Organization Newsletter

September 2013


In this issue...

  1. President's Message
  2. State Office of Rural Health: The Provision of Technical Assistance
  3. WRHA Website Gets a New Look!
  4. Professional Continuing Education Opportunities
  5. NW MedStar Base Chief and Coordinators
  6. Innovation in Therapy Solutions at St. Luke's
  7. A New Path for Forks Community Hospital
  8. Do Disparities in Clinical Quality Exist Between Rural IPPS Hospitals, Critical Access Hospitals, and Urban IPPS Hospitals? YES!
  9. Life Flight Network Critical Care Transport Helps Man Survive Mountainside Cardiac Event


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] 

At our most recent WRHA Board of Directors meeting one of the topics that surfaced during our discussion was the role that WRHA plays in advocacy for rural health in Washington. One person said that this is what we are really here to do. This is what people expect of us. Advocacy, however, is not the only activity that we do. Our current project, which I've written about before, is our Community Roundtable meetings in which we plan, with local health care and other leaders, a community meeting centered on coming changes in health care that are driven both by external mandates, like the Affordable Care Act and internal pressures such as the shortage of providers. Many rural hospitals and clinics are having a very tough time financially. As a result rural health care organizations all over the state are thinking about how they might do things differently in order to make the health care experience for the patient a better experience, how to improve the health of the community as a whole, and how to do all that and reduce the cost. The WRHA Roundtable meetings bring residents in rural areas together with health care leaders in the community and other leaders, such as school districts. We generally spend the first part of the meeting educating about what health care needs to look like in the future and then we facilitate a discussion with the whole group, looking for ways that the community can work together to achieve the three goals I mentioned earlier. We have held two such meetings so far, in Davenport and Pomeroy, and are planning a third in Dayton. A fourth community has asked to put them on our list.

The Roundtable meetings have been very successful and well received, but now I'd like to circle back to the issue of advocacy. WRHA as an independent not-for-profit organization has the freedom and desire to back certain issues that seem to us to be important for the improvement of rural health. We can also be the voice of opposition to proposed legislation that could hurt rural health. But I am wondering about something and I'll pose it as a question to you, our membership. How do you perceive our advocacy efforts? Do you think we're doing a good job of staying on top of these issues? Are you getting enough information? I invite you to let me know what you think. You can email me at [email protected]. If you know other board members and would like to communicate with them, go to and look for the Board. You'll find our email addresses there.

Please do let us know how we're doing. We are here, after all, to serve you.

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State Office of Rural Health: The Provision of Technical Assistance

submitted by: John Hanson

[email protected]

One of the services that the State Office of Rural Health (SORH) is expected to give is that of providing technical assistance (TA). The federal government, which funds the SORH grant every year, defines TA as: " . . . any activity provided by SORH that results in the delivery of substantive information directly to a client (s). TA must be provided face to face or via in-depth telephone and e-mail interactions." TA can be given to a variety of clients including health care providers, hospitals, clinics, networks, agencies, associations, organizations, academic institutions, government officials, communities, partners and other stakeholders.

During the twelve months from July 1, 2012 to June 30, 2013 the Washington SORH provided 117 TA encounters to clients. The unduplicated clients to which we provided TA were in the categories of Communities (2), Government Officials (5), Academic Institutions (3), Associations (9), Agencies (6), Networks (3), Emergency Medical Services (1), Clinics (12), Hospitals (12), Medical Providers (1) and a variety of uncategorized clients, including individuals seeking information (29).

On a completely different note I want to let you know that I'll be retiring from the Department of Health, where I have worked for the last eight years, as of September 30th. I've had a great time here, and am leaving with the feeling of satisfaction that I have helped many people navigate the confusing world of health care regulations, helped providers apply for loan repayment of their education costs, gotten to know many managers of our Rural Health Clinic system, had the privilege of writing this column most times (I occasionally ask others in the office to do it), and have enjoyed the company of my wonderful co-workers. I trust that I have made a difference in people's lives.

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WRHA Website Gets New Look!

submitted by: WRHA e-Newsletter Editor
[email protected] 


Your WRHA team has worked hard over the summer to bring an updated look to the WRHA website, but they didn't stop there! There are few new features worth checking out. In this article we will take a look at just a couple of these new features. 

To view and enjoy these features you will first need to log into your WRHA account.

Sharing Pictures

As a member you can now upload a photo of yourself or your company logo to accompany your membership profile. You can also upload photos of the great work you are doing in your community to share with the whole WRHA membership or just those you have selected as a Connection. You simply update your privacy settings by hovering your mouse over My Profile and selecting the Privacy selection in the menu. On the Privacy Settings page you can decide to keep those photos to yourself, share with your Connections, or keep the default and share with the membership as a whole. This feature is similar to other social media you might be familiar with, like Facebook. 

Making Connections

Do you want to reconnect with an old colleague or reach out to fellow member you met at a networking lunch? Hover your mouse over Connections and select Browse Directory to see all WRHA members. You can send them a private message from your WRHA membership profile or add them as a connection. You can see who they are connected to. This feature is similar to the "friends" feature of Facebook or other social media platforms.

Need a Receipt or Perhaps an Invoice?

Do you need to submit a receipt or print out your invoice for the accounting department? Hover you mouse over My Profile and select View Transactions from the menu selections. If you have made a recent payment or requested an invoice it will show here. You can download and/or print your selection, place it your records, or route it to the appropriate department.

We hope you like WRHA's new look and the added features. Get in there, take a look around, and be on the look out for more short articles highlighting various added features! Happy surfing!

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Professional Continuing Education Opportunities

Inland Northwest Health Services (INHS) and its service lines offer a variety of professional education opportunities throughout the year which we hope you’ll take advantage of. Through NW TeleHealth, health care professionals can access live, interactive continuing education to meet credentialing and educational needs, without having to travel to other locations. Please contact your TeleHealth Site Coordinator to arrange video conferencing.
The 2013-14 education calendar begins in September and includes:

Northwest MedStar Provider Chats

Provider Chats are conducted through the Northwest TeleHealth network and designed to promote experiential learning through the discussion of interesting cases.
When: Second Thursday of every month (except in the summer)
Where: Video conference locations around the region via Northwest TeleHealth
Time: 1 – 2 p.m. (PST)
Topics: Visit

St. Luke’s Rehabilitation Institute Clinical Education Series

Clinical Education Series are a chance for providers throughout the region to learn from St. Luke’s experienced nurses and therapists as they share best practices and knowledge.
When: Fourth Wednesday of every month
Where: St. Luke’s Main Campus and around the region via Northwest TeleHealth
Time: Noon – 1 p.m.
Topics: Visit

Health Training EMS [email protected]

A live, interactive program that broadcasts monthly over Northwest TeleHealth to rural and frontier EMS communities in Washington, Oregon, Idaho, Montana, the Aleutian Islands and Southeast Alaska.
When: Second Tuesday of every month (except in the summer)
Where: Video conference locations around the region via Northwest TeleHealth and other partner TeleHealth networks
Time: 6:45 – 8:15 p.m. (PST)
Topics: Visit

INHS Health Training

INHS Health Training provides classes according to the American Heart Association Guidelines and offers many scheduling options to fit your needs. This includes a combination option for an online course with an in-person skills test for any course listed. You can also call us at (509) 242-4264 to arrange classes at your location. Listings of classes and online registration are available at

If you are a Northwest MedStar member or member group, you can receive an additional 10 percent off of any continuing education class offered by INHS Health Training.

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NW MedStar Base Chief and Coordinators

submitted by: Jerrie Heyamoto
[email protected]

Roger Casey Joins Northwest MedStar as Tri-Cities Base Chief

Northwest MedStar is pleased to announce Roger Casey, MSN, RN, CEN, as the Tri-Cities Base Chief for their regional base at the Richland Airport. Casey has extensive critical care and emergency experience with more than 22 years of health care experience and 17 of those in the Emergency Department.

Well known by many Northwest MedStar partners in the southeast region, Casey previously was the Trauma and Stroke Coordinator at Kadlec Regional Medical Center in Richland. “I am a patient advocate and believe that the patients in our community and region deserve the best care available,” says Casey. “I’ve worked with Northwest MedStar and have seen firsthand their commitment to quality patient care.”

Base Coordinators Added Throughout the Region

In addition to a new base chief for Tri-Cities base, NW MedStar has added new base coordinators who will provide outreach to hospital partners and EMS. If you have a question or concern, be sure to let one of the base coordinators know how they can help.

Ben (Clyde) Suttlemyre, BSN, CEN, NREMTP, RN
Spokane Base Regional Coordinator
Ben Suttlemyre has more than 23 years nursing experience and is extensively qualified to provide critical care and on-scene emergency nursing. He has been a member of the NW MedStar flight team since 1998, two years after the inception of MedStar in 1996. “As Spokane Base Coordinator, I am looking forward to helping our partner agencies and hospitals in northeast Washington and northern Idaho find solutions to their patient transport needs,” says Suttlemyre.

Shawn Ottley, RN, BSN, CCRN, EMT-B
Moses Lake Base Regional Coordinator
Shawn Ottley joined NW MedStar three years ago. He has been in the air medical industry for the past 10 years and has been in health care for 15 years. “I grew up in Central Washington and am excited to have the opportunity to give back to the community,” says Ottley.

Bob Montgomery, RRT-NPS, EMT-B
Palouse Base Regional Coordinator
Bob has worked in health care for 23 years and in the air medical industry for 10 of those years. He has been with NW MedStar nearly four years. “One thing people may not know about me is that I am a Former Navy Deep-sea Diver/Medic and am retired Navy,” says Montgomery. “I love the Palouse region and hope to get to know the hospital and EMS providers, and the people who live in the Palouse region even better.”

Tri-Cities Base Open House – Thursday, September 12, from 4 until 6 p.m.
Join us at our Tri-Cities base open house, in collaboration with the Tri-City Regional Chamber of Commerce. We hope you will be able to stop by, say hello to Roger Casey and visit with our team.

Northwest MedStar
Based in Spokane, Tri-Cities, Moses Lake and the Palouse region.
To request a transport: (800) 422-2440

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Innovation in Therapy Solutions at St. Luke's

submitted by: Jerrie Heyamoto
[email protected]

View the “Innovation in Therapy Solutions photo album on St. Luke’s Facebook page.

New Assistive Technology Lab and Independent Living Apartment to benefit patients

St. Luke’s Rehabilitation Institute in Spokane, WA, is bringing additional innovative and family-centered health care to its patients and their care givers with a new Assistive Technology (AT) Lab and modernized Independent Living Apartment (ILA).

“The latest enhancements provide people with physical and cognitive disabilities access to technology and an area that helps them perform daily activities in a safe and controlled environment,” said Nancy Webster, director of rehabilitation services at St. Luke’s Rehabilitation Institute. “The latest technology and equipment promotes greater independence for people with disabilities to accomplish tasks and improve their quality of living.”

The AT Lab is fully equipped with adaptive technology to accommodate patients in both inpatient and outpatient settings and is overseen by an assistive technology professional certified by the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA). For patients with limited arm or hand function or full-body paralysis, the lab is adaptable to patients’ unique needs:

  • Dragon Naturally Speaking- the latest voice to text software 
  • iPads- with smart covers 
  • Web Cams- allows patients to communicate via video chat
  • WiVik 3 software- allows all-in-one touchscreen computer
  • Smart TV- good for group classes and patients with restricted eyesight

The upgrades in the ILA help prepare patients and their care givers for their transition from inpatient rehabilitation to their daily lives at home. “With a fully simulated living area, patients recovering from an injury or illness have the opportunity to practice their daily home routines,” said Chris Clutter, therapy manager for St. Luke’s. “This gives patients independence in a controlled environment and helps them gain confidence before they return home.”

Fully equipped with an automated environmental control system, the ILA allows for complete environmental control of the apartment such as turning the lights or TV on and off and opening and closing the window blinds. The system can be activated by iPad or wheelchair controls.

The AT Lab and ILA were made possible in part to generous grants and donations from the Christopher and Dana Reeve Foundation, tw telecom and individual donors.

About St. Luke’s Rehabilitation Institute

St. Luke’s Rehabilitation Institute is the region’s largest free-standing physical medicine and rehabilitation hospital and the only Level I trauma rehabilitation hospital in the Inland Northwest. St. Luke’s serves more than 7,000 patients each year in inpatient and outpatient settings - people who have suffered a stroke, lost a limb, and suffered a brain injury, spinal cord injury or one of many other illnesses or injuries. St. Luke’s is a division of Inland Northwest Health Services (INHS). For information on how to support St. Luke’s, please visit or call (509) 473-6099.

For more information on St. Luke’s:


A New Path for Forks Community Hospital

submitted by: Fran Miller, WRHA Board

Do you remember the old saying, “The only thing that is constant is change”? We all face this challenge, but in the rural healthcare setting, how do we make these transitions smoothly and efficiently while meeting the healthcare needs of our communities? During the past year, Forks Community Hospital and Clinics lost several key administrative personnel due to retirements. The search to fill the position of administrator/CEO lead to the hiring of William “Bill” McMillan, FACHE, a dynamic and innovative individual bringing new leadership and presence to Forks Community Hospital and the community.

Bill McMillan and his wife moved to Forks Washington from Gold Beach in southern Oregon to live closer to their parents, and to work in a rural healthcare setting with the goal of meeting the challenges of sustainable healthcare in our community.

He recently completed five years as CEO of a small hospital in Oregon and brought with him a vast amount of experience in the healthcare field, and new innovative ideas to maximize affordable healthcare services while adding new specialty services based on the chronic disease prevalence of our patients.

Bill is originally from Cleveland, Ohio where he completed his undergraduate degree. He began his career in Mental Health and Counseling which gave him a unique perspective of the challenges people face when life situations and health issues arise. When he moved out west in 1984, his experience transitioned into the professional side matching the right combination of physicians and mid-levels in rural healthcare practices. He began to understand the advantage of rural healthcare and the bond between people in this setting, plus the independent impact it made on the community. Bill continued his journey in the healthcare arena by establishing a Case Management Program that provided professional healthcare resources to facilities. He became a Methods Analyst and redesigned a program from manual to automated claims processing systems for Blue Cross in Northern Ohio.

After completing his MBA degree, Bill’s career took various turns from regional Lithotripsy Programs to revamping an Advantage care program setting up Provider resources for Washington Healthy Options at reduced reimbursement fee schedules. He became a member of the Fellow of the American College of Healthcare Executives (FACHE), and started a new position in Guam building a surgery center and subsequently becoming CEO of the island’s hospital. A plus for Bill, he was able to work in a location that included his love for scuba diving! Bill subsequently worked in Population Health Management leading to a better understanding of Chronic Disease. The education, experience and knowledge gained during his career gave him the tools needed to refocus on the rural communities to broaden the political foot print, sustainable healthcare and maximize services for the underserved areas.

Bill McMillan made a smooth transition as CEO of Forks Community Hospital demonstrating his ability to wear many “hats”, identify the areas of change, and improve upon pre-existing programs. Some of the current projects include:

  • Based on a high COPD patient population, a new Cardio-Pulmonary Service has been added including hiring a Respiratory Therapist and projections for cardiac stress testing.
  • The Interdisciplinary Care Management Committee (ICMC) has been established to focus on high resource utilizer patients to insure that medical care, mental health and chemical dependency care efforts are coordinated without duplication.
  • Collaboration with Swedish Health Network to update the marketing plan including Forks Community Hospital website redesign and community calendar. This year the hospital has already coordinated Forks Family Fair, Quileute Health Fair, Smile Mobile, World Diabetes Day, and Back-to-School Health Fair at the Bogachiel Clinic.

As new CEO of Forks Community Hospital, Bill feels our rural healthcare growth opportunities are unlimited, we need to continue our efforts to be efficient and productive, and the new focus will insure sustainability of our healthcare services to the community. The general opinion about the performance of our new CEO is that Bill McMillan has made a positive impact on both the hospital and our community. Welcome Onboard Bill!

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Do Disparities in Clinical Quality Exist Between Rural IPPS Hospitals, Critical Access Hospitals, and Urban IPPS Hospitals? YES!

submitted by: Jillyn Reid, MHA, CPHQ
[email protected] 

Performance Comparison on Inpatient Quality Reporting Program Metrics:

The Appropriate Care Measure (ACM) is a composite measure identified by CMS that captures whether a patient received all the care he or she was eligible to receive based on the following measures from the Inpatient Quality Reporting (IQR) Program: AMI, HF, PN, and SCIP. The ACM is a total patient level score versus scores for the individual indicators. Patients eligible for at least one metric (quality measure) are counted once in the denominator. Patients meeting all metrics for which they are eligible are counted once in the numerator, but are not counted if any measure is missed. If all metrics are met, the score is 100 percent, thus the patient has received all the recommended care for that condition. If any metric that the patient is eligible for is missed, the score for that patient is 0 percent. Qualis Health has computed the ACM for Rural IPPS hospitals, Urban IPPS hospitals, and Critical Access Hospitals. From this analysis, Qualis Health concludes that:

  • Urban AND Rural IPPS hospitals have higher overall ACM scores than CAHs
  • Urban AND Rural IPPS hospitals have higher scores for all 4 measures (AMI, HF, PN, and SCIP) than CAHs
  • No apparent difference is observed between Rural IPPS and Urban IPPS hospitals.

WA BOTTOM LINE: Disparities do exist between Washington CAHs and IPPS hospitals, in performance on the 4 IQR measures that comprise the ACM.

  • Urban AND Rural IPPS hospitals have higher overall ACM scores than CAHs.
  • Urban AND Rural IPPS hospitals have higher scores for all 4 measures (AMI, HF, PN, and SCIP) than CAHs. 
  • Rural IPPS hospitals have a lower ACM score than Urban IPPS hospitals. 

ID BOTTOM LINE: Disparities do exist between Idaho CAHs and IPPS hospitals, in performance on the 4 IQR measures that comprise the ACM.

Performance Comparison on Outpatient Quality Reporting Program Metrics:


  • Rural IPPS hospitals perform worse on the Surgical Measures (OP-6 and OP-7), when averaging by facility level, vs. Urban IPPS hospitals.
  • When averaging by patient level, there is no difference between performance on OP-6 and OP-7 in Rural IPPS vs. Urban IPPS hospitals. 
  • Rural IPPS hospitals consistently perform better than Urban IPPS hospitals, on OP-4 (AMI/CP measure), though the difference is minor. 
  • At this time, not enough data exists for Washington CAHs to be included in this analysis.


  • Rural IPPS hospitals perform worse on OP-6. (93.5% average by facility vs. 96.1%, or, 95.4% average by patient vs. 97.0%) vs. Urban IPPS hospitals. 
  • In fact, half of the Rural IPPS hospitals in Idaho are performing below the National Median on OP-6, vs. only one-third of the Urban IPPS hospitals. 
  • There is not enough OQR data from Idaho CAHs to complete an analysis.

As the Quality Improvement Organization for the states of Washington and Idaho, Qualis Health is charged with helping all hospitals in both states improve their quality, safety, and satisfaction outcomes. Since the most current publicly reported CMS data shows that apparent disparities do exist between Urban, Rural, and Critical Access hospitals, Qualis Health is committed to reducing or eliminating these disparities by offering support to our hospitals.

How Can Qualis Health Support our Hospitals?

We offer support to our hospitals so that you can submit your data timely and accurately
  • Qualis Health assists hospitals to get started with reporting their IQR and OQR metrics to CMS. We can help your hospital get set up to report, and train your staff on abstraction and submission.
  • We send out weekly reminders, tips, checklist of due-dates via the “Qualis Health Weekly Abstractors’ Newsletter”
  • Qualis Health has a standardized scheduled in which we send out e-mail and telephone reminders to those hospitals who have not yet submitted their IQR/OQR data. Typically, e-mail reminders are sent at 2 months, 1 month, and 2 weeks prior to the reporting deadline. Phone call reminders go out 2-weeks and 1 week prior to deadline, then daily until we verify your data has been successfully submitted and received by CMS.
  • 1:1 technical assistance is provided (usually via phone) regarding specific measure sets and data element requirements. We are always available via telephone and e-mail to answer questions, problem solve, assist with chart review, etc. 
We provide free, focused consultation to support quality data reporting and quality improvement efforts
  • We have the ability to tailor education, orientation, and training to our hospitals based on their specific organizational/staffing needs. This focused consultation is usually provided 1:1 via webinar, telephone, and/or via an on-site visit with our provider hospitals.
  • Quality improvement coaching and consulting is offered as well. Qualis Health can train on Quality Assurance and Performance Improvement basics, Lean, PDSA, IHI’s Model for Improvement, etc., and in some cases, we can facilitate onsite improvement activities in partnership with our hospitals.
  • Again, because Qualis Health serves as the Quality Improvement Organization and works under a Federal contract, we do NOT charge our hospitals for any of the support or services described above!

If you are interested in Qualis Health assisting your hospital to improve Quality, Safety, Satisfaction, and general performance metrics, thus eliminating the disparities between Rural/CAH/Urban hospitals, please contact me directly:

Jillyn Reid, MHA, CPHQ
Quality Improvement Consultant
[email protected] 
Qualis Health
PO BOX 33400
Seattle, WA 98133-9075


Life Flight Network Critical Care Transport Helps Man Survive Mountainside Cardiac Event

submitted by: Erick Borland
[email protected]

Joe Bernfeld suffered a cardiac event at the 8,000 foot level on Mt. Adams earlier this year. It was a situation where Joe would have to fight for his life to survive and the remote location would contribute to a tragic outcome if all components didn’t fall into place.

Joe was an experienced climber with 40 years of experience. He regularly climbed Grand Teton, which isn’t far from his home in Jackson Hole. Joe has also climbed Pico de Orizaba, the third highest peak in North America at 18,800 feet.

On July 9th, Joe and his wife, Betsy, were high up on the 12,181 foot mountain when he began experiencing a racing heartbeat. He’d been cardioverted for something similar a year earlier. Hoping it would pass, he sat down and waited for 30 minutes. Recognizing help was still needed, his wife Betsy called 9-1-1.

Klickitat County 9-1-1 received the call and dispatched Trout Lake Fire Department and Klickitat County Search and Rescue. They knew it can take 5-to-6 hours to mobilize a climbing rescue team and reach the patient. Chief Eric Schmid factored this knowledge with a report appearing to present a severe cardiac issue and requested Life Flight Network to respond.

Life Flight 7 out of Longview, Washington accepted the request. The flight crew was able to locate Betsy on the mountain as she waved a sleeping bag. The crew carefully selected a landing zone approximately 1,000 feet below Joe’s location. In addition to being the Flight Paramedic on board, Stephen Schutts was also a volunteer for the Volcano Rescue Team serving Mount St. Helens. He felt comfortable with the mountain environment.

The Bernfelds were on a rocky, sloping and snowy ledge at their camp site. As the crew arrived, Joe was placed on the monitor and found to be in ventricular tachycardia, a serious condition where his heart was racing at 217 beats per minute. Joe’s skin color was beginning to turn gray. The flight crew immediately placed an IV and gave Joe a mild sedative. The last thing he remembers is the Flight Nurse saying, “This might hurt a little.”

Cardioversion was performed and Joe’s heart immediately returned to a normal sinus rhythm. Due to the sedation, Joe was lethargic but responsive to commands. He was carefully packaged and Stephen guided the crew down the mountain to the aircraft. Joe received additional pain medication and sedation to keep him comfortable, along with IV fluids and supplemental oxygen. Betsy elected to stay on the mountain overnight and hike out with the search and rescue team the next day.

For Joe, the 33-minute flight from Mt. Adams to PeaceHealth Southwest Medical Center was uneventful. He said he “came to” while in the aircraft and remembers looking down and seeing the tops of trees. The hospital was notified of an incoming cardiac patient and Joe was taken directly to the emergency department.

Joe was later discharged, but not before receiving an automatic implantable cardioverter defibrillator (AICD). He climbed the Tetons four weeks after his experience on Mt. Adams. The Bernfelds live at the 6,000 foot elevation and Joe believes he feels his best when above 11,000 feet. He is hoping to return to Mt. Adams and is also planning a trip to climb the 23,000 foot Mt. Aconcagua in Argentina.

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