Organization Newsletter

January 2014

In this issue...

  1. President's Message
  2. State Office of Rural Health
  3. KVH Hospital Named in Top 20 Critical Access Hospitals Nationwide
  4. Care Coordination: The Shriners Hospital Difference
  5. Adventures in RUOP: Rural Health from the Students Perspective
  6. Robert Wood Johnson Foundation Recognizes WA Senior Center Programs
  7. Washington Quality Awards
  8. COHE Opens New Kennewick Office to Serve Injured Workers
  9. Former Youth Health Service Corps Coordinator Speaks at White Coat Ceremony
  10. Twice the Joy in Walla Walla
  11. Washington Native, Thankful for the Trauma System
  12. Health Care Reform and Rural Communities: Finding the Right Fit


The Washington Rural Health Association e-newsletter is a publication of Washington Rural Health Association, a not-for-profit association composed of individual and organization members who share a common interest in rural health. This e-newsletter seeks to disseminate news and information of interest to rural health professionals and stakeholders to help establish a state and national network of rural health care advocates.

WRHA members include administrators, educators, students, researchers, government agencies and workers, physicians, hospitals, clinics, migrant and community clinics, public health departments, insurers, professional associations and educational institutions. If you are interested in joining or renewing your membership with WRHA click here.

President's Message

submitted by: John Hanson
[email protected]

Over the years some people have looked at the Washington Rural Health Association (WRHA) and said, “So what?” Really? So what? Yes. “So what?” means what difference has the existence of WRHA made in the provision of high quality and more affordable health care in rural communities? That’s a fair question and I would like to tell you how we are answering it.

Let me start with the positive side. We sponsor great regional conferences every year that focus on Critical Access Hospitals and then on rural health from a broader perspective. These conferences draw up to 300 or more participants from Washington and from all of the surrounding states. We convene a planning committee months ahead of time for each conference. That committee has representatives from each of the states in the region. The committees work hard to ensure that the speakers we bring in and the messages that they share are relevant, timely and effective.

A year ago we convened our first Rural Roundtable community meeting in Davenport. We have subsequently hosted meetings in Pomeroy and Dayton, and are currently planning another in Newport. The format of these gatherings is first of all to give information to people in each community about coming changes to health care in general and how those changes might impact local health care. Following the presentation our professional facilitator invites a discussion between local health and community leaders and the general public. The discussion serves to allow everyone who wants to express their opinion on how their own health care system is working and, more importantly, what needs to change and how they go about doing that. Hopefully, these initial meetings will help mobilize each community to work together to create helpful change.

The board is now facing a new planning year. Our annual strategy retreat is scheduled for next month. I recently had a discussion about the agenda with Jon Smiley, interim CEO of Columbia County Health System in Dayton, and the incoming president of WRHA. Some of Jon’s thoughts were: 1) our purpose should be about maintaining and enhancing access to care in rural areas and that we should say so; 2) in order to fulfill our purpose the membership needs to grow and the Association needs to be more closely aligned with other organizations, both within the state and at the national level, that have the same goal; 3) we need to find an executive director, at least part time, to do most of the groundwork that the board wants to do, but whose makeup is almost entirely of people who already have full time management jobs; 4) we must have more of a presence and a louder voice with legislators, both at the state and congressional levels, in order to move legislation forward that is important to the wellbeing of rural health; and 5) the Rural Roundtable meetings need to continue and should be carried out in all rural areas of the state.

This is going to be an exciting year for WRHA. I like the energy that I see in President-Elect Jon Smiley.

Would you like to be more of a part of all this? We going to have at least three vacancies on the board at our annual meeting in March, and there are more seats that have never been filled. I want to encourage every member of the Association who would like to be more actively involved in making these goals come to life to let us know. Please go to our website at and click on “Contact Us.” We need board members and non-board members who are willing to work on committees.

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State Office of Rural Health: State of Reform: Telling the Rural Story

submitted by: Bonnie Burlingham
[email protected]

Tell me about the State Health Benefit Exchange. How is that going for you? When I ask the question to my colleagues in rural health, it elicits the answers, “It’s (pause) sort of working”, “It’s great for some”, or a much longer “It’s not and here are all the reasons why”. There are some glitches in the system.

At the State of Reform Conference on January 8, 2014 (, in Seattle, these glitches and many more were discussed by legislators, state and federal agencies, insurance companies, associations, and others. Our state is making a truly valiant effort to coordinate a tremendous culture change, to solve these problems, and to improve access to insurance for everyone.

Rural communities can be a big part of the solution. They have the relationships and health infrastructure necessary to reach their neighbors, and far-flung community members, but we need a coordinated rural effort to make this really work. At the State Office of Rural Health we are starting to coordinate this effort. How is the exchange rolling out in your communities? What are your barriers? What are your success stories? Let us know so we can begin to piece it together, to articulate the impact on rural health.

The glitches will pass, there are very skilled people working them out, but there is not a better time than now to keep pressing forward and to tell your story. It is impossible to predict how such a large health care culture change will roll out, but as it does, this is an opportunity for rural communities to continue to have a strong voice in continuously improving access to care.

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KVH Hospital Named in Top 20 Critical Access Hospitals Nationwide

submitted by: Vicky Brown

[email protected]

Earlier this year, KVH Hospital learned that it was included in a listing of the top 100 critical access hospitals, compiled by iVantage Health Analytics. In November, the National Rural Health Association named the top 20 hospitals from this list, which included KVH Hospital.

The top 100 critical access hospital list has only been released twice, in 2011 and 2013. KVH Hospital has been included both times, a distinction shared with only 60 hospitals. Each of the approximately 1300 critical access hospitals in the United States was considered for the rankings.

The results of performance in over 50 areas contribute to the rankings. Areas considered cover a broad range of topics, including quality of care, health outcomes after hospitalization, patient satisfaction, affordability, market share, and financial stability.

"Kittitas Valley Healthcare is a wonderful example of the role that a hospital can play in a community," said Scott Bond, CEO of the Washington State Hospital Association. "Not only do they provide top-notch services to every patient in the hospital, they work to meet the needs of the entire community in the long-term. They have a strong commitment to their mission, and I'm pleased they are being recognized for the work they do."

Very few hospitals in the Pacific Northwest were selected for the most recent top 100 critical access hospitals list - only two in Washington, one in Oregon, one in Idaho, and two in California. "It is an honor to be included in this listing of the leading hospitals across the nation - and to be included in the Top 20 is truly outstanding," said Paul Nurick, CEO of Kittitas Valley Healthcare. "It is the combined efforts of the caregivers, support staff, and leadership at KVH that allow us to provide exceptional care to our patients."

Critical access hospitals make up approximately 25 percent of hospitals in the United States; there are 39 critical access hospitals in Washington State. They are, by definition, at least 35 miles from another hospital and have no more than 25 acute care beds at any given time. Most are located in rural areas. 

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Care Coordination: The Shriners Hospital Difference

submitted by: Damon Pilgrim

[email protected]

Imagine this: you're in the hospital. You are there because your knee was injured and you have surgery scheduled for tomorrow. That's all you know.

I know, I didn't give you much to work with. The fact is that actual patients in actual hospitals don't get much more information than this.

If you are like most people, you are probably nervous. You have questions you want answered. You want to know that your medical care providers are all on the same page when it comes to your care. You want to know that everything will be managed with expertise, kindness and compassion. Am I close?

Shriners Hospitals for Children® - Spokane recognizes that a hospital visit can be a vulnerable time for anyone, but especially for children, parents and families. This is not a time for caregivers to simply deliver medical procedures. That care must be coordinated so that it is seamless, giving confidence and comfort to patients and families.

The Spokane Shriners Hospital's care coordination model is designed to deliver family-centered and patient-centered care. In this model, a care coordinator oversees families and patients as long as they are under Shriners Hospital's care. Care coordination proactively works on a plan of care for each patient. Coordinators communicate with the team to provide seamless care. They facilitate transitions in care as the patient moves between departments and finally back home. Additionally, care coordinators connect patients with community resources and align resources with patient needs.

What does this mean? It's simple. The care coordination team consists of registered nurses and social workers. The registered nurses work with your physician to plan the care for individual patients. The social workers accommodate transportation, housing, community resources and financial counseling, as well as patient and family resources.

This benefits the patient by giving them confidence in always knowing who to turn to when they have questions. They can get to know one person well by talking to the same person every time, creating a level of comfort that would otherwise not be present. They know that their Care Coordinator will address any concerns and questions with everyone who has a hand in their care. Ultimately, care coordination offers comfort to ordinary people in vulnerable situations. Imagine that. 

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Adventures in RUOP


Reflections From A Month in Rural Health

submitted by: Scott Hippe
[email protected]

I am a second-year medical student at the University of Washington and had the pleasure of spending a month this summer at Lake Chelan Clinic. I got to see the ins and outs of rural medicine. The Chelan community is vibrant and varied in character, and I was surprised by the breadth of experiences presented me. Amidst this considerable diversity there emerged a few oft-repeated phrases that illuminate some of the subtle nuances of rural medicine. If I had a dime for every time I heard one of these phrases, I would be able to afford at least a vente mocha frappuccino the next time I am up all night cramming for a test.

"So, I can get the [given procedure] done here in Chelan?" Without giving the doctor I was following time to respond, the patient would offer the follow-up question, "There isn't a drop-off in quality by getting it here instead of on the west side?" When given time to respond, my doctor would explain there was no difference between a CT (and many other procedures) here and any large metropolitan hospital - save for the fact that Lake Chelan Community Hospital is mere minutes away.

During my time in Chelan I've gained an appreciation for the extensive (albeit not exhaustive) capabilities of the healthcare team in this small community. It takes some convincing for the recently-arrived, but they learn. For those skeptical it seems important to keep patience in mind.

"Are you okay with this?" My doctor would often ask this question to patients before procedures such as IUD placements and vasectomies, ones that encroach on the boundaries of normal social interaction. Patients were often employees at the clinic or hospital or their significant others were, or they were in some way a part of the doctor's life outside of the doctor-patient relationship. Often patients would sacrifice privacy because the alternative was a considerable drive to access similar services.

One of the great things about living in a small community is you get to know your neighbors. The dark side of being in a small community is you get to know a lot about your neighbors. I learned that working in rural health requires a high degree of sensitivity because you never know who you will bump into outside the clinic or hospital. Your patients may very well be your friends and coworkers. I found myself driving extra-carefully around town because I didn't know if I would see the driver I accidentally cut off later in the clinic.

"Patient is going into [enter any number of conditions] - get to the hospital as soon as you can." I was lucky to be paired with a doctor who included me on a great deal of cases and procedures outside of the normal work week. I received this text message many times, at all hours of the day. Time between receiving the message and arriving at the hospital was about fifteen minutes. At my home on the west side, fifteen minutes barely got me to the freeway.

I've often heard it said that time moves slower in small towns. It is hard to believe when rushing to the hospital for a C-section. But what I can say about time in small towns is it seems like there is more of it. I will return to Chelan in my clinical years for four months of primary care rotations. I am already looking forward to this time, and I have my dime-collecting jar at the ready.

Just Another Day in Paradise

submitted by: Leah Kobes
[email protected]

Today I started the day off assisting with a C-section delivery, and for the first time in my medical training I got to cut the cord and do the initial reflex testing on the new little guy. The experience was amazing - it began with a major abdominal surgery and ended with a kiddo! After scrubbing out, we rounded on a patient who had a stroke with severe hemi-neglect and a woman with hyponatremia, then walked over to the clinic. Our activities for the morning included a few sports physicals, routine medication checks, immunizations, sick toddlers, removing a large basal cell carcinoma, and a terminal lung cancer diagnosis. As I was suturing up the incision following the basal cell removal, the patient and I had quite the lively conversation about his youth and how he had worked with the traveling circus. He was a great example of how many different and amazing people we get to see every day. The lung cancer diagnosis was a tough one for me because we had been following this patient for other health issues and he was finally doing well, and then this.

Just as we were about to sit down for lunch, we got a call that the hyponatremic woman was in a Code Blue - so we rushed back to the hospital to run the code and stabilize her for transport in the helicopter. What an amazing balance of medications, interventions, and 'a little of this and a little of that' to keep her alive long enough to get the surgery she needed for what turned out to be sepsis from a bowel perforation.

After lunch, some of the highlights included doing some joint injections for arthritis, a first well-baby exam, listening to an elderly gentleman who just needed someone to talk to, using an ultrasound to check a growing baby's progress inside her mom, casting a broken arm, reading a book to a young boy while his grandma had an imaging study, and watching the look of pure amazement on a little girl's face as I let her listen to my heart before I listened to hers.

As I drove home under a colorful sky, I watched some of my farming friends work the beautiful rolling hills of grain and reflected on how blessed I was to be involved in another incredibly varied day of medicine and life in rural eastern Washington - my corner of paradise.

Latinas Solas - UW-RUOP, Yakima 2013

submitted by: Teah Caine
[email protected]

Day one in Yakima I had the opportunity to accompany my preceptor to the hospital where he delivers his patients' babies who he has been following in clinic. This evening we were able to deliver two babies because an expecting mother checked in dilated to 7cm just as soon as we finished the c-section of the other patient. My first day in Yakima I was quickly oriented with the clinic, the hospital and the role a Family Practice physician who also does OB. My preceptor told me something Monday evening that has been on my mind since. He said that often when he delivers a baby, there is no family (mother, sister, partner, friend, etc) in the room with the mother. He also said this was characteristic only of his Latino patients in the community. This is something I have not experienced in my years working with the Latino population. Understanding the Hispanic (primarily Mexican) culture and its strong familial values, I have been thinking of the repercussions a woman may face being alone in a foreign country without support and help from her family. I have learned that many of the women travel to Yakima to work in the fields, and they often come without family or they come with a partner, and when the relationship terminates she is then left alone. The cultural expectation of help and support from family is so strong in the Hispanic culture, the lack thereof has to take an extreme toll on the lives of these women.

My thoughts were then solidified when I met with a woman at Casa Hogar. Casa Hogar is an organization where women go and can learn English, computers, and get help with immigration papers. When speaking with one of their representatives, she informed me that many of the women she meets are in Yakima alone, and have expressed feelings of anxiety and depression, and often use the resources at Casa Hogar as a means to finding friends and support. Also upon visiting the YWCA, I found that half of the women who were receiving YWCA support and shelter were Latina; a disproportional amount to the demographic of the community.  I am not sure if this is something characteristic of the Yakima Latina immigrants or of Latina immigrants working in areas of agriculture. Either way, I see it as an area of concern for this community, especially because it contradicts the cultural norms and has the potential to cause great mental health disparities amongst the Latina population.

On Learning to Change a Diaper: Reflections on a Rural Clinical Experience

submitted by: Mary Shickich
[email protected]

There are some basic things I’m realizing during my month long stint working at a clinic in rural Wyoming:

I don’t know how to turn a baby over. 

I don’t know how to change a diaper.

And I look a bit ridiculous when I carry a baby back to Mom or Dad from the physical exam table, because, in all honesty, I don’t really know how to carry a baby.  

As medical students, I suspect most of my peers, like myself, take great pride in excelling at whatever it is we’re doing. We are used to succeeding in school, and in many ways, want that trend to extend to other aspects of our life. The didactic experience of medical school nests me securely in my comfort zone: school. Learning in a classroom and transferring that knowledge on to a test. It’s the learning and doing outside of the classroom that both excites and intimidates me most. As soon as real human beings are involved and someone asks me to do something, whether it’s check an ear for otitis media or perform an abdominal exam, I am terrified I will miss something major, something real. Something that impacts not just how competent I might appear or my grade on some paper, but actually impacts the human sitting in front of me. 

I really enjoy working with babies. But they scare me the most. 

My younger brother was born when I was three, and I’m sure I poked and prodded at him plenty when he was an infant, but any tangible skills about handling a baby didn’t quite make it into my long-term memory. I babysat for a while as a teenager, but I usually cared for youngsters that had full command of their neck muscles, could form sentences to tell me what they needed, and were potty-trained. Now I find myself surrounded by babies on a daily basis, and while I have the cooing and smiling down, when it comes to actually checking them out, I feel clueless.

I was asked to change a diaper in the hospital NICU the other day.  I thought to myself, “OK… I’ve seen this a few times, I can do this.” I gingerly lifted the baby out of the diaper, and prepared the wipes.  “You’ve got this,” I told myself.  I wiped up the baby, was reaching for the clean diaper, almost there…and then, the baby was peeing. All. Over. Everything. The nurse rushed in, laughing and shaking her head as she changed the baby almost one-handed. She asked, “You don’t have any children, now do you?” Nope. 

I’m finding that to actually learn, I must humble myself and ask for help - even with the silly things. I sheepishly told the physician I’ve been working with that I’m nervous I’m going to hurt infants when I turn them over to check for spina bifida. He graciously smiled and told me not to worry - just go slow. Babies are sturdier than people think. The nurse who helped me clean up the diaper change disaster showed me the best way to change diapers (always, always put the new diaper underneath the old one you’re removing) and also showed me how to swaddle a newborn.

I deeply appreciate the respect I gain when people know I’m a medical student, and am flattered that many automatically assume I know technical terms, basic procedures, how to read a blood count, and how to hold a baby. Certainly I learned a great deal in my first year, but there is a lot I have yet to learn. Both clinically and practically I am working on owning up to all that I don’t understand, and getting better and better at asking for help. It’s honestly hard to admit that there is so much I don’t know, especially to people who think I know a great deal and treat me as a colleague as a result. But the reality is, if I don’t ask, or at the very least don’t write it down to look up later, I’m not actually learning. And I’m here to learn. Every day I get better at working with babies. And I’m actively looking for my next chance to change a diaper.

Reflections on a Summer in Rural Wyoming

submitted by: Mary Shickich
[email protected]

So this is it. My last day in this small Wyoming town. I was apprehensive, anxious even, when I arrived a month ago as part of University of Washington School of Medicine's Rural/Underserved Opportunity Program. It took a little while to get into the swing of things. But now I'm not ready to leave.

I've learned a great deal this past month in the busy pediatric clinic where I was placed. I've sharpened my pediatric clinical skills (although infant ear drums still allude me nine times out of ten), my interviewing skills, and my knowledge of basic pediatric well-child checks. I've seen my first surgery (a cesarean section where I had to remind myself to breathe as I saw a baby take its own first breaths of air), helped clean a wound, and observed countless stitches go into faces, toes, and hands. I've seen joy wash over new parents as they learn their newborn is healthy and happy, and I've seen pain expressed through solemn glances between family members processing difficult news. I saw a newborn intubated and a chest tube removed. I've held a lot of babies. I've also unintentionally made a lot of toddlers cry. As it turns out, toddlers are quite perceptive about impending shots.

I've reflected on my role as a medical student in these clinical settings and contemplated how things will change in terms of my involvement, autonomy, and decision making skills as I progress in school and beyond. I've been reminded each day that as part of my training I am afforded such an incredible and unique opportunity to learn from individuals who have been through so much. I want to hang on to this feeling I've experienced so many times in the rural community in which I've been living. What a gift it is to be a medical student. People allow you into their lives, allow you to examine their bodies, allow you to share their most personal spaces. It is an honor to learn from everyone I've seen, every pulse I've taken, and every procedure I've observed. Entering this profession is such a strange and incredible privilege. From very early on, we students have such unadulterated access to the human experience. Although medical school is set up to allow me and my colleagues to have those experiences, and although we are told to be aggressive in finding new things to see, new procedures to watch, new specialties to observe, we have no real right to enter patients' lives. When I am afforded that privilege by patients, in some small or large way, I want to remember to thank them.

There is so much that I learned this past month, and I am so grateful for this opportunity. I suspect many aspects of personal growth that occurred will not become fully apparent until I spend a bit more time reflecting. But my experiences shaped a wonderful month. As someone who never saw myself as a doctor growing up, who did not even consider medicine until the very end of my college career, I am astounded and incredibly thankful that I found something I love so much. There will be times this coming academic year where the work will be overwhelming. There will be times when I am envious of my friends with "normal jobs" and normal hours. I will miss out on social opportunities and family time for the sake of learning. But I want to remember that a balance can be struck between this remarkable training and everything else that shapes me as a person. And I want to remember how excited I am to practice medicine on a daily basis in the future. I hope that thinking back on this experience in Wyoming will help me do just that.

A Simple Solution to a Complex Challenge: Community Engagement in a Rural Setting

submitted by: Emilio Sulpizio
[email protected]

Life is daunting, that’s something everyone comes to realize. I faced one of those challenges this summer as I traveled to Montana for my experience with the UW School of Medicine’s Rural/Underserved Opportunities Program (R/UOP).  Fresh off my first year of medical school, I was filled with apprehension as I loaded up my Buick for the trip. I’d be working in a Community Health Center for one month, a frightening enough task on its own as my clinical skills were nothing impressive. Add to that the fact that all I knew about the community was that it was close-knit with a rough around the edges reputation, and it’s clear to see why there was anxiety.

 I’m not going to pretend the entire month went smoothly. However, in my time there I discovered a secret that allows about anyone into a close-knit community; something that creates a deeper human connection, and something that everyone is capable of doing. The secret is simple, it’s just a phrase, “Hi, how is your day going so far?”  You may wonder what makes this phrase special or how it even relates to healthcare in a rural community. 

 For the first week I spent time having lunch at local restaurants or just walking the neighborhoods. Whenever I encountered someone, I was met with hesitancy if I simply acknowledged the person with a casual greeting or opted to begin sharing my story from the start. I noticed a drastic change as soon as I employed that simple phrase to start a conversation. Those few words demonstrated that I genuinely cared about that person’s life, and that show of human connection made the difference. The lines of communication immediately opened.  All it takes is putting forth a little effort to demonstrate a genuine interest in someone, and your efforts will be rewarded. It’s easy to offer a greeting of acknowledgment and nothing more, but what makes this phrase different is it’s a question you are likely the first to ask. We are trained to respond with “good” or “fine” if a stranger asks how we are, but by focusing the question on a specific topic, the answer is forced to be more individualized and real.

 How does this connect to rural medicine?  In a rural setting, physicians are required to take on a larger role than simply a provider. They are active in the community, leaders of organizations, and voices for marginalized populations. It’s vital they take on this expanded role in a close knit community to build the kind of relationship that improves patient outcomes. But what is the good of this responsibility if it is not successful and continuously developing?  Going through the motions without progress does nothing to maintain the trust a provider has worked to build. 

 The interest that forms the foundation of this relationship can quickly be established by demonstrating real effort to the community. It is incredible what can happen when time is taken to engage someone in a heartfelt conversation. I found this opened people up, not only to helping with my R/UOP project, but also to helping me identify the needs of the community. Wandering in and out of restaurants or stores, I started every conversation with the same simple phrase. As I got to know the individual better, I was then very direct in asking what they felt the needs of the community were. Because it was apparent I was truly interested in the town, I got real, meaningful answers. This key step, the establishment of a connection, made the difference in my project. 

 This is a lesson all providers can benefit from. It is easy to come in to a new community and get caught up in how we have always done things. However, to be truly successful in a rural setting, community engagement must take place. It can certainly be a daunting task, but it all starts with baby steps. The take home message is really that a phrase that seems so simple or trivial, can really change outcomes. In the end, it’s not about the words specifically; it’s about the people and the emotion.

The Care of a Physician: A Small Town Experience

submitted by: Sawley Wilde
[email protected]

A life changing experience occurred during a rural community research project in Cody, Wyoming, and the care provided to one patient by a passionate physician demonstrated the importance of trust, respect, and responsibility in the healthcare profession. The small town at the base of Yellowstone Park consists of a community featuring a large elderly population. Over the course of four weeks a young family physician provided care for a sweet, 90 year old woman previously diagnosed with dementia and Stage III breast cancer. After weighing the risks and benefits, she previously chose not to pursue aggressive therapy.

During a routine clinical visit, it was evident that this woman had been under the care of the same physician for several years and a clear, personal relationship had developed between the doctor and all parties involved. She presently seemed very confused and had difficulties performing activities of daily living, relying on the care of her husband, sons, and various family members. Initially, a primary visit consisted of medication adjustments and a simple physical examination, a seemingly routine experience for the family. Shortly after, however, a devastating fall resulted in a severely fractured hip, forcing the patient to face the difficult decision of whether or not to undergo surgery. Even though the patient was clearly demented, the attending physician displayed great patience and involved her in the process as much as possible. After several consultations, the decision was made to proceed with surgical repair of the fracture. Unfortunately, complications arose, and with the patient's current health complications, rapidly progressed. The family now faced a difficult decision, and they agreed to place her in hospice care soon after, fully aware that the time remaining to spend with their loved one was very short. Emotions escalated and everyone searched for understanding.

The support, compassion, and care provided by the attending physician throughout the entire experience proved to be remarkable. He not only assisted in every decision made by the patient and family, including declining aggressive cancer treatment, surgical intervention, and eventually hospice care, but also showed unconditional support. The trust developed between the physician and patient's family never faltered. Although the family faced an incredibly difficult series of events, the compassion and patience displayed by the physician clearly lightened the burden, and the family's immense thankfulness toward him will never be forgotten. The care of one patient showed the importance of trust, compassion, and humility in the healthcare field, and a physician from the small town of Cody, WY provided a powerful example to a future physician that will always be remembered.

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Robert Wood Johnson Foundation Recognizes WA Senior Center Programs

submitted by: Gene Patterson

[email protected]

Through the Systematic Screening and Assessment of Workforce Innovations in the Provision of Preventive Oral Health Services project, the Robert Wood Johnson Foundation worked with ICF International to identify promising workforce innovations that have the potential to increase Americans’ access to preventive oral health services. The 25 programs described in the 2013 Report ( participated in evaluability assessment (pre-evaluation) site visits in September - December 2012.

The Smiles for Life Senior Dental Access Programs, designed by Cyndi Newman, RDH, BSDH, MS, and represented by the Bellingham Senior Center program operated by Anita Rodriguez, RDH, BSDH, since 2007, have been recognized as one of the 25 most promising innovative programs in the United States. The senior center programs in WA have further been distinguished as one of the top nine programs that may be further studied by rigorous outcomes evaluations. 

From the 2013 Department of Health draft report on the senior center programs we have the following statistics:

From July 1, 2007 to July 1, 2013, 3,344 individuals were seen in senior centers. The average patient age was 72.3 years. Of these senior citizens, 3,140 (93.9 %) did not have dental insurance coverage and 1,621 had a dental home (family dentist). Of 1,691 who did not have a dental home at the initial visit, 1,459 were referred to a dentist.

Time frame

Number of patients seen

Average patient age

July 1, 2007 to June 30, 2009



July 1, 2009 to June 30, 2013



July 1, 2007 to June 30, 2013



According to the Department of Health draft, there are currently 25 dental hygienists providing hygiene services in 88 approved senior centers. There were no adverse effects or events reported about services performed in the senior center programs.

The Smiles for Life Senior Dental Access programs were the only one of the innovations recognized by the Robert Wood Johnson Foundation which focused solely on care to seniors. Contact information and program descriptions are available now to other states looking at possible improvements in preventive oral health care for their own under-served populations.

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Washington Quality Awards

submitted by: Sharon Eloranta
[email protected]

The 2014 Washington Quality Awards opened on January 6, 2014. The awards, organized by Qualis Health, were created to reward Washington State organizations, institutions and practitioners for their work in improving patient safety and healthcare for all. Past recipients have been leaders in the industry who have created better healthcare for individuals, better health for populations and reduced costs through improvement. Awards will be presented at the 2014 Northwest Patient Safety Conference on May 28, 2014 at the Lynnwood Convention Center in Lynnwood, Washington.

Please encourage your healthcare colleagues to consider applying for this well-respected award. See the Qualis Health awards page ( for more information, including instructions for applying and award criteria.

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COHE Opens New Kennewick Office to Serve Injured Workers

submitted by: Jerrie Heyamoto
[email protected]

The Eastern Washington Center of Occupational Health & Education (COHE) recently opened a new Kennewick office to better serve southeast Washington counties to improve injured worker outcomes.

The Kennewick office will serve Benton, Franklin, Walla Walla and Columbia counties.

The Eastern Washington COHE also has offices in Yakima, Wenatchee and Spokane. The Eastern Washington Center of Occupational Health & Education (COHE) is a program of St. Luke’s Rehabilitation Institute and Inland Northwest Health Services (INHS) in collaboration with Washington State Department of Labor and Industries (L&I).

Two newly hired health service coordinators located at the Kennewick office are providing coordination and communication between health care providers, employers and injured workers throughout southeast Washington.

For one area employer, the Kennewick-COHE office provides consistency by working with the same people who understand the employer’s needs. “My weakness is having the time to communicate with doctors and hospitals, and COHE is good at speaking the same language as the medical professionals,” said Dan Eslinger, safety specialist for Pasco Processing, LLC. “COHE’s goal is to take care of the person, and part of that is getting them back to work when they’re ready.”

Eastern Washington COHE currently has more than 1,200 participating COHE health care providers, 35 hospital emergency departments, 800 employers and several labor unions. 

“Our efforts are to help get people back to work in a safe and timely way by working with health care providers, employers, L&I and employees,” said Nancy Webster, director of St. Luke’s Rehabilitation Institute and the COHE program. “There are approximately 5,000 state claims in the three-county expansion area, making our services vital to an effective workforce.”                                                       

The new office is located at:

3311 W. Clearwater Ave
Suite C116
Kennewick, WA 99336


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Former Youth Health Service Corps Coordinator Speaks at White Coat Ceremony

submitted by: Western Washington Area Health Education Center

[email protected]

During the 2011/2012 school year, Patricia Egwuatu was here at Western Washington Area Health Education Center (WWAHEC) as our Youth Health Service Corps Coordinator. The Youth Health Service Corps is a health career recruitment program that engages high school students in meaningful service addressing community health issues. Student volunteers increase their knowledge about health careers while participating in needed service activities and building their resume for college or work.

Following her work with WWAHEC, Patricia was accepted to the Pacific Northwest University of Health Sciences (PNWU) to become a Doctor of Osteopathic Medicine. At the end of her classes first year, they had their ‘White Coat’ ceremony and Patricia was asked to speak. With her permission, we have reprinted her speech.

Good morning Class of 2017, parents, families, faculty and staff. My name is Patricia Egwuatu and I am entering my second year at PNWU and am truly honored to be sharing this day with you. This time last year, I remember sitting in my seat waiting for my white coat and thinking to myself what did I get myself into and I hope I am not that girl that trips on the way up to receive my coat.

My story begins here in Yakima, Washington, where my father, left everything he knew in 1979 to come to America for a better life, and not just for himself but for his future family. To make ends meet, he picked cherries with other migrant farm workers. Later at Central Washington University, he met my mother, also an immigrant from Uganda. Their sacrifice and resilience continues to follow me through my own life journey.

At a young age, I heard my parents whisper about my relatives, who had passed away because of no access to healthcare. My grandmothers, many of my aunts and uncles died because of this consequence. I began to regard physicians as people who possess the spirit and ability to bring hope to their community. These are the characteristics we search for in a physician and we should strive to be as medical students. Our future patients will see us as a guiding light.

First year of medical school was a year of many moments when I sat down and thought to myself, “Who am I to be in medical school?” “Why am I doing this?” Then, as reality set in I remembered my chosen path. I chose this path to help make the world a better place.

During my first year, my parents decided to adopt four of my cousins from Uganda since their parents had passed away years prior and they were living on their own. I am the oldest of four siblings, so my first through about adding to our family was joyful. Now I would be the oldest of eight kids. You see for them, America is a land full of opportunities.

Their daily struggle to adapt to American culture opened my eyes during the journey through my first year of medical school. While my classmates and I are complaining about long school hours, other in my life wished they could be in a classroom. Their journey became my journey and they continue daily to open my eyes to the difference we can make as medical students. I asked one of my cousins, “What do you want to be when you grow up?” Her response was, “I want to be you, I want to be a doctor.”

By watching my cousins’ immigrate, it has allowed me to see how this journey through medical school will allow others to see that with hard work and dedication, they too can make a huge impact. When the challenge we face through this journey start to seem overwhelming, or even impossible remember this path is not an easy one and not one many individuals take. Please do not ever let someone tell you, you can’t do something. Because this is your dream and you have to protect it. If I had listened to an advisor I had in undergrad, I would not be here living my dream. PNWU will give you individual success but also success that can change the world as a community.

I want to leave you these words Nelson Mandela spoke during his inauguration. “And as we let our own light shine, we unconsciously give other people permission to do the same. As we’re liberated from our own fear, our presence automatically liberates others.”

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Twice the Joy in Walla Walla

submitted by: Jerrie Heyamoto
[email protected]

photo: James and Emma Givens

Billie Jo Givens’ twin babies came into the world all of a sudden and 10 weeks early. Nurses at Providence St. Mary Medical Center in Walla Walla, WA, hurried them into incubators and worked with NW MedStar’s pediatric specialty team to transport them to Richland, WA to the next level of care.

Everything moved so fast at the time of delivery. The NW MedStar team carried the infants to Mom’s bed before leaving - and she had her first glimpses of James (2 lbs., 15 oz.) and Emma (3 lbs).

“They were very reassuring,” Givens, 30, says of the NW MedStar pediatric registered nurse and respiratory therapist. “They told my family they were impressed with how the babies were doing. They gave everybody compliments.”

That reassurance was certainly welcome. Just days before during a normal, incident-free pregnancy, she went into labor unexpectedly one morning. Her doctor administered a shot to stop her contractions.

The babies came anyway, two hours and five minutes after labor had begun. “They were ready,” Givens says with a laugh.

The births were complicated. Baby James’s heart rate dropped drastically during delivery. Emma became stuck in the birth canal; the doctor performed a Caesarian section. Even before the ordeal had ended though, the care team was in action and the NW Medstar team was there and ready to transport them while providing the advanced care they needed during transport.

They took the twins to Kadlec Regional Medical Center in Richland, where the infants remained for 51 days. Givens convalesced in the hospital several days herself before going home on the third day. She and the twins are all doing well, she says.

Upon Givens’ return home from the hospital, a renewal notice for her family’s NW MedStar membership awaited in the mail. She’d paid $59 to join the previous year before knowing she was pregnant, and thankfully so, she said.

Without the membership, her family’s bill for transporting the twins would have totaled $43,000. With it, the flight cost nothing.

“We will never let that lapse,” she said. “I’m a big advocate. I tell everybody to buy it.”

For more information about Northwest MedStar visit

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Washington Native, Thankful for the Trauma System

submitted by: Justin Dillingham
[email protected]

Washington native, Cassidy Almquist, was volunteering at a church camp located at Bar M Ranch in Adams, Oregon when a zip line harness snapped, causing her to fall 45-50 feet to the ground. The 17 year old landed on her feet, which resulted in immediate pain and a loss of sensation from the waist down. The Bar M is located in the Blue Mountains and is approximately a 90 minute drive by car back to the closest hospital facility in Pendleton. The first responders from Umatilla Tribal Fire Ambulance requested Life Flight Network after assessing Cassidy's injuries and initiating care.

The flight crew of Life Flight 12 responded to the incident with Steve Hardin, Flight Nurse, and Michelle Broadsword, Flight Medic. Upon arrival to the location, they performed a quick assessment of Cassidy, who continued to be in extreme pain and still unable to feel or move her lower extremities. She was conscious and breathing normally, but had no memory of the event. Life Flight 12 spent only 9 minutes on the ground before departing with Cassidy on board en route to Kadlec Medical Center in Richland, WA.

Cassidy was given pain medications and her vital signs remained stable during the 21 minute flight to the trauma center. She was evaluated and stabilized before it was determined that the extent of her injuries necessitated transfer to a Level 1 trauma center - Harborview Medical Center - by fixed wing.

At Harborview, Cassidy was hospitalized for several weeks and underwent multiple surgeries to repair her extensive injuries. These included a burst T-12 vertebral fracture with spinal cord involvement, fractured pelvis, lower extremity fractures, sternal fractures, fractured right elbow, rib fractures, several internal injuries and a severe laceration to her posterior tongue. According to Cassidy's father Mark Almquist, the physicians continued to discover injuries up to two weeks after her admission. Mr. Almquist was in Montana when the accident happened and received updates by phone as he drove west to be with his family. Her family stayed closely by her and created a website to be able to update her friends and community.

Today Cassidy continues to recuperate from her injuries and has slowly regained some feeling in her lower extremities and pelvis. She is determined to recover use of her legs. Cassidy is thankful for the emergency responders, hospital staff at Kadlec, and Harborview who helped her. She is strongly supported by her family, friends, and church community in Tri-Cities, who came together to revamp her house to make it functional for her. She performs worship music with her friends and spends time with her new puppy, Hope.

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Health Care Reform and Rural Communities: Finding the Right Fit

submitted by: Shane Tuck
[email protected]

Join more than 200 rural health colleagues from Washington, Oregon, Idaho, Montana, and Alaska to share strategies, best practices, project models, innovative ideas, and success stories.

This year’s conference(s) focus is on how rural communities are navigating the changes in health care reform and finding the right fit for their community through sharing proven tips, tools, methods or initiatives. Breakout session content will focus on an exchange of information about programs and innovative strategies that can be models for changing rural health and health care delivery at the state and regional levels. Hundreds of rural health professionals attend, ranging from rural health administrators, health care providers, board members, educators, state and federal staff, public health officers, researchers, information technology specialists, and more.

Once again, sessions are content-rich and delivered by experts doing the work. See for yourself in the brief outline below or go online for more detail. We do hope you can join us. This largest gathering of rural health professionals in the Northwest will once again be at the Red Lion Hotel at the Park in Spokane, Washington, March 18-20, 2014.

Scholarships Available for the NW Rural Health Conference!
Seven scholarships accompanied by 1 night's lodging will be awarded by lottery for those indicating their interest by March 3rd. Simply indicate your interest during the conference registration process with specification for payment in the event your name is not drawn.

12th NW Regional Critical Access Hospital Conference

Plenary Sessions:
Surviving the Crossing of the Shaky Bridge
Eric Shell, CPA, MBA, Principal, Stroudwater Associates

The Future of Healthcare – It Starts with You
Lance Keilers, President, Connected Healthcare Solutions

Keeping Care Local with Telemedicine: The Grande Ronde Story
Doug Romer, Executive Director of Patient Care Services, Grande Ronde Hospital

The Art of Community Engagement
Michelle Rathman, Impact! Communications, The Right Strategies for Rural Healthcare

Choose from 5 concurrent breakout sessions that include public health, medical home, affiliation and more.

Come celebrate with us and connect with colleagues from around the Northwest at the Joint Conference Reception from 5 – 6:30 p.m. on Tuesday, March 18th.

27th NW Regional Rural Health Conference

Plenary Sessions:
Be the Bar
Zach Hodges, CPHIT, Senior Consultant, Qualis Health

Rural Strategies for a Value Based Future
Keith Mueller, PhD, Rural Health System Analysis & Technical Assistance (RHSATA)

Insurance Exchanges and Medicaid Expansion: Is the Rural Northwest Covered?
Panel Presentation, Representatives from:
Region X
Washington Health Care Authority
Cover Oregon
Moderated By:
Tom Martin, Lincoln Hospital, Davenport WA 

Choose from more than 19 concurrent breakout sessions designed to deliver content inclusive of collaborative rural models, innovative community projects, quality, and other underlying themes that shape the way business is done.

We look forward to seeing you there!

For More Information Visit Our Conference Website.

To Register for One or Both of the Conferences CLICK HERE.

More info: (509) 358-7640 or [email protected]

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