Monday, February 22, 2010

Small town perfect environment to raise family and to open a physical therapy clinic


A small town is where Wes Mentele wanted to raise his family. It was an added bonus that he was able to launch Howard Physical Therapy and have success in just over three years.
“We were awful nervous initially moving back,” Mentele said. “We really thought a lot about it and wrote a lot of letters to people in town. Talked to clinics we would be working with. We had people calling us the next day wondering if we were coming to town. Now, we are both very busy.”
Kim Eggert, executive director of Whispering Winds Senior Living Center in Howard, said we have used his services’ for our residents. “If we didn’t have him here, it would be more difficult for us because residents would have to find someone to haul them out of town for therapy,” she said. “Physical therapy is a much needed business in Howard.”
Rural Learning Center President Randy Parry said being able to have a young couple establish a business on Main Street is important to expand services for our community.
"It adds a critical dimension of services that we can be proud of," he said. "Having a variety of health care services helps attract young people to a community because there is a perspective that we are working to build a better community."
One of the important concepts that drove the Mentele’s to Howard was the community leaders’ drive to improve the city and the county. “We needed a progressive community to try and start our practice in,” he said.
Wes and his wife, Carrie, own Howard Physical Therapy. The Menteles have two children: Cole, 6 years old and Logan, 4 years old.
The main office is in Howard and there is a satellite office located in Woonsocket. All different types of physical therapy – ranging from back and neck pain, shoulder, physical rehabilitation after surgery and accidents – are all services that are offered.
“The neck and back problems are the most prevalent types of injuries that can limit patients,” Mentele said. “We are providing a treatment that allows them to live their life, work and enjoy different things is pretty satisfying to me.
Within the first few months the business was busy and stayed busy. Employees were hired in 2008 and 2009 and now the Menteles are looking to increase their staff to branch out into other communities.
Wes graduated from Howard High School in 1997 and then from the University of Mary in Bismarck, N. D. in 2003. Mentele has a bachelor’s degree in Rehabilitation and master’s degree in Physical Therapy.
He started a practice in Bismarck, but once moving to Howard he sold the business almost 18 months ago.
“We are busier here than we thought we would be,” he said.
What makes it work is that the clinic offers a wide range of treatment and conditions. “In small community, it is hard to be specialized in one particular area,” Mentele said. “You have to be able to work a wide range.”
What surprised Mentele when moving to Howard was the way everyone is supportive. To return their support, Mentele volunteers to do sports medicine for the Howard High School football team during the season.
“People in a small town want to see people succeed,” he said. “A lot of people recognize the benefit of having small medical service in a small town because they don’t have to travel so far.”
What also helps is that Howard Physical Therapy works closely with the medical clinics in the community. “We try to keep close contact with all the healthcare providers in town as well as specialty situations in other communities,” he said.

Monday, February 15, 2010

Former DeSmet physician has made an impact in community

If there is a question about the medical profession, it is almost a guarantee that Dr. Bob Bell can answer it because he has most likely experienced it at one time or another during his more than 40 years in family practice.
Janice Schardin, who is the CEO/Administrator at Avera DeSmet Memorial Hospital, was not fortunate to be working in her role during the more than 45 years Dr. Bell was practicing, but has heard about his legacy.
“Words will not do justice to describe the positive impact Dr. Bell had on the healthcare in this area,” she said. “His dedication to his medical profession was expressed in selfless sacrifice while providing quality care from infants through geriatrics. There was a period of about two years where he was the only physician in this area and was providing care 24/7.”
Bell, now 83, started his first practice in the fall of 1957 in DeSmet, S. D. After graduating from the University of Nebraska, he spent a year of internship in the United State Navy at Oakland Naval Hospital and then a year of family practice residency in Yankton, before settling in DeSmet.
It was in Yankton where Bell said he made arrangements with Dr. William Hanson to open a practice in the Kingsbury County community. Bell arrived in 1957 and Hanson joined him the next year.
There was only one doctor in the community at the time. Bell did minor surgery and obstetrics in that first year and after Hanson joined him, the two did major surgery and more obstetrics.
“We were very busy. It was very well received,” Bell said. “In fact we were doing so much work, after two years, we had to enlarge the facility. We raised money and built a new hospital.”
That new hospital was dedicated in 1961.
Hanson left after 10 years and Bell continued alone for three years, before Dr. Louis Karlen came into town to assist Bell. Karlen recently retired. Both had separate practices and assisted in each other in surgeries and covered each other on weekend calls and vacations.
Bell was born in Huron and it was there he first started thinking about becoming a doctor, partly because of his family physician. “In Huron I had a family physician I liked and was a good influence on me,” Bell said.
He graduated from Huron High School and then Huron College. Then he went on to the University of South Dakota Medical School, which at that time had only a two-year program. He finished his medical degree at the University of Nebraska before heading to Oakland Naval Reserve and starting his practice in DeSmet. In 1986, Dr. Bell was named the South Dakota Family Doctor of the Year by the American Academy of Family Practice.
During his medical tenure, Bell has seen a medical field that has changed.
“It has progressed and improved consistently year after year,” he said. “The utilization of the hospital is primarily for short term medical problems and outpatient testing and rehabilitation. They are doing no surgery and no obstetrics now.”
The change has occurred in DeSmet because Bell said it is just a natural tendency of the surgical and obstetric fields to be covered by specialists.
Then there are technological advances like the availability of ultra sounds, Cat scans and MRIs. “It has been good for the healthcare field and patients,” he said. “When those things can be performed locally they don’t have to travel 100 miles to have it done.”
Possibly the biggest accomplishment for Bell was that he and his partner, Hanson, were able to build up a large enough practice that showed the community it needed a hospital. In addition, the two had a hand in sending at least 12 DeSmet graduates into the medical field, including four from the Bell family.
After being retired for 10 years, Bell said he misses the personnel involvement with the patients and the fact that they trusted his decision on treatment and therapy.
What was also satisfying for Bell was that each year medical students took part in training in DeSmet. “Most requested to come here,” he said. “I try to instill in them a scientific part of medicine, but also a compassionate part of understanding things from a patient’s viewpoint.”
Then there was the personal satisfaction of his patients’ trusting him. “I felt I set a good example for other people that might want to go into the field,” he said. “Those were very satisfying things.”
Schardin said his legacy continues to this day as we strive to hold the quality of care standards high. “They just do not make doctors anymore like Dr. Bell.”

Sunday, February 7, 2010

Anesthetist committed to community he serves



If you go to the Madison Community Hospital and have any type of surgical procedure, it is quite possible Darrel Simon would be the one who would be administering the anesthesia for your surgery.
Simon, 63, is an icon at the Madison facility. For the past 38 years, he will tell you he has been “working in cooperation with the surgeon to do what’s best for the patient to be asleep during an operation so obviously they won’t feel any pain during a surgery.”
In other words, Simon is the hospital’s CRNA (Certified Registered Nurse Anesthetist) and is on call 24/7. “Our job is doing what needs to be done to keep the patient stable and alive,” he said.
Jerri McNary, supervisor of Radiology at Madison Community Hospital, has worked with Simon for 25 years. “He is dedicated to the hospital and the community. There are not too many people who would dedicate their life to a 24/7 job,” she said. “He’s good. He’s very knowledgeable in his job and he is good at what he does. He is a solid, all around good person.”
Another co-worker, Tim Higgins, who has been the laboratory supervisor at the hospital since 1980, said Simon is a professional person and is a very competent person. “I would trust him with my life,” Higgins said. “He knows his job. He does his job very well. He has had a definite positive impact because he is able to help out in so many ways.”
Simon, a 1964 graduate of Hoven High School, went to the Presentation School of Nursing in Aberdeen and graduated three years later as a registered nurse. He needed that background to get into anesthesia.
He knew a high school classmate whose brother-in-law was in anesthesia and felt that was something he would like to do. It also helped that he liked the sciences, especially biology, anatomy and physiology.
After graduation from Presentation School of Nursing, he went to Vietnam. He was in a MASH unit for one year near the DMZ and will tell you it was just like what you would see on MASH (the television show).
“All came in on helicopters, we took them off the helicopters and got them ready for the operating room,” he said. “It was rewarding from the stand point that you were there helping people who needed help.”
After his stint in the military, Simon went to anesthesia school in Rochester, Minn. He left there in 1972 to come to Madison and has been at the community hospital ever since.
“I liked the small hospital and wanted to come back to South Dakota,” he said. “I just thought the size of the hospital was what I wanted to work in. I wanted to do a little bit of everything. I wanted a variety.”
And that is where he stayed. This year marks 38 years of working with people. Simon estimates he averages administering anesthesia to about 400 people each year.
“The special part of it is that you get to help people,” he said. “What is more rewarding than taking a patient’s pain away?”
Simon said he also has pride in working with the surgeons and has a good working relationship with them. He is also comfortable working with his patients, always trying to give them a smile and ease their mind before heading into an operation.
“It is kind of nice when grandparents and parents tell their kids that it is okay because he was the one that put me to sleep during an operation,” he said. “I feel good when they say that because if they feel relaxed, more comfortable about it, they don’t come back to the operating room as worried.”
The key word for Simon is vigilance. “You are there and you have to watch them,” he said. “You can’t be reading books, drinking coffee, can’t be visiting with crew, and listening to the radio. You are sitting at the head of the table.”
In his 38 years, Simon has seen changes. Possibly the biggest change has been technology and superior monitoring. “Technology leads to superior monitoring,” he said. “The pulse oximeter (measures the amount of oxygen in blood), ventilator and alarms on the ventilators; if the oxygen level goes too low there are beepers and monitors for all of that.”
Pain is treated much sooner and much more aggressively then when Simon started 38 years ago. When he started, as a general rule, there was never anything given for three hours after post op because there was the belief that the patient would stop breathing. “Most people have something given for pain before they even leave the operating room,” he said. “We found out patients, if you relieve their pain, they actually breathe better.”
Also medicines are better and people are being seen sooner. But what has not changed is that people still want to be treated with good care.
“That never changes,” Simon said. “When they’re sick, they want to be treated fair, they want to be treated right, and they want communication.”

Monday, February 1, 2010

Rural communities receiving quality healthcare

Tammy Miller (left) John Mengenhausen (right)
Some might think that living in a small town in rural South Dakota might mean a person or family would not get the type of quality healthcare received in a larger metropolis. But for those who handle healthcare needs for people in Kingsbury, Lake, McCook and Miner counties, they will tell you that is just not true.
John Mengenhausen, who is the CEO of Horizon Healthcare based in Howard, thinks the quality of healthcare is as high or as good as you can receive anywhere. “The providers we have here have the ability of being a healthcare home for the individual,” he said. “That is extremely important. Granted, we don’t have all of the specialties that are available, but basic primary care is seen as a gatekeeper so you are not accessing specialty care when you don’t need to. You watch a family grow up. You become their healthcare family.”
Barb Sample, who is the acting business administrator at Interlakes Medical Center in Madison, believes the residents of Lake County are very lucky to have the physicians they have. “It is very difficult being a physician in a rural area,” she said. “It does take a special person to leave that security (of a big city) and venture forth into a rural area.”
In the four-county area there are a number of healthcare providers, including dentists, optometrists, chiropractors and physicians, who all work together to create the excellent healthcare, according to Tammy Miller, who is the CEO of the Madison Community Hospital. Madison Community Hospital provides services for residents of Lake, Miner, Kingsbury, as well as communities in those counties and other counties in the region.
“Our county is fortunate to have the amount of healthcare that we do,” she said. “It helps with the economic viability and development of our county because of the broad spectrum of services that are available and are not available in a lot of counties. Most are independent providers and have to work together for the continuum of care and the best care for the patient. That takes a lot of communication and working together so that we are knowledgeable about the patient.”
One way rural healthcare providers continue to provide quality service is through a continuing quality improvement program.
For example, at the Madison Community Hospital, each department participates in an ongoing quality improvement process. “Not only do we participate in-house and with Medicare, we also participate on a statewide level to improve the quality of care,” Miller said.
In DeSmet, CEO/Administrator Janice Schardin said that Avera DeSmet Memorial Hospital monitors what is appropriate to the community based on the national indicators. In addition, now that the hospital is associated with the Avera system, personnel participate in collaborative and quality conferences to deal with different issues.
Networking is a key component in providing quality healthcare in the rural counties. Many healthcare providers work hand-in-hand with others throughout the region.
In Kingsbury County, there are only two physicians and two-midlevel providers left in the community. But, the community is actively pursuing physician recruitment.
Now that the hospital is part of the Avera system, Avera DeSmet Memorial Hospital is seeking more opportunities to add outreach physician services and educational opportunities. Recently, Avera DeSmet Memorial Hospital started a teleconference educational series on parenting which includes topics involving family members from sibling rivalry to positive discipline techniques to everything you wanted to know about potty training.
In addition, the hospital works very closely with the volunteer ambulance service and fire department. Also, hospital personnel have worked with Kingsbury County to develop a pandemic flu plan. There is also collaboration between the hospital and the high school nurse in DeSmet. Recently, the Good Samaritan Center opened a home health service. And since there is no hospice service in DeSmet, the hospital is able to coordinate that hospice service through an agency in Sioux Falls.
For Horizon Healthcare, a community health center and a non-profit organization, a community board of directors is a key segment that helps with decisions for the communities the organization serves.
“Our goal is to ensure that there is healthcare available in a lot of small communities,” Mengenhausen said. “We work extremely well with the Avera Health System and Sanford Health System. They view us as good partners and colleagues because the type of care we deliver is not competitive to them.”
The bulk of the clinics associated with Horizon Healthcare are in a community of 1,000 people.
Networking is not the only component of quality healthcare. It is also important to provide programs and services.
The Madison Community Hospital provides both outpatient and inpatient services for those in Kingsbury, Lake and Miner counties, as well as other counties in the region. Inpatient services include medical and surgical, obstetrical emergency room, ICU/CCU and swing bed. Outpatient services are ambulatory, radiology, nuclear imaging, laboratory, respiratory therapy, cardiac rehabilitation, rehabilitation services, home care, hospice, Eastern Plains Surgical, emergency service, nutritional services and occupational health services.
“We are just one part of healthcare,” Miller said. “There are a lot of parties and providers that work for the betterment of the community and health of Lake County (as well as Kingsbury, Miner and other counties in the area.”
Horizon Healthcare has considered itself a healthcare home for the communities it serves. “You need one place where you can go for consolidation of all of your healthcare needs,” Mengenhausen said. “You need someone that is managing all of your care.”
Partnerships with the two larger systems in the state helps bring in outreach clinics, dental services and telemedicine for the communities. Each of the organizations’ facilities in Kingsbury and Miner County has different services that are provided.
In the Bell Medical Clinic in DeSmet, patients receive services in family medicine, obstetrics/gynecology, Geriatric Medicine, Family Planning, Women’s Health, Preventive Medicine, Podiatry, Cardiac Rehab and Behavioral Health.
DeSmet Dental provides the following services: extractions, examinations, cleaning, fillings, emergency treatment, oral health education and referrals for specialty care.
At the Howard Clinic, patients receive services for family medicine, internal medicine, physical therapy, women’s health, mammography, podiatry, family planning and primary care.
Services provided at Howard Dental include extractions, examinations, cleaning, fillings, emergency treatment, oral health education, root canals and referrals for specialty care.
Avera DeSmet Memorial Hospital has a medical unit, emergency room, swing bed, outpatient treatments, diagnostic imaging, community education, wellness screenings, laboratory, pathology and blood bank services and rehabilitation services.
Schardin said the hospital is always trying to attract more physicians and specialties through outreach or telehealth programs. “We have a well-rounded program that is beneficial to the community,” she said. “We are continually looking at what else we can offer. Demand, need and cost are all things that determine what programs we take on.”
Those challenges and others are always on the minds of those in the healthcare profession. One of those challenges is cost.
“We try to keep them as reasonable as possible,” Miller said. “We have professional and skilled people. Those types of professionals could make a lot more if they went somewhere else. We have to try and compete on their salaries and we do a lot of time. We still have to pay medical supplies, insurance, benefits for employees, education…it is a challenge. We have been fortunate to have enough patients who are loyal to us.”
Recruiting quality healthcare professionals continues to be an issue.
“Physicians are extremely difficult to recruit to a smaller community,” Mengenhausen said. “We’ll do signing bonuses, recruitment and retention packages for staff, and contract recruitment firms.”
Horizon Healthcare also works to grow its own healthcare professionals. “If you can find someone that is used to a rural community, the chances are you going to have better luck in retaining them,” Mengenhausen said. “What attracts a lot of people in our area is those who are interested in outdoor activities.”
Dealing with insurance companies can also be a challenge. “Each insurance company has several policies,” Sample said. “It is really impossible for us to keep track of what kind of a policy that each person walks in this door has. More rules have been created for particular policy. Patients really have to know the fine print in their insurance companies.”
Then there is the challenge of keeping a rural hospital open. Many healthcare professionals are closely watching the healthcare reform bill and what impact it would have on rural facilities.
“I do not think the public realizes or understands what it costs to keep a rural hospital like this running,” Schardin said. “You have overhead, you need to provide the services, but it cost you more than sometimes what you get reimbursed. How do you make up the difference? That is always a challenge.”
But those involved in the healthcare profession will tell you, that despite the challenges, healthcare is an exciting profession to be in. “I really think for a small rural county between the ambulance and clinic here, we provide a great network,” Schardin said.