McCreery Cancer Center

2013 Annual Report (for 2012 Data and Activities)

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Mission Statement:

Ottumwa Regional Health Center is a regional hospital committed to providing exceptional care in a

compassionate manner.

Vision Statement:

Ottumwa Regional Health Center will consistently be recognized in the top 5% in the nation as

a place where:

Our patients and their families receive exceptional care,

Our physicians experience a fulfilling practice

environment, and

Our staff and volunteers know they are respected and valued for the difference they make

every day.

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Table of Contents

Cancer Committee Chairman Report page 5

Cancer Committee Members page 6

Oncology Physicians page 7

Other Oncology Specialists page 7

Cancer Support Groups/Screening/Prevention page 8

Cancer Support Services page 9

Clinical Research page 10

Cancer Conferences page 10

Cancer Registry page 10

Performance Measures—CP3R Measures page 11-12

Statistical Summary of 2012 Cancer Cases page 13

References page 14

Important Numbers page 14

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Cancer Committee Chairman Report By Dr. Daniel Rothfuss, Radiation Oncologist Cancer Committee Chairman On behalf of the Cancer Committee of McCreery Cancer Center at Ottumwa Regional Health Center (MCC/ORHC), I am pleased to introduce the 2013 Cancer Program Report over 2012 activities and data. This report includes on overview of some of the improvements in patient care and significant events and accomplishments throughout the year.

♦ Ottumwa Regional Health Center strives to provide a full range of services and to continu-ously improve our quality of patient care, and through these efforts, Ottumwa Regional Health Center has maintained accreditation with the American College of Surgeons/Commission on Cancer continuously since 1990.

♦ Participation with American Cancer Society (ACS) activities and services has been a long-standing tradition at Ottumwa Regional Health Center. Patients and families benefit from the American Cancer Society’s Cancer Resource Network, Reach to Recovery, and Look Good…Feel Better services. Staff members take active roles supporting the ACS commu-nity events such as Relay for Life.

♦ Press Ganey, the nation’s leading healthcare satisfaction firm, conducts an on-going pa-tient survey to measure patient satisfaction at hospitals across the country. The results indicate that patients consistently perceive and rate their care experience at McCreery Cancer Center as exceptional. Patient satisfaction scores are almost consistently at the 99%, the highest possible ranking given in patient satisfaction.

♦ Review of performance measures supported by the American College of Surgeons/Commission on Cancer (ACoS/CoC) reveal that MCC/ORHC almost consistently maintains a 100% adherence to the recommended treatment guidelines for breast and colon

cancers. ♦ Ottumwa Regional Health Center acquired the Medical Oncology services and all the staff in October 2012 expanding the services available locally. The staff from Medical Oncology bring with them many years of experience and knowledge to provide specialized care for patients with cancer.

♦ The “Think Pink” event held October 1st was a huge success with 500 bags containing pink bagels from Big Apple Bagel and information from both the Susan G. Komen Founda-tion and the American Cancer Society was handed out in less than an hour! The goal was to raise awareness about breast cancer and the importance of screening for cancer. The Ottumwa City Hall also awarded Ottumwa Regional Health Center with a declaration that the first Monday of every October will be “Think Pink”.

♦ A Community Lecture Series has been launched with various physicians and ORHC asso-ciates covering a variety of topics. One of the topics covered was “Breast Health and Women’s Issues” with Lindsey Alons, MD.

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Cancer Committee Members The Cancer Committee is a multidisciplinary team representing physicians, ancillary services, support services and administration. The Cancer Committee is responsible for the direction of the cancer program by: ensuring high patient care standards, setting goals to improve patient care quality, recommending patient care improvements, monitoring screening and prevention programs, evaluating services that are available to guarantee the needs of cancer patients are met, and ensuring adherence to all American College of Surgeons’ Commission on Cancer (ACoS/CoC) standards. Listed below are the dedicated Cancer Committee Members who served for 2012.

Dr. Daniel Rothfuss, MD Radiation Oncologist Chairperson, Cancer Committee

Dr. Steven Quackenbush, MD Pathologist Chairperson, Cancer Conferences

Dr. Elvin McCarl, MD Radiologist

Dr. E. Brian Ortell, DO General Surgeon

Dr. Praveen Vikas, MD Medical Oncologist Cancer Liaison Physician

Lee Anne Montgomery Chief Nursing Officer

Andrew Payne, CNMTB, MHA Director of Medical Imaging & Radiation Oncology Cancer Program Administrator

Mary Ann Green, RN, MSN, CPC Chief Quality Officer

Marcy Dewitt, LMSW Social Worker

Margaret Wilson, RN, OCN Oncology Nurse

Kathy Burris, RN, OCN Oncology Nurse

Jessica Jones, RN, OCN Oncology Nurse

Cecile VanWinkle RT(R) (T) Radiation Oncology Manager

Cindy Snedigar Medical Oncology Office Manager UI Medical Oncology & Hematology

Peggy Carroll, RHIT, CTR Cancer Registrar

Deanne McAllister, CRA Clinical Research Assistant

Margaret Herman, RD, LD Dietician

Sandra Courtney, RN Hospice Nurse

Liddy Hora American Cancer Society Representative

Marjorie Evans Rehabilitation Director

Maggie Fuller RN, MSN Practice Management Director Community Outreach

Marilee Caves, RN Community Outreach

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Oncology Physicians Medical Oncologist

Praveen Vikas, MD, joined the UI Medical Oncology Hematology—Ottumwa in June 2011. He is board certified in internal medicine and medical oncology.

Dr. Vikas completed his internal medicine residency and his medical oncology fellowship at East Tennessee State University (ETU). He served as chief resent at ETSU and worked full time at the hospital as a hospitalist. He has experience and training in man-aging various malignancies and benign hematological conditions. During his residency and fellowship, Dr. Vikas’s rotations included training in hematology and bone arrow transplant at Vanderbilt University Medical Center and affiliated VAMC at Nashville, TN.

Dr. Vikas serves as ORHC’s Cancer Liaison Physician (CLP) whose primary role is to monitor, interpret, and report the program’s performance using the National Cancer Database (NCDB) data and to evaluate and improve the quality of care at our facility. The CLP is also responsible for re-porting the CoC activities, initiatives, and priorities to the Cancer Committee, serves as a liaison for the cancer program with the American Cancer Society, and meets with the CoC surveyor during the cancer programs survey. Dr. Vikas participates in clinical cancer research with North Central Cancer Treatment Group (NCCTG) and is the Chief Medical Director of Hospice Service Davis and Wapello Counties.

Radiation Oncologist Daniel Rothfuss, MD joined Ottumwa Regional Health Center in 1993. He is board certi-fied in radiation oncology.

Dr. Rothfuss received his medical degree from Indiana University School of Medicine and was employed as the General Physician for the Department of Corrections at the Indiana reformatory. Dr. Rothfuss completed his residency for radiation oncology at the University of Iowa Hospitals and Clinics. Dr. Rothfuss was the Medical Director for Ra-diation Oncology at the Regional Oncology Center at Park in Columbus Ohio until 1993. Dr. Rothfuss serves as the Cancer Committee Chair for the Cancer Program and as the Medical Director for the radiation oncology department at ORHC.

Oncology Specialists Medical Radiation Physicist The Medical Radiation Physicist works directly with the radiation oncologist in the treatment planning and delivery. They oversee the work of the dosimetrist and help ensure that complex treatments are properly tailored for each patient. The physicist is also responsible for developing and directing quality control programs for equipment and procedures and making sure the equipment works properly by performing safety testing. Medical Dosimetrist The Medical Dosimetrist is responsible for the design of a treatment plan (as prescribed by the radiation oncologist) to determine a treatment field technique that will deliver that prescribed radiation dose. The medical dosimetrist maintains a delicate balance between delivering the prescription the physician has written while ensuring the patient will not lose important healthy organ function. Oncology Certified Nurses and Certificate in Radiation Oncology Nurse An Oncology Certified Nurse (OCN) and Certification in Radiation Oncology are Registered Nurses (RN) that have obtained additional training, knowledge and certification in the oncology area to ensure that the patients are receiving the best and most up-to-date care in cancer treatments. All patients receiving che-motherapy are attended to by OCN nurses in Medical Oncology. All radiation oncology patients are at-tended to by an RN with a Certificate in Radiation Oncology. Radiation Oncology Therapists Radiation therapists use ionizing-radiation producing equipment to administer therapeutic doses of radia-tion as prescribed by physicians. The therapists work one-on-one with patients, administering radiation via linear accelerators to treat cancer. The therapists are certified and registered by ARRT (American Registry of Radiologic Technologists) after successful completion of an educational program that is ac-credited by ARRT.

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Cancer Support Groups/Screening/Prevention

Cancer Support Group Out Cancer Support Group is a forum in which patients, survivors, and families of cancer patients can meet and discuss issues, problems, or successes. The Cancer Support Group is also intended to be an educational event for all types of cancers. Some of the educational topics presented include: a dietician discussing healthy eating habits, a blood bank representative and the benefits of transfusions during cancer and cancer treatments, message therapy, and many others. The Cancer Support Group are held monthly in the Cancer Center Conference Room starting at 6 p.m. All can-cer patients and their families and/or care givers are invited. To attend, please call 641-684-2480.

Look Good...Feel Better The Look Good...Feel Better program is a free non-medical, product-neutral program offered in partnership with the American Cancer Society, the Professional Beauty Association/National Cosmetology Association, and the Personal Care Products Council Foundation, a charitable organization supported by the cosmetic and personal care products industry. The program aims to teach female cancer patients beauty tips to look better and feel good about how they look during chemotherapy and radiation therapy treat-ments.

Volunteer beauty professionals lead small groups through practical, hands-on experience. Women learn about make-up, skin care, nail care, and ways to deal with hair loss such as wigs, turbans, and scarves. Each woman gets a free makeup kit to use during and after the workshop.

Look Good...Feel Better classes are held on a monthly basis. Please contact the McCreery Cancer Center for more information at 641-684-2480.

Reach to Recovery Reach to Recovery is a program available through the American Cancer Society who helps people (both male and female) cope with their breast cancer experience. Volunteers are trained to give support and up-to-date information, including literature for spouses, children, friends, and other loved ones.

Cancer Prevention The best way to prevent cancer is through education. Pamphlets and educational material from the American Cancer Society are handed at various health fairs and events through out the year to edu-cate people about healthy lifestyles and the steps to take in cancer prevention. One of the most successful cancer prevention events is the Think Pink which occurs on the first Monday in October. ORHC associates handed out 500 pink bagels and information on self breast exams, recommended screenings, and prevention information in less than an hours time.

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Cancer Support Services Diagnostic Services ♦ Digital diagnostic and screening mammography ♦ Stereotactic breast biopsy ♦ Sentinel node injection for localization ♦ Magnetic resonance imaging (MRI) ♦ Nuclear medicine imaging and testing ♦ PET/CT imaging ♦ Ultrasound imaging ♦ Computed tomography (CT) including CT colonography. ♦ Special procedures—biopsies, paracentesis, thoracentesis, epidural and joint injection ♦ procedures Home Care Services Ottumwa Regional Health Center offers home health care to residents in our Iowa ten-county area: Appanoose, Davis, Jefferson, Keokuk, Mahaska, eastern Marion, Monroe, Van Buren, Wapello and western Washington. Our experienced nurses will provide a thorough assessment and work with your physician to set up an individualized plan of care to meet your health care needs. We are Medicare certified and will help you in seeking reimbursement for your home health care ser-vices from Medicare, Medicaid, and private insurers. The Joint Commission accredited services are available 24 hours a day, seven days a week, with office hours 8:00 a.m. to 4:30 p.m., Monday through Friday. For information, call 641-684-3136, or toll-free 1-800-933-ORHC. After hours, we can be reached by calling 641-684-2300 and ask for a Home Care Nurse. Rehabilitation Services The wide range of services that are provided at Ottumwa Regional Health center include: ♦ Acute Care Rehab in our inpatient hospital setting—we provide occupational and physical ther-apy as well as speech language pathology services following surgery, illness, and accident per a physician’s order.

♦ Outpatient Rehabilitation Services—our outpatient occupational and physical therapists and speech language pathologists provide care on an outpatient basis to patients with a wide range of diagnoses ranging in age from infant to the older adult. As part of our outpatient services, we offer sports medicine services, lymphedema therapy/treatment program, vestibular rehabilitation (for treatment in Benign Paroxysmal Positional Vertigo or other vestibular diagnoses) and indus-trial rehabilitation services.

Wound Healing and Hyperbaric Center The Wound Healing and Hyperbaric Center was created to assist patients with difficult wound-healing problems. The center provides advanced techniques like Hyperbaric Oxygen Therapy and state-of the art wound assessment, testing and treatment for individuals suffering from chronic hard to heal wounds. Our specialized staff has extensive training and expertise in wound healing and provides support to patients, their families and caregivers through comprehensive education pro-grams. The types of wounds that can benefit from our treatment include: diabetic foot ulcers, venous stasis ulcers, wounds caused by circulatory problems, pressure sores, traumatic wounds, post-radiation wounds, wounds resulting from post-op incisional breakdown, and other chronic, non-healing wounds. For more information, call 641-684-2530

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Clinical Research

Clinical research is an important part of any cancer treatment program; it helps to advance science and ensures that patient’s receive the highest possible level of quality care.

Before a clinical trial becomes available to patients at Ottumwa Regional Health Center, the proposed clinical trial is reviewed by an Institutional Review Board (IRB). Currently there are 23 open clinical trials available at Ottumwa Regional Health Center.

Ottumwa Regional Health Center participates in several clinical trial groups that include: North Central Cancer Treatment Group (NCCTG), Cancer and Leukemia Group B (CALGB), Cancer Trial Support Unit (CTSU), Eastern Cooperative Oncology Group (ECOG), National Surgical Adjuvant Breast and Bowel Group (NASBP), Wake Forest University (WF), and Southwestern Oncology Group (SWOG). NCCTG and CALGB have recently joined together to form the group Alliance.

For more information about clinical trial options, please contact Peggy Wilson, RN, OCN at 641-684-2359.

Cancer Conferences

The monthly cancer conferences are designed to be educational and practical for those involved with the diagnosis and treatment of cancer patients. Conferences are attended by physicians from Pathology, Medical Oncology, Radiation Oncology, Diagnostic Radiology, Surgery and other specialties as well as allied health care disciplines such as nursing, dieticians, and radiology technicians. Cases for discussion are selected to include examples of the major types of cancer seen in our area with priority given to those cases that present diagnostic or therapeutic difficulties. The majority of cases discussed are pro-spective, providing our patients the benefit of multi-disciplinary team approach for current problems or issues. In 2012, there were 10 conferences held, with a total of 41 case presentations.

Cancer Registry

The Cancer Registry systematically collects data related to the diagnosis and treatment of newly diagnosed cancer cases at ORHC. Information that is collected by the cancer registry is used to describe: occurrence of cancer (incidence); types of cancer (site, morphology, and behavior); extent of disease at the time of diagnosis (stage); kinds of treatment received by the pa-tients; and outcomes of treatment (survival). Once a patient has been added to the registry, yearly follow-up is required for his/her lifetime. This follow-up information aids in providing survival data and outcomes which enables researchers, physicians, and others to assess clinical standards and quality of care. Patient information that is collected is confidential and all Health Insurance Portability and Accountability Act (HIPAA) and state guidelines are adhered to in the process.

Information that is collected for new cancer patients and follow-up infor-mation on existing cases of cancer is submitted to the State Health Registry of Iowa, part of the Surveillance, Epidemiology and End Results (SEER) Program which is a source of cancer statistics in the United States. Information is also provided to the National Cancer Data Base (NCDB) which is a joint effort by the American College of Surgeon’s Commission on Cancer (ACoS/CoC) and the American Can-cer Society. The NCDB is nationwide oncology outcomes database for more than 1500 ACoS/CoC accredited programs. An estimated 20% of all facilities are accredited by the ACoS/CoC and approximately 75% of all cancers are reported by these accredited facilities to the NCDB.

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At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer.

Performance Measures

The trend in healthcare is moving towards ensuring patients are receiving quality care. One way to ensure quality care provided to patients is by reimbursing facilities based on approved quality measures. The CoC in collaboration with the National Quality Forum (NQF), American Society for Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) have developed a set of quality focused measures for breast and colon cancers. These quality measures are known as the Cancer Programs Practice Profile Reports (CP3R). These measures are reviewed and discussed on a regular basis by the Cancer Committee. Any measure that falls below specific thresholds established by the CoC will be addressed and corrective actions to maintain adherence to the measures will be taken by the Cancer Committee. The CP3R measures are broken down into two categories; accountability measures and surveillance measures. Accountability measure have been endorsed by the NQF and can be used to provide support in the selection of our facility by consumers or health plans and used for payment incentive programs. Surveillance measures are more for internal monitoring of performance and used to promote evidenced-based practice. Surveillance measures are on this page, accountability measures endorsed by the NQF are found on the next page.

Cancer Prog ram Pract ice Prof i le Repo rt s ( CP3R)

Ad jRT M easure

75%

80%

85%

90%

95%

100%

ORHC/MCC Iowa ACS Division

(M id-West)

CoC Program

Type (CHCP)

All CoC

Programs

2009

2010

2011

Cancer Program Practice Profile Reports (CP 3R)

12RLN Measure

75%

80%

85%

90%

95%

100%

ORHC/MCC Iowa ACS Division

(M id-West)

CoC Program

Type (CHCP)

All CoC Programs

2009

2010

2011

Surveillance Measures

Radiation therapy is considered or administered within 6 months (180 days) of diagnosis for patients under the age of 80 with clinical or pathological AJCC T4N0M0 or Stage III receiving surgical resection for rectal cancer.

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Performance Measures Accountability Measures Adjuvant chemotherapy is considered or administered within 4 months (120 days) of diagnosis for patients under the age of 80 with AJCC Stage III (lymph node positive) colon cancer.

Radiation therapy is administered within 1 year (365 days) of diagnosis for women under age 70 receiving breast conserving surgery for breast cancer.

Combination chemotherapy is consid-ered or administered within 4 months (120 days) of diagnosis for women under 70 with AJCC T1cN0M0, or Stage II or III ERA or PRA negative breast cancer.

Tamoxifen or third generation aromatase in-hibitor is considered or administered within 1 year (365 days) of diagnosis for women with AJCC T1cN0M0, or Stage II or III hormone receptor positive breast cancer.

Cancer P rogram P ract ice P ro f ile R epo rt (CP 3R )

ACT M easure

75%

80%

85%

90%

95%

100%

ORHC/MCC Iowa ACS Division

(M id-West)

CoC Program

Type (CHCP)

All CoC Programs

2009

2010

2011

Cancer P rogram P ract ice P ro f ile R epo rts (CP 3R )

BCS/RT M easure

75%

80%

85%

90%

95%

100%

ORHC/MCC Iowa ACS Division (Mid-

West )

CoC Program Type

(CHCP)

All CoC Programs

2009

2010

2011

Cancer P rogram P ract ice P ro f ile R epo rt (CP 3R )

M AC M easure

75%

80%

85%

90%

95%

100%

ORHC/MCC Iowa ACS Division

(M id-West)

CoC Program

Type (CHCP)

All CoC Programs

2009

2010

2011

Cancer P ro gram P ractice P ro file Repo rts CP 3R

HT M easure

75%

80%

85%

90%

95%

100%

ORHC/MCC Iowa ACS Division (Mid-

West )

CoC Program Type

(CHCP)

All CoC Programs

2009

2010

2011

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Statistical Summary of 2012 Cancer Cases

Incidence of Cancer by Site The ORHC cancer registry collected information on 355 new cases for the 2012 calendar year. The top 5 most common sites of cancer occurred in the breast, the respiratory system, the prostate, colorectal, and melanoma of the skin. These top 5 sites represented over 55% of all cancers collected for the 2012 calendar year. When cases are accessioned into the cancer registry, the cases are categorized as either analytic or non-analytic based on presentation of the patient to the fa-cility (ORHC). Analytical cases are defined as: ♦ cases in which the patient was diagnosed at the

facility and treated elsewhere, ♦ diagnosed and received all or part of the first

course treatment at the facility, ♦ or diagnosed elsewhere and received all or part of

the first course of treatment at the facility. Non-analytic cases include (but not limited to): ♦ Disease recurrence ♦ Diagnosed and treated in staff physician office only ♦ Presentation for staging or work-up of a cancer but

not diagnosed or treated at ORHC

Cancer Incidence by Sex For the 2012 calendar year, 54.8% of all cancers at ORHC occurred in women and 45.2% in men. According to “Cancer in Iowa-2012” published by the State Health Registry of Iowa, the projected top cancer sites in Iowa for both men and women were lung, colo-rectal, and non-Hodgkin lymphoma (NHL) with the number one cancer for women being breast cancer and prostate cancer being number one for men. ORHC cancer cases did follow the projected estimates by the State Health Registry with one exception, NHL in men was overtaken by melanoma and laryngeal incidence. Incidence rates for each sex at ORHC were as follows: ♦ Female: breast (35.6%), lung/bronchus (13.9%), colorectal (7.7%), NHL (6.2%), corpus uteri (5.2%). ♦ Male: prostate (16.8%), lung/bronchus (16.8%), colorectal (9.9%), melanoma (8.1%), larynx (6.2%).

Stage at Diagnosis Catching cancer at an early stage is important for better treatment options and the overall survival and outcome of cancer patients. Most cancer are staged using the American Joint Commission on Cancer (AJCC) staging system with Stage 0 being early (in situ) and Stage 4 being late (usually metastatic disease). Over 56% of all cancers seen at ORHC in 2012 were Stage 0 through Stage 2 upon initial diagnosis.

Incidence of Cancer by Site for 2012 At Ottumwa Regional Health Center

Primary Site Analytic Non-Analyti-cal

Cases Percent of Total

Breast 64 6 70 19.7%

Lung and Bronchus

36 18 54 15.2%

Prostate 10 17 27 7.6%

Colon, excl Rectum

25 1 26 7.3%

Melanoma - Skin

5 17 22 6.2%

Non-Hodgkin's Lymphoma

12 9 20 5.6%

Lip 0 14 14 4.0%

Ill-defined, Unspecified

6 6 12 3.4%

Esophagus 9 1 10 2.8%

Corpus 4 6 10 2.8%

Larynx 10 0 10 2.8%

Bladder 3 6 9 2.5%

Rectum & Rectosigmoid

5 0 5 1.4%

Pancreas 2 3 5 1.4%

Kidney, Renal Pelvis

4 1 5 1.4%

Multiple Mye-loma

3 2 5 1.4%

All other sites 23 27 51 14.4%

ALL SITES 220 134 355

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References 2012 Cancer Care Program Annual Report for Ottumwa Regional Health Center American Association of Medical Dosimetrists www.medicaldosimetry.org American Cancer Society (ACS) www.cancer.org American Cancer Society, Cancer Facts & Figures 2012 American College of Surgeons (ACoS) www.facs.org AJCC Cancer Staging Manual, Seventh edition, New York: Springer-Verlag; 2010 Cancer Registry Management Principles & Practice, Second Edition, National Cancer Registry Association, Kendall/Hunt Publishing Co.; 2004 National Cancer Database (NCDB) www.facs.org/cancer/ncdb/index.html Ottumwa Regional Health Center www.orhc.com Ottumwa Regional Health Center/McCreery Cancer Center Cancer Registry Professions in Radiation Therapy www.radiologyinfo.org State Health Registry of Iowa, Cancer in Iowa Report 2012 www.public-health.uiowa.edu/shri/ UI Medical Oncology-Hematology—Ottumwa at the McCreery Cancer Center brochure.

Important Phone Numbers Ambulatory Infusion Center....................................................................................641-684-2328 Associates of Dermatology (Dr. Ameln and Dr. Kent Walker) ................................641-683-3195 Cancer Registry .....................................................................................................641-684-2957 Cancer Support Groups .........................................................................................641-684-2480 Clinical Trials Information.......................................................................................641-684-2359 Department of Pathology .......................................................................................641-684-4621 Department of Radiology .......................................................................................641-682-5453 Dietary/Nutrition Education ....................................................................................641-684-2596 ENT of SE Iowa (Dr. Kurt Anderson)......................................................................641-684-0044 Gastroenterology (Dr. Jeffrey Brannen) .................................................................641-682-4594 Look Good...Feel Better .........................................................................................641-684-2480 Medical Oncology & Hematology of Ottumwa (Dr. Praveen Vikas)........................641-684-2615 Pain Management Clinic (Dr. Tim Miller)................................................................641-684-2461 Patient and Family Services...................................................................................641-684-2685 Radiation Oncology (Dr. Daniel Rothfuss) .............................................................641-684-2480 Rehabilitation Services...........................................................................................641-684-3125 Surgical Partners (Dr. E. Brian Ortell) ....................................................................641-684-2927 Urology (Dr. Michael Shaeffer)...............................................................................641-682-5481 Wound Healing & Hyperbaric Center .....................................................................641-684-2530

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