med-midwest medical edition-september/october 2010

September / OctOber 2010

6 The Pine Ridge Regional

Medical Clinic

Fighting a Legacy of Chronic Disease

By Alex Strauss

With a rate of chronic diseases hundreds of times higher than the general

population, Native Americans on South Dakota’s reservations are at constant

health risk. thanks to a unique collabo-ration between the Indian Health

Service, the state of South Dakota, and regional Health, more of them are

being armed to fight back, for their themselves and or future generations.

20 Obstructive Sleep Apnea

Sleep Center Helps Doctors and Patients Unravel

Potentially Dangerous Nighttime Problem

23In review . . .

reviewed by Dr. John berdahl A local ophthalmologist

reviews a controversial book

about lawsuits and eye surgery

Table of ConTenTs

CoverfeaTure

September / OctOber 2010

2 publisher’s/editor’s page

3 South Dakota Health Care Quality Score and Ranking Improve in 2009 by Dave Hewett

4 the more things change . . . By Dr. Rodney Parry

the med School Dean and South Dakota Native talks about the long

and bumpy path from canistota to the ‘U’. . . and how close he came

to being a pharmacist.

5 Sanford Health Unifies Health System Under New Name and Workmark

11 Avera Once Again most Wired, most Wireless

16 Anonymous donor triggers chain of kidney transplants at three hospitals

24 Revenue Cycle ManagementIs Your Office Receiving its Maximum Reimbursements? by Natalie L. bertsch, rHIt

26 Injury Prevention and Management in Healthcare Combining Job Function Matching and Ergonomics by Jeff roach

28 Grape expectations Insights from california’s Wine region

By Heather Taylor Boysen

30 News & NotesNews from around the region

midwest medical edition 2

a letter from the Publisher

a letter from the editor

It has been a busy summer here at meD. In July, we celebrated our official ribbon cutting at the Sioux Falls chamber of commerce. thanks to those of you who showed up to support us. It was great to meet many

of you and to put some faces to names. July was also a good time at the make-A-Wish annual Hot Harley Night’s fund-raiser event in Sioux Falls. congratulations to that great organization for another successful year.

In addition to preparing this, our fourth issue of meD, I spent a good portion of August getting ready for the SDmGmA meeting in chamberlain. I would like to thank everyone who stopped by our booth last month to say hello. I had a great time getting to know so many of you. this month, I look forward to seeing many of you at the South Dakota Association of Healthcare Organzations (SDAHO) conference. (www.sdaho.org). As a part of the South Dakota Association for Healthcare marketing and public relations (SDAHmpr) division, I will be learning how to help you market your business more effectively. meD will also have a booth in the vendor section, so if you are there please stop by and introduce yourself and sign up for our drawing.

As we head into the second half of our first year, we are already taking your Nominations for next year’s cover Story and Feature Articles. If you know of an out-standing physician, program or facility that deserves some recognition, take a minute to fill out the nomination form in this issue, or send us an email. And, as always, we love to get your feedback. —Steff

Disparity is a word no one in healthcare likes to hear. And yet, socioeconomic conditions, geog-raphy, and even cultural background can create disparities, even in a state that consistently earns

high marks for its quality medical care. but the progressive health systems of our region are not sitting back and watching the gaps widen. they are tackling disparities with innovative programs aimed at crossing lines, breaking bar-riers and bridging gaps to give every South Dakotan a shot at a healthier life. this month, meD takes a closer look at some of the programs that are paving the way.

Also in this issue, we bring you expert advice on everything from creating a more ergonomic workplace, to boosting your reimbursements and even choosing a great bottle of wine for your fall table. We have information on new clinical trials, upcoming conferences and news from around the region as well as some new opportunities for you to help shape this magazine. Dr. rodney parry kicks off our new ‘then & Now’ column with a reflection on medical school and Dr. John berdahl offers his views on a provocative new book in ‘In review’.

Now it’s your turn. How has the practice of medicine changed in our region? How has it changed for you or your practice? Have you read a great book, heard a powerful lecture, or seen a movie that moved you recently? meD wants to hear from you. take a few minutes to drop us a line and share your thoughts, reflections and opinions with your colleagues around the region. You can reach me any time at [email protected].

revel in the change of seasons and take your copy of meD along with you. We’ll meet you right back here in November. —Alex

Steffanie Liston-Holtrop

Alex Strauss

publisher Steffanie Liston-Holtrop editor in chief Alex Strauss

cover Design Darrel Fickbohm Design/Art Direction Corbo Design Web Design 5j Design

contributing Writers Dr. John Berdahl Natalie Bertsch Heather Boysen Dr. Michael Fiegen Dave Hewett Charlotte Hofer Mary Olinger Dr. Rodney Parry Dr. Thomas Repas Jeff Roach Advisory board John Berdahl, MD Mary Berg, MD Michelle L. Daffer, MD James M. Keegan, MD, Timothy Metz, MD Patty Peters, MD Juliann Reiland-Smith, MD Luis A. Rojas, MD Daniel W. Todd, MD

published by MED Magazine, LLC Sioux Falls, South Dakota

Contact Information

Steffanie Liston, Publisher 605-366-1479

[email protected]

Alex Strauss, Editor in Chief 605-359-8897

[email protected]

Fax: 605-271-5486

mAILING ADDreSS: pO box 90646 Sioux Falls, SD 57109

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©2010 midwest medical edition, LLc

Midwest Medical Edition (meD magazine) is commit-ted to bringing our readership of 3500 South Dakota area physicians and healthcare professionals the very latest in regional medical news and information to enhance their lives and practices. meD is published 8 times a year by meD magazine, LLc and strives to publish only accurate information, however midwest medical edition, LLc cannot be held responsible for consequences resulting from errors or omissions. All material in this magazine is the property of meD magazine, LLc and cannot be reproduced without permission of the publisher. We welcome article proposals, story suggestions and unsolicited articles and will consider all submissions for publication. please send your thoughts, ideas and submissions to [email protected]. magazine feedback and advertising and marketing inquiries, subscription requests and address changes can be sent to [email protected].

meD is produced eight times a year by meD magazine, LLc which owns the rights to all content.

From Us to YouStaying in touch with meD

3

Please fill out the form and fax or email to:

Steffanie Liston, publisher

midwest medical edition

4609 S. baha Ave #201

Sioux Falls, SD 57106

Phone: 605-366-1479 Fax: 605-271-5486

[email protected]

meD magazine is seeking Nominations for cover Article topics for 2011. meD is committed to focusing on pioneering physicians, institutions, programs and technologies that are paving the way for the future of healthcare in our region. If you know of a person or program that deserves a closer look, please let us know.

Nominee: _________________________________

Title: ______________________________________

Location of Practice: _______________________

City: ______________________________________

State: Zip ________________________________

Phone_____________________________________

Email: _____________________________________

Reason for Nomination: ____________________

___________________________________________

___________________________________________

___________________________________________

___________________________________________

___________________________________________

Your Name: _______________________________

Title: ______________________________________

Phone: ___________________________________

Email: _____________________________________

MED Nomination Application The 2009 Agency for health care research and Quality’s (AhrQ) national healthcare Quality report

ranks South Dakota’s overall health-care as 7th best in the country.

That’s really good news for pro-viders in South Dakota since this is the statistic used to measure quality when we talk about South Dakota being a “high quality, low cost” state. (The other measure related to cost is Medi-care dollars spent per Medicare benefi-ciary as compiled by the Dartmouth Atlas.) Simply put, this is the quality quotient that is used in the discussion about geographic variation and can influence which physicians and hospi-tals receive incentive payments for delivering “high quality / low cost” care.

South Dakota’s #7 ranking is one position better than 2008. The State’s overall score was 60.0 which places it well within the 75th percentile when being compared to other states. States ahead of South Dakota are new hamp-shire (65.15), Wisconsin (64.29), Min-nesota (64.02), Maine (63.81), rhode Island (61.76), and Michigan (60.42).

States with the lowest scores were Mississippi (34.38), nevada (34.26), Arkansas (33.49), new Mexico (30.63), Texas (29.38), and Louisiana (20.83). Maine, Maryland, Wyoming, South carolina, and the District of columbia are highlighted as showing the greatest improvement.

While South Dakota’s numbers are very good, we in the provider commu-nity cannot rest on our laurels. As the

“value” indicator becomes a greater factor in determining provider reim-bursement levels, please know that states ranked below us will be scruti-nizing ways to improve their scores. South Dakota physicians can take the lead in making sure this state continues to improve by analyzing the specific criteria used to establish each state’s overall quality score (there are over 140 factors).

It’s important because it’s more than just bragging rights that are at stake – it’s patient safety and reimbursement as well.

every year I find this report to be of great interest. It may not be perfect but it is consistent and demonstrates that South Dakota has been able to maintain a high ranking among states over the years. So stay tuned and celebrate our successes for at least a couple of minutes. Then it’s back to work to see if we can make the top 5 next year. The AhrQ study can be found at http://statesnapshots.ahrq.gov/snaps 09/index.jsp.

south Dakota’s Health Care Quality score and ranking Improve in 2009By Dave Hewett, SDAHO

Call for Nominations


The More Things Change . . .By

then & Now


W e WeLcoMe neW students to the Sanford School of Medicine of The University of

South Dakota at the end of July with our White coat ceremony. each year, the ceremony reminds me of when I was beginning medical school. That’s 45 years ago as of this fall.

Back then, we had no orientation. We were sent a list of equipment we needed and were expected to bring all of it to our classes on our first day. We were all strangers to each other at first. In addition to getting to know our classmates, I also needed to get to know myself better. I had some serious reser-vations about whether medical school was for me.

I still have the letter from Dr. Walter Hard, the dean of the medical school, that informed me I would receive a $350 scholarship my first year.

I grew up in the small South Dakota town of canistota. no one else in my family had even graduated from col-lege much less a professional school. In fact, the only two professionals I knew were the town physician and pharmacist. I guess that might explain why I earned my undergraduate degree

in pharmacy before attending medical school.

I considered becoming a pharmacist but my love of learning was so great that I decided to apply to medical school to continue my education. I actually applied in March 1965 and was admitted for the fall. rest assured, the application process takes a little more time now.

Paying for medical school was an issue then as it is today.

My means were so modest that I drove a car that would occasionally (my wife ruth would say frequently) leak gasoline onto the engine, causing a small (ruth would use another adjec-tive) fire to erupt. That was about the only car I could afford at the time.

To afford to go to medical school, I relied on loans and scholarships. I still have the letter from Dr. Walter hard, the dean of the medical school, that informed me I would receive a $350 scholarship my first year.

But my biggest doubts weren’t about whether I could afford medical school. rather, they were about whether I could handle the rigors of medical school. During my first year, I learned enough about medical school as well as enough about myself to realize I had made the right decision. And that’s when I finally stopped my daily ritual of looking at the help wanted ads in the newspaper, checking to see if any pharmacist jobs were listed, just in case medical school didn’t work out.

Dr. Rodney R. Parry, M.D., is the vice president of health affairs for The University of South Dakota and medical school dean of the Sanford School of Medicine at USD. He graduated from the school in 1967 with a B.S.M.D. He received his M.D. degree from the University of Wisconsin and completed his residency training at the Mayo Clinic. He joined the faculty of USD’s medical school in 1976.

By Dr. Rod Parry

Looking back lets us see how far we’ve come. Do you have a memory or musing on the practice of medicine in our region? How have things changed since you saw your first patient? What’s better? What’s harder? We want to hear from you! Send your reflections to [email protected].

Our changing medical Landscape

September / October 2010 5midwestmedicaledition.com 5

Congratulations to Our Two Newest Behavior Analysts!

CHILDREN’S CARE HOSPITAL & SCHOOLFor Children with Special Needs and Their Families

2501 W. 26th St., Sioux Falls, SD 57105-2498 (605) 782-2300 www.cchs.org

Dr. Kimberly Marso, Rh.D., BCBA-D, VP of Clinical Services

Amber Bruns, MS, BCBA, Behavior Analyst

Dr. Vicki Isler, Ed.D., BCBA-D, Clinical Director/Education

Ryan Groeneweg, Ed.S., BCBA

Erin Stabnow, M.A., BCBA

Ryan Groeneweg, School Psychologist/Behavior Analyst, and Erin Stabnow, Special Education Teacher/Behavior Analyst, have been accredited as Board Certified Behavior Analysts (BCBA) by the Behavior Analyst Certification Board, Inc.

Applied Behavior Analysis is a systematic, data-based teaching strategy appropriate for any population, regardless of ability or disability, and is the only research-based methodology approved for teaching children with autism.

Erin and Ryan join our current staff of behavior analysts:

Five of South Dakota’s seven board certified behavior analysts are on staff at Children’s Care Hospital & School!

SIoUx fALLS-BASeD SAnforD health & fargo-based Meritcare, which merged in 2009, further unified their two organizations under a single brand name and wordmark in July. The organization, now encompassed under the Sanford health brand, was intro-duced by Sanford health President and ceo Kelby Krabbenhoft during an address on the grounds of Sanford hospital on July 20th.

“Today, we are all under one name, Sanford health, with a new mission and vision that hold dear our histories and embrace a new purpose and goals moving forward, fulfilling the promise made during the merger,” stated Krab-benhoft. “We will relentlessly pursue the perfect patient experience. We make this promise to every patient, as well as to every community we serve.”

The Sanford health/Meritcare merger in november of 2009 created the largest not-for-profit rural health-care system in the nation serving 110 communities in six states. It includes 30 hospitals, 111 clinic locations and more than 800 physicians in 70 spe-cialty areas of medicine. With more than 18,000 employees, Sanford health is the largest employer in north and South Dakota.

Sanford health states its new mis-sion as “Dedicated to the work of health and healing”, which incorporates both preventive initiatives and treatment of illness.

The new blue wordmark does away with the traditional Sanford red and the Meritcare burgundy as well as the hearts used in both of the old logos and incorporates the Lorraine cross within

the ‘o’. The new workmark will be added to all Sanford health signage, in both north and South Dakota, at a cost of $3 million. The organization says the ‘visible changes’ will be implemented system wide over the next two years.

sanford Health unifies system under new name and Wordmark

Kelby Krabbenhoft

“Today, we are all under one name, Sanford Health,

with a new mission and vision . . . “

Endocrinologist Stephen Haas, M.D., examines diabetes patient Betty Wilson of Pine Ridge, S.D. at Pine Ridge Regional Medical Clinic. Haas retired after 30 years in Rapid City, but has come back part time to help make the clinic a reality.

All Photographs courtesy of Regional Health/Barbara Downen

7

By Alex Strauss

The AverAge LIfe exPecTAncy In SoUTh DAKoTA is 77.7, putting the state in the top 20 for length of life.

But for the South Dakotans living on the Pine ridge Indian reservation, the news is not nearly as good. In fact, men living on Pine ridge have an average life expectancy of just 48 years old. for women, it’s 52. In the Western hemisphere, the only population with comparably low life expectancies is the poverty- and AIDS-stricken country of haiti.

“Almost every chronic condition you can name is 200, 300, even 500 times higher on Pine ridge than it is nationally,” says Sandra ogunremi, DhA, Director of grant Services at regional health who is well versed in the health care chal-lenges of native Americans. “end stage renal disease, diabetes and its complica-tions, heart disease – these are all much more common in this population.”

Poverty plays a major role in the health picture at Pine ridge, where 80 percent of residents are unemployed and 49 percent live below the federal poverty line. even when patients with chronic conditions have the means to travel to the nearest Indian health Service facility to receive care, there is little time or money to educate them on the need for compliance or the importance of ongoing self-management. overwrought and underfunded, the Pine ridge Indian health Service (IhS) hospital is forced daily to triage patients who routinely wait hours in the emergency room for non-emergent care.

Pine ridge hospital ceo Bill Pourier, himself a native American, says his facility recognizes the need for education but like many rural hospitals, his facility also struggles with a shortage of providers and the necessity of addressing life-threatening issues first. The Pine ridge hospital and its two ambulatory care clinics in Kyle and Wanblee serve a population of about 50,000.

“We have to get pretty creative out here,” says Pourier.

A CREATIvE SOluTIONIn an effort to address the spiraling problems associated with chronic disease as

well as alleviate some of the pressure on area hospitals, the South Dakota Department of Social Services in 2008 approved a grant to fund a unique new collaborative effort. housed within the Pine ridge IhS hospital and staffed by regional health physicians and specialty providers, the Pine ridge regional Medical clinic is dedi-cated to diagnosis, treatment, education and ongoing management of the most prev-alent chronic conditions on Pine ridge. As a joint effort with a state government

The Pine Ridge

Fighting a Legacy of Chronic DiseaseRegional Medical Clinic

Diabetes educator Diane rolof provides consultation to patient maxine clifford of manderson, S.D. regarding her diabetes care. Diabetes and its complications are major killers of Native Americans.

“When I began to explain to the Tribal council what we were proposing, one by one around the room council members began to tell me about people in their own families who had died of heart conditions or pulmonary conditions or the complica-tions of diabetes at a relatively early age,” recalls Dr. ogunremi of that initial meeting. “They were all talking about the exact conditions we were seeking to treat. I did not even need to tell them why they should approve our idea. They were telling me why it was needed.”

The Tribal council approved the pro-posed clinic unanimously. Supplies were ordered and regional health began looking for specialty physicians willing to make regular treks to Pine ridge. The Pine ridge regional Medical clinic opened its doors in December of 2008.

FOCuSED APPROACHThe Pine ridge regional Medical

clinic focuses on four health concerns that are rampant among the native American population on Pine ridge: congestive heart failure, chronic obstructive Pul-monary Disease (coPD), Diabetes, and the management of blood thinner medica-tions such as Warfarin. The clinic, which is open two days a week, is staffed by physicians or mid level practitioners with expertise in cardiology, pulmonology, endocrinology and pharmacology.

endocrinologist Stephen haas, M.D., is one of those who answered the call to share his expertise. Although he retired in 2001 after 30 years of practice in rapid city, Dr. haas says the unique opportunity afforded by the state grant has made his part time return to work at the Pine ridge clinic rewarding.

“Diabetes is so common here and the people really seem to appreciate the time we are able to spend with them, helping them sort out their sugar levels, etc.,” says Dr. haas. “This kind of time investment is so important not only for teaching people what they need to know about self-care, but also for sending the message that it is important. When they see us treating it

seriously, they are more likely to take it seriously, too.”

native Americans are almost two and a half times more likely to have diabetes than caucasians, making it the most prevalent chronic disease on Pine ridge. In addition to having a tendency to gain weight around the abdomen, which is associated with insulin resistance, native Americans tend

to become diabetic at much

and a health care system, the clinic is unique within the IhS.

“Because hospital emergency rooms tend to see so many Medicaid patients for complications arising from chronic ill-

nesses, the hope was that intervention at an earlier stage would lead to not only better care but also to more cost-effective care,” says James Keegan, M.D., the chief Med-ical officer of regional health and ceo of regional health Physicians. Dr. Keegan says the lack of reliable transportation was another reason regional decided to help establish a clinic where the need is greatest.

“We are hoping that bringing these doctors out to the patients at Pine ridge will help improve compliance and, thereby, improve health,” says Dr. Keegan.

It was Dr. Keegan who first approached Dr. ogunremi, then a doctoral student in health Administration, about the possi-bility of taking the clinic project from idea to implementation. Dr. ogunremi brought the idea to Bill Pourier and the Pine ridge Tribal council. She says she was surprised – and ‘heartbroken’ – by the response.

“The health care system they are accustomed to is a system designed to take care of acute problems, not chronic conditions.”

“Almost every chronic condition you can name is 200, 300, even 500 times higher on Pine Ridge than it is nationally.”

earlier ages than caucasians, drastically increasing their lifetime risk of complica-tions, as well as the risk that those compli-cations will happen earlier in life. Many of Dr. haas’ new patients are teenagers.

chronic obstructive Pulmonary Dis-ease, encompassing both chronic bron-chitis and emphysema, is usually caused by a lifetime of smoking, a habit which is prevalent on the reservation. Although the lung damage cannot be reversed, treatment involves controlling symptoms and pre-venting further damage.

congestive heart failure, a condition in which the heart becomes too weak to work efficiently, results from chronic conditions such as heart disease or high blood pres-sure. The condition sends many Pine ridge elderly to the hospital, but effective medical management, along with lifestyle changes, can improve symptoms such as weakness and fatigue and increase survival.

regardless of why they may be at increased risk for blood clots, patients on blood thinners such as Warfarin need to be closely monitored in order to maintain the blood’s clotting ability and manage side effects. Although a significant segment of patients on the Pine ridge reservation are on these drugs, few are monitored regu-larly. A pharmacist at the Pine ridge regional Medical clinic provides care and management for these patients.

Pine Ridge Regional Medical

Clinic is within the indian Health

Service Hospital on the outskirts of Pine

Ridge, S.D.

uNCERTAIN FuTuREAlthough it was not uncommon for

patients to miss their appointments when the clinic first opened, Dr. haas says three years of patience and education are paying off. compliance is higher now, with few patients missing appointments, calling to cancel when they do have to miss, and even arranging to bring family members along so that they can be seen, too.

More than 400 patients are now regis-tered at the clinic, which has at times uti-lized money and food to encourage new patients to come. regardless of why they first come through the doors, Dr. haas says he believes it is time and education that keeps them- coming back.

“The health care system they are accus-tomed to is a system designed to take care of acute problems, not chronic conditions,” says Dr. haas. “But if a patient waits hours for a ten minute appointment, this does not send them the message that their problem is important. That is why this grant is such a great thing. I just deal with the patient in front of me and his or her problem and don’t have to worry about staying within a time limit.”

“It is such a valuable system because it allows us to offer services that we could not otherwise provide here,” says Pourier, whose hospital loses federal reimbursement dollars when patients have to be referred elsewhere for specialty care. “It saves our hospital money and it allows patients to be treated here, closer to their homes, instead of having to be transported

elsewhere.”But everyone

involved with the clinic cautions that it will take some time before the clinic will

have a statistical impact on the health pic-ture at Pine ridge. As with any project funded by grant money, the program’s future is uncertain. Judicious use of the funds allotted by the original 2-year grant has allowed the Pine ridge clinic to con-tinue for almost three years, but no one is

sure what will happen next year. Dr. Keegan, a public health and quality of care expert, says statistics are being compiled on the clinic’s first three years of operation that he hopes will be ‘compelling’ and Pourier says his hospital will do all it can to keep the clinic operating, even if the grant money runs out.

“We are hopeful that this will be able to continue because we believe we are making a real difference,” says Dr. ogun-remi, who encourages other semi-retired physicians like haas to consider lending their expertise to reservations in need. “I know that many physicians in our state travel around the world to provide care for the underprivileged. But we have a very great need right here in South Dakota.”

“I did not even need to tell them why they should approve our idea. They were telling me why it was needed.”

“This kind of time investment is so important… When they see us treating it seriously, they are more likely to take it seriously, too.”

“We have to get pretty creative out here.”


DonALD WArne, MD, MPh has been named the Director of Sanford’s newly created office of native American health.

Warne will be responsible for coor-dinating activities among Sanford health, tribal communities and the Indian health Service to facilitate improvement of native American healthcare. These activities will focus on, but not be limited to healthcare delivery and healthcare research.

Dr. Warne most recently served as the executive Director of the Aberdeen Area Tribal chairmen’s health Board in rapid city. In addition, he is an adjunct clinical professor at the Ari-zona State University Sandra Day o’connor college of Law where he teaches American Indian health Policy. Dr. Warne is a member of the oglala Lakota tribe from Pine ridge, and comes from a long line of traditional healers and medicine men. he received his medical degree from Stanford University in 1995 and his Master of Public health from harvard University

with a focus on health policy in 2002.Dr. Warne is a certified Diabetes

educator (cDe) and he is a Diplo-mate of both the American Board of family Practice and the American Board of Medical Acupuncture. he has completed fellowships in Alter-native Medicine from the Arizona center for health and Medicine and in Minority health Policy from harvard Medical School.

Dr. Warne’s work experience includes several years as a primary care and integrative medicine physi-cian with the gila river health care corporation in Sacaton, AZ and three years as a staff clinician with the national Institutes of health in Phoenix where he conducted diabetes research and developed diabetes education and prevention programs in partnership with tribes.

Warne Named Director of Sanford Office of Native American Health

Donald Warne

a Conversation with Doctor Donald WarneBy Charlotte Hofer, American Cancer Society

Dr. DonALD WArne, the American

cancer Society’s newest board member,

has a vision: to increase awareness of

American Indian cancer disparities. An

enrolled member of the Oglala Lakota

tribe in pine ridge, SD, Warne has felt the

impact of a cancer diagnosis within his

own family. When he was a young boy,

his grandmother, who lived on the pine

ridge reservation, died from lung cancer.

Health care advocate says native americans are being left behind in cancer care.

Warne believes that if his grandmother

had had access to more cancer resources

at the time, her suffering could have been

alleviated. Warne cites this experience as

one of the main reasons he got into

healthcare.

Despite his busy schedule, Warne

found time to answer some questions

about cancer disparities within the Native

American population.

CH: Where do you feel Native Ameri-cans are being left behind in cancer care?

DW: At every possible level. We have

populations that live in a great deal of

poverty, and a result of that is that our

health systems are impoverished as well.

We don’t have adequate prevention or

education. We unfortunately have very

high rates of cigarette smoke, and that is

leading to cancer disparities. We have

shortcomings in the amount and types of

screenings we are doing in our popula-

tion. Once we get a diagnosis, we don’t

always have access to the most current

technologies and treatments for cancer.

the shortfalls are in prevention, screening,

education, treatment, aftercare, research

and data. We need improvement on all

levels.

CH: How can we make healthcare materials more culturally appropriate for Native Americans?

DW: One size does not fit all when we’re

talking about cancer education. even

within populations like American Indians,

we have hundreds of tribes with different

beliefs about health. there has to be cul-

turally appropriate development of edu-

cation materials. that’s why it’s important

to have diversity in the makeup of the

board of groups like AcS, in order to help

facilitate more cultural competency.

CH: How important is collaboration between anyone involved with fighting cancer?

DW: We can’t connect resources to

people if we don’t collaborate. One of my

roles at AcS will be to facilitate those col-

laborations. We need to link programs

and services that are available in order to

provide the best services to all commu-

nity members, especially ones who are

September / October 2010 11midwestmedicaledition.com

ThIS IS AverA’S 12Th consecutive ‘Most Wired’ and seventh consecutive “Most Wireless” Award, making Avera the only health system in the nation to make both lists every year running since their inceptions. Avera is the only health system in the State of South Dakota to be named to the two lists this year.

“We are very proud of the work being done across the system to use technology to improve patient care,” said Jim veline, senior vice president of Information Systems. “To be included in this national recognition is affirma-tion that Avera is making an impact and staying ahead of the technology curve.” This year’s survey reveals continued

progress for hospitals in patient safety initiatives as compared to hospitals not on the most wired list. fifty-one per-cent of medication orders were done electronically by physicians at Most Wired hospitals, up from 49 percent last year.

Additionally, Most Wired hospitals have made improvements when it comes to sharing information during care transitions. for example, new medication lists are electronically delivered to caregivers and patients 94 percent of the time when a patient is transferred within the hospital, 98 per-cent at discharge and 86 percent when transferred to another care setting.

avera once again Most Wired, WirelessAvera has been recognized as one of the nation’s ‘Most Wired’ and ‘Most Wireless’ health systems according to the results of the 2010 Most Wired Survey released in the July issue of Hospitals & Health Networks magazine.

Bobby Hegge, CCRN, works with patient monitoring technology in the Avera McKennan iCU.

suffering from terrible disparities. We

absolutely cannot do that without

collaboration.

CH: What has cancer taught you?

DW: It has taught me there is an incred-

ible amount of suffering that communi-

ties endure that is preventable, and we

need to focus as much effort as possible

on prevention. but when someone is

diagnosed, we need to access resources

to alleviate suffering. the way our cur-

rent systems are set up for impoverished

people unfortunately facilitates more

suffering than healing. but what I

learned is it doesn’t matter if you’re

American Indian or non-Indian, these

circumstances in a nation as great as

ours should not be acceptable to any-

body. With the resources we have in this

country, we should not have to see this

type of suffering continue. American

Indians in the Northern plains have

among the worst disparities in cancer

incidence and cancer deaths in the

nation. It’s time for change.

Charlotte Hofer is Public Relations Manager for the American Cancer Society in South Dakota. Her work focuses on cancer education to diverse populations. She is a member of the Native American Journalists Association, and writes a national health column for Indian Country Today.


Daniel petereit, m.D., radiation Oncologist at the regional cancer care Institute and Walking Forward Grant principal Investigator; and b. Ashleigh Guadagnolo, m.D., mpH, of m.D. Anderson cancer center, radiation Oncologist and Walking Forward collaborator.

There Are MAny BArrIerS to cancer care within the American Indian community in Western South Dakota. Some barriers, such as lack of awareness about screenings and treatments, are specific to the patient or to the community. other barriers are within the healthcare system itself. Limited funding requires IhS facilities to prioritize, putting acute ‘life and limb’ prob-lems before chronic conditions. The nearest cancer center may be hours from a patient’s home, making treatment even more daunting.

“Self-advocacy may be an issue as there is limited cancer awareness in this population,” says Daniel Petereit, MD. Dr. Petereit is a radiation oncologist at the regional cancer care Institute and Principal Investigator for a unique com-munity-based research program called Walking forward.

funded by the national cancer Institute, the goal of Walking forward is to lower

cancer mortality rates among American Indians through tailored patient navigation and education and by helping more of them get enrolled in research initiatives and inno-vative clinical trials. The first step in estab-lishing the first-of-its-kind program was to build trust within the American Indian communities.

“Technology can only take you so far with this population,” says Dr. Petereit. “We obtained tribal letters of support for every new protocol we implemented with Walking forward, so it has been a long process. We now have staff embedded within the IhS system and we are known and have estab-lished trust on the reservations we serve.”

Within IhS, Walking forward health navigators or cancer screening coordinators help by educating the community about cancer and the importance of early detec-tion and by coordinating screenings for prostate, cervical, colorectal and breast

addressing Cancer Disparity among american IndiansBy Alex Strauss

Walking forward


the Walking Forward team, back row, L-r: Vanessa Short bull, community research Supervisor; Dave Koop, rN, patient Navigator & clinical Oncology research Nurse; caroline Spotted tail, community Navigator for the rosebud reservation; Daniel

petereit, m.D., radiation Oncologist & Walking Forward Grant principal Investigator; raylene miner, community Navigator for the cheyenne river reservation; bill Kelly, Grants Administrator; Amy boylan, rN, Lead clinical Oncology research Nurse; b.

Ashleigh Guadagnolo, m.D., mpH, m.D. Anderson cancer center radiation Oncologist and Walking Forward collaborator. Front row, L-r: Kristin cina, clinical research Assistant; Simone bordeaux, LpN, Health Navigator for the rosebud and pine ridge

reservations; Shalini Kanekar, phD, program Director; Kim crawford, community Navigator for the pine ridge reservation; Deb brunette, rN, clinical research Supervisor & patient Navigator; and michele Sargent, rN, clinical Oncology research Nurse.

Not pictured: Linda riggio, clinical research Associate.

cancer. Just as important as helping patients get those screenings is fol-lowing up on abnormal results and pointing patients toward next steps. As part of the new cancer screening pro-gram, Walking forward staff will assist patients with an appropriate referral who have abnormal test results.

“This structure has allowed us to further improve our community-based participatory research efforts,” says Dr. Petereit. “This is significant because no one has even been able to do this before, at this level, with this population. We have done it by hiring native American staff that live in the community who actively assist patients from cancer screening to treatment - which hopefully will lead to improve cancer cure rates.”

Two thirds of the Walking forward staff is based in rapid city, while the other third is distributed on the Pine ridge, rosebud and cheyenne river reservations. The research program covers all of western South Dakota and reaches into Wyoming and nebraska.

To date, the program has enrolled an unprecedented 2000 American Indians into various research studies.

“The idea behind involving more patients in clinical trials is that it gives them access to state-of-the-art therapy, it ensures that their therapy will be safe and closely monitored, and it improves the potential for positive outcomes and improved quality of life,” says Dr. Petereit.

one significant study made possible by Walking forward is a study of Ataxia Telangiectasia Mutated (ATM) gene, a gene involved in DnA repair. The premise of this study is that spe-cific mutations (or changes) in this gene could predispose American Indians to the side effects of radiation. To test the theory, one hundred American Indians and 100 non-natives have been enrolled in the trial. Their blood was tested for the presence of the mutations in this gene and radiation side-effects are being closely monitored and recorded. Data from this study may help the

physicians in providing the best treat-ment options to the patient.

In addition to generating participa-tion in the ATM genetic trial, Walking forward has helped bring about an accrual rate of 5 percent in clinical trials, including both cancer treatment and cancer control trials. American Indian cancer patients navigated through the program are also signifi-cantly less likely to miss radiation therapy appointments. ncI funding for the program has just been renewed for another five years.

“We want to continue to ‘walk for-ward’ and build on the initial success we have had and expand our collabora-tion with other researchers,” says Dr. Petereit, whose long-term dream is to build a research institute. “Ultimately, the things we are learning from this population may not only reduce cancer mortality rates but may also give us more information that will help other medically underserved and rural populations.”

13


UrInAry InconTInence is the involuntary loss of urine which affects nearly 200 mil-

lion people worldwide and 25 million adults in the United States, making it more prevalent than diabetes. Studies have shown the cost of urinary inconti-nence and overactive bladder to be as great as $32 billion annually in the U.S. Individuals with urinary inconti-nence pay an estimated $9,000 per year for routine care, although the cost directly increases as the severity of this condition increases.

Women are particularly prone to urinary incontinence. Surveys have shown that one in four women over the

age of 18 has experienced some level of urinary incontinence, and that 75 per-cent to 80 percent of urinary inconti-nence occurs in women. There are varying reasons why urinary inconti-nence rates are higher in women. Among these are pregnancy, vaginal deliveries, and menopause. other risk factors for urinary incontinence in all populations include obesity, diabetes, vascular disease, and smoking.

Incontinence has wide-reaching implications for individual sufferers. The social costs of urinary incontinence are great, where even mild symptoms can adversely affect social, interper-sonal, and professional functions. Social

c o n s e q u e n c e s include problems with quality of life, intimacy and self-esteem, all of which are strongly related to even minimal issues with hygiene asso-ciated with the condition. occu-pational issues include lost pro-ductivity and issues related to hygiene.

Urinary incon-tinence has been studied throughout the world in var-ious populations, including (chi-nese, Taiwanese, South Korean, egyptian, Turkish, Thai), and in the United States:

African American, hispanic-American and caucasian women. It is currently unknown if differences in incontinence prevalence or type exist for American Indian women because they have not been included in urinary incontinence research.

Preliminary investigation has now been performed and completed by the Sanford health Disparities group along with Drs. fiegen and Benson of San-ford Urogynecology and female Pelvic Medicine. These findings have not yet been published but are in preparation for submission to an appropriate journal. These findings have indicated the need for specialty care for this group of women.

A “Phase II” to the study is in prep-aration of implementation. The group at Sanford health and USD School of Medicine has been awarded a five year national Institutes of health grant to initiate this care for the American Indian women of the South Dakota region. The group’s goal is to serve as many women as possible, with a long range goal of extending the opportu-nity to all American Indian women in South Dakota and possibly beyond.Dr. Michael Fiegen practices with Dr. Kevin Benson at Sanford Clinic Urogynecology and Female Pelvic Medicine in Sioux Falls.

first study of Incontinence in american Indian Women shows need for specialty CareBy Michael Fiegen, MD


rural Digital mammography Gets a Shot in the Arm from

trust FundIn SoUTh DAKoTA, an estimated 520 women are diagnosed with breast cancer each year. now, funds from The Leona M. and harry B. helmsley charitable Trust are making it pos-sible for health systems around the region to try to improve those num-bers with the most advanced diag-nostic tool for breast cancer: digital mammography.

regional health will receive $1.98 million in funding over three years from the helmsely Trust for digital mammog-raphy services for rural western South Dakota. The sites to receive digital mammography equipment are Sturgis regional hospital, Queen city regional Medical clinic in Spearfish, and rapid city regional hospital.

Avera Queen of Peace hospital in Mitchell will receive $698,928 from the same trust to fund a mobile screening project for digital mammog-raphy. The majority of primary care clinics in the 19-county area served by Queen of Peace do not have digital mammography.

According to Mike Kowall, Direc-tor of Diagnostic Imaging at Avera Queen of Peace, “The grant has funded the purchase of a Lorad Selenia full field Digital Mammography-r2 Digital with cAD which will be loaded onto a 35 ft. customized mobile van.”

By fall, they anticipate taking digital mammography to Avera De Smet Memorial hospital, Aurora county clinic, Avera corsica Medical clinic, Avera Lake Andes clinic, Avera Salem family Medical clinic, Burke community hospital, Avera community clinic in chamberlain,

fort Thompson Indian health, Lower Brule Indian health, Avera St. Joseph Medical clinic in howard, and Whiting Memorial clinic in Woonsocket.

Another $489,300 from the Trust will go to Sanford health. Sanford will use the money to renovate the existing mammography service at Sanford Mid-Dakota Medical center (SMDMc) in chamberlain. In addi-tion, the Sanford health network will provide $371,836 to purchase and operate a 16-passenger van that will travel to Indian reservations and communities in remote areas in the three-county service area.

“We want to build awareness of the importance of cancer screening and debunk myths and misconceptions about cancer and cancer treatment,” said Maureen cadwell, ceo of SMDMc. “The center will be created for women, rather than a one-size-fits-all clinic waiting room.”

Brule county, home to SMDMc, has a death rate due to female breast cancer that is more than double the rates of the state of South Dakota and the nation. It is hoped that increasing the number of digital screenings will improve early detection and reduce breast cancer mortality rates.


An AnonyMoUS KIDney donor in July began a sequence of ten surgeries, resulting in five people in two states receiving kidney transplants.

The transplant chain included two surgeries in fargo at Sanford health Medical center and eight in Minne-apolis, four at Abbott northwestern hospital and four the University of Minnesota Medical center, fairview.

This rare chain of surgeries was made possible by unique programs at the transplant centers. The non-directed donor program allows individuals who meet strict criteria to donate a kidney, anonymously, to the most compatible recipient on the waiting list. The paired exchange kidney donation program allows a potential recipient with a willing, but incompatible, donor to be

placed in a “pool” with other incompat-ible donors and potential recipients. The end result is that the donor agrees to give a kidney if a match is found for his or her partner.

In this case, a non-directed donor in Minneapolis was a match for a potential recipient in fargo in the paired exchange pool. The Minneapolis kidney was flown to fargo. Two surgeries later, a kidney from fargo was driven to Minneapolis, extending the chain with four more trans-plants at Abbott northwestern hospital and University of Minnesota Medical center, fairview. In total, ten people pro-duced five successful kidney transplants.

“The idea of a transplant chain makes many additional living donor transplants possible, even when the donor- recipient pairs do not match,” says

transplant surgeon Dr. Bhargav Mistry with Sanford health. “chain transplants, also called ‘kidney exchange’ or ‘swap programs’, are very rare. With over 250 transplant centers in the nation, less than 20 programs offer such an option.”

non-directed donation is anony-mous. Transplant surgeons say all donors and recipients are recovering and doing well.

September 9th is International Fetal Alcohol Spectrum Disorder (FASD) Awareness Day The Center for Disabilities o�ers FASD diagnostic clinics in Sioux Falls and Rapid City. In-services, on-site consultations, and in-depth workshops on FASD are also o�ered.

Contact the Center for Disabilities at 800-658-3080 (V/TTY) or at www.usd.edu/cd to learn more!

FASD is 100% preventable!

A University Center for Excellence in Developmental Disabilities Education, Research and Service

Anonymous donor triggers chain of kidney transplants at three hospitals

September / October 2010 17midwestmedicaledition.com 17

Chances are your protection is coming up short.

05-2844 The Northwestern Mutual Life Insurance Company, Milwaukee, WI (Northwestern Mutual). Michael W Mohr is an Insurance Agent of Northwestern Mutual (life and disability insurance, annuities) and a Registered Representative and Investment Adviser Representative of Northwestern Mutual Investment Services, LLC (securities), a subsidiary of Northwestern Mutual, broker-dealer, registered investment adviser and member FINRA and SIPC.

Until you retire, your most important asset is your ability to earn income. Yet the average employee disability program covers only about 60% of your salary. At Northwestern Mutual, we offer disability insurance that can help close the gap, leaving you and your income protected if you’re sick or hurt and unable to work.

Michael Mohr Financial AdvisorThe Lowrey Financial Group(605) 995 - 0300 michaelmohr-nm.com

every yeAr in America, more than half a million babies are born prema-turely. nearly 28,000 die before their first birthday. The highest risk is among mothers who have no prenatal care.

It’s a healthcare crisis DAKoTA cAre, a South Dakota-based physician-owned insurance company is hoping to reduce by joining forces with the national ‘healthy Mothers, healthy Babies’ coali-tion and bringing Text4Baby to South Dakota. Text4Baby is a new mobile infor-mation service that provides free text messages to pregnant women and new mothers.

“There is a strong link between early prenatal care and a lower infant mortality rate. And yet, one out of every eight women don’t receive the care they need,” explains Trisha Dohn, Director of health and Wellness for DAKoTAcAre. “Text-4Baby is a great way to deliver valuable, potentially life-saving, information. And it’s delivered through a mode of commu-nication that is very popular, especially among women of childbearing age.”

Women can sign up for the service by texting BABy (or BeBe in Spanish) to 511411. Messages are sent each week, timed to the woman’s due date or the baby’s date of birth. The texts focus on topics critical to maternal and child health such as birth defects prevention, immunization, nutri-tion, seasonal influenza, mental health, oral health and safe sleep.

“Studies show each dollar spent on prenatal care through a maternity management program can save $4.75 in medical bills later,” says Dohn. “By con-necting South Dakota women with Text-4Baby, we believe premature births can be reduced and families spared thousands of dollars in preventable expenses.”

nationwide, more than 42,000 women have enrolled with Text4Baby since it launched earlier this year. Two thirds of the participants are expecting a baby.

New text message Service Aims to prevent premature births

Medicine is feeling the effects of regulatory and legislative changes, increasing risk, and profitability demands—all contributing to uncertainty and lack of control.

What we do control as physicians: our choice of a liability partner.

I selected ProAssurance because they stand behind my good medicine. In spite of the maelstrom, I am protected, respected, and heard.

I believe in fair treatment—and I get it.

One thing I am certain about is my malpractice protection.”

“As physicians, we have so many unknowns coming our way...

Professional Liability Insurance & Risk Management Services

ProAssurance Group is rated A (Excellent) by A.M. Best. For individual company ratings, visit www.ProAssurance.com • 800.279.8331

3-7-26 MED Magazine.indd 1 7/21/10 12:14:02 PM


SAnforD USD Medical center has been ranked among the top hospitals in the country for diabetes and endocri-nology care in U.S. news & World report’s 2010-11 Best hospitals, online at www.usnews.com/besthospitals and featured in the August print issue of U.S.news.

Best hospitals 2010-11 includes rankings of 152 medical centers nation-

wide in 16 specialties. The rankings in 12 of the 16 specialties were driven by hard data such as death rates, proce-dure volume, and balance of nurses and patients. In the four remaining special-ties—ophthalmology, psychiatry, reha-bilitation, and rheumatology—hospitals were ranked on reputation alone. Sanford ranked #43 in Diabetes & endocrinology category.

sanford ranks in u.s. news 2010-11 best Hospitals for Diabetes and endocrinology

“everyone on the diabetes and endocrinology team here at Sanford looks at patients in the totality,” says vishal Bhatia, MD, Sanford clinic Diabetes and Thyroid. “We pay close attention to all problems associated with their diagnosis. complete care for our patients is our priority, for both inpatients and outpatients.”

To be considered in any of the 12 data-driven specialties, a hospital first had to meet at least one of four criteria: It had to be a teaching hospital, be affili-ated with a medical school, have at least 200 beds or have 100 or more beds and the availability of four or more types of medical technology considered impor-tant in a high-quality medical facility, such as a PeT/cT scanner and certain precision radiation therapies.

The hospitals also had to meet a volume requirement, individually calculated for each specialty. The required volume was the number of Medicare inpatients from 2006 to 2008 who had various specified procedures and conditions in the specialty. A hos-pital that fell short could still qualify if it had been nominated by at least one physician in any of the U.S. news Best hospitals reputational surveys conducted in 2008, 2009 and 2010.

everyone has wishes. most people have been heard to say they wish it would quit raining, wish they could go to Hawaii, wish they could afford a Lexus or wish they could take the family on a cruise. For some, the wish is that their child did not have cancer. Unfortunately, many wishes never come true.

the make-A-Wish Foundation® of South Dakota is dedicated to making some wishes into realities. the organization gives children

2-1/2 to 18 years of age suffering with life-threatening medical conditions a wish or a dream of a lifetime. In June and July, the South Dakota chapter of make-A-Wish® granted 30 wishes, a record for the organization. Summer is a tremendously busy time at make-A-Wish®. At a cost of nearly $7,000 each, more than $210,000 was required to make those children smile.

While they can’t cure a child’s cancer, make-A-Wish can help make dealing with it

a little easier with a trip to Hawaii, a cruise, a chance to meet a favorite tV or Sports celebrity or a visit to Disney World. make-A-Wish can help make a shopping spree possible, take a child skydiving, buy them a big screen tV, or send them to the World Series or the Super bowl.

the make-A-Wish Foundation® of South Dakota depends on the help of medical personnel, physicians, nurses, social workers and

more. If you know of a child who has been diagnosed with a progressive, degenerative or malignant medical condition, please call us. the make-A-Wish Foundation® of South Dakota can be reached at 1-800-640-9198, 24 hours a day, 7 days a week.

Record Summer for Make-A-Wish

In whose hands will you place her?

Physicians’ Priority Line 1.888.592.7955

www.ChildrensOmaha.org

Intensive Care for Newborns

When a newborn is critically ill, a single call gives you instant access to our neonatal intensive care specialists and a full range of pediatric and surgical subspecialists, all supported by state-of-the-art technology and equipment. It can also link you to our neonatal transport service team, who will arrange for transport to Children’s Hospital & Medical Center based on the child’s needs. Twenty-four hours a day, seven days a week, one call links you to physician-to-physician consults, referrals and admissions. There’s no problem too large, no child too small.

MEd Midwest Med Ed, Aug, 2010.indd 1 8/5/10 9:54 AM

w

Primary care physicians see patients every day with risk factors for sleep apnea

such as diabetes, obesity and family history,” says Dr. Bryce Robison, President of Family

Health Care of Siouxland.

According to the national Sleep foundation, nearly one in five adults suffers from excessive daytime

sleepiness. Sleep disorders, such as obstructive sleep apnea, are often the undiscovered cause. finding and treating these disorders can not only improve sleep and cure daytime sleepi-ness, but it can also address a host of health problems associated with poor sleep quality.

family health care of Siouxland is committed to helping patients get a better night’s sleep – and stay healthier day and night – with its new Sleep center. Located on Sioux Point road in Dakota Dunes, the Sleep center is the only Sleep Lab in the Siouxland area accredited by the American Academy

of Sleep Medicine. Dr. ross Bacon, a Pulmonologist certified in Sleep Medicine, is the Sleep center’s Medical Director. In conjunction with hypnos Sleep Wellness, based in Sioux falls SD, family health care of Siouxland Sleep center has the technology to conduct and interpret a wide variety of sleep studies.

While patients sleep in comfortable hotel-like rooms, the center’s certified Sleep Technicians take measurements to determine how much and how well each patient sleeps. Multiple bodily functions including eye movements, brain waves, heart rate and rhythm, muscle function, air flow through the nose and mouth, respiratory effort and oxygen levels are monitored using state-of-the-art equipment.

“Because our Sleep center is an out-patient facility, having a sleep study done here can be an economic benefit for patients,” says family health care executive Director Shanin harding. “When they come to our facility, patients are not billed a facility fee as they would be if they had the same type of test in a hospital inpatient setting.”

About Obstructive Sleep Apnea The most common type of sleep apnea is obstructive sleep apnea which occurs when the muscles in the back of the throat that support the soft palate, uvula, tonsils and tongue relax too much to allow normal breathing. The airway narrows or closes making breathing inadequate for 10 to 20 seconds and

By Alex Strauss

obstructive sleep apneaSleep Center Helps Doctors

and Patients unravel Potentially Dangerous

Nighttime Problem

Family Health Care of Siouxland is an independent primary care network with 23 primary care physicians, three Urgent Care facilities and an Imaging Center offering Open MRI, CT and Ultrasound. To refer a patient to the Sleep Center, please call 605-217-3900.

2020

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potentially lowering oxygen in the blood. The brain senses this inability to breathe and briefly rouses the sleeper so that the airway reopens. The most noticeable sign of obstructive sleep apnea is snoring, although not everyone who has obstructive sleep apnea snores.

“Primary care physicians see patients every day with risk factors for sleep apnea such as diabetes, obesity and family history,” says Dr. Bryce robison, President of family health care of Siouxland. “In these cases, sleep studies can be invaluable. our outpatient facility provides a comfort-able and convenient place to have these studies performed.”

Anyone can develop obstructive sleep apnea, although it most commonly affects older adults. It’s also especially common in people who are overweight. obstructive sleep apnea treatment may involve using a device to keep the airway open, administering positive oxygen pressure, or undergoing surgery to remove excess tissue from the nose, mouth or throat.

Signs and symptoms of obstructive sleep apnea include:• excessive daytime sleepiness

(hypersomnia)

• Loud snoring

• observed episodes of breathing cessation during sleep

• Abrupt awakenings accompanied by shortness of breath

• Awakening with a dry mouth or sore throat

• Morning headache

• frequent urination at night

• Difficulty staying asleep (insomnia)

This pattern can repeat itself five to 30 times or more each hour, all night long, impairing the sleeper’s ability to have a deep, restful sleep. The result if often daytime sleepiness although many people with this type of sleep apnea think they sleep well all night.

Who is at Risk? Anyone can develop obstructive sleep apnea. however, certain factors increase the risk:

• excess weight. More than half of those with obstructive sleep apnea are overweight.

• neck circumference. A neck circumference greater than 17 inches (43 centimeters) for men and 15 inches (38 centimeters) for women is associated with an increased risk of obstructive sleep apnea.

• high blood pressure

• A narrowed airway, either because of genetics or because of enlarged tonsils or adenoids

• chronic nasal congestion

• Diabetes. obstructive sleep apnea is three times more common \in people who have diabetes.

• Being male. In general, men are twice as likely to have sleep apnea.

• Being black, hispanic or a Pacific Islander. Among people under age 35, obstructive sleep apnea is more common in blacks, hispanics and Pacific Islanders.

• Being older. Sleep apnea occurs two to three times more often in \adults older than 65.

• Menopause. A woman’s risk appears to increase after menopause.

• A family history of sleep apnea. If you have family members with sleep apnea, you may be at increased risk.

• Use of alcohol, sedatives or tranquil-izers. These substances relax the muscles in your throat.

• Smoking. Smokers are nearly three times more likely to have obstructive sleep apnea.

Potential ComplicationsSleep apnea is considered a serious medical condition. complications may include:

• cardiovascular problems – About half the people with sleep apnea develop high blood pressure (hyper-tension), which raises the risk of heart failure and stroke. Patients with sleep apnea are also much more likely to develop abnormal heart rhythms such as atrial fibrillation.

• Daytime fatigue – People with sleep apnea often experience severe daytime drowsiness, fatigue and irritability. They may have difficulty concentrating and find themselves falling asleep at work, while watching Tv or even when driving.

• complications with medications and surgery – People with sleep apnea may be more likely to experi-ence complications after major surgery because they’re prone to breathing problems, especially when sedated and lying on their backs.

• Sleep-deprived partners – It is not uncommon for a partner to choose to sleep in another room. Many bed partners of people who snore are sleep deprived as well.

People with obstructive sleep apnea may also complain of memory prob-lems, morning headaches, mood swings or depression, and a need to urinate frequently at night (nocturia)

Patients sleep in comfortable hotel-like rooms where strategi-

cally placed cameras allow the Sleep Center’s Certified Sleep Technicians to monitor them

throughout the night.


a new Treatment option for severe Hypercholesterolemia: lDl apheresis

Local research tests New Uses for FDA-Approved DrugsThe SAnforD ProJecT has begun a clinical trial to test a novel method of beta-cell regeneration in patients with recently-diagnosed type 1 diabetes. The trial, entitled rePAIr T1D (restore Pancreatic Insulin response in type 1 diabetes) is open to patients between 11 and 45 who have been diag-nosed with type I diabetes within the last four months and can come to Sanford for research visits.

“The objective of this clinical trial is to determine if the medications can rescue the few beta cells that remain soon after the diagnosis of type 1 dia-betes; and whether new beta cells can even be regenerated,” says Alex rabi-novitch, MD, Principal Investigator of the trial and Associate Director of The Sanford Project.

Both medications under study are fDA approved drugs and are currently widely used on their own for other medical conditions. Sitagliptin is a drug found to control blood glucose in people with type 2 diabetes. Lansopra-zole is prescribed as an antacid for heartburn.

A total of 54 patients will be enrolled in rePAIr T1D. Thirty-six patients will receive test medications and 18 will receive placebos daily for 12 months, followed by a 12 month follow-up.

At the same time, another group of Sanford researchers is trying to find out whether the drug metformin, used to treat everything from obesity to dia-betes, can be used to fight breast cancer. With a $600,000 grant from Susan g. Komen for the cure, the Sanford/research USD researchers will study metformin’s effectiveness as a breast cancer-fighting drug either alone or in combination with other drugs.

MoST PeoPLe WITh hIgh cholesterol respond to a combination of diet and cho-

lesterol lowering medication. however, for people with a genetic condition that prevents their liver from taking up LDL cholesterol, even high dose medication might not always succeed; others might not tolerate medication due to side effects. The condition is known as familial hypercholesterolemia and affects about 1 in 500 people. It results in extremely high total and LDL cho-lesterol. If left untreated, many people go on to experience premature cardio-vascular disease and sudden death, sometimes as early as their 20s and 30s.

Until recently, the options for those who did not respond to or did not tol-erate medications were limited. Many patients assumed they were destined to experience recurrent cardiovascular events and interventions before dying young as so many of their family mem-bers before them. however, earlier this year regional Medical clinic in rapid city became the first center in South Dakota to offer a new treatment option for such patients. The procedure, known as LDL apheresis, removes LDL cholesterol from the plasma in patients in whom diet and medications have been ineffective and/or not tolerated. LDL apheresis is approved by the fDA for the following patients:

1. LDL-c > 200 mg/dL(with cardiovascular disease)

- or -

2. LDL-c > 300 mg/dL(without cardiovascular disease)

During LDL apheresis, whole blood is removed from the patient, anticoagu-lated, and separated into blood cells and plasma. A disposable filter removes LDL and other atherogenic lipid parti-cles. The blood cells and plasma are recombined and then returned to the patient. The outpatient treatment ses-sions take about three hours and are usually performed every two weeks. LDL apheresis decreases risk of cardio-vascular eventsand death by as much as 72 percent compared to medications alone. In patients for whom the proce-dure is indicated, it is covered by Medi-care and most private insurance.

Physicians with questions about LDL apheresis can contact me at (605) 718-3300. Patients with questions should consult with their personal health care provider.

Thomas Repas, DO, FACP, FACOI, FNLA, FACE, CDE, is an Endocrinologist, Clinical Lipidologist and Physician Nutrition Specialist in practice at the Regional Medical Clinic in Rapid City and is a Clinical Assistant Professor with the Department of Medicine, Sanford School of Medicine, University of South Dakota.

By Thomas Repas, DO FACP


Reviewed by Dr. John Berdahl, Ophthalmologist

Medicine is a noble profession. Unfortunately, the professionals within it don’t always act nobly.

Waking Up Blind: Lawsuits Over Eye Surgery

MeDIcIne IS A noble profession. Unfortu-nately, the professionals within it don’t always

act nobly. I was recently at an ophthal-mology conference where a speaker was describing new advances in refractive surgery for children.

A colleague of mine from residency nudged me and said, “Do you know who that is? That’s Dr. c. have you heard about the book that was recently written about him?”

My friend went on to tell me about a new book on the speaker and his prac-tice as chairman of the esteemed emery University Department of ophthal-mology. The book, Waking Up Blind: Lawsuits over eye Surgery by Thomas S. harbin, Jr., MD, chronicles mis-deeds, misinformation and mistreat-ment of patients who had entrusted their eyesight to his care. I went to my hotel room that night and immediately downloaded the book and began reading. The experience was like none I had ever had.

I was immediately engaged. The characters were real people, some of whom I knew personally. As the elec-tronic pages turned, I found myself almost feeling guilty, as though I were reading someone else’s diary. Dr. c, the main character, was by all accounts a brilliant researcher and an adept sur-geon. According to the book, he lacked only judgment and scruples. he is described as having fostered an envi-ronment of fear in which everyone

including faculty, residents, nurses and staff obeyed orders like a military com-mand without question.

As I read, I was reminded that phy-sicians, nurses, and healthcare admin-istrators are susceptible to the same human flaws as everyone else. Because of Dr. c’s apparent lack of integrity, Waking Up Blind chronicles how trans-plantation tissue was distributed so that the rich (and potential donors to the institution) would receive the best tissue for corneal transplantation while patients of lesser means would end up with lesser quality tissue. other alle-gations include performing unneces-sary surgery, doing surgery on the wrong eye, and railroading any col-league who tried to question such behavior.

c. S. Lewis said, “If you take a dis-honest man and give him an educa-tion, instead of stealing the railroad spike, he’ll steal the whole railroad.” Unfortunately, humans don’t always err on the side of right. But as physi-cians, we have a sacred duty to put the needs of others before our own. There are few times in life where someone is more vulnerable than the moment when they entrust a doctor to make a decision, or make an incision, that will forever change their lives. This book reminded me that, if we can imagine ourselves as the patient in a vulnerable position and simply treat them as we would want to be treated, we will be a long way toward fulfilling the noble oath we once took.

author Dr. Thomas s. Harbin, Jr., MD

In review

Have you read a book, seen a movie, heard a concert, etc. that moved you? Whether it made you mad or make you laugh, meD wants to help you share it with your colleagues. Send your reviews to [email protected]

What You’re reading, Watching, Hearing


Getting it Right the First Time

Patient registration—it all starts with correct and complete front end data collection including patient demo-graphic input, insurance identification and eligibility verification. ensure that each patient has provided current and accurate benefits coverage at the time of the appointment; request updated information such as a copy of insur-ance cards, most current patient demo-graphics, and other relevant supporting documentation at each visit.

• Mandate that registration staff ask key qualifying questions relating to patient’s specific insurance coverage such as effective date of policy, co-payment for services, etc. and implement a standardized registra-tion “checklist”

• Implement security controls to limit staff members authorized to add new records to patient payer table files.

• getting the “front end” registration correct will have the greatest impact on improving your practice’s collec-tions rate.

Pre-Authorization; don’t miss out on reimbursement opportunities by missing this step. ensure appropriate staff mem-bers are aware of the circumstances/sit-uations that require this function to be performed.

Proper provider documentation; clinicians must provide thorough, accurate information that clearly

identifies the patient episode of care and substantiates the code levels used for optimal reimbursement.

Quality control; coders and billers should be well trained, certified and current with coding and reimburse-ment guidelines per payer, as well as being aware of upcoming revisions and mandates such as the new Medicare and Medicaid initiatives. (This will dramatically reduce denials and help alleviate the accounts receivable bottleneck.)

ensure all provider credentials are in place.

Claims Aging —Track, Manage, Improve

An effective age claims management process is an essential best practice component for any modern medical practice. Assign process ownership responsibility and be consistent in initiating aged claim follow up on a timely and regular basis. Develop a process that performs predictably and like clockwork day-in and day-out to optimize results. electronic claims processing allows for quicker reim-bursement and more efficient follow-up.

Denials —Do Not Accept “No”

Diligence in denials management; do not automatically accept a denial.

Thoroughly research and understand the underlying denial code basis to determine appeal options. Be aware that every claim is potentially a denial.categorize denial types to streamline the review and appeal process.

• Include line item denial research not just “zero pays”.

• Act on all correspondence from payers within 48 hours.

• failure to effectively address denials may result in repeated denials on subsequent claims.

revenue cycle management has the potential to provide a substantial roI in virtually any medical practice envi-ronment, with returns that can begin to be recognized within 30 days or less.

Natalie Bertsch is Vice President, Admin- istrative & Business Development with DT-Trak Consulting, Inc.

M ost medical practices come up short when it comes to recovering their full entitlement for services provided. Here’s how your team can ensure that your practice does not leave those hard earned dollars on the table.

revenue Cycle Management Is Your office receiving Its Maximum reimbursements?By Natalie L. Bertsch, RHiT


PeoPLe Are living longer. obesity rates are growing along with the health prob-lems that are tied to obesity.

This results in an increase in the number of heavy, sick, and dependent patients. The number of strain injuries is on the rise in healthcare and most of these injuries are due to overexertion from transferring and repositioning patients. The turnover among nursing assistants is extremely high. Workers quit because of stressful working con-ditions. high turnover means short staffing, lifting alone, and poor patient care. This all leads to higher costs for organizations in recruiting and training new employees. The conditions that cause the higher frequency and severity of injuries are also leading to higher workers’ compensation premiums.

healthcare organizations are begin-ning to try innovative solutions to decrease their exposure to these trends. Job function matching (JfM) is a very useful tool during the post offer phase as well as during the post injury/return to work phase. The process is first built

by performing a job function analysis. A job function description is developed based on the job analysis. A job func-tion test is then designed to simulate the job demands. This testing process is beneficial at the time of hire to ensure the prospective employee has the func-tional ability to perform the job. It is also beneficial after an injury occurs to help determine what an employee can do to stay at work as compared to what they cannot do (common work restric-tion is no lifting over 20 pounds).

employees who are better matched with their jobs are less likely to be injured since they have demonstrated the functional ability to perform the job. If they are injured, a more struc-tured return to work plan is activated.

Along with more detailed job func-tion descriptions, ergonomic opportuni-ties are also a result of the job function analysis. force gauge measurements of 100 pounds or more can be a catalyst for purchasing equipment such as ceiling lifts, repositioning slings, and the local invention, the Dignity Wheelchair. Without performing the job function analysis to build the JfM process, those ergonomic opportunities would not materialize and the exposures to strain injuries would remain.

Jeff Roach is an Ergonomic and Loss Control Specialist with Risk Administration Services. He is a member of the South Dakota Occupational Therapy Association and a Clinical Assistant Professor for the Occupational Therapy Program at the University of South Dakota. He is currently pursuing formal ergonomic certification.

Injury Prevention and Management in Healthcare: Combining Job function Matching and ergonomicsBy Jeff Roach, MS, OTR/L

one of the first in the region, The great Plains Multiple Sclerosis center repre-sents a collaborative partnership between neurology Associates Pc, The Avera neuroscience Institute, the national Multiple Sclerosis Society and a wide range of professional resources dedicated to MS care.

The great Plains Multiple Sclerosis center has been designed to improve the lives of patients and their families through partnership with a comprehensive team of specialists dedicated to each patient’s unique needs. The center combines the talents and expertise of specialists from neurology, urology, psychiatry, rehabilita-tive medicine, physical and occupational therapy, and clinical social work services, as well as coordinating care with primary care providers in order to offer advanced, specialized care and improve patient outcomes.

Lisa c. viola, Do, is the Director of the new center and the associate director is Karen r. garnaas, MD.

Great plains mS center certifiedThe Great Plains Multiple Sclerosis Center has gained certification from the National Multiple Sclerosis Society.


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from allergy Testing to seizures, Conference focuses on Pediatric HealthheALTh cAre ProfeSSIonALS Are InvITeD To at-tend the Upper Midwest regional Pediatric conference, Sept. 23 – 24, at the Marina Inn and conference center in South Sioux city, nebraska. The conference, in its third year, offers unique insight into treating a wide range of pediatric conditions.

Areas of emphasis include diagnostic strategies for genetic disorders, pre-participation cardiac screening, juvenile idio-pathic arthritis, allergy testing, seizures and cytopenias. Keynote sessions feature nationally known professionals David c. Stockwell, M.D., MBA, children’s national Med-ical center in Washington, D.c., and charles r. Woods, Jr., M.D., MS, University of Louisville in Kentucky.

The 2010 Upper Midwest regional Pediatric conference is sponsored by children’s hospital & Medical center, Mercy Medical center, St. Luke’s regional Medical center and Prairie Pediatrics & Adolescent clinic, P.c., in Sioux city, Iowa, and the Siouxland Medical education foundation.

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midwest medical edition

Insights from the California’s Wine regionBy Heather Taylor Boysen

I ThInK MAny of us breathe a sigh of relief when summer wanes and fall begins to make its pres-ence known. September is one of

my favorite months as it signals cooler days, longer nights and more gentle temperatures. Although I can’t say that I anticipate the long winter, I am happy to say goodbye to the searing heat and humidity of summer. however, I found out recently on a trip to california that many people on the West coast are wishing for even a small sampling of South Dakota August weather.

I just completed a trip to california and tours of vineyards in both napa and Sonoma counties in August. While there, the temperatures were soothing and crisp, a huge relief from the swamp-like atmosphere back home. As much as I enjoyed the temperatures in cali-fornia, winemakers and vineyard owners alike were lamenting the lack of heat and sun that moves the grapes in stages toward véraison or the onset of ripening. Without the summer heat and sun, grape clusters that are normally turning colors or ripening this time of year are experiencing longer hang time on the vine and not changing color.

everywhere I went grapes were showing colors from bright green to light purple on the same clusters. vine-yard workers were cleaning and sprucing up equipment and probably enjoying the slower pace of getting ready for harvest while winemakers were pacing and wondering where summer was. It was heavily apparent while in a vineyard in Dry creek, seeing grape clusters culled and cleaned from vines and thrown to the ground to avoid mildew and rot, that this harvest season in this particular area of cali-fornia was going to face challenges. To put it in perspective, when I was in this same area three years ago at the same time of year, cabernet grapes off the vine were ripe, sweet and shockingly rich. This year my son would have said “sour gummy grapes Mommy!”

only time and weather will tell us what to expect coming out of california for the 2010 harvest, but the 2007 and 2008 vintages are by all accounts stun-ning years for california reds, particu-larly cabernet Sauvignon. As I tasted my way through 12 vineyards and many samples of wine, the same recur-ring theme presented itself, both with information from my hosts at each vineyard and what my palate was telling me. The 2007 vintage year is spectacular.

In my store, we are slowly begin-ning to see vintages turn to 2007 and I couldn’t be more excited. This may be a vintage year that sees some of the same

excitement produced in 1997. In fact, it may be a couple years before we see more of the

2007 vintages released as winemakers are holding them longer both in barrel and bottle. Many wineries are just now releasing the 2006 vintages. And let us not forget, previously released vin-tages, including the 2006’s are starting to drink really well right now and I would be remiss in not telling your that there are wonderful wines on my shelves right now.

Traveling through wine country and enjoying the hospitality of wineries is one of the most favorite things about my job. Although a vacation, it is a working one. I come back refreshed, but also armed with new information, insider insights and new wines to put on my shelves. I’m keeping my fingers crossed for my friends on the coast that their 2010 season progresses to their satisfaction. In the meantime, I know what to expect from the 2007 vintage and eagerly await more releases.

Grape expectations

29

cArDIovAScULAr sur-geon Dr. James reynolds closed his practice in July after 35 years of practice in

the Sioux falls community. During his more than three decades of leadership, Dr. reynolds has helped north central heart Institute and the Avera heart hospital to be nationally recognized centers for cardiac care. Dr. reynolds has been at north central heart since 1981.

“I am proud of what we have achieved working together in the fight against cardiovascular disease. The ultimate reward for all of us is the appreciation that our patients frequently express both for their care and for the won-derful people who deliver that care,” said Dr. reynolds. “I look forward to spending more time with my family and friends, enjoying my hobbies, and pursing new interests.”

Dr. reynolds is a lifelong South Dakota resident. he attended the Uni-versity of South Dakota, and received surgical training at Johns hopkins School of Medicine in Baltimore, Maryland. Dr. reynolds began his

c a r d i o v a s c u l a r practice in Sioux falls in 1975. he and six fellow physi-cians founded north central heart Insti-tute in 1981. he was also instrumental in founding the Avera heart hos-pital which opened in 2001.

Dr. reynolds served on numerous boards including the Avera health board, Sioux valley hospital board, Dakota care board, and the South Dakota Board of Medical and osteo-pathic examiners. he is a past president of the American college of Surgeons,

South Dakota State Medical Associa-tion and north central heart Institute. Dr. reynolds was inducted into the South Dakota hall of fame in 2006. he and his wife, Debby, have five children and six grandchildren. Dr. reynolds enjoys boating, hunting, sailing and farming.

Dr. James reynolds retired after 35 Years

“I am proud of what we have

achieved working together in the fight against

cardiovascular disease.


News & Notes

RegionaLRegional Health has joined the Premier health care alliance’s Accountable care organization (Aco) readiness collaborative. Acos are groups of providers who come together to accept accountability for a defined patient population’s care. Acos are designed to keep patients healthy and out of intensive care settings while shifting reimbursements to increasingly pay based on the achievement of top performance goals. The Aco readiness collaborative includes more than 50 health systems nationwide.

Regional Medical Clinic is pleased to announce the addition of gary childers, D.o., Internal Medicine, to the clinic staff. childers specializes in Internal Medicine and earned his Do from A.T. Still University, in Kirksville, Mo. he completed his general medical internship at riverside

hospital, in Trenton, Mich., and his internal medicine residency at Akron city hospital/Summa health System in Akron, ohio.

Bob Baxter, the chief operating officer of rapid city regional hospital (rcrh), has accepted the position of President at St. rita’s Medical center in Lima, ohio. St. rita’s is part of catholic health Partners. Baxter has been employed at rcrh since 2003.

The Black Hills community has once again shown great support for the Children’s Miracle Network (cMn), with 17,000 ducks sponsored in the 21st annual great Black hills Duck race on Sunday, July 25. More than $93,000 was raised for cMn. one hundred percent of the funds raised will be used to provide services and equipment for ill and injured children in the Black hills area served by rapid city regional hospital.

Regional Home Medical Equipment (RHME), a specialty provider of respiratory and home medical equipment in Deadwood, rapid city, Spearfish and Sturgis, has successfully fulfilled the requirements for receiving the exemplary Provider™ certificate of Accreditation from The compliance Team, Inc., a centers for Medicare and Medicaid Services (cMS) approved healthcare accrediting body based in Spring house, Pa.

Michael O. Robinson, M.D., joined the regional cancer care Institute on July 6. Dr. robinson has more than 30 years of experience. his most recent practice was in Pierre. Dr. robinson received his medical degree at the University of nebraska in omaha.

he completed his internal medicine residency at the University of Kansas, Kansas city and then completed a fellowship in medical oncology, also at the University of Kansas. he is board certified in internal medicine, medical oncology, and hospice and palliative medicine.

five physicians graduated from the Rapid City Regional Hospital Family Medicine Residency Program, on friday, June 25. graduation festivities took place

at the rushmore Plaza holiday Inn. Patricia Brooks, M.D.; ross Pieper, D.o.; Ana-Maria Suroiu, M.D.; christopher Wangsness, M.D.; and Saba Awan, M.D. received diplomas for having completed the three-year residency program. Dr. Pieper and Dr. Wangsness were the chief residents.

Jessica Foster, DPT (Doctor of Physical Therapy), recently joined regional rehabilitation Institute as a member of the vestibular and Balance team. Team members have all completed specialty training in vestibular and balance disorders.

Rapid City Regional Hospital’s Regional Weight Management is hosting its “Walk It off” event on Saturday, Sept. 11. The walk will begin at 10 a.m. at the regional rehabilitation Institute lower parking lot at 2908 fifth St., and will cover 2.5 miles of trail around the hospital campus. “Walk It off” is an annual event held as part of regional Weight Management’s surgical and non-surgical weight loss programs.

In its first year of operation, more than 4,300 adults and children have walked through the doors of South Dakota’s only school-based community health center. Tucked within general Beadle elementary School in north rapid city, the General Beadle Family Clinic is one of the community health center of the Black hills’ five sites. The general Beadle family clinic opened in August 2009, thanks in part to $599,999 in federal stimulus funds.

Rapid City Regional Hospital’s Medical Imaging department recently installed new digital tomography and cT (computed tomography) scanners. The first is the volumerAD (digital tomography), an enhanced, innovative x-ray procedure. It provides multiple high-resolution images including the chest, abdomen, extremities and spine in 11 seconds or less at a dose in the range of a normal x-ray examination. The second is the new 4D cT scanners. The SoMAToM Definition flash (Dual Source) and the SoMAToM Definition AS. The Siemens SoMAToM Definition flash, 128 slice cT, offers a fast high quality image but delivers a low dose of radiation. The flash scanner is capable of scanning the entire body in less than five seconds resulting in patient friendly scans. Both will be fully operational by September 2010.

SanFoRDSanford Health and WebMD Health Corp. have announced an educational collaboration on children’s health, nutrition and fitness. The partnership’s online destinations will provide parents, children and healthcare professionals with personalized resources and support to help promote and maintain a healthy and fit lifestyle for children and address the health dangers of childhood obesity. The educational resources are planned for launch in 2011.

Strength and conditioning expert Steve Bliss of Sanford hospital Wellness center was recently awarded the Boyd epley Lifetime Achievement Award at the national Strength and conditioning Association’s 33rd national conference. Bliss, a former president of the organization, has been with the Wellness center for 12 years.

The American Society of Clinical Oncology (ASco) and the ASco cancer foundation awarded Sanford hematology & oncology with its 2010 clinical Trial Participation Award in June. This award was presented for the clinic’s efforts to improve care of people with cancer through participation in clinical trials. In 2009, Sanford hematology & oncology provided cancer therapies to its 125 patients enrolled in clinical trials. The clinic currently has 100 ongoing clinical trials in cancer treatment and cancer symptom management.

Sanford Neurosciences and MeritCare Neuroscience (now part of Sanford health) both recently received national recognition for multiple sclerosis care. The national Multiple Sclerosis Society designated Sanford neurosciences and Meritcare neuroscience as Affiliated centers for comprehensive care. The affiliation is an innovative quality designation that helps those with multiple sclerosis (MS) find medical facilities with expertise in providing specialized MS care. Sanford neurosciences and Meritcare neuroscience are two of five centers honored with this distinction in the north central States chapter, and Meritcare neuroscience is the first MS center to be affiliated with the national Multiple Sclerosis Society in north Dakota.

Breast cancer advocate and registered nurse Gloria Top recently participated in the evaluation of research proposals submitted to the Breast cancer research Program (BcrP) sponsored by the Department of Defense. Top was nominated for participation in the program by Sanford Breast health Institute. As a consumer reviewer, she was a full voting member, along with prominent scientists, at meetings to

determine how the $150 million appropriated by congress for fiscal year 2010 will be spent on future breast cancer research.

Sanford Clinic Lake Norden announces expanded pediatric care for patients in the area. Judi Anderson, family certified nurse Practitioner (cnP) has completed the Pediatric nursing certification Board Test. Anderson now locally prevents and manages common pediatric acute and chronic conditions. Sanford clinic Lake norden serves a tri-county area with more than 3,300 children, and the nearest pediatricians are in Watertown or Brookings.

This year marked the 25th anniversary of the Children’s Miracle Network broadcast, which aired live on KeLoLAnD-Tv from Sanford children’s hospital on June 6. People from the region pledged a record $1.38 million. These donations will directly support the healthcare needs of local sick and injured children and their families.

Top

Bliss

Foster

Robinson

Childers

Baxter

Happenings around the region

midwestmedicaledition.comSeptember / October 2010 31

North Dakota State University Athletics and Sanford Health have reached an agreement naming Sanford health as the official sports medicine team for the Bison. With the wellness of the student-athlete coming first and foremost, there will be no interruption of care for nDSU athletics. Sanford health will provide comprehensive sports medicine services, including board-certified and fellowship trained orthopedic surgeons and primary care sports physicians, researchers and exercise physiologists.

Sanford Health is pleased to announce that Dr. David Pearce has accepted the additional role of vice President of research for the Sioux falls region. Dr. Pearce will oversee the research centers and cores including: cancer Biology, cardiovascular health, children’s health, environmental health and Safety,

health Disparities, Lab Animal resource facility and the Sanford Project. he will continue as Director of Sanford children’s health research center and Senior Scientist. Dr. Pearce brings a wealth of research experience and program development to this position. Please join me in welcoming Dr. Pearce to his new role.

aveRaAaron P. Baas, general Surgeon, has joined Avera Mitchell Surgical. Dr. Baas received his medical degree from the Sanford School of Medicine at the University of South Dakota and completed his residency at the Wichita center for graduate Medical education in Wichita, KS. Dr. Baas is a member of

the American Academy of family Physicians and the American Medical Association. he completed a medical mission trip to Peru, Amazon, and to venezuela.

Avera McKennan Hospital & University Health Center has received the American heart Association/American Stroke Association’s get With The guidelinesSM Stroke gold Performance Achievement Award. The award recognizes Avera McKennan’s commitment and success in implementing a higher standard of stroke care by ensuring that stroke patients receive treatment according to nationally accepted standards and recommendations. To receive the gWTg-Stroke gold Performance Achievement Award, Avera McKennan had to achieve two or more consecutive 12 month intervals of 85% or higher adherence to all gWTg Stroke performance achievement indicators to improve quality of patient care and outcomes. In 2008 and 2009, Avera McKennan received the gWTg Silver Award.

The Avera Cancer institute and the River of Hope Foundation have created a new partnership, with the ultimate goal of bringing awareness to cancer as a life-changing disease. Through this partnership, tranquil and healing retreats will be provided at the residences of six nominated individuals diagnosed with cancer. Patients impacted by these projects are featured during the 30 minute “river of hope” Tv show. To watch episodes online or check the weekly schedule, go to www.riverofhopefoundation.org.

The Commission on Cancer (CoC) of the American College of Surgeons (AcoS) has granted Three-year Accreditation with commendation to the cancer program at the Avera Queen of Peace Cancer Center. A facility receives a Three-year Accreditation with commendation following the onsite evaluation by a physician surveyor during which the facility demonstrates a commendation level of compliance with one or more standards that represent the full scope of the cancer program, including cancer committee leadership, cancer data management, clinical services, research, community outreach, and quality improvement. In addition, a facility receives a compliance rating for all other standards.

April K. Magnuson, MD, Pediatrician, has joined Avera Pediatrics Plus in Mitchell. Dr. Magnuson completed her residency in pediatrics at the University of Missouri in columbia and received her medical degree from the Sanford School of Medicine at the University of South Dakota. Dr.

Magnuson received the Service excellence hero Award from the University of Missouri children’s hospital in 2008. She is a member of /the American Academy of Pediatrics, American Medical Association, and the South Dakota Medical Association.

The Avera Heart Hospital has once again received chest Pain center Accreditation with PcI from the Society of chest Pain centers (ScPc). The ScPc is an international organization dedicated to eliminating heart disease as the number one cause of death worldwide. Avera heart hospital was the first hospital in South Dakota to receive accreditation in 2004, and is recognized for a continued commitment to innovation and improvement.

The Avera Heart Hospital is offering a new vascular screening through the Planet heart screening and prevention program. The vascular screening includes carotid artery screening, abdominal aortic aneurysm screening and peripheral artery disease screening. Avera heart hospital also provides a cardiac screening through their Planet heart Program which includes a calcium score cT, blood pressure, cholesterol check and education by a cardiovascular team.

North Center Heart institute will host the 28th Annual Fall Symposium on friday, october 1st at the Sioux falls convention center. The Symposium is designed for any health professionals with an interest in the diagnosis and treatment of cardiovascular disease. registation begins at 7:30 a.m. Mark gorden, MD, fAcc is this year’s program director.

otheRSPrairie Lakes Healthcare System in Watertown is celebrating its 25th anniversary. In 1986, two local hospitals – Memorial hospital and St. Ann’s hospital - consolidated to create Prairie Lakes healthcare System. The goal of this new system was to provide Watertown and surrounding communities with quality care – close to home. The system kicked off its anniversary with a new image campaign.

David Sly, DO is the new Primary & Specialty Medicine Service Line Director at the Sioux falls Dept. of veterans Affairs (vA) Medical center. Dr. Sly began his vA career in 2006 at the vA community Based outpatient clinic in Sioux city, Iowa. Prior to that time, he was in private practice for 13 years in Sioux city, Iowa and Quincy, Illinois. Dr. Sly is board certified by the American Board of family Practice and is a fellow of the American Academy of family Physicians.

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