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Carti: Vision Casting A closer Look at Medicare Part B Q&A with Bo Ryall CEO, Arkansas Hospital Association

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Healthcare Journal of Little Rock analyzes healthcare for the purpose of optimizing the health of our citizens. Chief Editor

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ON the Cover: Pictured, L-R: Dr. Xiang Gao, Radiation Oncology; Dr. Balan Nair, Medical Director and Medical Oncology; Dr. Diane Wilder, Medical Oncology; and Dr. Mariann Harrington, Medical Oncology; and Dr. Theodore Hronas, Diagnostic Radiology

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Contents + /5

July / August 2018 I Vol. 5, No. 5

fe atures CARTI: Vision Casting...... 10 A Closer Look at Medicare Part B ................14 Q&A with Bo Ryall, MD...................................... 18 CEO, Arkansas Hospital Association

18

10

Depart m ent s Editor’s Desk.............................................................8 Healthcare Briefs............................................... 25 Hospital Rounds................................................. 55 Book Review......................................................... 65 Ad Index................................................................... 66

Co rr es po nd ent s Policy.......................................................................... 40 Director’s Desk.................................................... 42 Mental Health....................................................... 44

14

Medicaid................................................................... 46 Acupuncture.......................................................... 48 Wealth Management....................................... 50 Oncology................................................................. 52

Editor’s Desk

Slow down everyone. You’re moving too fast. Frames can’t catch you when you’re moving like that. -Jack Johnson, Inaudible Melodies

Sometimes moving too fast is fun. It’s a rush. People enjoy it. It can be like riding way too fast on a motorcycle on the open road—a Being aware of your body’s rate of movement will go a long way to improve your grace and health. There is a speed to life. It’s cultural. High speed offers many attractions— more accomplishments, avoidance of the quiet, strategic confusion, strategic focus. Speed of life, like wind and fire, offers gifts or trouble, depending on the use. The subtle movements of the body perform in conjunction with the fluctuations of the mind. There is a speed of health. Ever play a musical instrument? One of the worst things you can do is try to play too fast—before you’re ready. Few people are actual musical geniuses. All the time we see people moving fast, driving fast, talking fast. Some are ready for it. Some move at that pace. But most people are moving too fast. You can see it all around. Faster is slower and messier, if moving outside the natural rhythm. The world is often like a slick salesman. It delivers news, information, and self-righteous ideas so fast that we don’t take a moment to realize the ridiculousness of it all. It often delivers a message of pressure to move from a life of wellness to battle an unnecessary cause, and to feel unnecessary pain. The motives, while delivered righteously, are questionable. Anything to take your attention from a point of wellness must be considered carefully. Despite the world culture, and messages of more and faster, we can train ourselves to control our pace. Watch people

somewhat controlled exhilaration with inherent risks. Testing the boundaries of life is often a pleasure. When it’s a conscious decision, the rush is a healthy choice. For some it’s an opportunity to feel success, and to feel alive. What is success, if it’s not peace of mind? Tai Chi is an example of a practice which helps with the control of movements and fluctuations of the mind. Play with bringing the physical movements down a few octaves to observe and find a more ideal, or alternative pace for the mind through the movements of the body. It’s another form of calming the mind by first calming the body. Of course, it’s all connected. It’s certainly worthy of consideration. There’s so much to do, and so much see. The experiences of life are meant to be enjoyed. The experiences are meant to be lighthearted, and appreciated for their uniqueness, and appreciated for the pleasures of being ordinary. As we ride through it all, doing what we should do, at the speed of health, sharing life with the like-hearted, we support our own well-being. That’s the best we can do. When speaking with patients, we have an opportunity to notice their speed of life. We notice their pace and their relationship to their own pace. It may be an opportunity to recommend a practice of meditation, or play, which encourages a speed of well-being. It’s not just about going slower. For some, it may be about going faster. It’s about finding the speed that feels right. Only the individual will know the best speed of life. But, mindfulness of speed of life is usually an unconsidered concept in the flow. Just presenting the idea of speed of health may be sufficient for improving health. It’s best to be a living example.

rushing around. Watch people moving too fast. Watch people pretending to get more done than they really are. Know that many may have a burden in their mind, as evidenced by the body. It’s interesting to see. We hope it’s temporary. We’ve all struggled with an overly ambitious schedule, with selfimposed rankings of high priorities. I often wonder what we’re accomplishing, or hiding from, or selling, and wonder about the sanity of it all.

8 JUL / AUG 2018 I Healthcare Journal of Little rock

Smith Hartley Chief Editor

[email protected]

Q&A with

Adam Head

CEO, CARTI Cancer Center Adam Head grew up in North Little Rock, Arkansas. Upon graduation from the University of Arkansas with a degree in Business Administration, he was commissioned as an officer in the United States Army’s Medical Service

Balan Nair, MD

CMD, CARTI Cancer Center

Corps through the University’s ROTC program. After serving in various leadership capacities in the U.S. and overseas, he left the Army as a Captain and moved back home to become Assistant Administrator of Arkansas Heart Hospital. In early 2011, Adam received his Master’s degree in Business Administration from Capella University and left Arkansas Heart Hospital to become Chief Operating Officer (COO) and site Administrator of HealthSouth Lake-

Balan Nair, MD has been practicing as a medical oncol-

shore Rehabilitation Hospital in Birmingham, Alabama.

ogist in Arkansas for 20 years. He joined CARTI, Arkansas’s

After serving in that role for two years, he returned to

largest private, not-for-profit full service cancer center in

Arkansas Heart Hospital as Chief Operating Officer (COO)

2011 and was named Chief Medical Director in 2017.

and served in that role until August 2017. In September,

Nair sees patients in Little Rock and in clinics in El Dorado

he began in his current capacity as President and CEO of

and Heber Springs. He is a graduate of Grant Medical

CARTI. He is a fellow of the American College of Health-

College, University of Bombay, where he also was in resi-

care Executives (ACHE) and in 2015 received the ACHE

dency training in Pathology. Nair did his fellowship train-

Arkansas Chapter Young Administrator of the Year award.

ing at Yale University in New Haven, Connecticut, and

Adam is a student of leadership theory, team develop-

at the H. Lee Moffitt Cancer Center in Tampa, Florida.

ment and organizational system improvement.

Healthcare Journal of little rock I JUL / AUG 2018 11

dialogue

Chief Editor Smith W. Hartley How does

CARTI uniquely approach cancer care in Arkansas? CARTI CARTI delivers the highest quality

comprehensive cancer care, offering cutting edge radiation therapy, medical and surgical oncology, interventional oncology, and diagnostic radiology, along with many other services. The reach, delivery, and quality of this cancer care are unparalleled, and we bring that care to 11 cities throughout the state. Editor Can you shed some light on the

financial challenges CARTI has been facing? What can be done to improve the reimbursement/revenue side? How important is the foundation to CARTI’s financial success and overall mission? CARTI For the first 35 years of CARTI’s

proud 42-year history, financial performance was narrowly focused in the cancer sub specialty of radiation oncology. In 2011 and 2012, CARTI made the strategic decision to pull more components of the cancer care experience—and therefore more physician practices—under one umbrella. This led to the construction of the CARTI Cancer Center, which opened in late 2015. In the midst of this period of massive upscaling, many financial challenges became apparent due to the complex nature of a multi-faceted consolidation, and especially in light of a

occurrence and mortality, there is an incred-

unleashing of the patient’s immune system

$50 million bond issuance to support the

ible opportunity to use state-of-the-art

to attack the tumor with immunotherapeu-

construction of the Cancer Center.

technology, research in the latest drug ther-

tic agents, and the development of newer

Over the last nine months, CARTI has

apies, new screening techniques, and yes,

non-chemotherapy biologic agents that act

undergone a process of cultural refor-

preventative educational tools to change

by novel mechanisms of action. There have

mation, financial stabilization, and vision

this trend. Our entire team is focused on

also been impressive advances in imaging

casting. Revenue is up, new patients are

aggressively meeting this challenge, while

of tumors and in radiation and proton beam

up, and bottom-line performance has radi-

compassionately treating the patients we

therapy.

cally changed. This has all provided a strong

serve.

foundation for the vision of CARTI becoming the cancer treatment destination.

Editor Is cancer a curable disease? Editor What is new and interesting in the

field of cancer care? prevention of cancer?

CARTI It is already curable in certain tumor

types and certain stages, but for the major-

Editor Is CARTI doing anything towards the CARTI A number of fascinating trends in

ity of patients with advanced cancer, newer

oncology are beginning to revolutionize

developments hold the promise of convert-

CARTI In a state that consistently ranks

cancer care—the use of genomics of the

ing cancer care to a chronic disease model

in the top five in the nation for cancer

tumor to inform treatment decisions, the

in the future.

12 JUL / AUG 2018 I Healthcare Journal of Little Rock

Editor What are some expansions or merg-

ers CARTI is working on? CARTI As mentioned, CARTI’s vision is to

be the cancer treatment destination. To be that destination, we are absolutely focused on scaling our services and offerings up in pursuit of that vision. More to come. Editor How does CARTI take a holistic

approach to each patient’s care? CARTI At CARTI, we understand a diagnosis

of cancer presents a challenge to the physical, mental, emotional, and financial wellbeing of an individual. Our outstanding physicians, nurses, technologists, counselors, social workers, nutritionists, and research personnel are well equipped to help our patients meet these challenges. Editor How specifically does CARTI handle

and measure quality as an organization? CARTI Continuous quality improvement

is a huge focus at CARTI, and this is measured in medical oncology, surgical oncology, imaging, and radiation therapy. We are a part of a number of initiatives that seek to measure and deliver higher quality care so that we can be the best value proposition Pictured, L-R: Dr. Mariann Harrington, Medical Oncology; Dr. Balan Nair, Medical Director and Medical Oncology; Dr. Diane Wilder, Medical Oncology; Dr. Theodore Hronas, Diagnostic Radiology; and Dr. Xiang Gao, Radiation Oncology

for our patients and our payers. Editor What are some other things CARTI

is currently working on?

“We are working on a number of outreach initiatives, delivery of novel therapeutics, and therapies that have never been delivered in Arkansas before.”

CARTI We are working on a number of

outreach initiatives, delivery of novel therapeutics, and therapies that have never been delivered in Arkansas before. Editor What does the future of cancer care

look like in the state of Arkansas? CARTI The future of cancer care in Arkan-

sas is bright and promising. New scientific advances, the local delivery of comprehensive cancer care, and Arkansans never-giveup attitude promises increasing success in the fight against cancer. n


Examining Medicare

Some Doctors Still Billing Medicare for the Most Complicated, Expensive Office Visits A Closer Look at Medicare Part B By Charles Ornstein and Ryann Grochowski Jones Propublica

T

housands of times a year, Medicare patients file into Dr. Mark Roberts’ family practice clinic in rural Evergreen, Alabama, for standard office visits. And almost every time they did in 2015, Roberts billed Medicare for the most complex, and most expensive, type of office visit — one that typically takes 40 minutes and for which Medicare reimbursed him an average of $94. He billed for 4,765 such high-level visits that year, according to federal data, more than any other doctor in the country. And for that, he collected nearly $450,000 from Medicare.

14 JUL / AUG 2018 I Healthcare Journal of LITTLE ROCK

Examining Medicare

and inspections for the U.S. Department of Health and Human Services in Atlanta. Grant’s team produced reports in 2012 and 2014 that said Medicare needed to do more to address improper billing. “We continue to believe that focusing on these high-coding physicians is going to improve oversight, reduce overpayments and really serve as a deterrent effect,” he said. Among the 1,825 physicians who billed most often for complex office visits was Dr. Jose Prieto, an internist in Hialeah, Florida. He billed for 721 office visits in 2015, all of them at the highest level, Medicare data show. Medicare revoked Prieto’s ability to participate in the program in December 2016 for falsified information, according to data provided under the Freedom of Information Act. Prieto did not respond to a phone call and email seeking comment. A woman who Roberts’ billing pattern was highly

billed Medicare for the most expensive

returned a call placed to his office said Pri-

unusual compared to his peers. All told,

type of office visits for established patients

eto is an infectious disease doctor who treats

family medicine doctors in Alabama billed

at least 90 percent of the time in 2015. That

patients with HIV and routinely spends 45

for such visits only 5 percent of the time.

was almost the same as the 1,807 that we

minutes with each patient. The woman dis-

Roberts did so 95 percent of the time. Even

found based on 2012 data. Some physicians

puted that Prieto exclusively bills for the

some doctors who had sicker patients billed

that were billing Medicare this way in 2012

highest level office visits, as Medicare data

for top-level visits less often, Medicare data

still were in 2015, we found.

shows. “He bills for the time he spends with

show. Several messages left at Roberts’ office were not returned.

Office visits are a staple of medicine.

his patients,” she said.

In 2016, Medicare paid for more than 227

Another is Dr. James Beale, an orthopedic

For years, internal government watch-

million of them at a cost of $13.2 billion

surgeon in Warren, Michigan. All 1,150 of his

dogs have been warning the federal Medi-

(including Medicare outlays and patient

Medicare office visits were billed at the high-

care program that some doctors were over-

copayments). They are far from the most

est level in 2015. Beale has been disciplined

charging for office visits. And for years,

expensive services that Medicare provides,

three times by Michigan’s medical board,

federal health officials have been promis-

but they are ubiquitous.

most recently in May 2016 when he was sus-

While it’s possible that some physicians

pended for failing to respond to a 2015 board

But a new ProPublica analysis shows very

only treat the sickest patients who require

complaint that he prescribed controlled sub-

little has changed since we first wrote about

the highest level office visits, “I don’t think

stances for patients without adequate justi-

the issue in 2014. ProPublica found that 1,825

it’s very probable,” said Dwayne Grant,

fication. Beale also extensively billed Medi-

health professionals, including Roberts,

regional inspector general for evaluation

care for psychotherapy services in 2015. He

ing to focus on the problem.

90%


“ProPublica found that 1,825 health professionals billed Medicare for the most expensive type of office visits for established patients at least 90 percent of the time in 2015.”

could not be reached for comment. Also, on the list is Dr. Rand Ritchie, a Pismo Beach, California psychiatrist. He

The coding system developed by the Ameri-

meaning to bill at a higher level than justi-

can Medical Association gives doctors five

fied, Weston said. If doctors copy and paste

options.

phrases about a patient’s condition and

billed 1,475 visits at the highest level, or 97

An uncomplicated visit, typically of short

their electronic medical record automati-

percent of his Medicare office visits, in 2015.

duration and which may not require a physi-

cally decides how to bill for the visit, “that

The California medical board has disciplined

cian, is coded a 1; a visit that involves more

is worrisome.”

Ritchie twice for alcohol abuse and multiple

intense examination and often consumes

convictions for driving under the influence

more time is coded a 5. The most common

of alcohol. He completed probation most

codes for visits are in the middle, 3 and 4.

recently in 2014 and currently has an unrestricted license.

How We Did This Analysis

For this story, ProPublica analyzed pro-

Most health professionals had a tiny per-

vider billing patterns for standard office

centage, if any, visits billed at level 5, but

visits in Medicare. We focused on those for

Ritchie’s office manager, Darryl Schum-

more than 1,250 billed only at the highest

established patients who had been seen at

acher, who handles billing for the practice,

level in 2015, ProPublica found. Another 570

least one time by the provider previously.

said Ritchie had started accepting Medicare

billed that way more than 90 percent of the

These are among the most common services

around 2015 because no other psychiatrists

time. That was very similar to what we found

performed in the program.

in private practice in the area did so. “He was

three years earlier.

We used data released by the Centers

taking on many new patients and the com-

Cyndee Weston, executive director of

for Medicare and Medicaid Services show-

plexity of some of these patients, because

the American Medical Billing Association,

ing the services provided by and payments

they had either gone without treatment for

an industry trade group, said such num-

made to providers in Medicare’s Part B pro-

many years or had gone without a psychi-

bers raise red flags. “It’s not likely that every

gram in 2015. Medicare redacted data on ser-

atrist, was pretty difficult at the beginning,”

patient that comes to a doctor’s office is a

vices when a provider billed for a service for

Schumacher said.

level 5,” she said.

fewer than 11 patients.

Schumacher also said that no one from

The doctors who billed at the top level in

More than 490,000 providers billed the

Medicare had contacted the practice to ask

2015 were not all the same as those who did

program for standard office visits for at least

about Ritchie’s numbers and that questions

so in 2012. Of the 1,825, 650 were on the list

11 patients in 2015.

from ProPublica were the first indication

in both years. Another 536 billed for a lesser

Office visits are coded using the Current

that his billing pattern was unlike that of

share of visits at the highest level in 2012.

Procedural Terminology system devised

his peers. As for his discipline, Schumacher

And the remaining health providers did not

by the American Medical Association and

said Ritchie fulfilled the requirements of his

bill Medicare in 2012 for office visits involv-

used by Medicare. The severity of each visit

probation and is once again board certified

ing at least 11 patients.

depends on three criteria: the thoroughness

in psychiatry.

For some doctors, the shift was jarring.

of the review of a patient’s medical history,

Asked for comment, a spokeswoman for

In 2012, Roberts, the Evergreen, Alabama,

the comprehensiveness of the physical exam

the Centers for Medicare and Medicaid Ser-

family doctor, never billed for high-level

and the complexity of medical decision-

vices said the agency is exploring how to

office visits. He billed Medicare 4,681 times

making involved.

make changes to its billing rules for office

for level 3 visits, for which Medicare paid

An uncomplicated visit, typically of short

visits to reduce the burden on doctors and

him an average of $43.57, less than half as

duration, should be coded a 99211; a visit

better reflect the way medicine is practiced

much as he received per visit in 2015.

that involves more intense examination and

and care is coordinated.

In Oak Harbor, Washington, doctors Rob-

often consumes more time should be coded

In a notice in the Federal Register in

ert Lycksell and Zayan Kanjo also didn’t bill

a 99215. The most common codes for visits

November, CMS said the guidelines govern-

for level 5 visits in 2012. Lycksell billed for

are in the middle, a 99213 or 99214.

ing how health professionals bill for office

1,948 level 5 visits in 2015 and Kanjo 1,297 in

To protect against variation hidden

visits, more formally called Evaluation and

2015. The doctors did not return phone calls

by redactions, we focused on the nearly

Management visits, date to 1995 and 1997.

seeking comment.

364,000 providers who billed for at least

CMS said the process for updating them

Weston said it’s disappointing that the

100 standard visits in 2015.

same problems identified years ago appear

We identified more than 1,250 providers

As it stands now, doctors and their staffs

to remain today. Some of what’s happen-

who billed for every office visit using the

decide how to bill for a patient visit based on

ing, she said, is related to electronic medi-

99215 code. We found another 570 provid-

a host of factors, including how thoroughly

cal record systems that assign billing codes

ers who billed level 5 visits at least 90 per-

they review a patient’s medical history, the

based on the computer boxes doctors click

cent of the time. n

intensity of the physical exam and how com-

during office visits.

could take several years.

plicated the medical decision-making was.

“Those programs tend to upcode,” Healthcare Journal of LITTLE ROCK I JUL / AUG 2018 17

dialogue


A Q&A with

Bo Ryall

CEO, Arkansas Hospital Association

Bo Ryall is president and CEO of the Arkansas Hospital Association. He has been with the Association since 2005, and was named president in 2010. He holds a bachelor’s degree from the University of Arkansas at Fayetteville, and a master’s degree in public administration from the University of Arkansas at Little Rock. Bo also served as the chief lobbyist on the state level for Arkansas hospitals, and was previously executive director of the HomeCare Association of Arkansas. He currently serves as the chairman of the Health Care Providers Forum, is a member of the Health Care Industry Council of the Federal Reserve Bank of St. Louis, is an Arkansas Regional Organ Recovery Agency board member, and is a past-president of the Arkansas Society of Association Executives.

dialogue

Chief Editor Smith W. Hartley What is the

opinion of current payment models for hospitals? What would the Arkansas Hospital Association like to see differently in payment models? Bo Ryall The Arkansas Hospital Association

certainly recognizes that change is occurring, and it is occurring rapidly. Hospitals are attempting to survive in the current payment models, while preparing their systems for the new payment models. It proves the old saying, “one foot in the canoe and one on the dock”. We all talk about how feefor-service is an outdated system of payment, and that health care should be reimbursed on a value-based payment system. We believe this payment methodology shift is occurring, but all payers are testing it in a number of different forms. Medicare is testing Accountable Care Organization (ACO) models, and we have found that those throughout the nation require a significant capital investment, all the while knowing that any positive returns on those investments will take at least five years. This experiment may be attempted by a large health care system with the financial capabilities to absorb initial losses, but our state has many small rural hospitals that cannot afford the investment. Worse, if those small rural hospitals convert to a new payment system that reduces reimbursement significantly, it puts them in real jeopardy of no longer remaining viable. Medicaid is testing its Provider-led Arkansas Shared Savings Entity (PASSE) for developmentally disabled and behavioral health populations. This model is untested,

“Hospitals are attempting to survive in the current payment models, while preparing their systems for the new payment models. ”

and there are a lot of unknowns about the payments and the management of care that will ultimately be provided by four new

insurance through Arkansas Works and

that cause them to lose coverage in another

insurance company partnerships.

the subsidized plans on the health insurance

month.

Commercial insurance companies have

marketplace, which is extremely important

All of this is to say that while hospitals

experimented with episodes of care, and

to and appreciated by hospitals. Even with

are ready to be a part of changing reim-

are now outlining plans for their version

the improvements of reduced uncompen-

bursement methodologies, the entire health

of value-based payments, which has the

sated care because of Arkansas Works,

care system would benefit more if entities

potential to reduce reimbursement for

hospitals must still prepare for individuals

who reimburse hospitals and other health

all types of providers—not just hospitals.

who have insurance in a particular month,

care providers for patient care would get

Commercial insurance companies have

but do not keep up with the administrative

together on the most efficient and respon-

also assisted with the uninsured gaining

reporting requirements or other mandates

sible payment model, and have consistent


rules. The complexity of multiple payers, and a multitude of rules that predicate which hoops hospitals must jump through for adequate reimbursement, actually drives up the costs of care to hospitals and, ultimately, our patients.

“The entire health care system must do a better job of sharing patient information across computer systems, while maintaining appropriate patient privacy.”

Editor What are some ways hospitals can

leverage technology for better performance and coordination? Ryall Health care entities began buying

computer software to get away from the large amount of paper files and become more efficient. Some of those information technology systems worked adequately, and some did not work at all. All of them were expensive. They also came with an expectation that if hospitals were able to gather

Editor With so much effort towards cost

patients. The more uninsured and underin-

and maintain electronic health records, that

controls, how can hospitals continue to

sured people we have accessing emergency

those perceived data warehouses could

improve quality and patient safety?

care, the more pressure is placed on the

share information with anyone at any time.

other payers and the hospital to cover the

The reality is, of course, that all of these

Ryall Hospitals continue to invest in quality

costs of the uninsured. Because hospitals

computer systems are different, and they

and patient safety because, ultimately, that

are federally required to provide services to

do not easily communicate with one other.

is what drives better care for the patient,

all individuals, regardless of their ability to

We often hear the frustration of patients

produces efficiencies in care, and gives

pay, hospitals have a business model that is

who must complete multiple new forms at

the patient the best opportunity for better

not sustainable if large numbers of patients

every health care provider visit. The ques-

health outcomes. In addition, the cost of

have no source of payment.

tion is always, “Why can’t the doctors, the

any type of medical error to an organiza-

The ACA made health care as political as it

hospitals, the pharmacists, and the insurers

tion often outweighs the cost of implement-

has ever been. We hope to get away from the

all share patient information so I don’t have

ing a safe system. An easy example of this is

politicization of health care, and move into

to tell each one my entire medical history

the investment in lift equipment designed to

true problem-solving mode. Hospitals are

at every visit?” The entire health care sys-

prevent patient falls and employee injuries.

the backbone of the health care system, but

tem must do a better job of sharing patient

Averting the costs of the injury justifies the

we cannot improve health outcomes alone.

information across computer systems, while

purchase of the equipment.

It takes all health care providers and pay-

maintaining appropriate patient privacy.

ors working together; it takes appropriate

For hospitals, you can’t mention gains

Editor What would the Arkansas Hospital

patient engagement and involvement. Part

in technology without the excitement sur-

Association like to see regarding the unin-

of that has to be keeping people insured,

rounding the continued development of

sured and underinsured populations?

and assuring that insurance products for

telehealth as a tool to care for patient needs.

our most vulnerable Arkansans are afford-

We have seen major advancements in recent

Ryall With the passage of the Patient Pro-

able, and appropriately reimbursing health

years, and we need to continue improving

tection and Affordable Care Act (PPACA),

care providers.

the use of telehealth capabilities, and to pay

and the implementation of Arkansas Works,

fairly for those services. In rural states like

Arkansas saw one of the largest reductions

Editor Can you describe specific workforce

Arkansas, many people live in areas with

in uninsured people in the nation over a

issues facing hospitals?

limited access to hospital care. Hopefully,

one-year period. Since then, our state has

greater access increases efficiency, and over

seen the uninsured numbers creep up, all

Ryall Hospitals are competing for doctors,

time, creates better health outcomes for

while more insurance products offer high

nurses, and all types of therapists. There

patients, which can add to reduced health

deductible plans ($5,000 deductible or

are just not enough in the market to fill all

care costs.

more), which translates to underinsured

of the open positions throughout the state.

Healthcare Journal of Little Rock I JUL / AUG 2018 21

Google Maps/Google Earth

dialogue

“There will always be a need for hospitals, but hospitals have long since realized the shift from inpatient care to delivering services in an outpatient setting.”

Specifically, there are many opportunities

their communities tomorrow. AHA not only

Ryall Arkansas hospitals, which are primar-

for nurses in the health care field. We are

contributes to our mission with advocacy

ily small, rural, and independent, are very

not only competing with other hospitals, but

efforts, we also offer broad support with

similar to their sister facilities in other small

also clinics, insurers, and others. Arkansas

educational programming provided to hos-

rural states. If there is something that makes

has a great opportunity to recruit and retain

pital executives, trustees, managers, clinical

them unique, it is the improved chance of

graduates from the two new osteopathic

professionals, and rank-and-file employ-

long-term survival offered through the

schools in our state. Data show that health

ees. The quality improvement programs we

state’s commitment to insurance expan-

care providers—especially doctors—tend to

offer, and the information and communi-

sion through Arkansas Works.

locate close to areas where they trained. We

cations we distribute, keep members up to

hope to retain a number of those doctors

date on major issues.

in the state to help with our primary care shortage.

There will be other issues we need to

Editor What do you see as the future for

Arkansas’ hospitals?

address in Washington and Little Rock, but for now, our main objective will continue

Ryall There will always be a need for hos-

Editor What are some other issues Arkan-

to be the reauthorization of the Arkansas

pitals, but hospitals have long since real-

sas Hospital Association is working on, or

Works program. This program insures

ized the shift from inpatient care to deliv-

lobbying for?

275,000 individuals across our state. The

ering services in an outpatient setting. You

¾ legislative vote requirement for the pas-

will continue to see the growth of hospital

Ryall The AHA has been around since 1929.

sage of the appropriation for the Arkansas

clinics throughout the community, which

During that entire time, its primary purpose,

Works program will always create a chal-

make the services more accessible and

which is our mission statement today, has

lenge, but this program is important to the

convenient for patients. We will continue

been to safeguard hospitals’ operational

health of Arkansans and the sustainability

to serve the sickest and most vulnerable

effectiveness in advancing the health and

of hospitals.

patients through inpatient care, but we fully

well being of their communities. In one

recognize that in a world rapidly creating

way or another, that help is geared toward

Editor Are Arkansas hospitals unique to

new expectations for convenience and effi-

helping hospitals remain financially viable

other US hospitals in any way?

ciency, hospitals will do more to place qual-

today, so that they can continue serving

ity, efficient outpatient services closer to our patients. n


We’re a little bit different . . and we’re okay wit h that. Mailed directly to local healthcare leadership including physicians, administrators, insurers and ancillary providers. The most comprehensive and costeffective way possible to reach your local healthcare industry. Request a media kit at [email protected]

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Healthcare Briefs

Ribbon cutting for Philander Smith College Nursing Nook.

Philander Smith College Provides Space for Nursing Mothers Story next page


Healthcare Briefs Philander Smith College Nursing Nook Opens

breastfeeding in the workplace and institutional settings, making it the norm.

Despite major improvements in safety measures over the past few decades, motor vehicle

Brittany Taylor became a mother in 2016. It

Healthy Active Arkansas is a 10-year framework

crashes continue to be the leading cause of death

wasn’t until she chose to breastfeed her child

to increase the number of Arkansans at a healthy

for young children, and parents still frequently

that Taylor, a student of Philander Smith College

weight. There are nine priority areas, including

choose the wrong type of car seat or seat restraint

(PSC), realized that there was no place for parents

breastfeeding, that impact the health of the state.

for their children. The National Highway Traffic

Sisters United is a community-based initiative

Safety Administration has estimated, for exam-

“I am glad to say, in 2018, I helped establish

designed to increase public awareness and pro-

ple, that only about 46 percent of children aged

the first Nursing Nook on the Philander Smith

mote healthy behaviors aimed at reducing infant

ages four to seven years are placed in the proper

College campus geared toward offering a space

mortality among African-Americans. The initia-

booster car seats, and that 24 percent use a seat

to students and employees who are nursing,”

tive is a partnership among chapter members of

belt prematurely.

said Taylor, who is the 2017–2018 Miss Philan-

Alpha Kappa Alpha, Delta Sigma Theta, Zeta Phi

der Smith College and a Healthy Active Arkan-

Beta, and Sigma Gamma Rho.

to breastfeed on campus.

sas ambassador. PSC collaborated with the Arkansas Department of Health, Healthy Active Arkansas, and Sisters United to officially open the Nursing Nook in its Health and Wellness Center located in the M.L. Harris Building. Taylor spoke along with PSC President Roderick L. Smothers, Sr.; ADH Office

The Safety in Seconds v2.0 app works on iPhones and Android phones. It asks each partic-

To learn more about Healthy Active Arkansas,

ipant a series of questions about his or her prac-

visit www.healthyactive.org. To learn more about

tices and beliefs concerning child car seats, and

Sisters United, visit https://bit.ly/2jjoILG.

then, based on that information, delivers appro-

Arkansas Children’s: Smartphone App Successfully Promotes Child Car-Seat Safety

priate safety tips in a personalized way, using the names of the participant’s children and referring to relevant child car seat laws in the participant’s state. The app provides a link to an online par-

of Minority Health and Health Disparities Direc-

A smartphone app designed to promote proper

ent portal with additional safety education, and

tor Michelle R. Smith, PhD; HAA Worksite Well-

child car seat use among parents proved effec-

can send reminder messages about child car seat

ness manager Kenya Eddings; and ADH Family

tive in a study led by researchers at Arkansas Chil-

safety as the child grows.

Health Medical Director Dr. William Greenfield.

dren’s Hospital Research Institute and Johns Hop-

The Nursing Nook is the first free-standing

kins Bloomberg School of Public Health.

The researchers recruited a total of 742 parents of four to seven-year-olds to the study in

room solely dedicated to nursing among histori-

The researchers and their colleagues devel-

the emergency rooms of the Johns Hopkins Chil-

cally black colleges and universities in the state.

oped the interactive app, Safety in Seconds

dren’s Center and Arkansas Children’s Hospital.

When it comes to providing babies with the

v2.0, and tested it in a randomized, controlled

Each participant was randomly assigned to an

best nutrition, breastfeeding is not only econom-

trial involving more than 700 participants, half of

intervention group, which received the Safety in

ical, it has positive health effects for both baby

whom were seen in the emergency department

Seconds app, or a control group, which received

and mom. Despite the benefits, Smith said there

at Arkansas Children’s.

a similarly structured app about fire safety.

is a disparity in the breastfeeding rates between

Participants reported significant improvements

In the study, the team examined four behaviors

African-Americans and whites, according to

in several child car seat practices, such as having

reported by participants at enrollment, and after

Pregnancy Risk Assessment Monitoring System

the correct car seat or restraint for the child’s age

three and six months—having the correct car seat

(PRAMS) survey data.

and weight, and having the car seat inspected

or restraint for the child’s age and weight; always

“For example, in Arkansas, the 2015 PRAMS

by a child passenger safety technician. These

having the child ride in the back seat; buckling

survey found that 83 percent of white mothers

results held up at three and six months after the

up the child all the time; and having the car seat

reported that they breastfed compared to only

program.

inspected by a certified child passenger safety

57 percent of African-American mothers,” Smith

“We wanted to see how this form of commu-

said. “This translates to fewer African-American

nication with messages tailored to each family

technician, often accessible via a local fire depart-

babies receiving the nutrients needed for healthy

would help them improve compliance,” said Mary

At three months, the group receiving the Safety

brain development and biological milestones.”

Aitken, MD, MPH, medical director of the Injury

in Seconds app reported large and statistically

ment or children’s hospital.

Not only does breast milk offer a nutritionally

Prevention Center at Arkansas Children’s Hospital

significant increases in the rates of three of these

balanced meal, it also reduces the risk for cer-

and a professor of pediatrics in the University of

four behaviors—the exception was having the

tain allergies, asthma, and obesity in babies as

Arkansas for Medical Sciences College of Medi-

child’s seat belt buckled, for which the rates were

well as Type 2 diabetes in moms. The lower rate

cine. “We’re excited to see families will embrace

very high at the start and thus had little room to

of breastfeeding also contributes to a higher rate

an app like this and keep their kids safer by fol-

rise. For each of the three behaviors with signifi-

of infant mortality within the African-American

lowing its instructions.”

cant reported increases, the increase was roughly

community. One way to reduce this disparity is to promote

The study is published this month in the American Journal of Preventive Medicine.

26 JUL / AUG 2018 I Healthcare Journal of little rock

double than that seen in the control group. At six months, there remained significant

For weekly eNews updates and to read the journal online, visit HealthcareJournalLR.com

improvements in the intervention group rela-

“We are very fortunate to have identified Dr.

tive to the control group for two of the behav-

Patterson and his strong skill set that will help

iors—having the correct car seat and having it

lead UAMS into a very crucial period in its con-

inspected.

tinued tradition of innovation and excellence,”

“These results are encouraging. The trial design

said Donald. R. Bobbitt, PhD, president of the

with a well-matched control group gives us con-

University of Arkansas System. “His experience in

fidence that this is a real, positive finding that we

leading a very complex clinical enterprise and his

can attribute to the content of the app,” says co-

varied background in clinical care, research, and

author David Bishai, MD, PhD, pediatrician and

administrative leadership will complement and

professor at the Bloomberg School, and who led

elevate the momentum already being generated

the team’s analytic approach. “Reaching parents

there. I am thrilled to bring him into the UA Sys-

with messages focused on their child’s specific

tem, and I welcome him and his family to Arkan-

needs can help them sort through the confusing

sas. I am also extremely grateful to Dr. Gardner for

array of products and information currently in the

her leadership and willingness to take on incred-

the position to UAMS’ governing board, the

consumer market place.”

ible challenges in her time as interim chancel-

University of Arkansas Board of Trustees, which approved the appointment January 3.

The team is now following up with a larger-

lor. She has proven herself to be an exceptional

scale, foundation-sponsored trial of the app in

leader and an invaluable member of the UAMS

four states. They are also exploring ways to dis-

leadership team.”

Cam Patterson, MD, MBA

The search was conducted by Bobbitt and a campus advisory search committee, along with

tribute the app to parents, possibly via pedia-

Patterson previously held numerous academic

tricians’ offices or even Apple’s App Store or

and clinical appointments at the University of

Google’s Play Store.

North Carolina, including physician-in-chief at

The search committee was chaired by Jean-

“Results of an RCT in Two Pediatric Emer-

the UNC Center for Heart and Vascular Care and

nette Shorey, MD, associate provost for faculty

gency Departments to Evaluate the Efficacy

executive director of the UNC McAllister Heart

and professor of internal medicine. It included

of an m-Health Educational App on Car Seat

Institute.

representatives from campus faculty, administra-

the help of Isaacson Miller, a contracted national search firm.

Use” was written by Mary E. Aitken, Andrea C.

Over the course of his career, Patterson, as prin-

tion and staff, supporters from across the state,

Gielen, David M. Bishai, Elise Omaki, Wendy C.

cipal investigator or co-investigator, has received

and a member of the University of the Arkansas

Shields, Eileen M. McDonald, Nicholas C. Riz-

more than $60 million in grants from the National

Board of Trustees.

zutti, James Case, and Molly W. Stevens. Fund-

Institutes of Health, the American Heart Associ-

ing was provided by the National Institutes of

ation, and the Centers for Disease Control and

Health (HD069221).

Prevention. His work has been published in 323

UAMS Welcomes New Chancellor Cam Patterson, MD, MBA

peer-reviewed scientific publications.

Registered Dietitian Nutritionists Celebrate Healthful Eating and Lifestyle at the Capitol

He earned his Bachelor of Arts in psychology

Registered dietitian nutritionists from around

from Vanderbilt University, his medical degree

the state gathered at the Capitol recently to cele-

Cam Patterson, MD, MBA, a renowned cardi-

from Emory University School of Medicine, and

brate National Nutrition Month® and Registered

ologist and healthcare administrator, is the new

his Master of Business Administration from the

Dietitian Nutritionist Day. They handed out man-

chancellor of the University of Arkansas for Med-

University of North Carolina Kenan-Flagler School

darin oranges (also known as Cuties) to remind

ical Sciences (UAMS), the state’s only health sci-

of Business.

people about healthy food choices, and to edu-

ences university.

His residency, including a year as chief resident,

cate them on what exactly a registered dietitian

Patterson comes to UAMS from Weill-Cornell

was conducted at Emory University Affiliated Hos-

nutritionist can do for them. Approximately 100

Medical Center and Komansky Children’s Hospi-

pitals. He was a research fellow at the Cardiovas-

dietitians then met with Gov. Asa Hutchinson as

tal/New York Presbyterian Hospital in New York,

cular Biology Laboratory in the Harvard School

he declared March 14 as Registered Dietitian

where he was senior vice president and chief

of Public Health in Boston and a clinical fellow

Day, and the month of March as National Nutri-

operating officer since 2014.

in cardiology at The University of Texas Medical

tion Month®.

He replaces Dan Rahn, MD, who retired as chancellor July 31, 2017. Stephanie F. Gardner,

Branch at Galveston, Texas, where he joined the institution’s faculty in 1998.

National Nutrition Month ® is celebrated annually in March and encourages everyone to make

PharmD, EdD, who had been serving as interim

His wife, Kristine Patterson, MD, is an infec-

healthful food choices and develop realistic and

chancellor since that time, will continue as senior

tious disease specialist who is an expert in treat-

wholesome eating habits. National Nutrition

vice chancellor for academic affairs and pro-

ing menopausal women with HIV. They have three

Month ® also promotes the Academy of Nutri-

vost at UAMS, as she had before and during the

children Celia, Anna, and Graham.

tion and Dietetics and Registered Dietitians Nutri-

transition.

Patterson was recommended by Bobbitt for

tionists (RDN) as the most valuable and credible


Healthcare Briefs source of scientifically sound food and nutri-

state hospitals had higher readmission ratios for

APhA annual meeting on March 19 in Nashville,

tion information. The Academy of Nutrition and

pneumonia, heart failure, and heart attacks. But

Tennessee. About 300 students of the UAMS

Dietetics is the world’s largest organization of

when they controlled for hospital and commu-

College of Pharmacy are members of the APhA-

food and nutrition professionals, with more than

nity factors, the significant difference in readmis-

Academy of Student Pharmacists chapter that

100,000 credentialed members.

sion ratios for pneumonia and heart attack disap-

earned the awards. They were given in recogni-

Registered dietitian nutritionists have fulfilled

peared, and the difference for heart failure was

tion of its achievements in patient care and edu-

specific requirements to earn the RDN credential,

much less pronounced between hospitals in the

cation for diabetes and cardiovascular health,

which includes earning a bachelor’s degree, com-

Delta region and those in the rest of the nation.

along with the Division AA Chapter Achieve-

pleting a supervised practice program, and pass-

Factors linked to higher readmission ratios

ing a registration examination. To maintain the

for pneumonia and heart failure were whether

“These three national awards prove my belief

credential, continuing education requirements

a patient was treated in a major teaching hospi-

that these students are the best in the country,”

are required.

tal, which tend to take the sickest patients, and

said Eddie Dunn, PharmD, the chapter’s faculty

the percentage of the community that is African

advisor. “That a national association of profes-

American.

sional pharmacists shares that high opinion is val-

Community Factors Drive Hospital Readmissions in the Delta

ment Award.

Oddly, high poverty was associated with lower

idating. The entire college is proud of them and

readmissions for heart attacks, but the research-

the very hard work and effort they put in to be

Researchers at the University of Arkansas for

ers noted that mortality rates for this condition

so honored.”

Medical Sciences (UAMS) call for revision to the

are very high if patients cannot access treatment

Hospital Readmissions Reduction Program to

in a timely manner.

Dunn is an associate professor in the College of Pharmacy’s Department of Pharmacy Practice.

reduce unintended consequences that could

Chen and coauthors conclude that these find-

Operation Heart is a national, public educa-

threaten the healthcare delivery system in the

ings show that changes to the program are nec-

tion project of APhA-ASP, and Operation Diabe-

Mississippi Delta region in a new study published

essary and urgent to ensure that resources are

tes seeks to identify individuals with previously

in The American Journal of Managed Care.

not removed from the communities that need

undiagnosed diabetes while increasing overall

them most.

awareness of the disease. The Chapter Achieve-

The program provides financial incentives for hospitals to deliver higher quality care and higher

Her co-authors are Adrienne Nevola,

ment Award recognizes the overall activities of a

value care by reducing Medicare reimbursements

MPH.; Mack Bird, PhD; Saleema Karim,

chapter from patient care to policy activities and

to hospitals with higher than average readmission

PhD; Michael Morris, PhD; and J. Mick Tilford,

guest lecture programs.

rates for selected conditions.

PhD, from the Department of Health Policy

To win all three awards the students, through-

“In the Mississippi Delta, one of the coun-

and Management, and Fei Wan, PhD, from the

out the 2016–2017 academic year, participated

try’s poorest areas, community factors matter,”

Department of Biostatistics, both in the UAMS

in dozens of public outreach events, as well as

said Hsueh-Fen Chen, PhD, associate professor

College of Public Health.

organized many of their own, and visited public schools, Dunn said.

in the UAMS Fay W. Boozman College of Pub-

To read the full study, go to http://www.ajmc.

lic Health and lead author on the study. “They

com/journals/issue/2018/2018-vol24-n5/under-

Notably, he said the chapter in 2016–2017 initi-

matter so much that, once accounted for, read-

standing-factors-associated-with-readmission-

ated a new screening program at a commercial

missions were not much different from those

disparities-among-delta-region-delta-state-and-

gym to detect diabetes and high blood pressure

in the rest of the country for heart failure, and

other-hospitals.

in individuals who otherwise are athletic, fit, and

were about the same for pneumonia and heart attacks.” The study examined data from 2013–2016 for counties that fall under the Mississippi Delta

UAMS Student Pharmacists Win Three-Award Sweep in National Competition

may not think they need testing. The chapter also began an education campaign with flyers and a YouTube video to make people aware of the link between untreated psoriasis and an increased

Regional Authority in parts of eight states.

Students of the UAMS College of Pharmacy

Those states include Alabama, Arkansas, Illinois,

recently took home three American Pharmacists

The student chapter also placed as first runner-

Kentucky, Louisiana, Mississippi, Missouri, and

Association (APhA) national awards for patient

up in the national competition for awards for OTC

Tennessee.

care and education. Several of the college’s fac-

Medicine Safety and Operation Immunization as

ulty and alumni also were elected to leadership

well as second runner-up for Generation Rx.

Chen and her colleagues compared 30-day readmission ratios for hospitals in the Delta region, the remaining counties of the eight Delta

positions in the association.

risk of stroke.

Operation Immunization is an immunization

Nicki Hilliard, PharmD, a professor in the col-

education campaign that works to raise the num-

lege, became the first Arkansan to serve as APhA

ber of adults receiving immunizations. OTC Med-

When not controlling for hospital and com-

president. She will serve for the 2018–2019 term.

icine Safety is a campaign of APhA-ASP Chap-

munity factors, they found the Delta region and

The students garnered their wins during the

ters to educate fifth and sixth-graders in reading

states, and the rest of the nation.



medicine directions, following those directions,

continue exclusively breastfeeding for the rec-

and substance abuse diagnoses receiving ther-

proper measuring of medicine, safe storage and

ommended six month timeframe.

apy and regular doctor checkups were less likely

disposal of medicine, and consulting with par-

Individuals or organizations interested in learn-

to die, but only if they were not prescribed opi-

ents or guardians before taking medications.

ing how they can support breastfeeding can

oids or benzodiazepines. Another study showed

Generation Rx is another APhA-ASP national

learn more by visiting the Arkansas Breastfeed-

that veterans from Iraq and Afghanistan were

educational program. Its goal is to increase pub-

ing Coalition at www.arbfc.org. The Expressly for

prescribed opioids at rates similar to the rest of

lic awareness of prescription medication abuse

You breastfeeding helpline (501) 202-7378 is also

the U.S. population, indicating that overprescrib-

and to enhance cooperation between healthcare

available 24 hours, seven days a week to mothers

ing is a nationwide issue not specific to veterans.

providers, teens, parents, and communities to

who have questions or need advice. The Arkansas

Three related studies are looking at methods to

prevent such abuse.

Breastfeeding Helpline (1-844-344-0408) is also

decrease opioid use and improve pain manage-

Elected to APhA leadership positions are Lanita

available 24/7. Additional information, includ-

ment among veterans with chronic pain.

White, PharmD, faculty – APhA-APPM Precep-

ing lactation room design plans and community

Peter Crooks, PhD, is working to develop safer

tor SIG Coordinator; Rachel Stafford, PharmD,

breastfeeding resources, can be found at healthy-

opioid molecules that work better for pain than

faculty – APhA-APPM Medication Management

active.org.

existing drugs, with fewer side effects and less

SIG Coordinator; and Denise Clayton, BSPharm, alumnus – APhA-APPM Executive Committee Member-at-Large.

potential for addiction. Within the Women’s Men-

UAMS Fights Opioid Epidemic on All Fronts

tal Health Program, Jessica L. Coker, MD, is studying opioid addiction in pregnant women. Lisa

Nominated for leadership positions are Brandi

The University of Arkansas for Medical Sci-

Brents, PhD, is developing new therapies for opi-

Hamilton, PharmD, alumnus – candidate for

ences (UAMS) is attacking the nationwide opi-

oid addiction during pregnancy that reduce fetal

APhA trustee; and Stephanie White, PharmD,

oid epidemic on multiple fronts that have pro-

exposure to opioids. William Fantegrossi, PhD, is

pharmacy resident – candidate for APhA-APPM

duced new research and treatment options for

studying new types of opioids and whether they

new practitioner officer.

patients and healthcare providers across Arkan-

are more addictive than older types or require

sas and beyond.

more aggressive treatments for dependence and

Healthy Active Arkansas, RiverFest Partner to Support Breastfeeding Moms

There were 116 deaths per day from opioid-

overdose. Benjamin Teeter, PhD, is studying ways

related drug overdoses in the United States in

to more effectively distribute naloxone, which is

2016, according to the U.S Department of Health

used to treat opioid overdoses in emergency sit-

Healthy Active Arkansas (HAA) and the organiz-

and Human Services. Arkansas ranks second in

uations, in the community. Bradley Martin is also

ers of RiverFest partnered to offer a breastfeed-

the nation for its opioid prescribing rate with an

about to initiate a study to see if physical ther-

ing nook for breastfeeding moms as part of 2018

average of 114.6 prescriptions per 100 people,

apy can interrupt long-term opioid use among

RiverFest. They provided a comfortable, private

according to U.S. Centers for Disease Control and

patients with low back pain.

space for mothers who needed to breastfeed

Prevention data from 2014–2016.

The Psychiatric Research Institute’s Center for

their children or pump while visiting the event.

Research to improve understanding of opioid

Addiction Research has many ongoing studies

This is the first time a designated breastfeeding

addiction and its treatment is ongoing in depart-

related to improving opioid detoxification treat-

space has been offered as part of RiverFest.

ments across campus, and some of it is having

ments by testing different methods and drugs, or

national impact.

combinations of the two.

Staff from the University of Arkansas for Medical Sciences and the Arkansas Department of Health

For example, the Centers for Disease Con-

In addition to performing the kind of research

were at the breastfeeding nook, and available to

trol Prevention Morbidity and Mortality Weekly

that could change physician behavior nationwide,

answer questions about breastfeeding. The nook

Report published a study in 2017 led by UAMS

UAMS clinicians are turning a critical eye to their

was housed within a tent provided by the Arkan-

pharmacy professor Bradley Martin, PharmD,

own behavior in the name of improvement.

sas Coalition for Obesity Prevention—a partner

PhD, that showed that by prescribing patients

UAMS is the state’s largest public employer,

of HAA—in the Ford Family Fun Zone.

opioid supplies of three days or less, providers

with a hospital, five colleges, seven institutes,

can reduce the likelihood of the patient using opi-

a Northwest Arkansas campus, a network of

oids chronically one to three years later.

regional centers statewide and physician place-

Breastfeeding has been linked to fewer incidences of ear and upper respiratory infections in infants, sudden infant death syndrome, and obe-

The UAMS Psychiatric Research Institute’s

ment partnerships with Arkansas Children’s Hos-

sity over the lifespan. In addition, breastfeeding

Division of Health Services Research, directed

pital, the VA Medical Center, and Baptist Health.

benefits mothers by reducing their risk of breast,

by Teresa Hudson, PharmD, PhD, is conducting

With such a wide reach, changes to the institu-

uterine, and ovarian cancer, and aids in losing

a variety of studies related to opioid addiction,

tion’s internal processes can have a huge impact.

weight gained during pregnancy. Mothers who

including opioid addiction among people with

receive support to breastfeed through their fam-

mental health diagnoses and among veterans.

ily, employer, or community are more likely to

One study found that people with mental health

For example, colorectal surgeons in the UAMS College of Medicine Department of Surgery set out to change the way its physicians


Healthcare Briefs helped their patients manage pain, limiting opi-

doctor-patient discussions about pain manage-

discussing the opioid crisis, educating on phar-

oid use as part of a comprehensive Enhanced

ment and expectations before and after surgery.

macists’ role with administering naloxone and

Recovery Protocol. The process began with a year

There has been interest from outside groups to

of internal education about the new approach

adopt the protocols developed by the Orthopae-

In the College of Medicine, James Graham,

and the evidence to back it up, followed by an

dics Department and the accompanying patient

MD, associate dean for undergraduate medical

official kickoff in 2015.

information materials.

education, tracks the overall curriculum to ensure

emphasizing non-opioid pain management.

The latest data show that over a two-year

The emergency department, with the help of

that medical students learn about all of the neces-

period, narcotic use decreased 40 percent.

the Pharmacy & Therapeutics Service Line, con-

sary topics, including opioids. In response to the

Patients who are not prescribed narcotics are

ducted a similar review of the amount of opi-

crisis, the college’s leaders have made changes to

well enough for discharge an average of 1.5 days

oids being prescribed to patients when they are

how the information about opioids is presented

sooner. Complications resulting in readmission

discharged from the emergency department. It

to emphasize the dangers of its abuse and poten-

are also down among those patients.

found the averages were within an appropriate

tial for overdose.

“When we looked at the data, we saved about

range, but recommended improvements in the

“One of the issues that led to the opioid crisis

$2 million over two years just in length of stay

electronic prescribing processs, and better writ-

was a lack of education among doctors about the

alone, and if we accounted for other factors, like

ten guidelines for opioid prescribing.

dangers of opioids and the nature of addiction in

the reduction in complications and readmissions,

They revised prescribing protocols and updated

general,” Graham said. “We’re making sure that

we’re probably saving more,” said Jonathan A.

the automatic defaults of opioid orders within

the next generation of doctors doesn’t have those

Laryea, MD, colorectal surgeon and associate

the electronic health record. In addition, they

same gaps in their knowledge.”

professor of surgery. “More importantly, what’s

are seeking ways to make it easier for prescrib-

Direct clinical care related to opioid abuse is

behind those numbers is that our patients are

ers to see potential alternatives to opioids, such

another vital part of the effort. The Emergency

doing better and getting better sooner. We’ve

as nonsteroidal anti-inflammatory medications,

Department and UAMS Medical Center treat opi-

known for some time in the literature that nar-

acetaminophen, hot/cold treatments, and phys-

oid overdose patients. The Psychiatric Research

cotics impede recovery and increase complica-

ical therapy.

Institute’s Center for Addiction Services and Treat-

Moving beyond the walls of UAMS, educa-

ment treats opioid addiction through medication

tion and outreach are elements of achieving the

and group therapy. It has one program specifi-

Meanwhile, the Department of Orthopaedic

institution’s mission of improving the health of

cally for female patients. The institute’s Women’s

Surgery conducted a similar internal review and

all Arkansans. Professionals from across the state

Mental Health Program treats opioid addiction in

developed its own opioid prescription guide-

had access to the latest information at the Arkan-

pregnant and postpartum women

lines. Simon Mears, MD, orthopaedic surgeon

sas Pain Management Symposium at UAMS in

and professor of orthopaedic surgery, helped

April.

tions, but now we have our own institutional data to show that’s true.”

lead that effort. In a little more than a year, their

Educating the next generation of caregivers is

narcotic prescriptions have decreased by a third.

critical. UAMS has 2,834 students, 822 medical

Both Laryea and Mears said it’s common for

residents, and six dental residents.

UAMS Program to Expand in Five Arkansas Counties to Improve Doctor-Patient Communication Organizations in five Arkansas counties are

patients to come to them for surgery already

In the College of Pharmacy, faculty members

invited to participate in programs offered free of

on high doses of opioids prescribed to them by

are bringing their direct clinical experience with

charge by the University of Arkansas for Medical

other doctors.

the crisis to bear as they educate future pharma-

Sciences (UAMS) designed to improve doctor-

“So we are working on it from both ends,”

cists. Victoria Seaton, PharmD, works in veteran

patient communication.

Mears said. “In orthopaedics, it’s been incredibly

mental health at an inpatient psychiatric unit in

The How to Talk to Your Child’s Doctor program

common in the past for people to be prescribed

Fayetteville, where she also brings students for

will be provided to clinics, hospitals, schools, and

narcotics for things like osteoarthritis, when in fact

firsthand experience. The most common diag-

other interested community organizations in Cle-

they don’t help. There has also been evidence

nosis is addiction combined with chronic pain.

burne, Conway, Faulkner, White, and Van Buren

to show that if people are on narcotics before

In the classroom, the College of Pharmacy’s cur-

counties, thanks to a donation of $60,122 from

surgery, they actually do worse with something

riculum has included a section on chemical addic-

BHP, an Australia-based global resources com-

like a knee replacement. So, communicating with

tion for more than 30 years.

pany with shale operations in Arkansas.

patients about that has become a big part of our effort.”

“This is not a typical course required by other

Offered by the UAMS Center for Health Liter-

colleges, but our leadership recognized the

acy, the How to Talk to Your Child’s Doctor pro-

With that issue in mind, the orthopaedics

importance of educating future pharmacists on

gram was developed to help parents better pre-

team enlisted the help of UAMS’ Center for

the problems arising from addictive diseases,

pare for visits with their children’s primary care

Health Literacy, which produced clear and easy

including alcohol and drug abuse,” Seaton said.

doctors. A companion program for adult patients,

to read materials about opioids to help with

This year, they dedicated extra hours on

How to Talk to Your Doctor, is being implemented


Healthcare Briefs


in these communities now, and resources remain

during the coming summer months, the Arkan-

Arkansans should protect themselves from these

available at no charge, thanks to the BHP dona-

sas Department of Health (ADH) is stressing the

diseases by preventing tick and mosquito bites.

tion. This content can be delivered by UAMS or

importance of taking precautions against ticks

Tick and mosquito bites can be prevented in sim-

by lay persons at organizations such as churches,

and mosquitoes and the diseases they can carry.

ilar ways:

schools, hospitals, and clinics. Organizations

Arkansas has some of the highest rates in the

interested in participating in either program

nation for tick-borne diseases, such as Rocky

may contact Alison Caballero at (501) 686-5463

Mountain Spotted Fever (RMSF), Ehrlichiosis, and

• Use permethrin on clothing, as directed.

or [email protected].

• Use an EPA-approved insect repellant as directed.

Tularemia. Anaplasmosis, Lyme disease, Heart-

• Wear long sleeves and pants. Light-colored

After engaging in the original How to Talk

land virus, and other diseases may also be car-

clothing makes it easier to spot ticks. Tuck pants

to Your Doctor program, patients reported

ried by ticks. Mosquitoes in Arkansas can carry

improved confidence in communicating with their

West Nile Virus and other less common diseases.

• Check for ticks on yourself, your children, and

doctor and understanding their doctor’s instruc-

Arkansans traveling within or outside of the coun-

your pets regularly. Remove ticks quickly and

tions. Benefits also may include increased patient

try should educate themselves on the specific

satisfaction and engagement, such as improved

concerns ticks or mosquitoes may pose on their

adherence to preventive care, follow-up visits,

trip. Mosquito-borne diseases, such as Zika, Den-

and immunization schedules.

gue, malaria, and yellow fever, are more common

ADH: Take Precautions During Tick, Mosquito Season As Arkansans plan to enjoy the outdoors

outside of the United States.

into socks or boots.

correctly if they are found. • To avoid ticks, walk in the middle of a hiking trail or path; avoid tall grass and leaf litter. • To reduce mosquitoes around the home, get rid of any standing water on the property. Mosqui-

Some of these diseases can be fatal; some

toes can breed in as little as a bottle cap full of

of them can also be difficult to diagnose and

water.

treat. Whether in their own backyard or on a trip,

If found, it is important to remove ticks correctly.


Healthcare Briefs


Remove ticks with tweezers. Position the twee-

of cancer research will enable us to expand

Wilkerson of Little Rock were newly elected to

zers as close to the skin as possible and lift up

our efforts at understanding the causes of and

the AFMC’s Board of Directors at its May annual

on the tick firmly. Do not twist or jerk the tick or

improving the treatments for women with triple

membership meeting. Both physicians will serve

use home remedies such as petroleum jelly, heat,

negative breast cancer and will move us closer

a two-year term.

or waiting for the tick to fall off. These methods

to achieving National Cancer Institute (NCI) des-

Sneed, a board-certified pediatrician with The

can increase the chance that a tick may transmit

ignation,” said Cancer Institute Director Peter

Children’s Clinic in Jonesboro, earned her medi-

a disease.

Emanuel, MD. Emanuel also serves as a profes-

cal degree in 1989 from the University of Tennes-

sor in the UAMS College of Medicine Division of

see Center for the Health Sciences in Memphis.

Hematology.

She completed her pediatric residency at Lebon-

If you or your child does get a tick bite, be on the lookout for symptoms such as fever, chills, rash, fatigue, and aches and pains within the next

NCI-designated cancer centers are recognized

few weeks following the bite. If symptoms occur,

for their scientific leadership, resources, and

it is important to see a medical provider quickly.

research in basic, clinic, and population science.

Sneed has also served as chief of staff at St.

Learn more about insect-related diseases

There are 69 designated cancer centers in the

Bernard’s Regional Medical Center in Jonesboro

United States, and the UAMS Winthrop P. Rock-

from 2015-17 and has been practicing pediatrics

efeller Cancer Institute is in the process of pursu-

full time since 1994.

at www.healthy.arkansas.gov.

$1 Million Estate Gift to Benefit Breast Cancer Research at UAMS Cancer Institute

ing this nationally recognized status.

heur Children’s Hospital in Memphis in 1992 and was chief resident from 1992-93 at Lebonheur.

A “champion of the patient-centered medi-

In triple negative breast cancer, the cancer cells

cal home (PCMH) model,” Sneed said, “I under-

do not contain the hormones estrogen and pro-

stand that the present cost of medical care is not

A $1 million gift from the estate of Linda Gar-

gesterone or the protein HER2. Therefore, the

sustainable at its current rate of growth. I totally

ner Riggs to the Winthrop P. Rockefeller Cancer

most common hormonal therapies for breast can-

acknowledge the need to practice evidence-

Institute at the University of Arkansas for Medical

cer are not effective for women with this form of

based medicine to get the best outcome in the

Sciences (UAMS) will be used to advance research

the disease, which is often aggressive and likely to

most cost-effective manner.”

of triple negative breast cancer. Riggs, who died

spread or return after the initial diagnosis.

Sneed has served the community on sev-

in November 2017, was a former Arkansas insur-

Triple negative breast cancer is diagnosed in up

eral boards of directors including the Arkansas

ance commissioner and managing director at Ste-

to 20 percent of cases, and is more likely to occur

Board of Health, Court Appointed Special Advo-

phens Inc.

in younger people, African-Americans, Hispanics,

cates, and the State Volunteer Mutual Insurance

and those with the BRCA1 gene mutation.

Company.

“This gift will have long-lasting effects on UAMS’ ability to help women living with breast

In appreciation of her gift, Riggs will be honored

Wilkerson is a board-certified anesthesiologist

cancer. We are grateful to Mrs. Riggs for this

as a member of the 1879 Society of UAMS, which

and has practiced for more than 30 years in both

transforming gift, which provides vital funds for

recognizes all individuals who have made estate

private practice and university teaching. He has

our ongoing initiative for cancer research,” said

gifts to the university.

been a professor in the Department of Obstetrics

UAMS Interim Chancellor Stephanie Gardner, PharmD, EdD. A native of Fordyce, Riggs worked about 10

New Officers Elected to AFMC’s Board of Directors

and Gynecology and the Department of Anesthesiology at UAMS since 2012. From 2003 until 2014, he served as medical director for OB anes-

years in state government, serving as director of

The Arkansas Foundation for Medical Care’s

the research and committee staff of the Arkansas

(AFMC) Board of Directors recently elected new

thesiology at UAMS. He earned his medical degree in 1983 from

Legislature; legislative and budgetary director for

officers to lead the board for the next year, as well

UAMS and completed his anesthesiology resi-

Gov. Frank White; and insurance commissioner.

as two new board members. AFMC is a health

dency there in 1986. He relocated to Rogers and

She later joined Stephens Inc., where she worked

improvement organization that has served Arkan-

practiced anesthesiology for 14 years at St. Mary’s

for 25 years in corporate finance, and as manag-

sas physicians and the healthcare community for

Rogers Memorial Hospital.

ing director of investment banking.

more than 45 years.

In 2000, he returned to UAMS. He is currently a

“Linda lived an exemplary life, and I was so priv-

Stacy C. Zimmerman, MD, a practicing physi-

professor in the Department of Anesthesiology

ileged to know her and be her partner in it. She

cian in Searcy, will lead the 15-member board as

and holds a secondary appointment in the UAMS

was a wonderful example and role model to any-

its new chair. Other newly elected members of

Department of Obstetrics and Gynecology. He

one who wanted to become a better person,”

the AFMC Board’s Executive Committee include

has served as medical director of the Division of

said her husband, Lamar Riggs of Little Rock.

Vice Chair Harvey Potts, MD, MPH, of Fort Smith;

Obstetric Anesthesiology, working with high-risk

“We are honored and humbled that Mrs. Riggs

Treasurer Jennifer Styron of Little Rock; Secretary

cases. Wilkerson also served on the anesthesiol-

designated the UAMS Cancer Institute as a recip-

Alan Wilson, MD, of Crossett; and Member-at-

ogist staff of the John L. McClellan VA Hospital

ient for this generous gift from her estate. Her

Large LaDell Douglas, MD, of Hope.

in Little Rock.

foresight and dedication to the importance

Dr. Jane Sneed of Jonesboro and Dr. Danny


Wilkerson said he wants to “provide quality


healthcare for fewer dollars spent through cost

to the families served by Roller Funeral Homes

Treatment (AR-IMPACT) was announced at a news

sharing, such as electronic medical records and

and UAMS.

conference at the state Capitol with Gov. Asa

Health Information Management systems.”

“It has always been our calling to serve fami-

Hutchinson, Arkansas Blue Cross and Blue Shield,

He has served the medical community as a

lies with all our respect during one of the sad-

Arkansas Drug Director Kirk Lane, and partnering

member and president of the boards of both the

dest days of their lives,” said Byler. “Our wonder-

agencies. Those agencies include the Arkansas

Arkansas Medical Society and the Arkansas Soci-

ful friends at UAMS often serve these very same

Medical Society, the Arkansas Academy of Fam-

ety of Anesthesiologists; board president of both

families. That is why this partnership is so spe-

ily Physicians, the Arkansas State Medical Board,

the Benton and Pulaski County Medical Societ-

cial. Two separate work families coming together

the Arkansas Department of Human Services, and

ies; and Arkansas Director of the American Soci-

with the same heart to give back. We hope that

the Arkansas Department of Health.

ety of Anesthesiologists Board. He was named

this memorial will serve as a place of peace and

Funding for UAMS AR-IMPACT’s first year has

one of the Best Doctors in America every year

remembrance for our most precious little ones

been provided by $104,125 from Arkansas Blue

from 2009-2015.

and their families.”

Cross and Blue Shield and $49,000 from the office

Wilkerson has also volunteered on medical

The bereavement program provides person-

mission trips to Honduras, has participated in an

alized care through family-centered support for

“We are thankful to Arkansas Blue Cross and

emergency assistance course for the Red Cross,

those who have experienced pregnancy or infant

Blue Shield for their partnership as we work to

and has served on the Anesthesia Tech Advisory

loss. It provides the families with everlasting keep-

improve pain management in Arkansas,” said

Board of Pulaski Technical College.

sakes as a remembrance of their baby, as well

UAMS Interim Chancellor Stephanie Gardner,

as education and ongoing support to help each

PharmD, EdD. “As the state’s only health sci-

family member as they journey through the griev-

ences university, UAMS is uniquely positioned to

ing process.

address this issue head on for the betterment of

UAMS, Roller Funeral Homes Dedicate Memorial to Pregnancy and Infant Loss In memory of pregnancy and infant loss, the University of Arkansas for Medical Sciences

of the state drug director.

all Arkansans.”

Science Café Focuses on CSI & Evidence Collection

“Arkansas Blue Cross recognizes that the opioid epidemic threatens the health of the peo-

(UAMS) Love Lives Program and Roller Funeral

Science Café Little Rock, co-sponsored by

ple of Arkansas in many ways,” said Curtis Bar-

Homes dedicated the Love Lives Memorial

the University of Arkansas for Medical Sciences

nett, Arkansas Blue Cross president and CEO.

at Riverwood Memorial Gardens Cemetery in

(UAMS), held a public forum entitled CSI & Evi-

“For those in chronic pain and for those treating

Maumelle.

dence Collection. Panelists discussed crime

them, it’s not an easy resolution. We already have

Love Lives, the UAMS perinatal bereavement

scene best practices, types of evidence, col-

been working with healthcare providers to help

program, worked with Roller Funeral Homes to

lection methods, and how society defines and

get a better understanding of opioid prescribing

establish the memorial garden as a final resting

responds to crime.

patterns in Arkansas and we believe the new AR-

place for some. For others, it may be a conse-

The panel included Bob Lytle, PhD, assistant

IMPACT education program with UAMS will help

crated place of quiet reflection where families and

professor, department of criminal justice, Uni-

doctors learn about resources and alternatives

loved ones may come to feel close to their pre-

versity of Arkansas at Little Rock; Payton Tucker,

to managing pain. It will take everyone working

cious little ones whom they will always remember.

agent, Federal Bureau of Investigation, Little

together to truly impact this crisis.”

Neonatologist Sara Peeples, MD, an assistant

Rock; and Meagan Buchert, Crime Scene Search

professor in the department of pediatrics in the

Unit, Little Rock Police Department.

Arkansas ranks second in the nation for its opioid prescribing rate with an average of 114.6

UAMS College of Medicine, said establishing the

Dorothy Graves, associate director for adminis-

prescriptions per 100 people, according to U.S.

memorial garden recognizes that these losses

tration of the UAMS Winthrop P. Rockefeller Can-

Centers for Disease Control and Prevention data

have a profound and lasting impact on families.

cer Institute, moderated the event.

from 2014–2016.There were 116 deaths per day

“We would like to thank Roller and all of our community partners for supporting these families affected by perinatal loss,” said Peeples. “It is our hope that this becomes a place of comfort and healing for those who have been touched by

from opioid-related drug overdoses in the United

UAMS Launches Free Video Conference Service About Opioids for Arkansas HealthCare Providers

States in 2016, according to the U.S Department of Health and Human Services. UAMS AR-IMPACT is a live streaming online video conferencing service staffed by a multidis-

unspeakable and immeasurable loss. Together we

The University of Arkansas for Medical Sciences

ciplinary team from UAMS, including a pain physi-

can inspire hope as we bring awareness to the

(UAMS) has launched a free weekly education and

cian, an addiction psychiatrist, a psychologist, two

issues surrounding perinatal loss and the need

consultation service for Arkansas healthcare pro-

pharmacists, and a physical therapist. For more

for ongoing community support.”

viders to better manage chronic pain patients and

information, go to arimpact.uams.edu.

Ranata Jenkins Byler, third-generation owner of Roller Funeral Homes, said the memorial is a gift

those who need their opioid dosage reduced. Arkansas Improving Multidisciplinary Pain Care

“Prescribers are experiencing greater scrutiny than ever before,” said G. Richard Smith, MD, a


Healthcare Briefs professor in the department of psychiatry in the

state epidemiologist. “There are numerous Hep

UAMS College of Medicine who is spearhead-

A outbreaks occurring across the country. We

The new Arkansas numbers are based on infor-

ing the project. “However, they won’t be able to

are encouraging everyone in the county and sur-

mation collected from health and special edu-

reduce their patients’ dependency overnight. In

rounding areas to be aware of the risk factors for

cation records of almost 40,000 eight year old

fact, stopping cold is dangerous. What these doc-

getting Hep A.”

children living in Arkansas in 2014. They are the

Arkansas for Medical Sciences (UAMS).

tors need is access to the whole toolkit of what

Hep A is usually spread when a person ingests

first numbers statewide since a 2010 count and

is available so they can best serve their patients.

tiny amounts of fecal matter from contact with

are part of national data released by the Cen-

We hope to help with that.”

objects, food, or drinks contaminated by the

ters for Disease Control and Prevention that was

Each weekly conference will include a 20-min-

feces, or stool, of an infected person. Hep A can

gathered from the national ADDM network. The

ute presentation on an opioid-related topic and

also be spread through unprotected sex or the

2010 count estimated that one in 65 Arkansas chil-

a question-and-answer session. Participants are

sharing of injection drugs.

dren were identified with autism. The current esti-

encouraged to present patient cases for individ-

Typical symptoms of Hep A include fever,

mate still could be as high as 1 in 64 (1.6 percent),

ualized feedback about approaches to treatment.

fatigue, loss of appetite, nausea, vomiting,

accounting for records that were not located for

Physicians, physician assistants, nurse practitio-

abdominal pain, dark urine, clay-colored bowel

review.

ners, pharmacists, and other healthcare providers

movements, joint pain, or jaundice (yellowing of

The Arkansas monitoring program includes

are welcome to use the service and will be able to

the skin or eyes). Hep A can range in severity from

investigators with UAMS and operates in collab-

earn continuing medical education credits.

a mild illness lasting a few weeks to a severe ill-

oration with the Arkansas Department of Health

Topics will include how to taper off opioids,

ness lasting several months. A person can trans-

and the Arkansas Department of Education to

alternatives to opioids for pain management,

mit the virus to others up to two weeks before

track the number and characteristics of eight-

when physical therapy is appropriate, when to

and one week after symptoms appear.

year-olds with ASD and/or intellectual disability.

recommend a nerve block or an epidural, and

The virus can cause illness anytime from two

The AR ADDM data found that boys are 3.8

more. Smith said participant interest will guide

to seven weeks after exposure. If infected, most

times more likely to be identified with autism

future topic choices.

people will develop symptoms three to four

than girls. Also, white children are significantly

weeks after exposure. Many people, especially

more likely to be identified with ASD than black

children, may have no symptoms. The older a per-

or Hispanic children. In Arkansas, autism was 30

son is when they get Hep A, typically the more

percent more likely to be identified in white chil-

severe their symptoms are. Up to one in three

dren than in black children and 70 percent more

adults are typically hospitalized. Almost all peo-

likely to be identified in white children than in

The Arkansas Department of Health (ADH)

ple who get Hep A recover completely and do

Hispanic children. Of children identified as ASD

warned of a possible Hepatitis A (Hep A) expo-

not have any lasting liver damage, although they

cases based on record review, about 92 percent

sure after an employee of the Doublebee’s gas

may feel sick for months.

had developmental concerns by age three, but

Health Department Warns of Possible Hepatitis A Exposure to Customers of Walnut Ridge, Arkansas Doublebee’s

station in Walnut Ridge, Arkansas, located at 1003

Hepatitis A is preventable through vaccination.

Hwy 63, tested positive for the virus. Hep A is a

A Hepatitis A vaccine has been recommended for

contagious liver disease.

school children for many years, and one dose of

“As in the overall ADDM Network, Arkansas has

Anyone who ate at this facility between April

Hep A vaccine is required for entry into kinder-

a lag between first concern about a child’s devel-

7 and April 18, 2018 should seek care immedi-

garten and first grade as of 2014. Most adults are

opment and an autism diagnosis,” said Maya

ately if they have never been vaccinated against

likely not vaccinated, but may have been if they

Lopez, MD, associate professor in the UAMS Col-

Hep A, or are unsure of their vaccination status.

received vaccinations prior to traveling interna-

lege of Medicine’s Department of Pediatrics. “We

There are no specific treatments once a person

tionally. Contact the LHU in your county for more

should use this information to promote develop-

gets Hep A; however, illness can be prevented

information about vaccination. A listing of LHUs

mental screening in health and educational pro-

even after exposure by getting the vaccine or a

can be found at www.healthy.arkansas.gov.

viders statewide and to connect these children

medicine called immune globulin. This medicine contains antibodies to Hep A and works best if given within two weeks of exposure to the virus. So far this year, 13 cases of Hep A have been

CDC, UAMS Report: One in 77 Arkansas Children Has Autism Spectrum Disorder

only 31 percent had received a comprehensive developmental evaluation by age three.

with appropriate services.” UAMS’ Dennis Developmental Center and Schmieding Developmental Center, both in the College of Medicine Department of Pediatrics,

reported in this outbreak. Five of the cases have

An estimated one in 77 Arkansas children are

offer diagnostic multidisciplinary team evalua-

involved food service workers. All 13 of the cur-

identified as having Autism Spectrum Disorder

tions for children with developmental and behav-

rent cases have been in adults.

(ASD), according to a new report by the Arkan-

ioral concerns from birth to 21 years of age.

“The number of cases in this Hep A outbreak

sas Autism and Developmental Disabilities Mon-

The Arkansas monitoring program’s findings

are continuing to rise,” said Dr. Dirk Haselow,

itoring (AR ADDM) Program of the University of

also can be used to inform educational outreach



initiatives, specifically those targeting minority

will receive health education and screenings for

and underserved populations to promote early

untreated chronic conditions including obesity,

“At St. Bernards, we began the Internal Medi-

identification, plan for services and training, guide

diabetes, and anxiety/depression, as well as refer-

cine residency program to meet a very important

future ASD research, and inform policies promot-

rals to regional physicians for follow-up care.

need in this area—to equip clinically trained phy-

ing improved health outcomes for individuals with

Program.

“The Delta Care-a-van program will allow us to

sicians to provide care to the patients who need it

remove several of the obstacles to health care

the most,” said Chris Barber, president and CEO

AR ADDM provides individualized presenta-

that have prevented local residents from receiving

of St. Bernards Healthcare. “We are happy to

tions on the number and characteristics of chil-

the health services and education they deserve

partner with NYIT College of Osteopathic Medi-

dren with ASD to state and community agen-

and need,” said Shane Speights, DO, native

cine, Arkansas State University, and UAMS on this

cies. The Arkansas monitoring program also

Arkansan and site dean, NYITCOM at A-State.

Delta Care-a-van program so our internal medi-

co-sponsors educational events for families and

“At the same time, this service will provide valu-

cine residents can continue the St. Bernards mis-

educators, such as the Team Up state conference

able clinical training to an army of future physi-

sion of providing Christ-like healing.”

on autism, and collaborates on developmental

cians and health care professionals, and will also

The mobile clinic is expected to begin visiting

disabilities awareness events such as Arkansas

expose them to the joys, opportunities, and chal-

the Arkansas cities of Harrisburg, Leachville, Lep-

Walk Now for Autism Speaks.

lenges of rural practice.”

anto, Manila, Piggott, Walnut Ridge, and Marked

the disorder.

“Our college is excited to be involved in this

Tree in late summer 2018, with plans to expand

interprofessional education and service delivery

services to other areas of the Delta region. The

project that will impact many of the smaller towns

Delta Care-a-van will see patients in the seven

in our region. The health of our communities is so

communities, conducting an expected 78 mobile

New York Institute of Technology College of

important to our economic future,” said Dr. Susan

clinic encounters over the course of approxi-

Osteopathic Medicine at Arkansas State Univer-

Hanrahan, PhD, dean, Arkansas State University

mately 18 months, and will offer evening hour

sity (NYITCOM at A-State) has received a total

College of Nursing and Health Professions. “I

services.

award of $828,748 from the United States Depart-

think we can make a difference.”

NYITCOM at A-State Secures USDA Funding for Mobile Medical Clinic

From these visits, NYITCOM at A-State will col-

ment of Agriculture (USDA) for a mobile medical

Equipped with two examination rooms and

lect data regarding diabetes, obesity, immuniza-

clinic aimed at delivering healthcare to under-

state-of-the-art telemedicine technology (tele-

tion and vaccination, prenatal care, mental health,

served and rural populations in Arkansas and the

communication and information technology that

and other health topics to measure performance

Delta region.

enables clinical healthcare from a distance), the

levels and determine strategies for improving

Healthcare outcomes in the Mississippi

mobile clinic will offer a training program for

patient outcomes.

Delta region are among the worst in the nation,

medical students from NYITCOM at A-State,

creating a high demand for clinically trained rural

resident physicians from UAMS and St. Ber-

physicians and health professionals. In an effort to

nards Medical Center, and Arkansas State Uni-

break down barriers to health care, NYITCOM at

versity nursing and social work students. Under

A-State, in collaboration with Arkansas State Uni-

the guidance of NYITCOM at A-State faculty

versity (A-State) College of Nursing and Health

and trained medical experts, these students

Professions, University of Arkansas for Medical

will conduct screenings and wellness examina-

A University of Arkansas for Medical Sciences

Sciences (UAMS) Northeast Family Medicine Res-

tions to monitor blood pressure, blood glucose,

(UAMS) professor of neurobiology recently co-

idency Program, and St. Bernards Medical Cen-

and signs of mental health conditions. Patients

authored a Kentucky Law Review article that

ter Internal Medicine Residency Program, will

requiring additional treatment will be connected

offers insights into the nature of criminal intent,

develop a mobile medical clinic, known as the

to local providers or receive telemedicine con-

and urges the court system to admit more expert

Delta Care-a-van.

sultation while on board the mobile clinic, build-

testimony into trials regarding the subject.

For more information about NYITCOM at A-State, visit https://www.nyit.edu/arkansas.

UAMS Professor Offers Insights into Criminal Intent, CoAuthors Law Review Article

This mobile clinic will initially travel to the

ing upon NYITCOM at A-State’s legacy of being

In “Actus Reus, Mens Rea, and Brain Science:

heart of seven northeast Arkansas rural commu-

among the first United States medical schools to

What Do Volition and Intent Really Mean?,” Edgar

nities to deliver preventative care services and

train first-year medical students to deliver care

Garcia-Rill, PhD, and the late Erica Beecher-

health education without cost or need for an

via telemedicine.

Monas, JD, give the example of someone walk-

appointment. Funded by the USDA Delta Health-

“UAMS Northeast Family Medicine Residency

ing along a sidewalk while in conversation, yet

care Service Grant—with $828,748 awarded

is very excited to be a part of this innovative proj-

being preconscious of traffic and other pedestri-

in federal shares and $228,604 provided in

ect that will help bring vital preventative care ser-

ans, allowing for safe navigation.

kind—this service will expand care to

vices to Arkansans who live in the Delta,” said

The co-authors conclude that, “we are con-

patients who might otherwise be unable to see

Scott Dickson, MD, assistant professor and direc-

scious while performing the movement, and that

a physician. Patients visiting the mobile clinic

tor, UAMS Northeast Family Medicine Residency

the activity preceding the intent is a manifestation


Healthcare Briefs of our preconscious awareness. That is, we are

recently held two Hepatitis A (Hep A) vaccina-

weeks after exposure. Many people, especially

preconscious to the performance of our move-

tion clinics.

children, may have no symptoms. Up to one in

These clinics are for anyone at higher risk of

three adults are typically hospitalized. Almost all

getting Hep A. Risk factors include: close contact

people who get Hep A recover completely and

Studies by the late researcher Benjamin Libet

with someone who has Hep A; restaurant work-

do not have any lasting liver damage, although

in the early 1980s suggested that one’s voluntary

ers; people with infections or chronic diseases

they may feel sick for months.

movements begin unconsciously, because brain

like Hep B or C, HIV/AIDS, or diabetes; drug use;

Hepatitis A is preventable through vaccination.

waves are manifested in advance of the subjec-

homelessness; or incarceration. If you do not fall

Hepatitis A vaccine has been recommended for

tive will to move. This led to the suggestion that

into a group with a high risk of getting Hep A, but

school children for many years, and one dose of

there is no free will. Libet surmised that individu-

are still concerned about Hep A, see your doctor

Hep A vaccine is required for entry into kinder-

als still have the ability to stop actions or move-

or healthcare provider.

garten and first grade as of 2014. Most adults are

ments, and therefore responsible for all of our actions. And yes, free will is alive and well.”

ments of which they are not fully conscious. This became known as free won’t. However, Garcia-Rill has been working on the

At these clinics, the shot is provided at no cost

likely not vaccinated, unless they received vacci-

to the patient. ADH bills the patient’s insurance,

nations prior to traveling internationally. Patients

if the patient has it.

can contact the closest county health unit for

brain regions that further preconscious aware-

Since February of 2018, 31 cases of Hep A have

more information about vaccination. A listing of

ness, and such activity is present in a person’s

been reported as part of an outbreak in northeast

county health units can be found at www.healthy.

brain while conscious (not when one is uncon-

Arkansas, with a majority of the cases in Clay and

arkansas.gov.

scious) but the person is just not paying atten-

Greene counties. Cases have also been found in

tion to it, thus the term preconscious awareness.

Lawrence, Randolph, and Craighead counties. All

Garcia-Rill is director of the UAMS Center

of the cases have been in adults.

for Translational Neuroscience, funded by the

“The number of cases in this Hep A outbreak is

National Institute for General Medical Sciences’

continuing to rise,” said Dr. Dirk Haselow, state

IDeA Program.

UAMS, DHS Launch Free Consultation Service for Healthcare Providers Treating Opioid-Addicted Patients

epidemiologist. “There are numerous Hep A

The University of Arkansas for Medical Sciences

Beecher-Monas was a professor of law at Wayne

outbreaks occurring across the country. We are

(UAMS) and the Arkansas Department of Human

State University until her death in the summer of

encouraging everyone in these areas to be aware

Services (DHS) launched a free one-on-one con-

2017.

of the risk factors for getting Hep A and to get

sultation service for healthcare providers treating

vaccinated if needed.”

patients diagnosed with opioid addiction.

Garcia-Rill and Beecher-Monas argue that the legal concepts of criminal act and criminal intent are outmoded.

Handwashing can also prevent the spread of

These providers can call the Medication-

Hep A. If soap and water are not available, clean

Assisted Treatment Recovery Initiative for Arkan-

“The legal meaning of choice, intent, and voli-

hands with hand sanitizer containing at least 80

sas Rural Communities (MATRIARC) hotline for

tion originated not from empirical studies about

percent alcohol. Hep A is a contagious liver dis-

advice on a range of topics—anything from deter-

human brains and behavior, but from ungrounded

ease that results from infection with the Hepa-

mining dosages of addiction treatment medica-

beliefs about human nature,” the authors stated.

titis A virus. It is usually spread when a person

tions like buprenorphine/naloxone (Suboxone),

“The law still operates on outdated, 19th century

ingests tiny amounts of fecal matter from contact

to connecting patients with support services to

assumptions about how human beings function.”

with objects, food, or drinks contaminated by the

handling billing. The providers can also receive a

Refusing to admit expert testimony about men-

feces, or stool, of an infected person. Hep A can

telemedicine consult for advice or a second opin-

tal illness is contributing to the complex prob-

also be spread through unprotected sex or the

ion from a UAMS addiction expert.

lem of mental illness among prison inmates, and

sharing of injection drugs.

To connect with the hotline service, call (833)

failing to protect society when the convicted are

Typical symptoms of Hep A include fever,

released, Garcia-Rill and Beecher-Monas argued.

fatigue, loss of appetite, nausea, vomiting,

“There are few people in the state who are pro-

“Judges should instead admit expert testimony

abdominal pain, dark urine, clay-colored bowel

viding medication-assisted treatment, so many of

so the jury can perform its interpretive and evalu-

movements, joint pain, or jaundice (yellowing of

our patients drive hours for treatment and others

ative functions,” they concluded.

the skin or eyes). It can range in severity from a

never seek treatment because of these barriers

The article and the edition of Kentucky Law

mild illness lasting a few weeks to a severe illness

to care,” said Michael Mancino, MD, a psychia-

Review in which it was published were dedicated

lasting several months. A person can transmit the

trist, director of the Center for Addiction Services

to the family of Beecher-Monas.

virus to others up to two weeks before and one

in the UAMS Psychiatric Research Institute, and

week after symptoms appear.

leader behind MATRIARC.

ADH Holds Hep A Vaccination Clinics in Northeast Arkansas The Arkansas Department of Health (ADH)

872-7404 or (501) 526-8459.

The virus can cause illness anytime from two

“We think helping community providers gain

to seven weeks after exposure. If infected, most

the knowledge and confidence to treat these

people will develop symptoms three to four

patients close to home will be an important step



Helicopter Delivers Ball for First Pitch at Arkansas Travelers for Strike Out Stroke Night A helicopter landed with University of Arkansas for Medical Sciences (UAMS) neurologist and AR SAVES medical director Sanjeeva Reddy Onteddu, MD, to deliver the ball for the first pitch of the Arkansas Travelers’ game against the Springfield Cardinals. During the event, volunteers answered questions about stroke, distributed stroke education materials, and threw brain-shaped stress toys into the stands. Stroke survivors were also honored. The event, held at Dickey-Stephens Park, was sponsored by the UAMS-led AR SAVES (Arkansas Stroke Assistance through Virtual Emergency Support) program and hosted by the Arkansas Travelers.

in addressing the deadly opioid epidemic in

opioid addiction, also called opioid use disorder,

Arkansas.”

with medications like buprenorphine. Treatment

of Family Physicians. Physicians and APRNs also attended a separate

The service was announced at a symposium at

through the UAMS Center for Addiction Services

hands-on session to practice joint injection of the

UAMS about the opioid epidemic’s national and

involves a combination of medication and group

knee and shoulder taught by orthopaedic special-

state impact. The symposium speakers included

and individual therapy.

ists John Bracey, MD, and Michael Cassat, MD.

Mancino; Pedro Delgado, MD, director of the

In Arkansas, there are about 85 doctors certi-

Other topics were migraines, cold turkey smok-

UAMS Psychiatric Research Institute; Cindy Gil-

fied to prescribe buprenorphine, much less than

ing cessation, opioid use in Arkansas, breast can-

lespie, director of the Arkansas Department of

many other states. For example, in Tennessee,

cer screening, and genetic testing for gynecologi-

Human Services; Kirk Lane, state drug director;

there are more than 800.

cal cancer. It featured an Arkansas clinic’s success

John Kirtley, PharmD, executive director of the

“Most of those doctors are centered in large

Arkansas Pharmacy Board; and Laura Monteverdi,

cities; they’re not located in small communities

anchor on THV11’s Morning Show.

where people can drive down the street and go

MATRIARC is made up of two parts—the hot-

see their doctor,” Mancino said. “Our goal is for

line service that is open now and a group video

there to be doctors in every part of the state who

conference service that launches in August.

can offer help to these patients.”

The group conference program will also be free and open to healthcare providers who are treating or who are interested in treating patients addicted to opioids. The group will meet via a

story in team-based care, project management, electronic medical records, and billing.

Public Invited Attend UAMS Community Scientist Academy Arkansans interested in having a voice in

Family Medicine Conference Gives Practical Topics for Practitioners

research programs at the University of Arkansas for Medical Sciences (UAMS), or simply learning how research is done, were invited to participate in UAMS’ Summer 2018 Community Sci-

live online video connection and be able to learn

Family physicians, nurses, pharmacists, and

about treating opioid addiction and present spe-

physical therapists learned updates on marijuana

entist Academy. Sponsored by the UAMS Translational Research

cific cases for advice and consultation.

and medicine, fibromyalgia, sleep apnea, and

Institute, the Community Scientist Academy was

Arkansas ranks second in the nation for its opi-

common orthopedic issues at the 40th Annual

held on Tuesdays each week, May 22 through

oid prescribing rate with an average of 114.6

Family Medicine Intensive Review Course held

June 26, from 5:30–7:30 p.m. on the UAMS cam-

prescriptions per 100 people, according to U.S.

recently at the University of Arkansas for Medical

pus in Little Rock.

Centers for Disease Control and Prevention data

Sciences (UAMS).

The training was offered at no cost to

from 2014–2016.There were 116 deaths per day

With more than 23 hours of content, including

from opioid-related drug overdoses in the United

a full day of orthopaedic topics, the conference

Participants in the Community Scientist Acad-

States in 2016, according to the U.S Department

featured updates on the Medicare Access and

emy interacted with UAMS researchers and com-

of Health and Human Services.

CHIP Reauthorization Act of 2015 by Amy Mullins,

munity members involved in research in small

MD, medical director for the American Academy

roundtable discussions and other interactive

It takes specific training to be able to treat

participants.


Healthcare Briefs sessions. They learned:

an important population health issue, with the

* How researchers decide what health issues to

goal of improving public health outcomes.

study

The team consists of Keneshia Bryant-Moore,

* The research process

PhD, RN, associate professor; and Tiffany Haynes,

* The benefits of individual and community orga-

PhD, assistant professor. Both are with the UAMS

nizations’ involvement in research

Fay W. Boozman College of Public Health. The

Graduates of the Community Scientist Acad-

other members are Joy Rockenbach, faith-

emy became more knowledgeable volunteers

based coordinator at the Arkansas Department

with additional opportunities to help influence

of Health, and Rev. William Givens, minister of

UAMS research decisions on behalf of their communities. Examples include serving on:

Amanda George, CPA, MHSA

* Standing community advisory boards

Bryant-Moore is the team lead for Arkansas FAITH Network.

* One-time community boards created to advise

“This is a great opportunity for academia, pub-

researchers on specific studies * Panels that decide what research grants get

Christian education for St. John Baptist Church.

lic health, and faith/community leaders to not UAMS Medical Center. “Her experience in the

only have training and support from the national

funded

College of Medicine and at the service line level,

program and the CDC, but to really dig deep

For graduates who are leading community

as well as her work at other institutions, provides

and address population health with those most

organizations, there may also be opportunities to

insight into the budgeting process required to

affected by illness due to health disparities,” Bry-

partner with UAMS on community-based research

achieve our financial goals and support a bal-

ant-Moore said.

projects.

anced budget for the institution.”

Arkansas ranks 48th in the nation in overall

“The Community Scientist Academy will pro-

George previously served as service line admin-

health status and in the ability to access health-

vide the basic knowledge to strengthen the pub-

istrator for the Medical Specialties service line

care. Individuals in Arkansas are more likely to

lic’s voice on research steering committees, men-

and as administrator for the Department of Inter-

report engaging in behaviors such as smoking

toring committees, review committees, research

nal Medicine. Before joining UAMS, she served

and lack of physical activity that place them at risk

projects, and in other leadership capacities,” said

as controller for ambulatory services for the East/

for developing chronic health conditions.

Kate Stewart, MD, MPH, who leads the Transla-

Southeast division of Catholic Health Initiatives

The team will address three health issues due

tional Research Institute’s Community Engage-

in Little Rock and assistant controller for St. Vin-

to disparities experienced in racial/ethnic minority

ment program. “We want our fellow Arkansans

cent Health System hospitals in North Little Rock

communities and vulnerable populations includ-

to understand what we do because their input

and Morrilton.

ing mental health, obesity, and diabetes over the

makes a big difference in our efforts to improve health.” UAMS researchers conduct clinical studies and community-based studies. Its clinical studies are conducted in UAMS’ hospital and clinics across the state, including at its main campus in Little Rock, its eight regional campuses, Arkansas Children’s Research Institute, and the Central Arkansas Veterans Healthcare System.

Amanda George Named CFO for UAMS Clinical Programs Amanda George, CPA, MHSA, has been named associate vice chancellor for clinical finance and

She is a certified public accountant and has a bachelor’s degree in accounting and finance from the University of Central Arkansas and a master’s in health services administration from UAMS.

Arkansas FAITH Network Selected for National Public Health Leadership Program The Arkansas Faith-Academic Initiatives for

next several years. Initial projects will focus on mental health. “This program will impart population health teams with the skills to lead across sectors and collaboratively solve complex population health problems in innovative ways,” said Carmen Rita Nevarez, MD, MPH, vice president for external relations and director of the Center for Health Leadership and Practice.

Transforming Health (FAITH) Network has been

The National Leadership Academy for the Pub-

selected to participate in the National Leadership

lic’s Health will provide training and support to

Academy for Public’s Health program, funded by

assist the team in successfully addressing men-

the Centers for Disease Control and Prevention

tal health in Arkansas. Training and support will

(CDC).

focus on two tracks. The first track is the develop-

chief financial officer for the Integrated Clinical

The Arkansas FAITH Network is a collaboration

ment of leadership skills, including personal and

Enterprise at the University of Arkansas for Med-

of the University of Arkansas for Medical Sciences

collaborative leadership in a multi-sector environ-

ical Sciences (UAMS). George has been at UAMS

(UAMS) and faith-based organizations. They work

ment. The second track emphasizes growth from

since 2013.

to deliver health programs and health education

team-based collaborative work to policy and sys-

to faith communities across the state.

tems change.

“Amanda is uniquely qualified to serve in this role,” said Richard H. Turnage, MD, senior vice

The Arkansas FAITH Network team will work on

The National Leadership Academy for the

chancellor for clinical programs and CEO for

an applied health leadership project that tackles

Public’s Health is a national program focused



on improving population health by working with multi-sector leadership teams and training the teams through an applied, team-based collaborative leadership development model. The program is implemented by the Center for Health Leadership and Practice, a center of the Public Health Institute, and will provide training and support for one year.

UAMS Researchers Unlock More Clues to Alzheimer’s University of Arkansas for Medical Sciences (UAMS) researchers led by Sue Griffin, PhD, have found a way to illustrate how a protein known to be a risk factor for Alzheimer’s disease interacts with DNA. Sue Griffin, PhD, is an internationally known Alzheimer’s disease researcher at UAMS. The findings were published in February in Alzheimer’s and Dementia, the Journal of the Alzheimer’s Association.

University of Arkansas for Medical Sciences (UAMS) researchers Sue Griffin, PhD, right, Meenakshisundaram Balasubramaniam, PhD, and Paul Parcon, MD, PhD candidate.

Apolipoprotein E, more commonly known as ApoE, is a protein in the body responsible for carrying cholesterol and other fats through the

autophagy, the process by which cells get rid of

simulate what was happening at the molecular

bloodstream, and is the main protein for supply-

proteins that are no longer needed.

level by using advanced computational tools run-

ing lipids to brain cells. Everyone has two copies

“In Alzheimer’s, it’s pretty clear that autoph-

of the gene for ApoE, one inherited from each

agy has failed,” Griffin said. “Because there’s

“This research is a perfect example of interdis-

parent.

more buildup of tangles inside and plaques out-

ciplinary work,” Balasubramaniam said. “Biol-

side the nerve cells. The waste is just not being

ogy, computational modeling followed by exper-

eliminated.”

imental validation came together to understand

Most people have two copies of ApoE3, considered to be associated with average risk for devel-

ning on high-performance super computers.

molecular mechanism of ApoE4”

opment of Alzheimer’s. But 10–15 percent of the

Parcon and Griffin began looking at what could

population has at least one copy of the gene for

be causing that failure. Griffin said that three

Balasubramaniam says they not only predicted

ApoE4. That population is three times as likely

proteins are necessary for autophagy; all three

the ApoE4 interaction in the simulation, they

to develop Alzheimer’s, and will tend to develop

of these proteins are made from an interaction

proved it using the experimental approach in

symptoms at an earlier age. The risk increases to

between a transcription factor and a specific DNA

the research paper.

12 times for those who have two copies of ApoE4.

sequence, and Parcon proposed that this interac-

Abnormal clusters of plaques and tangles are

tion could be affected by ApoE4.

The researchers hope this finding will be the first step in developing a drug that would treat

the characteristic finding in Alzheimer’s. Griffin’s

“We proposed that ApoE4 competes with the

those with Alzheimer’s disease. “Now that we

group noticed that patient carriers of ApoE4 had

transcription factor—the final piece needed for

know it is the ApoE4 protein that is interacting

significantly more of these plaques and tangles

autophagy—to block the process,” Griffin said.

with the DNA, we may be able to model a mole-

built up between and within nerve cells, along

“This explained why those who have two copies

cule to block that interaction so that the cells may

with fewer nerve cells. She said the discovery of

of ApoE4 have more plaques and tangles, and

then function normally,” Parcon said.

more plaques and tangles in people with two

why they were more likely to develop Alzheim-

copies of ApoE4 gets scientists closer to answer-

er’s disease at an earlier age.”

ing the question, “Why are people with the

Caption: University of Arkansas for Medical Sciences (UAMS) researchers led by Sue Griffin,

Meenakshisundaram Balasubramaniam, PhD, a

PhD, have found a way to illustrate how a pro-

computational biologist and postdoctoral fellow

tein known to be a risk factor for Alzheimer’s dis-

Griffin and graduate student Paul Parcon were

at the lab of Robert J. Shmookler-Reis, DPhil, in

ease interacts with DNA. Pictured with Griffin,

discussing their ideas over lunch one day when

the College of Medicine’s Department of Geriat-

right, are co-author Meenakshisundaram Bala-

Parcon, an MD PhD candidate, suggested the

rics, is a co-author with Griffin, Reis, Parcon, and

subramaniam, PhD, and Paul Parcon, MD, PhD

problem might be caused by a disruption of

Ayyadeva. Balasubramaniam told them he could

candidate n

ApoE4 gene at a higher risk?”


column policy

The national dialogue on gun violence has intensified in response to mass shootings in Las Vegas, Parkland, Florida, and Santa Fe, Texas. The frequency of these events, and the protests and advocacy efforts they have inspired, have moved the issue of gun violence to the forefront of public consciousness. However, the frequency is also numbing because of the expectation, even voiced by school students across the nation, of the next shooting. A consensus on how to address the problem has not yet emerged, but it is time to initiate frank discussion on what we know.

a firm stance, stating, “The absence of guns from children’s homes and communities is the most reliable and effective measure to prevent firearm-related injuries in children and adolescents.” Earlier this year, Health and Human Services Secretary Alex Azar, expressed support for expanding federal gun violence research within the CDC. The CDC collects data on firearm deaths and injuries, but research has been limited since passage of the Dick-

Gun Violence: A Public Health Perspective

ey Amendment, a 1996 provision in federal legislation that prohibits the agency from spending money on advocacy or promotion of gun control. The amendment’s sponsor was Republican Rep. Jay Dickey of Arkansas, who died last year. In his later years, Dickey expressed regret about the amendment and favored new research on gun violence. In 2016, more than 100 medical organizations signed a letter calling on Congress to lift the Dickey Amendment. Azar has said he believes the amendment only bars the CDC from tak-

According to the Centers for Dis-

The rate of gun-related homicides in the

ing an advocacy position, not from doing

U.S. was 3.61 per 100,000. That was over

research. Language in Congress’ omnibus

Each year, 38,000 people in the U.S. die as

seven times higher than the rate in Canada,

spending bill earlier this year restated this

a result of gun violence, and almost 85,000

which had the second-highest rate at 0.5 gun

interpretation.

more suffer non-fatal gun injuries.

homicides per 100,000 people, and was 25

There is a financial—as well as a human—

times higher than the rate for the rest of the

cost to gun violence. A 1999 study published

wealthy nations as a group.

in The Journal of the American Medical Asso-

ease Control and Prevention:

Nationally, the rate of firearm-related deaths increased from 10.3 per 100,000 people in 2014 to 11.8 per 100,000 people

One concept that is gaining support is

ciation found that the 134,445 gunshot in-

in 2016. The rate is even higher in Arkansas,

that gun violence should be viewed and

juries reported in the U.S. in 1994 produced

which went from 16.6 deaths per 100,000

studied as a public health issue. The Amer-

$2.3 billion in medical costs, of which an

people in 2014 to 17.8 deaths per 100,000

ican Public Health Association cites gun

estimated $1.1 billion, or 49 percent, was

people in 2016.

violence as a major public health problem

paid by taxpayers. Lost productivity and dis-

and a leading cause of premature death. The

ability costs of survivors are immeasurable.

A 2016 study published in The American

Journal of Medicine reviewed 2010 World

American Medical Association has called

Also, studies have shown that violent

Health Organization data and found that:

gun violence a public health crisis requiring

crime and a perceived lack of safety have

Among the 23 nations with per capita

a comprehensive public health response and

an indirect impact on public health by cre-

gross national incomes greater than $12,736,

solution. Because children are frequently

ating barriers to outdoor physical activity.

the U.S. accounted for 46 percent of the pop-

injured at home or while visiting others, the

Physically active people have a lower risk

ulation, but 82 percent of gun deaths.

American Academy of Pediatrics has taken

for health problems such as heart disease,


Joseph W. Thompson, MD, MPH Director, Arkansas Center for Health Improvement

high blood pressure, and type 2 diabetes. As a pediatrician, I am acutely aware of and concerned about the impact of violence

unwilling to play outside, and fear of gangs

locks, gun safes, and storage strategies to

or crime was one of the top three responses

separate ammunition from firearms. Bal-

from both boys and girls.

ancing gun owners’ rights with their respon-

on children. Adverse Childhood Experiences,

Mass shootings typically are followed by

sibilities while finding ways to identify at-

or ACEs, is a term researchers use for stress-

calls for greater restrictions on gun access

risk individuals and engage in appropriate

ful or traumatic events such as abuse, ne-

by people with mental health problems.

interventions are discussions that need to

glect, or the witnessing of violence. ACEs are

The issue is complicated, however. Of the

happen.

associated with the development of risky

millions of Americans with mental health

Some may question why gun violence

health behaviors, chronic health conditions,

issues, the vast majority are not violent. Cer-

should be viewed through a health lens,

low life potential, and early death. The 2016

tainly, this is an area where more research

arguing that it has no medical cure. But

National Survey of Children’s Health found

would be beneficial.

healthcare professionals seek not just to

that 5 percent of Arkansas children have

The presence of youth-on-youth violence

cure ailments but also to promote health.

been a victim of, or a witness to, neighbor-

at schools is not new—Jonesboro experi-

It is becoming clear that gun violence is an

hood violence, compared to 3.9 percent

enced a school shooting two decades ago.

epidemic that threatens the ability of Ameri-

nationally.

However, the frequency and lethality of

cans to lead healthy lives, beginning as early

In one study, children ages 6-14 in New

these events is increasing. There are clear

as childhood. Arkansas is, unfortunately, no

Jersey were asked what would make them

strategies to safely maintain guns—trigger

exception. n


dialogue

column

Director’s Desk

Expanded Options for Adoption Records in Arkansas One of the important functions performed by the Arkansas Department of Health is to provide vital records for Arkansans. Vital records are documents of important life events, such as births, deaths, marriages, and divorces. There are procedures that instruct the public on how to access records. This month, there are changes pertaining to adoption records.

On average, there are about 400 adop-

Department of Health for birth parents to

new form that medical professionals, such

tions recorded in Arkansas each year. In the

complete. The first form is a contact prefer-

as obstetricians, should tell their patients

past, the law governing access to adoption

ence form that allows a birth parent to indi-

about if they are considering placing their

records meant that access to files was lim-

cate his or her preference for contact with

child up for adoption. This information will

ited, and Arkansas was considered a closed

the individual requesting the adoption file.

allow adoptees the opportunity to identify

adoption state. Act 519 of 2017 changed the

The second form is a family history form that

hereditary health issues. Not all adoption

law regarding who may access adoption

allows birth parents to add updated social,

files will include this updated medical his-

records. Now, adoptees are able to request

cultural, and medical history information to

tory; however, the new policy does allow

their adoption file from the Arkansas De-

what is already in an adoption file, including

for the medical history of an adoptee’s bio-

partment of Health after they turn 21 years

any known medical conditions of the birth

logical family to be updated, which has not

old. This law also brings significant changes

parents or their relatives. Birth parents can

always been the case.

for an adoptee’s birth parents, and parents

also indicate any drug or alcohol use during

considering adoption. Some changes for birth parents to be

the pregnancy, the mother’s reproductive life (age of first menses, age at menopause, mis-

aware of include the ability to provide im-

carriages or fertility issues), and if there were

portant contact and medical information for

special circumstances surrounding concep-

the adoptee, as well as the ability to redact

tion, pregnancy, or delivery. A special cir-

their names from the file, and their prefer-

cumstance could include the mother-to-be

ence for contact with the adoptee. Three

being put on bed rest or not carrying to term.

forms are available through the Arkansas

The medical history information form is a


Nathaniel Smith, MD, MPH Director and State Health Officer, Arkansas Department of Health

Finally, birth parents that would like to

Beginning August 1, 2018, written requests

must be notarized and include proof of

request the redaction of their names from

for adoption files will be accepted from

their identity. There is a $100 fee to process

the original birth file may do so by filling

adoptees or, upon their death, by a surviv-

an application for adoption files. Adoptees

out a redaction request. In order to submit

ing spouse, child, or guardian of a child of

must provide identification such as a driv-

a redaction request, the birth parent must

a deceased adoptee. Adoptees should note

er’s license, passport, or temporary resident

show proof of his or her identity and submit

that the information in an adoption file

card, while their surviving spouse, child, or

a notarized form. A form cannot be submit-

might vary widely from file to file. Each file

guardian of a child of a deceased adoptee

ted by one birth parent for another. While

usually includes an original birth certificate

must show documentation establishing their

the birth parent’s name will be redacted,

and adoption decree. Beyond this basic in-

relationship to the adoptee. Upon receiv-

the birth certificate may still include some

formation, some files may not contain much

ing a request, the Arkansas Department of

identifying information, such as race and

detail, while others include court documents,

Health staff will diligently search through

occupation, as well as the hospital and town

such as affidavits from grandparents, peti-

files for an adoption record that matches the

where the birth occurred. As adoption file

tions from the biological father if he is not

request. Timeframes for accessing files may

requests are made, Arkansas Department

named in the original birth record, or infor-

vary depending on how much information is available, age of the file, and other factors.

of Health Vital Records staff will look at all

mation from attorneys and others involved.

requests for redaction forms first, before

Before this year, an adoption file could only

The forms needed by adoptees, as well as

filling the requests. The redaction forms may

be accessed by a court order. A person had to

those forms for birth parents, may be picked

be filled out or updated at any time.

have a judge rule that he or she had a com-

up at any Arkansas Department of Health Local Health Unit in the state. Forms must

Birth parents who wish to redact their

pelling reason to access his or her adoption

names from adoption files or update their

record. The Arkansas Department of Health

be returned via mail to the Arkansas Depart-

contact or medical information are encour-

did not regularly receive court orders for

ment of Health Vital Records Department,

aged to fill out the forms found online at

adoption files.

www.healthy.arkansas.gov.

State Registrar, 4815 West Markham St., Slot

All written requests for adoptees’ files

44, Little Rock AR 72205. More information is available by contacting [email protected] or 1-800-462-0599, and asking to speak with someone about the forms and processes used by birth parents and adoptees. n

“Beginning August 1, 2018, written requests for adoption files will be accepted from adoptees or, upon their death, by a surviving spouse, child, or guardian of a child of a deceased adoptee.”

Healthcare Journal of LITTLE ROCK I JUL / AUG 2018 43

column Mental Health

Be the Voice

To Stop Suicide

Suicide is the 10th leading cause of death overall in Arkansas. On average, one person dies by suicide every 16 hours in the state, and more than twice as many people die by suicide in Arkansas annually than from homicide. Suicide knows no age, race, gender, or socio-economic boundaries, and no one expects it to happen to them or someone they love.

S

uicide did not cross my mind until it happened to my family. After losing my father, Larry, to suicide when I

was 13 years old, I was left trying to understand why.

How could this have happened? How could my intelligent, loving father, who loved his children, take his own life? He

was a wonderful father who, like many fathers, took us to our extracurricular activities, sporting events, and wonderful

What leads to suicide? There’s no single cause. Suicide most often occurs when stressors and health issues converge to create an experience of hopelessness and despair. Depression is the most common condition associated with suicide, and it is often undiagnosed or untreated. Most people who actively manage their mental health conditions lead fulfilling lives. Conditions like depression, anxiety and substance use problems, especially when unaddressed, increase risk for suicide.

vacations. One of his favorite things to do with us was take us camping and spend lots of time outdoors. What could I or anyone else have done? The question that weighs most heavily on my mind 37 years after losing my father is why are we still not treating mental health issues the same as other physical health issues? When are we going to start treating the brain like any other organ in our bodies, and when are we going to demand change? We cannot continue to lose our family and friends to an illness that is preventable. Suicide is a public health issue, and we all have a role to play in preventing suicide. It is time to take action. In 2008, I decided my role was to become a volunteer with the American Foundation for Suicide Prevention. AFSP is dedicated to saving lives and bringing hope to those affected by


Wendy Thompson Area Director American Foundation for Suicide Prevention

Prevention. This fundraising walk supports

Suicide Warning Signs

the American Foundation for Suicide Prevention’s local and national education and ad-

Talk If a person talks about: • • • • • •

Killing themselves Feeling hopeless Having no reason to live Being a burden to others Feeling trapped Unbearable pain

Behavior Behaviors that may signal risk, especially if related to a painful event, loss, or change: • Increased use of alcohol or drugs • Looking for a way to end their lives, such as searching online for materials or means

Withdrawing from activities Isolating from family and friends Sleeping too little or too much Visiting or calling people to say goodbye • Giving away prized possessions

vocacy programs and its bold goal to reduce

Mood

affected by suicide. Arkansas now has six

People who are considering suicide often display one or more of the following moods:

Texarkana, Malvern, and Jonesboro, and all

• • • •

• • • • • • •

the annual rate of suicide 20 percent by 2025. We walk to raise awareness about this important health issue. Suicide touches one in five American families. We hope that by walking, we save lives and bring hope to those community walks throughout the state in North Little Rock, Bentonville, Fort Smith, of them will take place this fall. More than 375 Out of the Darkness Community Walks are

Depression Anxiety Loss of interest Irritability Humiliation Agitation Rage

held nationwide. The walks are expected to unite more than 250,000 walkers and raise millions for suicide prevention efforts. These walks are about turning hope into action. Suicide is a serious problem, but it is a problem we can solve. The research has shown us how to fight suicide, and if we keep up the fight, the science is only going to get better, our culture will get smarter about mental health, and we’ll be able to save more people from dying from depression and other mental health conditions. It is time for ev-

suicide. AFSP creates a culture that is smart

Bereavement Clinician Training (SBCT) to

about mental health through education and

the state in August. SBCT is a one-day work- stop suicide.

community programs, develops suicide pre- shop that provides a focused overview of the vention through research and advocacy, and

Please join us at one of the walks at www.

impact of suicide on survivors, and the clini- afsp.org/walks or register to attend one of

provides support to those affected by sui- cal and support responses that are needed. cide. In 2008, the first Out of the Darkness

eryone to get involved and be the voice to

our upcoming trainings at www.afsp.org/

Developed jointly by the American Associa- arkansas. n

Walk for suicide prevention was held in Little

tion of Suicidology, the American Foundation

Rock, and in 2009, the Arkansas Chapter of

for Suicide Prevention, and John R. Jordan,

Wendy Thompson started the first Out of the Darkness Community Walk in Arkansas, and co-founded the is intended for clinical professionals seeking AFSP Arkansas Chapter in 2009. During her time as a volunteer, she served as the board chairman, secretary, to bolster their knowledge and understandtreasurer, Survivor Outreach Program coordinator, and ing of—and empathetic regard for—people walk chair before becoming the AFSP Area Director for Arkansas and Oklahoma in September 2016. Prior bereaved by suicide. As a non-profit, AFSP is able to further our to joining AFSP, Ms. Thompson served as Assistant Director at the UAMS Center for Health Literacy, and mission because of generous contributions Director of Operations at the March of Dimes. Wendy from individuals, corporations, and foun- is a suicide loss survivor after losing her father to suidations. Our signature fundraising event is cide in 1981. She is married to Executive Chef Len the Out of the Darkness Walk for Suicide Thompson, and they have two sons, Dylan and Tristan.

the American Foundation for Suicide Pre- Ph.D., a leading expert in this area, the SBCT vention was formed. Since 2008, we have had countless volunteers working across the state to further our mission. We have a variety of education programs, including Talk Saves Lives™, a communitybased program that teaches the risk and warning signs of suicide, research on prevention, and what people can do to fight suicide. In addition, AFSP will bring a Suicide


dialogue

column medicaid

Medicaid’s Response to Opioid

Prescribing

Overuse of prescription narcotics has led to a widely publicized epidemic of addiction and overdose deaths. Arkansas Medicaid had interventions in place to reduce some problematic prescribing earlier this decade, and has increased its interventions to reduce risks in our communities.

A summary of key changes follows:

shopping and patients collecting multiple prescriptions of narcotics paid for by the

Fentanyl lollipops

program.

Believe it or not, this potent drug was widely marketed 10 years ago. Designed for

Mandatory Provider Enrollment

like many other state programs, has gradu-

quick onset for short, painful procedures like

Pharmacy managers noticed patterns

ally reduced the maximum daily MME to be

the changing of dressings in burn patients,

likely representing “pill mill” prescribing in

paid for with program funds. As of this fall,

or for patients with head and neck cancer

out-of-state facilities. Rules were changed to

the program will pay for only the equivalent

who had limited oral intake, the drug be-

require prescribers and pharmacies to enroll

of 90 mg of morphine a day for chronic pain

came used in some primary care practices

as Arkansas Medicaid providers, which would

management.

for headaches and even back pain. Arkan-

require them to adhere to program oversight

sas Medicaid learned of abuses elsewhere

and potential removal for abusive activity

in the country and limited prescribing only

patterns. Several of the suspicious actors did

A core response to the opioid crisis is to

to cancer/burn patients with specific indica-

not enroll and thus could no longer supply

reduce the number of new patients depen-

tions several years ago, and tamped down the

narcotics paid for by program funds.

dent on prescription medication. In keeping

potential for widespread abuse and diversion.

New Start Limitations

with CDC guidelines, Arkansas Medicaid now Daily Morphine Equivalent (MME) Limits

limits new starts of opioid medications to

As health professionals re-evaluated ap-

7 days and 50 MME per day. Conversion to

Several years ago, the program did not

propriate dosing of chronic opioids, it be-

higher doses or longer duration prescriptions

limit the daily dosing of opioids, but did

came apparent that administration of these

would require review for appropriateness.

limit beneficiaries to a 30-day supply that

agents beyond the equivalent of 100 mg a

could not be refilled until the next month.

day of morphine did not improve non-cancer

This administrative rule, managed by point-

pain control, but did increase likelihood of

Eighty-five percent of eligible Medicaid

of-sale computer monitoring, reduced doctor

dependence or diversion. Arkansas Medicaid,

beneficiaries are now part of a voluntary

30-Day Supply Limits


Opioid Report Card

William Golden, MD Arkansas Medicaid Medical Director

“Arkansas Medicaid now provides each PCMH with an opioid report card that displays the percent of its patients receiving chronic opioids, chronic benzodiazepines, and chronic sleeping pills alone or in combination, and how that PCMH compares to statewide peer groups.”

Patient Centered Medical Home (PCMH).

nasal spray to patients with symptoms of an

Arkansas State Medical Board and its more

This popular program involves nearly 1,000

overdose. Repeat use of this agent or visits

aggressive oversight of physician prescrib-

primary care physicians in 200 practices. Ar-

to an emergency room for overdose events

ing and management of narcotic prescribing.

kansas Medicaid now provides each PCMH

are flags for future fatal events. Neverthe-

Nevertheless, street drugs, cash purchases,

with an opioid report card that displays the

less, many patients continue to receive pre-

and other behaviors by dependent patients

percent of its patients receiving chronic opi-

scriptions for those drugs that put them at

remain a challenge. Awareness has increased,

oids, chronic benzodiazepines, and chronic

risk. Arkansas Medicaid now has computer

and provider behavior has changed, but the

sleeping pills alone or in combination, and

alerts for patients that have refilled naloxone

opioid crisis will remain a substantial chal-

how that PCMH compares to statewide peer

or have been treated for an overdose. This

lenge in the near-term years ahead. n

groups. It is well known that opioids and

alert rejects new claims for narcotics or ben-

benzodiazepines prescribed in combina-

zodiazepines, and pharmacy professionals

tion increases the risk of serious overdose

contact the prescribing provider to discuss

events. The report card is used to sensitize

the problem. Most conversations reveal that

primary care doctors about their patterns of

the prescribing health care professional was

care that might need reevaluation. A similar

unaware of the overdose events, and quite

report card has been developed for dental

responsive to adjust management of these

providers to be used by the Medicaid dental

high-risk patients.

managed care program. As noted above, Medicaid has done a lot Naloxone and Overdose Alerts

in concert with other state partners such as

Recently, the program liberalized access

the Department of Health and its Prescription

to naloxone, an acute drug administered by

Drug Monitoring Program database, and the

Bill Golden, MD, Professor of Medicine at UAMS, holds a secondary appointment in the COPH Department of Health Policy and Management and has been appointed to serve as a member of the guiding committee for the national Health Care Payment Learning and Action Network. The network, which is under the federal Centers for Medicare & Medicaid Services (CMS), was convened to identify payment models and reforms that will lead to better care at lower costs – primarily by tying health care payments not to services but to value and quality of patient outcomes. Dr. Golden, who has been a leader in state and national efforts to move towards payment models that emphasize value over volume, also serves as Medicaid Medical Director for the Arkansas Department of Human Services.


column Acupuncture

Integrating the Whole: Personal care for your Patients’ Benefit Regardless of whether you are a doctor, nurse, acupuncturist, chiropractor, physical therapist, massage therapist, mental heath practitioner, or other medical therapist, you are in the business of listening to patients’ problems all day long. As medical practitioners, we have accepted the job of taking on other people’s burdens. Most of us entered our professions completely aware of this, but I think few of us imagined how significantly it would affect our minds and bodies. Moreover, I am sure that most practitioners are unaware, or won’t acknowledge, the effect it has on our daily health and lives. 48 JUL / AUG 2018 I Healthcare Journal of little rock

Martin Eisele, LAc Evergreen Acupuncture

Everything in the universe has energy in some form. Animals, and especially humans, are unique in how we take on the energy of others. Don’t believe me? Next time you pass someone, see how you feel. Are they smiling? Doesn’t that make you smile or feel relaxed? Are they frowning, or mad? It probably makes you uncomfortable, or go into protection mode. Are they describing something bad, telling a joke, or on the phone ignoring you? Even spaces can affect how we feel. Is there trash on the floor or flowers on the desk; is it dark and

“In acupuncture school, we were taught that because we are dealing with people’s energies, we need to have some sort of grounding practice to bring us back to a calm, centered space.”

dingy or bright and airy? How does that make you feel? In acupuncture school, we were taught that because we are dealing with people’s energies, we need to have some sort of grounding practice to bring us back to a calm, centered space. Asian medicine has always emphasized these types of health practices called nei gong, meaning internal work. Tai chi, chi gong (energy breathing), yoga, and prayer (if you are spiritual or religious) are all meditative practices that help you turn your thoughts inward to find your center. Asians also focus on feng shui (lit. wind water), the energy of living and working spaces. In Chinese medicine, practices are split into three levels relating to heaven, humans, and Earth. Earth practices are for body strength and stamina, and are what we think of as exercising our body and muscles (running, weights, biking, etc.). Human level practices represent our emotions, breath, and concentration/focus energy, that keep us going each day—coordinating mind and body, plus our daily care of diet and sleep. These practices involve tai chi, chi gong, yoga, body scan relaxation, or something similar. Heaven level represents our spiritual lives, be it prayer or spiritual based meditation—practices

of opening the heart and connecting to

a simple connection, whether it’s an intel-

something bigger than us.

lectual conversation, or primal lust. Some-

Many of my patients tell me they relax

times there is total connection between

by running or exercising. This is good, but

spouses or lovers; their minds, hearts, and

I tell them that it is something like starting

bodies are in sync. However, this is more

your car and letting in run in the driveway.

likely to happen if each individual in that

It gets their mind off of things, but is only

relationship practices each of the three

part of the picture. I try to emphasize the

levels as individuals.

addition of meditation to let both the mind

We have a relationship with our patients. Practicing health on the three levels at

and body rest together. The Chinese idea is practicing all three

least a few minutes a day, or longer, several

levels because they are interwoven strings

times a week, keeps us from taking on the

of the same yarn; yarn is much stronger

heaviness of the emotions and sicknesses

than the individual strings. Without body

of our patients. It is essential that we take

strength, your energy level is not support-

care of our health first, so we can take care

ed. Body strength without body awareness,

of our patients (and families). We must be

internal focus, and daily care leaves our

present when we meet with patients. We

health depleted. Either, without spiritual

must practice how to listen and observe,

practice, leaves us, and our connections

and give them the time they deserve, even

with others incomplete. Relationships

if we only spend a few minutes with them.

work in the same way. Sometimes there’s

We must practice health to give health. n


column Wealth

David Walker. Does that name ring a bell? David Walker served as the comptroller general of the federal government. What does that mean? It means he was the head of the government accountability office. He was the equivalent of the CPA of the United States. He did it for ten years under Bush and Clinton. David Walker took one look at the books and said, “Hey, we have promised way more than we can afford to deliver.” He said if you think social security is terrible, Medicare is five times more expensive.

ey grows, you get to pay a tax. At the end of the year, the financial institution sends you a love letter called Form 1099. It says, “Your money grew this much, and you must give a portion of that money back to the IRS in the form of taxes.” The growth on the money in this bucket is 100 percent taxable. 2. The Tax-Deferred Bucket The second type is what we call the tax-deferred bucket, meaning you don’t

The Four-Letter Word That Will Derail Your Retirement, and How to Fix It

pay taxes on any of those dollars saved until you withdraw the money. The most common tax-deferred account is the 401(k). Other popular accounts in this category include 403(b) and IRAs. 3. The Tax-Free Bucket The third type has all sorts of different names. Some people call it tax-advantaged, tax-preferred, or tax exempt. I call it tax-free. There are other investments out there that masquerade as tax-free, but in my opinion, to be truly tax-free, it must qualify in two different ways.

In 2008 Walker said to be able to deliv-

diagnosed the problem. He appeared on

er on these two promises alone, taxes

NPR to talk about his book and told the

First, it’s got to really be tax-free. By tax-

would have to double immediately. He

radio show hosts that tax rates have to

free, I’m talking free from three different

went on to say that you don’t have to

double or we’re going to go broke. Walker

types of taxes: free from federal tax, free

increase taxes right away, but for every

said, “I can give you one four-letter word

from state tax, and free from capital gains

year that you postpone, the national debt

to explain why tax rates have to double.”

tax.

will grow by about 2 trillion dollars per

The interviewer couldn’t figure out what

Second, a true tax-free investment has

year, every year, until we hit the moment

it was, so they opened the phone lines. No

no social security taxation. In other words,

in our country when we have 53 trillion

one could figure out what the one four-let-

when you take distributions from a true

dollars of debt. So, here is my question

ter word was to explain why tax rates must

tax-free investment, it should not count

for you. What’s wrong with a country that

double. The word is MATH.

as provisional income. Provisional income

What do MATH and taxes have to do

is the calculation the government uses to

At 53 trillion dollars of debt, all the rev-

with your retirement, and how do you fix

determine if up to 85% of your Social Secu-

enue flowing into the U.S. Treasury under

this freight train bearing down on your re-

rity benefit will be subject to taxes. For an

today’s tax rates would only be enough

tirement savings? Keep reading...

investment to be truly tax-free, it should

has 53 trillion dollars of debt?

to pay the interest payments, let alone

There are literally millions of different

not count against the threshold which

any principal or a single dollar for social

investment types out there, but no matter

causes social security taxation. When you

security, Medicare, Medicaid, or anything

where you save your money, all of those

take interest off of your municipal bonds,

else. David Walker was so concerned

investments basically fit into only three

does that count as provisional income? It

about this that in 2008 he resigned and

types of accounts. How’s that for easy? 1. The Taxable Bucket

sure does. An investment that we’ve been

started to crisscross the country raising the warning cry to whoever would listen.

The first type is what we call the taxable

In 2010, he wrote a book where he

bucket, meaning every year as your mon-


told for years is tax-free doesn’t even meet our two most basic tests. What if tax rates went up to 50 percent

David Lukas David Lukas Financial

as David Walker portends? How much money would you have to take out of your IRA to be able to pay the 50 percent tax to the IRS, and then be left with $5,000, with which you can then plug the hole in your social security? What is the double of $5,000? $10,000. I’ve done the math 100 times, in 100 different ways, and concluded that when your social security is taxed, you run out of money five to seven years faster than people who do not have their social security taxed. Why? Because the act of compensating for social security taxation forces you to spend down all your other assets that much faster. A disproportionate number of people I meet with have most of their savings waiting to be taxed by the government. They have no plan to be in the zero percent tax bracket in retirement. The truth is, with proactive tax-planning, it is possible to get into the zero percent tax bracket in retirement and live comfortably. The cost of getting to the zero percent tax bracket is that you must be willing to pay a tax. In my opinion, given the choice between paying taxes today at historically low tax rates, or postponing the payment of those taxes until some point much fur-

ther down the road, you’re probably better

someone who knows the rules, or you could get burned.

off paying them today. To get into the zero percent tax bracket

• Back Door Roth Conversions allow

in retirement, you’ve got to think beyond

higher income earners to contribute to

working with a CPA. Working with an ad-

ROTH accounts through a back door.

visor who understands tax-free accumula-

I wrote about this in detail in the 2017

tion and distribution strategies is a must.

September-October issue of Healthcare

The combination of the following five strategies can help you achieve a zero per-

Journal of Little Rock.

• LIRP or Life insurance Retirement Plans

cent tax-bracket in retirement.

are one of the most misunderstood op-

• Contribute no more to your tax-deferred

tions among the general population. At

accounts than what will be offset by

the same time, these specially designed

your standard deductions. This truly is

life insurance retirement plans are ex-

a winning strategy because not only do

tremely popular among the wealthy and

you get to take a tax deduction on the

large corporations for tax-free accumu-

front end, but you get to spend it tax-

lation and distribution strategies. Banks

free as well.

purchased 40 billion dollars of this as-

• If your employer offers a ROTH op-

set class alone in 2008. Industry-wide,

tion, contribute the maximum amount

these types of tax-free savings vehicles

allowed. Even higher income earners

dwarf real estate holdings among cor-

who cannot contribute to a traditional

porations and the wealthy. As of 2015,

ROTH can contribute between $18,000

Bank of America owned 20 billion in

to $24,000, depending on age. If this op-

Life Insurance Retirement Plans and

tion isn’t currently available to you, ask

just nine billion in real estate. The truth is, with a forward-thinking tax

for it. • Roth Conversions remain a viable op-

plan, one can achieve the goal of being in

tion, although this option has become

a zero percent tax bracket in retirement.

trickier with the recent tax reform

If tax rates double, two times zero is still

signed into law. Be sure to work with

zero. n


column ONCOLOGY

with imaging equipment so we can confirm exactly where the tumor is in the body

CARTI North Little Rock Debuts New Technology for Precise Cancer Treatment

before and during treatments. IMRT and IGRT are used at CARTI most often to treat prostate cancer, head and neck cancer, lung, and breast cancer. Part of the reason for this is that these tumors tend to be located close to critical organs and tissues in the body. The radiation treatment process follows a fairly standard pattern. Patients generally have surgery, followed by chemotherapy for some, followed by radiation, which

In June, CARTI North Little Rock began treating cancer patients with Vision RT—a new technology that makes sure radiation is delivered every treatment to the precise spot cancer has been detected. Although it is initially geared toward breast cancer patients to ensure the lowest possible dose to the heart, the applications go well beyond that diagnosis. It is one more example of how CARTI continues to be a leader in providing cutting edge technology to care for cancer patients of Arkansas. Radiation Therapy

IMRT and IGRT

generally begins one month from surgery or chemotherapy. For breast cancer, radiation patients have three to six and a half weeks of treatment, Monday through Friday, for about 10 minutes a day. The number of weeks depends on their age, type of cancer, and whether lymph nodes were involved with the cancer. Breast cancer treatment and risk of heart disease Earlier this year, the American Heart

I have served as president of Radia-

In 2001, the year I joined CARTI, I helped

Association issued a statement on the in-

tion Oncology Associates (ROAPA) since

to initiate and develop the IMRT program

tersection of cardiovascular disease and

2007, and have operated a single-physi-

for our physician practice, ROAPA, across

breast cancer. Although many people as-

cian facility at CARTI North Little Rock

CARTI facilities.

sume breast cancer is the number one

since 2001. CARTI’s mission is to promote

Intensity modulated radiation thera-

threat to women’s health, in reality, cardio-

the finest quality cancer treatment and

py, or IMRT, is a type of cancer treatment

vascular disease remains the leading cause

compassionate care, and to improve our

that uses advanced computer programs to

of death among women.

knowledge through education and re-

calculate and deliver radiation directly to

They referenced a study that compared

search.

cancer cells from different angles. It allows

women who had left-side breast cancer

In our practice, we see a lot of women

people with cancer to receive more even

to those who had right-side breast can-

with breast cancer. Typically, the women

doses of radiation, while limiting damage

cer. Both groups had radiation. The study

have had surgery, and radiation is then

to the healthy tissues and organs around

found that women who had left-side

used as a preventative treatment. I use the

it. In other words, you treat the areas you

breast cancer had a small but significant

analogy of a broken glass. After you clean

want to treat, and you don’t treat the areas

increased risk of heart disease 30 plus

up the pieces you see, you sweep and

you don’t want to treat. This increases your

years after their treatment.

mop to make sure you’ve gotten every-

chance for a cure and lessens the likeli-

thing, including the pieces you can’t see.

hood of side effects.

When treating cancer with radiation therapy, our goal is to deliver radiation to

That’s what radiation does. It increases the

Image guided radiation therapy (IGRT)

the breast area while protecting surround-

rate of survival because it decreases the

takes IMRT one step further. The machines

ing healthy tissue from exposure and po-

chance of cancer coming back.

used to deliver the radiation are equipped

tential damage. If a patient has left-breast


Mark R. Storey, MD President Radiation Oncology Associates PA

the same way as before. When their breast surface is at the right position, the display lights turn green and AlignRT turns the radiation beam on. Using three cameras to monitor thousands of points on the skin, AlignRT can detect any motion as the patient holds her breath, with submillimeter accuracy. If the patient moves out of position, the radiation beam is turned off. A recent study showed that AlignRT, when combined with DIBH, effectively prevented radiation-induced abnormalities in blood flow to the heart. Of the breast cancer patients treated, zero percent showed these abnormalities after six months. This compares to a previous study without AlignRT or DIBH, where 27 percent of patients showed new abnormalities in blood flow to the heart six months after radiation therapy.

New Vision RT Technology.

My clinical philosophy is to provide high-quality guideline-based care, while cancer, we take extra precautions to make

about heart disease down the road as a

caring for my patients as if they were my

sure their heart receives minimal radiation

result of radiation treatment.

family. I am excited to incorporate another

exposure during treatment. If the cancer

In conjunction with Vision RT software,

tool to help fight cancer aggressively, even

is in the center part of the chest, we have

we have incorporated deep inspiration

as I continue to protect my patients both in

to develop different plans to get the heart

breath hold (DIBH) for left-breast cancer

the short term and in the years to come. n

dose to safe levels. After that study, and

patients. DIBH is a radiation therapy tech-

with new emerging technology available in

nique where patients take a deep breath

the market, I started looking at ways to do

during treatment and hold this breath

things better.

while the radiation is delivered.

Vision RT

anterior descending (LAD) artery is an

In left-breast cancer patients, the left I have a biomedical engineering degree,

important part of the heart that lies very

and I remain very interested in technology.

close to the radiation field. By taking a

About two years ago, I started looking at

deep breath in, the patient’s lungs fill with

Vision RT, as I had patients I thought would

air and their heart will move away from

benefit.

their chest, providing more room to treat

Technology called AlignRT by Vision RT

and sparing those critical structures.

gives us a mapping of the patient’s surface

During treatment planning, patients lie

to help us make sure the radiation is de-

on their back for 3-D images to be taken of

livered to the right spot every treatment.

their body. They are asked to take and hold

Heart radiation damage is a widely ac-

a deep breath, usually for 15 to 25 seconds,

knowledged issue, and the goal with this

so that the breast area is as far from their

software is to make sure patients treat-

heart as it can be. Then, during treatment,

ed for breast cancer don’t have to worry

they will take and hold a deep breath in

Mark Storey has been in the NLR CARTI facility since 2001. He was born in Hot Springs, AR and graduated from Vanderbilt University with honors with a BE in Biomedical Engineering. He returned to Arkansas for medical school and then performed his residency training at MD Anderson Cancer Center in Houston from 1997-2001. After completing his training, he returned to his home state and has been in the NLR facility since graduation. He has been President of the Radiation Oncology Associates PA since 2007 and has served on the CARTI Board on two occasions. The NLR CARTI clinic has consistently performed in the top 1-3 percent nationally with respect to patient satisfaction based on third party Press Ganey survey data during his 15-year leadership. He started the CARTI IMRT program in 2001. He initiated forward planning for breast cases in NLR in 2003. Under his leadership, the NLR center was the first CARTI center to move to a fully electronic medical chart in 2009. The center began the hypo fractionated breast treatments (~3 weeks versus ~6 weeks) in 2009 to reduce patient time and expense.


H o s p i ta l n e w s a n d i n f o r m at i o n

Hospital Rounds

CHI St. Vincent Infirmary, Arkansas’s first hospital to achieve magnet status, celebrates having earned its first re-designation as a magnet hospital for its continued commitment to nursing excellence and patient care.

CHI St. Vincent Infirmary Receives Magnet Re-designation Story next page Healthcare Journal of Little rock I JUL / AUG 2018 55

Hospital Rounds CHI St. Vincent Infirmary Receives Magnet Re-designation

healthcare providers around the state to promote vaccine uptake is one of most gratifying aspects of what I do.”

CHI St. Vincent Infirmary, Arkansas’s first hospital to achieve magnet status, has earned its first

A frequent consultant for the Arkansas Depart-

re-designation as a magnet hospital for its con-

ment of Health (ADH) on vaccine issues, Romero

tinued commitment to nursing excellence and

also takes daily calls from physicians around the

patient care.

state regarding indications, side effects, and pol-

The magnet designation is the highest honor an

icy. In nominating him for the award, Hilda Dupwe,

organization can receive for professional nursing

ADH immunization program manager, wrote,

practice. It recognizes excellence in nursing leadership, clinical practice, innovations, and positive

José Romero, MD

outcomes. CHI St. Vincent Infirmary is one of just

“Most impressive is his ability to rally forces to execute ideas once he formulates a clear need for the community.”

over 400 magnet hospitals nationwide, and one

“Dr. Romero sets the standard for his peers

of just two in Arkansas. As a magnet institution,

hospitals generally have higher registered nurse

by documenting immunization records on every

it employs the highest standards of quality and

retention rates, fewer RN vacancies, and less nurse

patient who is seen in the Infectious Disease clinic

ensures that patient care and safety are the top

burnout than other hospitals.

on every appointment, to make sure they are up

priority. Studies show that magnet hospitals have better overall patient outcomes than non-magnet hospitals. “The magnet designation is an independent verification of the excellence demonstrated every day by our nurses at CHI St. Vincent Infirmary,”

CHI St. Vincent Infirmary’s magnet designation continues until 2022.

Dr. José Romero Recognized for Contributions to Childhood Immunization

to date on their immunizations,” Dupwe said. “Because he sees patients with immune compromising conditions, he promotes additional indicated immunizations in high risk groups and educates medical students and residents, thereby establishing himself as the primary instructor and resource for the state.”

said Polly Davenport, president of CHI St. Vin-

Dr. José Romero with Arkansas Children’s has

cent Infirmary. “Our journey to this designation

been named Arkansas’s CDC Childhood Immu-

It was a lecture on the poliovirus during medical

made us a better hospital, as we identified ways

nization Champion for his outstanding efforts to

school that led Romero to becoming a passionate

to strengthen our nursing program. Over the past

promote childhood immunization. Romero is

champion for childhood immunization. He said,

four years, we’ve made additional improvements

recognized for his critical analysis of vaccine data

“To see what a scourge it was and the impact the

in patient safety and quality, and we’re honored to

that has helped lead Arkansas through a num-

vaccine had on the lives of children made me real-

be re-designated as a magnet hospital.”

ber of influenza, pertussis, mumps, and measles

ize the importance of polio vaccine in maintaining

outbreaks.

the health of children.”

The American Nurses Credentialing Center (ANCC) Magnet Recognition Program follows a

Romero is director of the Pediatric Infectious

“One of the reasons I decided to pursue a

rigorous recertification process that included site

Diseases Section at Arkansas Children’s. He is a

career in pediatrics is because pediatricians make

visits, nurse and patient interviews, and public

professor of pediatrics in the University of Arkan-

such an impact on the longevity and quality of

comments. Magnet hospitals are recertified every

sas for Medical Sciences (UAMS) College of Med-

life of their patients,” Romero said. “Vaccines are

four years. CHI St. Vincent Infirmary first earned

icine, and holds the Horace C. Cabe Endowed

key to that. They prevent early death and lifelong

magnet status in 2013.

Chair in Infectious Diseases at Arkansas Children’s.

sequelae. As I tell the trainees, no other medical

He also serves as director of clinical trials research

intervention has such a profound and long-lasting

at Arkansas Children’s Research Institute.

effect as vaccination.”

“I am blessed and privileged to lead nurses who are dedicated to the profession and to providing excellent and compassionate patient care,” said

“I am extremely honored for being nomi-

“We are extremely pleased that Dr. Romero

Nancy Brown, chief nursing officer at CHI St. Vin-

nated for and having received the CDC Child-

has received the Childhood Immunization Cham-

cent Infirmary. “Nurses are fundamental to any

hood Immunization Champion Award out of all

pion award for Arkansas, said Jennifer Dillaha,

hospital’s success and critical to patient outcomes.

the extremely worthy candidates in our state,”

MD, ADH medical director for immunizations.

I’m grateful for the partnership and teamwork

Romero said.

“He is passionate about the health of our chil-

among everyone involved in helping to retain

Since medical school, Romero said, “I have

dren, and he has worked tirelessly to make sure

believed that vaccination for the prevention of

that vaccines are safe and effective and available

Multiple research studies indicate that mag-

infectious diseases is the single most important

to every child in our state.”

net hospitals have higher patient satisfac-

medical intervention that has led to improved

Each year, the CDC Foundation uses National

tion, decreased mortality rates, fewer falls, and

quality of life and longevity. The opportunity

Infant Immunization Week as an opportunity to

improved overall patient safety and quality com-

to work closely with the Arkansas Department

honor health professionals and community leaders

pared to other hospitals. In addition, magnet

of Health, vaccine advocacy organizations, and

from around the country with the CDC Childhood

magnet status.”



CHI St. Vincent marked a milestone in the expansion of its Arkansas Neuroscience Institute with a formal groundbreaking for a $17 million education and research center at CHI St. Vincent North in Sherwood. The new education and research building at CHI St. Vincent North near Little Rock will be part of a destination neurosciences institute that provides advanced neurosurgery care to patients in Arkansas, in the United States, and internationally.

Immunization Champion awards. These awards

submitted nominees to the CDC. One winner was

in Sherwood by the end of this year. The edu-

acknowledge their outstanding efforts to ensure

selected in each of the participating states and the

cation and research center will open its doors in

that children in their communities are fully immu-

District of Columbia.

early 2019.

CHI St. Vincent Breaks Ground on Arkansas Neuroscience Institute Project

for its internationally-recognized neurosurgeons

nized against 14 preventable diseases before the age of two. “The tremendous success of CDC’s immunization programs to protect the nation’s children

“The Arkansas Neuroscience Institute is known who perform more than 1,000 complex surgeries a year and serve as mentors to clinicians seeking

from vaccine-preventable diseases is a direct

CHI St. Vincent marked a milestone in the

to learn the most advanced, sophisticated tech-

result of the efforts of childhood immunization

expansion of its Arkansas Neuroscience Institute

niques for treating neurological disorders,” said

champions,” said Dr. Nancy Messonnier, direc-

with a formal groundbreaking for a $17 million

CHI St. Vincent CEO Chad Aduddell. “This world-

tor of the National Center for Immunization and

education and research center at CHI St. Vincent

class institute will give CHI St. Vincent additional

Respiratory Diseases at the Centers for Disease

North in Sherwood.

capacity to treat patients and improve upon the

Control and Prevention. “We cannot overstate

The new education and research building at CHI

excellent and compassionate care we strive to

the value of the dedication our champions have

St. Vincent North near Little Rock will be part of a

offer in the community and beyond. It’s an excit-

shown, which ultimately protects our children,

destination neurosciences institute that provides

ing day to launch the construction phase of our

schools, and communities from serious diseases.”

advanced neurosurgery care to patients in Arkan-

project, and reflect on efforts of the CHI St. Vin-

sas, in the United States, and internationally.

cent coworkers and benefactors that make this

CDC Childhood Immunization Champions were selected from a pool of health professionals, coali-

The Arkansas Neuroscience Institute, currently

tion members, community advocates, and other

located a few miles away at CHI St. Vincent Infir-

state-of-the-art institute a reality.” The education and research center will be adja-

immunization leaders. State immunization pro-

mary in Little Rock, will relocate its surgical and

cent to the hospital on the CHI St. Vincent North

grams coordinated the nomination process and

clinical operations to the newly expanded center

campus. It will feature an expanded laboratory


Hospital Rounds and classrooms, an auditorium, the Arkansas Neuroscience Institute clinic, and office space for the institute and other physicians. The laboratory will be the only one of its kind in the world, featuring a patented teaching model developed by Dr. Emad Aboud, director of the lab. Denver-based NexCore Group is the developer for the project and will oversee construction. Work is already underway to renovate part of CHI St. Vincent North to house the institute. Among those renovations are the addition of 10

David Hays, MD

Amy Jo Jenkins, MS, CCRP

intensive care unit rooms, updated operating rooms, an angiography suite, a new pharmacy, and advanced imaging technology, including a

service to ACR; evidenced significant accomplish-

Center, CARTI Little Rock, CARTI North Little

128-slice CT scanner and 3T MRI equipment.

ments in scientific or clinical research in the field

Rock, CARTI Conway, CARTI Mountain Home,

The Arkansas Neuroscience Institute is led by

of radiology; made significant contributions to

and CARTI Searcy. CARTI radiation oncology pro-

Dr. Ali Krisht, a renowned neurosurgeon who

literature; and/or provided outstanding work as

grams account for six of the seven ACR-accredited

specializes in vascular microsurgery involving the

a teacher of radiology. Only 10 percent of ACR’s

programs in Arkansas.

treatment of aneurysms, arterio-venous malfor-

members have been awarded this honor.

mations, cavernous sinus tumors, and acute treat-

Fellowship is awarded to diagnostic radiolo-

ment of stroke. Krisht is the chief editor of the jour-

gists, radiation oncologists, interventional radiol-

nal, Contemporary Neurosurgery.

UAMS’ Amy Jo Jenkins Named President-Elect of SOCRA

ogists, medical physicists, and nuclear medicine

Amy Jo Jenkins, MS, CCRP, executive director

“Our ability to serve the people of Arkansas

physicians at the convocation held during the

of the University of Arkansas for Medical Sciences

and truly, the world, has been limited only by

ACR annual meeting. Radiation oncology (radi-

(UAMS) Translational Research Institute, has been

the amount of space available to us,” Krisht said.

ation therapy) is the careful use of high-energy

named president-elect of the Society of Clinical

“This is an amazing opportunity to grow the Insti-

radiation to treat cancer. A radiation oncologist

Research Associates (SOCRA) Board of Directors.

tute, bring additional qualified neurosurgeons

may use radiation to cure cancer or to relieve a

to Arkansas, and conduct research that will

cancer patient’s pain.

change the lives of people living with neurological disorders.”

“CARTI is proud to add another ACR Fellow designation to our ranks,” said Jeremy Land,

SOCRA, a nonprofit, charitable and educational membership organization, provides an internationally recognized certification program for clinical research professionals (CCRP®).

Patients from 38 states and from all 75 coun-

senior vice president of radiation oncology and

Jenkins founded the Arkansas SOCRA chap-

ties in Arkansas have been treated at the Arkan-

imaging at CARTI. “Dr. Hays adds so much to our

ter in 2011. It has been recognized for a record

sas Neuroscience Institute. The institute is a com-

program, and we are proud to have his level of

six consecutive years by the international associ-

prehensive program that incorporates all aspects

expertise to offer our patients.”

ation for providing the most continuing education

of neurosurgery and a full spectrum of neurolog-

"This is a richly deserved honor for Dr. Hays. He

hours of any of its 63 chapters. She was elected

is an exemplary interventional radiologist, and

to the SOCRA Board of Directors in 2016 and will

For more information about the groundbreak-

we are fortunate to have him as a member of our

become president in 2019.

ing, including an animation of the planned

CARTI team,” said Dr. Christopher Pope, an ACR

center, visit http://www.nexcoregroup.com/

Fellow also at CARTI.

ical disorders.

anigroundbreak.

CARTI’s David Hays, MD, Awarded Fellowship in Radiation Oncology Dr. David Hays of CARTI has been named an American College of Radiology (ACR) Fellow.

“I believe education empowers people to be outstanding in both their personal lives and pro-

Hays, who has been an ACR member since 1999,

fessional careers,” said Jenkins, also an instructor

is also a member of the Society of Interventional

in the UAMS colleges of public health and phar-

Radiology, Arkansas Radiological Society, Pulaski

macy. “As president, I will work with the board of

County Medical Society, and Mid-America Inter-

directors to further establish SOCRA as the global

ventional Radiological Society. He and his wife,

leader in clinical research education and profes-

Cindy, have five children.

sional certification. It will be a privilege to serve

He is the medical director of imaging and inter-

In addition, CARTI has been awarded a three-

ventional oncology, who practices interventional

year term of accreditation in radiation oncol-

radiology and serves as a diagnostic radiologist.

ogy as the result of a recent survey by the ACR.

Clinical research professionals certified by

ACR Fellowship is awarded to members of the

This accreditation covers all of CARTI’s radia-

SOCRA work with volunteer participants in studies

ACR in good standing who have demonstrated

tion oncology sites, which include CARTI Cancer

at UAMS’ main campus in Little Rock and clinics


the diverse and robust clinical research workforce that makes up SOCRA’s membership.”


Rohit Dhall, MD

affects movement, thinking, and mental state.

were previously provided at two separate loca-

As the disease progresses, people with Hunting-

tions. The current medical oncology facility has

ton’s need help with all aspects of their daily lives,

12 chairs for infusion therapy, through which che-

and become bedridden in the final stages of the

motherapy is delivered. The renovated facility will

disease.

provide a new chemotherapy infusion center with

To make an appointment, call (501) 526-5443.

15 heated chairs, extra room for family members,

Huntington’s is a rare condition affecting about

and the space to grow at a later date. Public areas

30,000 people in the United States and 150-200

in the renovated clinic will include a lobby with

in Arkansas.

areas to sit, converse, or rest; an atrium; a coffee

While there are no treatments that stop the disease’s progression, there are supportive care

and refreshment bar; Wi-Fi; digital patient education; and a resource library.

resources and medications to help patients man-

Drs. Jamie Burton, Ryan Hall, and Lawrence

age symptoms. There have been advancements

Mendelsohn will provide medical oncology, while

across the state, including its eight regional cam-

in care, with newer medications developed in the

Dr. Christopher Pope will continue providing radi-

puses, Arkansas Children’s Research Institute, and

past five years.

ation oncology services.

the Central Arkansas Veterans Healthcare System.

Dhall also hopes to connect patients with Hun-

CARTI offers technologically advanced, com-

“The continuing education we provide ulti-

tington’s research. He has experience in clinical

prehensive diagnostic radiology, and is accredited

mately improves the quality of research in our

trials for Huntington’s disease, and worked on tri-

by the American College of Radiology. All areas

state,” said Jenkins. “This will be evident for any-

als for two medications aimed at helping patients

of diagnostic radiology services may be obtained

one who volunteers as a research participant.”

maintain motor skills.

by outside referrals for non-malignant diagnostic

UAMS Adds Huntington’s Clinic to Movement Disorders Care

The clinic can also connect patients with genetic

exams at CARTI Conway, including lung screen-

testing and counseling, which is an important part

ings, diagnostic CT, nuclear medicine, PET-CT

of Huntington’s care. Each child of a parent with

scans, ultrasound, and interventional radiology.

The Movement Disorders Clinic at the University

Huntington’s has a 50 percent chance of inherit-

“We are excited to expand our cancer care ser-

of Arkansas for Medical Sciences (UAMS) is offer-

ing the disease. Working with a genetic counselor

vices to the Conway community at one convenient

ing a monthly clinic for Huntington’s disease, fea-

is helpful for people considering being tested for

location,” said Adam Head, president and CEO

turing a multidisciplinary approach to care that

Huntington’s or people with Huntington’s who are

of the statewide network of cancer care provid-

aims to be a one-stop shop for patients.

considering having children.

ers. “From minimizing the steps a patient has to

The clinic’s multidisciplinary team includes

Tuhin Virmani, MD, PhD, is director of the Move-

take between registration and end-of-treatment,

movement disorder neurologists, nurses and

ment Disorders Clinic at UAMS and said the Hun-

to state-of-the-art equipment for optimal patient

nurse practitioners with expertise in Huntington

tington’s clinic adds to its overall mission of serv-

comfort, the delivery of care will make a huge dif-

disease, social workers, nutritionists, and speech

ing patients with movement disorders, which

ference to patients who receive their treatment

and physical therapists. The clinic partners with

includes Parkinson’s disease and essential tremor.

in Conway.”

neuropsychologists, psychiatrists, and genetic

“Too often, people with Huntington’s slip

When CARTI opened its radiation oncology

through the cracks in healthcare,” Virmani said.

clinic in Conway in 1996, it was the network’s

counselors for quick referrals. “Huntington’s disease can be incredibly chal-

“Our intent is to not only connect these families

fourth such clinic. Medical oncology services in

lenging for the individual and their family, and spe-

with our clinical expertise and access to research,

Conway have been provided since 2015. The

cialized care can be difficult to find. Most patients

but to build a structure of support.”

general contractor for the $1 million renovation

travel out of state for care, or do the best they can by working with their family doctor,” said Rohit Dhall, MD, director of neurodegenerative disor-

CARTI Renovation Combines Two Conway Clinics Into One Facility

ders and associate professor in the Department

Renovation is underway on the existing CARTI

of Neurology in the UAMS College of Medicine.

Radiation Oncology facility at 2605 College Ave-

“With the clinic, they can receive the expert care

nue. When complete, all CARTI Conway services

they need in one place, working with our sched-

will be offered from this facility, maximizing effi-

ulers to have their needs met with as few trips as

ciency and patient access.

possible.”

is Nabholz Construction. The project is expected to be complete in mid-September.

UAMS Professor Named Chairelect of the Board of Governors of National Doctors’ Group Omar T. Atiq, MD, FACP, has been named chairelect of the board of governors of the American

The newly renovated 13,400-square-foot cen-

College of Physicians (ACP), the national organi-

Huntington’s disease is an inherited neuro-

ter will fully integrate clinical services for medical

zation of internists. His term began during Inter-

logical condition that slowly causes a break-

and radiation oncology, as well as diagnostic radi-

nal Medicine Meeting 2018, ACP’s annual scien-

down among the nerve cells in the brain, which

ation. Radiation therapy and medical oncology

tific meeting held in New Orleans in April.


Hospital Rounds

Omar T. Atiq, MD, FACP,

Katie Brown, OD

Martin G. Radvany, MD

A resident of Little Rock, Atiq is a professor of

leadership, and volunteers their time. Brown was

medicine and otolaryngology—head and neck

nominated and selected by an awards committee

is a member of the Arkansas Optometric Associ-

surgery at the University of Arkansas for Medical

comprised of optometric physicians.

ation and the American Optometric Association.

Sciences (UAMS). He also serves as director of the

Brown has been at UAMS since 2013. She sees

Cancer Service Line at the UAMS Medical Center

patients at the eye institute, performing compre-

and associate director of the UAMS Winthrop P.

hensive eye exams, diabetic eye exams, glaucoma

Rockefeller Cancer Institute.

screenings, and contact lens fittings. She treats

and the Arkansas State Board of Optometry. She

Arkansas Department of Health Recognizes Hospitals for Stroke Care Performance

He most recently served as governor of the

conditions such as corneal abrasions, pink eye,

The Arkansas Department of Health (ADH) rec-

Arkansas Chapter of ACP. Governors are elected

corneal ulcers, dry eye syndrome, and glaucoma.

ognized 15 hospitals for excellence in stroke care

by local ACP members and serve four-year terms.

She works closely with cornea and retina spe-

performance at the Arkansas Chronic Disease

Working with a local council, they supervise ACP

cialists to provide prosthetic contact lens fittings

chapter activities, appoint members to local com-

for vision rehabilitation due to corneal dystrophies

The ADH awards are based on hospital perfor-

mittees, and preside at regional meetings. They

or after ocular trauma and corneal transplantation.

mance as documented in the Arkansas Stroke

also represent members by serving on the ACP

Brown is also an assistant professor in the UAMS

Registry between July of 2016 and June of 2017.

Board of Governors. He has been a fellow of ACP

College of Medicine’s Department of Ophthal-

They are given to hospitals for providing defect-

(FACP) since 1993. FACP is an honorary designa-

mology and teaches ophthalmic medical technol-

free stroke care (90 percent or higher adherence).

tion that recognizes ongoing individual service

ogy students, medical students, and ophthalmol-

Defect-free care is based on the seven American

and contributions to the practice of medicine.

ogy residents.

Heart Association/American Stroke Association

Forum held at the Little Rock Crowne Plaza.

Atiq earned his medical degree from the Khy-

Brown is involved with the association’s student

(AHA/ASA) achievement measures of the Get

ber Medical College, University of Peshawar, Pak-

membership, education, and recruitment. She

With The Guidelines®-Stroke Patient Manage-

istan. He is board-certified in medical oncology,

also volunteered this year with a UAMS medical

ment Tool. These measures are benchmarked

hematology, and internal medicine.

students’ nonprofit, ROOTS, which provided eye

according to the standards of evidence-based

The main areas of professional interest for Atiq

exams to children. She is the coordinator at the

stroke care guidelines to ensure stroke patients

include national health reform, Arkansas health-

Shepherd’s Hope Neighborhood Health Center’s

receive appropriate and timely care.

care access, scope of practice, private and com-

free eye clinic in Little Rock.

munity practice, and payment reform.

Katie Brown, OD, Chosen Young Optometrist of the Year

“I have a passion for optometry and providing high-quality eye care for Arkansans,” she said.

“We are delighted to see the improvement in stroke care as demonstrated by these hospitals”, said Appathurai Balamurugan, MD, DrPH, state

Brown graduated magna cum laude from South-

chronic disease director and medical director for

ern College of Optometry in Memphis. She com-

the ADH Chronic Disease Branch. “Through our

Katie Brown, OD, an optometric physician at the

pleted internships at the Air Force Academy in

work with the communities, EMS, and hospitals

UAMS Harvey & Bernice Jones Eye Institute, is the

Colorado Springs, Colorado, and The Eye Cen-

we hope to improve quality of stroke care among

Arkansas Optometric Association’s 2018 Young

ter in Memphis. She received contact lens train-

Arkansans with this devastating condition.”

Optometrist of the Year award recipient.

ing at Alcon Academy for Eye Care Excellence

The Arkansas Stroke Registry (ASR) is the ADH

The award is given to an optometrist who has

in Fort Worth, Texas, and at Vistakon Vision Care

stroke surveillance and quality improvement pro-

practiced at least four years, shows promise and

Institute in Jacksonville, Florida. Brown is certified

gram. Oversight for the ASR is provided by the

interest in Arkansas Optometric Association

by the National Board of Examiners in Optometry

Acute Stroke Care Task Force (ASCTF). The ASR



partners closely with the AHA/ASA, Emergency

at UAMS has worked hard to achieve these high

Medical Services (EMS), the ASCTF, Arkansas

standards of care for our patients and to sustain

Stroke Assistance through Virtual Emergency Sup-

that level of excellence each and every year since

port (AR SAVES), and the Mercy Telestroke sys-

we first reached them,” said Matthew Mitchell,

tem. The primary goal of the ASR is to perform

MNSc, RN, director of the UAMS Stroke Program.

stroke surveillance, monitor stroke care perfor-

“We’re grateful for these honors from the Amer-

mance, and provide stroke education and quality

ican Heart Association and Health Department,

improvement assistance to improve stroke patient

which motivate us to maintain our achievements

care and outcomes.

and even work to surpass them.”

Hospitals receiving stroke care performance awards for defect-free patient care include: Baptist Health Medical Center-Little Rock Baptist Health Medical Center-Heber Springs CHI St. Vincent Hospital Hot Springs

Martin Radvany, MD, Named Chief of Interventional Neuroradiology at UAMS

Susan Long, EdD

Martin G. Radvany, MD, an internationally

CHI St. Vincent Morrilton

known leader in interventional neuroradiology

on Accreditation of Healthcare Organiza-

CHRISTUS St. Michael Health System

and specialist in vascular disorders of the brain

tions (JCAHO) as a Comprehensive Stroke Cen-

Five Rivers Medical Center

and spine, has joined the Department of Radiol-

ter within three years.

Forrest City Medical Center

ogy at the University of Arkansas for Medical Sci-

Radvany has contributed chapters to more than

Medical Center of South Arkansas

ences (UAMS) as professor and chief of interven-

15 textbooks on endovascular treatment of neu-

Mercy Hospital Fort Smith

tional neuroradiology.

rovascular disorders, and published more than

Mercy Hospital Northwest Arkansas

Radvany received his medical degree from

50 articles in medical journals. He is a reviewer

Methodist University Hospital

Northwestern University in Chicago in 1991. He

for several medical journals and has lectured

Sparks Regional Medical Center

completed a residency in diagnostic radiology at

internationally.

University of Arkansas for Medical Sciences

Tripler Army Medical Center in Honolulu and a fel-

Wadley Regional Medical Center

lowship in interventional radiology at the Johns

Washington Regional Medical Center

Hopkins Hospital in Baltimore. After completing

Visit www.healthy.arkansas.gov for more infor-

his fellowship, he served for nine years at Brooke

mation on stroke prevention.

UAMS Stroke Program Wins Two Awards for Excellence in Care

Susan Long, EdD, Named Dean of UAMS College of Health Professions

Army Medical Center in San Antonio, where he

Longtime educator and administrator Susan

was promoted to lieutenant colonel and served

Long, EdD, has been named dean of the College

as chief of the Interventional Radiology Service.

of Health Professions at the University of Arkan-

Radvany returned to Johns Hopkins in 2007 for

sas for Medical Sciences (UAMS).

Excellence in treating stroke patients recently

a fellowship in endovascular surgical neuroradi-

Long, a UAMS faculty member since 1992, had

garnered two awards for the University of Arkan-

ology, and then joined the faculty as an assistant

been serving as interim dean since the retire-

sas for Medical Sciences (UAMS) Stroke Program.

professor of radiology, neurosurgery, and neurol-

ment of Douglas L. Murphy, PhD, on December

The American Heart Association honored the

ogy. He served as director of interventional neuro-

31, 2017. She has also been associate dean for

program with the Target: Stroke Honor Roll Elite

radiology at the Johns Hopkins Bayview Medical

academic affairs since 2012, which she continued

and Get with the Guidelines-Stroke Gold Plus

Center and director of the Endovascular Surgi-

while serving as interim dean.

award. The Arkansas Department of Health rec-

cal Neuroradiology Training Program in the Johns

ognized the program with a Defect Free Stroke

Hopkins University School of Medicine.

Patient Care award for the overall quality of

“Susan has proved herself a dedicated leader in the College of Health Professions, and I believe

Radvany worked with teams of internationally

she will accomplish great things as dean of the

known specialists developing endovascular tech-

college,” said Stephanie Gardner, PharmD, EdD,

The Target: Stroke Honor Roll Elite recognition

niques and medical devices for the treatment of

senior vice chancellor for academic affairs and

acknowledges the program’s compliance with

brain aneurysms, stroke, vascular malformations,

provost.

standards for quick and timely treatment of stroke

and pseudotumor cerebri syndrome, a condi-

“UAMS is incredibly important to me and

as well as counseling and follow-up treatment at

tion that arises when pressure inside the skull

to Arkansas,” said Long. “I am honored to be

discharge. The Get with the Guidelines-Stroke

increases.

selected as dean of the College of Health Pro-

UAMS’ stroke care.

Gold Plus status recognizes the program’s con-

In 2015, he was recruited to York, Pennsylva-

fessions, and I look forward to leading the col-

tinued high performance by those measures for an

nia, to establish the Interventional Neuroradi-

lege as we educate the allied health profession-

entire year after receiving a Gold or Silver award.

ology Program at WellSpan York Hospital. The

als of tomorrow.”

“For several years in a row, the stroke care team

program was certified by the Joint Commission

The college offers programs that provide


Hospital Rounds education, service, and research in the allied health professions. Educational programs include audiology and speech pathology, dental-general practice residency, dental hygiene, dietetics and nutrition, emergency medical sciences, genetic counseling, health information management, imaging and radiation sciences (diagnostic medical sonography, nuclear medicine imaging sciences, radiologic imaging sciences), laboratory sciences (cytotechnology, medical laboratory sciences), occupational therapy, ophthalmic technol-

Nicki Hilliard, PharmD

C. Lowry Barnes, MD

ogies, physical therapy, physician assistant studies, and respiratory and surgical technologies. Long joined the UAMS faculty in 1992 as an assistant professor in the college’s dental hygiene

(UAMS), recently became the first Arkansan to

Orleans at the 2018 Winter Meeting of The Hip

program, where she is now a professor. In addition

serve as president of the American Pharmacists

Society.

to associate dean for academic affairs in the col-

Association (APhA), the largest pharmacy profes-

Barnes is chair of the Department of Orthopae-

lege, she has been serving as associate director of

sional organization. Hilliard will serve for the 2018–

dic Surgery in the UAMS College of Medicine. He

clinical programs in the UAMS Center for Dental

2019 term.

also holds the Carl L. Nelson, MD, Distinguished

Education. She was appointed an inaugural professor in the Clinton School of Public Service for her contribution to the development of the cur-

Hilliard is a professor in the College of Pharmacy Department of Pharmacy Practice.

Chair in Orthopaedic Surgery. Barnes is the only Arkansas member of The Hip Society since the

After serving for a year as president-elect, she

death of Nelson, the former chair of the Depart-

became president at the association’s annual

ment of Orthopaedic Surgery for whom the dis-

She completed her undergraduate training at

meeting in Nashville, Tennessee. In 2019, Hilliard

tinguished chair is named.

The Ohio State University in Columbus, Ohio, in

will become past-president and will continue to

1986. She received a master’s degree from the

serve on the board of trustees.

riculum for the Master of Public Service degree.

Barnes graduated with honors from the College of Medicine in 1986 and completed his internship

University of North Florida in 1992, and in 1997,

Hilliard is a former APhA-Academy of Phar-

and residency in orthopaedic surgery at UAMS.

earned a doctoral degree from the University of

macy Practice and Management president and

He completed a fellowship in adult reconstruc-

Arkansas at Little Rock.

an APhA trustee. She now also serves on the APhA

tive surgery and arthritis surgery at Harvard Med-

As associate dean, she has been responsible for

Finance and Executive Committees and repre-

ical School and Brigham and Women’s Hospital

the administrative leadership of the college’s aca-

sents the association on the Joint Commission of

in Boston.

demic affairs, including curriculum, new program

Pharmacy Practitioners.

Barnes is one of Arkansas’s and the region’s

development and approval, educational meth-

In 1996, Hilliard earned her doctorate in phar-

foremost joint replacement experts. He is also a

ods and technology, interprofessional education,

macy, and in 1983, she earned her bachelor’s

member of the prestigious Knee Society, an exclu-

regional and specialty accreditation, faculty devel-

degree in pharmacy, both from the UAMS Col-

sive organization of the world’s experts in ortho-

opment, and policy development and implemen-

lege of Pharmacy. In 1990, she earned a master’s

paedic surgery, where he is also the only Arkan-

tation. During her tenure, she has received nearly

degree in health services administration from the

sas member.

a total of $1.4 million for service projects in which

University of Arkansas at Little Rock.

she has collaborated, mostly in the area of oral health. In 2008, she was named a Public Health Hero by the Arkansas Department of Health in recognition of her work to increase access to oral health for the underserved.

UAMS College of Pharmacy Professor First Arkansan to Serve as American Pharmacists Association President Nicki Hilliard, PharmD, a pharmacy professor at the University of Arkansas for Medical Sciences

C. Lowry Barnes, MD, Inducted into Prestigious Hip Society

Barnes is president of the Mid-America Orthopaedic Association and a past president of the Arkansas Orthopaedic Society, the Southern Orthopaedic Association, and the Society of

C. Lowry Barnes, MD, an orthopaedic surgeon,

Arthritic Joint Surgery. He has served as treasurer

professor, and department chair at the University

and is currently president-elect of the American

of Arkansas for Medical Sciences (UAMS), has

Association of Hip and Knee Surgeons.

been inducted into The Hip Society, a national

Barnes has published extensively and is on the

organization dedicated to the advancement of

editorial boards of peer-reviewed publications

knowledge relating to the hip joint. Its members

including the Journal of Arthroplasty and Clini-

are recognized thought leaders in the field of hip

cal Orthopaedics and Related Research. Barnes

surgery.

is known nationally for his expertise in healthcare

Barnes was recognized as a new member in New


quality and efficiency. n

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Reviews by the bookworm

For the last few days, you’ve had a tickle in your throat. It’s not much, just a hrrumph that’s gone from occasional to annoying. You’ve looked it up online and, well, it’s either allergies, a cold, or you’re going to die. But, as author Nina Shapiro, MD says in her new book, “Hype” (with Kristin Loberg), be careful what you think you know. Your doctor may be rolling her eyes at you. But don’t worry. Says Shapiro, showing up at an appointment armed with sheaves of print-outs, having “done… research” is often a good thing; most physicians are glad to serve better-educated patients. The problem is that some of your new education may be false and some of it may be dangerous. So how do you know the difference? To start, if you’re looking for information online, be superspecific in your search and bear in mind that websites with colorful ads are often “exaggerated.” Pay attention to what comes after the “dot” because it matters in a web address. And just because the website looks authentic doesn’t mean its information is. Remember that we tend to panic about that which is newsworthy, while ignoring what’s good for us; you may worry about Ebola, for instance, (a threat that’s truly small) but you don’t use your seat belt. Learn how to assess risk and remember that sometimes, not acting is the riskier choice. Also remember that even the most benign substances can kill you if they’re consumed in excess. In this book, Shapiro explains how to tell if a “study” is really of any use for you, and how to properly use the information you’ll get from genetic testing. Find out why there is no “best” diet or exercise. Get the final word on vaccinations. And that handful of supplements you were about to take? Hold off a minute… Lie-ins and thyroids and scares, Oh, My! What do you do when you’re feeling poorly? “Hype” lets you separate the help from the hooey. Don’t, however, think that this is just another voice in the medical jungle. Author Nina Shapiro, MD (with Kristin Loberg) doesn’t tell readers what to do; instead, she offers the tools to figure out the best

“‘Hype’ lets you separate the help from the hooey.”

By Nina Shapiro, M.D. with Kristin Loberg c.2018, St. Martin’s Press

next step based on calm truth, not rumor. Shapiro doesn’t hyperventilate in her writing, which is handy and reassuring when you’re faced with a lot of decisions or too much conflicting information. On that conflict, Shapiro is careful to show both sides to a medical coin – few things, as she points out, are all good or all bad. To that point, she reminds readers that there’s no onesize-fits-all when it comes to healthcare; she’s also refreshingly candid about her own medical superstitions and practices. For anyone who wants to be extra proactive in their healthcare choices, this is a book to have. Even though it’s pretty no-nonsense, it’s got a breezy feel to it and sometimes, the authors have a little fun with readers, too. “Hype” is down-toearth, informative, and your funnybone may even be tickled. n


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