Progress 2019: Healthcare

Minot Daily News SATURDAY, APRIL 6, 2019

Healthcare

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Surgeon program revives lost medical service in rural ‘deserts’ Photo by Jill Schramm /MDN

ABOVE: Dr. Mary Aaland extends a welcome to the new surgical area at Tioga Medical Center March 4.

Small town specialty care

Submitted Photo

MAIN: Team Members of the surgical team serving Tioga Medical Center, from left, Jeff Olson, Certified Registered Nurse; Ardis Stewart, Registered Nurse; Mandy Houim, surgical technologist; Jordan Nielsen, RN, surgical supervisor; Dr. Mary Aaland, surgeon; Karen Johnson, CRNA; Terri Brown, CRNA; Sarah Rice and Rayann Vande Sandt, both RN, pre- and post-op.

Heart of America stands out with rural regional pain clinic

By JILL SCHRAMM

Senior Staff Writer • jschramm@minotdailynews.com

RUGBY – In an era when specialized medical treatment is gravitating toward major centers, Heart of America Medical Center in Rugby is bucking the trend with its investment into a scope of pain management services that’s rarely found in rural areas.

TIOGA – When a surgical team inaugurated the new operating room at Tioga Medical Center last Nov. 5, it ended nearly 20 years of a surgical drought for the rural hospital.

Tioga is one of several hospitals participating in the Rural Surgery Support Program of the University of North Dakota’s Department of Surgery.

The program is providing surgeons on a part-time basis to rural hospitals in an effort to re-launch or sustain surgery programs in smaller communities.

“There’s a huge shortage of rural surgeons,” said Dr. Mary Aaland, a surgeon with the program. “It’s a big problem – access to surgical care.”

Aaland comes to Tioga two days each month to perform hernia surgeries, conduct pre- and post-op visits and do educational outreach.

The Rural Surgery Support Program started about four and a half years ago, led by Dr. Robert Sticca, UND surgery department chairman.

Aaland courted communities on behalf of the program to look for local in-

Photo by Jill Schramm/MDN

Heading the Heart of America Pain Management Clinic team are physician’s assistant Nicole Lemieux, Dr. Ted Fogarty and nurse anesthetist Chelsey Wyatt, who stand next to a CT scanner. The scanner has been added to the clinic’s tools for guided pain intervention.

By JILL SCHRAMM

Senior Staff Writer • jschramm@minotdailynews.com

Rural surgeon program brings surgeries back to Tioga

terest.

“Literally, I knocked on doors.

When I started, it was just an idea,” she said. “What I learned is every community is different. It has different resources, different patient populations.

So we are trying to make it specific for the community.”

It takes vision, commitment and an analysis of local resources to develop a surgical program from scratch, Aaland said.

“We have to build the infrastructure and the team. Surgery is a team approach,” she said.

Jordan Nielsen, surgical supervisor in Tioga, said most of the surgical team consists of staff members who already had been working at the medical center and trained for the new roles. Trinity Health in Minot supported the program with training and also provides anesthesiology services for sur-

geries.

“We spent a lot of hours working on policies, making sure we knew exactly what we were doing before we had our first procedure,” Nielsen said.

Tioga spent more than $600,000 to build a state-of-the-art operating center.

Unlike visiting a bigger center, when patients come to Tioga, they see the same caregivers for their pre-op, admission, operating room, recovery, post-op and follow-up visits.

“Getting to know us, I think, helps with the comfort level,” Nielsen said.

“That’s unique here,” Aaland said.

“That is totally unique to what we can do in a community like this, and I think that’s so being lost in medicine nowadays in the big city.”

Forty years ago, every one of North See TIOGA — Page 2

Summer Unplugged

Having opened in late 2016, the pain clinic has been slowly building its practice, evolving into a fullservice practice for the Rugby and surrounding areas, said Chelsey Wyatt, certified registered nurse anesthetist, who helped found and lead the program.

Heart of America carved out a clinic area for pain management in its specialty services wing by converting space previously used as a board room. It invested in new fluoroscopy equipment, training and the expertise of an interventional radiologist.

“We want to offer individualized care for each patient through multiple modalities. We don’t limit them to medication or to a therapy or to an injection.

We want to assist patients in a non-narcotic, interventional, multimodal pain treatment plan that gives them the very best improvement in their quality of life,” Wyatt said.

The clinic recently added the services of Dr. Ted Fogarty, chairman of radiology at

the University of North Dakota School of Medicine.

Fogarty, who comes to Rugby about three days a week, has been building a rural interventional radiology practice.

“What I bring in is something that we’ve lost on the Northern Plains. We’ve lost general radiologists with hands-on skills to do interventional procedures, and that’s been occurring over the last 10 years in a fairly rapid fashion,” Fogarty said.

“We’re getting into this really troubling consolidation situation in medicine, and in part, it has really come through my specialty, first and foremost – through teleradiology. So it kind of opened the genie’s bottle, so to speak about 10 years ago in the Dakotas, with more and more of our advanced imaging being interpreted by non-North Dakotans through teleradiology services.”

If a Rugby surgeon wants to talk to the radiologist who read the mammogram on his See RUGBY — Page 2

Hess, YMCA partner to get families playing outdoors

By JILL SCHRAMM

Senior Staff Writer • jschramm@minotdailynews.com

Set aside the gadgets and get moving. That’s what the Minot Family YMCA and Hess Corp. encouraged kids and their families to do last summer at their first eight-week Summer Unplugged.

Looking to bring more fun to the community, the YMCA and Hess are putting on the weekly event this summer, beginning June 5, at the YMCA. “Hess is excited to support the second year of a great program designed to engage families in being active outside,” said Brent Lohnes, general manager for Hess in North Dakota, in a prepared statement. “I have confidence that the success and visibility of the YMCA and the Summer Unplugged events will once again benefit children and their families. We hope everyone takes advantage of this organized opportunity to be away from electronic devices and simply have fun!”

Hess had approached the YMCA about sponsoring an event last year that would be free to all age ranges. YMCA aquatics director Alina Olivares and marketing director Tia Klein took on the challenge.

“It was an awesome experience. We’re very lucky that Hess approached us with this idea,” Olivares said. “They wanted something that brought communities outside – children outside to play. Get them unplugged, so to speak, from the tablets and the phones and just TV in general, and get them moving.”

See YMCA — Page 3

Submitted Photos

ABOVE: Children play with a parachute at Summer Unplugged 2018.

LEFT: Families exercise with yoga during a session of Summer Unplugged in 2018.

Page 2

Minot Daily News • PROGRESS: Healthcare

Tioga

Saturday, April 6, 2019

Continued from Page 1

Expanding medical services New McKenzie County hospital brings back surgical care

By JILL SCHRAMM

Senior Staff Writer jschramm@minotdailynews.com WATFORD CITY – A new hospital complex that opened last June afforded McKenzie County Healthcare Systems the ability to take on a broader range of medical services, including re-establishing surgical care that had been absent for more than 20 years.

The first surgery in a new, state-of-the-art surgical suite took place March 27, performed by orthopedic surgeon Dr. Ravindra Joshi.

“One of the driving goals we had with building the new facility was maximizing our options. One of the difficulties of operating in the Bakken is you often don’t know what’s going to be needed, because things do change so quickly here,” said Michael Curtis, chief administrative officer. “We wanted to build it in a way that if there was an need for orthopedics, we have the space to do it. If there’s a need for general, we had space to do it.

So, we did build it with two rather large operating suites – large enough that we can do anything that came up in the future – and two additional

procedure rooms.”

Samuel Perry, director of operations at the facility, said the surgical service ramped up slowly to ensure everything was operating as needed, but going forward, the suite should be busy.

Joshi, who is full-time in Watford City, offers total shoulder, knee and hip replacement as well as sports medicine. He also works in outreach in Stanley.

Another surgeon, Dr. Torfi Hoskuldsson, currently parttime, will be performing a variety of general surgeries and procedures such as colonoscopies.

Going forward, any expansion will depend on how needs evolve, Curtis said.

“We have had several surgeons reach out to us with interest in coming out here with various specialties,” he added, noting an ear, nose and throat specialist has been working in the clinic and hopes to eventually do procedures and surgeries in Watford City. Great Plains Women’s Center in Williston also operates a clinic in the facility and plans to eventually add gynecological procedures. Curtis said he expects the hospital also may be able to offer at some point the

Submitted Photos

TOP: Dr. Ravindra Joshi, orthopedic surgeon, works with Erika Perry at McKenzie County Healthcare Systems, where he has begun seeing patients and performed the new center’s first surgery March 27.

ABOVE: A state-of-the art operating room is one of two operating rooms and two procedure rooms in Watford City’s new hospital building that opened in 2018. services of visiting surgeons for the more specialty procedures.

McKenzie County Healthcare Systems invested not only into the surgical suite equipment but in staffing the department. The facility began hiring new staff and has relied on traveling professionals as it builds up that staff.

“Starting surgery from nothing is daunting at best,” Curtis said. “Part of that is the staffing and making sure that we have stable staff that are well trained to support the surgeon.”

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benefit to residents of the area. Curtis said traveling to a larger center often means an overnight stay prior to surgery and a long day with travel home afterwards. The need to arrange logistics can delay a surgery, and if there is a concern post-surgery, it is a long distance to commute to or communicate with the medical center.

“So for the population here, the ability to literally come in, have their procedure done, not have to travel, and then go home, it’s truly advantageous,” Curtis said.

“We can get people in quicker. We don’t have to push them out several months, and ultimately they will get alleviated from their pain much sooner.”

The facility added a internal medicine physician, who can assist in preparing patients for surgery. Dr. Lucinda Mundorf provides predominantly outpatient visits for the higher acuity primary care but also some inpatient care and resident care in the nursing home.

The new construction included a 47-bed nursing home, which like the clinic is attached to the hospital.

In addition, the Watford City hospital took a large step forward in acquiring an MRI machine. Curtis said accessibility to MRI is limited in the region, creating waits in many cases.

“We’re able to get in the patients much faster, and that’s proven extremely beneficial,” he said. “Ultimately we’re designing the whole system to get patients treated faster, whether that’s an MRI or surgery, and the whole goal is to take out the delays that people often experience in care.”

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Dakota’s approximately 30 critical access hospitals did surgery, Aaland said. That number dwindled to almost none. Hettinger had continued to provide surgeries at times.

“There were basically big deserts,” Aaland said. “Now, 65 percent-plus of all surgery is done as an out-patient. The model that we are taking is, let’s build community-based, out-patient surgery centers.”

General surgeries, such as for gall bladders and hernias, as well as orthopedics, ophthalmology, podiatry or plastic surgery fit the out-patient model.

The rule of thumb is a community needs about 10,000 people to support a general surgeon, Aaland said. Most towns aren’t that large, but their regional service areas are, she said.

Her goal is for no one in North Dakota to have to drive more than 60 miles to see a surgeon. The surgery still may need to be referred on, but having that surgeon consult is important in keeping the rural patients from being forgotten, she said.

In her role with Tioga Medical Center, she can go to bat for a patient needing a referral to a larger center, she said. If it’s a rancher up against calving season, she can help ensure that patient gets seen sooner rather than later.

“To be a champion for the rural people is important,” Aaland said. “You have to be a patient advocate. Hopefully, I am seen as an advocate for the surgical diseases in rural America.”

Rugby

Continued from Page 1

patient, that person may be in California or Florida, he said.

“That’s where we have lost the human element in rural American medicine,” he said.

“We’re kind of trying to do a little barnstorming revival of patient care and bringing the high-tech stuff back home to the small town.”

In working with the Rugby pain clinic, Fogarty can augment Wyatt’s ability to deliver treatment by providing CT and ultrasound guidance. He has experience in ultrasoundguided injections of the joints of the hand, which few physicians do because it is a complicated procedure due to the numbers of nerves and tendons.

“There are a lot of procedures that really require ultrasound and/or CT guidance for the safest care,” Fogarty said.

Part of his role will be to teach the use of advanced imaging processes, giving Wyatt the ability to best approach the more complicated pain management cases, he said.

Having that ability means area patients can get that high-level of care locally.

From a rural medicine standpoint, there are both safety issues and feasibility issues in transporting someone or requiring someone to travel to a larger center to receive pain management services, Fogarty added.

“Those travel issues become a second-layer hazard for a lot of folks in rural America,” he said. “That’s where I feel like this mission is very important for a state that has a lot of rural, hard-working folks and a big need – almost a crisis need for interventionalists, proceduralists, who can help with the pain of daily life.”

Wyatt said the majority of her clinic practice is chronic pain management.

“Often we see people that are elderly who are in a lot of pain. It’s an issue with quality of life. They may not have transportation or family available to get them to outside facilities.

And more importantly, now they don’t need to,” Wyatt said. “We can really get patients good relief.

With the recent attention to opioid narcotic issues throughout America, this is one more level of care that helps people to avoid some of those medications that cause long-term problems for them.

Our goal is to continue to bring more services directly.”

Wyatt, who also works in Rugby’s surgical center, has been spending a day a week on pain clinic services. Hours

‘We have to build the infrastructure and the team.

Surgery is a team approach.’

– Dr. Mary Aaland

Aaland expects to eventually spend more time in Tioga as the surgical program grows and includes more procedures, although it will never be full-time. She also has provided surgeries in Watford City, Hettinger and Linton and helped out in Dickinson’s existing surgical program. Two other surgeons with the Rural Surgery Support Program assist in the program, which has brought surgeries back to Devils Lake, Carrington, Hazen and Wishek and supported the program in Jamestown.

She stresses the surgeons in the rural support program are not visiting physicians but an active part of the hospitals they serve and a consistent face for patients.

“It’s a local commitment,” she said. “That’s the only way you build a team. That’s, again, what surgery is.”

The program that started with a vision and no guarantee that it would work has been a challenge, but it is working, Aaland said.

Nielsen said Tioga-area residents are pleased to be able to have surgery locally and not have to travel to Minot, and that’s particularly true of the senior population.

“The older people really like being closer to home,” she said.

“We’re kind of trying to do a little barnstorming revival of patient care and bringing the high-tech stuff back home to the small town.”

– Dr. Ted Fogarty of the pain clinic will be restructured as services expand.

Currently, the clinic is booked out for weeks with patients, so expanding the hours is necessary, Wyatt said.

The pain clinic has been able to work with a Heart of America family-care physician, but in May, the clinic will be adding Nicole Lemieux, a physician’s assistant to provide its primary care. Having that primarycare component means any medication adjustments, imaging or referrals can take place in one appointment, streamlining the process for pain patients.

“They’re really getting a whole circle of care,” said Lemieux, whose presence also will increase the opportunity for patient education.

There are discussions regarding working with an accredited compounding pharmacy in Dickinson to customize medications for patients at the pain clinic. The clinic also coordinates nonmedicated treatments through physical and occupational therapy.

Wyatt called it a team approach. The immediate team includes two nurses and a radiology tech as well as Wyatt, Fogarty and Lemieux.

“Within our team, we work to coordinate this patient’s physical therapy needs, their medication needs, their education needs, their procedures. We do a lot of follow up with our patients,” Wyatt said. “We revisit what works for them and what didn’t, and I think that is really a benefit to the patient to have a whole team of people within their own specialties just working to improve their care.”

Wyatt said credit goes to the hospital leadership for its support for a pain management program in Rugby.

“Our hospital here has made it a priority in seeing the need for pain services in the community and surrounding areas,” she said. “Not a lot of rural hospitals have the ability to prioritize. They’re barely keeping their doors open, so we’re very fortunate here to have a hospital board and executive team that have prioritized this service for our community.”

Saturday, April 6, 2019

Educating women on options

By JILL SCHRAMM

Senior Staff Writer jschramm@minotdailynews.com Cervical cancer screening is a routine aspect of women’s health care. That doesn’t mean women are necessarily aware of their options or are receiving the screening that’s best for them, said Shawn Brooking, women’s primary care provider at CHI-St. Alexius Clinic in Minot.

As a certified nurse midwife, Brooking views her role as that of a patient advocate.

She seeks to educate women about different procedures and the importance of those procedures so her patients can make informed decisions.

“Because it’s very important that you’re in control. And for too long in women’s health, we’ve just listened to what people said and had no idea why we were doing it,” she said.

In the case of cervical screenings, the traditional procedure has been cytologybased screening known as the Pap test, used to detect abnormal cells. Women aren’t always aware of a second form of testing that detects the presence of the human paillomavirus (HPV), of which certain strains are known to lead to cancer.

“Over a decade ago, we made some changes to the national guidelines, where we incorporated HPV testing into what we do when we screen for cervical cancer,” Brooking said.

For a woman older than 30, the HPV test, along with the Pap, will give a better risk projection for cervical cancer, she said. While cytology alone is acceptable, the preferred method is co-testing, she said.

“It’s very important that testing be there,” she said of HPV screening. “All the evidence is there. And yet women are getting their Paps every three years without the co-testing.”

Eighty to 90 percent of cervical cancers are caused by

YMCA

Continued from Page 1

Each Wednesday’s threehour time block had a theme. The YMCA partnered with other nonprofits and drew on its own resources to offer music, art, tie-dye, waterworks with a large sprinkler and slide, yoga and a zoo day, along with a variety of outdoor activities from hula hoops and tug-o-war to an oversized parachute and a lawn Twister game. Whether bubble making, jumping rope, riding scooters or drawing with sidewalk chalk, there’s always something to do. The YMCA’s outdoor fitness park with a basketball court and playground provide space for free play. Indoor space is available when necessary due to weather.

The kick-off event featured a barbecue, drawing about 150 children. Snacks were included at other events.

Summer Unplugged attracted families with babies in strollers to teenagers. From 30 to 50 children attended each week with parents or caregivers in tow.

“Having parents come out with their kids is also fun to watch because they interact and they unplug,” said Oli-

Page 3

Minot Daily News • PROGRESS: Healthcare

Midwife raises awareness of HPV testing for cervical cancer

‘If we’re not doing the HPV testing and we don’t know if you have it, let alone which strain you have, you’re kind of at a disadvantage.’

– Shawn Brooking, certified nurse midwife, CHI St. Alexius

Photo by Jill Schramm/MDN

Nurse midwife Shawn Brooking at CHI St. Alexius in Minot encourages women to be knowledgeable about their care. two strains of HPV, identifiable in HPV testing, she said.

“If we’re not doing the HPV testing and we don’t know if you have it, let alone which strain you have, you’re kind of at a disadvantage,” she said.

A large study showed women who have negative tests for HPV have a less than 1 percent chance of developing severely abnormal cells on the cervix or higher risk lesions within the next five to 10 years, Brooking said.

If a test suspects HPV, a colposcopy can be performed to examine the cervix and take a biopsy, which could catch a potential problem earlier than

abnormal cells might show up on a Pap, Brooking said. HPV testing is generally covered by insurance. In co-testing, only a single sample is necessary to perform both HPV and Pap tests.

For women younger than 30, the HPV test isn’t routine because the risk of cervical cancer at younger ages is too low to warrant the testing, Brooking said. However, she sees medical recommendations adapting as evidence grows.

“I think that in the next 20 or 30 years, we’re going to see huge changes – where we will probably do away with a Pap

vares, who noted the activities are designed for family members of all ages to take part.

“This is the fun part of our job as program directors. We get to just use our imagination and figure out some fun stuff for the kids to do, and I really enjoy it. Having the support of Hess and basically getting the ‘go’ from our bosses to just do whatever our minds could possibly

They’re out there. They’re playing. We always have balls at hand and chalk and the parachute. It’s just to watch them interact with the other kids and make friends,” she said.

No registration is necessary to participate. Children are simply invited to drop in.

It is not necessary to be a member of the YMCA to participate, although some par-

“It’s fun to watch them kind of disconnect and just be unplugged for two to three hours out of their day.”

– Alina Olivares

come up is awesome,” Olivares said.

Hess also showed its commitment in providing volunteers for the activities.

Activities were broadcast on Facebook Live so family members who couldn’t be there could tune in.

The true measure of the event’s success was in seeing kids unplug.

“They’re not even thinking of the electronics,” Olivares said. “It’s fun to watch them kind of disconnect and just be unplugged for two to three hours out of their day.

ticipants later became involved at the YMCA after seeing the opportunities for their families there. They also were exposed to the outdoor park and facilities, which are free to anyone from the public.

This summer’s afternoon activities will run for two hours and will include both new themes and many of the same themes that were popular last year. Olivares said the YMCA will be working with partners again because of the success with those cooperative ventures last year.

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and go straight to HPV testing, and we probably won’t start testing until a little bit later,” Brooking said.

The HPV vaccine given to youth and now being made available at older ages may well reduce the incidence of cervical cancer even more in years ahead, she said.

Brooking attended a conference last July at which there was discussion about home testing for HPV. Such testing particularly is viewed as a solution in countries with less access to routine health care.

The biggest issue worldwide is half of women who develop cervical cancer have

never been screened appropriately, Brooking said.

“Of women diagnosed with invasive cervical carcinoma, half have never had a Pap test and another 10 percent have not had a test in the last five years. In the United States in 2015, 83 percent of women 21 to 65 with a cervix had a Pap within the previous three years or co-testing within five years.

So in the United States, we do a really good job of getting that word out,” she said. However, she added, there is concern over the 17 percent of U.S. women who go unscreened.

Brooking said one reason some women aren’t screened

is cervical testing tends to be unpopular with patients. It’s important to her to make patients comfortable during the procedure but also to educate them about what the screening entails and why it’s important.

“Many women have no idea why they’re getting a Pap. They think the Pap is testing for sexually transmitted disease, ovarian cancer, uterine cancer. They think they need it every year. We haven’t needed it every year for a long time. The evidence isn’t there for that,” she said.

A medical provider may recommend more frequent testing than indicated in standard guidelines based personal experience with outcomes, but patients have a right to know why a recommendation might differ from the guidelines, Brooking said.

Various governing bodies from the American College of Obstetricians and Gyneologists to the America Cancer Society publish guidelines for cervical cancer screening, and those groups do not agree in all areas.

Brooking said they do agree that women younger than 21 should not be tested. They also have established three-year Pap screening for women 21 to 29 and co-testing for women 30 to 65 every five years, assuming no other risk factors.

Testing typically ends at age 65, although that should be a conversation a woman has with her provider, Brooking said.

For some of the best information on cervical cancer, she directs patients to the Centers for Disease Control and Prevention website at cdc.gov/cancer/cervical/index. htm.

Cervical cancer doesn’t have to be a scary thought for women, Brooking added. With screening and early detection, cancer can be stopped.

“We really shouldn’t have anybody developing cervical cancer,” Brooking said. “We should be able to get there with early screening.”

Page 4

Saturday, April 6, 2019

Minot Daily News • PROGRESS: Healthcare

Establishing a home

Construction plans focus on senior living in Stanley

By JILL SCHRAMM

Senior Staff Writer jschramm@minotdailynews.com STANLEY – Big changes are coming to senior living and long-term care in Stanley, starting with the construction of an assisted living center that’s on schedule to open this summer.

The Mountrail County Health Center underwent major improvements in recent years with the $4 million construction of a new emergency center and clinic expansion.

Now sights have turned to a new phase of construction that will improve existing services and add new services through the center’s Mountrail Bethel Home.

The projected move-in date for Rosen Place on Eighth, an assisted living center, is July 1, said Stephanie Everett, foundation and marketing director and administrator-in-training for the health center.

Prospective residents already have begun reserving some of the 14 units.

“We are excited to get assisted living here because it’s a service we do not have in Stanley,” Everett said.

An assisted living facility will enable Stanley to keep its seniors in the community, giving them the opportunity to stay in a place where they

Submitted Photos

MAIN: A rendering of the new chapel at the Mountrail Bethel Home shows an attractive stained glass display.

TOP LEFT: A rendering by EAPC Architects/Engineers shows the Great Room in the assisted living center under construction in Stanley.

TOP CENTER: A rendering shows a living unit in the assisted living center under construction in Stanley.

Photo by Jill Schramm/MDN

TOP RIGHT: Construction continues on an assisted living center in Stanley March 4.

have roots and have made contributions over the years, she said. Retaining that population also helps keep local businesses viable and supports the future of the health center.

Assisted living services will be provided by staff at Mountrail Bethel Home and will include three meals a day, personal assistance, a 24/7 call system, medication management

and in-unit meal tray delivery and washer/dryers.

The assisted living center is the first of a series of construction projects planned during this phase of improvements at the health center.

Once the work is completed, Mountrail Bethel Home will provide a full continuum of healthcare services, so a resident transition from independ-

ent living to assisted living to nursing care while remaining under the home’s umbrella.

The next project will be construction of Bethel Chapel in the existing courtyard area. Work is expected to start this spring and finish around July 1.

In the years to come, construction is planned on a new nursing home

to replace the aging 48-bed facility, partially built in the 1950s. At 28 residents in early March, the nursing home is likely to see the demand for beds rise as baby boomers reach their elderly years, Everett said. Planning for that demand is ongoing in the construction process, she said.

In addition to a new nursing home on the property, the health center would relocate and rebuild existing independent living housing known as Centennial Court, although replacing it with more assisted living is an option if Rosen Place on Eighth indicates that type of housing is especially popular, Everett said. She noted there is other independent living housing in the community.

“We just need a lot of strategic planning to see how to do it right,” she said.

The health center also hopes to make space for a wing to accommodate visiting medical specialists at Mountrail County Health Center.

The foundation will be seeking grants to help with the future construction. The foundation has provided $9 million since 2013 for health center improvements, including fully funding the emergency room and T.H. Reierson Rural Health Clinic.

The $4.8 million project for the assisted living center, chapel and parking lot is largely funded with grants and donations, along with a $1.6 million, low-interest loan.

“We have wonderful donors here who really believe in the projects we are working on,” Everett said. “We want to bring in more services in Stanley so our residents can stay in Stanley.”

Saturday, April 6, 2019

Area medical centers step up their care

By JILL SCHRAMM

Senior Staff Writer jschramm@minotdailynews.com Small-town hospitals fill a need in rural areas, and area facilities are continually finding new ways to take care of their communities. These centers have made a number of changes in the past year to enhance their services. The facilities provided some of their past year highlights, which follow.

CHI St. Alexius Health Garrison

The CHI St. Alexius Health Garrison Nursing Facility has been recognized as a Best Nursing Home for 2018-2019 by U.S News & World Report. This is the first time CHI St. Alexius Health Garrison has received this national recognition.

“It is an honor to be recognized as a Best Nursing Home

by U.S. News & World Report.

These rankings acknowledge the outstanding care that our staff delivers to our residents each day,” said Tod Graeber, administrator of CHI St. Alexius Health Garrison, in a news release.

For the 2018-19 rankings, U.S. News evaluated more than 15,000 nursing homes and short-stay rehabilitation facilities. U.S. News recognized nursing homes as high performing across multiple areas of care.

Also, this past fall CHI St. Alexius Health Garrison became a host location for the Dakota Nursing Program through Bismarck State College.

The first class has six students working toward their licensed practical nurse degrees. Another LPN class will begin this fall, along with a registered nursing course.

The Dakota Nursing Program is a nursing education consortium made possible through the collaborative efforts of four state colleges: BSC, Lake Region State College, Dakota College at Bottineau and Williston State College.

The four community colleges provide education for a practical nursing certificate and an associate degree in nursing.

Students are educationally prepared to continue on to a fouryear BSN degree and beyond.

Courses are delivered in a combination of face-to-face lab and clinical courses with theory courses over Interactive Video Network.

Mountrail County Medical Center

Mountrail County Medical Center recently began offering orthopedic care once a week.

Dr. Ravindra Joshi with

Rural hospitals improve services across region LEFT: Kaylyn Applegate, radiologic technician, shows a CT scan machine to a group of third graders during a tour of McKenzie County Healthcare Systems March 22.

BELOW: Registered nurse Ashlee Schaff shows monitoring equipment in a hospital room to third graders touring McKenzie County Healthcare Systems March 22.

St. Aloisius Medical Center

Last August, St. Aloisius Medical Center in Harvey reopened a full-service clinic next to the hospital that had been closed for more than 30 years.

Drs. Rick Geier and Imran Dean, who arrived in January, and family nurse practitioner Kim Thorson practice at the clinic.

Harvey native Dr. Kelly Krohn, commutes between his Harvey and Arizona homes once a month to provide bone health services. The hospital acquired a DEXA scan machine for assessing bone density. Dr. Ronald Skipper comes from Rugby to do general surgeries, colonscopies and clinic procedures.

The clinic also offers joint injections and Department of Transportation physicals.

Beth Huseth, community liaison for St. Aloisius, said clinic numbers have exploded from about 350 visits a month last fall to about 600 a month this spring. Harvey has two other independent clinics, giving the community three doctors and four mid-level providers.

Huseth said the service area could support seven physicians so the community is trying to meet the demand.

Improvements at the hospital include a 32-slice CT scanner, added last August as an upgrade from the previous scanner. The hospital is finalizing the purchase of an upgraded mammogram machine, Huseth said.

The hospital added nuclear medicine and other testing options for physicians. A mobile MRI unit comes weekly rather than every other week. Physical therapy added Graston therapy, a technique for soft tissue injuries, and dry needling, involving placement of needles for pain or movement impairment.

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Minot Daily News • PROGRESS: Healthcare

Submitted Photos

McKenzie County Healthcare Systems and family nurse practitioner Leah Brewster are providing the service.

The physical therapy department is enhancing its services. Among programs being offered are LSVT Big, a researched and proven treatment for the physical impairments of Parkinson’s disease. The department also offers dry needling and Rock Blades.

With dry needling, the goal is to deactivate a trigger point, using needles to reset the nervous system input to the specific muscle. In Rock Blades therapy, metal tools are used with different rates and depth to affect different sensory receptors to decrease pain, improve range of motion and flexibility or improve muscle activation.

McKenzie County Healthcare Systems

McKenzie County Healthcare Systems opened a new facility last July.

The new facility is over 125,000 square feet and came with a $76 million price tag.

The new facility has 24 inpatient hospital rooms. The old facility had one emergency room; the new one has nine.

The Emergency Department has seen more than 3,200 patients since it opened. Located nearby, urgent care has been seeing no less than 50 patients a day.

Lynn Welker, marketing consultant for the healthcare system, said the previous oneroom emergency department had been inundated before urgent care was established.

“That allows for those cases to be triaged as far as who needs to be seen in the ER, who needs to be seen in urgent care.

I think that’s just very innovative to have in a community that’s grown so much,” she said.

“It’s hard for me to say that it was the new building or designing it that way, or just the population growing or changing, but our urgent numbers have about doubled since we’ve moved in,” added Michael Curtis, chief administrative officer. “The popularity of that particular service is enormous.”

“In rural communities, it’s so important to have a facility like this,” Welker aid. “Really, McKenzie County Healthcare Systems is able to address anything within an hour-plus in the perimeter. It’s very much a blessing that the new facility is here.”

Days after the new hospital opened, a tornado struck the community, turning the Emergency Department into ground zero in addressing the needs of the individuals injured, she said.

The new hospital has the space and equipment for labor and delivery services, which will be available in the future as program implementation occurs. A partnership with Great Plains Women’s Health Center has been established so those seeking obstetric and gynecological care can obtain it locally in Watford City through the specialty clinic.

3D mammography is now available as a new service, and the radiology department now has an MRI machine. The CT Scan machine was upgraded to 64-slice capability.

There is a helipad on the new location, which is critical for transporting patients if nextlevel trauma care is necessary.

The Good Shepherd Home has 44 private resident rooms and three couples rooms. There are three community rooms in each of the three wings.

Heart of America Medical Center

After a year-log fundraising

cose monitoring and Buzzy to block needle pain.

The glucose tool involves an implant that captures a glucose reading every five minutes and creates a personalized report.

Small and discrete, it can be worn up to six days. Used with a smart phone app, the device enables patients to see how their daily routine affects blood sugar and allows them to set reminders to test for blood glucose.

Buzzy is ideal for children but can be used by anyone of any age when there’s a concern over pain from needle injections. Chilled, Buzzy is placed on a site for up to a minute prior to the injection, then moved up and secured before the vibration is switched on.

The device activates the brain’s natural ability to block pain.

The medical center also recently obtained a portable ultrasound machine for the clinic and emergency room. With regular ultrasound services available only three days a week for an hour, the screenings provided by the portable machine fills a void in quickly getting information to aid in decision making. Among uses are prenatal care, bladder scans and other abdominal screenings.

Internally, the medical center has equipped its staff with the Quick Access phone app giving employees access to emergency policies and procedures and allowing for emergency alerts. Created for schools, Tioga is among the first healthcare facilities to adopt it.

This is the first year that Tioga Medical Center has engaged with Williston State College to provide an offsite nursing program campus.

“It’s a good opportunity for those students and it’s a great opportunity for us,” said Dean, who noted the program can be a recruiting tool for the medical center. Students are able to take their clinical training and much of their coursework locally through the program.

In addition, Tioga’s longterm care center updated its transportation offering with a new 10-passenger, handicapped-accessible bus to take residents to appointments and activities.

packing and use of a tourni- tion experience that results in quet. The course was devel- a deeper understanding of oped for a nonmedical what it’s like to live with cogaudience to provide immediate nitive impairment and sensory response to control life-threat- change. Participants are outfitening bleeding until help ar- ted in gear designed to simulate common age- and dementiarives.

The medical center worked related vision, auditory and with Tioga Ambulance to ob- tactile sensory changes.

In another initiative, medtain donated kits to equip each participant who took the first ical staff are utilizing a medical class. Dean said efforts are necessity test with laboratory being made to offer more and radiology orders, which classes, including in the provides information to paschools. tients regarding possible out-ofLast August, the medical pocket costs associated with center began a palliative care procedures. The information program to educate staff and can assist a patient in disTioga Medical the community on advanced cussing with their providers Center directives. With that training, the most suitable and affordTioga Medical Center began the medical center seeks to in- able diagnostic options. offering patients the option of a corporate Dementia Live trainOther tools now available portable heart-monitoring de- ing. for providers and their patients vice in October.

Dementia Live is a simula- are the Medtronic iPro2 for gluNancy Larson, a registered nurse and cardiac rehabilitation director at the medical center, said it had been about 20 years since the hospital has been able to provide the service. The hospital sought for about two years to get the servWith Chief Pharmacist, Donell Kjos at White Drug Pharmacy, ice, which became possible last inside Marketplace Food & Drug North Hill in Minot. fall when cardiologist Dr. Peerawut Deeprasertkul began coming once a month from CHI-St. Alexius Williston. The service requires a cardiologist to interpret results.

The single-use monitors are Spring will be in full bloom before you know it... fairly small devices that adhere but before it does get a jump start on allergy season! to the skin near the heart. Patients wear them for 14 days Millions of Americans suffer from seasonal allergies. When plants start to bloom before mailing them to the company, which then sends allergy sufferers start sniffing and sneezing. Many people wait to treat their allergy results electronically back to symptoms once they are full blown and miserable. Waiting to manage your symptoms until it’s too late can mean you may need stronger and additional allergy medicines or the Tioga hospital.

“We actually have been more intensive treatment throughout the course of the season. using them a lot more than I thought we would,” Larson By taking allergy medicine before the season and your symptoms start, you can said. In the first six months, six reduce your suffering. The sooner you start the better! This type of treatment is called patients had used the moni- pretreatment. If you know which spring allergies trigger your symptoms, start taking tors. your medicines a few weeks before the season actually starts. Medicines include, She explained the Zio XT nasal spray, eye drops and antihistamines. Antihistamines are an easy and effective monitors from iRhythm Techway to ease your discomfort. Many of these medications offer long-lasting relief and nologies are useful for patients who present with heart issues are non drowsy. that aren’t consistent, which means they may not show up To reduce your allergies and manage your symptoms follow these steps. when patients are tested. Monitoring the heart over a longer • Don’t take more allergy medication than • Dust and vacuum your home regularly. term can reveal any abnormalneeded and take as prescribed.

• Keep your pets bathed and cleaned. ities.

• Talk with your doctor and ask if an • Don’t dry your clothes outside, use your dryer.

Having the capability to proallergy test is right for you. vide longer term monitoring is • Don’t tackle too much yardwork. Mowing and important in serving the car- • Change air conditioning and heating raking can stir up allergens. air filters often. diac needs in the Tioga area, • Track pollen counts and stay indoors as much Larson said.

• Wash your bedding weekly in hot water. as possible when the counts are high.

“People are having a lot • Shower before bed to rinse off any pollen. more heart issues. That’s becoming more prevalent in society in general,” she said.

Getting care has meant traveling to Bismarck or Minot, so any service, such as the monitoring, that can be made available locally saves residents considerable travel time and WHITE DRUG PHARMACY expense.

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Three-dimensional mammography is the new standard in the detection and diagnosis of breast cancer, and in recent years, HAMC providers had begun to refer some of their patients to other facilities for 3D mammograms. Soon, Rugbyarea women will be able to access this life-saving diagnostic tool close to home.

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Page 6

Minot Daily News • PROGRESS: Healthcare

A breast cancer diagnosis is stressful and treatment can be as well. A new method of marking small breast tumors is lessening that treatment stress for patients who undergo lumpectomies in Minot.

Trinity Health surgeons are using the Magseed magnetic marker as an advanced method of marking the location of a cancer lesion for removal during surgery. The marker consists of a stainless steel bar, about the size of a grain of rice, that is placed into breast cancer lesions.

“We need a localization method to find breast cancers within a breast that are too small to feel,” explained Dr. Gillian Lavik, Trinity general surgeon. “Most places across the country are still using a wire. We’re one of the first facilities to switch over to this technology.”

The standard technique for marking a breast tumor is the placement of a guide wire in the breast on the day of surgery. One end of the wire is inserted into the tumor.

The other wire end protrudes from the breast.

Besides the discomfort, there is potential for the wire to migrate with the application and removal of any temporary protective tape that might be placed over the protruding end, Lavik said.

The bar implants are more desirable for patients.

“It’s just nicer for patients – a little bit more convenient.

They can have it done on a different day so that their surgery day isn’t so long,” Lavik said. “If a biopsy is being done of a lesion that looks very suspicious for cancer, they can actually put the seed in right at that time, and it saves the patient a procedure.”

Magseed is implanted into a tumor with the guidance of a mammogram, ultrasound or breast MRI. In the operating room, the surgeon then uses a probe that generates an alternating magnetic field to locate the seed and remove it, along with the cancer.

The probe enables the surgeon to be more precise in removing tissue because of the improved ability to estimate the location of the

Saturday, April 6, 2019

‘In general, we used to only take out tumors that we could feel because that was the only way we knew they were there. Now we need localization techniques, because we’re finding them earlier and earlier.’

– Dr. Gillian Lavik, Trinity general surgeon

Submitted Photo

General surgeon Jerel Brandt, left, and radiologist Thompson Kamba view a breast image with an implanted Magseed marker. The marker is placed at the site of a cancerous lesion so that days later a surgeon can accurately locate the cancer and remove it.

Big change in small package Magseed eases stress of breast tumor removal

By JILL SCHRAMM

Senior Staff Writer • jschramm@minotdailynews.com tumor, said Dr. Jerel Brandt, Trinity general surgeon.

“Before, if you just have the wire, you just take out a big wad of tissue, knowing that the wire is in there somewhere. But now, we can significantly decrease the amount of tissue we take out because we know how big the cancer lesion is,” he said.

Endomag, the maker of Magseed marker, describes itself as the only seed technology with four sensing techniques designed to guide surgeons and aid surgical dis-

section during a breast lumpectomy, according to information from Trinity. It can estimate distance so the surgeon can remove the tumor more precisely from any angle.

From the surgery center’s standpoint, Brandt said, the Magseed makes it easier to schedule surgeries because the implant can be done in advance. Previously, surgeries were limited to one a day because of all the procedures involved. Now, two or three lumpectomies can be per-

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formed in a day.

“It’s nice for the patient because they can get their surgeries done sooner.

They’re not having this wire sticking out of them, which is awkward and uncomfortable and strange. So it’s nice for the patient experience,” Brandt said.

Lavik said patients already under stress from a cancer diagnosis can avoid some of the additional stress of having to come to the surgery center early to have multiple procedures done.

“That overall patient satisfaction seems to be a little bit higher now that they can get some of these steps out of the way early on, and they feel like something’s being done.

They’re not sitting around waiting,” she said.

The ability to find smaller tumors has led to the evolution of localization techniques like Magseed, Lavik said.

“In general, we used to only take out tumors that we could feel because that was the only way we knew they

were there. Now we need localization techniques, because we’re finding them earlier and earlier,” she said.

Mammography can find tumors as small as five millimeters, but certain other diagnostic tools can find even smaller tumors, she said.

Because of that diagnostic ability, patients who don’t require localization are rare, Brandt said.

Brandt learned about Magseed in attending a breast cancer conference. Various types of marker implants exist, but Magseed caught his attention because its magnetic seeds are a safer alternative to commonly used radiation seeds. He discussed Magseed with Trinity’s radiology director, who also had just learned about and taken an interest in the magnetic seeds. That led to the decision to enter a pilot project.

Trinity participated in a trial with Magseed last year before officially adopting its use.

“I think, right away, we recognized that it was useful,” Lavik said. “There’s a learning curve with some of those new technologies, but overall, the experience has been very positive.”

Saturday, April 6, 2019

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Minot Daily News • PROGRESS: Healthcare

Tablet telemedicine

Technology gives Trinity patients access to burn specialists

‘It’s really in many ways not very different than if I call one of our specialists about a patient and they come down and put eyes on the patient in the ER and help coordinate the next plan of care.

It’s really allowing us specialty coverage even though it’s 500 miles away.’

– Dr. Scott Knutson, Trinity emergency medicine

Dr. Scott Knutson, holding an iPad that connects him with specialists at Regions Hospital in St. Paul, checks a patient’s burn at Trinity Hospital.

By JILL SCHRAMM

Senior Staff Writer jschramm@minotdailynews.com Telemedicine is helping to ensure the best care for burn patients at Trinity Health, and it’s being delivered via a common tablet device.

The Teleburn iPad is giving Trinity medical providers and patients access to the expertise of specialists at Regions Hospital in St. Paul, a nationally recognized burn center. Installed on a traditional iPad, the software allows virtual face-to-face discussions between providers at Trinity and Regions and close-up views of burns by the specialists. Encryption safeguards patient privacy in transferring information.

“It really is all about facilitating the decision making for transfers to a burn center,” said Dr. Scott Knutson, Trinity emergency medicine physician.

“There’s a lot of low complexity burns that are just routinely managed locally and that’s not really a consideration to go to a burn center, but there’s a lot of in-between areas where either the size or the location or something about it creates concern that they may benefit from a more collaborated, involved approach.”

Burns over large areas or critical

Submitted photo

areas of the body are straightforward, and these patients tend to get flown to Regions fairly quickly. However, there are many nuances to burn management, and the initial care prior to transport is important. Consequently, there may be a conversation with the burn center even prior to an obvious transport, Knutson said.

A transfer is a logistically involved process. Knutson said decisions to transfer patients aren’t made lightly.

“It’s a big expense to the patient families and companies involved and it is a large step in care. So we also make sure that we’re doing it for the right reasons, that there are indications that patients are going to benefit from that transfer. We make sure that we’ve done our due diligence in maximizing our care locally as well,” Knutson said.

When patients are transferred, Trinity can continue to track their care at Regions and can consult with Regions specialists on follow-up care once patients return home.

Rhonda Gunderson, Trinity trauma program manager, said Trinity and Regions can work together to develop a plan of care that doesn’t require the recovering patient travel back and forth to St. Paul.

The iPad also is used in Trinity’s in-

tensive care unit to assist in caring for burn patients who aren’t stable enough to transport straight from the emergency room.

“That consult with that burn surgeon at the bedside is great,” Gunderson said.

Response is rapid when there’s a need for a consult. Regions has physicians always ready to take a call from any of the referral facilities in its consultation program.

“It is sort of adding another specialist to our coverage care,” Knutson said.

“Having that availability of the quick consult, it’s really in many ways not very different than if I call one of our specialists about a patient and they come down and put eyes on the patient in the ER and help coordinate the next plan of care. It’s really allowing us specialty coverage even though it’s 500 miles away.”

The Teleburn iPad doesn’t necessarily change the care being provided locally, but it does add a layer of confidence in the care, Knutson said.

“It adds a component to assuring us that we’re doing the right thing and managing our patients well, and when they need additional services that they’re getting them,” he said. “It’s been helpful in giving us assurance

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that we are moving care in the right direction.”

There’s also peace of mind in transferring patients because of the familiarity with the people and services at Regions, he said.

In addition to the consultations, Regions sends representatives to Minot twice a year to conduct trauma continuing education and meet with local staff.

“They do give us feedback as far as if there is anything in our process that we could improve on,” Gunderson said.

Trinity staff began using the Teleburn iPads last July. The telemedicine has been used with a couple of cases every month or two. Knutson expects use to increase as staff find benefit and utility from it.

Gunderson said families of burn patients appreciate the consultations because they want to know their loved one is receiving that specialty care.

Family members can be present for a consult or otherwise be kept informed of those discussions.

“But it gives a little peace of mind to the family that what’s being done would be done the same in St. Paul, Minnesota, as it is here in Minot, North Dakota,” Gunderson said.

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Minot Daily News • PROGRESS: Healthcare

Saturday, April 6, 2019