Newsletter - Bartlett Regional Hospital

HouseCalls Fall
We bring healthcare information home to you.
2011
our mental health team
Keeping those hands clean!
See page 15

Board Talk
Kristen Bomengen, President, BRH Board of Directors
The board’s vision is for Bartlett to be the best community
hospital in Alaska. Clearly, this vision is shared by
Bartlett’s staff as demonstrated by their work each day.
The articles in this newsletter reveal some of the gains we have
made toward realizing this vision and focus on our progress in
the treatment of mental illness. The board intends for Bartlett
to continue this progress as we plan for the development of a
child and adolescent mental health unit at our facility in the
coming years.
Bartlett’s Mental Health Unit, housed on the top floor of our
hospital’s new wing, is a critical part of a community effort to
provide inpatient and outpatient care for those with mental
health challenges. It is encouraging to read of the heightened
empathy for the mentally ill in our community. We all have a
stake in serving our community, and I’m proud that the people
of Juneau have taken the initiative to improve our capacity to
serve those in need, as shown by their support of the agencies
that provide these services.
To measure just how we rate as a “community hospital” we
often compare Bartlett with similar facilities, and even with
those of Anchorage or Seattle. When it comes to the primary
care provided at Bartlett, our services stand among the finest.
As a board member, it is gratifying to read letters we receive
from visitors to our city who have needed Bartlett’s medical
care. Repeatedly, this correspondence declares our staff and
services to be outstanding.
But BRH faces many challenges to providing a broader range
of care. The population of our service area is not large enough
to support many special services readily found in a large urban
setting, such as a burn unit, a neonatal care unit, or organ
replacement surgery. The development of capabilities such as
these would generally require a larger population base to have
a sufficient number of patients to keep the respective medical
teams certified in a specialized field.
It is through the medivac services, as described in this issue,
that we are able to provide the people in our region with access
to specialty care facilities in large medical centers. The physicians
serving our community deserve great praise for so
promptly recognizing when a patient’s medical condition warrants
treatment at an intensive care facility.
We are proud that our hospital has made a commitment to
improving health care in our community through partnering
with Hospice and Home Care of Juneau so that more people
can receive appropriate care in appropriate settings.
Health care is a complex, ever-evolving system in which we
gain improvements and efficiencies by applying new knowledge,
integrating new technologies, and improving coordination
among many medical practitioners. On behalf of our
board, I congratulate the nurses working at Bartlett who have
taken the lead through the Shared Governance process to
improve patient care.
The Highest Possible Quality Obstetrical Services
Vaginal Birth After Cesarean: VBAC
At Bartlett Regional Hospital, our mission is to provide the highest possible quality
obstetrical services to the women of Southeast Alaska. Patient safety is our primary
objective in all that we do.
In August of 2010, the American College of Obstetrics and Gynecology (ACOG) published
a position statement explaining the benefits and risks of vaginal birth after Cesarean
(VBAC: pronounced “vee-back”).
Because of recent community interest, we have consulted with area physicians and carefully
reviewed our VBAC policy. We have concluded that it is prudent to continue our
current policy of not offering VBACs at Bartlett Regional Hospital.
We have reached this conclusion after extensive consideration of ACOG’s position statement,
discussions with our advisers, who include pediatricians and perinatologists (high
risk OB specialists), and consultation with our risk management specialists.
Continued, page 18
HouseCalls — 2

Caring for the Mentally Ill
A highly functional system
Most of us will experience depression or anxiety to one degree or another at some point
in our lives. With prolonged feelings of sadness or hopelessness, such conditions become,
by medical definition, mental illness. Fearful of being labeled “crazy,” all too often people
suffering from depression and anxiety disorders are reluctant to seek help when they need
it most. When fearful that such a state could lead to self-harm, friends and family have
reason to take pro-active steps for their loved one.
A
strongly built man stalks down
the middle of a South Franklin
Street sidewalk flailing his arms
while carrying on a loud and vigorous
argument—with himself. Tourists step
aside to let him pass.
Two police officers, responding to calls
from concerned merchants, make contact
with the man and begin a dialogue.
Their immediate concern is whether he
is a threat to others or, much more likely,
a threat to himself.
“This can be a very challenging environment
for police officers,” says Lt.
Kris Sell of the Juneau Police Department.
“People who come to our attention
because of this sort of behavior are
rarely criminal, but they can be alarming
to their families or the people around
them. The question we have to answer
is does this person meet the standard for
‘emergency detention for evaluation’?”
For an adult to be committed for psychiatric
care, he or she must meet certain
criteria. In the above scenario, if police
officers determine the man’s behavior
suggests he is a danger to himself or
other people, or is incapable of caring
for himself, the next stop will be the
Bartlett Regional Hospital Emergency
Department.
Lt. Sell says that Juneau police officers
do their best to avoid the use of force.
“But we have to respond to the person’s
behavior. He controls the situation.”
Typically, such a person is well known to
the police. “Often our officers have built
a rapport with such people,” she says.
“Most cooperate when we tell them they
have to go to the hospital, but sometimes
we have to physically restrain them. We
hate doing this. We did not get into this
job to constrain the mentally ill.”
Once at the Emergency Department,
the officer will often stand by, not as an
enforcer, explains Sell, “but keeping the
person company so that they are not
alone in a cubical.”
When a patient presents mental issues,
the Emergency Department will place
a call to the Juneau Alliance for Mental
Health, Inc. (JAMHI, commonly
referred to as “jammi”). One of the clinicians
on call might be Lee Burgess, who
supervises the JAMHI mental health clinicians—eight
professionals who work
either as clinic staff or on contract. A
clinician is on call 24/7 to respond to
mental health emergencies.
“When we see the patient in the ER,”
Burgess explains, “we triage to determine
whether the person meets the criteria
for admission.” A clinician decides
if the patient poses a threat to himself
or others or has a grave disability, which
is defined as being unable to meet one’s
basic needs.
One challenge for the ER medical staff
and the clinician is to evaluate accurately
whether a person who is talking
aggressively about suicide or harming
others is serious. Maybe the person
is very intoxicated, or has been abusing
drugs, has a medical condition like
a traumatic brain injury or dementia.
“Sometimes they simply do not have the
capacity to harm anyone or their intent
to harm themselves is not credible,” says
Burgess. “Before we can make a determination,
sometimes we have to wait
until they detox.”
Continued, next page
3 — Fall 2011

Rich in Resources
“We are blessed with a high number of psychiatrists,” says
Dr. Robert Schults, referring to the strong quality of professional
resources immediately available to the residents of Bartlett
Regional Hospital’s service area. “We have five psychiatrists here
at the hospital, and another four in private practice.”
According to Dr. Schults, four of the nine local psychiatrists are
trained in childhood/adolescent psychiatry.
Psychiatrists are physicians who specialize in the diagnosis and
treatment of mental disorders. About a dozen masters level or
higher psychologists and as many similarly credentialed Licensed
Professional Counselors also provide counseling services in the
Juneau area.
Bartlett Service Area Resources:
The Juneau Alliance for Mental Health, Inc. (JAMHI)
provides emergency response 24/7, as well as
rehabilitation, psychiatric and nursing care, general
mental health, a drop-in center, and enhanced
residential services.
NAMI—the National Alliance on Mental Illness—is a
nationwide support network that provides technical
assistance to local mental health affiliates. It also
advocates for the mentally ill and their families, and
provides community education to combat the stigma
frequently associated with mental illness.
The Juneau Community Suicide Prevention Task
Force, a coalition of community resources, hosts a
website that provides links to services available for
those with thoughts of suicide, or their family and
friends. See:
www.juneausuicideprevention.org
A person cannot be admitted to the
MHU, voluntarily or involuntarily, without
meeting basic criteria. Occasionally,
a homeless person may act out, hoping
for a few days of shelter. But even if
someone appears to be falsifying symptoms,
he or she is still taken seriously.
The underlying concern is that even
those who have threatened suicide or
homicide for spurious reasons might
at some point become serious. “We
want to err on the side of caution,” says
Burgess.
The underlying concern is
that even those who have
threatened suicide or homicide
for spurious reasons
might at some point become
serious.
Burgess admits the process of assessment
can be frustrating for family,
friends, or advocates for the mentally ill,
especially when a person with mental illness
refuses treatment. “The family may
not understand the strict criteria,” he
says, “and not understand how it could
be that we would not admit an obviously
mentally ill person.”
“It is a civil rights issue,” says Pam Watts,
head of JAMHI. “Sometimes the situation
gets tense. To family members
it may seem like a no-brainer. They
become indignant, concerned that the
mentally ill person is vulnerable. But
we can’t just lock somebody up because
someone else thinks they should be
locked up. There has to be a medical
necessity; before admission, that person
has to meet the statutory risk requirements.”
The determination of medical necessity
is made by a psychiatrist.
Dr. Robert Schults, MD, a psychiatrist at
Bartlett for over 11 years, has practiced
in Alaska since 1985. “A clinician will call
HouseCalls — 4

me and describe the situation,” he says
of a typical discussion that precedes a
request of the court for an ex parte decision
on commitment. If the psychiatrist
confirms the clinician’s assessment that
an involuntary admission is justified,
then the court is petitioned.
If the court accepts the ex parte petition,
a person can be involuntarily admitted
for psychiatric care, without a hearing,
for up to 72 hours. (The 72-hour hold
is defined in state law as three working
days.) In addition to the mental state of
the person being assessed, Dr. Schults
says he and the clinician will also discuss
the patient’s medical history and physical
condition.
District Court Judge Keith Levy routinely
handles ex parte cases. “Most of
the time, the petitions are granted,”
he says. “The conditions under which
ex parte requests are considered are set
out in statutes and are well defined.”
Extending the hold beyond 72 hours
requires a court hearing. Patients then
have the right to counsel. “This becomes
a formal, recorded proceeding that usually
involves a psychiatrist, an assistant
attorney general representing the state,
and a publicly appointed attorney representing
the patient,” Judge Levy explains.
For those with acute mental illnesses,
such as people who present with symptoms
of schizophrenia, are not uncommon,
more typically patients admitted
for treatment at the Mental Health Unit
are suffering from anxiety disorders
(often due to an underlying physical
problem like diabetes or low oxygen
levels caused by such conditions as
emphysema) or profound depression.
“There are more suicides due to depression
than other causes,” says Schults.
“Sometimes sadness and depression
come on without cause. Often, the brain
chemicals that allow us to enjoy life are
depleted,” he says.
Schizophrenia is of a different order
than depression or anxiety, but these
conditions all respond to pharmaceutical
treatments. “These days, medications
are usually well tolerated,” says
Dr. Schults. “We work to get the right
combination—we don’t give up. We can
usually dial in the dosage and combination,
and some people can stay on the
medication for years. Unfortunately, the
all too common response is that when
people begin feeling good they stop the
medication.”
“We work to get the right
combination— we don’t
give up. We can usually dial
in the dosage and combination,
and some people can
stay on the medication for
years.”
—Dr. Robert Schults
Even if a person meets the criteria and
is admitted to the MHU, he or she
might be treated and within a day or
two discharged. If not yet stabilized,
some patients will volunteer to stay
longer, thereby avoiding a court hearing.
“Most people wind up cooperating,”
says Eddie Jones, discharge planner
for the MHU. “A 30-day extension
doesn’t have to be 30 days. Might just
be a couple of extra days. Sometimes,
if there is no sign of improvement, a
stay might be extended to 90 days.”
It is Jones’ responsibility to make certain
that a patient has a safe living situation
following discharge. “Many are homeless,
living on the street,” says Jones, who
comes to his role at MHU with a 20-year
background in similar positions, most
recently with REACH, a local agency
that provides developmental disability
services. “It can be difficult to plan
around those situations. Typically, we
try to connect with JAMHI services or
other mental health agencies that can
follow them once they are back out in
the community.”
For those people who stop using their
meds, the cycle can repeat itself and the
police may be called. The police officers
will do their best to contain the situation,
get the person back to a place of safety,
and avoid the necessity of yet another
visit to the Emergency Department.
Eddie Jones confirms Lt. Kris Sell’s
description of police officers as empathetic.
Over his career, he has observed
a steady increase in the Juneau Police
Department’s capabilities in dealing
with the mentally ill. “Police are the front
line assessors of people’s behavior,” says
Jones. “I know many of these police officers.
They are very astute, highly competent,
and know what their role is.”
As with any complex system involving
institutions like the police department,
the courts, the medical and mental
health professions, and social services,
improvements are part of the ongoing
process. “There are always bumps in the
road,” says clinician Lee Burgess, “but
by working together to iron out those
bumps, we are able to help each other
maintain a high standard of care. We
spend a lot of time improving what is
already a highly functional system.”
5 — Fall 2011

Nurses: Educated Locally
For many, a mid-life career choice
Leslie Vianne, a mother of four
adult children, was in her early
40s when she decided to become
a nurse. Lincoln Farabee, a glass artist
and part-time Certified Nursing Assistant,
entered the University of Alaska’s
nursing program about the time he
turned 30. Deanna Browne went back to
school soon after her third child turned
two; and Sally Whiting’s daughter was
in kindergarten when she enrolled. A
semester before graduating, Whiting
gave birth to her second daughter.
Vianne, Farabee, Browne, and Whiting
all graduated from a two-year distance
learning Associate Degree Nursing Program
hosted by the University of Alaska
Southeast in Juneau. In May 2003,
Vianne was among the last graduates of
the UAS-based Weber State program.
Soon after, the University of Alaska
Anchorage extended its distance learning
program for nursing to the UAS
campus.
In the eight years since Vianne graduated
and completed a preceptorship
at Bartlett Regional Hospital, she has
advanced through several levels of nursing
(Clinical Nurse I, II, and III), most
recently earning a medical/surgical
certification through the Academy of
Medical Surgical Nurses. “Normally, I
would have had to go outside to take
the test, but Bartlett rallied and got
enough nurses that we were able to
study and take the test here in Juneau.
The hospital has been extremely generous
in its support,” says Vianne, now
a CN III.
“Nursing turned out to be a great
career choice for me, with lots of educational
opportunities,” Vianne says.
Vianne has helped out in other sections
of the hospital, such as obstetrics and the
Critical Care Unit, but she is assigned
to the medical-surgical (“med‐surg”)
floor. “Medical-surgical nursing can be
extremely demanding,” she says. But she
enjoys a good challenge. “We’ll have as
many as 20 patients on the floor, with
each of us handling the admission, discharge,
or care of four to seven patients
a day. This involves a lot of critical decision
making as well as teaching patients
such things as wound care and medication
management.”
Deanna Browne began working as a
technician at Juneau’s Reifenstein Dialysis
Center while participating in the
UAA/UAS distance learning program.
“During our clinical rotations, while still
in school, I rotated through the dialysis
center. I liked it. I approached the
manager and was hired as a technician,”
Browne recalls.
After she passed her nursing exam in
2008, Browne continued working at the
dialysis center, but as a fully accredited
nurse. In early 2010, when the center’s
manager transferred to another clinic,
she was appointed interim manager,
a position she served in until October
Deanne Browne, a 2007 graduate of the
UAA/UAS distance learning Applied Science
Nursing Degree.
2011, when she returned to the nursing
duties she favors. “As a manager, I did
not get the hands-on experience I prefer,”
says Browne.
One of the advantages of being a nurse
at Bartlett Regional Hospital, Lincoln
Farabee says, is that the work schedules
allow for ample time to pursue other
interests such as working part time as
a hospice nurse. Most nurses at Bartlett
work three 12-hour days and are off duty
four days a week.
Farabee, also an active glass artist, is
hard-pressed to contribute as much
time as he would like with Juneau Hospice,
an experience he describes as
highly rewarding. “When I work at the
hospital, I’m in charge of my environment.
With Hospice, I go to another
Sally Whiting, born and
raised in Juneau, now lives in
Anchorage with her daughters
Cecilia (6) and Alanna (12),
pictured here with the family
cat, Piper (see eyes), and
Cordelia the dog. Sally got
her two-year nursing degree
in Juneau, and now has a BS
in Nursing that she earned
in another distance learning
program.
HouseCalls — 6

earning a Bachelor of Science Nursing
degree through another distance learning
program. “Nursing is flexible and
exciting—there are so many avenues you
can go down. If you like to do multiple
things, don’t want to be tied down to one
type of job, it’s a great, very dynamic job,”
she says, while admitting that there can
be a down side to 12‐hour shifts three
days a week. “Long hours, lots of stress;
it can be exhausting.”
Whiting recently received the “Daisy
Award for Extraordinary Nurses,” an
award given by a national program
started by the parents of a son who died
of an autoimmune disease to honor his
nurses (DAISY: diseases attacking the
immune system). Patients have to make
the recommendation for a nurse to be
considered for the award. It is a distinction
that Whiting says she is “super
proud to have won.”
Lincoln Farabee, a 2007 graduate of the distance
learning program hosted at UAS, is a Bartlett RN who
moonlights with Hospice and Home Care of Juneau.
person’s house and work by their rules.
It is a very humbling feeling.”
Now four years into his nursing job at
Bartlett, Farabee says he looks forward
to going in to work. “After several days
off, I find it exciting to be back at the
hospital. You don’t know what you’ll run
into.” He enjoys rotating through Med-
Surg, the Critical Care Unit, and the
Emergency Department, but working
in the Mental Health Unit is a particular
favorite. “The experience can be similar
to hospice—you are dealing with
people’s emotions, as well as being concerned
with their medical and physical
conditions. It is a good challenge.”
While earning her Applied Science
Degree in Nursing, Sally Whiting
worked as a Certified Nurses Assistant
in Bartlett’s Mental Health Unit. Soon
after graduating from the UAA distance
learning program, Whiting, born and
raised in Juneau, moved to Anchorage
with her two daughters. She is now a
nurse at Providence Alaska Medical
Center, where she works the surgical
end of the med‐surg floor.
Whiting continued her education after
moving from Juneau, receiving a medsurg
certification and, more recently,
The Applied Science Nursing Degree
A demanding and increasingly selective program
According to Kathleen Stephenson, Associate Professor of the UAA distance
learning nursing program, Ketchikan and Kodiak hosted the first remote applied
science nursing degree program sites in 1999. “Including Anchorage, we now have 13
sites,” she says. “We are in a majority of the communities with hospitals in Alaska .”
When Stephenson first began teaching distance education classes, there was no video
conferencing. “We had some computer applications and teleconferencing, but video
came later.”
Teaching from a distance presents challenges not faced by live classroom instructors.
“It is different,” says Stephenson. “With a classroom, you can watch reactions. My
experience with distance learning is you have to work very hard to engage with
students.”
The University of Alaska Anchorage offers advanced nursing programs such as
Bachelor of Science and Masters degrees, but unlike these programs, which require
the student to live in Anchorage, the distance learning degree has the advantage of
allowing people to live, raise their families, and often work in their home communities
while earning the degree, a requirement for a candidate to sit for the board certification
to become a Registered Nurse.
Without the two-year distance learning program, Deanna Browne does not believe she
could have become a nurse while raising three young children. Even then, it was a
balancing act. “I did the mom duty, but it was pretty difficult to get all the study in,” she
recalls. “You have to be on your game.”
Justine Muench, RN, MN, is now the Juneau-based UAA Assistant Professor of Nursing
for the Associate Degree program, which was formerly run by Chris Urata, RN. Urata
now heads the Health Sciences Department for the University of Alaska Southeast.
“The Applied Science degree provides a solid foundation in nursing and allows nurses
to work in a variety of situations in hospitals and in outpatient settings,” says Muench,
who advises graduates from the two-year program to continue their nursing education,
if possible. “Among other opportunities, with a BSN or Masters degree, you can
advance to a teaching career or nurse practitioner work.”
“In some ways, it is more efficient to get a BSN,” says Prof. Stephenson, “but it doesn’t
work for those students who can’t move to Anchorage for three or four years. A lot
of our distance learning students tend to be older, have growing families, and want a
program that allows them to start out sooner.”
The current UAS Juneau cohort will graduate in December 2011, while the succeeding
cohort of eight students—selected from 19 applicants—will begin studies in January
2012.
7 — Fall 2011

Annual Report Figures
FY 2011 Unaudited data
Revenue 2011
Billed for services to governmental and commercial
contractual providers and private payers (patients) $ 115,844,279
Received from other sources, such as grants and rentals 3,709,917
Total sources of revenue: $ 119,554,196
Billed but payments not received from:
Governmental and commercial contractual agreements $ 26,403,431
Patients who did not pay (bad debt) $ 9,267,542
Community-funded care (charity care) $ 1,437,588
Net revenue from patient care and other services: $ 82,445,634
Expenses
Salaries and benefits $ 46,470,478
Supplies, insurance, utilities and other general expenses 24,948,915
Interest on debt 1,301,797
Depreciation of buildings and equipment 6,552,177
Total cost for patient care and other services: $ 79,272,868
Net income (funds available for capital expenses,
such as new programs, equipment, and facilities): $ 3,172,767
A healthy newborn is the happy result of Bartlett’s determination to
provide the highest possible quality obstetrical services (see page 2).
Cori Austin, RN, right, discusses Shared Governance issues with facilitator
Sarah Hagrave, RN. (See story, page 16.)
Photo by Seanna O’Sullivan Hines
Statistics
2011
Licensed inpatient beds..........................................45
Mental health inpatient beds...................................12
Chemical dependency beds...................................16
Full-time-equivalent employees............................441
Credentialed medical staff......................................75
Courtesy credentialed medical staff.......................46
186 27
14 50
343
Inpatient
2011
Inpatient surgeries performed.......................................................................... 723
Patients discharged (Adults and Pediatrics)................................................. 2,371
Patients discharged (Rainforest Recovery Center)........................................ 209
Days of patient care provided (Adults and Pediatrics)................................ 9,139
Days of patient care provided (Nursery).......................................................... 819
Days of patient care provided (Rainforest Recovery Center)...................... 3,706
Babies delivered.............................................................................................. 409
Outpatient
2011
Patients cared for in the emergency room..................................................14,636
Outpatient surgeries performed.....................................................................2,642
Laboratory tests performed.......................................................................112,568
Diagnostic imaging procedures performed.................................................30,844
HouseCalls — 8

Heart Attack Care
We achieved a 100% composite score (compared to a 95% national average)
for achieving the nationally-measured care standards for heart attack
care:
Giving aspirin at arrival
Giving clot-busting medications within 30 minutes for certain types of
heart attack
Prescribing aspirin at discharge
Prescribing the appropriate medications for patients with weakened
heart muscles
Prescribing cholesterol-lowering medications for patients with high
cholesterol levels
Providing smoking cessation information to patients who smoke
Heart Failure Care
We achieved a 97% composite score (compared to a 94% national average)
for achieving the nationally-measured care standards for heart failure
care:
Providing specific discharge instructions that help patients transition
to self-care
Testing patients’ heart muscle function
Prescribing the appropriate medications for patients with weakened
heart muscles
Providing smoking cessation information to patients who smoke
Pneumonia Care
We achieved a 97% composite score (compared to a 94% national average)
for achieving the nationally-measured care standards for pneumonia
care:
Providing influenza and pneumococcal vaccination
Testing blood samples correctly to maximize effectiveness of antibiotic
therapy
Starting the right antibiotics early
Providing smoking cessation information to patients who smoke
Surgical Care
We achieved a 97% composite score (compared to a 96% national average)
for achieving the nationally-measured care standards for surgical care:
Giving the right antibiotics as an infection prevention measure within 1
hour prior to making an incision
Stopping use of preventative antibiotics on time to reduce negative
side effects
Removing body hair around the surgical area correctly
Removing urinary catheters quickly after surgery to prevent infection
Actively warming patients after surgery to prevent complications
Giving necessary heart medications to patients who have been taking
them in the past
Taking timely steps to prevent blood clots after surgery
The Mammovan during a 2011 visit to Skagway. The mobile mammography
service is a partnership between Bartlett Regional Hospital and the SEARHC
Breast and Cervical Health Program.
Frank Sis, RT, right, testing Diagnostic Imaging’s brand new 128-slice CT scanning
device, which produces high resolution images very quickly, and is of sufficient
diameter to accommodate large patients. (see Robyn Free profile, page 11).
Therese Thibodeau, RN, shows off her clean hands during Bartlett’s Hand
Hygiene Fair in August (see page 15).
9 — Fall 2011

Profiles
Urologist Recruited by BRH
Michael J. Saltzman, MD
Kidney stones don’t always cause
pain; most pass unnoticed through
the urine stream. But those who have
suffered from large kidney stones that
obstruct the ureter describe the experience
as among the most intolerably
painful episodes of their lives. Thanks
to the arrival in Juneau of urologist
Dr. Michael Saltzman, non-surgical
relief is at hand.
“Shock wave lithotripsy is not new, but
it is new to Juneau,” says Dr. Saltzman.
“This is a non-invasive treatment for
kidney stones.” The procedure applies a
focused, high-intensity acoustic pulse to
break up the stone.
Dr. Saltzman was recruited to Juneau by
Bartlett Regional Hospital. He arrived in
April 2010 and has since opened a pri-
Post-graduate training 1997-98
Auckland Hospital, Auckland, New Zealand
Internship & Residency 1991-97
Urology: New York University Medical
Center, New York, NY
Rotations:
Tisch Hospital, New York University Medical Ctr.
Manhattan Veterans Affairs Hospital
Bellevue Hospital
Cabrini Hospital
Memorial Sloan-Kettering Cancer Center
General Surgery:
New York University Medical Center
Education
Eastern Virginia Medical School, Norfolk, VA, M.D., 1991
College of William & Mary, Williamsburg, VA, B.S. 1986
vate practice. He is the only urologist
practicing in Juneau.
Continued, page 19
Felix Hands Over Helm at Treatment Center
Sandra Kohtz joins Rainforest Recovery Center as new director
In May of this year, Sandra Kohtz succeeded Matt Felix as the director of Rainforest
Recovery Center. Felix, on contract from the National Council on Alcoholism
and Drug Abuse, handed off to Kohtz a revived treatment program. “Matt did a
wonderful job getting this program back on an even keel,” she says.
Kohtz has over 30 years of experience in providing and supervising behavioral
health and clinical treatment of substance abuse problems, most recently in Sparks,
Nevada, where she worked with a staff of 120 professionals. She now supervises
approximately 30 staff members at Rainforest.
Through her many years in the profession, Kohtz has developed an expansive view
of recovery. A good treatment program, she maintains, is one that is flexible. “This is
a soft science; it can be very difficult to measure outcomes. But the push these days
is to count the number of people we treat who stay straight and sober—not necessarily
the best measure,” she says, explaining that, too often, treatment is looked at as
something that either worked or didn’t. “Sometimes treatment lengthens the time
between binges. Maybe they slip, but still, the treatment has improved their quality
of life—they are employed, staying out of legal trouble, and their health is good.”
Even though the medical profession has long recognized addiction as a disease
and, more recently, the insurance industry has too, it remains a condition fraught
Continued, page 17
HouseCalls — 10

New Diagnostic Imaging Director: Robyn Free
We had her at “Want to take a look around?”
hen I came in for an inter-
I was so impressed,” says
“Wview,
Robyn Free, who has nearly 30 years
in the radiology profession, 20 of those
in management positions. Taking up
the offer of a tour of the facility, Free
inspected the equipment, almost all of
which has been acquired since the Diagnostic
Imaging Department moved into
its space on the ground floor of Bartlett’s
new wing in 2007. “Everything was so
new and shiny. I said to myself, I want
this job!”
During the course of her career, Free
has worked in several diagnostic imaging
departments where the equipment
was outdated because the replacement
schedule had repeatedly been pushed
forward, and, due to budget constraints,
the cost of replacing a full suite of equipment
kept putting the acquisitions out
of reach.
Hired as Director of Bartlett’s Diagnostic
Imaging Department in December
2010, Free has since presided over
Robyn Free, the new Director of Diagnostic Imaging, explains one of the latest equipment additions to her
department, a stereotactic biopsy table. The table is a recent upgrade of equipment Bartlett has had for about
seven years that allows surgeons to extract tiny fragments of suspicious breast tissue without resorting to
invasive surgery.
the addition of two new 16-slice and
128-slice computed tomography (CT)
scanners, both of which are designed
to accommodate bariatric (overweight)
patients. The additional capacity of the
128-slice scanner is useful in cardiac
studies.
“The 128, which is going to be the workhorse,
is positioned close to the emergency
room,” Free explains. “Both are
excellent scanners: the 16 is not the
lesser scanner, but the 128-slice CT is
ideal for vascular or cardiac scans.”
The additional speed and imaging
capacity of the 128-slice scanner allows
it to take several thousand images
within seconds that, through sophisticated
software, assemble as threedimensional
images of heart chambers,
The Robyn Free with the new 16-slice CT recently
acquired by Bartlett Regional Hospital, which will
provide backup for the “workhorse” 128-slice scanner.
blood vessels, and other parts of the
human body.
Free is not new to Alaska, having
worked in the Anchorage area for five
years beginning in 2002. She grew up
in Oregon and worked in Washington
and Tennessee. Free, who has degrees
in Radiologic Technology and Organizational
Leadership, also holds a Juris
Doctor of Law. “Getting a law degree
was my mid-life change,” she says. “I
enjoyed the educational part, but found
that I didn’t want to pursue the profession.”
Her husband is currently in nursing
school at Boise State and, having served
an internship at Bartlett, intends to seek
a job here upon graduating in May of
2012. Free moved here with two dogs
she describes as “huge” and well adapted
to the climate. “My dogs are ecstatic to
be back in Alaska.”
11 — Fall 2011

Hospice and Home Health Services for Bartlett Patients
Thinking outside the walls
A
strong and collegial relationship
became even stronger in
May of this year when Bartlett
Regional Hospital contracted with Hospice
and Home Care of Juneau (HHJC)
to provide more home health and hospice
services to Bartlett’s patients.
“We were looking at what we could do
differently that would reduce the hospital
readmission rate,” says Nancy Davis,
RN, who job-shares a position at Hospice
and Home Care with Rosemary
Gruening, RN. Davis is credited with
initiating the discussion with hospital
management.
Before the agreement was signed, most
reimbursements for home health services,
including those from Medicare,
required a patient to be classified as
homebound; in other words, hospice
services provided in a hospital setting
are rarely reimbursable. “We saw a real
need for people who did not meet the
severe standard of being homebound,”
Davis says, “but who clearly needed help
getting a better plan for home care.”
“With this arrangement, we can see
patients at the hospital or in their
homes,” explains Gruening. For such
services, Bartlett now reimburses Hospice
and Home Care.
According to both Davis and Gruening,
a major reason for people requiring
readmission to the hospital is the failure
to adhere to a medication regime. “Usually
there is a good reason they cannot
adhere to their prescriptions,” says Gruening.
“Rarely is it purposeful.”
Davis gives the example of patients with
early-onset dementia who are at risk of
not properly taking their medications.
“People with this condition usually
function really well at home and may
live alone with minimal help,” she says,
describing the very type of person who
would probably not qualify under Medicare
as homebound. “But their inability
to manage a medication regime is right
up there with other executive function
difficulties like bill paying.”
You don’t have to be afflicted with early
dementia to have trouble keeping your
medication schedule straight, adds Gruening.
Many people who would not otherwise
qualify for home care coverage
are dealing with very serious medical
conditions, such as complications from
diabetes, heart disease, or emphysema,
or multiple illnesses, and have to take
a series of medications. “They may not
be sure how to use the medications
carefully,” says Gruening. “We can help
structure their drug intake.”
In return for the reimbursement, home
health and hospice services are provided
to all Bartlett patients who are in need.
Previously, pre-discharge services were
often provided to hospital patients, but
at a loss to Hospice and Home Care of
Juneau because reimbursements from
insurance programs would not kick in
until a patient had returned home. In
addition, many patients coming out of
the hospital do not meet the strict insurance
qualifications for reimbursed home
health and hospice services.
Now, under the terms of the contract,
a qualified Hospice and Home Health
RN— usually Gruening or Davis—
attends the daily discharge meetings
with the hospital’s case management
workers, and a home health nurse is
available to meet with patients and families
prior to discharge from the hospital
and provide education as needed. For
an at-risk patient, a nurse assigned by
HHCJ will visit the patient’s home prior
to discharge to assess the readiness and
ability of the domestic arrangement to
ensure safe care at home. And, upon
discharge, in-home nursing services will
be provided to those patients at high risk
for readmission to the hospital.
While one might think that having a
revolving door of readmissions would
be a good thing for a hospital, such a
business model doesn’t work in the
realm of health care. Bartlett Regional
Hospital provides care to whomever
comes in the door, regardless of whether
the patient has insurance or monetary
resources. Unfunded care quickly adds
up, so reducing or preventing hospital
readmissions helps to mitigate financial
losses.
The rubber meets the road in the office
of Case Management. “We prepare the
way for a patient to leave the hospital,”
says Maureen “Mo” Lodovici, RN, a
case manager. “Before, if we thought
there might be a referral, we’d call and
let Hospice know there was a patient
needing their services. This just slowed
the process. Now, with the new agreement,
a hospice nurse attends the daily
discharge meetings and is very much
a part of the collaboration for those
patients who will need hospice services.”
Lodovici says that without this close
collaboration, a patient who is ready
for discharge on Friday might have to
remain in the hospital until Monday to
HouseCalls — 12

wait for home health services to become
available. “Now it is a more streamlined
process.”
The contract negotiations involved
Rosemary Hagevig, Executive Director
of Hospice and Home Care of Juneau,
and hospice nurses Gruening and Davis.
“Bob Urata, our medical director, also
participated,” recalls Davis, “as did board
members Kevin Richie and Dr. Lindy
Jones.” Bartlett personnel included Chief
Executive Officer Shawn Morrow, Chief
Financial Officer Garth Hamlin, and
Cathy Carter, Director of Nursing.
“I give Bartlett a huge amount of credit
for thinking outside the walls,” says Davis,
who will soon complete her three-year
term as President of the Alaska Nurses
Association. “The hospital really wants
the health of our community to improve.
People should be as healthy as possible,
and Hospice and Home Care of Juneau
and Bartlett Regional Hospital have
come together with a plan that makes
sense for our community.”
The Necessity of Medivacs
When illness or injury requires transport to specialty medical centers
At 18 months, Jason was the
picture of health—happy,
exuberant, and speaking his
first words. Then, suddenly, while in his
father’s arms, the boy began convulsing.
His eyes rolled back in his head, and he
stopped breathing.
Quick action by Jason’s father, who
applied CPR, may have saved his life.
Alerted by a frantic phone call from
the boy’s mother, Bartlett’s Emergency
Department was prepared to receive the
child the moment he arrived by ambulance.
Upon examination, Jason presented
no obvious symptoms, so he was
admitted to the hospital for a period of
observation.
The next morning, while being examined
by family practice physician Richard
Welling, MD, Jason seized again.
“He doesn’t present the symptoms we
are hoping for,” Dr. Welling explained
to Jason’s parents. If Jason had a febrile
seizure caused by elevated body temperature,
Welling said, that would be the
answer. “It is not unusual for children
this age to seize when ill with a viral
infection.”
The alternative diagnoses were much
more serious than a febrile fever: a possible
brain bleed, which could have been
caused by head trauma, or perhaps an
organic malfunction similar to epilepsy.
Dr. Welling briefly considered a CT scan
or an MRI—both difficult to perform
with a child of Jason’s age. The doctor
then reasoned that if a scan revealed a
problem with the brain,
pediatric neurological
care would be required
that is not available at
Bartlett. All things considered,
it was time to
medivac Jason to a pediatric
care facility.
Jason, a grateful customer, now
two years of age poses in the
arms of Shelly Deering, RN, who
stands with the Airlift Northwest
crew, from left to right, Joy
Gaddis, RN; Lori Avaiusini, RN;
Garth Rydell, pilot; Chad Stilp,
pilot; Jeremy Fradet, pilot; Carl
Bottorf, RN; Eric Barry, pilot; and
Diana Paul, RN.
Continued, next page
13 — Fall 2011

Within a few hours, Jason and his
mother, Gemma, were aboard a Learjet
on their way to Anchorage. His father
and brother followed later that day on a
commercial flight.
Organized medivac service in Southeast
Alaska, now so common as to be taken
for granted, was nonexistent 30 years
ago. In 1978, Michael Copass, MD, a
specialist in neurology and critical care
medicine who had long been associated
with Harborview Medical Center of the
University of Washington in Seattle,
was visiting Sitka to teach a course in
trauma medicine for medical practitioners.
“There was a terrible house fire in
Sitka while I was there, and three children
were severely burned,” recalled
Copass in a recent telephone interview,
remembering the tragic events
of December 2, 1978. “We had no way
to get them to a burn center. I spent all
afternoon and evening trying to find a
plane—any plane—to transport the, by
then, two survivors. We found someone
from Oregon who was able to fly up, but
it was blowing so bad in Sitka he missed
the first approach. By the time the plane
arrived, we had one survivor. The child
later died somewhere over Chatham
Strait.”
Upon learning that the last survivor had
died, Dr. Copass vowed to do what he
could to keep a similar tragedy from
ever occurring again.
He discussed the situation with two
Southeast Alaska colleagues, surgeons
Dr. George Longenbaugh of Sitka and
Dr. Henry Akiyama of Juneau, both now
deceased. “They had each sent a lot of
people to Seattle,” Copass explained.
He said the travel arrangements in
those days further compromised many
patients’ already frail medical conditions.
“Alaska Airlines was very helpful,
but it required taking out nine seats—
an arduous process.”
Copass succeeded in raising awareness
and interest at Harborview, and, by
Shelly Deering, RN, shows a fully recovered Jason the
interior of the jet that took him to Anchorage last
April.
1982, Airlift Northwest, a subsidiary of
Harborview Medical Center, was operating
in Southeast Alaska.
About the same time, trauma life-support
training began in Southeast, educating
physicians and nurses about the
latest techniques in stabilizing patients
for transport.
Today, two medivac services operate out
of Southeast Alaska: Airlift Northwest
and Guardian Flight. Every community
in the region with an airport that can
accommodate a jet airplane is served
by these two companies. More remote
locations in Southeast are served by
the U.S. Coast Guard helicopter base at
Sitka.
Eric Magnuson, a pilot who has worked
for Airlift Northwest, is now flying for
Guardian Flight. He is a big admirer
of the medivac teams. “I just drive
the plane. They are taking care of the
patients’ medical and emotional needs,
and they do it very, very well. I could not
be more impressed, and it is one of the
reasons that I like my job.”
Rick Janik, RN, is a flight nurse with
over a million miles flown on medivacs.
“The basic requirement to be an Airlift
Northwest flight nurse is five years
of critical care experience,” says Janik,
who has been with Airlift Northwest
in Juneau for 12 years. “Right now, the
most junior flight team from the Juneau
base, two nurses, has, collectively, 20
years of experience; the experience of
some of our two-person teams exceeds
50 years.”
Shelly Deering, RN, established the base
for Airlift Northwest in Juneau. “One
of the biggest things for us— those of
us who have been based here for a long
time—is the great relationship we have
with providers and the teamwork we’ve
developed with Capital City Fire & Rescue,
with the clinics, and the hospital. It
is an amazing collaboration.”
According to Deering, the Juneau crew
makes over 240 patient transports annually.
Company-wide, annual airlifts can
exceed 3,500 transports. Airlift Northwest
stations one Learjet at its base in
Juneau throughout the year, and, during
the summer, a day jet from Seattle
rotates through the larger Southeast
Alaska communities.
“The people we transport need to receive
the type of care a community hospital
can’t provide,” says Janik. “To have
specialists, you need to have a certain
volume of patients to keep the specialists
current. This is not something that
can be done in Southeast Alaska—we
see the same thing in Washington State.
The smaller hospitals have to transfer
patients that need tertiary or quaternary
care to larger medical centers.”
From the vantage point of one who pioneered
medivac transfers in Southeast
Alaska, Dr. Copass has watched Bartlett
achieve the status of a truly regional
hospital with “very good doctors and
very good nurses. I’ve come up in the
middle of the night on a Cheyenne III,
gone right into the operating room,
HouseCalls — 14

and assisted Bill Palmer in finishing a
surgical procedure necessary to stabilize
a patient. You don’t get any better
than Palmer; same goes for [Dr. Allan]
Schlicht,” he says of two long-time
Juneau surgeons. “Bob Urata—an excellent
physician and a superb leader—I’d
have no problem with him taking care
of my family. Sure, for normal medical
care, Juneau residents can come down
to Seattle, but you certainly don’t have
to.”
There are circumstances in which a
patient needs to be transferred to a large
medical center, Dr. Copass explains,
such as someone suffering multiple
traumatic injuries that would require
the efforts of several surgeons working
simultaneously or a patient who is in
need of more intensive or specialty care
than a community hospital and its staff
can provide. “Some patients need to be
transferred. It can be a very hard thing
for a doctor to say ‘I can’t do it.’ You spend
your entire career saying ‘I can do it.’ ” In
Dr. Copass’s estimation, it is the physician
who recognizes the limitations of
the resources immediately available and
makes the call for a medivac who lives up
to the highest standards of the profession.
As for Jason, his immediate and extended
family are forever thankful that Dr. Richard
Welling made that call. Several days
after Jason and his mother took off from
Juneau in an Airlift Northwest Learjet,
his life very much in the balance, Jason
returned home to be greeted at the
arrival gate by a crowd of uncles, aunts,
and cousins. If anyone were in doubt as
to his recovery, Jason put that to rest by
leaving his parents and brother in his
wake as he bounded through the airport
exit, arms reaching out just before he
leapt into the embrace of a loving family.
Antibiotic Resistant Microbes
Preventing infections
Jan Beauchamp, Bartlett’s Infection Prevention Coordinator, has declared
the “Hand Hygiene Fair” a great success. “People were really having a blast.
We had every participating health care worker make a pledge to ‘practice
what I learned in kindergarten’ each and every day.” Following the pledge,
which included the promise to wash hands before and after every patient
contact, each person traced a hand outline and then signed it.
Held in August, the Hand Fair was repeated throughout the week to coincide
with each shift. While a fun event, it underlined a serious concern: healthcare
acquired infection.
The good news is that Bartlett has one of the lowest rates of infection of any
similar hospital in the country. The bad news is that infection by Staphylococcus
is, well, bad news.
Staph is a common bacteria—one in
four people will test positive with a skin
swab. In most cases, such surface “colonizations”
remain benign, but “if staph
gets inside you, it can be a big problem,”
says Beauchamp. An even bigger
problem is the antibiotic resistant
strain: methicillin-resistant Staphylococcus
aureus, otherwise known as MRSA
(MER-suh). About two out of 100 people
carry MRSA.
According to Beauchamp, MRSA first
came to the attention of Bartlett’s health
care providers in the 1990s. “People
would come in to the emergency room
complaining of infected spider bites.
Jan Beauchamp administers a hand washing
pledge to Bartlett employees.
It turned out this was happening all over the county. Then someone wrote
a paper and said, Hey, this isn’t spider bites, this is MRSA.” The infections
looked similar: red angry boils with a hole in the center. “Pretty soon, we realized
very few of the infections we were seeing were spider bites.”
While MRSA can present challenges, Beauchamp says it is very uncommon
that the condition can’t be resolved—although it is an unpleasant experience.
“People get pretty sick. It goes from a pimple yesterday to a four-inch
wide boil today. Get that and you’ll feel really ill.”
The standard protocol for patients who show MRSA-like symptoms is to
use isolation precautions. There are isolation rooms in both the Emergency
Department and the Critical Care Unit. “If a patient is in the operating room,
it doesn’t matter what the staph strain might be—it’s contagious. What they
do is to schedule the operation for the last case of the day, using similar isolation
procedures. Then they do an end of the day cleaning, taking extra
precautions. We do everything we can to keep everything in room: gowns,
gloves; it all stays in the operating room until collected and disposed.”
15 — Fall 2011

Excellence in Nursing
Advocating for patients and the nursing profession
It is a busy day on Bartlett’s medsurg
floor. Each nurse on duty is
responsible for at least half-a-dozen
patients, and, on this day, most of the
patients are very sick. That there are
very sick patients in a hospital may seem
self evident, but their prevalence is a
fairly recent trend—a result of increasingly
prompt discharges and a high percentage
of day surgeries. These days, the
patients who spend time in a hospital
are far sicker and often need much more
attention than the average patient of a
generation ago. It all adds up to more
demands on the time and attention of
med-surg nurses.
This day, one patient is particularly
needy—an elderly woman with mild
dementia suffering from hypertension
brought on by Type II diabetes, a condition
that will put her at risk for serious
infection if bed sores develop. The
patient, who has been admitted because
of breathing problems and low blood
oxygen, is also suffering from anxiety
attacks, not uncommon for people who
can’t catch their breath. Her heart has
been weakened by a lifetime of smoking,
and she also has urinary issues. Her
frequent trips to the rest room put her
at risk for falls. Such a patient needs the
full attention of her primary nurse.
A patient with such a complex array
of needs draws on multiple hospital
resources. In addition to physicians,
nurses, and nurse assistants, other professionals,
such as pulmonary therapists,
pharmacists, physical therapists,
nutritionists, and discharge planners
will need to be consulted. “Most people
don’t realize how much goes on behind
the scenes,” says Sarah Hargrave, RN.
“This is a complex, multi-disciplinary
system.” One way of addressing the present-day
challenges of patient care, she
explains, is by instituting the modern,
research-based professional practice
model known as Shared Governance.
“In a Shared Governance model, frontline
nurses come to the table with nurse
managers to shape nursing policies and
practices,” says Hargrave, who is the
facilitator for Bartlett’s Shared Governance
initiative.
Simply put, shared governance provides
“stakeholders,” in this case nurses, the
means to change their practice.
The Nursing Department
[at Bartlett Regional
Hospital] is launching its
shared governance plan....
Shared governance brings
a commitment from all
aspects of nursing —staff,
specialists, managers and
administrators — to share
in both the rights and
responsibilities and to be
accountable for nursing care
in their facility.
— Excerpt of a statement by Nancy
Davis, RN, MS, President, Alaska
Nurses Association, that appeared in
the organization’s June 2011 “Alaska
Nurse” newsletter.
The efficiency of any complex system,
Hargrave points out, can benefit by the
implementation of new technology or
streamlining a process. “We’ve all witnessed
improvements in making travel
arrangements,” she says of the transition
from the time-demanding process of
making reservations then getting tickets
at airline counters, to the scheduling
flights on-line, then downloading boarding
passes from a website. How to introduce
such process changes to improve
patient care is the focus of the Shared
Governance process now in its first year
at Bartlett Regional Hospital.
“The heart and soul of nursing is patient
care,” says Susan Thompson, RN, who,
along with Margie Fisher, RN, co-chairs
the Coordination Council for Share
Governance. Thompson, who previously
served as an ER nurse for 15
years, is House Supervisor for Bartlett.
“Shared Governance is about elevating
the profession, with the ultimate goal
always to improve patient care,” she says.
“We believe that the professionals most
knowledgeable and best suited to do that
are the bedside nurses.”
According to Fisher, the shared governance
process seeks to increase quality
nursing time spent at the bedside and
improve the professional peer review
process for nurses. “With the senior
leadership and the board, we have support
for doing this,” Fisher says. “We
were given a budget, by which we were
able to get materials that didn’t have to
come out-of-pocket. Instead of upper
management telling us what to do, they
are saying, Hey, you are the front line staff —
do it.”
Thompson agrees that the administration
has provided strong support. “They
HouseCalls — 16

approved an operating budget— that we came under, by the way,” she says. Thompson
praises Chief Nursing Officer Cathy Carter as being especially supportive and
encouraging. “Overall, nurses throughout the hospital are very enthused about this.”
“Previously, there wasn’t a formal structure,” says Hargrave. Bartlett’s Coordinating
Council for Shared Governance held its first organizational meetings in mid-2010.
There are currently two subcommittees: Clinical Practices and Professional Development.
“Now we have the structure to make change. This is about nurses having
control of their practice and having a robust structure that will improve communications,
because it elevates the discussion to a professional level.”
The front line staff: Sarah Sjostedt, RN, Billy Gardner, RN, Gail More head, RN, and Alicia Gillis, RN, discuss staff
engagement in the shared governance process.
The Origin of Shared Governance
The concept of shared governance was first defined over 30 years ago as an
effort to give nurses an equal voice with physicians within hospitals. Nationally,
through the 1980s and 1990s, the concept broadened to one that embraced all levels of
hospital management. A committee structure brings managers and staff to the same
table where they address issues such as practice, management, quality, and education.
Every department that utilizes the services of nurses is represented on Bartlett’s
Shared Governance Council. “We are very early in the process,” says facilitator Sarah
Hargrave. “Normally, it takes at least three years to have a robust structure.”
“Shared governance to me is a means of pushing the nursing profession forward,”
says Leslie Vianne, a Bartlett RN since 2004. “It will allow nursing across the country
to self-regulate, to support more education that will get more nurses into the
profession. It’s cool to be a part of it. I’ll be there supporting the effort, a brick in the
foundation.”
Coordinating Council for Shared Governance
· Margie Fisher, RN (Co-Chair)- Bartlett Beginnings
· Susan Thompson, RN (Co-Chair)- House Supervisor
· Alicia Gillis, RN (Secretary)- Critical Care Unit
· Brian Tennant, RN (Treasurer)- Emergency Department
· Cece Brenner, RN- Medical/Surgical Unit
· Cori Austin, RN- Same Day Care Unit
· Hannah Mendelsohn, RN- Surgical Services
· Sarah Sjostedt, RN- Medical/Surgical Unit
· Amy Center, RN- House Supervisor
· Robin Basque, RN- Mental Health Unit
· Cathy Carter, RN- Chief Nursing Officer
· William Gardner, RN- Medical/Surgical Unit Director
· Gail Moorehead, RN- Staff Development
· Sarah Hargrave, RN (Facilitator)-Quality Department
Profile: Sandra Kohtz, continued from page 10
with shame and moral condemnation.
Kohtz would prefer that people look
at Rainforest Recovery Center in the
same way they would a doctor’s clinic.
“Alcoholism and other addictions are
medical conditions like diabetes,” she
says, noting susceptibility to addiction
is most often an inherited trait.
Addiction, especially in older adults,
can be very difficult, and almost impossible
to turn around without help. “At a
certain point, the addict will no longer
be able to make rational judgments,”
says Kohtz. “Almost always, they blame
their problems on something other
than their addictions.” Kohtz has yet
to encounter someone who has come
in for treatment without being compelled
by their circumstances or by
another person. “No one wants to go
into treatment . Once you have found
the impetus, it helps in providing them
with the appropriate treatment.”
When Kohtz began her career in 1977,
treatment was largely designed on the
Alcoholics Anonymous model. “At the
time, if someone did not remain abstinent,
they would be out of the program—they
had not reached bottom,”
she recalls. Kohtz explains that while
the goal of RRC’s treatment approach
is eventual abstinence, she is not one
for absolutes. “Through treatment and
other interventions, we are seeing people
seeking help before they have lost
everything.”
Kohtz has a Master of Social Work
Administration degree, is a Licensed
Clinical Social Worker, and a Certified
Alcohol and Drug Abuse Counselor.
In 2003, she was named “Manager/
Supervisor of the Year” for Nebraska
Health and Human Services. She has
also served on numerous boards of
directors for substance abuse programs
throughout her career.
17 — Fall 2011

VBAC, continued from page 2
As ACOG’s guidelines make clear, labor
after cesarean section can only be safely
undertaken in a facility that has sufficient
surgical and pediatric resources
to provide the full suite of emergency
services that can be necessary if a VBAC
were to result in life threatening complications.
Bartlett Regional Hospital is a small
community hospital. We have excellent
but limited obstetrical and surgical
services. The nearest neonatal intensive
care units are in Anchorage and Seattle.
Several possible complications can
occur with VBAC, including rupture
of the uterus. ACOG’s position states
that there are no accurate predictors in
labor for uterine rupture, and if a facility
cannot provide immediate neonatal
emergency care, women should be
referred to the closest facility that can
provide such services.
Risks of uterine rupture include:
• Permanent injury to baby
• Need for removal of mother’s
uterus (hysterectomy)
• Damage to mother’s bowel or
bladder
• Severe hemorrhage requiring
blood transfusion to mother or
baby
• Severe infection of mother or
baby
While the risk of such uterine rupture
is low—less than one percent— the
potential outcomes can be catastrophic
and can occur quickly.
Time is critical in recognizing and
managing this complication to prevent
permanent brain damage to the baby.
In such instances, the lives of both the
mother and baby are at great risk. No
one knows exactly how much elapsed
time is acceptable, but we do know
that delivery needs to occur in a matter
of minutes. Bartlett does not have the
benefit of anesthesiologists and surgical
teams assigned exclusively to obstetrics,
so every minute of delay could lead to
severe complications.
We understand that many women want
VBACs. We also understand that relocating
from home late in pregnancy is
disruptive, but we fully support Juneau
doctors who feel it is the safest option
for women in Bartlett’s service area
wishing to attempt VBAC deliveries.
If a woman is considering VBAC delivery,
we recommend that she and her
doctor have a thorough discussion
about it early in pregnancy. Not everyone
is a good VBAC candidate and an
early discussion can make planning
the delivery in a larger hospital easier
to facilitate. Discussing your options
and risks with your doctor is critically
important.
Bartlett Regional Hospital will continue
to provide high quality obstetrical care.
Our goal is to provide maximum safety
for both mother and baby. We therefore
encourage interested women to pursue
VBAC at facilities designed to accommodate
her circumstance. Your physician
will be more than happy to discuss
with you other choices of facilities.
On a mission — for
children treated at
Bartlett Regional
Hospital. Thanks to
the annual Toy Run
by members of the
Southeast Alaska
Panhandlers Motorcycle
Club, every child who
receives treatment at
Bartlett also receives
a toy.
HouseCalls — 18

Profile: Dr. Saltzman, from page 10
Like most medical specialists working in
a comparatively small service area like
Juneau and the surrounding communities,
Saltzman’s practice is broad, including
everything from general to pediatric
urology.
“There is plenty of demand for a general
practice,” he says. “Prostate disorders are
a major part of the practice. There is no
shortage in Juneau of patients with elevated
PSA levels.”
Prostate-specific antigen (PSA) is a protein
produced by the prostate gland, and
elevated levels of this protein are associated
with prostate cancer.
Dr. Saltzman has found no shortage of
kidney stones in Bartlett’s service area.
“Some people have expressed surprise
that lithotripsy is available here,” says
Dr. Saltzman, who is happy to provide
an effective and relatively pain free procedure.
“There was some thought that
the procedure would become common
place, provided by general practitioners,
but if the acoustic waves don’t break up
the stone, then the next procedures are
those best provided by a urologist.”
Dr. Saltzman says he intends to remain
in Juneau for the foreseeable future. “I
like the frontier spirit and the tightness
of the community.”
“I’m originally from New Jersey. I got
my medical degree in Virginia, took my
residency in upstate New York, and have
been moving west ever since,” he says.
He practiced in Montana and Oregon
prior to moving to Juneau. “I really enjoy
Juneau. I just wish I had moved here ten
years ago.”
Directory of Active Medical Staff, Bartlett Regional Hospital
Dr. Brian Benjamin, Family Medicine ............................................463-4040
Dr. Mimi Benjamin, Family Medicine ............................................463-4040
Dr. Gordon Bozarth, Orthopedic & Spine Surgeon.........................364-2663
Dr. Robert Breffeilh, Ophthalmology ............................................586-2700
Dr. Beatrice Brooks, Emergency Medicine.....................................796-8447
Dr. Carolyn Brown, Gynecology......................................................523-5025
Dr. George Brown, Pediatrics.........................................................586-1542
Dr. Kenneth Brown, Emergency Medicine.....................................796-8447
Dr. Catherine Buley, Family Medicine ...........................................463-4040
Dr. John Bursell, Physical Medicine/Rehabilitation.......................364-2663
Dr. John Connolly, Anesthesiology ................................................796-8433
Dr. Gregory Dostal, Plastic/Reconstructive/Hand Surgery ............586-3068
Dr. Amy Dressel, Pediatrics ............................................................586-1542
Dr. Taylor Dunn, Family Medicine..................................................463-4040
Dr. Sharon Fisher, Family Medicine ...............................................586-2434
Dr. Steve Greer, Family Medicine...................................................463-4040
Dr. Alan Gross, Orthopedics...........................................................364-2663
Dr. Pam Gruchacz, General Surgery...............................................796-8700
Dr. Nathaniel Haddock, Internal Medicine ....................................789-2910
Dr. Daniel Harrah, Orthopedics......................................................364-2663
Dr. Carlton Heine, Emergency Medicine........................................796-8447
Dr. Dorothy Hernandez, Family Medicine......................................586-2434
Dr. Susan Hunter-Joerns, Neurology..............................................790-3224
Dr. Melissa Hynes, Internal Medicine.............................................789-2910
Dr. Lindy Jones, Family Medicine...................................................586-2434
Dr. J. Kennon Kirk, Family Medicine ..............................................463-4040
Dr. Deb Lessmeier, Family Medicine..............................................789-2910
Dr. Heidi Lopez-Coonjohn, Psychiatry............................................796-8498
Dr. Aric Ludwig, Emergency Medicine...........................................796-8447
Dr. Anya Maier, Family Medicine...................................................586-2434
Dr. Alex Malter, Internal Medicine ................................................789-2910
Dr. Alan McPherson, Emergency Medicine ...................................796-8447
Dr. Amber Miller, Pediatrics ..........................................................463-1210
Dr. Ben Miller, General Surgery.....................................................796-8700
Dr. David Miller, General Surgery ..................................................586-4126
Dr. Kelly Moxley, Podiatry..............................................................789-0405
Dr. Joy Neyhart, Pediatrics.............................................................463-1210
Dr. Eric Olsen, Family Medicine .....................................................789-2910
Dr. Mary Owen, Family Medicine ..................................................463-4040
Dr. Penny Palmer, Psychiatry ........................................................796-8498
Dr. William Palmer, General Surgery.............................................586-1895
Dr. John Pappenheim, Psychiatry..................................................796-8498
Dr. Steven Parker, Anesthesiology ................................................796-8433
Dr. Eric Paulson, Oral & Maxillofacial Surgery................................789-5008
Dr. Catherine Peimann, Internal Medicine.....................................586-8100
Dr. Nathan Peimann, Emergency Medicine...................................796-8447
Dr. Norvin Perez, Family Medicine.................................................790-4111
Dr. Gordon Preecs, Ophthalmology...............................................586-2700
Dr. John Raster, Otolaryngology....................................................790-4047
Dr. Joseph Roth, Family Medicine..................................................586-2434
Dr. Michael Saltzman, Urology......................................................500-9920
Dr. Jessica Scott, Family Medicine..................................................463-4040
Dr. Allan Schlicht, General Surgery................................................789-1277
Dr. Don Schneider, Family Medicine..............................................586-2434
Dr. Robert Schults, Psychiatry........................................................796-8498
Dr. Charles Schultz, Oral & Maxillofacial Surgery...........................586-9586
Dr. Ted Schwarting, Orthopedics...................................................364-2663
Dr. Marna Schwartz, Pediatrics......................................................463-4040
Dr. Theresa Shanley, Diagnostic Imaging......................................796-8800
Dr. Janice Sheufelt, Family Medicine.............................................463-4040
Dr. Paul Skan, Anesthesiology.......................................................796-8433
Dr. Kim Smith, Family Medicine ....................................................789-2910
Dr. Anne Standerwick, Internal Medicine......................................586-8100
Dr. Mark Stauffer, Psychiatry .........................................................796-8498
Dr. Steven Strickler, Diagnostic Imaging .......................................796-8800
Dr. Myanandi (Nandi’) Than, Family Medicine..............................789-2910
Dr. James Thompson, Emergency Medicine .................................796-8447
Dr. Norman Thompson, Pathology................................................796-8840
Dr. Robert Urata, Family Medicine.................................................586-2434
Dr. Priscilla Valentine, Family Medicine.........................................586-2434
Dr. Burton Vanderbilt, Pathology...................................................796-8841
Dr. Nell Wagoner, Gynecology.......................................................586-1717
Dr. Richard Welling, Family Medicine............................................586-2434
Dr. William Wood, Anesthesiology................................................796-8433
Honorary Staff
Dr. Estol Belflower, Diagnostic Radiology
Dr. Tally Blair, Diagnostic Radiology
Dr. Len Ceder, Orthopedic Surgery
Dr. Gary Hedges, General Surgery
Dr. Sarah Isto, Family Medicine
Dr. Thomas McCabe, Pediatrics
Dr. Mark McCaughan, Urology
Dr. Ken Moss, Pediatrics
Dr. Joseph Riederer, General Surgery
Dr. Henry Wilde, Internal Medicine
19 — Fall 2011

Presrt Std.
3260 Hospital Drive, Juneau, Alaska 99801
U.S. Postage
PAID
Juneau, Alaska
Permit No. 130
ECRWSS car-rt sort
Postal Customer
BRH Board of Directors
Kristen Bomengen, President
Linda Thomas, Vice President
Robert Storer, Secretary
Mary Borthwick
The Annual Toy Run: Brillo (a.k.a. Michael Chitty), left,
collects toys for children who are treated at Bartlett
Regional Hospital during the event held in September by
Southeast Panhandlers, a local motorcycle club.
HouseCalls is written and produced by Peter Metcalfe,
graphic design by Sue Kraft, and copy editing by Liz
Dodd. Photos are by Jim Strader and Peter Metcalfe.
Dr. Alex Malter
Lauree Morton
Dr. Nathan Peimann
Reed Reynolds
Kevin Sullivan
David Stone, Assembly Liaison
www.bartletthospital.org
Cover photos: From left to right, Judy Cavanaugh, RN (Emergency Department); Shawn Sundberg, security; Annie Nunley, PA (ED); Zelda
Swain, RN(ED); Jim Thompson, MD (ED); Jeanne Crochet, RN (ED); Sandra Rup, Mental Health Unit manager; Eddie Jones, MHU discharge
planner; Lisle Hebert, MHU mental health assistant; Lee Burgess, JAHMI’s supervisor of mental health clinicians; and Ginny Hayes, MHU
mental health assistant. Inset: Nurses Michelle Van Kirk and Deborah “Mouse” Manowski demonstrate proper (and enthusiastic) hand
washing techniques.
HouseCalls — 20