a since-shuttered Continued on Page 32

Page 27

Healthy eating | OILS

ANDY TULLIS

Which oil is right for you?

Dietitians weigh in on the characteristics to consider

BY TARA BANNOW

I

t can be daunting, given the dizzying array of cooking oil options lining grocery store shelves, to know which ones are the best for you.

First off: If you’re in that aisle at all, good job. Dietitians interviewed for this article said simply turning to oils rather than heading to the dairy coolers for butter is the biggest step toward choosing a healthier fat and, thus, improving one’s heart health.

Solid fats such as butter and margarine contain both saturated and trans fats, the kinds that increase the level of LDL, or “bad” cholesterol, in the blood. LDL cholesterol contributes to the buildup of plaque in the arteries, and it also makes them harder — creating an environment that’s ripe for a heart attack. The American Heart Association recommends limiting saturated fats to 5 to 6 percent of

Page 28

total calories.

That’s where oils come in. Cooking oils such as canola, olive, peanut and safflower oil contain what medical professionals consider to be “good” fats: monounsaturated and polyunsaturated fats. Research has found these fats can actually lower LDL levels and, in turn, reduce the risk of heart disease and stroke. The links to these effects are more solidified when it comes to monounsaturated fats than polyunsaturated fats.

“That makes these poly- and monounsaturated fats really attractive,” said Libby Mills, a Philadelphia-based registered dietitian and spokeswoman for the Academy of Nutrition and Dietetics.

When it comes to cooking, though, an oil’s smoke point, or the temperature it can be heated to before it starts to smoke, is perhaps SUMMER / FALL 2016 • HIGH DESERT PULSE

the No. 1 characteristic of importance. That’s because heating an oil longer than that point causes it to not only taste bad — it also creates chemicals that can be bad for you.

When choosing an oil, Garrett Berdan, a chef and dietitian in Bend, first considers what meal he’s cooking and how he’ll cook it. If he’s sauteing, it’s usually going to be pure olive oil or canola oil. Those are his go-to’s because they have high smoke points. He also likes grapeseed oil, although it can be expensive.

“They have the right smoke point to get a little bit higher without breaking down or smoking, which can lead to bitterness, which you don’t want in your dish,” Berdan said.

Extra virgin olive oil, by contrast, has a lower smoke point than pure olive oil. It’s a more flavorful oil, which makes it good as a finishing oil or dressing, but not as good for cooking as pure olive oil, Berdan said.

From a health perspective, extra virgin olive oil is high in monounsaturated fats, Mills said. It raises one’s good cholesterol, and “more or less acts like the trash man in our blood vessels,” when it comes to bad cholesterol. That said, Mills added she thinks people can be a bit overzealous with extra virgin olive oil when it comes to cooking.

When oils are cooked past their smoke points, they create what’s called free radicals, toxic molecules that hold the potential to damage healthy cells in the body. Some studies have linked high concentrations of free radicals to the development of some types of cancer.

Not only that, when oils break down and produce smoke, they also produce a chemical called acrylamide, which in studies caused cancer in animals exposed to amounts that are likely thousands of times higher than that which humans consume in food. Studies in humans haven’t shown a clear cancer risk.

Aside from the potential risks, acrylamide produces a bitter, acrid taste, as its name suggests, Mills said.

“Imagine you bite into a peanut or pecan that goes rancid,” she said. “When it goes rancid, what you’re tasting is that acrid, icky flaContinued on Page 32 GREG CROSS

SUMMER / FALL 2016 • HIGH DESERT PULSE

Page 29

Snapshot | SOUTH SISTER

Page 30

PHOTO BY JOE KLINE

Hikers walk across the glacier crater near the summit of South Sister west of Bend. August is one of the most popular months to hike the 10,358-foot mountain. The South Sister Climber Trail begins at the Devils Lake Trailhead, located 29 miles west of Bend off the Cascade Lakes Highway.

SUMMER / FALL 2016 • HIGH DESERT PULSE

Healthy eating | OILS

Profile | KEITH BELL

Continued from Page 29

Continued from Page 27

vor. It no longer tastes good.”

Oils with higher smoke points than extra virgin olive oil and with more neutral flavors include avocado or grapeseed oil.

Choosing an oil with a healthy omega-6 and omega-3 fatty acids ratio is also important. While both are essential to the body, most dietitians recommend people get between a 2-to-1 ratio of omega-6 to omega-3s to a 4-to-1 ratio. Most Americans get more like a 10to-1 ratio of omega-6 to omega-3, Mills said, so it’s important to try to consume more foods that contain omega-3, such as fish. Omega-6 fatty acids are found in vegetable oils like corn, safflower and sunflower.

Canola oil, which is made using a plant called rapeseed, has a 2-to1 ratio of omega-6 to omega-3, which makes it a good choice in that respect, Mills said.

Some have raised concerns about the use of the solvent hexane to extract vegetable oils from seeds to make things like canola, corn and soybean oils.

Vegetable oils contain small amounts of trans fat, although it’s generally too small (less than 5 percent) to prompt concern, according to the Harvard T.H. Chan School of Public Health. The Food and Drug Administration allows products with very small amounts of trans fat (less than 0.5 grams per serving) to say their products contain zero trans fat, although that’s not technically the case.

Mills cautions people not to simply trust the most recent study published, because some of them can overgeneralize their results. For example, a recent study that found corn oil lowers bad cholesterol, but another one said it raised it, she said. The conclusion of the latter study was that polyunsaturated fats might not be so good for heart health, after all, which she said is not a fair conclusion to draw, as lots of different oils, including safflower, soybean and sunflower, include polyunsaturated fats.

“Be scrutinous of new findings,” she said. “I’m not saying ignore them, put them into context into what has historically been proven to date with scientific information.” •

cafe. Bell was living in Boulder, Colorado, at the time. Small world: Rebecca was moving there to study yoga. She asked him for a ride.

They’ve been together since. Keith Bell was already devoted to meditation, but Rebecca introduced him to yoga. His subsequent work as a yoga instructor eclipsed his intention to pursue medicine.

“Sometimes you meet someone, and you intermingle with their path and that can throw you off your own,” Bell said.

The Bells were living in Bend and considering opening a yoga studio when Keith experienced his epiphany at the Vipassana meditation retreat, sending them eastward. Three years later, they returned to Central Oregon — Keith toting his Master of Science physician assistant degree — because Bend seemed like an ideal place to raise children. Along with good schools and a network of friends, the Bells appreciate Bend’s access to skiing, mountain biking and climbing — activities they wanted for their children. When they were each 4 years old, Bell took his sons mountain biking on Whoops Trail. Now that they’re older and attempting rock jumps, their father advises them to first “check your gut — do you feel exhilaration or fear?

pediatrics with a difference

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“I don’t want to just watch a video of my kids; I want to be there for my kids.”

— Keith Bell “Sometimes they decline to do it, and that’s fine, too,” he said.

“That’s a part of refining their inner judgment.”

As for Rebecca’s path with yoga, the couple were delighted to learn the location in which she had envisioned a yoga studio was again available. Rebecca, with three partners, co-founded The Yoga Lab in 2013. Keith attends one of Rebecca’s classes once a week, as he did recently with Liam and Emmett. He splits his riding time between his mountain bike and his road bike as he trains for the 100-mile Cascade Cream Puff mountain bike race, which he intends to have completed earlier this month. Liam, when asked about his father’s prowess on a mountain bike, effused.

“I think (his riding) is really amazing. When I watch the pros race on TV, I think my dad could do the course easily. He might not get first, second or third place, but he might get sixth or seventh,” he said. Overhearing his son, Bell laughed. “It’s good he has a healthy view of me and doesn’t think I’m god,” he said.

Work-life balance

ERIKA BEARD-IRVINE

MD, LLC

Bell wondered whether his work as a physician assistant might lead him to neurosurgery, but he worried the 80-hour work weeks would compromise time at home. As a family practice specialist, Bell said he has found an ideal work-life balance.

He loves what he does and he is glad to serve the community, but he has other passions. “I don’t want to just watch a video of my kids; I want to be there for my kids,” he said. “I feel like my presence is a resource that reaches far beyond any material stuff.” •

325 NW VERMONT PLACE, SUITE 105, BEND

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SUMMER / FALL 2016 • HIGH DESERT PULSE

Cover story | HEP C: BARRIERS TO CARE

Continued from Page 9

husband would be doing stuff, and I would feel so guilty.”

When Harvoni came out in 2014, she asked her doctor, Koteen, about the prospect of getting the drug. Koteen’s nurse told her they’d try to make it happen.

The first denial letter came in March 2015.

Conry and her family were covered under her husband’s private Providence Health Plan policy, which he received through his employer. The letter said the scarring in her liver hadn’t progressed enough. “‘You’re not sick enough. You don’t meet the criteria,’” Conry repeated. “I think they hope that you’re dead or something, that you die.”

The Conrys tried two more times, and received two more rejection letters. The fourth time around, Conry wrote her own letter to Providence, pleading for the medication and explaining how the disease hindered her ability to raise her kids.

Recalling that time while sitting in her Redmond home earlier this summer, Conry’s gaze fell on her young son. He was watching

her through a plastic childproof gate, sliding coins through the holes and watching them hit the floor.

“I’d see all these other parents doing stuff,” she said, pausing after she started cry. “I know it’s such a small thing, but to a parent, I think it’s bigger, because I wanted to be able to do lots of stuff.”

After her fourth rejection from Providence, Conry, always researching potential solutions online, found the website for a Dallas Buyers Club-type situation for hepatitis C drugs. The Dallas Buyers Club was a group that smuggled unapproved drugs into the U.S. and sold them to AIDS patients.

Conry’s Buyers Club is a bit different. It’s run by an Australian man, Greg Jefferys, who traveled to India to find affordable, generic hepatitis C drugs after he was diagnosed with the disease in summer 2014. He succeeded, cured himself and has since established a supply chain whereby patients can — upon providing identification, prescriptions or medical records and payment — buy generic Harvoni from India, Bangladesh and Australia

through the mail. The process is explained on Jefferys’ website, www.fixhepc.com.

Jefferys has received lots of media attention for his work as the demand for hepatitis C drugs has grown, including stories by CNN, Bloomberg and The Times of India.

When Conry asked Koteen to write her a prescription, he was skeptical.

“I said, ‘I don’t know anything about this,’” Koteen recalled. “‘There are a lot of fakes and frauds, and be careful.’”

Finally, Koteen agreed. Conry sent $1,300 to Jefferys and received an eight-week regimen in the mail in December 2015.

After three months, a blood test showed that Conry, now 36 and raising three children, ages 2, 3 and 16, was cured of hepatitis C, Koteen said.

“She responded to everything,” Koteen said in June, sounding amazed. “Her virus is still undetected, so she’s a cure.”

These days, Conry said she has her energy back. She doesn’t have to worry about infecting her kids anymore, which could happen if they somehow became exposed to her

Cover story | HEP C: BARRIERS TO CARE

blood. She also doesn’t worry about developing liver scarring or, worse, liver cancer.

Her message to other hepatitis C patients: Don’t give up.

“This situation was such a miracle for me,” she said. “I can’t even share how grateful I am.”

Sick enough for treatment?

Oregon’s Medicaid program has some of the most restrictive treatment criteria in the country, enough to garner warnings from the federal government and the looming threat of a lawsuit from patient advocates.

“Our state is knowingly killing people on Medicaid,” said Lorren Sandt, the executive director of Caring Ambassadors, an Oregon City-based patient advocacy group.

A state committee that sets treatment criteria will meet in September to review the state’s policies, but Sandt, whose organization receives funding from hepatitis C drugmakers, such as Gilead, said she wants to see changes before then.

That leaves OHP leaders in a precarious position. Perhaps unsurprisingly, they’re far from forthcoming when it comes to talking about hepatitis C. OHP provided treatment using the new hepatitis C drugs to a total of 665 members between January 2014 and April 2016, according to numbers provided by the Oregon Health Authority. Officials declined to provide the amount of money spent on the drugs during that time.

Under OHP’s current criteria, hepatitis C patients are not eligible for treatment until they reach fibrosis stage 3 or 4 — 4 being the final stage, or cirrhosis. They can be eligible at stage 2 if they also have HIV. Asked why it’s necessary for patients to be that sick before qualifying for treatment, Dr. Jim Rickards, the OHA’s chief medical officer, distanced himself from the criteria. He said he started in his position in December, and thus wasn’t involved in much of the discussion by the state committee that sets the criteria, called the Pharmacy & Therapeutics Committee.

“I think based on, again, the review of the medical literature and the outcomes and the effectiveness and efficacy of the different drugs, they felt that those are the most appropriate stages of the disease to treat,” he said.

Rickards declined to go into specifics Page 34

Hepatitis C in Central Oregon Chronic cases, as shown in the graph, represent people who acquired the virus sometime in the past, even decades ago.

People with chronic infections are at high risk for liver disease, liver cancer and liver failure.

Acute cases, or new infections, are much more rare. They’re most common among people younger than 30, and injection drug use was means of transmission in 64 percent of cases.

Deschutes County has seen five acute cases since 2010, and there were not cases in Crook or Jefferson counties in that time.

Chronic Hepatitis C infection cases Jefferson

Crook

Deschutes

300 250 200 150 100 50

Source: Oregon Health Authority

about the medical literature, instead directing a reporter to the state committee’s meeting recordings and minutes.

But the state committee’s position is not the consensus either within or outside of Oregon. Joint guidelines set by the Infectious Diseases Society of America and the American Association for the Study of Liver Diseases recommend treating all patients with hepatitis C, regardless of their fibrosis stages or drug and alcohol use.

“There are no data to support the utility of pretreatment screening for illicit drug or alcohol use in identifying a population more likely to successfully complete HCV therapy,” the guidelines state. “These requirements should be abandoned, because they create barriers to treatment, add unnecessary cost and effort, and potentially exclude populations that are likely to obtain substantial benefit from therapy.”

Massachusetts’ Medicaid program lifted its hepatitis C treatment restrictions in June after the state negotiated affordable prices with drugmakers.

A federal judge in May ordered the state of Washington to cover all patients diagnosed with hepatitis C regardless of their fibrosis stage amid a class-action lawsuit filed on behalf of patients. The state’s Medicaid director, in a letter to the U.S. Senate in September 2015, wrote that treating everyone diagnosed with hepatitis C would cost roughly triple the agency’s annual drug budget of roughly $1 billion.

Florida’s Medicaid program removed its fibrosis restrictions, which required pa-

0

2009

2010

2011

2012

2013 CARLI KRUEGER

tients be at stages 3 or 4, shortly after the Washington ruling in response to a lawsuit there.

In April, New York’s attorney general reached an agreement with seven of the state’s private health insurers to remove their fibrosis criteria. The agreement also forbids the insurers from denying coverage based on drug or alcohol use or because the prescribing physician is not a specialist.

‘We’re talking about a cure’ In November 2015, CMS sent a notice to state Medicaid programs warning them against coverage criteria that may “unreasonably restrict access” to hepatitis C drugs, including requiring patients be at fibrosis stage 3 or 4, instead requiring a period of abstinence from drugs and alcohol and requiring that the drugs be prescribed by a specialist.

Such restrictions would violate federal Medicaid law, according to the notice.

Oregon’s rules used to require six months of abstinence from drugs and alcohol, but the most recent guidelines, updated in February, require that patients be under the care of an addictions specialist.

It’s unclear whether those patients can be actively using drugs or alcohol and still receive treatment.

OHP guidelines also require the patient’s treatment regimen be prescribed by or in consultation with a specialist, such as a gastroenterologist, hepatologist or infectious disease physician.

Asked whether that means a primary care provider can prescribe the drugs if they comSUMMER / FALL 2016 • HIGH DESERT PULSE

“It’s fantastic that for that $15,000 a year, we can keep people healthy and live the rest of their life.

In this case, we’re talking about a cure. One time, 12 weeks, one pill a day, for $30,000. That’s it.”

— Robert Greenwald, a clinical law professor at Harvard Law School and faculty director of its Center for Health Law and Policy Innovation, comparing the annual costs of treating HIV patients to the one-time cost of treating someone with hepatitis C municate with specialists about the case, Rickards said, “It sounds like that’s the case.”

Regarding state plans to respond to the CMS notice, Rickards said state leaders monitor the guidelines on an ongoing basis. He said they’ll likely be updated at the September meeting, by which point a new drug is expected to be available.

Rickards acknowledged hepatitis C drugs are expensive, but said that doesn’t influence Oregon’s restrictions.

“That is true,” he said, “but when the (Pharmacy and Therapeutics) committee makes these decisions, it really is based on the medical evidence and medical literature that’s available, and so I think that is the main component that goes into their decisions.”

The OHP guidelines pertain only to members who are not enrolled in so-called coordinated care organizations, groups that administer Medicaid regionally. Roughly 90 percent of OHP members are in CCOs, including more than 50,000 people in Central Oregon.

Although CCOs are free to set their own coverage criteria, they generally tend to follow the state’s guidelines, Rickards said.

The November CMS notice also warned against allowing groups like CCOs to institute stricter coverage criteria than the state’s as a whole. In a February letter to CCO leaders, Rickards asked them to send him their updated criteria and urged them to ensure they com-

plied with the federal law.

PacificSource Community Solutions, which operates Central Oregon’s CCO, was not among those whose policies were more restrictive than the state’s, Alison Little, the CCO’s medical director, wrote in an email. While PacificSource has the same fibrosis score and drug and alcohol treatment criteria, it does not require that hepatitis C be diagnosed or treated by or in consultation with a specialist.

Advocates argue it would be more cost effective to treat all patients diagnosed with hepatitis C, regardless of their fibrosis stage, rather than risk the patients getting sicker and treating related conditions, such as liver cancer or liver transplants. Some even advocate for treating current drug users in an effort to theoretically slow the spread of the disease among the population.

Greenwald, the Harvard Law School professor, said treatment in many states, after rebates from drug manufacturers, costs Medicaid programs in the $30,000 range. For comparison, programs pay between $12,000 and $15,000 annually to keep HIV patients healthy, he said.

“It’s fantastic that for that $15,000 a year, we can keep people healthy and live the rest of their life,” he said. “In this case, we’re talking about a cure. One time, 12 weeks, one pill a day, for $30,000.

That’s it.”

Getting more docs to treat These days, treatment for hepatitis C is mostly provided by specialists.

Primary care providers are still reluctant to treat the disease — not only because of the hoops insurers make them jump through, but because the medications themselves are still relatively complicated compared with other types of treatments. Not only do most patients take a combination of medications, their regimens must be tailored to one of six hepatitis C genotypes.

“It’s still fairly complex,” said Benner, the Portland gastroenterologist.

That’s changing, though. The FDA at the end of June approved a

Cover story | HEP C: BARRIERS TO CARE

new drug, Epclusa, that’s essentially one-size-fits-all. It can be used in patients with all six genotypes.

In an effort to increase the number of primary care providers treating hepatitis C, especially in rural areas, the University of New Mexico developed a program called Extension for Community Healthcare Outcomes, or ECHO. ECHO provides a platform for specialists at medical centers to give training and advice to rural primary care providers through regular video conferences or teleconference calls. Primary care doctors share their patients’ medical histories, lab results and treatment plans.

A study tested ECHO by dividing 407 patients into two groups, those treated in the primary care setting under the model and those treated at the University of New Mexico Health Sciences Center. The results, published in the June 2011 issue of the New England Journal of Medicine, found the two groups fared basically the same.

Dr. Michael Chang, director of the Portland Veterans Affairs Health Care System’s hepatitis C clinic and section chief of gastroenterology and hepatology, said the VA has been using the ECHO model to mentor more than 25 primary care providers throughout the region.

Treating hepatitis C is slowly getting easier, Chang said, and the advent of drugs like Epclusa will help primary care providers feel comfortable treating the disease.

“Hep C right now is primed to be a primary care-managed disease,” he said.

The VA steps up Before his diagnosis, Cox, who served in the Army between 1968 and 1971, spent years drinking heavily while working as a painter, which likely hastened the progression of his disease. The doctor who diagnosed him was firm: no more drinking or smoking marijuana if you want to live.

“The way I took it was, ‘If you aren’t ready to change your life, go away, because you’re ready to die from this,’” Cox recalled.

Cox was scared enough to quit everything. He kept drinking the naturopath’s concoctions and felt better for a while, despite working long hours.

Diane Sutton, Cox’s partner of more than seven years, said she’d occasionally notice a yellow hue in Cox’s eyes, but it always cleared up after a few days.

“I wouldn’t say nothing because I didn’t want to alarm him,” she said.

When Cox’s U.S. Department of Veterans Affairs doctor told him about the new hepatitis C drugs, he was skeptical at first.

“It works,” he recalled her saying to him. So he gave it a shot.

The VA announced in March it would treat all of its hepatitis C patients, regardless of disease stage, after Congress approved $1.5 billion specifically so the VA could buy the expensive drugs.

Another contributing factor was the VA’s ability to negotiate drug prices directly with manufacturers, Chang said. Around the same time, Gilead cut its prices by roughly half for the VA. “The purchasing power automatically almost doubled,” Chang said, “and that literally was almost overnight.”

Likewise, Medicare in 2014 dropped its restrictions on hepatitis C Page 36

treatment, instead embracing guidelines set forth by the Infectious Diseases Society of America and the American Association for the Study of Liver Diseases, which recommend treating all patients with hepatitis C, regardless of their fibrosis stages or drug and alcohol use.

Only 49 veterans in the Portland VA system, which covers most of Oregon and southwest Washington, received treatment for hepatitis C in 2014. That grew to 377 patients in 2015. Between Oct. 1, 2015, and mid-June, 422 veterans received treatment, Chang said.

About 1,500 veterans in the Portland VA system are still waiting to get treated for hepatitis C, Chang said in June. That includes 74 veterans in Deschutes County, 16 in Crook County and 12 in Jefferson County.

“We’re accelerating pretty rapidly,” Chang said.

Unlike other health care providers, the VA’s barrier isn’t so much access to treatment, but having enough providers to treat patients.

That’s why they’re involved with the ECHO project to train primary care providers.

No providers in the Bend outpatient clinic have been trained to provide hepatitis C treatment yet, although the VA sends specialists there once a month to treat patients, Chang said.

Hepatitis C is three to five times more prevalent among veterans compared with nonveterans, Chang said. A 1998 study used a sample of hepatitis C-positive veterans and determined 64 percent of them served in the Vietnam War. There are a number of reasons why veterans, particularly Vietnam veterans, have higher rates of the infection. Anyone who was injured, hospitalized or received blood transfusions before 1992 is at risk of contracting the virus, placing veterans at particularly high risk.

Getting tattoos from unclean needles is another way hepatitis C can be transmitted, although that’s uncommon. Sexual contact can also transmit the virus, although that’s also uncommon.

Sharing needles during illegal drug use is a common route of hepatitis C transmission, which was a particularly high risk factor during the Vietnam War. When asked about their use of hard drugs for a 1989 federal government study, 2.5 percent of Vietnam veterans said they used hard drugs, while 3 percent were found to have used drugs upon examination. The study defined hard drugs as cocaine, heroin, amphetamines, barbiturates, psychedelics, phencyclidine and methaqualone.

Cox prefers not to disclose where he served, and he said he doesn’t know how he contracted the virus. He figures it was when he was hospitalized during his service.

“They were saving my life,” he said. “They didn’t know they were killing me.”

Today, Cox is cured. But he’s still very aware of the stigma around having hepatitis C, and understands why so many people don’t even want to get tested. His advice: Get tested, get cured.

“It’s curable,” he said. “It’s something we can beat.”

Cox retired about a year ago. He’s humbled by his near-death experience. He tears up easily. He’s excited to go fishing.

He added, “I’m amazed that I get to turn 65 years old.” • SUMMER / FALL 2016 • HIGH DESERT PULSE

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2016 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

M E D I C A L B U S I N E S S E S B Y S P E C I A LT Y C O N T. FAMILY MEDICINE

St. Charles Family Care

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

FAMILY MEDICINE

St. Charles Family Care

630 Arrowleaf Trail • Sisters

541-549-1318

www.stcharleshealthcare.org

GASTROENTEROLOGY

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

GASTROENTEROLOGY

Cascade Gastroenterology

1247 NE Medical Center Dr. • Bend

541-706-5777

www.cascadegastroenterology.com

GASTROENTEROLOGY

Gastroenterology of Central Oregon

2239 NE Doctors Dr., Suite 100 • Bend

541-728-0535

www.gastrocentraloregon.com

GENERAL DENTISTRY

Coombe and Jones Dentistry

774 SW Rimrock Way • Redmond

541-923-7633

www.coombe-jones.com

GYNECOLOGY

High Lakes Health Care - Upper Mill

929 SW Simpson Ave., Suite 300 • Bend

541-389-7741

www.highlakeshealthcare.com

GYNECOLOGY

High Lakes Health Care - Redmond

1001 NW Canal Blvd. • Redmond

541-504-7635

www.highlakeshealthcare.com

HERNIA SURGERY

Bend Hernia Center

2450 NE Mary Rose Pl. • Bend

541-383-2200

www.bendherniacenter.com

HERNIA SURGERY

Dr. Andy Higgins, MD, FACS

2450 NE Mary Rose Pl., Suite 205 • Bend

541-749-7000

www.drandyhiggins.com

HOME HEALTH SERVICES

Partners In Care - Home Health

Bend, Redmond, La Pine, Madras, Sisters, Sunriver, Prineville, Tumalo, Terrebonne, Crooked River Ranch & Christmas Valley

541-382-5882

www.partnersbend.org

HOME HEALTH SERVICES

St. Charles Home Health

2500 NE Neff Rd. • Bend

541-706-7796

www.stcharleshealthcare.org

HOME INFUSION

AxelaCare

2065 NE Williamson Ct. • Bend

541-382-0287

www.axelacare.com/homecareiv

HOSPICE

Hospice House at Partners In Care

2075 NE Wyatt Ct. • Bend

541-382-5882

www.partnersbend.org

Bend, Redmond, La Pine, Madras, Sisters, Sunriver, Prineville, Tumalo, Terrebonne, Crooked River Ranch & Christmas Valley

541-382-5882

www.partnersbend.org

Bend, Redmond, La Pine, Prineville, Madras & Sisters

541-706-6700

www.stcharleshealthcare.org

2500 NE Neff Rd. • Bend

541-382-4321

www.stcharleshealthcare.org

470 NE A St. • Madras

541-706-7796

www.stcharleshealthcare.org

HOSPICE

Partners In Care - Hospice

HOSPICE

St. Charles Hospice

HOSPITAL

St. Charles Bend

HOSPITAL

St. Charles Madras

HOSPITAL

St. Charles Prineville

384 SE Combs Flat Rd. • Prineville

541-447-6254

www.stcharleshealthcare.org

HOSPITAL

St. Charles Redmond

1253 NE Canal Blvd. • Redmond

541-706-7796

www.stcharleshealthcare.org

HYBERBARIC OXYGEN THERAPY

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

IMAGING SERVICES

Bend Memorial Clinic

Bend & Redmond

541-382-4900

www.bendmemorialclinic.com

IMAGING SERVICES

Cascade Medical Imaging

Bend & Redmond

541-382-9383

www.cascademedicalimaging.com

IMAGING SERVICES

Central Oregon MRI

Bend & Redmond

541-382-9383

www.corapc.com

IMAGING SERVICES

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

IMMEDIATE CARE

High Desert Family Medicine & Immediate Care

57067 Beaver Dr. • Sunriver

541-593-5400

n/a

IMMEDIATE CARE

Mountain Medical Immediate Care

1302 NE Third St. • Bend

541-317-0909

www.mtmedgr.com

IMMEDIATE CARE

NOWcare

2200 NE Neff Rd. • Bend

541-322-2273

www.thecenteroregon.com

IMMEDIATE CARE

St. Charles Immediate Care

2600 NE Neff Rd. • Bend

541-706-3700

www.stcharleshealthcare.org

IMMEDIATE CARE

Your Care

3818 SW 21st Pl., Suite 100 • Redmond

541-548-2899

www.yourcaremedical.com

IMMUNOLOGY

Allergy and Asthma Care Center

2253 NE Doctors Dr. • Bend

541-317-1700

www.allergyandasthmacarecenterbend.com

INFECTIOUS DISEASE

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

INFECTIOUS DISEASE

St. Charles Infectious Disease

2965 NE Conners Ave., Suite 127 • Bend

541-706-4878

www.stcharleshealthcare.org

INTEGRATED MEDICINE

Center for Integrated Medicine

916 SW 17th St., Suite 202 • Redmond

541-504-0250

www.centerforintegratedmed.com

INTERNAL MEDICINE

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

INTERNAL MEDICINE

High Lakes Health Care - Hospital District

2088 NE Kim Lane, Suite A • Bend

541-389-7741

www.highlakeshealthcare.com

INTERNAL MEDICINE

High Lakes Health Care - Redmond

236 NW Kingwood Ave. • Redmond

541-548-7134

www.highlakeshealthcare.com

INTERNAL MEDICINE

High Lakes Health Care - Upper Mill

929 SW Simpson Ave., Suite 300 • Bend

541-389-7741

www.highlakeshealthcare.com

INTERNAL MEDICINE

Redmond Medical Clinic

1245 NW 4th St., Suite 201 • Redmond

541-323-4545

www.redmondmedical.com

LABORATORY

Bend Memorial Clinic

Bend, Redmond & Sisters

541-382-4900

www.bendmemorialclinic.com

2016 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

M E D I C A L B U S I N E S S E S B Y S P E C I A LT Y C O N T. LABORATORY

St. Charles Laboratory Services

MASSAGE THERAPY

Synergy Health and Wellness

NEPHROLOGY

Eight Locations in Central Oregon

541-706-7717

www.stcharleshealthcare.org

244 NE Franklin Ave., Suite 3 • Bend

541-323-3488

www.synergyhealthbend.com

Bend Memorial Clinic

Bend & Redmond

541-382-4900

www.bendmemorialclinic.com

NEUROLOGY

Bend Memorial Clinic

Bend Westside & Redmond

541-382-4900

www.bendmemorialclinic.com

NUTRITION

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

NUTRITION COUNSELING

Synergy Health and Wellness

244 NE Franklin Ave., Suite 3 • Bend

541-323-3488

www.synergyhealthbend.com

OBSTETRICS & GYNECOLOGY

East Cascade Women’s Group, P.C.

2400 NE Neff Rd., Suite A • Bend

541-389-3300

www.eastcascadewomensgroup.com

OBSTETRICS & GYNECOLOGY

St. Charles Center for Women’s Health

2600 NE Neff Rd. • Bend

541-706-5920

www.stcharleshealthcare.org

OBSTETRICS & GYNECOLOGY

St. Charles Center for Women’s Health

Locations in Redmond & Prineville

541-526-6635

www.stcharleshealthcare.org

OCCUPATIONAL MEDICINE

Mountain Medical Immediate Care

1302 NE Third St. • Bend

541-317-0909

www.mtmedgr.com

OCCUPATIONAL MEDICINE

Your Care

3818 SW 21st Pl., Suite 100 • Redmond

541-548-2899

www.yourcaremedical.com

ONCOLOGY ~ MEDICAL

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

OPHTHALMOLOGY

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

OPTOMETRY

Bend Memorial Clinic

Bend Eastside, Old Mill District & Redmond

541-382-4900

www.bendmemorialclinic.com

OPTOMETRY

Central Oregon Eyecare, PC

2155 NW Shevlin Park Rd. • Bend

541-647-2760

www.centraloregoneyecare.com

OPTOMETRY

Integrated Eye Care

452 NE Greenwood Ave. • Bend

541-382-5701

www.iebend.com

ORTHODONTICS

O’Neill Orthodontics

Bend & Sunriver

541-323-2336

www.oneillortho.com

ORTHOPEDICS

Desert Orthopedics

Locations in Bend & Redmond

541-388-2333

www.desertorthopedics.com

OSTEOPOROSIS

Deschutes Osteoporosis Center

2200 NE Neff Rd., Suite 302 • Bend

541-388-3978

www.deschutesosteoporosiscenter.com

PALLIATIVE CARE

Partners In Care Palliative Care

2075 NE Wyatt Ct. • Bend

541-382-5882

www.partnersbend.org

PALLIATIVE CARE

St. Charles Advanced Illness Management

2500 NE Neff Rd. • Bend

541-706-5880

www.stcharleshealthcare.org

PEDIATRIC DENTISTRY

Deschutes Pediatric Dentistry

1475 SW Chandler Ave., Suite 202 • Bend

541-389-3073

www.deschuteskids.com

PEDIATRICS

Erika Beard-Irvine, MD, IBCLC

425 NW Vermont Pl., Suite 105 • Bend

541-241-6371

www.bendkidshealth.com

PEDIATRICS

Bend Memorial Clinic

815 SW Bond St. • Bend

541-382-4900

www.bendmemorialclinic.com

PEDIATRICS

High Lakes Health Care - Shevlin

2175 NW Shevlin Park Rd. • Bend

541-389-7741

www.highlakeshealthcare.com

PEDIATRICS

St. Charles Family Care

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

PHARMACY

Cascade Custom Pharmacy

PHYSICAL MEDICINE

Desert Orthopedics

PHYSICAL MEDICINE/REHABILITATION

Bend Memorial Clinic

PHYSICAL THERAPY

Healing Bridge Physical Therapy

PODIATRY

19550 SW Amber Meadow Dr. • Bend

541-389-3671

www.cascadecustomrx.com

Locations in Bend & Redmond

541-388-2333

www.desertorthopedics.com

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

404 NE Penn Ave. • Bend

541-318-7041

www.healingbridge.com

Cascade Foot Clinic

Offices in Bend, Redmond & Madras

541-388-2861

www.cascadefoot.com

PODIATRY

Central Oregon Foot & Ankle

400 SW Bluff Dr., Suite 220 • Bend

541-728-0858

www.cofafoot.com

PODIATRY

Deschutes Foot and Ankle

Bend & Redmond

541-317-5600

www.deschutesfootandankle.com

PULMONOLOGY

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

PULMONOLOGY

St. Charles Heart & Lung Center

Locations in Bend & Redmond

541-706-7715

www.stcharleshealthcare.org

RADIOLOGY

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

RADIOLOGY

Central Oregon Radiology Associates, P.C.

REHABILITATION

St. Charles Rehabilitation Center

RHEUMATOLOGY

Bend Memorial Clinic

RHEUMATOLOGY

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

Locations in Bend, Redmond, Prineville, & Madras

541-706-7725

www.stcharleshealthcare.org

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

Deschutes Rheumatology

2200 NE Neff Rd., Suite 302 • Bend

541-388-3978

www.bendarthritis.com

RHEUMATOLOGY

St. Charles Rheumatology

2965 NE Connors Ave. • Bend

541-706-7735

www.stcharleshealthcare.org

SLEEP MEDICINE

Bend Memorial Clinic

1080 SW Mt. Bachelor Dr. • Bend (West)

541-382-4900

www.bendmemorialclinic.com

2016 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

M E D I C A L B U S I N E S S E S B Y S P E C I A LT Y C O N T. SLEEP MEDICINE

St. Charles Sleep Center

Locations in Bend & Redmond

541-706-6905

www.stcharleshealthcare.org

SPORTS MEDICINE

Desert Orthopedics

Locations in Bend & Redmond

541-388-2333

www.desertorthopedics.com

SURGICAL FACILITY

Redmond Surgery Center

244 NW Kingwood Ave. • Redmond

541-316-2500

www.redmondsc.com

SURGICAL SPECIALISTS

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

SURGICAL SPECIALISTS

Dr. Andy Higgins, MD, FACS

2450 NE Mary Rose Pl., Suite 205 • Bend

541-749-7000

www.drandyhiggins.com

SURGICAL SPECIALISTS

St. Charles Surgical Specialists

Prineville • Redmond

541-548-7761

www.stcharleshealthcare.org

URGENT CARE

Bend Memorial Clinic

Bend & Redmond

541-382-4900

www.bendmemorialclinic.com

URGENT CARE

Mountain Medical Immediate Care

1302 NE Third St. • Bend

541-317-0909

www.mtmedgr.com

URGENT CARE

NOWcare

2200 NE Neff Rd. • Bend

541-322-2273

www.thecenteroregon.com

UROLOGY

Bend Urology Associates

Locations in Bend & Redmond

541-382-6447

www.bendurology.com

UROLOGY

Urology Specialists of Oregon

Locations in Bend, Redmond, & Prineville

541-322-5753

www.urologyinoregon.com

VASCULAR SURGERY

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

VEIN SPECIALISTS

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

VEIN SPECIALISTS

Inovia Vein Specialty Center

2200 NE Neff Rd., Suite 204 • Bend

541-382-8346

www.bendvein.com

WOUND CARE

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

M E D I C A L P R O F E S S I O N A L S B Y S P E C I A LT Y ALLERGY & ASTHMA RIPDEEP MANGAT, MD

Allergy and Asthma Care Center

ADAM N. WILLIAMS, MD

Bend Memorial Clinic

2253 NE Doctors Dr. • Bend

541-317-1700

www.allergyandasthmacarecenterbend.com

Bend & Redmond

541-382-4900

www.bendmemorialclinic.com

STEPHEN B. ARCHER, MD, FACS Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

VANESSA COBARRUBIA, RD, LD Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

NGOCTHUY HUGHES, DO, PC

St. Charles Surgical Specialists

1245 NW 4th St., Suite 101 • Redmond

541-548-7761

www.stcharleshealthcare.org

NICOLE O’NEIL, PA-C

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

BARIATRIC & GENERAL SURGERY

BEHAVIORAL HEALTH KAREN CAMPBELL, PHD

St. Charles Behavioral Health

2542 NE Courtney Dr. • Bend

541-706-7730

www.stcharleshealthcare.org

BRIAN EVANS, PSYD

St. Charles Behavioral Health

2542 NE Courtney Dr. • Bend

541-706-7730

www.stcharleshealthcare.org

JANET FOLIANO-KEMP, PSYD

St. Charles Behavioral Health

2542 NE Courtney Dr. • Bend

541-706-7730

www.stcharleshealthcare.org

WENDY HATCHER, PSYD

St. Charles Center for Women’s Health

2600 NE Neff Rd. • Bend

541-706-5920

www.stcharleshealthcare.org

WILLOW HUFFINE, PHD

St. Charles Family Care

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

SONDRA MARSHALL, PHD

St. Charles Behavioral Health

2542 NE Courtney Dr. • Bend

541-706-7730

www.stcharleshealthcare.org

JAMES PORZELIUS, PHD

St. Charles Behavioral Health

2542 NE Courtney Dr. • Bend

541-706-7730

www.stcharleshealthcare.org

SCOTT SAFFORD, PHD

St. Charles Family Care

2965 NE Conners Ave., Suite 127 • Bend

541-706-7730

www.stcharleshealthcare.org

REBECCA SCRAFFORD, PSYD

St. Charles Behavioral Health

2542 NE Courtney Dr. • Bend

541-706-7730

www.stcharleshealthcare.org

LAURA SHANK, PSYD

St. Charles Behavioral Health

2542 NE Courtney Dr. • Bend

541-706-7730

www.stcharleshealthcare.org

KIMBERLY SWANSON, PHD

St. Charles Family Care

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

SHILO TIPPETT, PHD

St. Charles Family Care

480 NE A St. • Madras

541-475-4800

www.stcharleshealthcare.org

2450 NE Mary Rose Pl., Suite 205 • Bend

541-749-7000

www.drandyhiggins.com

2500 NE Neff Rd. • Bend

541-388-4333

www.stcharleshealthcare.org

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

BREAST & GENERAL SURGERY ANDY HIGGINS, MD, FACS

Dr. Andy Higgins, MD, FACS

CARDIOLOGY HUGH ADAIR III, DO

St. Charles Heart & Lung Center

JAMIE BARTNICK, FNP

Bend Memorial Clinic

2016 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

CARDIOLOGY CONT. JEAN BROWN, PA-C

St. Charles Heart & Lung Center

CASSANDRA DIXON, PA-C

St. Charles Heart & Lung Center

NAHAL FARRAJ, DO, FACC, FSCAI Bend Memorial Clinic

2500 NE Neff Rd. • Bend

541-388-4333

www.stcharleshealthcare.org

2500 NE Neff Rd. • Bend

541-388-4333

www.stcharleshealthcare.org

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

GARY FOSTER, MD

St. Charles Heart & Lung Center

2500 NE Neff Rd. • Bend

541-388-4333

www.stcharleshealthcare.org

NANCY HILLES, NP

St. Charles Heart & Lung Center

2500 NE Neff Rd. • Bend

541-388-4333

www.stcharleshealthcare.org

BRENDA HOCHULI, PA-C

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

KRISTEN HUDSON, NP

St. Charles Heart & Lung Center

2500 NE Neff Rd. • Bend

541-388-4333

www.stcharleshealthcare.org

SHEROLYN JENNART PA-C

St. Charles Heart & Lung Center

2500 NE Neff Rd. • Bend

541-388-4333

www.stcharleshealthcare.org

A. RICK KOCH, MD, FACC

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

JAMES LAUGHLIN, MD

St. Charles Heart & Lung Center

2500 NE Neff Rd. • Bend

541-388-4333

www.stcharleshealthcare.org

BRUCE MCLELLAN, MD

St. Charles Heart & Lung Center

2500 NE Neff Rd. • Bend

541-388-4333

www.stcharleshealthcare.org

CAREY PULIDO, FNP

High Lakes Health Care - Upper Mill

929 SW Simpson Ave., Suite 300 • Bend

541-389-7741

www.highlakeshealthcare.com

ALLEN RAFAEL, MD

St. Charles Heart & Lung Center

2500 NE Neff Rd. • Bend

541-388-4333

www.stcharleshealthcare.org

IAN C. RIDDOCK, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

STEPHANIE SCOTT, PA-C

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

JASON SHEN, MD

St. Charles Heart & Lung Center

2500 NE Neff Rd. • Bend

541-388-4333

www.stcharleshealthcare.org

MICHAEL WIDMER, MD, FACC

High Lakes Health Care

Bend, Redmond & Sisters

541-389-7741

www.highlakeshealthcare.com

EDDY YOUNG, MD

St. Charles Heart & Lung Center

2500 NE Neff Rd. • Bend

541-388-4333

www.stcharleshealthcare.org

CHIROPRACTIC

JORDAN T. DOI, MSC, DC

NorthWest Crossing Chiropractic & Health

628 NW York Dr., Suite 104 • Bend

541-388-2429

www.nwxhealth.com

JASON M. KREMER, DC, CCSP, CSCS

Wellness Doctor

1345 NW Wall St., Suite 202 • Bend

541-318-1000

www.bendwellnessdoctor.com

THERESA M. RUBADUE, DC, CCSP

NorthWest Crossing Chiropractic & Health

628 NW York Dr., Suite 104 • Bend

541-388-2429

www.nwxhealth.com

DENTISTRY MICHAEL R. HALL, DDS

Central Oregon Dental Center

1563 NW Newport Ave. • Bend

541-389-0300

www.centraloregondentalcenter.net

BRADLEY E. JOHNSON, DMD

Contemporary Family Dentistry

1016 NW Newport Ave. • Bend

541-389-1107

www.contemporaryfamilydentistry.com

2450 Mary Rose Pl., Suite 200 • Bend

541-382-4900

www.bendmemorialclinic.com

2747 NE Conners Ave. • Bend

541-382-5712

www.bendderm.com

388 SW Bluff Dr. • Bend

541-678-0020

www.centraloregondermatology.com

2747 NE Conners Ave. • Bend

541-382-5712

www.bendderm.com

2450 NE Mary Rose Pl., Suite 220 • Bend

541-382-4900

www.bendmemorialclinic.com

541-382-5712

www.bendderm.com

DERMATOLOGY SAMUEL CHRISTENSEN, PA-C

Bend Memorial Clinic

WILLIAM DELGADO, MD (MOHS)

Bend Dermatology Clinic

MARK HALL, MD

Central Oregon Dermatology

FRIDOLIN HOESLY, MD

Bend Dermatology Clinic

JAMES M. HOESLY, MD, FAAD

Bend Memorial Clinic

JOSHUA MAY, MD

Bend Dermatology Clinic

2747 NE Conners Ave. • Bend

KRISTIN NEUHAUS, MD

Bend Dermatology Clinic

2747 NE Conners Ave. • Bend

541-382-5712

www.bendderm.com

GERALD E. PETERS, MD, FAAD, FACMS (MOHS)

Peters Dermatology Center

2041 NE Williamson Ct., Suite B • Bend

541-323-7546

www.petersderm.com

ANN REITAN, MHS, PA-C

Peters Dermatology Center

2041 NE Williamson Ct., Suite B • Bend

541-323-7546

www.petersderm.com

ALLISON ROBERTS, PA-C

Bend Dermatology Clinic

2747 NE Conners Ave. • Bend

541-382-5712

www.bendderm.com

STEPHANIE TRAUTMAN, MD

Bend Dermatology Clinic

2747 NE Conners Ave. • Bend

541-382-5712

www.bendderm.com

LARRY WEBER, PA-C

Bend Dermatology Clinic

2747 NE Conners Ave. • Bend

541-382-5712

www.bendderm.com

2450 Mary Rose Pl., Suite 200 • Bend

541-382-4900

www.bendmemorialclinic.com

Bend & Redmond

541-317-5600

n/a

OLIVER J. WISCO, DO, FAAD, FACMS (MOHS) Bend Memorial Clinic ENDOCRINOLOGY STACY CALDWELL, PA-C

Endocrinology Services NW

MARY F. CARROLL, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

RICK N. GOLDSTEIN, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

2016 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

ENDOCRINOLOGY CONT. TONYA KOOPMAN, MSN, FNP-BC Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

PATRICK MCCARTHY, MD

Endocrinology Services NW

Bend & Redmond

541-317-5600

n/a

TRAVIS MONCHAMP, MD

Endocrinology Services NW

Bend & Redmond

541-317-5600

n/a

NICK WILLIAMS, PA-C

Endocrinology Services NW

Bend & Redmond

541-317-5600

n/a

FAMILY MEDICINE CAREY ALLEN, MD

St. Charles Family Care

384 SE Combs Flat Rd. • Prineville

541-447-6263

www.stcharleshealthcare.org

HEIDI ALLEN, MD

St. Charles Family Care

384 SE Combs Flat Rd. • Prineville

541-447-6263

www.stcharleshealthcare.org

THOMAS L. ALLUMBAUGH, MD St. Charles Family Care

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

SONI ANDREINI, MD

St. Charles Family Care

630 N Arrowleaf Trail • Sisters

541-549-1318

www.stcharleshealthcare.org

KATHLEEN C. ANTOLAK, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

JOSEPH BACHTOLD, DO

St. Charles Family Care

630 Arrowleaf Trail • Sisters

541-549-1318

www.stcharleshealthcare.org

JEFFREY P. BOGGESS, MD

Bend Memorial Clinic

SHANNON K. BRASHER, PA-C MEGHAN BRECKE, DO

815 SW Bond St. • Bend

541-382-4900

www.bendmemorialclinic.com

St. Charles Family Care

384 SE Combs Flat Rd. • Prineville

541-447-6263

www.stcharleshealthcare.org

St. Charles Family Care

2965 NE Conners Ave., Suite 127 • Bend

541-706-4800

www.stcharleshealthcare.org

NANCY BRENNAN, DO

St. Charles Family Care

2965 NE Conners Ave., Suite 127 • Bend

541-706-4800

www.stcharleshealthcare.org

HAVILAH BRODHEAD, NP

St. Charles Family Care

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

JEREMY BRODHEAD, NP

St. Charles Family Care

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

SARAH CARVER, FNP

St. Charles Family Care

384 SE Combs Flat Rd. • Prineville

541-447-6263

www.stcharleshealthcare.org

MATTHEW CLAUSEN, MD

St. Charles Family Care

2965 NE Conners Ave., Suite 127 • Bend

541-706-4800

www.stcharleshealthcare.org

TAMMY EVERHART, FNP

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

MAY S. FAN, MD

Bend Memorial Clinic

231 East Cascades Ave. • Sisters

541-549-0303

www.bendmemorialclinic.com

JAMIE FREEMAN, PA-C

High Lakes Health Care - Upper Mill

929 SW Simpson Ave., Suite 300 • Bend

541-389-7741

www.highlakeshealthcare.com

JESSICA GATTO, FNP

High Lakes Health Care - Shevlin

2175 NW Shevlin Park Rd. • Bend

541-389-7741

www.highlakeshealthcare.com

YVETTE GAYNOR, FPN-C

St. Charles Family Care

630 Arrowleaf Trail • Sisters

541-549-1318

www.stcharleshealthcare.org

MARK E. GONSKY, DO

Deschutes Family Care

1345 NW Wall St., Suite 302 • Bend

541-323-3960

www.deschutesfamilycare.com

NATALIE GOOD, DO

St. Charles Family Care

384 SE Combs Flat Rd. • Prineville

541-447-6263

www.stcharleshealthcare.org

BRIANNA HART, PA-C

St. Charles Family Care

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

645 NW 4th St. • Redmond

541-923-0119

www.cofm.net

865 SW Veterans Way • Redmond

541-382-4900

www.bendmemorialclinic.com

236 NW Kingwood Ave. • Redmond

541-548-7134

www.highlakeshealthcare.com

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

MARGARET “PEGGY“ HAYNER, FNP Central Oregon Family Medicine ALAN C. HILLES, MD

Bend Memorial Clinic

MICHELLE HIRSCHY, FNP

High Lakes Health Care - Redmond

SING-WEI HO, MD

St. Charles Family Care

HEIDI HOLMES, PA-C

High Lakes Health Care - Shevlin

LYNN HUGHES, FNP

The Ross Clinic

MARK J. HUGHES, D.O

Central Oregon Family Medicine

PAMELA J. IRBY, MD

St. Charles Family Care

KRISTI JACKSON, DO

Bend Memorial Clinic

PAUL JOHNSON, MD

2175 NW Shevlin Park Rd. • Bend

541-389-7741

www.highlakeshealthcare.com

336 SW Black Butte Blvd. • Redmond

541-504-7781

www.therossclinic.com

645 NW 4th St. • Redmond

541-923-0119

www.cofm.net

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

815 SW Bond St. • Bend

541-382-4900

www.bendmemorialclinic.com

High Lakes Health Care - Upper Mill

929 SW Simpson Ave., Suite 300 • Bend

541-389-7741

www.highlakeshealthcare.com

DAVID KELLY, MD

High Lakes Health Care - Upper Mill

929 SW Simpson Ave., Suite 300 • Bend

541-389-7741

www.highlakeshealthcare.com

MAGGIE J. KING, MD

St. Charles Family Care

384 SE Combs Flat Rd. • Prineville

541-447-6263

www.stcharleshealthcare.org

CRYSTAL LARSON, DO

St. Charles Family Care

2965 NE Conners Ave., Suite 127 • Bend

541-382-4900

www.stcharleshealthcare.org

CRAIG R. LAWS, MD

Bend Memorial Clinic

815 SW Bond St. • Bend

541-382-4900

www.bendmemorialclinic.com

PETER LEAVITT, MD

St. Charles Family Care

2965 NE Conners Ave., Suite 127 • Bend

541-706-4800

www.stcharleshealthcare.org

JINNELL LEWIS, MD

St. Charles Family Care

480 NE A St. • Madras

541-475-4800

www.stcharleshealthcare.org

2016 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

FAMILY MEDICINE CONT. CHARLOTTE LIN, MD

Bend Memorial Clinic

STEVE MANN, DO

High Lakes Health Care - Upper Mill

JOE T. MCCOOK, MD

815 SW Bond St. • Bend

541-382-4900

www.bendmemorialclinic.com

929 SW Simpson Ave., Suite 300 • Bend

541-389-7741

www.highlakeshealthcare.com

St. Charles Family Care

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

LORI MCMILLIAN, FNP

Redmond Medical Clinic

1245 NW 4th St., Suite 201 • Redmond

541-323-4545

www.redmondmedical.com

EDEN MILLER, DO

High Lakes Health Care - Sisters

354 W Adams Ave. • Sisters

541-549-9609

www.highlakeshealthcare.com

KEVIN MILLER, DO

High Lakes Health Care - Sisters

354 W Adams Ave. • Sisters

541-549-9609

www.highlakeshealthcare.com

JENNIFER K. MITCHELL, MD

Bend Memorial Clinic

815 SW Bond St. • Bend

541-382-4900

www.bendmemorialclinic.com

JESSICA MORGAN, MD

High Lakes Health Care - Shevlin

2175 NW Shevlin Park Rd. • Bend

541-389-7741

www.highlakeshealthcare.com

DANIEL J. MURPHY, MD

St. Charles Family Care

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

AIMEE NEILL, MD

St. Charles Family Care

480 NE A St. • Madras

541-475-4800

www.stcharleshealthcare.org

SHERYL L. NORRIS, MD

St. Charles Family Care

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

ELISA PEAVEY, DO

St. Charles Family Care

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

AUBREY PERKINS, FNP

St. Charles Family Care

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

JANEY M. PURVIS, MD

Bend Memorial Clinic

815 SW Bond St. • Bend

541-382-4900

www.bendmemorialclinic.com

NATHAN REED, DO

St. Charles Family Care

384 SE Combs Flat Rd. • Prineville

541-447-6263

www.stcharleshealthcare.org

DANA M. RHODE, DO

Bend Memorial Clinic

815 SW Bond St. • Bend

541-382-4900

www.bendmemorialclinic.com

JOHN K. ROSS, MD

The Ross Clinic

HANS G. RUSSELL, MD

336 SW Black Butte Blvd. • Redmond

541-504-7781

www.therossclinic.com

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

DAVID SEIFFERT, FNP

Bend Memorial Clinic

865 SW Veterans Way • Redmond

541-382-4900

www.bendmemorialclinic.com

LINDA C. SELBY, MD

St. Charles Family Care

384 SE Combs Flat Rd. • Prineville

541-447-6263

www.stcharleshealthcare.org

CINDY SHUMAN, PA-C

Bend Memorial Clinic

815 SW Bond St. • Bend

541-382-4900

www.bendmemorialclinic.com

PATRICK L. SIMNING, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

57067 Beaver Dr. • Sunriver

541-593-5400

n/a

DANIEL M. SKOTTE, SR. DO., P.C. High Desert Family Medicine & Immediate Care PATRICIA SPENCER, MD

St. Charles Family Care

480 NE A St. • Madras

541-475-4800

www.stcharleshealthcare.org

EDWARD M. TARBET, MD

Bend Memorial Clinic

815 SW Bond St. • Bend

541-382-4900

www.bendmemorialclinic.com

AMY TATUM, FNP

St. Charles Family Care

JOHN D. TELLER, MD

Bend Memorial Clinic

NATHAN R. THOMPSON, MD

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

St. Charles Family Care

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

AMBER TOOMEY, FNP

St. Charles Family Care

384 SE Combs Flat Rd. • Prineville

541-447-6263

www.stcharleshealthcare.org

MATTIE E. TOWLE, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

LISA URI, MD

High Lakes Health Care - Shevlin

2175 NW Shevlin Park Rd. • Bend

541-389-7741

www.highlakeshealthcare.com

MARK A. VALENTI, MD

St. Charles Family Care

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

THOMAS A. WARLICK, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

BRUCE N. WILLIAMS, MD

St. Charles Family Care

384 SE Combs Flat Rd. • Prineville

541-447-6263

www.stcharleshealthcare.org

MARK WILLIAMS, MD

St. Charles Family Care

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

GASTROENTEROLOGY RICK BOCHNER, MD

Cascade Gastroenterology

1247 NE Medical Center Dr. • Bend

541-706-5777

www.cascadegastroenterology.com

ELLEN BORLAND, FNP

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

ARTHUR S. CANTOR, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

HEIDI CRUISE, PA-C, MS

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

LAUREL H. HARTWELL, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

M. CHRISTINA HATARA, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

SIDNEY E. HENDERSON III, MD Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

2016 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

GASTROENTEROLOGY CONT. SANDRA HOLLOWAY, MD

Cascade Gastroenterology

GLENN KOTEEN, MD

Gastroenterology of Central Oregon

1247 NE Medical Center Dr. • Bend

541-706-5777

www.cascadegastroenterology.com

2239 NE Doctors Dr., Suite 100 • Bend

541-728-0535

www.gastrocentraloregon.com

JENNIFER MCCLEERY, PA-C, MS Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

JAMIE TIGNER, PA-C

Cascade Gastroenterology

1247 NE Medical Center Dr. • Bend

541-706-5777

www.cascadegastroenterology.com

MATTHEW T. WEED, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

143 SW Shevlin-Hixion Dr., Suite 203 • Bend

541-678-5417

www.cocgc.org

GENETICS – MEDICAL OSVALDO A. SCHIRRIPA, MD, MS Central Oregon Clinical Genetics Center GYNECOLOGY JANE BIRSCHBACH, MD

High Lakes Health Care - Upper Mill

929 SW Simpson Ave., Suite 300 • Bend

541-389-7741

www.highlakeshealthcare.com

TAMMY BULL, MD

High Lakes Health Care - Upper Mill

929 SW Simpson Ave., Suite 300 • Bend

541-389-7741

www.highlakeshealthcare.com

Dr. Andy Higgins, MD, FACS

2450 NE Mary Rose Pl., Suite 205 • Bend

541-749-7000

www.drandyhiggins.com

2450 NE Mary Rose Pl. • Bend

541-383-2200

www.bendherniacenter.com

HERNIA SURGERY ANDY HIGGINS, MD, FACS

MICHAEL J. MASTRANGELO, MD, FACS Bend Hernia Center HOSPICE HANK HORAK, MD

St. Charles Hospice

2500 NE Neff Rd. • Bend

541-706-6700

www.stcharleshealthcare.org

MICHAEL KNOWER, MD

St. Charles Hospice

384 SE Combs Flat Rd. • Prineville

541-706-6700

www.stcharleshealthcare.org

SONIA THAKUR

St. Charles Hospice

1253 NW Canal Blvd • Redmond

541-706-6700

www.stcharleshealthcare.org

INFECTIOUS DISEASE LAURIE C. D’AVIGNON, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

JON E. LUTZ, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

REBECCA SHERER, MD

St. Charles Infectious Disease

2965 Conners Ave., Suite 127 • Bend

541-706-4878

www.stcharleshealthcare.org

JOHN R. ALLEN, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

CHRISTINE ANDERSON, PA-C

High Lakes Health Care - Shevlin

2175 NW Shevlin Park Rd. • Bend

541-389-7741

www.highlakeshealthcare.com

JENESS CHRISTENSEN, MD

High Lakes Health Care - Upper Mill

929 SW Simpson Ave., Suite 300 • Bend

541-389-7741

www.highlakeshealthcare.com

SARAH DAWSON, DO

St. Charles Family Care

2965 NE Connors Ave. • Bend

CARRIE DAY, MD

High Lakes Health Care - Shevlin

CELSO A. GANGAN, MD

INTERNAL MEDICINE

541-706-4800

www.stcharleshealthcare.org

2175 NW Shevlin Park Rd. • Bend

541-389-7741

www.highlakeshealthcare.com

Redmond Medical Clinic

1245 NW 4th St., Suite 201 • Redmond

541-323-4545

www.redmondmedical.com

MICHAEL N. HARRIS, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

ELIZABETH KAPLAN, PA-C

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

ANNE KILLINGBECK, MD

High Lakes Health Care - Redmond

236 NW Kingwood Ave. • Redmond

541-548-7134

www.highlakeshealthcare.com

MATTHEW R. LASALA, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

MADELINE LEMEE, MD

High Lakes Health Care - Upper Mill

929 SW Simpson Ave., Suite 300 • Bend

541-389-7741

www.highlakeshealthcare.com

MARY MANFREDI, MD

High Lakes Health Care - Upper Mill

929 SW Simpson Ave., Suite 300 • Bend

541-389-7741

www.highlakeshealthcare.com

A. WADE PARKER, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

JOHN K. ROSS, MD

The Ross Clinic

336 SW Black Butte Blvd. • Redmond

541-504-7781

www.therossclinic.com

KALLIE A. SCHNEIDER, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

MARK D. STERNFELD, MD, PHD

Bend Memorial Clinic

865 SW Veterans Way • Redmond

541-382-4900

www.bendmemorialclinic.com

KRISTIN A. STRATTON, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

LESLIE STROUSE, MD

Bend Memorial Clinic

865 SW Veterans Way • Redmond

541-382-4900

www.bendmemorialclinic.com

MARK THIBERT, MD

High Lakes Health Care - Hospital District

2088 NE Kim Lane, Suite A • Bend

541-389-7741

www.highlakeshealthcare.com

DAVID TRETHEWAY, MD

High Lakes Health Care - Redmond

236 NW Kingwood Ave. • Redmond

541-548-7134

www.highlakeshealthcare.com

JENNA WAITON, FNP

High Lakes Health Care - Hospital District

2088 NE Kim Ln., Suite A • Bend

541-389-7741

www.highlakeshealthcare.com

2016 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

MASSAGE THERAPY RANDEE ANSHUTZ, RD, LD, LMT Synergy Health and Wellness

244 NE Franklin Ave., Suite 3 • Bend

541-323-3488

www.synergyhealthbend.com

NEPHROLOGY MICHAEL E. FELDMAN, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

RUSSELL E. MASSINE, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

ROBERT V. PINNICK, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

MOLLY A. TILLEY, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

FRANCENA D. ABENDROTH, MD Bend Memorial Clinic

1080 Mt. Bachelor Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

GARY BUCHHOLZ, MD

Bend Memorial Clinic

1080 Mt. Bachelor Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

STEVE GOINS, MD

Bend Memorial Clinic

1080 Mt. Bachelor Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

CRAIGAN T. GRIFFIN, MD

Bend Memorial Clinic

1080 Mt. Bachelor Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

Bend Spine and Neurosurgery

2421 NE Doctors Dr. • Bend

541-647-1638

www.belzamd.com

Locations in Bend & Redmond

541-388-2333

www.desertorthopedics.com

RANDEE ANSHUTZ, RD, LD, LMT Synergy Health and Wellness

244 NE Franklin Ave., Suite 3 • Bend

541-323-3488

www.synergyhealthbend.com

ANNIE BAUMANN, RD, LD

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

NEUROLOGY

NEUROSURGERY MARK BELZA, MD

NONOPERATIVE SPINE/REGENERATIVE MEDICINE

JON SWIFT, DO

Desert Orthopedics

NUTRITION

Bend Memorial Clinic

OBSTETRICS & GYNECOLOGY JAMES BAUER, MD

St. Charles Center for Women’s Health

Locations in Redmond & Prineville

541-526-6635

www.stcharleshealthcare.org

CHERYL CZAPLA, MD

St. Charles Center for Women’s Health

2600 NE Neff Rd. • Bend

541-706-5920

www.stcharleshealthcare.org

SARAH HELLMAN, DO

St. Charles Center for Women’s Health

340 NW 4th St. • Redmond

541-526-6635

www.stcharleshealthcare.org

NATALIE HOSHAW, MD

St. Charles Center for Women’s Health

Locations in Redmond & Prineville

541-526-6635

www.stcharleshealthcare.org

ERIN LEGRAND, DO

St. Charles Center for Women’s Health

340 NW 4th St. • Redmond

541-526-6635

www.stcharleshealthcare.org

AMY B. MCELROY, FNP

St. Charles Center for Women’s Health

Locations in Redmond & Prineville

541-526-6635

www.stcharleshealthcare.org

MEGUMI MORISHITA, MD

St. Charles Center for Women’s Health

2600 NE Neff Rd. • Bend

541-706-5920

www.stcharleshealthcare.org

JAY MURPHY, MD

St. Charles Center for Women’s Health

2600 NE Neff Rd. • Bend

541-706-5920

www.stcharleshealthcare.org

BETH MURRILL, MD

St. Charles Center for Women’s Health

340 NW 4th St. • Redmond

541-526-6635

www.stcharleshealthcare.org

JESSICA NELSON, CNM

St. Charles Center for Women’s Health

2600 NE Neff Rd. • Bend

541-706-5920

www.stcharleshealthcare.org

ROZA PACIFICO, WHNP-VC

St. Charles Center for Women’s Health

2600 NE Neff Rd. • Bend

541-706-5920

www.stcharleshealthcare.org

HANNAH RENZI, CNM

St. Charles Center for Women’s Health

2600 NE Neff Rd. • Bend

541-706-5920

www.stcharleshealthcare.org

CLARE THOMPSON, DNP, CNM

St. Charles Center for Women’s Health

Locations in Redmond & Prineville

541-526-6635

www.stcharleshealthcare.org

OCCUPATIONAL MEDICINE GLYNDA CRABTREE, MD

Your Care

3818 SW 21st Pl., Suite 100 • Redmond

541-548-2899

www.yourcaremedical.com

ANITA HENDERSON, MD

Your Care

3818 SW 21st Pl., Suite 100 • Redmond

541-548-2899

www.yourcaremedical.com

ERIC WATTENBURG, MD

Your Care

3818 SW 21st Pl., Suite 100 • Redmond

541-548-2899

www.yourcaremedical.com

ONCOLOGY – MEDICAL ROB BOONE, MD

St. Charles Cancer Center

Locations in Bend & Redmond

541-706-5800

www.stcharleshealthcare.org

CORA CALOMENI, MD

St. Charles Cancer Center

Locations in Bend & Redmond

541-706-5800

www.stcharleshealthcare.org

AMY CAMERON, PA-C

St. Charles Cancer Center

Locations in Bend & Redmond

541-706-5800

www.stcharleshealthcare.org

ANDREW T. CHEN, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

BRIAN L. ERICKSON, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

STACIE FILCHER, PA-C

St. Charles Cancer Center

Locations in Bend & Redmond

541-706-5800

www.stcharleshealthcare.org

2016 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

ONCOLOGY – MEDICAL CONT. BILL MARTIN, MD

St. Charles Cancer Center

A. OLA MCLEOD, MD

Locations in Bend & Redmond

541-706-5800

www.stcharleshealthcare.org

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

BENJAMIN J. MIRIOVSKY, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

WILLIAM G. SCHMIDT, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

1247 NE Medical Center Dr. • Bend

541-322-5753

www.urologyinoregon.com

ONCOLOGY – UROLOGY MATTHEW N. SIMMONS, MD, PHD, FACS Urology Specialists of Oregon OPHTHALMOLOGY BRIAN P. DESMOND, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

THOMAS D. FITZSIMMONS, MD, MPH

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

ROBERT C. MATHEWS, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

SCOTT T. O’CONNER, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

452 NE Greenwood Ave. • Bend

541-382-5701

www.iebend.com

2155 NW Shevlin Park Rd. • Bend

541-647-2760

www.centraloregoneyecare.com

452 NE Greenwood Ave. • Bend

541-382-5701

www.iebend.com

541-382-4900

www.bendmemorialclinic.com

OPTOMETRY KIT CARMIENCKE, OD

Integrated Eye Care

TONI DECKER, OD

Central Oregon Eyecare, PC

MARY ANN ELLEMENT, OD

Integrated Eye Care

MICHAEL J. MAJERCZYK, OD

Bend Memorial Clinic

Bend Eastside, Old Mill District & Redmond

HALEY M. MCCOY, OD

Bend Memorial Clinic

Bend Eastside, Old Mill District & Redmond

541-382-4900

www.bendmemorialclinic.com

BRIAN OULMAN, OD

Central Oregon Eyecare, PC

2155 NW Shevlin Park Rd. • Bend

541-647-2760

www.centraloregoneyecare.com

452 NE Greenwood Ave. • Bend

541-382-5701

www.iebend.com

1475 SW Chandler Ave., Suite 101 • Bend

541-617-3993

www.drkeithkrueger.com

Locations in Bend & Redmond

541-388-2333

www.desertorthopedics.com

Locations in Bend & Redmond

541-388-2333

www.desertorthopedics.com

KIRSTEN CARMIENCKE SCOTT, OD Integrated Eye Care ORAL & MAXILLOFACIAL SURGERY KEITH E. KRUEGER, DMD, PC

Keith E. Krueger, DMD, PC

ORTHOPEDIC SURGERY – FOOT & ANKLE AARON ASKEW, MD

Desert Orthopedics

ORTHOPEDIC SURGERY – JOINT REPLACEMENT ERIN FINTER, MD

Desert Orthopedics

ORTHOPEDIC SURGERY – PEDIATRIC,YOUTH & ADULT SPORTS MEDICINE ARI AMITAI, MD

Desert Orthopedics

1303 NE Cushing Dr., Suite 100 • Bend

541-388-2333

www.desertorthopedics.com

MICHAEL RYAN, MD

Desert Orthopedics

1303 NE Cushing Dr., Suite 100 • Bend

541-388-2333

www.desertorthopedics.com

Locations in Bend & Redmond

541-388-2333

www.desertorthopedics.com

ORTHOPEDIC SURGERY – SHOULDER ROBERT SHANNON, MD

Desert Orthopedics

ORTHOPEDIC SURGERY – SPINE GREG HA, MD

Desert Orthopedics

1303 NE Cushing Dr., Suite 100 • Bend

541-388-2333

www.desertorthopedics.com

KATHLEEN MOORE, MD

Desert Orthopedics

1303 NE Cushing Dr., Suite 100 • Bend

541-388-2333

www.desertorthopedics.com

ORTHOPEDIC SURGERY – SPORTS MEDICINE JEFFREY ABILDGAARD, MD

Desert Orthopedics

1303 NE Cushing Dr., Suite 100 • Bend

541-388-2333

www.desertorthopedics.com

BRETT GINGOLD, MD

Desert Orthopedics

1315 NW 4th St. • Redmond

541-388-2333

www.desertorthopedics.com

Locations in Bend & Redmond

541-388-2333

www.desertorthopedics.com

2200 NE Neff Rd., Suite 302 • Bend

541-388-3978

www.deschutesosteoporosiscenter.com

ORTHOPEDIC SURGERY – UPPER EXTREMITY AARON HOBLET, MD

Desert Orthopedics

OSTEOPOROSIS & BONE HEALTH MOLLY OMIZO, MD

Deschutes Osteoporosis Center

PALLIATIVE CARE JENNY BLECHMAN, MD

Partners In Care

2075 NE Wyatt Ct. • Bend

541-382-5882

www.partnersbend.org

LIZ LEVESQUE, DO

St. Charles Advanced Illness Management

2500 NE Neff Rd. • Bend

541-706-5885

www.stcharleshealthcare.org

2016 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

PALLIATIVE CARE CONT. LISA LEWIS, MD

Partners In Care

2075 NE Wyatt Ct. • Bend

541-382-5882

www.partnersbend.org

RICHARD J. MAUNDER, MD

St. Charles Advanced Illness Management

2500 NE Neff Rd. • Bend

541-706-5885

www.stcharleshealthcare.org

LAURA K. MAVITY, MD

St. Charles Advanced Illness Management

2500 NE Neff Rd. • Bend

541-706-5885

www.stcharleshealthcare.org

STEPHANIE CHRISTENSEN, DMD Deschutes Pediatric Dentistry

1475 SW Chandler Ave., Suite 202 • Bend

541-389-3073

www.deschuteskids.com

STEVE CHRISTENSEN, DMD

1475 SW Chandler Ave., Suite 202 • Bend

541-389-3073

www.deschuteskids.com

2175 NW Shevlin Park Rd. • Bend

541-389-7741

www.highlakeshealthcare.com

PEDIATRIC DENTISTRY

Deschutes Pediatric Dentistry

PEDIATRICS CHRISTINE ANDERSON, PA-C

High Lakes Health Care - Shevlin

BROOKS W. BOOKER, MD

Bend Memorial Clinic

815 SW Bond St. • Bend

541-382-4900

www.bendmemorialclinic.com

KATE L. BROADMAN, MD

Bend Memorial Clinic

815 SW Bond St. • Bend

541-382-4900

www.bendmemorialclinic.com

CARRIE DAY, MD

High Lakes Health Care - Shevlin

2175 NW Shevlin Park Rd. • Bend

541-389-7741

www.highlakeshealthcare.com

JENNIFER GRISWOLD, PNP

Bend Memorial Clinic

815 SW Bond St. • Bend

541-382-4900

www.bendmemorialclinic.com

NANCY HEAVILIN, MD

St. Charles Family Care

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

CASSANDRA JONES, PNP

Bend Memorial Clinic

815 SW Bond St. • Bend

541-382-4900

www.bendmemorialclinic.com

MICHELLE R. MILLS, MD

Bend Memorial Clinic

815 SW Bond St. • Bend

541-382-4900

www.bendmemorialclinic.com

KRISTI NIX, MD

High Lakes Health Care - Shevlin

2175 NW Shevlin Park Rd. • Bend

541-389-7741

www.highlakeshealthcare.com

JENNIFER B. SCHROEDER, MD

Bend Memorial Clinic

815 SW Bond St. • Bend

541-382-4900

www.bendmemorialclinic.com

RUPERT VALLARTA, MD

St. Charles Family Care

211 NW Larch Ave. • Redmond

541-548-2164

www.stcharleshealthcare.org

JENNIFER B. WARTON, DO

Bend Memorial Clinic

815 SW Bond St. • Bend

541-382-4900

www.bendmemorialclinic.com

Locations in Bend & Redmond

541-388-2333

www.desertorthopedics.com

929 SW Simpson Ave., Suite 300 • Bend

541-389-7741

www.highlakeshealthcare.com

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

Locations in Bend & Redmond

541-388-2333

www.desertorthopedics.com

PHYSICAL MEDICINE & REHABILITATION ROBERT ANDREWS, MD

Desert Orthopedics

LINDA CARROLL, MD

High Lakes Health Care - Upper Mill

NANCY H. MALONEY, MD

Bend Memorial Clinic

JON SWIFT, DO

Desert Orthopedics

PODIATRY DEAN NAKADATE, DPM

Deschutes Foot and Ankle

KRISTY SIX, DPM AMANDA WESTFALL, DPM

Bend & Redmond

541-317-5600

www.deschutesfootandankle.com

Central Oregon Foot & Ankle

400 SW Bluff Dr., Suite 220 • Bend

541-728-0858

www.cofafoot.com

Central Oregon Foot & Ankle

400 SW Bluff Dr., Suite 220 • Bend

541-728-0858

www.cofafoot.com

2500 NE Neff Rd. • Bend

541-706-2949

www.stcharleshealthcare.org

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

Locations in Bend & Redmond

541-706-7715

www.stcharleshealthcare.org

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

PREOPERATIVE MEDICINE BROOKE HALL, MD

St. Charles Preoperative Medicine

PULMONOLOGY JONATHAN D. BREWER, DO, D-ABSM Bend Memorial Clinic JAMIE DAVID CONKLIN, MD

St. Charles Heart & Lung Center

LOUIS M. D’AVIGNON, MD

Bend Memorial Clinic

ERIC S. DILDINE, PA-C

St. Charles Heart & Lung Center

Locations in Bend & Redmond

541-706-7715

www.stcharleshealthcare.org

FARAH MADHANI-LOVELY, MD

St. Charles Heart & Lung Center

Locations in Bend & Redmond

541-706-7715

www.stcharleshealthcare.org

JONATHAN MCFADYEN, NP-BC

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

KEVIN E. SHERER, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

Locations in Bend & Redmond

541-706-7715

www.stcharleshealthcare.org

BETHANY TAYLOR-SPILLET PA-C St. Charles Heart & Lung Center RADIOLOGY – BODY IMAGING TRACI CLAUTICE-ENGLE, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

ROBERT HOGAN, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

STEVEN MICHEL, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

2016 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

RADIOLOGY – BODY IMAGING CONT. JAMES L. OCKNER, MD

Bend Memorial Clinic

STEPHEN SHULTZ, MD

Central Oregon Radiology Associates, P.C.

DAYMEN S. TUSCANO, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

RADIOLOGY – INTERVENTIONAL PATRICK BROWN, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

JEFFREY DRUTMAN, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

STEVE KJOBECH, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

GARRETT SCHROEDER, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

DAVID ZULAUF, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

RADIOLOGY – MUSCULOSKELETAL NICHOLAS BRANTING, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

THOMAS KOEHLER, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

JOHN STASSEN, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

BRANT WOMMACK, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

RADIOLOGY – NEURORADIOLOGY TRAVIS ABELE, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

JEFFREY DRUTMAN, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

JAMES JOHNSON, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

WILLIAM WHEIR III, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

RADIOLOGY – NUCLEAR MEDICINE LAURIE MARTIN, MD

Central Oregon Radiology Associates, P.C.

RADIOLOGY – PEDIATRIC PAULA SHULTZ, MD

Central Oregon Radiology Associates, P.C.

RADIOLOGY – WOMEN’S IMAGING KAREN LYNN, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

LAURIE MARTIN, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

CLOE SHELTON, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

STEPHEN SHULTZ, MD

Central Oregon Radiology Associates, P.C.

1460 NE Medical Center Dr. • Bend

541-382-9383

www.corapc.com

St. Charles Rehabilitation Center

2500 NE Neff Rd. • Bend

541-706-7725

www.stcharleshealthcare.org

CHRISTINA M. BRIGHT, MD

Bend Memorial Clinic

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

DANIEL E. FOHRMAN, MD

Deschutes Rheumatology

2200 NE Neff Rd., Suite 302 • Bend

541-388-3978

www.bendarthritis.com

2965 NE Connors Ave. • Bend

541-706-7735

www.stcharleshealthcare.org

Bend Eastside & Redmond

541-382-4900

www.bendmemorialclinic.com

REHABILITATION NOREEN C. MILLER, FNP RHEUMATOLOGY

HEATHER HANSEN-DISPENZA, MD St. Charles Rheumatology ANTHONY M. KAHR, MD

Bend Memorial Clinic

AMY MADISON, MD

Deschutes Rheumatology

2200 NE Neff Rd., Suite 302 • Bend

541-388-3978

www.bendarthritis.com

TIANNA WELCH, PA

Deschutes Rheumatology

2200 NE Neff Rd., Suite 302 • Bend

541-388-3978

www.bendarthritis.com

JONATHAN D. BREWER, DO, D-ABSM Bend Memorial Clinic Sleep Disorders Center 1080 SW Mt. Bachelor Dr. • Bend (West)

541-382-4900

www.bendmemorialclinic.com

NANCY BURGESS, NP

St. Charles Sleep Center

Locations in Bend & Redmond

541-706-6905

www.stcharleshealthcare.org

ARTHUR K. CONRAD, MD

St. Charles Sleep Center

Locations in Bend & Redmond

541-706-6905

www.stcharleshealthcare.org

DAVID L. DEDRICK, MD

St. Charles Sleep Center

Locations in Bend & Redmond

541-706-6905

www.stcharleshealthcare.org

T. CHRIS KELLEY, DO, D-ABSM

Bend Memorial Clinic Sleep Disorders Center 1080 SW Mt. Bachelor Dr. • Bend (West)

541-382-4900

www.bendmemorialclinic.com

SLEEP MEDICINE

2016 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

SLEEP MEDICINE CONT. DEBBIE RIEF-ADAMS, FNP

St. Charles Sleep Center

Locations in Bend & Redmond

541-706-6905

www.stcharleshealthcare.org

NATALIA USATII, MD

St. Charles Sleep Center

Locations in Bend & Redmond

541-706-6905

www.stcharleshealthcare.org

1303 NE Cushing Dr., Suite 100 • Bend

541-388-2333

www.desertorthopedics.com

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

SPORTS MEDICINE MARK GOODMAN, MD

Desert Orthopedics

SURGICAL SPECIALISTS TIMOTHY L. BEARD, MD, FACS

Bend Memorial Clinic

DAVID CARNE, MD

St. Charles Surgical Specialists

ANTHONY J. FILLMORE, MD

1103 NE Elm • Prineville

541-548-7761

www.stcharleshealthcare.org

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

GARY J. FREI, MD, FACS

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

JACK W. HARTLEY, MD, FACS

St. Charles Surgical Specialists

1245 NW 4th St., Suite 101 • Redmond

541-548-7761

www.stcharleshealthcare.org

SEAN HEALY, PA-C

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

ANDY HIGGINS, MD, FACS

Dr. Andy Higgins, MD, FACS

2450 NE Mary Rose Pl., Suite 205 • Bend

541-749-7000

www.drandyhiggins.com

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

1245 NW 4th St., Suite 101 • Redmond

541-548-7761

www.stcharleshealthcare.org

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

DARREN M. KOWALSKI, MD, FACS Bend Memorial Clinic JOHN C. LAND, MD, FACS

St. Charles Surgical Specialists

JEFFREY R. MATHISEN, MD

Bend Memorial Clinic

SUZANNE MARCATO, PA

St. Charles Surgical Specialists

384 SE Combs Flat Rd. • Prineville

541-548-7761

www.stcharleshealthcare.org

ANDREW SARGENT, PA-C, MS

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

RONALD SPROAT, MD

St. Charles Surgical Specialists

384 SE Combs Flat Rd. • Prineville

541-548-7761

www.stcharleshealthcare.org

GEORGE T. TSAI, MD, FACS

St. Charles Surgical Specialists

1245 NW 4th St., Suite 101 • Redmond

541-548-7761

www.stcharleshealthcare.org

JEANNE WADSWORTH, PA-C, MS

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

ERIN WALLING, MD, FACS

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

JEREMY ALLEN, PA-C

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

BIRGITTA BELLA, PA-C

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

DIANA BURDEN, FNP-C

Mountain Medical Immediate Care

1302 NE Third St. • Bend

541-317-0909

www.mtmedgr.com

JEFF CABA, PA-C

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

ANN L. CLEMENS, MD

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

MEGAN CONDON, PA-C

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

TERESA COUSINEAU, PA-C

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

TRICIA COUTURE, FNP

Your Care

3818 SW 21st Pl., Suite 100 • Redmond

541-548-2899

www.yourcaremedical.com

GLYNDA CRABTREE, MD

Your Care

3818 SW 21st Pl., Suite 100 • Redmond

541-548-2899

www.yourcaremedical.com

DAVID H. CRAIG, MD

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

BRIAN DALY, PA-C

Mountain Medical Immediate Care

1302 NE Third St. • Bend

541-317-0909

www.mtmedgr.com

SCOTT FLECK, PA-C

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

OMAR GARZA, FNP

St. Charles Immediate Care

2600 NE Neff Rd. • Bend

541-706-3700

www.stcharleshealthcare.org

MONICA GIAMELLARO, PA-C

Mountain Medical Immediate Care

CHERYL D. HADLEY, MD

Bend Memorial Clinic

KEITH HARRINGTON, MD

Mountain Medical Immediate Care

ANITA HENDERSON, MD

Your Care

DAVID G. INGRAHAM, MD

URGENT CARE

1302 NE Third St. • Bend

541-317-0909

www.mtmedgr.com

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

1302 NE Third St. • Bend

541-317-0909

www.mtmedgr.com

3818 SW 21st Pl., Suite 100 • Redmond

541-548-2899

www.yourcaremedical.com

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

KIM KLEAVELAND, FNP

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

MILES LILLY, MD

St. Charles Immediate Care

2600 NE Neff Rd. • Bend

541-706-3700

www.stcharleshealthcare.org

DENNIS MAYRA, FNP

St. Charles Immediate Care

2600 NE Neff Rd. • Bend

541-706-3700

www.stcharleshealthcare.org

2016 CENTRAL OREGON MEDICAL DIRECTORY

ADVERTISING SUPPLEMENT

URGENT CARE CONT. JAY O’BRIEN, PA-C

Bend Memorial Clinic

JESSICA ODDO, FNP-C

Mountain Medical Immediate Care

DIKLAH OREVI, PA-C

Bend Memorial Clinic

MELISSA ORMAN, MD

St. Charles Immediate Care

CASEY OSBORNE-RODHOUSE, PA-C

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

1302 NE Third St. • Bend

541-317-0909

www.mtmedgr.com

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

2600 NE Neff Rd. • Bend

541-706-3700

www.stcharleshealthcare.org

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

COLLEEN O’SULLIVAN, PA-C

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

LAURIE D. PONTE, MD

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

MATTHEW REED, PA-C

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

JONATHAN SCHULTZ, MD

St. Charles Immediate Care

2600 NE Neff Rd. • Bend

541-706-3700

www.stcharleshealthcare.org

JENNIFER L. STEWART, MD

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

SEAN SUTTLE, PA-C

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

LAUREN TOMENY, MD

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

CINDI WARBURTON, FNP

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

ERIC WATTENBURG, MD

Your Care

3818 SW 21st Pl., Suite 100 • Redmond

541-548-2899

www.yourcaremedical.com

EMILY J. WOMMACK, MD

Bend Memorial Clinic

Bend Eastside, Old Mill District, Redmond

541-382-4900

www.bendmemorialclinic.com

MICHELLE WRIGHT, FNP

St. Charles Immediate Care

2600 NE Neff Rd. • Bend

541-706-3700

www.stcharleshealthcare.org

UROLOGY ALYSSA ARGABRIGHT, PA-C

Bend Urology Associates

2090 NE Wyatt Court • Bend

541-382-6447

www.bendurology.com

MEREDITH BAKER, MD

Bend Urology Associates

2090 NE Wyatt Court • Bend

541-382-6447

www.bendurology.com

RONALD BARRETT, MD, FACS

Bend Urology Associates

2090 NE Wyatt Court • Bend

541-382-6447

www.bendurology.com

JACK BREWER, MD

Bend Urology Associates

2090 NE Wyatt Court • Bend

541-382-6447

www.bendurology.com

SHELLY FITTS, PA-C, M.S.

Urology Specialists of Oregon

1247 NE Medical Center Dr. • Bend

541-322-5753

www.urologyinoregon.com

MARTA JOHNSON-MITCHELL, MD

Urology Specialists of Oregon

1247 NE Medical Center Dr. • Bend

541-322-5753

www.urologyinoregon.com

JONATHAN KELLEY, PA-C

Bend Urology Associates

2090 NE Wyatt Court • Bend

541-382-6447

www.bendurology.com

TIM KRIGBAUM, PA-C

Urology Specialists of Oregon

1247 NE Medical Center Dr. • Bend

541-322-5753

www.urologyinoregon.com

ANDREW NEEB, MD

Urology Specialists of Oregon

1247 NE Medical Center Dr. • Bend

541-322-5753

www.urologyinoregon.com

BRIAN O’HOLLAREN, MD

Bend Urology Associates

2090 NE Wyatt Court • Bend

541-382-6447

www.bendurology.com

1247 NE Medical Center Dr. • Bend

541-322-5753

www.urologyinoregon.com

MATTHEW N. SIMMONS, MD, PHD, FACS Urology Specialists of Oregon SARA STAFFORD, PA-C

Bend Urology Associates

2090 NE Wyatt Court • Bend

541-382-6447

www.bendurology.com

NORA TAKLA, MD

Bend Urology Associates

2090 NE Wyatt Court • Bend

541-382-6447

www.bendurology.com

VASCULAR SURGERY CATHERINE BLACK, PA-C

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

ELYSIA CARNAGEY, PA-C

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

JASON P. JUNDT, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

WAYNE K. NELSON, MD, FACS, RPVI

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

EDWARD M. BOYLE, JR., MD, FACS

Inovia Vein Specialty Center

2200 NE Neff Rd., Suite 204 • Bend

541-382-8346

www.bendvein.com

ANDREW JONES, MD, FACS

Inovia Vein Specialty Center

2200 NE Neff Rd., Suite 204 • Bend

541-382-8346

www.bendvein.com

DARREN M. KOWALSKI, MD

Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

WAYNE K. NELSON, MD, FACS, RPVI Bend Memorial Clinic

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

1501 NE Medical Center Dr. • Bend

541-382-4900

www.bendmemorialclinic.com

VEIN SPECIALISTS

WOUND CARE SHIRLEY TAYLOR, ANP

Bend Memorial Clinic

Feature | STANDARDS UNDER SCRUTINY

Erik Berkey, owner of Country Side Living in Redmond, says he interprets the state requirement to provide “meaningful activities” as generously as possible.

“I’m huge on activities. …

The longer they’re able to do stuff themselves,” he says, “then we don’t have to do so much caregiving.”

Continued from Page 25

years old, and in community-based care, where most memory care occurs; 55 percent of residents take nine medications a day, according to Portland State’s annual survey. In addition, people with dementia have trouble communicating their basic physical and emotional needs, so they become agitated, combative or try to escape.

Their caregivers, who might or might not have experience with dementia, earn an average $12.62 in Oregon, Washington, Alaska and Hawaii, according to a Hospital and Healthcare Compensation Service report.

Turnover in dementia-specialist facilities in those states was 39 percent last year.

The question is how memory care facilities should be staffed and what level of training should be required. Keny-Guyer and Rep. Caddy McKeown, D-Coos Bay, convened an informal work group on memory care after McKeown’s bill, which would have required memory care to employ certified nursing assistants, failed to gain traction in the short 2016 legislative session.

This is not the first time Oregon has looked to raise standards in care for dementia. As Jim Carlson, CEO of the Oregon Health Care Association, which represents the long-term care industry, pointed out during testimony on McKeown’s bill, the SUMMER / FALL 2016 • HIGH DESERT PULSE

JOE KLINE

Erik Berkey, the owner of Country Side Living, says he likes to have about one aide for every eight residents at his facility.

state already has an action plan for Alzheimer’s disease and related dementias. One of the stated goals is to optimize the quality and efficiency of care, and it calls for an analysis of the effectiveness of existing memory care standards.

Keny-Guyer said she wants to raise standards without driving companies away from the industry. “If they start closing down because they can’t make ends meet, then you’ve got nowhere to put people,” she says.

Facility owners say there’s plenty of incentive to get into the memory care business in Oregon. Those that receive the endorsement also get a higher rate of reimbursement for Medicaid-eligible residents, $4,100 per month. Most memory care facilities in Oregon, 83 percent, accept Medicaid, according to Portland State’s survey.

Oregon spent $248 million last year on Medicaid for residential care and assisted living, and $70 million of that was spent in memory care.

The bill for residents who are paying their own way is even higher, an average base rate of $4,781 per month, according to Portland State.

The pay, plus demand from an aging baby boomer population, makes specializing in memory care attractive. There were 160 facilities with a memory care endorse-

ment in Oregon last year, up from 148 in 2014, according to Portland State. This year, 10 more facilities plan to apply for the state endorsement.

Struggle over staffing An old-time country-western song twangs in the background as Country Side Living residents in Redmond gather in a circle and hold colorful pieces of swimming noodle, which they use to bat at a balloon floating above their heads.

Country Side owner Erik Berkey said he interprets the state requirement to provide “meaningful activities” as generously as possible. “I’m huge on activities,” he said, adding that he employs four people in that area, so there’s something going on every day of the week.

A strong daily routine keeps residents calm, he said, and activity keeps them healthy and independent.

“The longer they’re able to do stuff themselves,” he said, “then we don’t have to do so much caregiving.”

When it comes to direct care, Berkey said he likes to have about one aide for every eight residents, but there’s no rule in the memory care endorsement standards, or in residential-care licensing, that specifies staffing levels. Oregon’s residential-care and assisted living facilities “must have Page 51

Feature | STANDARDS UNDER SCRUTINY

“It’s hard to get caregivers to come in and do the hard work when they can go down and rent out rafts for the same wage.”

— Dusty Ahrens, director of clinical services for Frontier Management, which owns Aspen Ridge Memory Care and Mt. Bachelor Memory Care in Bend, on the challenge of finding and keeping qualified staff

qualified awake caregivers, sufficient in number, to meet the 24hour scheduled and unscheduled needs of each resident,” the regulations state.

Those open-ended staffing requirements for residential care assume people are independent enough to speak up for themselves, Long-Term Care Ombudsman Fred Steele said. “Should that be the default way of approaching memory care?”

The Oregon Health Care Association declined to comment in the absence of a live bill related to memory care. During testimony on McKeown’s bill in February, Carlson pointed out that the Department of Human Services already has the authority to require facilities to bring in consultants or ramp up staff in response to problems.

Carlson also presented a cost analysis showing that if caregivers were required to be CNAs, costs would rise for residents. Aides would go from earning $10.90 an hour in the Coos Bay area to $13.26, and medication aides would go from earning $10.90 per hour to $16.20.

That would raise facility costs by more than $217,000 a year, which would translate to private-pay rent increases of $581 a month.

California and Washington have recently revised their training standards around dementia. This year California required dementia training for all caregivers who work with the elderly, not just those who work in dementia specialty units.

Driven by the Service Employees International Union, Washington now mandates hours of training and a competency exam for anyone who works in long-term care, regardless of the setting. The training covers dementia, and the Alzheimer’s Association’s state-by-state guide to memory care regulations notes that Washington’s competency requirements are the most specific and detailed of any state.

Wendy McIlnay, director of operations for Senior Housing Managers in Wilsonville, said Washington’s long-term care training requirements drove up costs for companies and workers, who usually don’t have $600 to pay for the courses and testing. “It’s hard enough for us to attract folks who want to come in and take care of seniors,” she said. “We’re now facing a labor crisis in Washington.”

McIlnay said Senior Housing Managers doesn’t cover the cost of training in Washington because it’s already operating at a low profit margin. The company’s stated mission is to serve as many Medicaid-eligible residents as possible, though she also said the company’s Washington properties have a higher portion of private-paying Page 52

residents.

Senior Housing Managers is a privately held company that operates Elderberry Square in Florence, which saw 16 substantiated abuse and neglect reports in 2015 and early 2016. That was after a license inspection found enough problems that the state banned new admissions for a period in 2014.

“It is true, they have had some issues,” McIlnay said. Her position was created in part to help turn around Elderberry Square, in which nearly every resident is Medicaid-eligible. Facility owners say Oregon’s Medicaid reimbursement for memory care, around $4,100 per month, is enough to cover the extra needs of residents, but they limit Medicaid admissions to protect their profit margins.

McIlnay said Senior Housing Managers is able to work with the Medicaid population because it’s more “creative” than most owners.

For example, the company combines the role of executive director and marketing manager and may use fewer aides.

Elderberry Square, which has 48 beds with the capacity for 32 in memory care, employs one medication aide and one direct-care aide for a total of two caregivers per shift, McIlnay said. So the executive director and other ancillary staff also pitch in with residents. She added, “Our executive director there walks the dining rooms. Many times we’ll see her sit down and help a resident eat that’s struggling.”

McIlnay said Elderberry Square is a completely different place than it was in 2015. She went through two executive directors before finding the current administrator and in the meantime relied on help from nurses and managers at other properties, including East CasSUMMER / FALL 2016 • HIGH DESERT PULSE

PHOTOS BY JOE KLINE

Left and above, residents at Country Side Living participate in morning “town hall” activities at the facility in Redmond. Activities keep residents healthy and independent, owner Erik Berkey says.

cade Retirement Community in Madras. “We basically stayed there until all the issues we had were taken care of,” she said.

The long-term care industry generally opposes state-mandated staffing ratios, and new software technology could provide a more precise way to cover residents’ needs.

About a year ago, Frontier Management, which owns Aspen Ridge and Mt. Bachelor in Bend, began using a software program to determine staffing levels according to residents, said Dusty Ahrens, director of clinical services. Each resident has a service plan that spells out his or her needs, such as help with bathing, and notes any highrisk behaviors, such as trying to escape. All that data is poured into the program, which translates it to staffing hours. Any changes in a resident’s condition will prompt an update in staff hours. A resident’s condition might decline so that she needs two people, instead of just one, to move from bed to wheelchair, Ahrens said. “We can see that in real time.”

The Department of Human Services is piloting a similar software program that will be available to other long-term care facilities.

High stakes, low pay Finding and keeping qualified staff has been especially challenging in Bend, Ahrens said, and turnover may have contributed to the problems cited at Aspen Ridge last year.

“It’s hard to get caregivers to come in and do the hard work when they can go down and rent out rafts for the same wage,” Ahrens said.

She spent a lot of time at Aspen Ridge and ended up using a staffSUMMER / FALL 2016 • HIGH DESERT PULSE

ing company to cover gaps. Since last September Frontier has raised its base pay for aides to around $11 per hour and created wage differentials for night shifts, prior experience and a certified nursing assistant license.

Most of the serious problems that a Department of Human Services license inspector found at Aspen Ridge last year revolved around medication, and Ahrens blames those on a gap in nursing oversight after a key employee committed fraud.

Aspen Ridge promoted Melissa Olson, who’d been the residential-care coordinator since June of 2013, to the registered nurse post in June of 2015 after she told managers she’d graduated from nursing school and showed them a diploma and a fake license, which she created from her sister-in-law’s nursing credentials.

Ahrens said she caught on to Olson, who is on probation after a conviction on two felony counts of identity theft, and was doing her own investigation when the Oregon Board of Nursing tipped her off.

Olson was fired and a replacement hired by the time of the license inspection, but there was a period when the facility didn’t have it’s own RN, Ahrens said.

“There wasn’t anything that showed the residents were harmed,” Ahrens said of the inspection report. “There was lack of documentation of what had or hadn’t been done.”

The state inspector found that Aspen Ridge made mistakes carrying out medication-related tasks, and several residents were placed at risk of harm. One woman returned to the emergency room after Aspen Ridge failed to administer her antibiotics, and another resident, who was on hospice care, might have suffered needless pain. Two residents experienced a change of condition — significant weight loss and a pressure sore, respectively — without being assessed by a nurse, according to the report.

While Aspen Ridge’s experience with an employee posing as a nurse is unique, it shows that much of what happens in a long-term care facility comes down to individuals. Conditions in any facility can quickly spin out of control if the director, residential-care coordinator and registered nurse don’t work well together, said Joe Coss, a retired marketing executive and president of the Gero Leadership Alliance of Deschutes County. “It’s high pressure, low margin of error,” Page 53

“The only thing I would advise people is not to put your loved one in there without going in every day.

When you keep your eyes on them, they’re not going to make mistakes with your loved one.”

— Carol Dickerson, who made frequent visits to her husband James at Aspen Ridge Memory Care

JOE KLINE

Lynne Farrell, a music therapist, works with residents during music hour at Aspen Ridge Memory Care in Bend. The facility was one of many in Oregon that kept licensing inspectors and Adult Protective Services investigators busy last year.

Feature | STANDARDS UNDER SCRUTINY said Coss, who worked in long-term care facilities. “You’ve got to synchronize.”

The inspection at Aspen Ridge also demonstrates the complexity of residents’ medical needs. One resident, admitted in May 2015 with diabetes, had orders for four blood-sugar checks per day with insulin to be administered depending on the results.

The state inspector found Aspen Ridge’s nurse never delegated tasks for the insulin-dependent resident, meaning the aides weren’t taught, supervised and evaluated, nor was the patient’s condition re-evaluated at regular intervals.

Several times, the staff either administered insulin after noting low blood sugar, or did nothing in response to high blood sugar, greater than 450 milligrams per deciliter, according to the report.

Aspen Ridge was not allowed to admit new residents from Aug. 5, 2015, to Dec. 17, 2015, after a re-inspection found everything to be in order. “I feel like they have greatly improved,” Ahrens said of Aspen Ridge.

Page 54

“The nurse is doing a fantastic job.”

Compassion needed Melody Horner’s first job taking care of others was at Aspen Ridge Memory Care, but the 23-year-old Bend resident said she was struck by her peers’ lack of respect for human dignity.

During the four months she worked at Aspen Ridge in the spring and summer of 2015, she said she witnessed a man by the nickname of “Doc” often left lying on the floor after he’d fallen out of his chair. Other caregivers would insist that he preferred the floor, but Horner wasn’t convinced. “Every time I would get down there and talk to Doc and give him enough time to respond, he always wanted back up,” she said.

Horner realized the man was falling out of his chair because he liked to reach down and pick at carpet fibers, so she brought him a baby book with textured pages for him to hold and touch. “Once I gave him that book, he stopped falling out of his chair,” she said.

Horner, who now works in home health,

said she left Aspen Ridge because she felt the environment was unprofessional. A state license surveyor observed the same lack of concern. According to the inspection report, several residents sat for 3½ hours or more without moving. At one point the inspector tried to track down help for a resident who’d been identified as needing heavy care but sat for several hours without moving or a change of briefs. Two separate aides replied, “Not my resident,” before walking away.

Dickerson said she knew that Aspen Ridge was facing sanctions — there was a notice on the front door — but she doesn’t have any complaints about her husband’s care.

“They did the best they could with what they had,” she said. “I’m just glad I was a presence there every day.”

Dickerson said she was one of few daily visitors at Aspen Ridge. “The only thing I would advise people is not to put your loved one in there without going in every day.

When you keep your eyes on them, they’re not going to make mistakes with your loved one.” • SUMMER / FALL 2016 • HIGH DESERT PULSE

One voice | A PERSONAL ESSAY

2016: It’s the Year of the Pullup (Secret truth: That’s really stupid and you shouldn’t lame the flexed arm do that. Stop doing that.) hang.

There are really terrible, Does that even exist hard workouts. (Secret anymore? truth: It doesn’t matter When I was a kid, we had how much better shape to do the Presidential Fityou get in — because ness Challenge every year in then you just do them school. I was (and sometimes harder, faster, etc.) think I remain) an athlete — I Here’s some more played soccer and basketball, truth: It’s super fun, and ran track and cross-country. it’s taught me a lot about And when it came to the chalboth my mind and my lenge, ridiculously, my best body. events were the shuttle run My mind: I am a cheatand the sit-reach, in which er at heart. You tell me to you sit on the floor and bend do 20 repetitions of an over as far as you can and JOE KLINE exercise and I have to your gym teacher bends over WILL MYSELF not to do in his short shorts to mea- Sheila Miller lifts weights at Oregon CrossFit in Bend in her quest to complete a 18. I am mentally weak sure how far your fingers can pullup. Miller has been active in CrossFit, which combines weightlifting, gymnastics — all I think about somereach. That was a measure of and high-intensity exercise, the past couple of years. times is quitting. And fitness, somehow. then, another insight: I The flexed arm hang was my great downfall. It measured in seconds how long you could hang am tremendously competitive, even if I’m in last place. I want to quit from the pullup bar with your arms flexed. I distinctly remember the all of the time, and the only reason I don’t is, really, that I see other tiniest girl in our class, April Ferriera, just hanging there for minutes. people finish a hard workout and start telling myself: Come on, Miller. You can do this. Yes, when I work out I refer to myself by my last I could do it for, solidly, nine seconds before collapsing to the floor.

This has not improved. For starters, I’ve never been a woman with name. Always have. It’s my tough kid name.

My body: I am really strong. OK, “really strong” might be a stretch. a great deal of arm strength — my strength is focused, shall we say, entirely in my thighs and butt. I once threw my friend’s college-aged I am nowhere near as strong as many of the other women, let alone little sister over my head and into a bush after she questioned my flip the men, I work out with. But I shock myself all the time by how cup win (a drinking game) — but that was done completely thanks much weight I can lift and the number of times I can lift that weight. to pure leg strength. And really, beer-related is the kind of athletic I think there’s no way I can do one more burpee. Then I do 10 more.

Twenty more. It’s astonishing what your body can do once you think pursuit I’m most successful at these days.

I’ve maintained a level of activity that some would consider im- it’s tapped out.

But my arms. God, my arms. They’re still so weak. And doing a pressive — I play soccer two days per week and over the past couple of years have taken up CrossFit, a fitness program that combines pullup is not just about arms. It’s about strengthening your core and your back and, probably, not drinking so much beer and eating weightlifting, gymnastics and high-intensity exercise.

And that brings me to my 2016 New Year’s resolution. Usually it doughnuts at work whenever they’re available.

Still, it’s my goal. So I am supposed to do ring rows and pushups involves things like: drink less, use eye cream, read 50 books. (ha!) and lots and lots of these workouts. I’m not there yet.

This year it is to do a pullup.

And if I’m honest with myself, it might not happen this year, in And I have a heck of a long way to go.

So. CrossFit. You’ve heard the rumors, and some of them are true. part because the past few months I haven’t exactly committed myThere are meatheads. (Secret truth: A lot of meatheads, 99 percent self. But I am getting stronger. Sometimes I don’t even finish last in really, are nice people who love lifting weights and want you to feel the workout.

Perhaps soon I’ll be able to hang with flexed arms for more than the same way about their hobby.) There are times you risk injury because you want to compete in the workout or impress your coach. nine seconds. •

BY SHEILA MILLER

B

SUMMER / FALL 2016 • HIGH DESERT PULSE

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