med-midwest medical edition-november 2011

OF HEALINGHISTORY

South Dakota and the Upper Midwest’s Magazine for Physicians and Healthcare Professionals

Novem

ber2011

Vol. 2, Issue 7

4101 West 41st StreetSioux Falls, SD 57106

(41st St. at the Empire Mall)

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THE 2011

2

From Us to YouStaying in Touch with MED

ConTaCT InForMaTIon

Steffanie Liston-Holtrop, VP Sales & Marketing

605-366-1479 [email protected]

Alex Strauss, Editor in Chief 605-759-3295 [email protected]

Fax 605-271-5486

MAiLing AddrESS Po Box 90646 Sioux Falls, SD 57109

WEbSitE MidwestMedicalEdition.com

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©2011 Midwest Medical Edition, LLCMidwest Medical Edition (MED Magazine) is committed to bringing our readership of 3500 South Dakota area physi-cians 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.

Publisher MEd Magazine, LLC Sioux Falls, South dakota

VP Sales & Marketing Steffanie Liston-Holtrop Editor in Chief Alex Strauss Design/art Direction Corbo design Cover Design darrel Fickbohm Web Design 5j design Contributing Editor darrel Fickbohm

Contributing Writers Heather boysen dave Hewett theresa Parish

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Write

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A letter from the VP and Editor alex StraussSteffanie Liston-Holtrop

Each year at this time, we find ourselves taking stock of the many things

for which we are thankful. We are thankful for the outstanding advertisers

whose support continues to bring you this locally-produced publication

free of charge. It is a luxury few other medical markets enjoy.

We are thankful that healthcare professionals like you take the time to read and

respond to MED, offering us not only your suggestions but also your expertise, opinions,

memories, book reviews, and practice news. Your readership and submissions keep MED

timely, local and relevant for a growing base of readers across three states. Keep it up!

and we are thankful for the fine creative team whose time and talent has helped

to build a publication worthy of the nation’s finest doctors. We hope that you, too,

can take pride in MED, a publication for and about YoU, the healthcare professional

in South Dakota, Minnesota or Iowa.

Thank you for all you do to help and to heal. Let us know how MED can serve

you better.

Happy Thanksgiving! — Steff & Alex

august marked the 900th wish granted by the Make-

a-Wish Foundation of South Dakota since the chapter

began in 1984. Three-year-old ashtyn Empkey of Yank-

ton was the recipient. He and his family enjoyed a trip

to Walt Disney World. Empkey’s wish was one of 65

granted by Make-a-Wish in SD this past fiscal year.

Fifty eight children are in the process of receiving a

wish and new children are referred each month. Make-

a-Wish’s goal is to reach every eligible child between

the ages of 2 ½ and 18 with a life-threatening medical

condition in South Dakota. a life-threatening medical condition is defined as pro-

gressive, degenerative or malignant. It is not the disease or condition that qualifies

the child, but the fact that, at the time of referral, the disease or condition places

the child’s life in jeopardy.

The medical community is the number one referral source for Make-a-Wish.

Physicians providing medical care to a child who may qualify are encouraged to

take the time to call and make the referral. often, a Make-a-Wish experience is

just what the child and family need during a challenging time. according to Make-

a-Wish, a recent national study found that a granted wish is often a turning point

in a child’s fight against their illness.

To refer a child or for more information about the Make-a-Wish Foundation of

South Dakota, please call 800.640.9198 or visit www.southdakota.wish.org.

Medical Community Key for referrals

to Make-a-Wish

In whose hands will you place her?

Physicians’ Priority Line 1.888.592.7955

Intensive Care for Newborns

www.ChildrensOmaha.org

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 Mag.Sept., 2011indd 1 8/2/11 2:22 PM

MEDMagazine 2012 Call for Nominations

Please include the following information:

name of nominee ______________________________________________________________________________________________________

Location of Practice _____________________________________________________________________________________________________

reason for nomination __________________________________________________________________________________________________

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Mail / Fax or email this form to: Po Box 90646 Sioux Falls, SD 57109—Fax 605-271-5486—email [email protected]

MEd Magazine is seeking nominations for Cover and Feature Article topics for 2012. MEd is committed to focusing on pioneering physicians, institutions, programs and technol-ogies that are paving the way for the future of healthcare in our region. no one knows these pioneers better than MEd readers.

if you know of a person or program that deserves a closer look, tell us about them. (Self-referrals are permitted!) Send us the following information via fax, mail or email.

5

page 10

Avera McKennan Hospital & UniversityHealthCenterturnsahundredyearsoldthismonth.ButthesignificanceofthecentennialreachesbeyondtheAveracampus.Thehos-pital’sfoundingsparkedaspiritofcompeti-tionintheregionthatcontinuestoraisethehealthcare bar today. We get some insightinto thehospital’shistoryfromafewof thepeoplewhoknowitbest.

Contentsnovember 2011

Midwest Medical Edition

RegulaR FeatuRes

2 | From Us to You

20 | nEW! Off HoursOtolaryngologist Has a Passion for the Past

29 | grape Expectations it’s turkey time! By Heather Taylor Boysen

31 | news & notesnews from around the region

33 | Learning Opportunities Upcoming Symposiums, Conferences and CME Courses

In thIs Issue 6 | avera to Participate in Clinical Trial Collaborative

7 | nIH Grants for Sanford researchers

8 | new Cardiovascular Fellowship for SD

9 | HealthGrades report released

16 | The real Meaning of “Bending the Health Care Cost Curve” By Dave Hewett

17 | Sanford recognized as IT Innovator

18 | Healing art at St. Luke’s

22 | Managing Challenging Behaviors in the Healthcare Environment By Theresa Parish

24 | Pa’s and the HITECH act

27 | research Spotlight: a Genetic Link fo Pelvic Prolapse?

28 | new ophthalmology and Derm Clinics for SF

30 | a Milestone for the Bloodbank

telling thestory

AVErA’S FirSt HUndrEd YEArS

COVEr FEAtUrE

Cover Photo: a young McKennan nurses receives her cap at an early pinning ceremony.Photo courtesy Avera.

Midwest Medical Edition 6 Midwest Medical Edition 6

Exclusively promoted and recommended by the South Dakota State Medical Association.

You’re always there for them.

We’re always here for you.

We have defended and supported the individual needs of health professionals for more than 30 years. And nobody is more personally

committed to protecting you from the risks you face every day.

To learn more, call 888-397-3034 or visit MMICGroup.com

Avera to Participate in Clinical Trial CollaborativeAverAMCKennAnHospiTAl&UniversityHealthCenterhasbeenselectedbytheeducationnetworktoAdvanceCancerClinicalTrials(enACCT)asoneofsix community-basedcancerorganizations toparticipate in thenationalCancerClinicalTrialspilotBreakthroughCollaborative.

The six organizations were selected from a nationwide pool of applicantsseekingtoimprovepatientparticipationincancerclinicaltrials,especiallythosefromethnicandracialminoritygroupsandthose65yearsandolder.eachorgani-zationhasformedanimprovementTeamthatwilldrivetheorganization’sefforts.

“WeknowthatcancerclinicaltrialparticipationintheUnitedstatesremainsunder 3 percent, with even lower participation rates among ethnic and racialminority groups and those over 65,” says enACCT executive Director MargoMichaels. “ThisCollaborative is thefirst ever tobe implementedaroundcancerclinical trials and the improvement strategies tested and implemented by theseorganizations will be shared nationwide, and will benefit community oncologypracticesthroughoutthecountry.”

“AveraMcKennanhas an excellent opportunity through this collaboration tobenefitthepatientsweserve,”addsDr.AddisonTolentino,physicianChampionofthe Avera McKennan enACCT improvement Team. “Cancer research is—andalwayshasbeen—apriority toAveraMcKennan.Withoutclinicalcancer trials,therewouldbenonewcancertreatmentsavailable.”■

regional Doctor Honored for

Excellence in TeachingH. THoMaS HErMann, MD, a family

medicine provider at Massa Berry regional

Medical Clinic in Sturgis, was recently hon-

ored by the Sanford School of Medicine

at the University of South Dakota with the

Edward J. Batt, MD Memorial award. The

award is given to a clinical faculty member

in the Department of Family Medicine for

excellence in teaching.

“Dr. Hermann is respected as a teacher,

dedicated physician for the community of

Sturgis, and a valued member of the

regional Health team,” says regional

Health Physicians Chief Executive officer

James Keegan.

Dr. Hermann is an alumnus of the Uni-

versity of South Dakota School of Medicine

and completed his residency in family

medicine at Sioux Falls Family Practice. He

is also a Fellow in the american academy

of Family Practice. Dr. Hermann has been

practicing with regional Medical Clinic

since 1995. ■

november 2011 7MidwestMedicalEdition.com

FivereseArCHlABsattheCenterforCancerBiologyresearchatsanfordresearch/UsDwillbenefitfromamulti-milliondollar,five-yeargrantfromthenationalinstitutesofHealth(niH).

TheniH has awarded the Center for Cancer Biologyresearch$2.3millionannuallyforresearchdoneonbreast,headandneck,colon,prostateandlymphoidcancers.ThemoneywillbeusedtohiremoreinvestigatorstohelpwiththeCenter’songoingresearchandwillaidinthedevelopmentofwhatarecalled“corefacilities.”Thefacilitieswillbeavailableforusebyallsanfordresearchinvestigators,notjustthoseintheareaofcancer.investigatorswhowillsharethegrantincludeKristiegland,phD,MeenaJaggi,phD,subhashChauhan,phD,satoshinagata,phDandWilliamspanos,MD.

Atthesametime,thenationalinstituteofMinorityHealthandHealthDisparitieshasawarded$1.5milliondollarstoacollaborativeincludingsanfordresearch/UsD,theUniversity

ofMinnesota,southDakotaUrbanindianHealth,andtheGreatplainsTribalChairmen’sHealthBoardtostudytheprob-lemofteenpregnancyinAmericanindians.TheteenpregnancyrateforAmericanindiansinsouthDakotaisfourtimeshigherthanthestate’sgeneralpopulation.

“Wewanttobetterunderstandwhythenumbersaresomuchhigheranddevelopamulti-site,culturallysensitiveteenpreg-nancypreventionprogramforreservationandurbannorthernplainsAmericanindianteens,”sayssanfordresearch/UsDHealthDisparitiesresearchCenterdirectorAmyelliot,phD.

“WewillholdfocusgroupsandinterviewstolookatthesocialnormsanduniqueculturalfactorsthataccountforhighteenpregnancyratesinournorthernplainsAmericanindiancommunities,”saysDenYelleKenyon,sanfordresearch/UsDAssociatescientist.“Wealsowanttoexaminehowthosenormsandfactorsdifferfortheyouthlivingonthereservationversusanurbansetting.”■

nIh grants Support Cancer and Teen Pregnancy research at Sanford

Midwest Medical Edition 8

THe UniversiTY oF soUTHDAKoTA sAnForD school of theMedicine has been approved by theAccreditation Council for GraduateMedical education (ACGMe) for the

state’s first cardiovascular fellowship. The programwillaccepttwofellowsperyearforthethree-yearprogram.

scheduled to begin in July 2012, the program willincluderotationsinareassuchascardiaccatheterization,coronary critical care, electrophysiology, non-invasivecardiacevaluation, cardiac research,andothers.Fellowswill do their rotationswith cardiologists and cardiotho-racicsurgeonsatsanfordHeartHospital(openingin2012)andthevAHospitalinsiouxFalls.

“Thesecardiovascularfellowswillbeamongthebesttrainedintheworld,”saysAdamstys,MD,interventionalcardiologistwithsanfordanddirectorofthenewfellow-ship program. “This will strengthen the cardiovascularprogramatsanford.ourcardiologistswillbestimulatedtoteachandstayon,oraheadof,cuttingedgeindiagnosisandtreatmentofcardiovasculardisease.”

Thenewprogramisoneof187approvedU.s.cardio-vascular fellowships and addresses a critical health careneedinsouthDakota.Graduatesoftheprogramwillbeboardeligiblecardiologists.■

CarDIoVaSCULar FELLoWSHIP approved

for South Dakota


rApiD CiTY, sD–THe nATionAl CAnCer insTiTUTe’s CenTers toreduceCancerHealthDisparitiesrecentlyawardedaone-yearsupplementalgrantof$139,968totheregionalCancerCareinstitute’sWalkingForwardprogramforaweb-basedclinicaltrialeducationmodule.

Theweb-basededucationalmodulewillbeusedasatoolforcommunityhealtheducatorstoaddressthespecificneedsandexpectationsofat-riskandunderrepre-sentedcommunities.

TheWalkingForwardprogram’scommunityhealtheducatorswillevaluatethevalueofthewebmoduletoenhanceknowledgeandclinicaltrialparticipationinregional underserved communities, help adapt the webmodule to be culturallysensitivetoAmericanindiancommunities,disseminatenationalCancerinstituteeducationalmaterialsandmessages,andparticipateinannualnationaloutreachnetworkprogrammeetingstoexchangeideasandmethods.■

Regional Cancer Care Institute Receives grant from

national Cancer Institute

HealthGrades releases Quality ratings for nation’s HospitalsDenver, Colo. –HealthGrades hasreleased its 2011Healthcare Consum-erismandHospitalQualityinAmericareport,ananalysisofpatientoutcomesatnearly5,000Americanhospitals.

Thereportanalyzedobjectivemor-talityandcomplicationratesacross27differentmedicalproceduresanddiag-noses,atallofthenation’snonfederalhospitalsusing40millionhospitaliza-tionrecordsobtainedfromtheCentersforMedicareandMedicaidservices,partoftheU.s.DepartmentofHealthandHumanservices.Datawasanalyzedover a three year period from 2008through2010.

ThereportalsoanalyzedwebusebypatientsfromJan,throughJune.2011.Accordingtothepewinternetproject,increasinglypatientsaremovingfromsearchingdiseaseandtreatment-specificinformationtousingtheinternettofindquality information on doctors andhospitals,47%and38%respectivelyin2010,upfrom21%in2003.Morethan10millionpeopleeachmonthresearchphysicianandhospitalqualityonHealth-Grades.com.

The2011HealthcareConsumerismandHospitalQualityinAmericareportfoundthatseriousgapsinqualityamongU.s.hospitalspersist:At5-starratedhospitals,patientshada73%lowerriskofdyingwhencomparedwithpatientsat1-starratedhospitals.

HealthGradesqualityratingsreleasedareavailabletoconsumersatHealth-Grades.com/MyCity.■


by Alex Strauss

telling thestory

AVErA’S FirSt HUndrEd YEArS

All photos Courtesy Avera

This MoNTh, AVErA MCKENNAN hosPiTAl & UNiVErsiTy hEAlTh CENTEr celebrates a hundred years of providing healthcare to sioux Falls and the surrounding communities. But the significance of the anniversary extends beyond the Avera campus to other providers in the region. Because Avera McKennan’s story is closely connected to the story of medicine in sioux Falls.

Established as a healthcare ministry under the guidance of the Aberdeen-based Presentation sisters, McKennan hospital not only en-hanced the healthcare options in the region in 1911 but also, by its very presence, sparked a spirit of competition that was to help make sioux Falls the advanced medical center it is today. Competition raised the healthcare

McKennan Hospital, circa 1911

by Alex Strauss

bar and paved the way for a level of medical care rarely seen in a market the size of sioux Falls.

Avera McKennan credits much of its success to its stability, in both management and mission. Prompted by a $25,000 dollar bequest from sioux Falls resident helen Gale McKennan in 1906, the hospital has been run by the Presentation sisters since it opened its doors on December 17, 1911. its stated mission of compassionate, gospel-based care remains unchanged.

in that first year, McKennan hospital treated 100 patients. But as sioux Falls grew, so did the numbers, and by 1920, 1,500 patients a year were seeking care at McKennan. Today, Avera McKennan is a 545-bed tertiary care hospital

and health network that also includes 14 regional hospitals, over 70 primary and specialty care clinics, long term care facilities and more. Annu-al inpatient admissions are now approaching 22,000 with over 260,000 outpatient visits and a million clinic visits a year.

Under the guidance of both the Presentation sisters and the Benedictine sisters of yankton with whom they joined forced in 2000, Avera McKennan became part of Avera health, an extensive system with nearly 300 locations in 97 communities across 5 states.

in recognition of the anniversary, MED asked some of Avera McKennan’s key figures to talk about the hospital’s history, mission, and future.

Avera’s story is closely connected to the story of medicine in Sioux Falls.

avera McKennan Hospital & University Health Center, circa 2011

“


Fred Sluneckaavera Health Chief operating officer and former long-time CEo of avera McKennan

iwashiredatAveraMcKennaninnovember1982asanAssistantAdmin-istrator. i became Ceo in 1989 andservedinthatcapacityuntil2010whenibecameCooofAveraHealth.sooutofthat100years,iaccountfor29.ithinkthatgivesmeaboutasmuchperspectiveasanyoneelseintheorganization.

YoureallyhavetotipyourhattothecitizensofHelenMcKennan’stime.itwouldhavebeensoeasytodroptheballandnotdothisright.HelenMcKennangave $25,000, but the hospital cost$160,000tobuild.sothislittlecommu-nitygroup,underthedirectionofColonelThomasBrown(ofBrown&saenger),hadtotaketheballandrunwithit.Andbecausehospitalsatthattimewerepri-marilyforthepoor,theyhadtogoouthat-in-handfrom1911 to1940 togetdonationstokeepitgoing.itwasagar-gantuantask,soithinkCol.BrownisasmuchafounderofMcKennanHospitalasHelenMcKennanherself.

Then there were the presentationsister.Women-ownedbusinesseswereveryrareinthatage,andthisonewasemployingalotofpeople.Theyweremakingitupastheywentalong.imaginethefirstX-raymachineandyou’reanunandyou’regoing‘now,whatdoidowith

this?’Whenyouputitinperspectivelikethat,yourealizethatnothingwedotodayisgoingtobehalfastoughaswhattheyhadtodobackthen.

Atthesametime,theyhavemanagedtopreservetheiroriginalmission.Thereisstillverymuchaheritageconnectionhere.lotsoforganizationshaveoperatedfor100years,buttobeownedbytheoriginalownersfor100yearsisunusual.Whenyouhaveaconsistentmessage,deliveredinanuncompromisingwayfor100years,peoplebegintogetit.employ-eescan’thelpbecomingtotallygroundedinthatmission.

TheoriginalhospitalwaslocatedinthespotwheretheemergencyDepart-mentparkinglotisnow.otherbuildingswentupover theyearsandthemainbuilding that we now recognize asAveraMcKennanhospitalcameaboutin1975.Wheniwalkedinthedoorsin1982,youcouldnotevenseethehospi-talfromCliffAvenue.Today,giventheexpanseofthecampus,thatishardtoevenimagine.

in1977,whenistartedmycareerinhealthcare at MercyMedical CenterinsiouxCity,Mercywas the largesthospitalinthearea.siouxvalleywasthesecondlargest,st.luke’sinsiouxCitywasthirdandMcKennanHospitalwasfourth.Today,youcanputallthepatients that are in those siouxCityHospitalsinsideAveraMcKennan.Thedifference, i think, was the sisters’

avera Health Chief operating officer and former long-time CEo of avera McKennan

Fred Slunecka

retired General Surgeon, Practiced 36 years at avera

Dr. Patrick McGreevy

Sister Mary ThomasSenior Vice President of Mission

“

The Iron Lung

an early surgical room

a modern or


In the early years, many of the Presentation Sisters were intimately

involved with the McKennan’s day-to-day operation.

commitmenttoruralhealthcare.in1982,whenst.luke’sinAberdeenbecameourfirstleaseagreement,mostorganizationsweren’twillingtotakeonthesesmallruralhospitals.

oneofthethingswehavedonewellischangingtomeetchanginghealthcareneeds.inthe1970’s,cataractsurgeryhadjustbeeninventedandanentirefloorofthehospitalwasdevotedtoophthal-mology.specialtiesandtechnologyhavetochangeandmorphovertime,becausewhatfillsourhospitaltodaymightbefixedbyapill inthefuture.Havingalargeintegratedsystempreparedustomeetthesechangingneeds.

ifyourmissionisjusttomeetneeds,itguaranteesthatyouaregoingtoremainrelevanttoyourcommunity.Thatiswhyihavenodoubtthatinanother100yearsoursuccessorswillbecelebratingthe200thanniversary.Averawillstillbehere,adaptingandchangingastheneedschange.”

Sister Mary thomas Senior Vice President of Mission

HelenMcKennan left $25,000 in1906tosometrusteeswithinstructionstouse themoneytoopenahospital.That was the equivalent of about$500,000in today’sdollars.notonlydidthetrusteeshavetoraiseadditionalfunds,buttheyhadtofindsomeonetorunthehospital.Theyneedednurses,staff,managers,etc.sotheyengagedthehelpofBishopThomaso’GormanandhecontactedMotherJosephButlerofthepresentationsistersinAberdeen.Bishop o’Gorman knew that thepresentationsisterswerealreadyestab-lishedinhealthcare.

ThepresentationsisterscamefromirelandandsetupaconventandschoolinAberdeenin1886withamissiontoeducatethelakotasiouxindiansand

thepioneers.eventhoughtheirmissionwasprimarilyeducation,in1900therewasadiphtheriaepidemicintheregionandtheconventwasmadeintoamake-shifthospital.Wehad toget specialpermissionfromthebishoptodothisandweareoneof thefewgroupsofsisters thathavetheirownhealthcarebranch.

itwasarealsenseofacallfromGod.Therewouldhavebeenthesensethatweareheretorespondtotheneedsofpeopleandwhatwasneededatthetimewassomesortofstructuredresponse.sobythetimethesisterswereapproachedbyBishopo’GormanabouttakingonMcK-ennan Hospital, they were alreadyrunningthreeotherhospitals.

Atfirst, thereweresistersineverydepartmentofthenewhospital.Anditwasreallytheirpresence,prayerfulnessanddevotiontoGodthatcommunicatedthemissionofcompassionatecareandpromotinghumandignitytothepeopleinthatdepartment.Butasthehospital

new avera Surgery Center


grew,therewerenotnecessarilysistersineverydepartmentanymore.sowehadtostartthinkingmorestrategicallyaboutwaystomakesurethateveryoneworkingatMcKennanreallyunderstoodtheheartandsouloftheorganization.Thehospitalhasbeenthroughalot–theinfluenzaoutbreakinthe1930’s,theWorldWars,economic challenges – but we haveweatheredthesebyhangingintherewitheachother.

Themessagewewantedtocommu-nicateisthatthisisnotourministry;itis Jesus’ministryandweare simplycarryingitout.itwasinthe70’sthatthepresentation sisters decided that weshouldhaveanoffice–theoneiholdnow – to communicate the heritage,understandthethemesinourhistory,andperpetuatethegenerosityofheartthatwestandfor.

WhenwejoinedwiththeBenedic-tinesisterstoformAvera,itwasarealshiftforus.Wehadtobewillingtoletgoofsoleownershipofsomethingthatwehadreallyputourblood,sweatandtearsinto.Butweknewthatitwastherightthingtodoasthehospitalgrew.Today,thereareabout25to30sistersstilldirectlyinvolved,6to8oftheminday-to-dayoperations.

Werecognizethattheveryfactthatapersoniscomingtothehospitalputsthatpersoninastateofvulnerability.That,initself,callsforacompassionate,mission-orientedresponse.Whenyoucomedowntoit,healthcareisveryper-sonal.Themissionhastobelivedouteverydayinourresponsetopatients,familymembers,andco-workers.

AveraMcKennancouldnotbeherewithoutthecommunity’ssupport.ithasstoodbyus,supportedus,andcalledustobewhowearetoday.itisreallythecommunitythathastaughtushowtoofferthisfaith-filledresponse.Weholdtruetoourdeepest traditionsandwedon’tstandinisolation.Thiscelebrationisreallyacommunitycelebration,too.”

dr. Patrick Mcgreevyretired General Surgeon, Practiced 36 years at avera

igrewupinsiouxFallsandmydadwasadoctor.McKennanHospitalwasalwaysapartofmylifeandihavemanymemoriesofit.

one image that has really stayedwithmeis thenunwhoattendedthereceptiondeskinthehospitalwhenmybrotherandiwerekids.itwouldhavebeen around 1950. My dad used to

sometimes take my brother and mealongtothehospitalintheeveningandhaveuswaitinthelobbywhilehemaderounds.

Thisnunat thefrontdesk, in fullhabit,wasamazing.ifsomeonehadaquestion,shewastheinformationdesk.ifsomeonecameforadmission,shereg-isteredthem.sherantheswitchboard.Andwhenevershehadafewminutesofdowntime,shewouldgetoutthisgigan-ticledgerbookandstartwritinginit.Andallthewhile,shewasalsowatchingmybrotherandme.sheneverseemedtogetflustered.Andshewasnotevengettingpaid!

i have often thought through theyears,thatthatwomanreallyembodiedthemissionofselfless,compassionatecareforeveryonewhocomesthroughthedoors.ibelievethatattitudestillpre-vailsheretoday.

ileftsiouxFallstotraininmedicineatCreightoninomahaandthencamebacktotownin1969tojoinmydadandmyuncle,Drs.JohnandedMcGreevy,andtheirpartnersatthefirstMcGreevyClinic. They had built the clinic ontheMcKennancampusin1962,aftermovingoutofthebuildingdowntownthathadbeentheMoeHospital.Atthat

“

avera Heart Hospital, built in 2001

november 2011

time,mostofthedoctorswerelocateddowntown.

in1969,whenicametotheclinic,McKennan was a small communityhospital. itwasn’t anything like thereferral or specialty center that it istoday. Therewere no computers, ofcourse.Andthephysicalpresenceofthepresentationsisterswasmuchmoreevident.everyonekneweveryoneelseon campus because itwas so small.Whenicame,notalotofthingswereeverreferredtosiouxFallsortoMcK-ennan.Today, there isnotmuchthatcan’tbeaccomplishedhere.

Buteventhoughourabilitytoservepatients isfarmoresophisticatedandbroad-based,somehowthepresentationandBenedictinesistershavemanagedtopreserveaphilosophyofhealthcarebeingaministry that isrootedin thegospel. i can’t imagine that this hasalwaysbeeneasy.Forinstance,thenunsmakeavowofpoverty.Andyet,theyhavefoundthemselvesrunningamul-tibilliondollarbusiness.ihavealwaysfoundthattobeaninterestingbalance–howtheykeeptruetotheirmissionwhilerunningabusinessinacompeti-tiveenvironment.ithinktheyhavedoneanexcellentjobofthis.”■

avera McKennan Hospital & University Health

Center will celebrate its centennial year with the

“Gala for a Century” on Friday, nov. 11, at the

Sioux Falls Convention Center.

a social hour begins at 6 p.m., followed by

dinner at 7 p.m., and a program, entertainment

and dancing. Featured speaker is Eric J. Topol, MD,

on “The Future of Health Care.” named one of

the 12 “rock Stars of Science” by GQ Magazine,

Dr. Topol is a distinguished physician and scientist

working on the forefront of digital medical tech-

nology. a premier cardiologist, genetic researcher

and technologist, Dr. Topol is bringing a new kind

of medicine into widespread practice: specifically-

designed treatments based on an individual’s

unique genetic structure.

Tickets are $100 per person. Learn more about

this event and purchase tickets at www.avera.org/

gala. or, call the avera McKennan Foundation at

(605) 322-8900.

Marking the Centennial

15Sculpture outside the avera Behavioral Health Center


The real Meaning of “Bending the health Care Cost Curve”by dave Hewett , President/CEO, SdAHO

We’ve Been hearingthatphrase fora longtime.it’saphrasethathasbeenusedbyboth

sides of the political aisle during theongoingdebateonhealthcare reform.it has also been used by the providercommunity to spur us on to thinkcreativelyaboutahealthcaredeliverysystem that is more efficient, moreorganized,andmoresustainable.

Butforthegeneralpublic,theideaofbendingthehealthcarecostcursehasalso become somewhat of a hollowphraseasincreasesinthecostofhealthcarecontinuetooutpacepriceincreasesingeneral.

Thefrustrationiswellillustratedbythisgraph.Thegraphshowstherateofgeneralinflationandmedicalinflationovertime.notsurprisingly,theredline(medicalinflation)hasexceededtheblueline(generalinflation)forquitesometime.Theimplicationsare:Thepercent-ageofgrossdomesticproductdevotedtohealthcarecontinuestogrow

Healthinsurancepremiumscontinuetorise

ourfederalandstateelectedofficialscontinuetosearchforwaystoreduceproviderreimbursementtocontaincosts

nowwhenpolicymakerstalkabout“bendingthecostcurve”ibelievewhattheyarereallysayingisthatthegoalofhealthcarereformistohavemedicalinflationriseataratenogreaterthangeneral inflation.simplystated, theywanttheredandbluelinestotakeonapurplishhue.Theirdesireto“bendthecostcurve”hasproducedotherphrasessuchas“doingmorewithless”,“valuenotvolume”,“qualitynotquantity”,and

“doinglesswithless”.(ofcourse,theabilitytoachieveallofthesegoalsaretemperedthepublic’sinsatiableappetitefor more, high tech health care andaccess to that care on a moment’snotice…butthat’sanotherstory.)

Thatsaid,newdatastronglysuggeststhatsouthDakotaphysiciansandothermembers of the health care providercommunityaremorethandoingtheirsharetoachievethecostsavinggoalsthatrepublicans,Democrats,andinde-pendentsespouse.

First,accordingtorecentlyreleaseddatafromtheDartmouthAtlas,Medi-care costs per beneficiary in southDakotaareamongthelowestinthecoun-try.expendituresvariedfrom$6,264intherapidCityregionto$7,118inthesiouxFallsregion.Thatcomparestothehighestinthecountry,Miami,Floridawherethecostperbeneficiaryis$15,571.

Wearealsodoingcomparativelywellonqualityandpatientsafetynumbers.readmissionratesinsDarelowcom-pared to national averages and otherpatient safety indicators are equallyfavorable. For example, according torecentlyreleasedCMs-issuedreadmis-sionrates,southDakotaranks3rdfromthebestforheartattacks,13thforheartfailure,and9thbestforpneumonia.

Areweperfect?Farfromit.Weneedtoworkonhowourpatientsviewthetreatmentwe provide andwhile ourrankingsmaybefavorabletoday,every-oneis tryingtogetbetterandreducetherateofincreaseinhealthcarespend-ing. This becomes all the moreimportantas thepoliciesofspendinglessarespelledoutinreformedreim-bursementpolicies thathavealreadyreached thehospitalsandwill likelyreachthephysicianssoon.■

november 2011 17MidwestMedicalEdition.com 1717

FOr tHE SixtH COnSECUtiVE YEAr, sanford HealthhasmadetheinformationWeek500,anannuallistingofthenation’s most innovative users of business technology.The2011listwasrevealedatagalaawardsceremonyattheinformationWeek500ConferenceinDanapoint,California.

Akeyconsiderationinthisyear’srecognitionwassanford’sdisasterpreparednessplanaimedatprotectingitscriticaleMrsystem,“sanfordoneChart”,inanemergency.sanfordnotonlypurchasednewhardware,butalsoupgradedtheexistinghardwareanddevelopednewproceduresdesignedtomitigatetheeffectsofplannedandunplanneddowntimesfortheeMr.

“‘sanfordoneChart’allowsustospeakwithonevoicewitheachotherandwithourpatients,andprovidesconnec-tivitytodeliveraseamlessexperienceacrossalarge,ruralnetwork”,sayssanfordHealthChief informationofficerArlynBroekhuis.

on“MysanfordChart,”awebadaptationof“sanfordoneChart,”patientscanaccesstheirmedicalrecords,reviewlabresultsandscheduleappointments.Morethan30,000sanfordHealthpatientsareactiveusers.

“For23years, theinformationWeek500haschronicledandhonoredthemostinnovativeusersofbusinesstechnol-ogy,”saidinformationWeekeditorinChiefrobpreston.“inthisdayandage,however,beinginnovative isn’tenough.CompaniesandtheiriTorganizationsneedtoinnovatefasterthaneverbeforetostayasteportwoaheadoftheircustomers,partners,andcompetitors.

Thisyear’srankingplacedspecialemphasisonthosehigh-octanebusiness technologyinnovators.”informationWeekhasbeenidentifyingandhonoringthenation’smostinnova-tiveusersofbusinesstechnologyfor23years.pastwinnershaveincludedThevanguardGroup,CMeGroup,Conway,

Sanford Health recognized as IT InnoVaTor

nationalsemiconductor,Kimberly-Clark,HiltonHotelsandUnum.TheinformationWeek500rankingsareuniqueamongcorporaterankingsforspotlightingthepowerofinnovationin information technology, rather thansimply identifyingthebiggestiTspenders.■

interactive EMr system and

emergency preparedness

were key considerations


ST. LUKE’S rEGIonaL MEDICaL CEnTEr In SIoUx CITY is enhancing its healing

environment with the nature photography of Sioux Falls photograph Paul Schiller. The

hospital’s new art & Healing project, made possible through the Wrede and Barbara

Smith family, includes the installation of 160 pieces of tranquil artwork throughout

the hospital.

“It definitely enhances the healing environment, not only for patients but also for

their families and even for the healthcare workers,” says Steven Shook, MD, of Family

Health Care of Siouxland, Indian Hills Clinic.

“Looking at these images of areas and plants that are familiar can take a person

temporarily out of the hospital environment in their mind and into a more peaceful

place. I have seen many people out in the halls looking at the photographs. It is like

stepping into a museum every time you go there.”

numerous studies have shown the healing impact of peaceful artwork and its con-

nection to improved patient outcomes. St. Luke’s says the new artwork is “closely

aligned with the hospital’s patient and family-centered care philosophy”, a philosophy

the Smith family also embraces. ■

the photography of Paul Schiller on display at St. Luke’s regional Medical Center in Sioux City.

st. luke’s Enhancing healing with New Art

MED

Hypertension is oneof the most serious healthproblems in the country.

Fortunately, itʼs also one ofthe easiest to diagnose

and treat.You know the classificationsand risks. Donʼt assume your

patients do. Talk to themabout their BP and do it often.Breaking the silence is one

of the best ways to fightthis silent killer.



off HoursPassionate Pursuits outside the office

Dr. Patrick Collisonotolaryngologist and

Student of archaeology

by darrel Fickbohm

iT TooK VEry liTTlE coaxingto convinceDr.patrickCollison,anear,noseandThroatspecialistwith YanktonMedical Clinic, to

talkabouthis long-standing interest inarchaeology. But hewas also quick todifferentiatebetweena“hobby”andan“avocation.”Aswithmanyotherphysi-cians, Dr. Collison’s passion for hisextracurricularoccupationturnedouttobemuchmorethanmerelydabbling.

“My interest inarchaeologyfirstcametomewhileiwasdoingresearchforanarticleonmastoiditis inchil-dren”saysDr.Collison.“icameacrosssomearticlesbyDr. JohnGregg,anenTinsiouxFalls,whohaddevelopedasecondcareerinarcheology.Hehad

published articles about fascinatingthingslikeevidenceofeardiseasesin500-or600-year-oldnativeAmericanskulls.itjustcaughtmyinterest.”

Dr.Collison,whowasinhis50’satthe time,began to feedhisgrowinginterestwithinternetclasses throughUsDandtheUniversityofiowa,even-tually completing an undergraduatedegree inarchaeology.After that,hetookaseminarclasspersemesterthatmetonceaweek–theonlyschedulehecouldmanagewithhisenTpractice.eventually,overanumberofyearshe“cobbled together”acourseofstudythatearnedhimaMastersDegree ininterdisciplinary studies, primarilyArchaeologyandAnthropology.

“itwas likegetting a second lifewithout actually being illegal orimmoral,”jokesDr.Collisonwhocallshis archaeology studies a “moodelevator”.

“ontheotherhand,itwasn’teasy.Youmustinteractwithprofessorswith-outbeingaknow-it-all,obviously.Andiwillneverhave the traditionalstu-dent’squickmemoryorcomputerskills.But itstretchesyou.i tookwaymoreclassesthanineededto—ididn’twantittoend.Thestudywastheend,soidraggeditout.”

Amongotherthings,Collisonsayshisacademicstudieshelpedrevivehiswritingskillsandhisabilitytoexpresshimself without using jargon or

Patrick Collison, Md

november 2011 21november 2011 21

“medicaliese”.Morethanthat,hesaysarchaeol-ogyhasbroadenedhisworldview.

“Archaeologyisasocialscienceasopposedtoabiologicalsciencelikemedicine,”heexplains.“Medicineemphasizesscientificpositivismtoastrictdegree,so it’sverydifferent in itsworldoutlook.lookingatthingsfromananthropologicalstandpointgivesmeamoreinclusiveworldview.Archeologydovetailswithmedicinebyitsverycontrast,ifyouwill.ithelpsmeinmypractice,indirectly. itgivesmeanoverviewofdifferentperspectives.”

overtime,Dr.Collison’spassionalsobegantopayoffinpracticalwaysandthedevotedstudentalsobecameateacher.

“suddenly,theyweregivingmeresearchtodoandilovedit!ienjoyedthechallengeoffiguringout‘Whomadethis?Wherediditcomefrom?’Andtheniwascomingupwithareporttodescribeitall.(Andigotpaidforsomeofit,too.)Meanwhile,ifineededto,icoulddropeverythingthatdayandsuddenlygoworkintheer.”

Dr.CollisonbeganteachingclassesatUsDonthestudyofartifactsandmethodsofstudyinghis-toricallyimportantdiseasesthroughtheanalysisofskeletalremains.Hehasanalyzedtherecordsofthe7thCavalry forear,noseandThroatdiseases,whichwillsoonbepartofanewbook.

“Allofthisgivesmeawideningfuture,”saysDr.Collison.“i’mhopingtostretchthistoanicepart-timeretirementjobafteri’moutofthepractice.Myfamilysupportsthis,althoughmykidsrolltheireyeswheni’mrangingintosomeobscuredetailsoutloud.Mywifeactuallygoesalongonsomeofthefieldwork.

“Whenyouthinkofarcheol-ogy,youthinkofindianaJonesgoingaftertheArcoftheCove-nant.That’s thewrongattitude.Whatwe’re tryingtoacquire isunderstanding,not stuff.That’swhatmotivatesme.”■

Tell us about your

own ‘passionate pursuits’ outside

the office.

Write to us!

SEnSOrY PrOCESSing EVALUAtiOn

Acomprehensivesensoryprocessingevaluationmayleadyoutoconclusionsthathelpyouunderstandthatthebehav-iors you are seeing are brain driven.sensoryprocessingisthewayeachandeveryoneofusrespondstoincomingsensoryinformation.Welearnandgrowthroughoursenseswhichincludetouch,sight,sound,smell,taste,proprioceptionandvestibularsensation.Wemanageourday-to-day activities through all theinformationourbodiestakein.ofwhich,90% is actuallybelowourconsciouslevelofawareness.itisthefoundationforemotional, languageandcognitiveprocessing.Withoutthefoundation,indi-vidualsstruggle.

bEHAViOrS ArE nOt “On PUrPOSE”

Thoseofuswhosesensorysystemsare“normal”respondappropriatelytomostsituations.Weareabletofixthesituationwithoutmuchdifficulty.nowthinkofsomeoftheclientsyouserve.Theymaybeunable to tellyouwhatnoxioussensationstheyareexperiencingorhowtoadapttothem.Theyarelivinginanenvironmentthatputsstressontheir system littleby littleuntil their

body reacts because it can’t take thestressanymore.Thisiswhenachalleng-ingbehaviorwilloccur.itisactuallyanormalchemicalresponseoftheirner-vous system. The reaction is braindriven.

bEHAViOr MAnAgEMEntManagingandcontrollingdifficult

clientbehaviorscanbeveryexhaust-ing.Caregiverandclientsafetyareofthe utmost importance and manytimespeopleareunaware that therearemethodsavailabletohelpimproveclientbehaviorsand improve safetywhen the foundation forbehavior isaddressedfirst.

Many organizations have goodbehaviormanagementprogramsandstillhavecaregiversandclientsbeinginjuredorpropertydamaged.Theseprogramsgenerallyworkwelltode-escalate individuals; other timesnothingseemstowork.supportstaffdo not look forward to coming toworktogethit,bit,grabbed,andhavetheir hair pulled when assisting apersonwith challengingbehaviors.However,therealityisthatithappensalltoooften.

StAY At WOrk/rEtUrn tO WOrk

Whenanemployeeisinjured,it isdifficultfor thephysiciantosendtheinjuredemployeebackintothissituation,soreturntoworkcanbecomeaproblem.ifthisisaconcern,determineiftheiremployerhassafe,modifiedjobduties.Acomprehensiveprogramformanage-mentofchallengingbehaviorsisalsoimportant.Companiesshouldhavewrit-tenpoliciesandprocedures, training,behaviorinterventionplans,documenta-tion,debriefing,modifiedjobdutiesforinjuredemployees,aswellasannualreviewsoftheirprocesses.

A nOn-trAditiOnAL APPrOACH

inadditiontobehaviormanagementprograms, some organizations arebeginning to implement sensoryprocessingintervention(spi) tohelpreduceclientbehaviors.However,someorganizationshaveneverheardofspiorhowtoeasilyimplementitintotheirdaily activities. All behavior has ameaning.Usingspiisjustonepieceofthe puzzle when looking at the bigpicture.itisanon-traditionalapproachtohelpingwithbehaviormanagement.Thefirststepisawareness.

Managing Challenging Behaviors in the healthcare Environmentby theresa Parish, Otr/L

as physicians and healthcare workers, do you serve clients who have challenging behaviors such as hitting,

kicking, pulling hair, biting thus injuring themselves or others? Do you also serve the employees who are

injured by these behaviors? are you sometimes at a loss as to what you can do to help both the clients and

employees? If so, simple solutions may be found by exploring sensory processing issues.


it iS brAin driVEnAwarenessthateverybrainhasbasic

needsofsafety,security,andcomfortiskey.Thebraindrivesan individual toachievethosebasicneeds;sometimes,withoutregardtowhoisgettinginjured.ifthesebasicsensorydrivenneedsareprovidedbycaregivers,thenfewerchal-lengingbehaviorsoccur.Thisimprovesthequalityoflifeforeveryoneinvolved.

ifyouareunsureofhowtohelp,asensoryprocessingevaluationandasen-soryflowofthedaymaybethemissingpieceinacomprehensiveplan.Thissolu-tionwillrequirespecialtrainingforthecaregivers,butthetechniquesaresimple,easyandfun.Thebenefitsareincredibleandevenlifechanging.■

theresa Parish, Otr/L, CEES is an

Ergonomic and Loss Control Specialist/

Sensory Processing Specialist with risk

Administrative Services, a provider of

workers’ compensation in the Upper

Midwest, headquartered in Sioux Falls, Sd.

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november 2011 23MidwestMedicalEdition.com 23

Eric Pickering, Certified Prosthetist/Orthotist

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Todd Jensen, Certified Prosthetist

Sioux Falls (605) 782-2400 for appointment.

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THE aMErICan aCaDEMY oF PHYSICIan aSSISTanTSiswelcoming legislation to amend the Health informationTechnologyforeconomicandClinicalHealth(HiTeCH)Actto extend electronic health record Medicaid incentivepayments to all physician assistants who meet the Act’scriteriainservingMedicaidpatients.

TheHealthiTModernizationforUnderservedCommuni-tiesActof2011wouldamendtheHiTeCHAct toapplytopA’s whose patient volume includes at least 30 percentMedicaidrecipients.

“FortheHiTeCHActtohaveafarreachingimpactonthehealthcareenvironment, it is imperative to includenotonlyphysician Assistants that lead rural Health Clinics andFederallyQualifiedHealthCenters,butallpA’sthatserveahighMedicaidpatientvolume,”saysHollyArends,ClinicalManager of HealthpoinT, south Dakota’s regionalextensionCenter, a part ofDakota stateUniversity. “Thiscould not come at a better time as the urgent need forpracticestoadoptanelectronichealthrecordiscrucial.”

“enhanced,qualitypatient care is thegoalof electronichealthrecords.ThecurrentHiTeCHlimitationonMedicaideHr limits thedevelopmentofeHrsystems forMedicaidbeneficiarieswhoareservedbypAs.Thislegislationextendsadditional support to community health centers and othermedicalpracticesinwhichpAsprovidecaretoahighvolumeofMedicaidpatients,”saidrep.KarenBass(D-CA),oneofthelegislation’ssponsor’s.

TheHiTeCHActcurrentlyofferstheincentivepaymentstophysicians andnursepractitionerswhoprovideprimarycare to the requisite 30 percent threshold of Medicaidrecipients, but limits the eHr incentive payments forMedicaidservicesprovidedbyphysicianassistantsinruralhealth clinics and federally qualified health centers withpAsatthehelm.

robert Wooten, AApA president, said he was pleasedwith the legislation.He saysmedical practices and clinicsthatemployalargenumberofpA’sarepenalizedthroughtheMedicaideHrincentivelimitation.physicianAssistantsareoftenthesolehealthcareprofessionalsinmedicallyunder-served communities. Yet, an incentive program that fullyrecognizesphysiciansandadvancepracticenurses,butnotpA’s,createsafinancialdisincentiveformedicalpracticestohirepA’s.

“Theultimatebeneficiariesofelectronicmedicalrecordsare patients, and this bill extends the promise of improvedmedical care to theMedicaid patients served by physicianassistant,”Wootensaid.■

Ehr EqualityPa’S SaY BILL WoULD

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ThE NUMBEr oF PhysiCiAN assistants in southDakota–andtheamountofmoneytheyareearning–isontheincrease,reflectinganationaltrendthathasmorepAsinpracticethaneverbefore.

“Whenicamesixyearsago,wehadapproximately350 pAs practicing in south Dakota,” says sDApAexecutive secretaryMarynafus. “now, that numberstandsatleast450andmayevenbehigher.”

numbers in other states tell a similar story.According to new census data from the AmericanAcademyofphysicianAssistants,thenumberofprac-ticing pAs reached 83,466 in 2010, a 100 percentincreaseoverthelast10years.pAsalariesarealsoupbyanaverageof2to8percentnationwide,butinsouthDakota,thatincreasewasmorethan9percentovertheprevious year.onlyrhode island andMissouri pAssawapayincreasethatlarge.

nationwide,morethan30percentofpAspracticein primary care, making them an important com-modity in states likesouthDakotawhere access toprimarycareislimited.

“pAs are the only health care providers educatedandcredentialedwithaprimarycarefocus,providingastrongfoundationforanyspecialtyinwhichtheymaychoose to practice,” said AApA president robertWooten,pA-C.“TheinformationfromAApA’ssalaryand census reports clearly confirmwhatpAs and thehealthcareworldhaveknownforyears:ThepAprofes-sion is growing rapidly, and it is key to expandingaccess to quality health care for millions ofAmericans.”

otherAApAcensusfiguresshowthatnearly30per-centofpAspracticeinsingle-specialtyphysiciangrouppractices, and 40-percent have been in their currentprimaryspecialtyforatleastsixyears.TheCensusalsoshowsthatpAsenjoytheirwork,as66percentindicatetheyaresatisfiedormostlysatisfiedwiththeircareer.

WhilethemajorityofpAsareinclinicalpractice,an estimated5,079pAswork either aloneor concur-rently in health care education, administration,researchandpublichealth–afigurethatdemonstratesthe growing role pAs play in influencing the entirehealthcarefield.■

Rising Number of South Dakota PA’s Mirrors National Trend


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SAnFOrd HEALtH HAS PUrCHASEd tHrEE EC145 helicopters

from american Eurocopter. The aircraft will be part of an initia-

tive to expand Sanford’s coverage area and its services to patients.

Sanford Health is, geographically, the largest rural not-for-profit

health care system in the nation with locations in 112 communi-

ties across seven states.

orlen Tschetter, Vice President at Sanford Health, says there

was a long selection process for the EC145s. “We knew we

wanted an established product with the size to accommodate

passengers and equipment, and the performance to provide the

range to service our growing coverage area.”

The EC145 provides a combination of reliability, performance,

advanced technologies and a spacious cabin that has made it

the platform of choice for a growing number of EMS operators

in the United States and around the world. Powered by two

Turbomeca arrIEL engines, the aircraft offers a fast cruise speed

and long range, and its high set main and tail rotors, rear-loading

clamshell doors, extra payload capacity, unmatched visibility and

additional safety features are ideal for air medical missions.

The first EC145 will be in service in Sioux Falls by the end of

this year. The other two will be put into service in the Fargo

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research Spotlight

a SIoUx FaLLS

DoCTor’S rESEarCH

InTo a GEnETIC LInK

SHarED BY WoMEn

WITH rEoCCUrrInG

PELVIC orGan

ProLaPSE MaY

Soon HELP PaTIEnTS

aroUnD THE WorLD.

MICHaEL FIEGEn, MD,recentlypresentedtheresultsofhistwo year study at the annual scientificmeeting of interna-tionalUrogynecologyAssociation inlisbon,portugal.Thespecialistinurogynecologyandreconstructivepelvicsurgerywas one of a select group of researchers chosen to presenttheirfindingstothemeeting’s1500internationalattendees.

Dr.Fiegen’sstudyfocusedondifferencesingeneexpres-sionamongwomenwhoexperiencerecurrentpelvicorganprolapseandthoseforwhomasinglesurgeryissufficienttocorrecttheproblem.Bystudyingthreegroupsofwomen,somewithpelvicorganprolapse,somewithouttheconditionandotherswhohavehadarecurrentprolapse,Dr.Fiegenwasabletoidentifyageneticexpressionuniquetotherecur-rentgroup.ifaprocesscanbeusedtoidentifythesewomenpriortosurgery,doctorsmaybeabletoplanprocedurestosignificantlyreducetheriskofrecurrence.

“About30to40percentofwomenhaveahigherrateofrecurrence,”saysDr.Fiegen.“sooneoutof threewomenwho has gone through this major surgery will end upneedingsurgeryagain.ifweareabletoidentifyageneticpredispositionbeforehand,wemayapproachtheinterventiondifferentlyfromtheoutset.”

Dr.Fiegensaysa‘steppedup’surgicalintervention,forthose shown tobe at higher risk for prolapse recurrence,mightincorporatetheuseofprolenemeshforextrasupportofthepelvicorgans.

“itwouldfirstbeamatterofdiscussingthiswiththepatientandmakingherawareofherrisk,”saysDr.Fiegen.“Thenthepatientcoulddecideforherselfwhethershewantstotakeanaugmentedapproachtosurgery.”

phase i of theresearchiscompleteand Dr. Fiegen andhis colleagues arenow working onprotocolassignmentand funding for thenextphase,whichhe

hopeswillincludemultiplecentersforalargepatientsample.Dr.Fiegen,agraduateofUniversityofsouthDakotaand

ohiostateUniversityschoolofMedicine,practicesatsanfordClinic Urogynecology and Female pelvic Medicine insiouxFalls.■

“. . . one out of three women who has gone

through this major surgery will end up

needing surgery again”

a Genetic Link to Pelvic Prolapse?


AverAMCKennAnHospiTAl&University Health Center has openedtwonewclinicsinsiouxFalls,includingits first ophthalmology clinic. Jeffreystevens, MD and victoria Knudsen,MDwillprovidearangeofophthalmo-logic services, from eye exams andprescriptions to eye trauma, treatmentfor inherited or congenital conditions,and eye diseases common in seniorsincludingglaucomaandcataracts.

Dr. stevens completed hismedicaldegreeandophthalmologyresidencyatDrexelUniversityCollegeofMedicineinphiladelphia.Dr.Knudsen receivedherMDfromYaleUniversityschoolof

Medicine and did a residency in oph-thalmology at the University of Cali-fornia, san Diego. she is fellowshiptrainedinvitreoretinalsurgeryandhasspecial expertise in the treatment ofretinal conditions such as maculardegenerationanddiabeticretinopathy.

“Demand is growing for ophthal-mologicmedicalcare,andakeyreasonis our aging population,” said Dr.David Kapaska, Avera McKennanregional president andCeo. in addi-tion, incidence of diabetes is on therise, a key complication of which isdiabetic retinopathy. The new clinicislocatedintheAveraDoctorsplaza2

ontheAveraMcKennancampus.At thesame time, thehospitalhas

opened a new dermatology clinic onMinnesota Avenue. The newly con-structed facility replaces the formerclinicat69thandMinnesotawhichisnowAveraMedicalGroupMcGreevyClinic pediatrics. The 22,000 sq. Ft.dermatologyclinicincludesDrs.BrianKnutson,Douglaspay, JanaJohnson,Michelle Wanna and valerie Flynn;as well as one certified nurse practi-tioner, Heidi Furth. The clinic hasits ownhistology lab, state-of-the-artprocedures rooms, and on-sitepharmacy.■

NEwly oPEN iN sioUx FAlls

Avera opthamologyand Dermatology Clinics

Victoria Knudsen, MD

Jeffrey Stevens, MD

november 2011 29

Grape Expectations

MidwestMedicalEdition.com

it’s Turkey Time!

We reMoDeleD ourhouse a couple ofyearsagoandthecon-struction included my

dreamkitchen.Anagreementwithmyparentstohostallfuturefamilyholidaygatherings in exchange for livingaccommodations wasn’t out of lineconsideringtwoadultsandtwoyoungchildren were going to be invadingtheir living space for an unknownamountoftime.

ThatThanksgivingdaywasgorgeouswiththecrunchofleavesunderfootandthesunlightmakingthecolorsof theseasonglow.ourtwoturkeyshadbeenbrininginmassivecoolersfor24hoursandwerereadyfor their trip into theovens.Yes,youreadcorrectly,wealwayshave two turkeysbecausemostofuswant dark meat! We had 16 peoplecomingtoourhouseandeveryonewasbringing different side dishes anddesserts.

Asawineshopowner,iwasn’twor-riedatallaboutthefood(althoughmyMothercalledmeveryearlyinthemorn-ingtomakesuretheturkeyswereintheoven),butratherwhatwinewouldgowithallofthosedifferentflavors?inourfamily theThanksgivingmeal is thesameasithasbeensinceiwasakid.saltyappetizers,cheeseandrelishtrays,sweetpotatoesandcranberrysauces,starchymashedpotatoeswithbutterandgarlic,whiteanddarkturkeymeat,theobligatorygreenbeancasserole,home-madebunsandpies–lotsofpies.

Asitellallofmyclientswhocometomywineshop,itisn’tabouttheturkeyon Thanksgiving when it comes to

choosinggreatwinepairings.Theturkeyismoreofthestructureorbackboneofthemeal.itistheplethoraofsidesthatcreatesthedifficultyinchoosingawineorwinesforthemeal.ihaveseveralrulesforThanksgivingwinethathavegivenmegreatsuccessthroughouttheyearsinpairingwineforthisparticularmeal.stickwithwinesthathaveanalcoholcontentunder14%,enoughaciditytobalancethefood,lowtanninsandverylittleoak.

TworedsthatrarelyworkwiththistypeofThanksgivingfareareCabernetsauvignonandMerlot.Thealcoholcon-tentistoohighinmostcasesandwilltaste“hot”andthetanninswilltakeonunpleasantbitternotes.Unlessprimeribisonyourmenuiwouldavoidthesevari-etalscompletely.iwouldalsorecommendstaying away frombig, creamy, oakyChardonnaysastheyhaveatendencytocling toyourpalateandobliterate thedelicatenessoftheturkeyaswellastasteterriblewithmostofthesides.

ilovetobeginourgatheringwithasparklingwine.Whetherit isFrench,italianordomestic,itisuptoyouandyourbudget.Thebubblescleansethepalate,putyouinafestivemoodandgowithjustabouteverything.ThewhitewinesilovetoputonaThanksgivingtable include unoaked Chardonnays,preferablyFrench,withbrightacidityandacrisplivelyfinish.pinotBlanc,viognier,DryrieslingsandpinotGrisarealsowonderfulespecially ifyourguestsdon’twantabone-drywhitewiththeirmeal.

Mygo-toredsincludelighterstylepinotnoirandBeaujolais.Bothofthese

redshaveapleasantacidityaswellasbrightfruitflavorsthatarebeautifulforThanksgiving.Averyrefreshingandlightrosémadefromsyrahorpinotnoirgrapesisalsofantasticasabridgebetween white and red. if you wantsomethingalittlebiggerbutnottoooverthetop,asyrahorevenZinfandelwouldfitthebill.letmebeclear–redZin-fandel–notWhiteZinfandel!

Desserts including pumpkin andapplepiescreamforhighacid,sweetbotrisizeddessertwineincludinglateharvestrieslingsandiceWine.AverysimpleMoscatod’Astiwouldalsoworkwell.

pleasemakesureallofyourwinesare served at a proper temperature.Kitchenshaveatendencytogetverywarmwithovensandburnersgoingfullblastwhichwillheatupyourbottlesofwine,sothrowyourredsinthefridgetogetthemaround60degreesbeforeyouservethemandkeepyourwhiteseitherinthefridgeorinanicebucketoficewaterifyoucan.

Aboveall,rememberthatitisacel-ebration.raiseyourglass,celebratewithyourlovedones,eatuntilyoucan’teatanymore, watch a little football andworryaboutwashingthedisheslater!■

by Heather taylor boysen

IT WaS noVEMBEr 1991 and the

Community Blood Bank Board of

Directors and staff members had

high hopes of collecting additional

blood for local hospital patients by

implementing a “bloodmobile.”

The bloodmobile would offer a

complete donor room facility on

wheels going out to businesses,

schools, and residents within a

50-mile radius of Sioux Falls. This

would be a custom-built coach

with state-of-the-art equipment

and a full staff to expand the donor

base of the Community Blood

Bank, ensuring an adequate blood

supply for the nine hospitals that

Community Blood Bank services.

The first blood drive would takeplaceatCitibankinsiouxFallsonnov.20,1991.Uponcompletionoftheblood-mobile’sfirstblooddrive,58pintsoflifesavingbloodwerecollected,itwasapparent that the mobile operationswouldbesuccessful.

Today,CommunityBloodBankser-vicesa150-mileradiusofsiouxFallsprovidingbloodto29hospitalsthrough-out southeastern south Dakota,northwesterniowa,andsouthwesternMinnesota.CommunityBloodBankcurrentlyoperates twobloodmobileswhich collect over 20,000 units ofblood,providingover80%ofthebloodsupplyforthearea.sinceCommunity

BloodBank’smobileoperationbegan,there has been a total collection of241,000blooddonations tohelpareapatients.

“At thecoreofourservice to thepeopleofourregionisasenseof‘com-munity.’ it is in our name, in thecooperationbetweenAveraandsan-ford,inthesupportofbusinessesandorganizationsandinthespiritofeachandeverydonorwhooffersbloodasagiftoflife,”statesHenryTravers,MD,Community Blood Bank Medical

Director/BoardChair.Dr.Travershasbeen instrumental indeveloping themobileoperationsalongwithMedicalDirector /BoardChairKeithAnder-son, MD, Board Member DianneBreen,recruitmentsupervisorritanelson,leadDriverDavidliesinger,and Bloodmobile supervisor pamsandro.

CommunityBloodBankisanon-profit,cooperativeofAveraMcKennanHospital&UniversityHealthCenterandsanfordUsDMedicalCenter.■

CoMMUNiTy BlooD BANK Celebrates 20 Years of Mobile ServiceThe Community Blood Bank of Sioux Falls is celebrating its 20th anniversary of providing mobile service through its bloodmobile program.


Dr. Howard

for helping me heal.THANK YOU

Vulnerable. Shy. Self-conscious. It’s how many women feel abouttheir breasts after breast cancer.That’s why you want a surgeon youcan trust who will take the time tolisten to your feelings, someone whounderstands what it means to movebeyond the scars of cancer to feelwhole again.

Call for your private consultation today!605.334.1930

www.richardhowardmd.com | 6301 S. Minnesota Ave., Suite 300 | Sioux Falls, SD 57108


news & notesHappenings around the region

AverAAvera Mckennan Hospital & University Health Centerhasbeennamedawinnerofthe2011AArpBestemployersforWorkersover50Award.eachyear,AArpselects50employersthathavedemonstratedexemplarypracticeswithregardtorecruitment,retentionandpromotionofolderworkers.programsatAveraMcKennanwhichareattractivetoolderworkersincludeflexibleworkenvironmentsandscheduling,educationalopportunities,lifeandhealthbenefits,retirementplan,acommitmenttowork-lifebalance,andanemployeehealthprogram.

the Avera Mckennan radiology department and imaging Center hasbeenawardedthree-yearaccreditationinMribytheAmericanCollegeofradiology.TheACrgoldsealofaccreditationisawardedtofacilitiesmeetingACrpracticeGuidelinesandTechnicalstandardsafterapeer-reviewevaluation.imagequality,personnelqualifications,adequacyoffacilityequipment,qualitycontrolproceduresandqualityassuranceprogramsareassessed.

Avera Heart Hospital hasbeenrecognizedasa gold-Level Start! Fit-FriendlyCompanybytheAmericanHeartAssociation’sstart!initiativeforhelpingemployeeseatbetterandmovemore.lastyear,HeartHospitalemployeeshadtheopportunitytoattendafreewellnessfair,participateinateamweightlosschallenge,gaintrainingtipstoruna5K,andparticipateinnationalWalkatWorkDay.

karl richards has been named Clinic Administrator of Avera Medical group Pierre.Bornandraisedinpierre,richardsisalifetimeresidentofthecommunity.HeholdsaBsinpublicrelationsandadvertisingfromUsD.AveraMedicalGrouppierrehasatotalof24physiciansin10specialties,includingfamilypractice,internalmedicine,pediatrics,hospitalistcare,orthopedics,neurosurgery,oB/GYn,generalsurgery,podiatryandurology.

Avera Queen of Peace Hospital inMitchelland Avera Heart Hospital in Sioux Fallshavebeennamedinthenation’stopperformersforkeyqualitymeasuresbyJCAHo,theleadingaccreditorofhealthcareorganizationsinAmerica.Toberecognizedasatopperformeronkeyqualitymeasuresanorganizationmustmeet95percentperformancethresholds.AveraQueenofpeaceHospitalwasrecognizedforachievingthesethresholdsforpneumoniaandsurgicalcareandAveraHeartHospitalwasrecognizedforachievingthesethresholdsforheartattack,heartfailureandsurgicalcare.

nOrtH CEntrAL HEArt inStitUtE HAS WELCOMEd tWO nEW PHYSiCiAnS:

Elden r. rand, Md, FACC, receivedhismedicaldegreefromtheUsDsanfordschoolofMedicine.HecompletedhisinternalmedicineresidencyattheBrookeArmyMedicalCenterinFortsamHouston,Texas,andhiscardiologyfellowshiptrainingatsanAntonioUniformedservicesHealtheducationConsortium.Dr.randisboardcertifiedininternalMedicine,Cardiology,echocardiography,CardiovascularCTandnuclearCardiology.

Jeremy W. Scott, Md, receivedhismedicaldegreefromtheUsDsanfordschoolofMedicineandcompletedhis

internalmedicineresidencyattheMayoGraduateschoolofMedicineinrochester.Dr.scottthencompletedhiscardiologyfellowshiptrainingandinterventionalcardiologytrainingattheUniversityofnebraskaMedicalCenterinomaha.HeisboardcertifiedininternalMedicineandCardiology.

regionAlrita Stacey, rn, CdE, Directorofpatientservicesatlead-DeadwoodregionalHospital,was

recentlyrecertifiedinDiabeteseducationbythenationalCertificationBoardforDiabeteseducators.staceyhasbeenemployedatlDrHformorethan20years,15yearsasadiabeteseducator.Currently,therearemorethan17,000diabeteseducatorswhoholdnCBDecertification.Certificationisawardedforafive-yearperiod.

regional Health network hasenteredintoamanagementagreementwithCrookCountyMedicalservicesDistrictinsundance,Wyoming.Awiderangeofmanagementsupportservicesareprovidedtoassistthelocalorganizationinquality,cost-effectivehealthcaredelivery.TheBoardofthelocalorganizationretainscontroloverpolicysettingandfiduciaryobligations.CrookCountyMedicalservicesDistrictincludesa16-bedcriticalaccesshospital,32-bedskillednursingfacility,homehealthservicesandthreeclinics.

kelly Stacy, M.d., an internist with regional Medical Clinic, has been named the 2011 South Dakota American College of Physicians Young Physician of the Year. a native of Midland, Texas, Dr. Stacy completed her medical school training at St. George’s University School of Medicine in new York and her residency in Internal Medicine at University of roanoke/Salem in Virginia. Dr. Stacy is also active in teaching Internal Medicine to third and fourth year medical students and is an academic assistant Professor with Sanford School of Medicine. Dr. Stacy has been with regional Medical Clinic since 2007.

the intersocietal Commission fortheAccreditationofvascularlaboratorieshasgrantedathree-yeartermofaccreditationinextracranialCerebrovascularTestingto regional Heart doctors Vascular Laboratory.Accreditationisgiventofacilitiesthatcomplywithnationalstandardsinprovidingqualitypatientcare.

SAnfordSanford Medical CenterhasbeennamedaConsumer Choice Award winnerbynationalresearchCorp.sanfordsiouxFalls&Fargowerebothrecognizedforthe6thconsecutiveyear.ThelistwaspublishedMondayoct17,inModernHealthcare.TheawardisbasedonthehospitalthatpossessesBestoverallQuality,Bestoverallimage/reputation,BestDoctorsandBestnurses.sanfordisrankedalongsidehospitalslikeMayoClinic,MassGeneral,Cedars-sinai,andClevelandClinicaswinnersintheirrespectivemarketsthisyear.


news & notesHappenings around the region

SAnford continued

david P. Munson, Md,hasreceivedthepioneerAwardfromthesouthDakotaperinatalAssociation.Theawardrecognizes

“thepioneeringeffortsofthosewhohavebrokengroundincaringfornewfamilies.”Dr.Munsonreceivedtheawardthe36thannualsouthDakotaperinatalAssociationConference.Dr.MunsonpracticesneonatalandperinatalmedicineandpediatricswithsanfordChildren’s.

the American Society for gastrointestinal Endoscopy recentlyrecognizedsanfordHealthanditsphysiciansforqualityandsafety.ThesanfordHealthgastroenterology/endoscopysuiteisoneof314endoscopyunitsgrantedthehonorfromtheAsGeendoscopyUnitrecognitionprogramsince2009.

david rogers is the new CEO of Sanford Webster Medical Center/bethesda Home. rogers

spentthepasttwoyearsservingastheadministratorofWebster’sBethesdanursingHomeandHeritagevillage.AWatertown,sDnative,rogersearnedhisbachelor’sdegreeinsiouxFallsatAugustanaCollege.Healsoholdsamaster’sdegreeinhealthcareadministrationfromBellevueUniversityinBellevue,ne.

Sanford Health brookings Clinicis now offering Acute Care forpatientswithnon-emergencymedicalconditionssuchasminorburnsandcutsandillnesses.AcuteCarepatientscanvisittheofficewithoutanappointmentMonday-Friday,4:30-8:30p.m.,saturday,8a.m.-12:30p.m.AcuteCareislocatedinsanfordHealthBrookingsClinic’slocationat92222ndAvenues.

Sanford Health has announced Letters of intent withClearwaterHealthservicesandBroadwayMedicalCenterinMinnesota.Anloiisanon-bindingfirststepinapotentialmerger.CHsincludesMemorialHospitalinBagley,theattachedCHsclinic,theClearwaterAmbulanceserviceandtheCHsclinicinClearbrook.CHscurrentlyhasamanagementcontractwithsanford.BroadwayMedicalCenterinAlexandriahas34providersandover100staffintwolocations.servicesinclude:allergy,emergency,familypractice,generalsurgery,hospitalists,internalmedicine,oB/GYn,oncologyandpodiatry.

Eric Hilmoe, Administrator/CEO of Sanford Hospital Canton-inwood,waselectedChairpersonattheAnnual

BusinessmeetingofthesouthDakotaAssociationofHealthcareorganizations(sDAHo).HilmoeservedlastyearasChairperson-electofsDAHo.AnativeofColman,HilmoereceivedhisdegreeinhealthcareadministrationfromUsD.HehasbeentheAdministrator/CeoinCantonsince2002andhasservedonthesDAHoBoardofTrusteessince2004.HilmoeassumedhisleadershiproleatsDAHo’s85thAnnualConventioninrapidCity.

radiologists at Sanfordarenowusinganewpieceofequipmentdesignedtoimproveimagequalityandspeedupimagingthrougheaseofuse,whileloweringpatientradiationdose.sanfordhasinstalledKonicaMinolta’sWirelessAeroDrsystemintheemergencyDepartmentandwillusethreemoreoftheunitsinthesanfordHeartHospitalwhenitopensnextyear.sanfordreportsthatthenewequipmenthasallowedfora40percentreductioninradiationdoseovertheXpressCrsystem,whichhaditselfreduceddosageoverthepreviousCrsystem.

otherYankton Medical Clinic, P.C. ispleasedtoannouncetheassociationofinternalMedicinephysician,

Clarissa barnes, M.d.,

Obstetrician/gynecologist Jill F. Sternquist, M.d.and

nephrologist byron S. nielsen, M.d. dr.

dr. barnes is a graduate of the Johns Hopkins School of Medicine. shecompletedherinternalMedicine

residencytrainingatTheJohnsHopkins.Additionally,Dr.BarnescompletedinternshipswiththeGlobalAiDsAlliance,theCenterforBiosecurity,andtheDepartmentofHealthandHumanservicesduringheryearsinmedicalschool.

dr. Sternquistis a graduate of USd School of Medicine. shecompletedherobstetricsandGynecologyresidency

trainingatCreightonUniversityMedicalCenter.Dr.sternquistwillprovidemedicalandsurgicaltreatmentofdiseasesuniquetowomen,regularexaminations,papsmears,infertilitytreatment,familyplanningandcareofwomenbefore,duringandafterchildbirth.

dr. nielsen is a graduate of USd School of Medicine.HecompletedhisinternalMedicineresidencytraining

andhisnephrologytrainingattheUniversityofiowa.inadditionaldiagnosingandtreatingkidneydisease,Dr.nielsenalsospecializesinthetreatmentofhypertension,electrolytedisturbances,themedicalmanagementofkidneystones,andprovidesbothinpatientandoutpatientdialysis.

Midwest Medical Edition Midwest Medical Edition

Learning opportunitiesHappenings around the region

MED reaches more than 5000 doctors and other healthcare professionals across

our region 8 times a year. If you know of an upcoming class, seminar, webinar,

or other educational event in the region in which these clinicians may want to

participate, help us share it in MED. Send your submissions for the Learning

opportunities calendar to the editor at [email protected].

november 2011

November 3 – 4 Perinatal Clinical Update: Maternal-Newborn/Low Risk 7:30 am – 4:45 pm Newborn NCC Certification Review Course Location:Sanford USD Medical Center, Schroeder auditorium

Information and Registration: [email protected], 605-328-6353

November 4 5th Annual Denny Sanford Pediatric Symposium7:30 am – 5:30 pm Location: Sanford Center

6.0 aMa Pra Category


1 CME Credits, 6.4 CnE Contact Hours

November 7 4th Annual eHealth Summit7:00 am Location: Sioux Falls Holiday Inn Downtown

Information: http://healthpoint.dsu.edu/summit2011, 605-256-5555

November 11 & 12 Van Demark Spinal Cord Injury Symposium Location: Sanford Center, Dakota room


12.5 aMa Pra Category 1 CME Credits

November 18 2011 Avera Pediatric Symposium8 am.-4 pm Location: avera Education Center auditorium

Information: [email protected], 322-8950

www.averaMcKennan.org; click on Events Calendar

December, Perinatal Nurse Fellowshipmultiple dates Information on dates and locations: [email protected],

8 am – 5:00 pm 605-328-6353

I-29 and West 12th Street - Sioux Falls - 888-339-5050

luxuryautomallofsiouxfalls.comluxuryautomallofsiouxfalls com

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