Obtaining quality medical care is difficult for the approximately 350 residents of Bison, and studies show they and others living in remote rural areas of America have a higher mortality rate as a result.
The northwestern South Dakota town lies about 30 miles from the North Dakota border. Horizon Health Care runs a small clinic staffed by a physician’s assistant, but it is only open weekdays from 8 a.m. to 5 p.m. and services are limited.
Receiving care at a more well-equipped hospital or visiting a medical specialist requires a drive of about 120 miles to Mobridge.
As medicine and medical procedures have continued to advance in recent years, much of rural America has been left behind.
Yet for the past decade, a well-funded charitable trust has been pumping millions of dollars into technology, training and telemedicine programs to expand access to health care in rural areas. Now, the Helmsley Charitable Trust hopes to bring remote robotic open-heart surgery to small towns across the Great Plains, including in South Dakota.
Research is ongoing, but a recent successful test of the remote surgery in India has given Helmsley trust officials hope they can help people in small-town America get life-saving heart surgery without the time, cost and hassle of traveling across the state. By installing robotics in rural hospitals, the system would allow a specialist with a joystick to conduct heart surgeries remotely.
“This could be a game changer not just for rural America, but across the globe,” said Walter Panzirer, a trustee of the Helmsley trust who lives near Pierre. “It would totally level the playing field so you’re not having any different care in Sioux Falls or Rapid City or in any small town in South Dakota.”
In general, improving services and installing new technologies in rural areas is expensive and may not be cost-effective with few patients to serve. Specialists and experienced physicians typically don’t practice in small towns or remote regions.
Improving care often boils down to finding money to better equip medical facilities, train more physicians and expand communication between remote and urban providers.
On many fronts, rural communities in South Dakota and six other Great Plains states have benefited greatly from investments made by the philanthropic trust funded through the estate of the late hotel and property magnate Leona Helmsley, who died in 2007. Improving the quality and access to health care in rural areas is one goal of the Leona M. and Harry B. Helmsley Charitable Trust, which had an initial endowment of about $5.5 billion.
To date, the Helmsley trust — which has an office in New York City and another in Sioux Falls — has made 414 grants worth nearly $400 million to improve health care delivery, expand training of the medical workforce and spur innovation in rural health care in South Dakota, Iowa, Minnesota, Montana, Nebraska, North Dakota and Wyoming. In South Dakota, the Helmsley trust has invested nearly $100 million to improve rural health care.
Coordinated care saves a life
Jason Semmler of Parkston was having a beer at a bar in 2011 when he almost fell victim to the risks associated with limited rural health care.
Semmler, then 41, recalls that his eyes began to water excessively and when he tried to remove his glasses, they fell from his limp hands.
His wife rushed him to the Avera St. Benedict Hospital in Parkston and the emergency room physician there, Dr. Jason Wickersham, began a diagnosis.
Though Wickersham is highly respected in Parkston, and had colleagues in the room with him, none was an expert on the so-called clot-buster drug that can either cure or kill someone experiencing a stroke.
Wickersham used a Wi-Fi connection and TV screen to link up verbally and visually with doctors at Avera Health in Sioux Falls, including a neurologist who specialized in use of the clot buster.
The link-up is part of a wide-ranging system of medical treatment known as eCare that Avera uses to connect specialists and experts at its Sioux Falls hub to doctors working in small towns or rural hospitals across the Avera footprint. After Panzirer became aware of eCare, the Helmsley trust began investing heavily in the system, providing more than 150 grants totaling $77 million to expand telemedicine across the Great Plains.
As Semmler drifted in and out of consciousness in the Parkston hospital, his family conferred with Sioux Falls specialist and learned the odds, risks and potential benefits of the medication. Semmler’s family decided to go ahead with the clot-busting drug, and Semmler quickly improved during a flight to Sioux Falls. Once there, surgeons who were briefed via the remote connection were ready to operate and repair what was determined to be a hole in Semmler’s heart.
Semmler, now 48, made a full recovery and is back at work in the feed division of Farmer’s Alliance in Mitchell. He looks back on the ability of doctors in Parkston to link up with those in Sioux Falls as a life-saver.
“I’m not saying Dr. Wickersham couldn’t haven’t figured it out, but it connected him with a bigger system where all of a sudden you have a bunch of doctors talking it through,” Semmler said. “Anytime you can connect Parkston, a town of 1,500 people, with doctors in Sioux Falls or at the Mayo Clinic or a hospital of that size, it’s just like being there with that technology and experts.”
The eCare program at Avera began before the Helmsley trust got involved and early efforts featured video links between a doctor and remote patient that sometimes had grainy or shaky images that reduced efficacy, said Deanna Larson, CEO of the eCare Program at Avera Health that provides remote services in more than 20 states.
Since partnering with Helmsley, Avera eCare has received about $22 million in grants to expand offerings, Larson said. Overall, Avera hospitals across the Great Plains have received almost $52 million in Helmsley grants.
Wickersham said eCare has helped him save the life or expedite the diagnosis and recovery of numerous patients.
“You may be hundreds of miles from necessary medical services and this is a great way for a smaller rural facility to have necessary and potentially life-saving services that otherwise wouldn’t be available,” he said.
Rural health risks
Residents of rural areas face increased chance of death compared to people in more urban or highly populated areas, according to data from the Rural Health Information Hub, a statistical service of the U.S. Department of Health & Human Services.
For people living in a rural county without a city of 10,000 or more people, the chance of death is roughly 30 percent higher from chronic pulmonary obstruction, heart disease or other unintentional deaths when compared to people living in a large metro county.
Furthermore, the federal data show that the chance of surviving a preventable death from stroke, heart disease or cancer is about 50 percent lower for rural residents compared to those in urban areas.
The National Rural Health Association reported that less than 10 percent of American physicians work in rural areas even though nearly a quarter of the national population lives in those areas.
South Dakota faces the same health care challenges as other rural states.
In 2016, the state Department of Health published the South Dakota Primary Needs Assessment, which examined access to health care across the state.
The report indicated that major deficiencies in access and other health risk categories exist in 10 rural counties — Buffalo, Bennett, Corson, Dewey, Gregory, Jackson, Mellette, Roberts, Todd and Ziebach.
The report said that “health professional shortages” are present in all but 18 of the state’s 66 counties, that residents are “medically underserved” in all but 19 counties, and that mental health services are lacking in all but six counties.
The deficiencies are more pronounced in the northwest quadrant of the state, which is the least populous.
A mission to help others
Panzirer, 43, was a former police officer and emergency medical technician when he learned his grandmother had died and named him as a trustee of her foundation. Suddenly, he became one of three leading deciders in an effort to spend millions on programs ranging from environmental conservation to aiding vulnerable children in Sub-Saharan Africa. Other Helmsley grant efforts include helping Israel, improving life in New York City and funding research into Type 1 Diabetes and Crohn’s Disease. Additionally, Panzirer has made it a mission of the trust to improve access and quality of rural health care.
“It should not matter where a person chooses to call home, the health care should be equal in a rural setting or an urban setting, and your access to health care should be equal,” Panzirer said. “I feel that in the past rural America has been marginalized, and this is really leveling the field and taking care of people where they are.”
Beyond eCare, Helmsley grants in South Dakota have funded development of cancer care centers, expanded offerings of robotic surgery and paid for trucks that simulate real-world challenges faced by emergency medical responders to deepen their skills. The trust also dramatically expanded rural access to digital mammograms by purchasing about 50 machines that provide sharper images to aid in breast cancer diagnosis.
In November, Panzirer went to India to witness the first use of remote robotic heart surgery. He watched as a doctor with a joystick directed a robot in a hospital 20 miles away to send a catheter into a patient’s beating heart. With great precision, the doctor and robotics worked together to perform an angioplasty to break up a blockage and insert a stent to ensure future blood flow.
Panzirer said the trust will work with any hospital ownership group or individual hospital to improve health care processes or delivery methods. In South Dakota, the trust has provided grants to several providers, including Avera, Sanford and Regional health systems.
STURGIS | The city of Sturgis is proposing fees — as high as $5,100 in some cases — that would have to be paid in advance by campgrounds outside city limits if they want ambulance service at this year's Sturgis motorcycle rally.
The proposed fees range from $300 to $5,100 and are based on the number of ambulance calls to the campgrounds during the 2018 rally, Sturgis City Manager Daniel Ainslie said at a Feb. 19 special meeting in Sturgis with campground owners.
Under the proposal, campgrounds that had no ambulance calls last year would be assessed a $300 fee to cover this year’s rally in August. Those with one to four calls last year would pay $650, those with five to nine calls would pay $1,850, and a fee of $5,100 would be charged to those that had 10 or more calls during the 2018 rally.
According to listings on sturgiscampgrounds.com, there are more than a dozen campgrounds in and around Sturgis. Ainslie said services provided to campgrounds inside the city limits are covered by city sales-tax and property-tax revenues.
The city’s proposal is set for discussion before the Sturgis City Council on April 15.
If approved, the fees would have to be paid by May 15. Campgrounds not paying the fees by that date would no longer receive city ambulance service.
At the Feb. 19 meeting, Ainslie said during the 2018 rally the city ambulance service responded to 60 calls from campgrounds, amounting to 17 percent of total calls during the rally.
Of those calls, he said, 33 percent of patients refused transportation to a hospital after the ambulance arrived and of those transported only 23 percent of the amount billed was paid, creating a more than $25,000 shortfall, he said.
“We travel the distance out there and either we bandage the person up or give them the immediate aid they need and they refuse transport to the hospital, or other times we go all the way out there and no one’s there. That’s a significant cost that there’s absolutely no reimbursement for,” Ainslie said.
Ainslie said reimbursement for ambulance services by Medicare, Medicaid and private insurance coverage is limited.
Medicaid reimbursements, for example, only cover 20 percent of the cost of an ambulance call, while Medicare covers 50 percent of ambulance services and private insurance covers 60 percent of a call.
According to the city, calls for ambulance service have essentially doubled in 10 years, from 1,076 in 2009 to 2,070 calls in 2018.
Ainslie said in 2018 the city provided $277,201 to the Sturgis Volunteer Fire Department and Sturgis Ambulance Service. He said the total losses for the ambulance service in 2018, including building maintenance insurance and equipment replacement, was $250,798.
Calls to a number of campground owners around Sturgis revealed some who were unaware of the Feb. 19 meeting. Others voiced strong opposition to an upfront fee.
“They basically have told us if we don’t submit and pay, they’ll deny us ambulance services and we’re not OK with that,” said R.J. Ludwick, of No Name City Campground, located between Sturgis and Tilford along Interstate 90.
“We all pay taxes, and we have higher taxes because of our businesses, and we all feel that’s not right,” Ludwick said.
Buffalo Chip Campground owner Rod Woodruff said the campground has a full staff of EMT-trained security that will verify the legitimacy of an ambulance call and take a patient to a pickup point to minimize the time for an ambulance run from Sturgis
“We’re doing that just to help the ambulance service to keep their costs down and eliminate the false calls,” he said.
Woodruff said campgrounds bring in thousands of visitors who spend millions of dollars in Sturgis during the rally.
“It doesn’t seem like much appreciation for the campgrounds who are taking care of these people that are going into town and spending all this money and helping Sturgis realize this income every year,” Woodruff said. “It looks like we are being asked to pay the lion’s share of losses he (Ainslie) says the city has."
Ainslie said he is open to other ideas for addressing the funding needs for the ambulance, which serves 20 percent of Meade County, along with a small portion of Lawrence County.
He asks for any written proposals to be submitted by March 15.
“If they have any ideas for alternative ways, we’re happy to discuss them,” Ainslie said.
The campground proposal is one of several funding avenues the city is exploring in the wake of a series of town-hall meetings concerning funding for fire and ambulance services, Ainslie said.
In December, a pair of proposed fire and ambulance districts to help cover expenses for areas just east and north of Sturgis were turned down by county voters.
Another area brought up concerned the cost of responding to areas in Lawrence County along Interstate 90 and in Boulder Canyon west of Sturgis. Ainslie said negotiations are underway with Lawrence County to cover some of those costs.
Meade County recently approved a $5,000 annual payment to the city to cover transporting county jail inmates for medical treatment. In 2018, there were 15 of those calls, he said.
The Interior community is holding a fundraiser to support one of its firefighters who was seriously injured in a gas explosion.
Matt Harvey was hurt in a gas explosion accident while working in North Dakota, according to a news release from the Interior Volunteer Fire Department.
Harvey suffered burns on 68 percent of his body. A gofundme page for Harvey says the accident was in mid-January, and he is still at the Regions Hospital Burn Center in St. Paul, Minnesota.
Harvey has been a member of the Interior Volunteer Fire Department since 1986. To help him and his family manage the cost of medical care, travel to and from Minnesota and lodging while there, the fire department canceled its annual pancake feed and will instead hold a free-will donation supper to benefit Harvey.
The event starts at 5 p.m. March 2 at the Interior Fire Station, 117 Sixth Ave., Interior. There will be live and silent auctions, and music from The Sad & Lonesome Boys band. All proceeds will go to Harvey and his family, according to the release.
Those unable to attend the event can donate at his GoFundMe at gofundme.com/matt-harvey or at any Black Hills Federal Credit Union by requesting the Matt Harvey Benefit.
Cards and letters can be sent to Interior Fire Department, c/o Matt Harvey, PO Box 35, Interior, SD 57750-0035. For more information or to donate to the event auctions, visit facebook.com/InteriorVFD or call Katie Johnston at 515-0128, Rhonda Vogelsgang at 441-7209, Kim Carlbom at 441-6383 or any member of the Interior fire department.
Volunteer lauded for work with young professionals group
The Helpline Center and Black Hills Urgent Care named one of Rapid City's young professionals as the December 2018 Volunteer of the Month.
Kelli Kabrud, who was nominated by the Rapid City Young Professionals Group, received the recognition, according to a news release from the Helpline Center.
Volunteer of the Month recognizes outstanding individuals "who make the community stronger through volunteerism," according to the release. The program is sponsored by the Helpline Center and Black Hills Urgent Care, a division of Black Hills Surgical Hospital.
Kabrud has been a part of the Young Professionals Group since 2015. Through her role on the YPG Steering Committee, Kabrud coordinates monthly volunteer activities for the group's Community Involvement subcommittee. Volunteer efforts in the last year have included a Habitat for Humanity work site, Adopt-A-Creek Clean up with the Nature Conservancy, and Feeding South Dakota and Kids Against Hunger.
She also helped coordinate making cards for My Golden Valentine, dyeing Easter eggs with WellFully, and helped with the YFS Monster Bash and Scare in the Square.
“Kelli works tirelessly to find opportunities to get Young Professionals in Rapid City connected to volunteering. While there are some organizations the group partners with annually, she does not stop there,” Shiloh Francis, with the Rapid City Area Chamber of Commerce, said in the news release. “She finds needs and uses the YPG resources to fill them in the community. It is through her leadership and a dynamic group of involved committee members the YPG has gained a reputation of volunteers who show up and do great work.”
Helpline Center and Black Hills Urgent Care presented Kabrud with a framed certificate and Helpline Center T-shirt, gifts from Black Hills Urgent Care and a letter of appreciation from Rapid City Mayor Steve Allender. The Helpline Center will also recognize her at the Spirit of Volunteerism Awards banquet on May 21 at the Best Western Ramkota Hotel and Convention Center.
Rapid City nurse wins national award
A nurse at Regional Health Rapid City Regional Hospital has received a national award for her care.
Samantha Loen, a registered nurse, received the DAISY Award, which is presented to nurses across the United States "who go above and beyond for their patients and community," according to a news release from the hospital.
Loen received nominations from a patient and two family members. They commented on her thorough assessments, sense of humor and ability to connect with patients.
“The care she provided my dad was top notch. Her assessment skills and care are 100% thorough; she does not miss a beat! She knows how to relate to her patients and meet them where they are,” said the family member of a former patient. “Mostly, I want to thank her for her advocacy. She kept dad’s medical team informed and helped make decisions regarding his care.”
A man who previously stole drugs from an Ohio hospital will spend a year on probation after admitting to stealing morphine and fentanyl from the Pine Ridge hospital, where he worked as a nurse.
Robert Wetenkamp was sentenced Wednesday at the federal courthouse in Rapid City after previously pleading guilty to acquiring drugs by fraud, court records show. He could have been sent to prison for up to four years.
As part of his plea deal, prosecutors dropped charges of health care fraud and making a false statement regarding health care.
Wetenkamp was a registered nurse at AB Staffing Solutions, which contracts with the Indian Health Service, when he began working at the Pine Ridge hospital's emergency department in August 2016, according to a factual basis document he signed.
After being given a prescription from a doctor, nurses are allowed to access controlled substances through an automated dispensing machine, the document says. The machine records which nurse is using it and can compare the amount of drugs taken to doctors' prescriptions and the patient's medical records.
Hospital records found that on "numerous instances" between Jan. 3 and Feb. 23, 2017, Wetenkamp took drugs he wasn't authorized to access and took morphine and fentanyl for his own use, the document says. A hair sample from Wetenkamp tested positive for "numerous" drugs, including fentanyl.
Using a similar method, Wetenkamp also stole fentanyl "for his personal use" in 2002 while working as a nurse at the emergency department of University Hospital in Cincinnati, according to a consent agreement between him and the Ohio Board of Nursing.
After he was caught stealing the drugs from a dispensing machine, the document says, Wetenkamp entered a drug-addiction program. But in 2003 he relapsed and began using cocaine, and in 2004, he gave narcotics to patients even though he wasn't allowed to.
Wetenkamp had his Ohio nursing license suspended in 2005 but moved to Florida before he could try to regain it, the document says.
State and federal court records in Ohio show no criminal charges against Wetenkamp.
Fentanyl is an opioid that is prescribed to treat extreme pain, according to the Centers for Disease Control and Prevention. The drug is 50 to 100 times stronger than morphine, another opioid painkiller. Both can be addictive and abused for non-medical purposes.
AB Staffing Solutions immediately fired Wetenkamp after it learned he was being investigated for stealing drugs and the company cooperated with the investigation, company spokeswoman Meredith Donoho said. It's unclear if Wetenkamp still has a nursing license.