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Welcome to the November 2014 issue of the Washington Rural Health Association e-Newsletter. Inside this issue you will find news and information from our members and community partners from across the state of Washington. If you would like to submit your own story, please click here.
The WRHA e-newsletter is a publication of Washington Rural Health Association, a not-for-profit association composed of individual and organization members who share a common interest in rural health. This e-newsletter seeks to disseminate news and information of interest to rural health professionals and stakeholders to help establish a state and national network of rural health care advocates.
WRHA Members
WRHA members include administrators, educators, students, researchers, government agencies and workers, physicians, hospitals, clinics, migrant and community clinics, public health departments, insurers, professional associations and educational institutions. If you are interested in joining or renewing your membership with WRHA click here.
In a recent article in USA Today (Nov. 14, 2014) regarding the critical condition of rural hospitals across the nation it was reported that 43 Critical Access Hospitals (CAH) in rural communities that have closed since 2010, and the remaining number are threatened if the current reductions in reimbursement continue in the near future. The possibility of more closures threatens to leave 283 rural communities without primary care access. We, who live in rural Washington, would no doubt be affected by some degree. Hospital closures would leave many to travel long distances to access health care.
I would urge you to call Washington US Senators Murray and Cantwell to sign a bi-partisan letter that has been authored by Senators Baldwin and Crapo to President Obama. This letter urges the President not to consider reducing health care access in rural America. In his budgets, the President has considered closing the distance between CAHs and other hospitals thereby curtailing cost based reimbursement. We find in Washington that our more rural communities are inhabited by older and poorer populations who need access to primary care closer to where they live.
Today a number of our rural CAHs are serving small communities that are fiscally fragile and often rely on their communities for local funding (local taxes) to enable them to continue to operate. These small facilities are not only providing access to care; they are most often the largest employer in the region. It is vital to our state and nation to maintain access for the 20% of the population living in rural regions.
Please call our Senators and ask them to sign the letter to the President regarding maintenance of access to health care in the rural areas of our state.
April 11, 2014 was a beautiful day for a motorcycle ride with friends. The snow had melted, the rain had stopped, and it was unseasonably warm. Twenty-three year old Megan Berry met up with an eclectic mix of old and new friends. They were headed for the Washougal River Road in southwest Washington; a scenic trip through the greening cottonwood, oak, and cherry trees with spectacular views of the river. On this trip, she would experience a life changing event: a terrible accident with another vehicle.
It was about mid-day on her motorcycle ride when Megan pulled out in front of a Honda Civic. Despite wearing a helmet and other protective gear, the impact from the crash caused Megan to lose consciousness. Skamania County Fire Department arrived on scene a short time later, quickly realizing Megan needed rapid transport to a trauma center. Life Flight Network was called. The helicopter landed soon thereafter at a pre-designated landing zone near the scene. Megan had regained consciousness, but was in incredible amounts of pain. Flight nurse Pam Logalbo and paramedic Justin Dillingham realized the seriousness of Megan’s injuries. “We recognized there were multiple fractures and she had life threatening internal injuries," Logalbo stated.
Knowing that time was critical to Megan’s survival, the team loaded Megan in the helicopter and lifted off within seven minutes of getting to her. It would be a short flight to the awaiting trauma team at PeaceHealth Southwest Medical Center. Megan’s mom had been contacted about the accident, but did not realize the extent of her daughter’s injuries. She called the hospital and was told that Megan made it there alive but was given no other details. Megan later explained, her mom “was blindsided by that realization that I might not live.” Her family was horrified to learn the extent of Megan’s injuries: her tibia and fibula were broken in 7 places, her femur broken in 4 places, her left clavicle and right scapula were broken in several places, and bone had also been pushed into the pocket of her shoulder joint. Of greater concern, Megan had severe injuries to her liver, kidney, spleen, lungs, and her aorta was torn.
Dr. Sarff at PeaceHealth Southwest Medical Center said of Megan,”She was really sick, most people in her condition would have been unconscious. After surgery, Megan was off the ventilator after a day and headed to physical therapy after a day and a half. Her remarkable recovery is a testament to her determination and positive attitude.” Megan recalls her interaction with trauma surgeon Dr. Sarff. “She was great with my family and kept them informed of my progress. She did a wonderful job of putting me back together.” Despite these life threatening injuries, Megan would not only survive, but amaze her doctors with the speed of her recovery. She was told she wouldn’t walk for a year; that was unacceptable to the indomitable Megan. She was walking with the aid of a walker within three months. By her 24th birthday, Megan had set aside the walker. Determined to have fun, she went kiteboarding again. Megan said “[I] couldn’t ride much, but enough to put a smile on my face.”
Though Megan has recovered a great deal, she still faces obstacles including additional surgeries. When asked about her future plans, Megan's response is enthusiastic. She met a new friend in a similar situation and they started a nonprofit organization to help those in wheel chairs get involved with kayaking and make local docks more ADA accessible. She also plans to get in some snowboarding before the next surgery, and as she puts it, “enjoy the life I get to live thanks to all of you.”
WHAT: Imbalances in the U.S. health care system result in people experiencing difficulty accessing health care services and receiving lower quality care. These inequalities perpetuate poor health and the under-representation of minority and disadvantaged people in the health care workforce.
In 1971, the AHEC (Area Health Education Centers) program was developed by the U.S. Congress to recruit, train and retain a health professions workforce committed to underserved populations. AHEC programs across the country play a key role in correcting these inequities and strengthening the nation’s health care safety net. The Western Washington Area Health Education Center (WWAHEC) continues to respond to the needs of its constituents to live a healthy life. Its focus areas include workforce development, health professions education, continuing education for health professionals, community assessment and development of health systems, health promotion/disease prevention/health education and advocacy for rural and underserved populations through public policy development.
WHO: Sandy Kukla, telehealth senior program manager, Pacific Northwest medical services for ConnectMD, has been appointed to the board of the WWAHEC.
Kukla is an RN, a certified EMT and a certified financial health professional. She has been with GCI since 2006 and has more than 30 years of experience in various healthcare disciplines, including hospital and emergency room nursing, practice administration, hospital business services, application implementation and training, medical financial consulting and clinical analytics. Kukla is also a member of Telehealth Alliance of Oregon, where she previously served on the board, a past member of the Washington Technology Collaborative, and a current member of the American Telemedicine Association, the Medical Group Management Association, the Center for Telehealth and eHealth Law, and the Healthcare Financial Management Association.
She is active in chronic care collaboratives, patient safety initiatives, and the advancement of telemedicine applications. ConnectMD is the premier provider of telehealth connectivity and services throughout the Pacific Northwest and Alaska. ConnectMD and Kukla have been involved with WWAHEC for several years, including sponsorship of the Rural Outreach Nursing Education Program and sponsoring participants in the Washington Rural Health Care Conference and Critical Access Hospital Conference.
Would you like to have a greater impact on the future of rural health and the direction of the WRHA? If so, consider joining one of WRHA’s committees.
The WRHA is seeking volunteers to join the following committees:
Awards Committee – selects WRHA award winners and presents awards at the 2015 NW Regional Rural Health Conference in March
Communications Committee – coordinates WRHA publications including the e-newsletter
Membership/Development Committee – promotes the association to prospective members, increases awareness of WRHA, and develops member benefits
Legislative Committee – mainly active during the legislative session, this committee reviews the Bill Tracking Report, compiles a list of bills to be tracked, and works for legislative event planning
Bylaws Committee – headed by the WRHA president, this committee meets every two years to review Association bylaws
Finance Committee – assists the treasurer in developing an annual budget, review disbursements, makes recommendations to the Board, and manages additional revenue
Bone Densitometry: Bone Mineral Density (BMD) Testing Dual Energy X-Ray Absorptiometry (DXA) is the best way to measure bone density since it measures BMD at the hip and the spine, two locations at risk for osteoporotic fracture.
The DXA is painless and non-invasive and takes only minutes to complete. When having a DXA-BMD please wear workout-like or sweat type clothing that DOES NOT have zippers, hooks, grommets or anything metal on them (also no bras with underwire, watches, bracelets, necklaces, etc.) Metal interferes with the DXA results. Odessa Memorial Healthcare Center offers this state-of-the-art DXA testing with excellent precision and at the most convenient location, right here in Odessa, WA!
Alright, how many of you anesthesia providers out there working in rural settings and critical access hospitals have been charged with developing a new department policy or updating an existing policy and said to yourself, “Where do I start?” Or something like, “Surely someone out there in a similar position has had to tackle this very same issue.”
Unlike in larger hospitals and academic centers, nurse anesthetists and anesthesiologists practicing in rural settings are often called upon to provide care and services to patients in situations where resources are limited and collegial support and expertise may not be readily available. Practice isolation and stagnation can often occur despite our best efforts. One constructive way to address these scenarios is the development of the opportunity to network and share useful information and knowledge with other anesthesia providers in similar rural settings. Such a network could be effective in helping each other with policy development and updates, dealing with communication issues with co-workers, understanding the impact of new regulations, reviewing equipment, and providing easily accessible answers and resources to common practice related problems. And don’t forget the importance of sharing with others our success stories as well.
If you would be interested in forming a network specifically for anesthesia providers in rural settings in WA, let’s make it happen! Hospital administrators please pass this along to your respective anesthesia personnel.
Contact me with your ideas, interest and energy.
Rick Brown, CRNA Willapa Harbor Hospital Dept. of Anesthesia 800 Alder Street South Bend, WA 98586
Washington Academy of Family Physicians (WAFP) is pleased to announce that Carl Olden, MD, FAAFP was elected to the American Academy of Family Physicians (AAFP) Board of Directors on October 22, 2014, during the AAFP’s annual Congress of Delegates meeting in Washington D.C. Carl has been elected to serve a one-year term on the AAFP board, after which he can choose to run for re-election to a three-year term.
Carl is a rural family physician who has maintained a private practice for 30 years in the Yakima community where he was raised. He is the senior family physician at Pacific Crest Family Medicine in Yakima, WA.
He also serves as the medical director for quality assurance, utilization review and medical staff services for Yakima Valley Memorial Hospital. He is a clinical instructor in family medicine for the University of Washington School of Medicine and Pacific Northwest University of the Health Sciences.
Carl was supported by a small, but focused and hardworking campaign team from Washington State including AAFP delegation colleagues, Drs. Jonathan Sugarman, Gregg VandeKieft, and Alex Brzezny. Others on Carl’s team included Chris Gaynor, June Bredin, Angie Sparks, Kevin Wang, and Eric Wall. Mike Tuggy, a leader in the Health is Primary effort, also arrived in time to show support.
Dr. Olden is enthusiastic about the opportunity he has to help shape family medicine’s future through the AAFP. His aim is to guide lawmakers in crafting a more appropriate payment system for family physicians within an affordable system of care that works for everyone in America. He is also looking forward to digging into work on developing the future pipeline of family medicine doctors.
Northwest MedStar Membership Gift Saves Out-of-pocket Costs for Nurse
Jennie Tracy received her NW MedStar membership as a holiday gift. It ended up saving her family from paying high out-of-pocket costs when she had her accident.
Registered Nurse Jennie Tracy says she has little to no memory of her vehicle accident while traveling home to Elk, Wash., 50 minutes north of her job at a Spokane hospital. “My car was demolished,” she says. “Because I was unconscious, the paramedics weren’t sure what all my injuries were.” Jennie says first responders speculate that she swerved to avoid hitting a deer. Her car first hit a telephone poll and then wrapped around a tree. Paramedics called in NW MedStar to take Jennie to Providence Sacred Heart Medical Center.
“When they put me in the back of the helicopter, my first thought was that I was going into a very safe cocoon,” Jennie says about the inside of the EC 135 aircraft that took her to the hospital in minutes. “Being a nurse myself, I felt I was being transported with loving care. You’re scared when something like that happens; and they took such good care of me.”
“I was in the hospital for three days,” Jennie says. Her accident badly damaged her hands making Jennie unable to return to work. After a 50 year career in nursing, she says, at the age of 73, retiring was not an unwelcomed change. “It’s just a miracle I’m alive.” Jennie says her accident could have cost her and her family almost $17,000 in critical care air transport costs. Her family’s NW MedStar membership was a holiday gift from her daughter.
“As a nurse, I had heard of [NW] MedStar plenty of times. I just never thought I would need them. For me, the membership is phenomenal. The membership is worth the money,” Jennie says. “I can’t say enough about the quality of care with [NW] MedStar. I hope I never have to use it again,” Jennie says, “but I’m glad it’s there if I do.”
To enroll in membership or purchase a gift membership visit: www.nwmedstar.org
Shriners Hospital for Children® in Spokane is growing and changing to consistently meet the needs of the surrounding community. The needs of a rural health community can be different than those who live near our hospital. If a child has an orthopaedic need that requires an expert who knows the special needs of growing bones and joints, it is important they come to the Spokane Shriners Hospital. These patients will be delighted to discover that once they arrive at Shriners Hospital, they encounter an abundance of people eager to help.
The admissions process is simple and our friendly staff will walk the patient and family though the whole process. All ancillary services are performed on site at the hospital, including radiology and laboratory needs. Shriners Hospital also offers physical therapy and occupational therapy rehabilitation services. Patients even benefit from the comfort of a growing respiratory therapy department. A Care Coordinator is assigned to each patient and will arrange for the entire spectrum of care for the patient and assist with the needs of the family, including on-site lodging if necessary. Put simply: you made it this far; we’ll take care of the rest.
We continue to expand to make your experience the best it can possibly be by consistently adding new services. This growth, in order to be smooth and cohesive, needs common direction. With this in mind, we are proud to introduce three of our newest leaders.
“I work for a great team of respiratory therapists! Together, we are working to expand our department’s scope of services for future growth and continue to provide excellent patient and family centered care,” says Deborah Reich at Shriners Hospital.
“I am privileged to work with an enthusiastic team providing physical therapy and occupational therapy. It’s great to work with people who love their job of working with kids of all ages,” states Katy Frankenfield.
“The scheduling staff has an amazing ability to put a smile on the patient’s face. By making this process simpler, we help reassure the patient and their family,” says Amber Biljan.
What started with a real-world, simulated community inside the walls of St. Luke’s Rehabilitation Institute with a bus, airplane, grocery store, bank and more, has now moved outside with the second phase of the community completed November 7th, called St. Luke’s Community Park.
The Mike Utley Terrain Park With the support of the Mike Utley Foundation is a place where patients and their therapy team members will experience an outdoor terrain park, challenging individuals recovering from injury or illness to navigate ramp elevations, gravel patches, cobblestone paths, bark and speed bumps.
The Children’s Miracle Network Hospitals Adaptive Play Area incorporates play time with the recovery process for children to create more than just fun. This multipurpose area will include an adaptive swing, a small climbing wall and tic-tac-toe to work on modality and hand-eye coordination for pediatric patients and visitors.
Adaptive Garden Horticultural therapy can be an important part of a patient’s recovery process. This updated area will include pre-molded, cement garden beds at varying heights teaching patients that their love of gardening can continue after an illness or injury.
Hand Cycle Track - Hand cycling is an important exercise with the benefit of cardio, strength training and flexibility with specialized equipment. This five-foot wide path around the perimeter of St. Luke’s Community Park allows patients and Team St. Luke’s participants to try a variety of hand cycles in a supportive and safe environment.
Special thanks - St. Luke’s Community Park was built with support from the Mike Utley Foundation, Children’s Miracle Network Hospitals, KXLY Extreme team and many generous donors, the $250,000 project includes a terrain park, adaptive play set, hand-cycle track and updated adaptive garden area.
Medical assistants working in Washington State must either have a medical assistant-certified (MA-C) or Medical Assistant-Registered (MA-R) credential through the Washington Department of Health.
The Medical Assistant (MA) Pathways Program provides individualized education plans for working MAs who need to catch up on education and training, or for MAs who need to prepare for a national certification exam. Typically, costs are limited to Department of Health fees and transportation to classes since the project is funded by a Hospital Employees Education and Training grant funded by the Washington State Board of Community and Technical Colleges. The project is a partnership between SEIU Healthcare 1199NW and its Multi-Employer Training Fund, healthcare employers, Highline, Yakima, Olympic and Skagit Valley Colleges.
The education plans are individualized and consist of online and hands-on components that prepare working MAs to take a national exam and meet the MA-C standards as outlined in Chapter 18.360 RCW with minimal disruption to work schedules.
In Eastern Washington, in-person clinical classes are held at Yakima Valley Community College. Rural Health Leaders in Eastern Washington, if you are interested in holding a cohort at another location to mitigate the travel barrier for working MAs, please contact Nico Patel through email, [email protected], for further conversation. Winter classes begin January 5, 2015 and spring classes begin March 30, 2015.
In Western Washington, clinical in-person classes are held at Highline College in Des Moines and on the Olympic Peninsula. Winter quarter starts January 5, 2015 and spring quarter starts March 30, 2015.
WRHA members now have a new way to share community events affecting rural health in and around Washington State. As members, you can now post your community event on the WRHA website calendar so that others from across Washington can stay current and share information about what is happening in your town.
To submit a calendar event, simply click here or go to www.wrha.com and hover over “Events” and select “Calendar of Events”. You can view current events on the WRHA calendar or submit your own event by clicking “Submit an event” in the bar just above the calendar.
Once you have submitted your event, the WRHA support team will review and approve it for posting.
WRHA Members also enjoy these membership benefits: • Discounted registration to the annual Northwest Regional Rural Health Conference (March 18-19, 2015) • Representation in Statewide Office of Rural Health • Representation in State Association Council of National Rural Health Association • Networking opportunities with other advocates of rural health from across Washington • Individual members have one vote pertaining to Association matters • Organizational and Sponsorship members have three votes pertaining to Association matters • Receive the electronic newsletter 6 times annually
minutes of getting to her. It would be a short flight to the awaiting trauma team at PeaceHealth Southwest Medical Center. Megan’s mom had been contacted about the accident, but did not realize the extent of her daughter’s injuries. She called the hospital and was told that Megan made it there alive but was given no other details. Megan later explained, her mom “was blindsided by that realization that I might not live.” Her family was horrified to learn the extent of Megan’s injuries: her tibia and fibula were broken in 7 places, her femur broken in 4 places, her left clavicle and right scapula were broken in several places, and bone had also been pushed into the pocket of her shoulder joint. Of greater concern, Megan had severe injuries to her liver, kidney, spleen, lungs, and her aorta was torn. 
(DXA) is the best way to measure bone density since it measures BMD at the hip and the spine, two locations at risk for osteoporotic fracture.
“I am privileged to work with an enthusiastic team providing physical therapy and occupational therapy. It’s great to work with people who love their job of working with kids of all ages,” states Katy Frankenfield.
pler, we help reassure the patient and their family,” says Amber Biljan. 
The Medical Assistant (MA) Pathways Program provides individualized education plans for working MAs who need to catch up on education and training, or for MAs who need to prepare for a national certification exam. Typically, costs are limited to Department of Health fees and transportation to classes since the project is funded by a Hospital Employees Education and Training grant funded by the Washington State Board of Community and Technical Colleges. The project is a partnership between SEIU Healthcare 1199NW and its Multi-Employer Training Fund, healthcare employers, Highline, Yakima, Olympic and Skagit Valley Colleges.