Med Magazine, November 2024 by MED- (Midwest Medical Edition)

AT HOME IN HURON

The Risks of Missing Infections

The State of Palliative Care in SD

A Quarter Century of Cancer Care in Watertown

HOW HRMC IS CULTIVATING A DIVERSE WORKFORCE

2024

EVERYWHERE YOU NEED US TO BE

KENNETH MILLIGAN, M.D. Orthopedic Surgery

Total Joint and Hip Preservation Specialist Rapid City

SCOTT FRANSSEN, D.O. Orthopedic Surgery Gillette, Spearfish

JOSEPH HUMPHERYS, D.O. Orthopedic Surgery

ERIC KROHN, D.O. Pediatric Orthopedic Surgery Rapid City

DANIEL

M.D.

DAVID WOODARD, M.D. Orthopedic Surgery Rapid City

RAY JENSEN, D.O. Orthopedic Surgery Spearfish

RICHARD LITTLE, M.D. Orthopedic Surgery Spearfish

STEVEN

M.D.

PAGE 6 | This Month Online

SDAHO honors Distinguished Service, a troubling trend for amputations in the Upper Midwest, and where MED’s been mingling lately

PAGE 12 | Understanding Palliative Care in South Dakota: A Conversation with Michele Snyders

Explore the state of palliative care in South Dakota with Michele Snyders, including misconceptions, benefits, and SDAHO’s efforts to improve access.

| NEWS & NOTES

PAGE 17 | USD School of Health Sciences Success Spotlight: Tyler Hemmingson, MPH

PAGE 19 | Heightened Awareness to Reduce Missed Diagnosis of Infections

■ By Dr. Eric Zacharias

A trail runner’s bruise turns deadly: The experts at COPIC discuss how heightened awareness can prevent missed infections and their medical and legal complications.

PAGE 20 | Beyond the Border

A sampling of recent news from MED’s multi-state coverage area including an Iowa ‘Hospital Hero’, a milestone for Nebraska heart care, and a high honor for a Sanford CFO

PAGE 22 | Prairie Lakes Cancer Center Celebrates 25 Years

Before you go: Prairie Lakes Cancer Center marks 25 years of growth, innovation, and community care in Watertown.

cover photo: (l to r) Paw Sa, community liaison, Sau-Mei Ramos, community liaison, and Yendy Castillo, Foundation and marketing assistant. Photo courtesy HRMC.

CONTACT INFORMATION

STEFFANIE LISTON-HOLTROP

VP Sales & Marketing

Publisher / MED MAGAZINE, LLC

Sioux Falls, South Dakota

Vice President Sales & Marketing

STEFFANIE LISTON-HOLTROP

Editor in Chief / ALEX STRAUSS

Staff Writer / KIM LEE

Magazine Design / ANGELA CORBO GIER

Client Relationship Manager / BARBIE MUNOZ

Digital Media Director / HYA AMURAO

605-366-1479

Steff@MidwestMedicalEdition.com

ALEX STRAUSS

Editor in Chief

605-759-3295

Alex@ MidwestMedicalEdition.com

WEBSITE MidwestMedicalEdition.com

MAILING ADDRESS

PO Box 90646, Sioux Falls, SD 57109

VOLUME 15, NO. 7 ■ NOVEMBER

FROM US TO YOU

t has been a whirlwind fall for MED so far as the team has crossed and re-crossed our wide coverage area to attend a range of healthcare conferences. It has been delightful to connect directly with so many of you. You’ll find photos from a few of those events throughout this issue, with more on the website. If we missed you this fall, look for us again in the spring.

IAlso in this issue, how Huron Regional Medical Center is strategically embracing cultural diversity to grow its workforce and enhance care. We talk with HRMC leadership and introduce you to some of the people who have crossed the globe to work in Huron.

We also have an eye-opening discussion about palliative care with one of the state’s leading experts, an infection case study that highlights how easy they can be to miss, and, of course a roundup of top news items from across the region.

Thank you for your continued readership and support of MED!

In Gratitude, Alex & Steff

JULY/AUG June 10

SEP/OCT August 10

NOVEMBER Oct 10

DECEMBER Nov 10

NEXT ISSUE

Editorial contributions due December 5

Ads due December 10

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THIS MONTH ONLINE

Articles and Resources Only on Our Website MidwestMedicalEdition.com

SDAHO Recognizes 11 for Distinguished Service at Annual Convention

The South Dakota Association of Healthcare Organizations celebrated its 98th annual convention September 25-27, 2024, in Rapid City. During the event, SDAHO presented its Distinguished Service Awards, honoring healthcare professionals nominated by peers for their dedication and impact in the field. This year, eleven individuals received recognition across various categories.

2024 AWARD RECIPIENTS

HEALTHCARE PROFESSIONAL OF 2024: Dr. Travis B Henderson, Mobridge Regional Hospital and Clinics

STATE LEGISLATOR OF 2024: State Senator Bryan Breitling, Miller SD

STATE TRUSTEE OF 2024: Larry Gabriel, Philip Health Services

QUALITY CHAMPION OF 2024: Stacey Erickson, Avera Health

STATE OFFICIAL OF 2024: Dr. Mary S. Carpenter, State of South Dakota (Retired)

• HEALTHCARE HERO OF 2024: Dr. Stephen Tamang, Monument Health

• HEALTHCARE JOURNALIST OF 2024: Alex Strauss, Midwest Medical Edition

• YOUNG PROFESSIONAL OF 2024: Kasara Sutton, Aberdeen Medical Center

SEE THE WEBSITE FOR A DETAILED PROFILE OF EACH AWARD RECIPIENT AND MORE PHOTOS FROM THE EVENT.

• POST-ACUTE CHAMPION OF 2024: Doug Ekeren, Avera Sacred Heart Hospital

• HEALTHCARE COMMUNITY IMPACT AWARD: Jeff Partridge, South Dakota Board of Regents

• LARRY VEITZ LIFETIME ACHIEVEMENT AWARD: Tammy Miller, Madison Regional Health System

Great Plains States Face Elevated Amputation Risks

The PAD (peripheral arterial disease) Collaborative has released an interactive online heat map highlighting the risk of non-traumatic lower limb amputations and the news is not good for the states in MED’s coverage area.

According to the research, although the highest risks are in several Southern states, South Dakota, North Dakota, Nebraska and most of Iowa all face an elevated risk of PAD-related amputations.

The lower limb amputation heat map is meant to serve as a tool for healthcare professionals to become aware of what the amputation data looks like

in their region. Professionals and healthcare systems can use that information when considering the need for patient and staff education, health programs, community screenings and outreach concerning research and advocacy.

The PAD Collaborative, convened by the American Heart Association, includes 17 organizations dedicated to raising awareness, advancing education, promoting research, improving treatment and advocating for PAD.

READ MORE ABOUT THE PAD RESEARCH AND LINK TO THE DETAILED HEAT MAP ON THE WEBSITE.

SDAHO President Tim Rave and Healthcare Professional of the Year Dr. Travis Henderson of Mobridge Regional Hospital.

Out

IHLA Fall Convention With Monument Health's Paulette Davidson at SDAHO Annual Convention

Upcoming EVENTS

DON’T MISS IT!

and

About with MED

MED’s team has been making the rounds lately! This fall, we have met friends and shared our mission to promote healthcare news in the region at:

• Iowa Healthcare Leaders Association Fall Convention in Des Moines

• South Dakota Association of Healthcare Organizations Annual Convention in Rapid City

• Iowa Hospital Association Annual Meeting in Des Moines

• South Dakota Healthlink in Sioux Falls

• Nebraska Hospital Association Annual Convention in La Vista

STAY IN THE KNOW

Eide Bailly Business of Healthcare Webinar Series

November 6

Capital Markets and Budgeting: What Does the Future Hold?

December 4

OIG Update: A Compliance “Grab Bag” of Emerging Focus Areas

AVERA

November 7

Avera Spotlight Series for Healthcare Providers

Find more information on these and other upcoming events and share your own at MidwestMedicalEdition.com/Events

MED updates our digital subscribers twice every month with a curated selection of top healthcare industry headlines from around the region. Every MED newsletter features direct links to the articles you’re most interested in. PLUS, get free early access to every digital issue of MED Magazine.

Scan the QR code on this page or visit MidwestMedicalEdition.com TO JOIN THE VIP LIST. FOLLOW

At Home in Huron

BY ALEX STRAUSS

How HRMC is Cultivating a Diverse Workforce

HURON HAS BEEN ONE OF THE MOST

culturally and ethnically diverse communities in South Dakota for nearly two decades. According to the latest US Census data, about 14 percent of the community is either Hispanic or Southeast Asian – twice as high as the state average. Erick Larson, CEO of Huron Regional Medical Center, says the community owes much of its diversity to two businesses – the Jack Links Beef Jerky plant in Alpena which opened in 1999 and the Dakota Provisions turkey processing plant which opened in 2005.

The plants brought in workers from places like Puerto Rico, Brazil, the Dominican Republic, Vietnam, El Salvador, India, Nepal, and Guatemala as well as many Karen people, an ethnic group from Myanmar. Today, 25 years after the first plant opened, a second generation is entering the workforce and HRMC is positioning itself to welcome them.

“We are trying to structure our organization to mirror and match our community,” says Larson. Larson says many immigrant children who have grown up in Huron are now uniquely positioned to help bridge the gap between their first generation families and the Western healthcare system.

“It’s also about workforce development,” says Larson, who is not focusing solely on the younger generation. “We have people in our communities who are capable and hard working, many of whom even have medical degrees or training from other countries. So we are trying to be strategic about leveraging that, as well.”

Teresa Haatvedt, RN, describes herself as the “boots on the ground” element of HRMC’s recruitment strategy.

CEBU, PHILIPPINES

MIKE JACYN SAGUIN, ELOIZRA JRA TABINGO, MATTHEW ADRIAN LONGINOS

department of health in Cebu.

The trio connected with an agent and agreed to a threeyear work commitment at HRMC as part of an immigration program. The stark winter cold of South Dakota in February was a shock but the three young men liked the size and diversity of the community — including Asian grocery stores and restaurants — and the intimate feel of the small hospital.

During the holidays, they helped create a piece of art on their whiteboard depicting a festive tree with greetings in a variety of languages. They have enjoyed traveling and exploring the rest of the country during their time-off.

ARECIBO, PUERTO RICO

LIZAMARIE VALENCIA FELICIANO, LPN

LizaMarie moved to Huron Arecibo, Puerto Rico with her family at age 15. She started high school in Huron with a dream of becoming a nurse like her mother. After graduation, though, she held back on enrolling in nursing school because she lacked confidence in her English skills.

Several years later, with encouragement from another nurse, support from HRMC’s career outreach director Teresa Haatvedt, RN, BSN, and scholarships from the HRMC Foundation, LizaMarie was able to earn her associate’s degree in nursing from Southeast Technical College. She received her LPN pin from her mother, who had been a nurse in Puerto Rico, and now works at the HRMC Physicians Clinic while pursuing her bachelor’s degree in nursing at Southeast Technical College. She is part of a study group of nurses who speak Spanish as their first language.

LizaMarie recalls the uncomfortable feeling of seeking medical care before she was able to speak English and notes the relief she often sees in her patients’ faces when she addresses them in Spanish.

She has served as HRMC’s Director of Career Development and Outreach for the past four-and-a-half years.

“It really started out with me visiting high schools and middle schools to help entice students to have an interest in the healthcare pathway,” says Haatvedt. When that interest is piqued, Haatvedt can help students find job shadowing opportunities, scholarships, and other tools to help them succeed. “I stay connected with them throughout their course of study,” she says.

KHU KLE SHEE

For the hands-on portion of their training, HRMC has developed several healthcare apprenticeships in conjunction with the South Dakota Department of Labor. Among them are surgical technician, respiratory therapy, information technology, CNA, LPN, and (coming soon) RN.

In some cases, foreign-born workers have healthcare training or licenses that aren’t recognized in South Dakota. HRMC has already enrolled one such group of people in an online medical terminology course for non-English speakers. The plan is to support them through their NCLEX review classes, help finance their licensure, and ease them back into the profession with an apprenticeship. HRMC’s three community liaisons (grant-funded Community Health Workers) − one Hispanic, one Karen, and one white − have helped to identify community members who would qualify for this track.

“ WE ARE TRYING TO STRUCTURE OUR ORGANIZATION TO MIRROR AND MATCH OUR COMMUNITY.”

Klu Kle Shee (or KK) immigrated to Huron from Thailand with her family when she was just three. As a high school freshman, she worked as a tray aide for the food service department at HRMC, giving her a firsthand opportunity to see the care pro vided in many areas of the hospital.

With a lifelong desire to work in healthcare and a better understanding of the hospital system, Shee connected with a leader in the laboratory department who helped her gain the training to become a phlebotomist when she turned 18.

As a phlebotomist, She feels especially grateful to be able to help the community’s Karen patients feel comfortable in their most vulnerable moments. She has even been known to sing to her pediatric patients to make them more comfortable when drawing their blood.

Eager for a challenge and a career in direct patient care, Shee is pursuing an LPN degree at Southeast Technical College with financial support from Build Dakota Scholarship and HRMC Foundation.

THAILAND

But not all international workers in Huron were refugees or came for the meat processing plants. Some were hired directly by HRMC, working through a recruiter, from places like Puerto Rico and the Philippines to address severe post-pandemic staff shortages.

Regardless of where they came from, or how they got here, once they join the staff, HRMC is striving to make sure all of its workers feel at home. The HRMC Central Café is developing new culturally diverse menu items. The hospital hosted a parade of cultures and a potluck on World Population Day in July. And a task force has been formed to plan a mural reflecting Huron’s many cultures. The hospital even recently redid its mission, vision, and values to include a statement on diversity.

Larson and Haatvedt say these efforts ultimately benefit the entire community of Huron. Not only is HRMC

“HAVING A DIVERSE

WORKFORCE

IS VITAL FOR US TO

UNDERSTAND

THE PATIENT PERSPECTIVE AND PROVIDE THE EXPERIENCE THAT ALL PATIENTS DESERVE.”

successfully filling healthcare gaps, but they are also helping to build bridges to their international patients, some of whom may be distrustful of Western medicine.

“We want to personalize, humanize, and demystify their care,” says Larson.”Huron is unique in its diversity and we need to capitalize on that. Having a diverse workforce is vital for us to understand the patient perspective and provide the experience that all patients deserve.”

“Now every patient, even if they are Karen or Hispanic, can feel like they have a nurse they can relate to and trust,” says Haatvedt. “It also impacts HRMC as an organization because our departments are now staffed to care for our community safely. And it impacts the international workers themselves because they are now working in the field they really want to be working in.” ❖

Our thanks to Mati Felderman, HRMC’s Director of Marketing and Communications, for preparing the staff profiles.

GUATEMALA

KATHERINE HUNTLEY GOMEZ, LPN

Katherine, who goes by Kat, immigrated to the US from Guatemala when she was just eleven. At the start of 6th grade, she spoke no English.

After graduating from high-school in Huron, she tried to go to college in Brookings but the travel became too much. When she discovered that she was pregnant, she took a job as a receptionist in the HRMC emergency room.

From that vantage point, she watched with admiration as nurses cared for patients during the pandemic.

That experience, in combination with scholarship money from the HRMC Foundation, made it possible for Kat to earn an LPN at Southeast Technical College in Huron, making her the first person in her family to earn a degree. Kat transitioned from ER receptionist to caring for patients as a nurse in the respiratory therapy department, filling a significant staffing need.

Kat has gotten additional education and mentorship through an LPN apprenticeship at HRMC through the South Dakota Department of Labor. She is now pursuing her RN degree and hopes to inspire other first-generation students in the US to pursue healthcare careers.

HUMACAO, PUERTO RICO

SAU-MEI RAMOS, CHW

Sau-Mei Ramos, a community health worker at HRMC with a BS in nursing, was 25 when she came to the US from Puerto Rico. As a certified CHW, she works to build trust in healthcare and preventative care and helps individuals access important community resources, bridging the gap between healthcare and many social supports.

Helping new and expectant moms is a passion and an area in which she has identified a need. She helps patients to receive education to keep themselves and their babies healthy and also works to ensure they understand the labor and delivery process, helping them to have a positive birth experience.

Ramos recently worked with Norma Torres-Ortiz, RN and Brooke Sydow, EdD, program manager for HRMC, to arrange an opportunity for individuals trained in nursing in other countries to come together to study for the NCLEX exam. The group, including Ramos, consists of six nurses in Huron who will be eligible for a registered RN apprenticeship through HRMC and the South Department of Labor upon receipt of their South Dakota nurses’ license.

Understanding Palliative Care in South Dakota

A Conversation with Michele Snyders

YOU MAY THINK YOU UNDERSTAND palliative care but do you really?

Michele Snyders, Hospice and Palliaitve Care Program Manager at SDAHO, says it is still often misunderstood — even by healthcare professionals.

MED: Can you explain your role at SDAHO and how it relates to palliative care?

MS: My role is relatively new, created about two years ago when we absorbed the LifeCircle organization, previously run through the medical school. It is a good fit for SDAHO because we have a large number of members in post-acute care, home health, long-term care, hospice, and assisted living, as well as hospitals.

MED: What is palliative care, and how does it differ from hospice care?

MS: Palliative care is specialty medical care provided for serious illness, available from the moment of diagnosis through the end of life. It’s important to note that palliative care is not specific to people with a terminal diagnosis. You could be receiving aggressive chemotherapy with the goal of curing cancer and still benefit from palliative care. It’s meant to support anyone going through a serious illness by attending to their psychosocial, spiritual, and physical needs, as well as supporting family members and caregivers. The key difference is that palliative care is not hospice care. Palliative care can be provided alongside curative treatments, whereas hospice is typically for end-of-life care.

There’s still a big misconception about this. When I was working in palliative care it was not uncommon to hear a provider say ‘We can’t refer to you because we’re not there yet.’ And

we’d ask, ‘What do you mean? Doesn’t your patient have a serious illness?’

MED: How is palliative care delivered, and who is involved in providing it?

MS: Palliative care is delivered by an interdisciplinary team. This team may include a physician, a nurse practitioner, a nurse, a social worker, and a chaplain. Often, pharmacy is consulted too, because symptom management is a big goal. It’s important to note that palliative care never takes over the management of a patient’s care; instead, it works in conjunction with the patient’s primary care team to ensure continuity.

MED: What is the current state of palliative care in South Dakota?

MS: In South Dakota, with a population of roughly 900,000, we recently completed a survey that showed we only have 12 certified hospice and palliative care physicians, with 9 of them in the southeastern part of the state. The three large health systems have palliative care teams starting with inpatient roles, and two of these systems also have outpatient teams. Some outpatient care is actually done via telehealth. There are also a couple of organizations that provide home-based palliative care.

MED: What are the different types of palliative care, and what training is involved?

MS: There are two types of palliative care:

Specialty palliative care involves team members involves team members with specialized training in hospice and palliative care. They typically deal with more complex patients and situations. There is fellowship training or certification available for advanced practice providers and palliative care nurses.

Primary palliative care includes teams that haven’t gone through fellowship or certification but understand basic symptom management and how to have conversations with patients about palliative care. They also know when to refer to a specialty care provider.

For training, the Center to Advance Palliative Care is a leading resource. Other programs like Vital Talk teach how to have care conversations. At SDAHO, we try to find education and webinars to make available to our members.

MED: What steps are being taken to improve palliative care access and coverage in South Dakota?

MS: We’ve recently put a palliative care definition into statute. This is a crucial step towards getting reimbursement for the entire palliative care team. Currently, only healthcare providers are reimbursed under insurance. Our next step is to explore how we can get coverage for the whole interdisciplinary team.

We’re also working on educating providers and the public about what palliative care really is. Once people understand it, they’ll see that all healthcare should be delivered this way if we want to do what’s in the best interest of patients.

Lastly, we’re looking at the benefits of palliative care, such as fewer ED visits and hospitalizations. Some states are working with independent payers to try to get teams reimbursed, and we’re exploring similar options in South Dakota. ❖

Certified Speech Therapy

for Children & Adults

DAN RUBENS Speech-Language Pathologist

Dan has served the Siouxland community for the past four years as a speech-language pathologist. His primary focus is on treating adults with speech, language, cognitivecommunication, and/or swallowing disorders after a stroke, traumatic brain injury, head or neck cancer, or from other neurogenic pathologies.

Dan also has experience with pediatric patients who have speech-sound disorders or developmental language disorders.

• Speech, language and cognitive-communication

• Swallowing and stroke-related challenges

• Traumatic brain injuries

• Head or neck cancer conditions

• Parkinson’s Disease and other neurological disorders

Certified in Lee Silverman Voice Treatment (LSVT) for individuals with Parkinson’s Disease. The area’s only clinician in the area certified in McNeil Dysphagia Therapy Program (MDTP)—an intensive program intended for adults with mild to severe swallowing issues.

❱ Learn more about the value and importance of palliative care and hear from patients in a Legislative Update video from SDAHO on our website.

News & Notes

AVERA

Avera launched its third annual Ask the Question suicide prevention campaign in September. The campaign, fully funded by Avera Foundation donations, focuses on encouraging direct conversations about suicide, particularly with teens. South Dakota suicides have decreased for two consecutive years, from 203 in 2021 to 180 in 2023. Avera is also sponsoring the 437 Project, a relay-style running event to raise awareness and support the Helpline Center, South Dakota’s only accredited suicide crisis center.

The Avera Foundation set a new annual fundraising record in fiscal year 2024, raising over $53 million from 20,848 benefactors. The funds support various projects, including new facilities and programs across Avera’s network. Notable projects include a new obstetrical surgical suite in Pierre, an updated women’s center in Aberdeen, and the new Helmsley Behavioral Health Center in Sioux Falls. This year’s Avera Race Against Cancer also set a record, raising $725,000 with 6,700 participants. The annual race has raised a total of $11 million for the past 36 years. Proceeds go toward needs including cancer navigation services, wigs for cancer patients and more.

MONUMENT

ALAN SOLANO

Monument Health has announced Alan Solano as the new Vice President of Governmental Affairs, effective January 2024. Solano, currently CEO of the John T. Vucurevich Foundation, will leave that role in December 2024. He previously served as a South Dakota State Senator and CEO of Behavior Management Systems. In his new role, Solano will focus on building relationships with legislators, policymakers, and community stakeholders to support Monument Health’s mission.

Monument Health Rapid City Hospital received the American Heart Association’s Get With The Guidelines - AFib Gold quality achievement award for its management of atrial fibrillation. The award recognizes the hospital’s commitment to using up-to-date, researchbased guidelines in patient care. AFib, which affects millions of Americans, can increase stroke risk fivefold. The program aims to improve patient outcomes through evidence-based care and patient education. Participating hospitals often see improved outcomes, fewer readmissions, and lower mortality rates.

Monument Health implemented a new electronic visitor management system at Rapid City Hospital this summer. The system aims to streamline check-in processes for more than 800 daily visitors, enhance safety, and improve patient care. Initially serving hospitalized patients and Emergency Department visitors, the system will be expanded to additional units. Multilingual support is available, and Guest Services staff will assist visitors with the new process.

SANFORD

SCOTT ENGEL

Sanford Health researcher, Scott Engel, PhD, along with his

co-Principal Investigators, Kristine Steffen, PhD, Pharm.D (NDSU) and Leslie Heinberg, PhD (Cleveland Clinic), were recently awarded a $4.25 million grant from the National Institutes of Health. Dr. Engel’s lab is investigating patient outcomes after bariatric surgery. The grant will fund a study into the relationship between bariatric surgery and post-operative hazardous alcohol use. Research shows that patients who undergo bariatric surgery are at an increased risk for an alcohol use disorder.

Sanford Health recently broke ground on the new Good Samaritan Society - Founder’s Crossing senior community in Sioux Falls. The campus will offer a range of services including independent living, assisted living, memory care, and rehabilitation. Amenities include fitness areas, a golf simulator, and restaurant-style dining. A future Sanford Health clinic and Lewis Drug will be directly connected. The project will be completed in phases, with the first units opening in spring 2026. In total, the senior living community will be home to nearly 500 residents and supported by 200 employees

Five new members recently joined the Sanford Health Plan Board of Directors: Nworah Ayogu, MD, DeAnna Carlson Zink, Joshua Crabtree, MD, Josh Pauli, PhD, and Michael Wagner. These leaders bring diverse experience in healthcare, business, technology, and education. Their addition expands the board to 12 members. The new directors will guide the strategic direction of the Sanford Health Plan, aiming to benefit members and their families.

DEEANDRA SANDGREN,

DeeAndra Sandgren, chief nursing officer at Good Samaritan Society, participated in the 2024 Skilled Nursing News RETHINK conference in Chicago in September. She discussed resident safety, care transitions, and collaboration between acute care and skilled nursing facilities. Sandgren highlighted Good Samaritan Society’s initiatives, including the Sanford Accountability For Excellence (SAFE) program and innovative care models like home hemodialysis dens in skilled nursing facilities.

MARIA STYS

Dr. Maria Stys, cardiologist and director of the women’s heart program at Sanford Heart Hospital

and Associate Academic Professor at the University of South Dakota Sanford School of Medicine, is expanding her outreach to include Sanford Sheldon Medical Center in northwest Iowa. She will provide services on the 1st and 3rd Thursdays of each month in Sheldon, while continuing her outreach at Sanford Clear Lake Clinic and Sanford Rock Rapids Clinic.

Dr. Richard Clark, cardiologist and director of cardiac rehab at Sanford Heart Hospital, is also expanding his outreach to include eight new locations.

Dr. Clark is director of cardiac rehab at Sanford Heart Hospital. He will now serve communities in Minnesota including Jackson, Luverne, Ortonville, Slayton, Tracy, Windom, and Worthington, as well as Orange City, Iowa. Dr. Clark will continue providing services to Armour, Burke, Pierre, and Winner in South Dakota.

NATASHA SMITH

Natasha Smith, head of diversity, equity and inclusion at Sanford Health, has been named to Becker’s Hospital Review’s “Hospital and health system diversity, equity and inclusion officers to know” list for the second consecutive year. Under her leadership, Sanford has conducted over 100 inclusivity trainings, created new DEI resources, and expanded benefits for same-sex marriages and domestic partnerships across the organization.

Sanford Health has been named one of America’s Best-In-State Employers 2024 by Forbes in South Dakota, North Dakota, and Minnesota. The recognition is based on an independent survey of over 4.4 million U.S. employees working for companies that employ more than 500 people. Evaluation criteria included employees’ willingness to recommend their employer and public perception of the organization. With more than 46,000 employees, Sanford Health is one of the largest employers in the upper Midwest. Sanford USD Medical Center made Forbes’ Best In-State Employers list last year, as well as the list of Best Employers for Veterans.

❱ Intrigued by something you’ve read here? Want to go deeper? Read the full versions of these and other recent news items on our website.

SIOUXLAND

PATRICK KELLY

Patrick Kelly, MD, a board-certified vascular surgeon from Dakota Vascular in Sioux Falls, has returned to the Siouxland area to provide specialized vascular care in the new UnityPoint Clinic location. Dr. Kelly will offer treatment for complex arterial and venous conditions at UnityPoint Clinic–Dakota Dunes. Dr. Kelly will offer treatment for complex arterial and venous conditions twice a month at the Dakota Dunes location, improving access to advanced care for patients in the Siouxland area.

ASHLESHA KAUSHIK

Dr. Ashlesha Kaushik, a pediatric infectious disease specialist at UnityPoint Clinic, has been elected Vice President (President-Elect) of the Iowa American Academy of Pediatrics. She is the first physician from Sioux City to hold this position. In addition to her leadership role, Dr. Kaushik has been recognized as one of five national subject matter experts for the newly released AAP Virtual Reality module on immunization confidence and infection prevention and will speak at several upcoming conferences.

MercyOne Siouxland Medical Center has received four American Heart Association Get With The Guidelines® and Mission: Lifeline® achievement awards. The recognitions highlight the hospital’s commitment to treating heart disease and stroke using up-to-date, research-based guidelines. MercyOne’s comprehensive cardiac program includes open heart surgery, WATCHMAN device, TAVR, and heart failure care. The awards cover stroke care, coronary artery disease management, and heart failure treatment, with additional recognitions for diabetes care in cardiovascular patients.

INDEPENDENTS

MERRETTA ANDERSON SPENCER BLOCH

Horizon Health Foundation recently welcomed Merretta Anderson and Spencer Bloch as new board members. Anderson, from Isabel, brings experience in education and community involvement. She holds a Master’s in Sports Medicine and Injury Prevention and owns a bakery and catering business. Her father was the original x-ray and lab technician at the Isabel Community Clinic in the 1980’s. Bloch, a Finance Business Partner for Mosaic, oversees finance performance in the Midwest region. He holds degrees in accounting and business administration from Dakota Wesleyan University and resides in Scotland, South Dakota.

Yankton Medical Clinic has expanded flu vaccination options this year.The popular drive-thru flu shots were offered twice in October behind the YMC building, with no appointment required. In addition, a new Tuesday clinic is being offered this year, from October 1st through November 12th, offering flu shots from 3-5pm in the clinic. Walk-ins are accepted, but appointments are preferred for the Tuesday clinic.

KRISTOPHER JOHNSON

Dr. Kristopher Johnson recently joined Prairie Lakes Healthcare System as a General Surgeon. He performs a variety of surgical procedures, including colonoscopies, breast, thyroid, and hernia, gallbladder, acid Dr. Johnson earned his medical degree from the University of South Dakota Sanford School of Medicine and completed his general surgery residency at USD Sanford School of Medicine in Sioux Falls. He recently moved to Watertown from Sioux Falls with his family and joins joins Dr. Greg Gerrish and Dr. Jacob Shaeffer in the General Surgery Clinic.

KRISTIN VANBUSKIRK

Kristin VanBuskirk, CNP, a family nurse practitioner at Huron Regional Medical Center Physicians Clinic, has expanded her practice to include ear, nose, and throat specialty care. She will assess, diagnose, and treat ENT diseases and perform minor surgical procedures. VanBuskirk earned her nursing degrees from Mount Marty College and Presentation College. She joined HRMC in 2020 after serving as an ENT nurse practitioner at Avera Medical Group in Aberdeen.

DOUG VAN MAREL

Doug Van Marel, MD, joined Huron Regional Medical Center’s medical staff this summer. As an internal medicine physician, he will provide inpatient and emergency care. Dr. Van Marel graduated from the University of South Dakota Sanford School of Medicine and completed his residency at Michigan State University. He previously worked at Three Rivers Health in Michigan and looks forward to providing complex care locally in Huron.

Chelsie Babl, LPN, at Huron Regional Medical Center Physicians Clinic, has received the DAISY Award for exceptional nursing care. Babl was nominated by a colleague for going above and beyond for her patients. The DAISY Award is an international recognition program honoring nurses who provide compassionate and skillful care. Babl is the eighth DAISY Award winner at HRMC, with one nurse recognized each quarter.

Tyler Hemmingson Degree: Master of Public Health

Current Position: Senior Director of Practice Advancement, American College of Lifestyle Medicine

Tyler Hemmingson was exposed to the health professions much earlier than a lot of people. He was born with a congenital heart condition that wasn’t detected until he was 6 years old. Had there been a pediatric cardiologist in his hometown of Spearfish during that time, he might have had only one surgery, instead of the ten he ended up needing.

“Once I realized how different things were for me just because of where I grew up, I became intrigued by public health,” says Hemmingson.

Originally bound for medical school, Hemmingson changed his mind after a health disparities class in his senior year of college. He worked first for Sanford Research and then at the USD Sanford School of Medicine’s RISE UP program designed to introduce public health to minority students.

Hemmingson was still working full time when he enrolled in the USD School of Health Sciences Master of Public Health program, even though he wasn’t yet sure exactly where the degree would take him.

“One thing that really impressed me about the program was the fact that I had a lot of direct access to the professors and great mentorship,” says Hemmingson. “That encouraged me to engage deeply in absorbing as much as I could.”

Hemmingson’s career has been diverse. He worked for Sanford World Clinics and for Monument Health in organizational leadership development and lab management before accepting his current position with the American College of Lifestyle Medicine.

“I lead a department that supports health systems, payers, ACOs, community health centers, public health departments and others in integrating lifestyle medicine into clinical areas,” says Hemmingson. “My MPH degree gave me a broad foundation — including data analysis skills, strategic planning, leadership, and a knowledge of how healthcare is delivered in different settings — that I use every day.”

This SUCCESS

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SPOTLIGHT

around the region

Brookings Health System became the 46th breastmilk collection depot for the Mother’s Milk Bank of Iowa, the fourth such site in South Dakota. Approved donors can drop off frozen milk by appointment at the New Beginnings Birth Center. The milk will be frozen and stored until gathered by Mother’s Milk Bank of Iowa which will pasteurize the milk and dispense it to locations across the United States. The program aims to support vulnerable infants, particularly those born prematurely or with weakened immune systems. In 2023, the Mother’s Milk Bank of Iowa served 44 hospitals across eight states.

ANTHONY P. FIEGEN

Orthopedic Institute recently welcomed Anthony P. Fiegen, MD, and Joshua J. Meaike, MD, to their team. Dr. Fiegen specializes in comprehensive sports medicine, having completed his residency at Mayo Clinic and a fellowship at Wake Forest University. Dr. Meaike focuses on conditions of the hand, wrist, elbow, and shoulder, with training from Mayo Clinic and the Indiana Hand to Shoulder Center in Indianapolis. Both doctors bring extensive experience and a commitment to providing high-quality orthopedic care to patients in the region.

DANIEL RUBENS

CNOS has expanded its Therapy Services by adding Daniel Rubens, Speech-Language Pathologist, to their Dakota Dunes Clinic. Rubens specializes in treating adults with speech, language, cognitive-communication, and swallowing disorders resulting from various neurological conditions. He is certified in the Lee Silverman Voice Treatment for Parkinson’s Disease and is the only area clinician certified in the McNeil Dysphagia Therapy Program. This addition allows CNOS to offer physical, occupational, and speech therapy services under one roof.

MED’s Executive Editor and co-founder, Alex Strauss, is this year's winner of the Distinguished Service Arward for Healthcare Journalism from the South Dakota Association of Healthcare Organizations (SDAHO). Alex accepted the award at SDAHO's Fall Convention in Rapid City in October. Alex, who founded MED with Steffanie Holtrop, has been covering and promoting healthcare in the South Dakota region for more than 25 years. She is the daughter of a pediatrician and holds an MA in Broadcast Journalism from American University.

OTHERS

The University of South Dakota hosted Jennifer Weber, MPH, RD, a national expert on child health, nutrition, and wellbeing, for speaking engagements statewide this fall. Weber’s presentations focused on the WIC program, which serves over 13,000 South Dakota participants monthly. The program aligns with child abuse prevention strategies by providing support, education, and resources to families. Weber spoke at various events, including the annual Community Response to Child Abuse Conference, addressing topics related to child health and family support.

Over 500 people attended the 24th Annual Community Response to Child Abuse Conference in Sioux Falls in October. The event featured national and regional speakers addressing topics to help professionals and the public better understand and respond to child abuse. Keynote presentations covered subjects such as digital child safety, vulnerable child syndrome, and questioning techniques. Breakout sessions explored topics including social media’s impact on mental health, child perpetrators, and indigenous approaches to addiction healing and mental health management.

The University of South Dakota Department of Occupational Therapy hosted CarFit check-ups for senior drivers in September, with events in Hawarden, Iowa and Vermillion, South Dakota. CarFit, developed by AAA, AARP, and the American Occupational Therapy Association, provides comprehensive checks on how well older drivers and their vehicles work together. The program addresses age-related changes affecting driving and offers tools to enhance safety. Occupational therapists were available for consultations on maintaining and improving driving health.

Southwest Minnesota EMS Corp. recently received $9.9 million in federal funding to improve post-crash care in rural communities. The grant will provide 54 EMS agencies in an 18-county region with Avel eCare’s telemedicine services, giving EMTs and paramedics virtual access to emergency physicians and experienced medical professionals wherever they are. The initiative aims to reduce traffic fatalities and improve trauma care in an area where long distances and limited resources often impact emergency response times. The University of Minnesota will evaluate the program’s efficacy.

Alex Strauss receives the SDAHO Distinguished Service Award for Healthcare Journalism from SDAHO President Tim Rave at the 2024 Fall Convention in Rapid City

HEIGHTENED AWARENESS TO REDUCE MISSED DIAGNOSIS OF INFECTIONS

BY DR. ERIC ZACHARIAS

CASE STUDY

A 45-year-old woman was trail running when she tripped on a rock and fell, scraping her knee and straining the back of her calf and hamstring. Three days later, she noted a sudden worsening of her leg pain and presented to her physician’s office with complaints of “leg pain and muscle pull.” At the appointment, she complained of diffuse, severe pain in the areas she strained, her upper calf and hamstring as well as around her knee radiating to her thigh.

On exam, her physician noted the pulled muscles and knee joint were very painful on palpation and range of motion. Of note, the intake vital signs for the patient were T=100.8, P=110, and BP=95/60. No respiratory rate or pulse oximetry were documented. It is unclear from the record whether the physician saw these vital signs, but he made no entry to explain why they were abnormal or as to why he was not acting on them. The physician diagnosed the patient with “acute calf and hamstring injury, possible partial tear,” advised her to avoid activities that made the symptoms worse, and referred her to physical therapy.

Later that evening, the patient’s symptoms worsened dramatically. She called the physician on-call who advised rest, ice, elevation, and ibuprofen. The following morning, she went to the emergency department where she was diagnosed with acute necrotizing fasciitis and sepsis syndrome. She underwent emergency fasciotomy, multiple follow up surgeries and skin grafts, and a prolonged hospital course including two weeks in the surgical intensive care unit. She ultimately sued the physician who saw her in clinic for, among other allegations, negligence in failing to recognize and treat her infection at the clinic visit. The on-call physician was also named in the lawsuit with allegations of failure to take an adequate history from a patient with worsening symptoms.

ANALYSIS

1. Failing to document one’s thought process regarding the potential causes of and follow-up plans for abnormal vital signs can make it difficult to defend care. A reasonable thought process, even if incorrect, is more defensible than what appears to have happened in this case study—the vital signs were not reviewed or not recognized as abnormal and requiring more action.

ALLEGATIONS OF NEGLIGENT DELAY IN DIAGNOSIS AND/OR INADEQUATE TREATMENT OF INFECTIONS AND SEPSIS REMAIN COMMON. THIS IS THE CASE FOR SEVERAL REASONS:

2. Infections that ultimately become severe or life-threatening may present with subtle or non-specific findings early in their course before progressing to a severe clinical level. Infections are often more difficult to diagnose at an early point in their progression, however, allegations of missing this early “window of opportunity” for treatment when patients may be more responsive to treatment are often made in claims.

❱ For more reasons why infections often go undiagnosed, see the extended version of this article on the website.

3. There is a common misperception that infections are always easy to diagnose, that fever always equals treatable infection, and that infections are easily cured with antibiotics. When an infection is missed early in its course or when it progresses to an adverse outcome, patients or their families may assume the care team must have “done something wrong.”

Dr. Eric Zacharias is Chief Medical Officer at COPIC.

BEYOND THE BORDER

In addition to MED Magazine in South Dakota, MED also curates and shares medical community news with 14,000+ digital subscribers in North Dakota, Nebraska, and Iowa. We periodically print some of the most notable news items from our wider coverage area.

CHI Health Good Samaritan in Kearney recently celebrated 30 years of launching the region’s first full-service heart program. Today, more than 42,000 procedures have been performed in Good Samaritan’s two fully-equipped cath labs and new state-ofthe-art hybrid cath lab. The only one of its kind from Lincoln to Denver, the hybrid cath lab is equipped for both catheterization and surgical procedures.

Also new to the heart program is the first FDA approved mechanical thrombectomy system. Using nitinol mesh disks and large lumen aspiration catheters, the procedure removes blood clots in the lungs or legs.

New Orthopedic Center for West Omaha

CHI Health has announced plans for a new Orthopedic Center at Lakeside in West Omaha, slated to open in Summer 2026. The facility will repurpose the former wellness center building on Lakeside’s campus, aiming to meet the growing community’s needs.

The two-story, 49,500-square-foot center will accommodate up to 20 orthopedic surgeons and house outpatient rehabilitation services. This setup will allow patients to see both orthopedists and therapists in one location. The center’s connection to Lakeside Hospital will provide easy access to imaging, surgical suites, and other hospital services.

Current rehabilitation and orthopedic services at CHI Health Lakeside will continue uninterrupted during construction.

NORTH

DAKOTA

New Partnership will Expand Bismarck Services

Essentia Health and Brightside Surgical in Bismarck have announced a new partnership, becoming shared owners of the ambulatory surgery center. The collaboration aims to improve access to surgical care in the Bismarck-Mandan area.

“Since Mid Dakota Clinic joined Essentia in late 2022, we have recruited more than a dozen new providers to our Mid Dakota Bismarck locations. This new partnership allows us to extend that dedication by bringing stability and growth in surgical services to the region,” says Dr. Stefanie Gefroh, who serves as Essentia’s interim president for its North Dakota and western Minnesota footprint.

Brightside Surgical will maintain its current local operations and care teams, while Brightside Specialty Clinics will remain independent.

Sanford’s Kristin Herrmann Named to Becker’s Top Women CFO List

Becker’s Health Review has named Sanford Health Fargo’s Kristin Herrmann to the 2024 edition of its “Women hospital and health system CFOs to know” list.

Herrmann oversees the financial operations of a premier rural health system with an annual net patient revenue of $1.8 billion and also oversees the finances of Sanford Fargo’s four critical access hospitals. Her strategic leadership has significantly improved Sanford Fargo’s financial performance, achieving a 90% improvement since 2022. Herrmann has overseen financial planning for major initiatives, including the expansion of Sanford Roger Maris Cancer Center and the implementation of the blood and bone marrow transplant program.

❱ Interested in more news from MED’s wider coverage area? Select your preferred regional newsletters on our website.

IOWA

UnityPoint Health’s Iowa Methodist Medical Center

Named State’s Top Rehab Hospital

UnityPoint Health’s Iowa Methodist Medical Center in Des Moines has been named Iowa’s top rehabilitation hospital for 2024 by Becker’s Healthcare. The recognition highlights Younker Rehabilitation’s excellence in caring for patients recovering from conditions such as stroke, traumatic brain injury, spinal cord injury, and amputation.

“This achievement underscores our dedication to delivering high-quality, compassionate care to our patients as they recover and rehabilitate from

challenging medical conditions,” said Jon Rozenfeld, UnityPoint Health – Des Moines President.

Becker’s ranking, based on U.S. News & World Report’s 2024 evaluations, assessed 1,049 hospitals nationwide. The study used Medicare data and other sources to identify top performers in patient care and outcomes.

Younker Rehabilitation offers comprehensive services tailored

to each patient’s needs, combining advanced medical expertise with personalized treatment plans.

A multidisciplinary team of rehabilitation specialists, physicians, and therapists works closely to support patients throughout their recovery journey.

The recognition solidifies Iowa Methodist Medical Center’s position as a leader in rehabilitation services in the state. ❖

• Addressing other concerns related to neurological, musculoskeletal, or other developmental diagnoses

• Decreasing pain

• Reducing fear of falling associated with balance and/or walking concerns

• Providing a calm environment for children with autism to participate in therapy

Prairie Lakes Cancer Center Celebrates 25 Years

PRAIRIE LAKES Cancer Center in Watertown recently celebrated a quarter of a century of providing hope and healing in Watertown and the surrounding communities. They welcomed their first patient in 1999 and now serve more than 400 new patients a year, about 40 patients every day.

The Cancer Center’s journey from a team of one physician and nine staff members to a comprehensive care center with three employed physicians, one nurse practitioner, and 22 staff members is a testament to the health system’s commitment to cancer care excellence.

In addition to Radiation Oncologist Dr. Joni Buechler, Medical Oncologists/Hematologists Dr. Bipin Amin and Dr. Vijay Rao, and CNP Kristina Rieffenberger, the cancer team includes oncology-certified nurses, a radiation dosimetrist, a social worker, a research specialist/ clinical trial coordinator, radiation therapists, and dedicated office staff.

The team also collaborates with specialists across the Midwest to allow patients to stay in their own community whenever possible. And, to ensure that quality cancer care is accessible to their rural neighbors, Cancer Center providers offer outreach services to Dawson, Madison, and Montevideo, Minnesota and Milbank, Sisseton, and Webster, South Dakota.

Over the past 25 years, the Cancer Center has continually upgraded their cancer services, which now include:

DIGITAL PET/CT

The state-of-the-art mobile imaging unit offers exceptional image quality, reduced radiation dose levels, faster scan times, and the ability to perform additional diagnostic CT exams in combination with PET scans.

TOMOTHERAPY

TomoTherapy combines the functions of a traditional radiation therapy unit and an on-board CT scanner.

CLINICAL TRIALS

The Prairie Lakes Cancer Center actively participates in and continually adds new clinical trials to their offerings, providing patients with access to many cutting-edge treatments soon after FDA clearance.

ADVANCED THERAPIES

The Cancer Center can administer a variety of immunotherapies, chemotherapies, and hematology services.

MED congratulates Prairie Lakes Cancer Center for this milestone and wishes them another 25 years of success! ❖

Dr. Joni Buechler, Radiation Oncologist

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