Health News

Aspirus in Iron River named Top 100 Critical Access Hospital

By | Emergency Medicine, Health News, Innova News, Rural Communities

So proud of our partner hospital in Iron River, Michigan!

IRON RIVER — Aspirus Iron River Hospital recently was named one of the Top 100 Critical Access Hospitals in the U.S. by iVantage Health Analytics and The Chartis Center for Rural Health.

As a top-performing CAH, Aspirus Iron River is recognized as being one of the best of the 1,332 rural safety-net hospitals in the nation, officials said.

“This achievement is very gratifying and validates our daily commitment to providing the best health care possible to our community while maintaining an efficient and effective facility,”Aspirus Iron River CEO Connie Koutouzos said. “It’s a testament to the high-quality, patient-centered care we provide. This recognition also salutes the skill and dedication that is displayed daily by our medical staff and employees. We are dedicated to leading the transformation of health care for the communities we serve.”

A CAH is a hospital certified to receive cost-based reimbursement from Medicare. This program is intended to reduce hospital closures in rural areas, promote a process for improving rural health care and focus on community needs.

CAHs are in rural areas, can have a maximum of 25 acute care in-patient beds, and provide 24-hour emergency services.

Aspirus Iron River Hospital scored in the top 100 of Critical Access Hospitals on iVantage Health Analytics’ Hospital Strength INDEX. The INDEX is a comprehensive rating of rural providers. It provides the data foundation for the annual Rural Relevance Study and its results are the basis for many of rural health care’s most prominent awards, advocacy efforts and legislative initiatives.

The list of the Top 100 Critical Access Hospitals and more information about the study can be found at

Aspirus Iron River was among only five to make the list in Michigan, another being Aspirus Ironwood Hospital. Aspirus partner hospitals in Wisconsin, Aspirus Medford Hospital and Aspirus Langlade were the only CAHs to receive the designation from Wisconsin.

The Top 100 Critical Access Hospitals play a key role in providing a safety net to communities across America — and the INDEX measures them across eight pillars of hospital strength: Inpatient Share Ranking, Outpatient Share Ranking, Cost, Charge, Quality, Outcomes, Patient Perspectives, and Financial Stability.

Aspirus is a non-profit, community-directed health system based in Wausau, Wis.

Aspirus serves communities throughout northern and central Wisconsin, as well as the western Upper Peninsula.

The integrated system includes four hospitals in Michigan and four hospitals in Wisconsin, 50 clinics, home health and hospice care, pharmacies, critical care and helicopter transport, medical goods, nursing homes and affiliated physicians.

New Car Seat Safety Recommendations for 2018

By | Health News

The American Academy of Pediatrics (AAP) has published new car seat safety guidelines as of August 30, 2018.  They have updated their recommendations to state that children should remain rear-facing until they reach the highest weight or height (whichever they reach first) for their seat.  Previously the AAP recommended rear-facing until at least age 2, but with these new guidelines, many children can and should remain rear facing much longer.

You may be wondering – why is rear-facing important?  Infants and toddlers have heads of disproportionate weight to the rest of their body.  Rear-facing seats help to better cradle the head during a crash, therefore protecting the neck and spine from injury.  Neck and spine injuries are some of the most devastating and heart-breaking injuries we care for in the emergency department.

As Emergency Physicians, we are thrilled with these new recommendations.  Car accidents remain a major cause of death and disability for children under age 15 and this evidence-based policy recommendation guides parents in proper restraint use to protect their child. Please check your specific seat for the height and weight limits for rear-facing installation.

The National Highway Traffic Safety Association has published guidelines, recommendations and can even help set up an installation inspection.   See their website for further information.

EpiPen Shortages & Anaphylaxis Risks

By | Emergency Medicine, Health News

EpiPen Shortages & Anaphylaxis Risks

Drug shortages are affecting our patients and providers on a daily basis.  One of the most concerning recent shortages is the limited availability of the Epi-Pen, a home device used to deliver epinephrine to patients with life-threatening allergic reactions (anaphylaxis). 1-2% of the population will develop anaphylaxis in their lifetime.  Anaphylaxis is a complicated reaction leading to mast cell release, airway swelling, and can cause cardiopulmonary arrest.  Epinephrine is the treatment of choice.

The development of epinephrine auto-injectors has allowed patients with a history of anaphylaxis to initiate immediate life-saving treatment in cases of repeat events.  Patients are provided with prescriptions for epinephrine auto-injectors to carry with them at all times.  Patients benefit from having multiple auto-injectors to keep at home, school, work, and daycare.

In order to manage this dangerous shortage, the FDA has extended the expiration date of some of the pens (regular Epi-pens, not the Jrs) by up to 4 months.  Patients can check the FDA website to verify the lot number on their pen.  Patients should not throw away their pens until they check the website to see if the expiration date has changed and also verify that the pharmacy can refill them.  Some schools and daycares are still refusing to use expired pens even with this FDA announcement due to liability concerns.

Verify your EpiPens here

There are now additional auto-injectors available – Adrenaclick or Auvi-Q – both are FDA approved epinephrine devices but they have a different delivery system so patients will need to read the instructions carefully and train themselves before they need to use them. Patients should check with their pharmacy to determine what they have in stock and what their insurance will cover.

Senator Cory Gardner hears about opioid solutions

By | Emergency Medicine, Health News

Senator Cory Gardner speaks out about Colorado’s Opioid Crisis

In March 2018, Senator Cory Gardner spoke to locals in Alamosa about his plans combat the Opioid Crisis in Colorado.  You can read the original post from the Alamosa Valley Courier here.

ALAMOSA — Meeting with staff and guests at SLV Health in Alamosa on Thursday, U.S. Senator Cory Gardner said he wanted to hear what is happening locally with the opioid crisis and how his office might be able to help.

“This is an incredible challenge,” Gardner said. “This is a significant public health crisis.”

Gardner spoke about two pieces of legislation designed to help deal with this crisis. The Comprehensive Addiction and Recovery Act, which has received more than a billion dollars in the past year and recently $500 million more, provides funding for prevention, education and other efforts such as promoting better tracking in an effort to eliminate “pill mills” that have overprescribed opiates.

The 21st Century Cures Act facilitates faster Food and Drug Administration (FDA) approvals of opioid treatments such as a new injectable medication introduced by Indivior that lasts for a 30-day period and helps prevent relapses.

Gardner (R) and Senator Michael Bennet (D) have also introduced SB2516, the Alternatives to Opioids (ALTO) “to get our hands around this crisis,” he said. It would direct the Secretary of Health and Human Services to conduct a demonstration program to test alternative pain protocols to reduce opioid use in emergency departments.

Also present on Thursday, Dr. Brian Shiozawa, regional director for Region 8 of the U.S. Department of Health and Human Services, which includes Colorado, said dealing with the opioid problem is the department’s number-one priority.

SLV Health CEO Konnie Martin said funding has made its way to the San Luis Valley “in very small doses” so far.

SLV Health is already implementing its own ALTO project, which is ready to become operational by May 1.

Martin and others in the room talked about measures SLV Health and its affiliates in the Valley have taken and are taking to reduce opioid use and provide alternatives to it.

Efforts include pain management contracts for patients with chronic pain, for example, and the hospital staff has updated those to make them more easily understandable for patients, SLV Health Emergency Room physician Dr. Megan Koenig said.

To make sure pain prescriptions are taken properly, those receiving such prescriptions must sign contracts that include such provisions as no refills for stolen or lost medication and urine tests before refills to make sure the person receiving the prescription is the one using it.

As part of its ALTO project SLV Health providers also recommend non-medication pain treatments such as physical therapy and acupuncture, pain management groups and referrals for other services such as behavioral health services. SLV Health also has strict internal security and monitoring for medications, Martin explained.

Koenig further described SLV Health’s ALTO project and acknowledged that while opioid prescriptions could not be entirely avoided there are other options to providing pain relief for patients. She said all departments have been cooperative, from the pharmacy to the emergency department, and providers themselves are re-educating themselves on alternatives to prescribing pain medications. She said there are four or five steps a provider must go through before writing an opioid prescription. One of those, for example, is checking the Prescription Drug Monitoring Program (PDMP), a database of patients’ prescription history. Access to PDMP is restricted, and the system is not nationwide yet.

Dr. Koenig said she wished she could access records nationwide, especially since she is seeing more patients that have moved here from other places.

She and Martin said PDMP is also limited to patient history, not provider history, so they could not find out if a provider was aggressively prescribing medications, for example.

Dr. Koenig stressed the importance of providing alternatives to patients.

“There are a lot of resources,” she said.

Dr. Donna Nelson, who attended Thursday’s gathering by phone, is a physician with the emergency department at SLV Health Conejos County Hospital. She is getting an ALTO program going there as well, and the staff is receptive to it. She added that they had already been limiting narcotics in the emergency department there for five or six years.

Senator Gardner asked Dr. Nelson where people are getting prescription drugs if the hospitals are not prescribing them as much. She said in the Valley there are still a lot of purchases on the street, although she did not know where the supply was coming from.

When the senator asked about heroin, Dr. Nelson said heroin has been prominent in the Valley for several years now.

“I couldn’t tell you where they are getting it,” she said. “It’s just as common as methamphetamines. I assume it’s very easy to get on the street because everybody’s using it.”

She said sometimes she also sees patients who overdose on heroin, and their drug screens come back positive for fentanyl, which is sometimes mixed with heroin and other drugs like cocaine.

Dr. Koenig added unfortunately this is all too common and that doctors know when a new drug supply has hit the Valley because they see patients with reactions to the new mixtures.

When asked about emergency and long-term substance abuse treatments, Dr. Koenig said many police are carrying Narconon; three providers are giving Suboxone with the goal of every clinic having at least one provider who can provide it; and a SHARRP (San Luis Valley Health Access Risk Reduction Project) clinic now offers services every Wednesday morning including a needle exchange.

Audrey Reich Loy, who directs SLV Health’s Primary Care Clinical Operations, added that there is also a methadone clinic here.

She said SLV Health can provide some outpatient treatment on a limited basis and she would like to see that expanded.

Loy said inpatient treatment is limited.

Dr. Nelson added that at the Conejos Hospital staff refer patients to groups like Narcotics Anonymous and Alcoholics Anonymous, and several of the AA meetings here also welcome those suffering from other addictions besides alcohol.

Donna Wehe, SLV Health director of communications, added that another treatment tool being implemented here is the LEAD (Law Enforcement Assisted Diversion) program that will assist defendants with options and resources other than incarceration.

Senator Gardner asked about marijuana in relationship to opioids. Kelly Gallegos, administrator for the SLV Health Conejos County Hospital, said that while some have said marijuana is the answer to the opioid problem, providers have found the opposite to be true. She said marijuana has contributed to the problem.

Martin added that too often people who have relocated here to be closer to legal marijuana have brought a myriad of other problems with them, and they have not been contributing members of the society.

“It stresses our system, and it stresses our community,” she said.

Dr. Koenig said there are patients who receive some benefit from marijuana use and are not abusing it.

Gardner asked SLV Health Interim Chief Medical Officer Dr. David Geiger, a surgeon, what legislation he would like to see at the federal level, whether it would mean more money or other resources. Geiger said money is always helpful, but the key is education regarding alternatives.

Loy added that another solution is to deal with the poverty that exists in many of the communities where people have turned to drugs.

Martin said, “This problem is huge … but the only way you are going to solve it is a piece at a time.”

It is like a puzzle, she said, where one piece at a time can be put in place to solve the bigger picture problem. She said SLV Health has shifted resources to make it a priority to implement the ALTO project.