4 December, 2004 
Health program pays off at Array 
By Kate Kompas 
kkompas@stcloudtimes.com 

SARTELL -- Company-sponsored lunches feature healthful options such as grilled chicken and sushi. Treadmills are in the basement. 
Employees take walks during breaks and can see a physician's assistant during work hours.
And the most dramatic change: The company's health-care costs have been sliced in half.
Leaders of the call center Array Services Group in Sartell were forced to transform their business' culture after several years of double-digit increases in health-care costs.
The idea of businesses trying to encourage more healthful habits among workers isn't unique. St. Cloud Hospital, Stearns County and ING Direct are some of the local employers that have created such programs for employees. Array's transformation was inspired by a health program at Becker Furniture World.
But what Array's leaders did ranks as one of the more ambitious health campaigns a Central Minnesota business has undertaken:
- Array arranged with HealthPartners Central Minnesota Clinics to bring a physician's assistant into the company 31/2 days a week. That person deals with employees' minor health problems such as coughs or colds and advises on health issues.
The physician's assistant also leads talks on health topics such as stopping smoking and generic vs. name-brand prescription drugs.
- Array bought exercise equipment so employees could work out during spare time. Sometimes employees take organized walks during break time. A pilates class will be added next.
"I don't think anybody knew that word a year ago," Array Chief Executive Officer Jim Christensen said.
- Healthful meals are catered for employees on Tuesdays, Wednesdays and Thursdays. The meals come from Pacific Wok, Blimpie Subs & Salads and Short Stop Restaurants. 
A Weight Watchers at Work group was started, and in a year 15 people have lost almost 800 pounds. At least two other better-nutrition groups are active at Array, too.
Cindy Cormier lost 52 pounds through Weight Watchers at Work. Array's health transformation has turned some of Array's 450 employees "into exercise nuts," she said.
Cormier enjoys using Array's mini-gym: It's convenient and saves her the cost of a gym membership.
"It's nice to be able to go down there and relieve some stress," she said.

Results
Before the changes, many of the employees were stuck at their desks for their entire workday. Pizza was ordered frequently.
"Not being active for eight to 10 hours a day is not a good thing," Christensen said.
The results from all these changes? From April 2002 to March 2003, Array's health-care plan paid about 140 percent of health-care costs incurred by Array employees, according to data kept by the plan. That means the plan paid significantly more compared with what the company was paying.
From April 2003 to March, the percentage of what the health-care plan paid dropped to 68, and it has continued to decline.
Array's leaders can't say for sure that the drop in their health-care costs is directly linked to their new health culture. But they figure it is, and even if it isn't, it's made employees happy.
"Much of the link has been anecdotal, but we have seen in the most recent cycle our premiums for coverage decrease, seen our employees become smarter spenders, probably better eaters and more active," Array's Chief Financial Officer Chuck Engebretson said.
Christensen and Engebretson figured if they could withstand any more cost increases, it would be the corporate equivalent of a home run.
With the significant drop, "this is like a grand slam," Christensen said.
Andy Vinson, executive director of HealthPartners Central Minnesota Clinics, said he would like to do similar partnerships with other businesses. It would have to be a good match for it to work, though, he said.
HealthPartners officials are complimentary of Array's leaders, who they say made a strong commitment to helping their employees change their lives by bringing in a physician's assistant.
Vinson said the contract has Array pay the salary of a physician's assistant, as well as minimal administrative costs.

Savings
Stacy Schmitz-Jansky is the physician's assistant who spends the majority of her work week at Array. The back of her office is partially closed off, and in that space there's an exam table.
Posters promoting health cover the office. Employees who glance at them can learn 100 tips for healthful eating and quick ways to get fit.
Employees can walk in to Schmitz-Jansky's office or schedule an appointment. She also can write prescriptions.
"A lot of employees see it as saving themselves a co-pay," Schmitz-Jansky said. "But I think it saves a lot more."
Schmitz-Jansky sees up to 10 people a day, but it varies. She's been seeing a lot of Georgia Gilbert lately, who has bronchitis.
"It's cheaper than a doctor," Gilbert said.
Schmitz-Jansky said most employees come to her with minor health problems such as back pain or upper respiratory infections.
"For a lot of them, it's nice not having to miss work and having the service on-site," she said. 

By JONATHAN SEGAL
Herald Staff Writer

Steven Dean would have had a long, bloody ride up Highway 1 if not for the Big Sur Health Center. When Dean, a 38-year old fire prevention captain with the U.S. Forest Service, cut his thumb open early this week as he was working on wiring at his home in Big Sur, his wife Dianna knew just where to go. Or did she? "It was the first place I thought of," she said. But when she and her husband got to the health center's temporary site at Julia Pfeiffer Burns State Park, it wasn't there. That meant her husband would be cared for at the health center's new building, which officially opens today. The old building was a 15-year-old converted construction trailer. The health center's new $300,000 prefabricated building is the product of a two-year fund-raising effort, with half the money raised in Big Sur.

Vern Fisher/The Herald  Physician’s assistant Sharen Carey looks at Steven Dean’s finger in the Big Sur Health Center’s new building. Dean’s  wife, Dianna, and child Nicole look on.

It's wired to the Community Hospital of the Monterey Peninsula via high-speed Internet. The new building includes a small lab, drug storage room, examination rooms, a washer and dryer, and, thankfully for the five-person staff, windows. The cramped old building didn't have them.

"In the summertime, the heat would cook the building," said Sharen Carey, a physician's assistant who doubles as the health center's administrator. "We would all be dying."

The building also has a multipurpose room, to be used eventually for holding classes or other events, and 
a spare room that could possibly be used for an in-house chiropractor or massage therapist.

"We just have to take it one step at a time," Carey said.

The clinic gets about 2,600 visits a year from patients across Big Sur's socioeconomic spectrum, people ranging from wealthy retirees to old hippies to tourists to the workers at the area's hotels and resorts. It charges for services on a sliding scale that accounts for differences in income and insurance.

"We try to be comprehensive and to treat all of them," she said.

But the clinic's location is the key to its success. They can treat many injuries there, or stabilize critically ill patients for the 45-minute drive up the highway to CHOMP.

"If you're right here, you have easy access," said Carey. "If you've got a hand that's bleeding, you're not driving to town."
source: http://www.montereyherald.com/mld/montereyherald/10107311.htm

Gloria Kornish, a physician assistant at St. Patrick Hospital, does a routine physical  on Gary Tobol of Bonner on Monday afternoon at the hospital. There are about 30 PAs  working in Missoula and around 300 in the state. Photo by MICHAEL GALLACHER/Missoulian

"The classic thing was, 'When are you going to become a doctor?' " said Jerry King, a Missoula physician assistant who was the second one in Montana when he began working on the Flathead Reservation in 1976.

The answer? They're not trying to be doctors. And most people don't expect them to anymore. Physician assistants, called PAs for short, are their own profession: mid-level health care professionals who work with doctors. They diagnose and treat illness, develop and carry out treatment plans, assist in surgery, order and interpret lab tests, stitch lacerations and apply casts for broken bones. In most states, they prescribe medications.

Physician assistants' field is the third fastest growing profession in the United States, according to the Bureau of Labor Statistics. More than 50,000 PAs practice in the country.

In Montana, about 300 PAs practice. Missoula's PAs have grown to about 30 in number. They work in fields including family practice, cardiology, neurosurgery, trauma, orthopedic surgery, dermatology, ear/nose/throat, allergy and more.

In greater Missoula, they recently reached a critical mass that prompted them to form an official group, Missoula Regional PAs. They have a Web site, www.missoulapas.com, and they hold monthly meetings.

On Wednesday, the PAs will hold a free blood sugar screening for the public at Southgate Mall. They want to serve the public and celebrate the 37th year of their profession.

The blood sugar test can detect on the spot whether a person has diabetes.

"It's probably one of the fastest growing health problems in this country," said Mindy Opper, a family practice PA with a specialty in women's reproductive health, "and Type II (diabetes) has a huge correlation with the growing amount of obesity."

In the United States as of 2002, an estimated 18.2 million people - 6.3 percent of the population - have diabetes, according to the Centers for Disease Control and Prevention. Montana is among 23 states with the fastest growth in numbers of cases, Opper said.

At the screening, PAs will also be ready to talk to the public about what they do.

The profession began when Duke University graduated the first four PAs in 1967. They were Navy corpsmen who had in-depth medical training in the service but then no civilian equivalent in the country's medical system. At the same time, there was an uneven distribution of physicians in the country; inner-city and rural areas were short.

"That's what sparked the development of the mid-level practitioner," King said.

PAs always practice with a physician, often as a member of a team with the physician as its head. In their two-year programs, they are trained to address 80 to 85 percent of the problems presented at a general practice.

When the field first began, there was tension in some parts of the country, where doctors or nurses saw physician assistants as competitors. Today, the Missoula PAs said, their role is generally understood as physician extenders. Doctors can expand their practices with a PA to help carry the load.

For instance, said Paula Colledge, a PA who works with the multiple-doctor neurosurgery practice in Missoula, she can meet with and interview a patient who is being discharged on a Saturday morning, and have everything ready when the physician arrives.

She loves her work, she said.

"As a new PA in this practice, I've been really well accepted by all the physicians," she said.

Brittney Matheson, who works as a trauma PA, sees people who are in the hospital unexpectedly. She works to help them adjust to an injury and a rehabilitation. While most PAs work for doctors, she is employed by St. Patrick Hospital.

In a family-practice setting, the PA can improve the accessibility of health care dramatically, said Kristene Provo, a family practice PA. If a doctor is booked, the PA in the practice can often see the patient the same day.

"In the morning, my schedule might be pretty open," she said. "By the end of the day, I'm full, and people have been able to be seen that day in their own doctor's office."

The job is never dull, said Gloria Kornish, a PA who works in occupational health and primary care.

"It's interesting working with people and being able to make a difference," she said.

PAs draw a wide range of salaries. They're licensed by the state, recertified every two years and take a national recertification exam every six years.

There is no apostrophe in physician assistant, PAs note. They work with physicians, but they don't belong to them.

"The physician-PA relationship is very important to us," said Matheson, "because we work so closely with them."

source:http://www.missoulian.com/articles/2004/10/05/news/local/news02.txt

Sentinel Staff Writer

FAIRMONT -- Not a doctor, not a nurse; who is this person providing my health care, the one called a physician assistant?

Physician assistants are an integral part of the health care team at Fairmont Medical Center, although many people do not completely understand their role.

"I think the term physician assistant says it all in terms of a PA," said Dr. Steve Parnell, medical director at the medical center. "Physician extender is another term. There are not enough doctors to get things done so they help bridge that."

Because of the close collaboration between doctors and PAs, Parnell said there is no real difference in the quality of care a patient receives when seeing one or the other.

"We know from experience what they are trained to see without direct oversight and they are good at collaborating when (issues) are not always straight forward. They are an important part of the health care team and I don't know what we would do without them," Parnell said.

There are five P.A.-Cs (certified physician assistant) at the medical center. The most senior among them is Perry Berhow, with 31 years at the center. Along with Berhow, Julie Von Ohlen with six years, and Anissa Olson with five years, and two new PAs, Nathan Reyelts and Holly Anderson, round out the PA staff.

To further clarify the role of a PA, Berhow said they are both dependent and independent practitioners.

"PAs are probably defined as dependent practitioners because we work under the guise and licensure of a physician, but also independent because we see our own patients," Berhow explained. 

He said physician assistants see patients based on their scope of practice, which depends on their supervising physician. Most PAs at the medical center work in family practice, but Berhow was recently trained to work in orthopedics. When the primary supervising physician is not there, each has a secondary physician they are assigned to so they can see patients in those areas as well. So, for example, Berhow could see patients for family practice-related issues if he was not seeing any orthopedic cases.

"It is interesting to know that (PAs) are trained through medical schools and take classes with medical students," Anderson said. 

So while a physician assistant is not fully a physician, neither are they nurses. 

"Nurses can't make diagnoses or see their own patients," said Reyelts.

"Nurses are more therapeutic, not diagnostic," Berhow continued. "We are scheduled just like physicians with our own schedules. But most of ours are scheduled the same day."

Having PAs available to see patients provides more choices and limits waiting to see a provider about health care issues.

"The term 'health care team' is important because it takes all of (the various types of providers)," Berhow said. "Some people consider a PA as their primary care provider."

One of the main differences in a physician and a physician assistant is that of time commitment. 

"The lifestyle is different," Reyelts said. "You are not on call as much as a doctor, but you have enough responsibility and get to do what you want: diagnose and treat patients. You still practice medicine, but don't have to spend 10 years in medical school."

Anderson said she intended to be a doctor at first.

"I actually planned to go to medical school and did pre-med when I was in Canada with my husband," she said. "When I moved back I had never heard of a PA, but it seemed like what I was looking for. I could have the patient contact and diagnosis, especially the patient contact -- I like that."

Berhow said he is one of the few PAs in Minnesota that was informally trained. Prior to becoming a physician assistant, he was a medical corpsman in the Navy and graduated from Mankato State University with a major in biology and minor in psychology.

"Mainly a PA is a second vocation. Most were trained in other health care fields," Berhow said. "They didn't become doctors because of the time factor; they could do the same things without the time commitment."

Physician assistants must have a bachelor's degree and meet science pre-requisites to get into PA schools. 

"Every state has at least one nationally accredited school," Berhow said.

Each PA must take a national board exam, and retake it every six years. They must also complete 100 hours of continuing education every two years.

"Basically it's the same requirements as physicians," Berhow explained.

Source:http://fairmontsentinel.com/news/stories/100704c.html

Twenty-seven students in the physician assistant program at Pennsylvania College of Technology gained real-world experience while they served baseball teams 24 hours a day for 16 days during the recent Little League World Series in South Williamsport.

The students, who are juniors and seniors in the program, provided urgent care for players, coaches and their hosts, or "uncles," from Aug. 15 to 30. They saw more than 200 patients while they manned the infirmary in International Grove, the residential area set aside for the baseball teams.

In addition to seeing patients for coughs, sore throats or cuts and bruises, this year the physician assistant students worked with state agencies when a baseball player from Taiwan came down with chicken pox. According to Susan Swank-Caschera, assistant professor in the physician assistant program, four students helped to make phone calls to more than 200 parents worldwide to find out whether baseball players had been immunized or had already had chicken pox. 

Those players, along with coaches, "uncles" and Little League employees who hadn't been exposed, were offered a vaccine for the disease, which was administered by the students.

Students who helped make the phone calls were Todd A. Husson, Svetlana Z. Rutgayzer, Jessica M. Whiting and Miriam J. Witmer. Student Yidrisca Vargas took time out of her office internship to do phone consultations with some of the Spanish-speaking players.

The students again worked with state agencies when a pinkeye (conjunctivitis) outbreak made its way through two teams. 

On Aug. 17, when a driver pulled into the World Series complex with a passenger who was in full cardiac arrest, Swank-Caschera and student William E. Buckner helped paramedics to resuscitate the victim.

The students served 12-hour shifts, with seniors -- who are doing rotations in the field as part of their coursework -- working day shifts and juniors working in the evenings, so their duty would not interfere with their class schedules. The students were paired with supervising physician assistants, all of whom are faculty members at Penn College.

For several years, a nurse was available in "The Grove" during the day, but there was no one to turn to if a player got ill during the evening. Last year, Little League asked Penn College faculty, staff and students to provide medical care in the infirmary at night. This year, Penn College's physician assistant program was asked to provide 24-hour coverage.

Swank-Caschera said that, through assisting at the Little League World Series, students gained unique experience in working with people who don't speak English, and, this year, learned in hands-on fashion how to deal with contagious diseases, interfacing with outside agencies and providing screenings and immunizations.

"The other thing the students got used to was how to set up a medical clinic. How do you run a thing from start to finish?" Swank-Caschera said.

Physician assistant students who served at the World Series were Kimberly A. Allen, Strong; Jonathan E. Baldwin, Williamsport; William E. Buckner, Elizabethtown; Jeffrey W. Chan, Williamsport; Mandy M. Collins, Coudersport; Nicole R. Confer, Bellefonte; Heather Suzanne 
Dorman, Picture Rocks; Melissa M. Fry, South Williamsport; Natalie Gabinskiy, Lock Haven; Jennifer E. Goodling, Seven Valleys; Todd A. Husson, West Reading; Jennifer L. Knadler, Tamaqua; Bruce W. Kreider, Lebanon; Jonathan D. Lehman, Williamsport; Whitney N. Lerch, Williamsport; Lucia L. Martarano, Bloomsburg; Glenn A. Miller Jr., DuBoistown; Ann M. Morrison, Shippensburg; Jennifer C. Reed, Hegins; Mark J. Rockwell, Linden; Svetlana Z. Rutgayzer, South Williamsport; Girma M. Semru, Takoma Park, Md.; Kent L. Shippen, Montoursville; Adam D. Thompson, State College; Yidrisca Maria Vargas, Lock Haven; 
Stephanie E. Vrontisis, Milton; and Hilary C. Weymer, Strasburg.

Gregory R. Frailey, assistant medical director of the college's Physician Assistant Program, served as supervising physician for the students and faculty members at the games. He worked closely with David N. Ambrose, the medical director for the World Series.

Penn College faculty and staff members who served as supervising physician assistants were: Jane R. Arenas, clinical director; Lane R. Bower, part-time instructor; Paula D. Holmes, program coordinator; Joseph Mileto Jr., instructor; Cory Sefchick, part-time instructor; and Swank-Caschera.

According to Swank-Caschera, the physician assistant students were just one part of a volunteer medical team at the World Series. That team also included volunteer students and staff from the Penn College paramedic program, who provided medical care to the public at the games, and a sports medicine specialist and volunteer ambulances and paramedics from neighboring communities.

For more information about the academic programs offered by the School of Health Sciences at Penn College, call (570) 327-4519, e-mail healthsciencs@pct.edu or visit http://www.pct.edu/schools/hs/ on the Web.

Karen Fields M.S.P.A.S., PA-C, provides personalized orthopedic care to individuals, with a special interest in sports medicine and fracture care. Karen earned her bachelor's degree from Wheaton College, Wheaton, Ill., and is a graduate with distinction from the Master of Science in Physician Assistant Studies program at Arcadia University, Glenside, Pa. Karen is nationally certified by the NCCPA, professionally licensed in the state of Wisconsin and is a member of the American College of Clinicians and Physician Assistants in Orthopaedic Surgery. http://www.KEFields-pa.com http://www.affinityhealth.org/page/physicianProfile.html?id=4449

Karen Fields MSPAS, PA-C and  Dr. Joseph McCormick, MD Perform as a team in Orthopedic Surgery

Joseph McCormick, MD, provides comprehensive orthopedic surgery care, with an emphasis in joint replacement, sports related injuries and pediatrics. Dr. McCormick earned his medical degree from the Medical College of Wisconsin in Milwaukee. He served his residency in orthopedic surgery at the University of Colorado-Health Sciences Center in Denver. http://orthodoc.aaos.org/mccormick http://www.affinityhealth.org/page/physicianProfile.html?id=3694

“Excellent orthopedic patient care is built on professional medical excellence and outstanding team work” said Fields.  “Dr. Joe McCormick, MD is our exceptional Team Leader of Surgical Services. Nancy Buchholz, RN is our first-rate Clinical Nurse. I count medical product representatives like Fred Fullerton and Greg Manion of Zimmer Thomson Assoc Inc. a part of our extensive health care team. We’re all committed to excellence in our medical practice and patient care for the love of medicine and our orthopedic patients.” 

“Fred arranged for Dr. McCormick and myself to attend Zimmer’s Surgeon-to-Surgeon Program, at Johns Hopkins,” continued Fields.  “Dr. Steven Weeden, MD, gave a fantastic presentation demonstrating surgical procedures and knowledgeable tips of minimally invasive joint replacement that Zimmer illustrates will minimize blood loss during surgery which will shorten or nearly eliminate the associated hospital stay, while minimizing pain in rehabilitation and accelerate the orthopedic patients return to their normal lifestyle.”

“I support the goals of Zimmer’s Surgeon to Surgeon program, and look forward to more opportunities to further enhance my surgical skills,” said Fields.

Zimmer.com  “The Surgeon to Surgeon program is designed for surgeons who want to improve their technical proficiency with Zimmer products in a live, real-time setting. This program arranges for you to observe a live procedure with one of our host surgeons. It provides an opportunity to learn new surgical techniques and tips, and get answers to your questions from surgeons who have in-depth knowledge regarding instruments and techniques. Many of the host surgeons are consultants or members of the design teams involved with the development of our implants. All of the host surgeons and O.R. personnel involved have clinical experience with the products that are the focus of your visit. …The Institute offers surgeons the opportunity to learn the surgical procedure in a laboratory environment that closely simulates an operating room. In addition, the Institute employs advanced electronic training equipment and links to satellite facilities.” 

Fields emphasizes, “I can’t stress enough the cooperative teamwork necessary to deliver the best in patient care to our patients.  I’m glad to be a part of the Affinity Health Systems’ wonderful team and I want to contribute to Affinity and to our patients my intense desire to serve the full health care community.  That’s why I’m a member of professional Medical organizations like, the American College of Clinicians, Physician Assistant World, the Physician Assistants in Orthopedic Surgery, and support The American Academy of Physician Assistants and the have applied to the American College of Surgeons.  Together we can strengthen health care to the maximum benefit of all our patients.

source: http://www.paworld.net/kefields-zimmer.htm

BY JORDAN LITE
New York Daily News

NEW YORK - (KRT) - When former President Bill Clinton undergoes surgery this week, his doctors will stop his heart for up to three hours to allow them to carry out the bypass.

While it sounds dramatic, Dr. Joseph DeRose, chief of minimally invasive heart surgery at St. Luke's-Roosevelt Hospital in Manhattan, who regularly performs bypass operations, said the operation is now routine, and when Clinton's heart is restarted it is likely to work better than it did before.

Here he explains who will perform the operation and provides a step-by-step guide about what Clinton will face in the theater.

THE TEAM: There will be a large team for the operation, led by a head heart surgeon, who will perform the bypass, assisted by a second heart surgeon. An anesthesiologist will tend to Clinton while he is asleep, while a physician assistant harvests veins from the president's leg that will be used to create some of the bypass of the blockages around his heart. A scrub nurse will help the surgeons, while two or three "perfusionists" will run the bypass machine that maintains blood flow while the heart is stopped.

THE OPERATION: When Clinton is anesthetized, a special probe will be inserted through the mouth to monitor the heart throughout the operation. The surgeon will open the chest with a saw, dividing the breast bone, to remove the mammary artery, which will also be used for bypassing the blockage.

At the same time, special instruments will remove a vein from his leg through a tiny incision by the knee.

After they remove the 1- to 2-mm artery and veins - at this point about an hour and a half into the operation - doctors will stop Clinton's heart. To do that, the surgeon will place a large IV into the heart and another into the aorta, the major artery in the body. The IVs take the blood out of the patient and into the bypass machine, which will pump blood around his body to keep him alive.

The heart stops, and the surgeons will start sewing the new vessels onto the areas of the heart where the blood needs to go around the blockages. After the bypass grafts are completed, the blood flow to Clinton's heart will be restored.

Many times, once the heart senses blood, it will restart right away, but there may be the need for a little shock to get it back into a regular rhythm. Next, everything will be closed and Clinton will return to the intensive care unit.

RECOVERY: The patient will be on a breathing machine for three to six hours, but once Clinton wakes up from anesthesia, the breathing tube will be removed.

He is likely to remain on some medications to help the heart pump better, but will be weaned off those within 24 hours.

Clinton would be expected to leave the intensive care unit the first or second day after surgery to go to a regular room, and at this point will be able to get out of bed, eat regular food and perhaps walk a short distance.

By the third or fourth day, he will be on ordinary painkillers, walking without assistance up and down the hall, and by the fifth day will probably go home.

REHABILITATION: Four or five weeks later, Clinton will start cardiac rehabilitation, which focuses on increasing the heart rate - working out the heart to help it get used to its new circulation.

Clinton will have to do aerobic exercise - walking or biking or treadmill - to increase the heart rate and the blood pressure. With the newly forceful blood flow, the heart is able to get stronger and stronger.

To: Health Reporter, State Desk 

Contact: Keith Poche, 985-369-6070 or bigk53@yahoo.com; Peter Stevens, 504-842-5398 or pstevens@ochsner.org; lapa@pncpa.com, both of the Louisiana Academy of Physician Assistants; Web: http://www.louisianapa.org

BATON ROUGE, La., Sept. 22 /U.S. Newswire/ -- Health care in Louisiana has moved forward another step with the expansion of medical care services provided by physician assistants (PAs).

On September 22, 2004, the Louisiana Board of Medical Examiners approved the first applications by physician assistants to prescribe medications in the state. Approximately 100 PAs were granted the authority to begin prescribing medications. Physician assistants throughout the state of Louisiana are ready to rise to their new responsibilities and be even more of a solution to expanding access to quality health care.

This action by the Louisiana Board of Medical Examiners comes just weeks prior to a national celebration of the physician assistant profession. From October 6 to 12, PAs around the United States, including the members of the Louisiana Academy of Physician Assistants, will celebrate National Physician Assistant Week. It was on October 6, 1967, that the first class of PAs graduated from Duke University in North Carolina.

Physician assistants are highly trained health professionals licensed to practice medicine with physician supervision. As part of their comprehensive responsibilities, PAs conduct physical exams, diagnose and treat illnesses, order and interpret tests, counsel on preventive health care, and assist in surgery.

The Bureau of Labor Statistics currently lists the PA profession as the third-fastest growing profession, projecting that the number of PA jobs will increase by 49 percent between 2002 and 2012. The BLS predicts the total number of jobs in the country will grow by 15 percent over this 10-year period. The profession has grown from the first handful of graduates in 1967 to more than 50,000 clinically practicing PAs in 2004.

Practicing as members of physician-directed teams, PAs are found in all areas of medicine. In Louisiana, 36 percent of PAs work in general surgery and the surgical subspecialties, according to data from the American Academy of Physician Assistants 2003 Physician Assistant Census Report. Twenty-two percent of respondents in the state reported that they work in family/general medicine, and 18 percent work in general internal medicine and subspecialties.

PAs are employed by solo physician practices, health maintenance organizations, group practices, nursing homes, and hospitals. PAs also serve as commissioned officers in all branches of the military and practice as members of the White House medical team caring for the President and Vice President. In Louisiana, 41 percent of PAs work in a hospital setting, close to 23 percent in a single-specialty group practice, and 15 percent in a solo-physician practice.

A national report by the American Medical Association showed that solo physicians who utilize PAs can increase the number of patients seen. Studies conducted by the Kaiser Permanente Center for Health Research found patients reported high satisfaction levels when receiving medical care from physician assistants, ranging between 89 and 96 percent.

The Physician Supervised Prescriptive Authority Bill, which allows supervising physicians to delegate prescriptive authority to PAs, was passed by the state legislature earlier this year and signed into law by Gov. Kathleen Blanco.

"This legislation is a major step forward for Louisiana since we were one of only three states that did not allow prescriptive privileges for PAs," explained Peter Stevens, president of the Louisiana Academy of Physician Assistants. "Safe, expeditious, quality health care has always been the goal of PAs in Louisiana. The new regulations will allow physicians to utilize physician assistants to their fullest capabilities and improve the health care situation in the state."

"Physician assistants are a very valuable asset. I have worked closely with many of them for years, and highly respect their training and skills. They are accepted almost universally by my patients, who see them as a trusted extension of my ability to deliver their health care," said E. Edward Martin, M.D., of the Ochsner Clinic Foundation and past president of the Louisiana Academy of Family Physicians. "With physicians now able to delegate prescriptive authority, the efficiency of PAs is further increased in the primary care setting."

The mission of the Louisiana Academy of Physician Assistants (LAPA) is to promote physician assistants in their professional pursuit of excellence, and to strengthen their role in health care delivery through public education, continuing medical education, physician education, member services, physician assistant student involvement, and legislative efforts.

source: http://releases.usnewswire.com/GetRelease.asp?id=36720

KUNAR, September 21 (Online): The baby was no bigger than a man's fist. Wrapped in scarves, she had been carried for almost a mile in the arms of her sister to the only place she could get help - a medical clinic at the American base in the Kunar province. 
A Special Forces physician assistant met the little girl at the door and slowly took the baby to an examining table. The baby's father did not come because he was busy tending to his fields. The mother stayed at home because, in Afghan culture, it is shameful to be examined by non-Muslims. 

A Special Forces medic said babies are often brought to the clinic by their siblings. 

After a brief examination, the physician determined the baby was dehydrated and had a fever. The doctor wanted to give her an IV to replace lost fluids, but the sister refused. Most of the Afghans in the nearby village are afraid of shots because the local doctor often is not careful, and the shots fester into open wounds. 

The physician gave the baby's sister several cans of formula, but that was all that he could do. Afghanistan has one of the highest rates of infant mortality in the world. 

"She has about a 60 percent chance of making it," said the 39-year-old native of Fayetteville. 

For most of the Afghans in the Kunar Province, the Sgt. 1st Class Christopher Speer Medical Clinic, which is at a Special Forces fire base, offers the best medical care available. The clinic is named after a Special Forces soldier killed in action. Speer died on Aug. 6, 2002, 10 days after a 4-hour gunbattle near Khost in eastern Afghanistan. The battle happened during a search for Taliban and al-Qaida fighters believed to be in the region. 

The clinic looks primitive to Americans accustomed to hospitals filled with the latest medical equipment. The four examination tables are litters propped on stands. The roof is made of wood, and the walls are made of mud. Medical supplies are stacked three rows deep in tall wooden shelves. 

source: http://paktribune.com/news/index.php?id=77761

Leon Rodriguez is haunted by ghosts. If he closes his eyes, they appear as vividly as when he first saw them unloaded from the helicopters at the 24th Evacuation Hospital in Vietnam. He clenches his fists and tries to will them gone, but they never go away. 

It's why he chooses to focus instead on the miracles.

At his southwest Denver home, a flag is hung by the front door and a Kerry-for-president sign is in the yard. On the walls everywhere are photos of his children. They're smiling, happy, each one a miracle.

But especially Barbara. Barbara cheated a long, brutal war of one more death.

For years, Rodriguez has kept the story of Barbara to himself. But now, he said, people need to hear it.

It began about 10:30 p.m. on Sept. 26, 1967. Sgt. Rodriguez was in charge of surgery at the 24th Evac. Barbara's parents and her 6-year-old brother were brought into the hospital after Cambodian insurgents attacked their village on the edge of a rice paddy. Green Berets had rescued them. Barbara's mother was "gut-shot," Rodriguez said, and rushed into surgery.

But before the surgeons could save her life, they delivered her tiny twin girls, several weeks premature but hardy and undeniably beautiful.

The army nurses scavenged the Quonset hut for two boxes, some blankets, hot water bottles and makeshift clothing. They placed the babies in the closest thing to incubators to be found that near to the front and put the boxes on either side of the mother's bed in the recovery room. Her husband and son curled up and slept on the floor beneath the bed with a small bag containing everything they owned between them.

The next day, the larger of the two babies died. Her immature lungs had failed her. The other baby survived by accident. During the night, the blanket protecting her from the hot water bottle had slipped. She touched the bottle and burned her arm. The pain kept her crying - and breathing - all night.

In his scrapbook, under the picture of the preemie in the cardboard box, Rodriguez wrote about the miracle: "This sweet baby brought joy and hope to members and patients of the 24th Evacuation Hospital."

The family stayed in the hospital until the mother had recovered. Then the GIs took them to a refugee camp near Saigon. They left the baby behind.

"I have no idea why they abandoned Barbara," Rodriguez said. They were Montagnards, Vietnam's indigenous people. They were known to be superstitious. They had no home. She was so small. Maybe they couldn't take care of her.

Rodriguez said nurses, doctors, even patients at the 24th doted on the baby he'd named Barbara. The engineers built her a crib and a highchair. In the midst of mayhem, where the average number of craniotomies - only one of the many surgical procedures done at the MASH unit - was 180 a month, everyone watched out for her.

By December, the fighting was becoming more intense and casualties were mounting. Rodriguez said orders came down to save every available bed for wounded soldiers. So during inspections, Barbara had to disappear.

Nurses and patients would slip her from ward to ward, keeping her quiet and away from the eyes of officers.

She was growing more and more healthy and beautiful. Rodriguez had fallen in love with her.

Finally, one night he got on the radio to his wife, Else.

"She's a baby who needs parents. Over," he said. "We're parents who need a baby. Over." Else's response was immediate. "She would make our family complete. Over."

With that, the Byzantine process of adopting a baby at the height of the war began.

Rodriguez hired an interpreter and combed the refugee camps searching for the Montagnard family. Unable to find them, he entered negotiations with the South Vietnamese government to get the adoption approved without the parents' permission.

By spring, Barbara had her very own Vietnamese passport, a small green, hardcover document with a black-and-white photo of a black-haired, brown-eyed baby girl, and a visa, signed by a U.S. State Department official while the U.S. Embassy in Saigon was under attack.

At last in June, after a year at Long Binh, Rodriguez caught an embassy flight back to the world. He held his baby girl in his arms the whole way.

Later, when they all were back in the states, Virginia Devine, one of the Army nurses who cared for Barbara, and her husband, Col. Robert Leaver, an army neurosurgeon, were godparents at her baptism.

Now, 36 years after celebrating his first Father's Day, Rodriguez is telling the story as if it were yesterday. He remembers the names of the fellow soldiers, the feeling of the sweat running down his back in the operating room, the overwhelming fatigue after weeks on end of 16-hour days spent fighting for life in the theater of death.

"A couple of my friends in Vietnam wanted me to write about all this," he said. "It's highly personal. It's never been written."

Twelve years ago, the 24th had a reunion at the Mayflower Hotel in Washington. More than 400 people - surgeons, nurses, corpsmen, even former patients - came to share old stories. They invited Barbara to speak.

"It was wonderful," Rodriguez said. They remembered her and what she meant to the unit. She thanked them. "It was such a thrill for her, for everyone.

"War is a constant catastrophe," Rodriguez said. "Most of the time we were overwhelmed, triaging as fast as we could. There was a constant threat. It was hot. We were sweating. Sometimes we'd have to hold the nurses back when a child would arrive on a litter to make sure the patient wasn't rigged to a bomb.

"Those are things the chicken hawks have never seen."

Rodriguez served 20 years in the Army, two tours in Vietnam. At 66, he still works as a physician's assistant in the operating room. He's still married to Else, still capable of getting all mushy about his kids, still an unabashed patriot.

"Maybe now you can see why I'm talking about this after all these years.

"I want to do something to protect my kids, something for the future," he said.

"People need to understand. No one should be coloring the facts to justify going to war. No one should go to war on superficial evidence. We need to know the truth."

The truth, Rodriguez said, is that with all its suffering, its casualties, the deaths, the ghosts and even the occasional blessed miracle, war is not glorious.

"It's not a game," he said, his hands clenched into tight fists to keep the ghosts at bay.

"It's madness."

source: http://www.denverpost.com/Stories/0,1413,36~115~2219825,00.html

 Reagan Assistant Remembers 

As a young man serving in the United States Air Force, it was Dallas Diederich's dream to be a physician assistant in the White House.

He later fulfilled that dream and attributes it to being in the right place at the right time. In 1986, Diederich joined President Ronald Reagan's 12-member medical unit as a P.A.

"We were part of the motorcade, we were part of the event sites, and basically, we trailed the President to all event sites and every place they went, from the time the Air Force One landed until it took off again," Diederich said.

Diederich spent 2.5 years by President Reagan's side.

"After he was shot and got into an exercise program and the training program, I mean he told all the rest of us, he was in the best health he'd ever been in his entire life," he said.

Diederich remembers many details about the Commander-in-Chief. His favorite drink was Diet 7-Up. And he often injured or cut himself while clearing brush.

"When we were at Santa Barbara, he cut wood, he rode, he lifted weights when he was at the White House," Diederich said.

A President who was active in recreation and in showing appreciation to those who worked for him.

"I wish people got a chance to know him as an individual the way in which we were able to know him," Diederich said. "I mean the kind, loving individual. I just can't tell you the gratitude that I have of being able to have the opportunity to spend that little bit of time with him. And his passing is going to be a big kind of hollow spot in my life and my heart."

As it will be for many other Americans who love and respect our 40th President.

Dallas Diederich also served as physician assistant to President George H.W. Bush until 1991. Diederich now works as a P.A. for Trinity Clinic in Tyler.

source: http://www.kltv.com/Global/story.asp?S=1933113&nav=1TjDNpXo

Photo By Linda Mcconnell © News
Physician assistant Kim Woodke, one of the providers at the San Luis Health Center, jokes with patient Elizabeth Gifford. Federal grants and altruistic health professionals help make sure that no one in the San Luis Valley goes without primary care.

By Bill Scanlon, Rocky Mountain News
May 29, 2004

ALAMOSA - Look carefully at the people of the San Luis Valley, at the many old faces, the many obese frames, the mostly healthy children.

In this poorest region of Colorado, many people die young of car accidents and other injuries, testament to the high rate of alcoholism and the distance most people are from a hospital or ambulance.

The rate of diabetes is much higher here than the rest of the state, due in part to obesity and lack of exercise in a region where people drive or sit more often than they run or bicycle.

More people limp here and more people lug oxygen tanks.

Yet, the San Luis Valley in south-central Colorado boasts a higher percentage of people over the age of 85 than the rest of the state.

Locals credit that to lower stress and a low cancer rate, perhaps because the high-altitude farming here doesn't require as many pesticides and herbicides as does agriculture elsewhere.

The paradox of dying too young or not dying until you're very old is part of the puzzle of the San Luis Valley.

No one must forgo care 

Here, almost no one goes without good primary care, thanks to a huge federal grant and some former hippie doctors who founded Valley-Wide Health Systems Inc.

"We're resilient," Valley-Wide CEO Margaret Salazar said of her organization's hand-to-hand battle with annual budget cuts. "Nobody has to go without primary care whether they have money or not."

At Valley-Wide's seven clinics throughout the San Luis Valley, the typical co-pay is $5 to $15, depending on income, for an office visit or a month's worth of pills. That makes health care affordable for people without insurance in a region where the average yearly household income is about $25,000.

A $4.8 million yearly grant from the Centers for Disease Control and Prevention, which extends funds to rural regions that are underserved, makes it possible.

But if you need an artificial hip, or you've had a car crash on a lonely mountain road, or if you have cancer or a neurological disease, you might limp the rest of your life - or die early.

"People will live here permanently with a severely arthritic joint," rather than getting an artificial hip or knee, said Dr. Ricardo Velasquez, medical director of Valley-Wide. "You often see them on the streets."

"There is no such thing as a 'golden hour' here," he added. Suffer a heart attack and chances are that critical first hour will pass before medical help arrives. The body either gives out or keeps breathing without help from doctors.

Routine care, including physicals, well-baby checks and antibiotics for strep throat, is abundant, but "we're in a crisis with our specialty providers," Salazar said.

So, while there are plenty of babies born in the valley, there's no place to handle a Caesarean section or a complicated delivery.

Missy Hopkins of Center had twins April 22. She had high blood pressure, so a month before the delivery she was flown - on Medicaid's dime - to Denver. She had her babies at Presbyterian St. Luke's Medical Center, which is certified for high-risk deliveries, something the only hospital in the San Luis Valley is not.

Hopkins, 34, described the prenatal care she received in Alamosa and at the small clinic in Center as "wonderful. They were very, very helpful."

But when a doctor in Center noticed her high blood pressure, he directed her to get to a hospital - and that became a Denver hospital.

With even Alamosa Hospital 30 miles from home, she fears what might happen if a serious illness struck her family. "I worry about it a lot," she said.

'Only one Wal-Mart!' 

In Center, most of the jobs are in warehouses, sorting and stacking boxes of potatoes, carrots, lettuce and other crops, Hopkins said.

Her husband goes to Trinidad Junior College's local branch because he can't find work. He's studying to become certified in Cisco Systems' software management.

Hopkins herself is going to school for certification in child development.

There is a caring spirit in the valley, but Hopkins often longs for a bigger city with "more jobs and more opportunities" for her, her husband and their babies, Breanna and William.

"There's only one Wal-Mart in the whole valley!" she said.

San Luis is unique in many ways.

It is the oldest settled region of the state. The hamlet of San Luis was settled by Mexican land-granters in 1851, but Spaniards and Hispanics had farmed and ranched in the region for a long time before that.

It's a place where some people still hunt for their food, where some homes still are without plumbing or electricity.

Marie Romero, who was born in the valley and raised her five daughters there, says jobs are too scarce.

"There's some agricultural and fast-food jobs, but you can't get 40 hours a week," she said. "There's no industry down here."

Alcoholism and drug abuse are big problems in the valley.

"We have so much manual labor," said Salazar, of Valley-Wide Health Systems. "There are a lot of disabilities from back problems, and a lot of people abusing regulated narcotics, seeking pain killers for their chronic pain."

In the past decade, the valley has become home to many Guatemalans who work at the large mushroom farms near Alamosa.

Guatemalan girls who become pregnant at 15 or 16 aspire to secretarial jobs so they can leave the field work at the mushroom farm.

They often marry by 16. If they're in the state legally, they'll get home visits during their pregnancies "to make sure they're getting adequate prenatal care," Salazar said.

But while the San Luis Valley has a high teen-pregnancy rate, its rate of low-birthweight babies is very low.

"They might not have running water or electricity or transportation, but the babies are born relatively healthy."

They don't always remain that way, though.

Health officials say one in three babies born in the San Luis Valley will develop diabetes sometime in their lives.

An aggressive diabetes-management program helps many people control the disease, yet the death rate from diabetes remains almost three times higher than on the Front Range.

A dearth of specialty care 

Marie Romero is a diabetic who has had two heart attacks and also has muscular dystrophy. She lives in Monte Vista, 17 miles from Alamosa.

"Overall, the health care is pretty good," she said. Once a year, Medicaid gives Romero a travel voucher so one of her daughters can drive her to Denver to see her muscular dystrophy specialist.

A heart specialist comes to the valley every three months and she sees him then.

Otherwise, her internal medicine doctor takes care of things, including working with diabetes educator Mary Jane Bangert on managing Romero's disease.

"I haven't seen an endocrinologist yet, but they do a good job taking care of my medications," she said. "If I had a complication, I'm sure they could get me a referral."

The dearth of specialty care and the emphasis on primary care isn't without its advantages, Salazar said. Without much in high-tech equipment, primary care costs stay low.

Internal medicine doctors have learned how to deliver chemotherapy in between residents' trips to Denver or Albuquerque to see their oncologists.

Of course, it's a trick, too, to find an oncologist or a heart specialist.

A few specialists will find a way to offer nearly free care, or will come to the valley for a month at a time.

Mostly, though, they'll say, "If they walk in our door, they had better have the money in their hands," said Nora Liest, director of case management for Valley-Wide.

Patients are often referred to University Hospital in Denver, but nearly as often are told the hospital can't take anymore nonpaying patients.

"You can cry, there are really heart-breaking cases," Liest said. "You try to beg, borrow and steal; you just call and call and call."

Edward F. Kulp is a physician assistant with Valley-Wide and integral to the primary care in the valley.

As he checked a baby for ear infection and her 13-year-old brother for sclerosis last week, he emphasized to their mother the danger of secondhand smoke in the house.

"We have evening clinics, a Saturday clinic, a migrant clinic where we go to the fields," Kulp said.

"None of us goes home until everyone is seen every day."

The mother of the two being checked by Kulp praises the primary care they receive and thanks heaven it is almost free.

"I work at Wal-Mart, but I can't afford the benefits," said Sheri Jones, referring to the part of the premium that must be paid by the employee if the whole family is to be covered.

Pushing healthier lifestyles

Starting in January, local people trained as counselors at Adams State College in Alamosa, will begin visiting the homes of families at risk for diabetes.

The National Institutes of Health provided $3 million to the Rocky Mountain Prevention Research Center for the five-year program, called the San Luis Valley Healthy Families Project.

The aim is to help diabetics manage the disease and to keep other family members healthy.

"The ultimate goal is a better lifestyle," said Melissa Donahue, coordinator of the Healthy Families Project.

The approach is to gently nudge the person as far as he or she is willing to go. For some, it might mean an enthusiastic embrace of exercise and better eating habits.

Hispanics, who comprise 47 percent of the San Luis Valley's population, have twice the diabetes risk as the non-Hispanic whites here, said Dr. Julie Marshall, principal investigator of the Healthy Families Project.

"Increasing rates of obesity have led to escalating rates of diabetes."

Meantime, health providers write recipe books, subtly introducing healthier ingredients into old valley favorites.

They conduct taste tests to see if families with obesity problems truly can tell the difference between 1 percent and whole milk. They provide vouchers so low-income mothers can purchase vegetables and fruit from the local farmer's market.

Valley-Wide was begun in 1976 by local doctors, many of whom came to the area with the National Health Services.

Back then, its budget was $1.2 million, there were four small clinics and the pledge was that people could get free health care even without insurance.

Twenty-eight years later, primary care is still almost free to many patients.

Those on the sliding scale are the most prompt to pay their bills, Salazar said.

"These are the working poor - construction workers, Wal-Mart workers. They are so happy to receive care," she said.

Family medicine doctors here make about $125,000 a year compared with the national average of about $140,000, said Velasquez.

"Doctors are spread thin and work hard," Velasquez said. Some work in Alamosa in the morning, then drive 42 miles to an outlying clinic in the afternoon.

When a doctor must accompany a patient in an ambulance, it leaves an outlying clinic uncovered.

Until two years ago, anyone who needed dialysis would have to travel to Pueblo three times a week.

The clinic in the small farming community of Moffat is open just three days a week, so itinerant doctors who stay from a week to six months before moving on are hired.

Every fourth night, that doctor has to cover calls in Alamosa. Occasionally, the doctors are from other countries such as India or the Philippines.

"There are no more Marcus Welbys, doctors who work full time in small towns," Velasquez said. "Seven years is our average tenure. It's a real recruitment challenge."

Most people in the valley, and most health care professionals, don't want the people in the state to feel sorry for them.

They say the valley can be a textbook for the rest of the state, showcasing the advantages of easy access to primary care and the heartaches that come when specialty care is out of reach for the average family.

Meantime, there's that platinum lining: More than a quarter of the people in the valley live to 85 or older.

Maybe it's the air, maybe it's the pace of life. Maybe it's something else.

"We're slower moving," Salazar said.

"The sky is always blue. We're not fatalistic. We're more in control of our own destiny."
 

source: http://rockymountainnews.com/drmn/state/article/0,1299,DRMN_21_2923987,00.html

Thursday, May 20, 2004 7:29AM EDT

Where caring is hard, he cares 
A physician assistant in a state prison earns an award for a lifetime of service 

By VICKI CHENG, Staff Writer

Physician assistant Earl Echard provides health care to about 1,000 inmates of the Polk Youth Institution in Butner. 
Staff Photos by Harry Lynch

Physician assistant Earl Echard provides health care to about 1,000 inmates of the Polk Youth Institution in Butner. 
Staff Photos by Harry Lynch

Echard treats inmate Lonnie Little's finger. Echard has worked in the prison system for 25 years. 
Staff Photos by Harry Lynch

Physician assistant Earl Echard checks Willie Boyd during a Monday evening visit to a clinic run by Urban Ministries in downtown Durham. Echard works at the homeless shelter clinic three days a week. 

BUTNER -- Earl Echard reports to work every morning at a gray concrete fortress, surrounded by coils of barbed wire, their jagged hooks glinting in the sun. 
"Polk Youth Institution," reads the sign, sounding more like a school than a place where about 1,000 criminals -- including the 96 most dangerous in the state -- are held. 
For 25 years, the physician assistant has been working in prisons, providing health care to inmates who may spit at him, hurl bodily fluids, even try to sue him. He's learned to examine patients with their arms and legs shackled, or through the tiny door through which an inmate receives his dinner tray. Three days a week, after putting in a full day at Polk, Echard works a second job, treating homeless people in Durham.

For his dedication and years of service, the American Academy of Physician Assistants will present Echard with the Outstanding Physician Assistant of the Year Award on May 31 in Las Vegas.

"A lot of people don't want to work in the inner city," said Echard, who lives in Garner. "But there are a lot of people in the inner city that need care. That's what I'm trying to do."

Sometimes, he's saddened by what he reads in the newspaper about his patients. "Man's inhumanity to man is something," he said. But he doesn't dwell on the rapes or murders they may have committed. He learned long ago not to ask for their stories.

"We were hired to provide health care for the inmates, regardless of their crime," Echard said. "That's our purpose. Someone else is judge and jury."

Echard does almost everything a doctor would do, although physician assistants generally turn over their most complicated cases to the M.D.s who supervise them.

Now 60, Echard grew up in Western North Carolina and was a young man during the civil rights era. While his Duke University classmates took jobs in academia, suburban practices or corporate America, Echard decided to work with minorities in a public housing complex in Durham.

Then, in 1979, he joined the state Department of Correction. Fifteen years ago, he began treating the homeless.

John Davis, his old study partner at Duke, said that early on, Echard showed compassion for people accustomed to being ignored. He remembers the day they encountered a man who was probably an alcoholic behind the Veterans Affairs hospital in Durham.

"We saw this guy coming across the street, and we could hear this little, 'squish, squish,' " said Davis, now a physician assistant in Memphis, Tenn. "When we got close to him, we noticed his abdomen was protruding. He was leaking fluid out of his umbilical area, down into his shoes. Earl just looked at him and just spoke to him and asked him how he was doing, and said, 'Well, you know, I'm one of the PA students. Are you going into the hospital because you have an appointment? If we can help you, let us know.' "

Breaking bad news

At Polk, Echard is the primary health-care provider. There, he gives physicals to virtually every 18- to 25-year-old male felon who enters the state prison system. Most of those who remain at Polk are healthy, but some suffer from diabetes, HIV and mental disorders. Friday, he scribbled in Lonnie Little's yellow medical file.

Little, clad in the standard brown jumpsuit, held out the pad of his ring finger for Echard to examine. Little thought it was a splinter that just wouldn't go away and had tried to cut it open, risking an infection. But it was a wart, and Echard quickly trimmed it down with a scalpel.

"A wart is a virus," Echard explained. "You may wake up one day, and it's gone. You could get it in some other spot. ... The most common areas I see like that are on the bottom of the feet."

"Word?" Little replied.

"Yeah. Just don't cut it anymore, OK?"

"I ain't going to cut it."

George E. Currie, Polk's superintendent, said that many of the inmates have never had regular medical care. Echard is often the one to break the news that a prisoner has diabetes or some other serious health problem.

"You're telling them they have to take insulin by needle," Currie said. "To this macho guy off the street, that's a sign of weakness. ... Sometimes, you have to wipe away tears."

Then there are other challenges that come with working with felons, like fights. Their penchant for tearing off eye patches or bandages, because they're a sign of vulnerability. The urine and feces they may try to throw on the staff.

Almost every day, Echard makes the rounds at HCON -- High Intensity Control. It's also known as the "supermax," home to the state's worst criminals.

On Friday, lunch had just been served -- the guards refer to it as "feeding time" -- so the HCON inmates were subdued. They stood at their narrow windows as Echard walked past their metal doors, staring silently.

Some of them have high blood pressure. Others have hepatitis C or HIV. Still others are self-mutilators or ingestors. They know not to swallow batteries or hurt themselves until Echard has left for the day. That way, they get a trip out of the prison to the emergency room.

When Echard examines someone at HCON, three officers stand by. If he has to take a handcuff off, a sergeant must be present. If the inmate is known to spit, the guards put a mask over his face.

"What bothers me most is we have an audience," Echard said, referring to the officers. "He's more likely to show off."

Help the homeless

On Mondays, Tuesdays and Wednesdays, Echard leaves Polk and works an evening shift in the clinic at the Urban Ministries of Durham's homeless shelter.

Sometimes the homeless walk up to his car, holding up traffic to ask him for money. "Doctor Earl," they entreat him. He doesn't give them any. But often, he brings them clothes and shoes, said Deborah Wilson, a nurse at the clinic.

The rewards for his work are simple, and they come in unexpected places. Once, Echard treated a lethargic 3- or 4-year-old boy with a high fever and an ear infection.

The next day -- or maybe it was a week later -- the boy saw him at the end of the hallway, ran as fast as he could and jumped into Echard's lap.

"At that moment, if someone had said, 'You can take this little kid home with you,' I would have," Echard said.

On Memorial Day, Echard collects a more tangible reward, the award from the American Academy of Physician Assistants. Then he heads back to Polk, where he's accustomed to the heavy metal doors sliding open and closed for him, because the guards are always watching.

source: http://newsobserver.com/features/story/3598756p-3199976c.html

Congratulations to Dr. William A. Dolan
on winning the prestigious New York State Society of Physician Assistant's MD of the Year Award

Shown above from right to left: Gregg Shutts, MS, RPA-C, NYSSPA Reimbursement Chair; Amy Munro, RPA-C, NYSSPA District Director; Cindy Zink, RPA-C, RRPAA Treasurer; Mark Cottle, RPA-C, RRPAA President-Elect; Dr. Bill Dolan, MD, NYSSPA MD of the Year Award Recipient; Diane L. Stadtmiller, MA, CIW, RPA-C, RRPAA President; Valerie Parrish, RPA-C, RRPAA Secretary; and Jennifer Butler, RPA-C,
RRPAA Director-at-Large.

On Monday evening, May 11, 2004, Dr. William A. Dolan was presented the NYSSPA Physician of the Year Award at the Brio Mediterranean Restaurant in Pittsford, NY, by NYSSPA Director-at-Large Amy Munro, RPA-C and NYSSPA Reimbursement Chair, Gregg Shutts, MS, RPA-C.

Dr. Dolan was nominated by the Rochester Regional Physician Assistant Association (RRPAA) for this award this past March.  Dr. Dolan was among several individuals who were nominated by other PAs across NY State, and the RRPAA is very 
pleased that our nominee was chosen for this prestigious award. 
Dr. Dolan has also received the RRPAA's Distinguished Physician of the Year Award on PA Day 2003, and has served as President of the Medical Society of the State of New York.  He has been a long-time advocate of training and employing PAs.

Thank you NYSSPA for honoring such a deserving and outstanding contributor to the PA Profesision!

Diane Stadtmiller, MA, CIW, RPA-C
RRPAA President

OUR VIEW: Turn to physican assistants and nurse practitioners as one solution to the rural hospital crisis.

As Herald staff writer Ryan Bakken showed, rural hospitals are vital to a community's economic health.

No wonder small towns pull out all the stops to save their local hospital. Here's another idea to help them in this fight:

Let nurse practitioners and physician assistants and paramedics carry more of the medical load.

Bakken's series documented two key trends. First, most small-town hospitals are having a hard time recruiting doctors. They're getting important relief from federal programs that encourage foreign-trained physicians to work in rural areas; those programs should be expanded.

But the other trend suggests that in addition, a new staffing response is called for. This second trend shows hospitals in small towns giving up many traditional services, such as delivering babies. These hospitals contract until they're down to the most basic service of all: emergency care.

As Bakken wrote, "When asked for the No. 1 reason for maintaining small-town hospitals, residents' answer is always the same: for the emergency room."

The insight that should be debated in Congress and elsewhere is that as hospitals lose their advanced services, they lose their need for a physician, too. Why not rely more on other primary-care providers such as physician assistants and nurse practitioners?

Physician assistants, for example, are the senior medical officers aboard some Coast Guard cutters. If a sailor gets hurt at sea in the middle of the Pacific, the PA shoulders the load.

Could small-town emergency rooms be staffed on the same principle? Could physician assistants and/or nurse practitioners - working closely with physicians at a metro hospital, and quickly transferring critically ill or injured patients after stabilizing them - deliver the needed care?

It costs less money to train a physician assistant than a full physician, and less to pay the PA's salary, too. So a federal initiative to ramp up the supply of these practitioners would be more affordable than an effort to train more doctors.

Small towns need to save their hospitals and must think creatively to do so. And as they pare the hospital down to its most basic mission, they should be empowered to pare down the staffing requirements, too.
 

--------------------------------------------------------------------------------
Tom Dennis for the Herald 
source: http://www.grandforks.com/mld/grandforksherald/news/opinion/8662952.htm

Master Sgt. John Sullivan, of Camden, stands beneath the tail of a Delaware Air National Guard plane. A physician assistant at Bayhealth-Kent General Hospital in civilian life, he has been deployed overseas three times in the last two years and will go again in May. Submitted photo/Tech. Sgt. Benjamin Matwey 
 

CAMDEN - When Master Sgt. John Sullivan of Camden graduated from physicians assistant school in 2002, he thought nothing would stand in the way of his new career.

Then came the war in Iraq, and a call to serve overseas.

In the past two years, he has been to Southwest Asia three times, and will be deployed again in May.

But he is no stranger to military battles. Since joining the Air Force in 1984, Sgt. Sullivan has served in Operation Desert Storm, and been deployed to Korea and Iceland.

He admits it's not easy putting his civilian life on hold, but said he is proud to serve his country. 

Now a loadmaster with the 166th Airlift Wing of the Delaware Air National Guard in New Castle, he is just seven months away from retirement.

He looks forward to returning full-time to Bayhealth-Kent General Hospital in Dover, where he works as a physician assistant in the emergency room.

Sgt. Sullivan, 38, earned his physician assistant degree from Hanemann University in Philadelphia, and worked at Kent General just four months before being placed on active duty.

"It's hard to leave my job, because I like it," he said. "It's a nice feeling being a physician assistant, because I get to help make someone else's life a little better."

Sgt. Sullivan's passion for the medical field began in the early 1990s, when he became a Kent County paramedic. After several years working for the county, he decided to pursue a career as a physician assistant.

"When I was a paramedic I would only see patients for 15 to 20 minutes," he said. "As I got older, I wanted to see people long term."

Sgt. Sullivan said his job at Kent General is very different from his work as a loadmaster, but both are duties he enjoys.

As a loadmaster, he drops cargo out of airplanes to troops serving overseas.

His colleague, Master Sgt. John Crowley of Hebron, Md., praised Sgt. Sullivan for his commitment to America.

"He's very dedicated. He takes his job very seriously," Sgt. Crowley said. "Being a physician assistant, it makes it more difficult for him to be deployed, because he misses out on things and needs to go through more [medical] training when he gets back. My hat is off to him, for his decision to stay in his unit and serve his country."

At Kent General Hospital, they're also proud of Sgt. Sullivan.

Attending physician Craig Hochstein said he can't wait for Sgt. Sullivan to return full-time. He believes the airman's military skills transfer into the emergency room, making him an asset to the local hospital.

"It's definitely a high-stress environment, with lots of people requiring lots of attention," Dr. Hochstein said. "[Sgt. Sullivan] handles it very well, which is probably because of his military background. He is a very happy, energetic person and does a very good job taking care of the patients."

source:http://www.newszap.com/articles/2004/04/18/dm/central_delaware/dsn05.txt

By Journalist Seaman Kary Favell, USS George Washington Public Affairs

USS GEORGE WASHINGTON, At Sea (NNS) -- Lt. James Strafford of USS George Washington (CVN 73)was honored as the Naval Association Physician Assistant of the Year on March 10. 

After hearing the news during morning quarters, Strafford found the honor an exhilarating surprise. 

“I was overwhelmed by the news,” said Strafford, who first joined the military 25 years ago, spending the past four in the Navy. “I’ve been blessed to have good opportunities to grow. I’ve been surrounded by so many good leaders over the years, and this award proves the positive influences they had on me.”

While Strafford found the news overwhelming, his co-workers say it has been a long time coming. 

“Lt. Strafford has great concern for his patients,” said Cmdr. Andrew Nelson, George Washington’s (GW)senior medical officer. “He is an excellent clinician and enjoys people. He is an eager worker with a great sense of humor.”

Nelson listed one of many experiences highlighting an amazing career. 

“While Strafford was deployed as a member of the Navy Emergency Medical Surgical Team on the Horn of Africa, he was dually billeted as both the physician's assistant and Camp Lemonier's health care assistant. During that time, his direct leadership led to a new Medical and Dental clinic being designed and built.”

Not only did Strafford spend time on the Horn of Africa, he was also stationed in Laos, England, Haiti and Sewell’s Point, Norfolk, Va. 

“I had a lot of fun at each duty station,” he said. “Each place I’ve been to has given me the chance to meet people and explore different cultures, and I’ve enjoyed it.”

Aboard GW, Strafford is responsible for the ship’s Mass Casualty Staging Team and Aft Battle Dressing Station. 

It was under Strafford’s leadership where these two entities shined at the critical moment. 

“Both stations performed flawlessly during exercises and the September flight deck mass casualty, directly saving fellow shipmates,” Nelson said. “Lt. Strafford also acts as Medical Department’s Public Affairs representative, making several training videos and writing several articles, among others.”

“I want the crew to understand [that] Medical doesn’t have a one-dimensional mission,” Strafford said. “It goes 24 hours a day. We’re always there, making sure the ship is ready for war. GW is the most amazing place in the world.”

After traveling the world, Strafford reported to GW in August 2003. He has spent the past seven years as a physician's assistant. While he credits being surrounded by good leaders with his success, Strafford says if it wasn’t for his family and faith, he wouldn’t be aboard GW today. 

“I had a choice. If it wasn’t for my wife, I wouldn’t have gone through PA (physician assistant) school,” Strafford explained. “She supported me through school. She supported me during my deployments. Anything I do here is a direct reflection of my wife. Without my family and my faith, I wouldn’t be on GW.”

source: http://www.news.navy.mil/search/display.asp?story_id=12491

P.A. and N.P. – not M.D., but still A-O.K. 
By Fred Zimmerman, Stars and Stripes
Pacific edition, Monday, March 22, 2004

Fred Zimmerman / S&S 
Navy Lt. Jessie C. Santiago, a physician assistant at Camp Courtney's Bush Clinic, gives 4-month-old Amiya Eady a well baby check-up Thursday. As a physician assistant, Santiago can provide most of the same services as a regular physician.

Fred Zimmerman / S&S 
Lt. Ron Fancher is a nurse practitioner on Okinawa.

CAMP FOSTER, Okinawa — Two letters seem to carry a lot of clout when it comes to medical care — M.D.

But medical doctors aren’t the only option. Two other health-care professions with two-letter abbreviations — P.A. and N.P. — come with more training and expertise than most patients realize, said Navy Lt. Jessie C. Santiago, who works in family practice at Camp Courtney’s Bush Clinic.

Santiago is a physician assistant. The other profession is a nurse practitioner. Both are midlevel providers. 

“If you’re not a medical doctor, patients don’t understand what we do and our capabilities,” said Santiago, who earned a master’s degree in physician assistant studies from the University of Nebraska. “There are some people who say ‘I want to be seen by a doctor’ … they may think that if you don’t have an M.D. behind your name, then you can’t provide the same level of care.”

But providing quality care is something Santiago said physician assistants are trained to do. He said physician assistants take the same core classes as doctors and rotate through the various clinics with them for one year. 

“We are trained and taught like physicians, so we think like them,” Santiago said. “The major difference is the length of formal education. What we learn in classroom time is the same as an M.D., but they get into more detail.”

Santiago added that those in his field basically cram five years of medical school that doctors go through into two years.

While physician assistants can provide the same level of care an M.D. does, they work under the supervision of a doctor, who helps them whenever needed, Santiago said. 

“There are different levels of supervision,” he said. “If it’s a difficult situation, I either refer the patient or get assistance from a doctor in house.”

Santiago said there are physician assistants working in many fields, including dermatology, orthopedics and surgery. He added that some physician assistants are qualified to perform specialty care such as vasectomies and colonoscopies, but whether or not to be certified for specialties is up to the individual. Santiago said all physician assistants see only patients who are “in the scope of our practice.”

While some patients may question a physician assistant’s credentials, others don’t make it past the nurse portion of nurse practitioners, according to Navy Lt. Ron Fancher, a family practice nurse practitioner at Futenma Marine Corps Air Station’s Medical Clinic.

“Some people think we’re just a nurse and wonder why they’re not seeing a doctor,” Fancher said.

A nurse practitioner is a registered nurse with an advanced degree in a specialty, Fancher said. He added that unlike physician assistants, nurse practitioners are required to have a master’s degree in their specialty. Physician assistants aren’t required to hold a master’s.

“The entire master’s degree is clinical … like two years of medical school,” Fancher said.

Another difference between the two is that the nurse practitioner is a licensed independent practitioner and has no oversight by a physician.

“We still collaborate, but it’s not oversight,” Fancher said.

Nurse practitioners set themselves apart from doctors and physician assistants by treating the whole person, not just the problem the patient has that day, Fancher said. 

“We’re not doctors and we don’t want anyone to think we are,” he said.

The Navy has three different fields that nurse practitioners work in on Okinawa, Fancher said. They are pediatrics, which covers birth to 18 years old; women’s care; and family, which covers birth to death. Fancher said the only thing a nurse practitioner cannot do is deliver a baby. He said they will be there for the delivery, but a family physician must be present. 

Both Fancher and Santiago said the American Medical Association has published studies in the last several years that show nurse practitioners and physician assistants provide as high a quality care as physicians. 

source:http://www.estripes.com/article.asp?section=104&article=21140
 

McLEAN, VIRGINIA PHYSICIAN ASSISTANT TO BIKE 4,300
MILES TO HELP MIGRANT FARMWORKERS
 

McLEAN, VA? A McLean physician assistant (PA) gets ready to start a 4,300 bike ride across the United
States to raise awareness about the dramatic health situation of migrant farmworkers across the United
States.

D. Cristopher Benner, a graduate of Emory University's graduate Physician Assistant program, James Madison
University and McLean High School, starts his long ride this summer immediately after completing
volunteer work with Emory University?s South Georgia Farmworker Health Project, a unique program that
addresses the health needs of nearly 2000 migrant farmworkers in the state of Georgia every year.

"The apple you just snacked on, the peach you enjoyed with breakfast, the tomatoes on your salad, these and
hundreds of other fruits and vegetables represent the labor and toil of thousands of migrant farmworkers."
These folks, men and women, work under extremely difficult circumstances and their health suffers; they
have serious health issues that need help," Mr. Benner says.

What Mr. Benner and Emory University hope to achieve this summer is to increase the national level of
awareness about the migrant farmworker plight and raise funds for equipment, clothing and medicine to
benefit the migrant farmworkers and their children.

It is estimated that more than three million migrant and seasonal farmworkers in the United States travel
throughout  the country serving as the backbone for a $28 billion agricultural industry.  Without their invaluable help,
crops would have to be destroyed or never planted.

In addition to low wages, poor housing and dismal working situations, migrant farmworkers rarely have
access to health insurance or other health benefits. 

Mr. Benner will be self-funding his ride.  All donated funds will go directly to Emory University's South
Georgia Farmworker Health Project.  Mr. Benner has worked with Emory's unique migrant farmworker project
as a physician assistant, and says he was overwhelmed about the workers health problems: tuberculosis, lung
and skin disorders from exposures to pesticides, hearing and vision disorders from overexposure to sun
and industrial noises, unimmunized children of farmworkers and lack of prenatal care for the women.

"Many of their ailments are easily treated and preventable," he adds,  "It just takes a caring person
and money to buy the right medicine and educational materials."

http://www.emorypa.org/news.htm

Matthew McQuillan said the calls come frequently from doctors who want to hire physician assistants. "The doctors are saying, 'Where's my PA?'" recalled McQuillan, who teaches physician assistants at the UMDNJ School of Health Related Professions. 

His experience reflects new data by the U.S. Bureau of Labor Statistics indicating the profession of physician assistant will be the third fastest-growing occupation in the country between 2002-2012 (after medical assistants and network systems and data communications analysts). 

The government predicts the number of physician assistant jobs will grow by 49 percent. The bureau estimates there were 63,000 PA jobs in 2002, but the number of jobs to be filled in 2012 will be 94,000. 

The trend is holding true in New Jersey. 

"New Jersey is starting to catch on that PAs are extremely valuable as a PA-physician team, in hospitals and in the office," said Whitney Gaydos, president of the New Jersey Society of Physician Assistants. 

"They can handle run-of-the-mill cases, enabling the doctor to spend more time with complex cases," she said. 

Last year, job prospects for PAs got even better in the state because of new rules requiring hospitals to reduce the number of hours that residents work. Hospitals are hiring physician assistants to fill in the gaps. More PAs now work in emergency departments, on medical floors and in operating rooms. 

Physician assistants work under the supervision of doctors. They can prescribe medications, evaluate patients, diagnose and treat illnesses, order and interpret tests and counsel patients on their health. 

The UMDNJ physician assistant program requires students to complete three years of post-graduate study. "If the family doctor needs to make rounds, the PA can see patients," McQuillan said. "Physicians have learned they can open up hours to see more patients by hiring PAs." 

The PA tradition in New Jersey is relatively young. Although UMDNJ has trained PAs since the 1970s, the graduates had to leave the state to get jobs. State law did not allow them to work in New Jersey until 1992. New Jersey was the last state to recognize PAs. 

The number of practicing PAs in the state went from zero before the law to 751 in January of this year, according to the American Academy of Physician Assistants. 

In contrast, more than 3,000 PAs work in Texas; 4,800 in California. 

Physician assistants are sought after in areas where there is a need for doctors, such as in urban and rural communities, experts said. "Reports are showing we are approaching a period where there will be a shortage of physicians," said Stephen Crane, executive vice president and chief executive officer of the American Academy of Physician Assistants. "It's a lower-cost way for physicians to expand their services." 

Nationwide, recent graduates earn about $65,000. The average salary for all PAs is $76,000. PAs in New Jersey, particularly those with specialties in such areas as surgery or cardiology, will earn more, experts said. 

-- Carol Ann Campbell 
source:http://www.nj.com/business/ledger/index.ssf?/base/business-6/1079421037175220.xml

Somerset woman a pioneer in field of physician assistant

By VICKI ROCK
Daily American Staff Writer 

Fae Foust, Somerset, was a pioneer in her field. She was the first physician assistant in Somerset County and may have been one of the first in Pennsylvania.

She is the daughter of the late Earl Saylor and the late Leora Saylor Walker. Fae is the youngest of five children and was born in a house located where Wendy's Restaurant is currently. 

She and her husband, Robert, will celebrate their 45th wedding anniversary on March 21, which is also her birthday.

They have two daughters, Erin, married to Dr. David Sanderson, St. Mary's, and Marjorie, married to Scott Primrose, Manassas, Va. Sanderson is a podiatrist and his wife is the billing manager for his office. Marjorie works with computer systems for an engineering firm. Her husband is a lieutenant in the Fairfax County Fire Department. There are five grandchildren.

When Fae was 2, her grandfather became ill and her family moved to her grandparents' farm in the Brotherton area. They lived there until she was 9, then moved back to the same house in Somerset. Her father died at the age of 44.

"He was a talented guitar player and he was going to teach me to play," she said. "The day he died was going to be the first day of my lessons. I never learned to play. That's something I regret."

 Her mother turned their home into a tourist home and she also worked in the creamery and cleaning motels. She started to work very young, cleaning rooms and checking in tourists in their home because her mother was working outside the home.

"I wasn't planning on doing much (after high school)," she said. "We got engaged when I was a senior in high school. Pauline Glessner, the guidance counselor, said 'Fae, you have to do something, you're smart.' I planned to go to nursing school because it was a year shorter than college."

She and her mother had to go to Dr. Harold Musser Sr. Fae was getting immunizations needed for school and her mother had to have a skin tag removed.

"When I smelled the aroma of burning flesh, I passed out," she said. "Dr. Musser said, 'Fae, You'll never be a nurse.' I wanted to prove him wrong."

She attended the West Penn Hospital School of Nursing.

"You have to have a compassionate personality of wanting to help people to be a nurse," Foust said. "Seven or eight in my family went to West Penn Hospital School of Nursing after me. I'm proud of that."

She finished her training and started working at Somerset Hospital in August of 1959. In May of 1961, she became head nurse. Medical Associates of Boswell then recruited her.

The physician assistant profession originated at Duke University in Durham, N.C., in the mid-1960s, according to the Duke University Medical Center Web site. Dr. Eugene A. Stead Jr., then chairman of the Department of Medicine, believed mid-level practitioners could increase consumer access to health services by extending the time and skills of the physician.

When Foust began working at Medical Associates of Boswell, Dr. Jan R.J. DeVries coined the term "physician expander."

"We couldn't use the name physician assistant at first because she hadn't attended the programs at Duke or in Seattle," he said. "We created the name expander because it expands my capabilities to take care of patients. The expander is my hands, ears, eyes and voice."

During November of 1971, she accompanied DeVries on his hospital rounds to receive instruction as an intern would. She started seeing patients in December. DeVries was so pleased with the outcome that he wrote an article about the concept for Pennsylvania Medicine which appeared in November, 1973.

She later took physician assistant classes at the University of Pittsburgh School of Medicine. Under a grandfather clause, those who were working in the field for at least four years were allowed to apply. Only half of those who applied were accepted.

The first national board exam, the National Commission on Certification of Physician Assistants, was given in 1975. Only half passed the two-day examination, which consisted of both a written and a clinical examination.

"I was fortunate, I passed," she said. "I also applied for licensure as a nurse practitioner and I have both certifications."

Under the state regulations, a physician assistant works interdependently with physicians. The physician assistant is always linked to a physician who is the supervisor, either in the office or by telephone.

Physician assistants may only see a patient a maximum of two times, according to state regulations. Then the patient must see a physician. The state association is working to have that changed. In most states, including Pennsylvania, physician assistants may write prescriptions.

They must be recertified with 100 hours of continuing education every two years and must retake the board examinations every six years.

The Bureau of Labor Statistics states the field of physician assistant will be the third fasting-growing profession for 2002 to 2012. While total employment is projected to increase by 15 percent during those years, the number of physician assistant jobs will increase by 49 percent.

"I absolutely recommend this profession to young people," Foust said. "I really feel that being a physician assistant, you have a one-to-one relationship with patients. The feedback is really itself rewarding."

She retired Dec. 31, after being employed at Medical Associates of Boswell for over 32 years, but plans to keep her certification current for awhile.

"The physician assistants we've had in this office have been invaluable," DeVries said. "We've had magnificent people. Fae deserves an enjoyable retirement. I wish her well."

She likes doing crafts, flower gardening, swimming and cooking, especially trying new recipes. Her husband enjoys looking for Indian artifacts in Somerset County and both enjoy traveling. They are members of Somerset Church of the Brethren and she has been in the choir for over 25 years.

"We hope to travel and spend time visiting with family," she said. 

source:
http://www.dailyamerican.com/articles/2004/03/14/news/news02.txt

By Rose Post, Salisbury Post
Like father, like son ...

But how many sons go to Iraq with their dads?

Some, said Lt. Col. Tim Mauldin.

Probably enough so no records will be set this week when he and the oldest of his eight children, Spc. Clint Mauldin, 24, leave for the same area in northern Iraq.

Not that they'll be stationed at the same place or see each other often, but they'll be close. And that's unusual but not unheard of.

"I know there's another father-daughter in this call up," Tim Mauldin said.

Tim Mauldin will leave Fort Bragg for the Middle East today, and Clint Mauldin will leave Saturday.

And they'll both be dealing with medical care, though their duties will be different.

Tim, 52, has been a physician's assistant at the Hefner VA Medical Center for the past 20 years and is also a member of the N.C. National Guard attached to its state headquarters command.

"But when they started calling people up, they took 15 medics from the state command and assigned them to the 30th Brigade" of the 1st Infantry Division, which is replacing the 4th Infantry Division in Iraq, he said. "And I was one of the 15.

"I got my orders Sept. 20," to report Oct. 1 to Fort Bragg for a little more than a two-year tour, and he's had training since then at Fort Polk, La., in Germany, San Antonio, Texas, and Fort Bragg.

But they're trained now, and groups have been leaving Bragg daily since Monday.

"I'm the 'surgeon' in the brigade," he said, but that doesn't mean he'll operate on people.

"That's a title that means you're the top medical person in the brigade, and you advise the general on the well-being of his troops. It's my job to make sure that we place all the brigade's medical assets -- doctors and physicians' assistants and several hundred medics -- in the right places.

"I'm the planner," he said. "I'll be doing some hands-on care, too. If we get hit, I'll be in there with everybody else, but somebody's got to be the planner.

"And Clint," he added, got called up in the same fashion. Also a medic in the National Guard, he, too, was one of 20 pulled from the headquarters command to go with various units. He was also assigned to the 30th Brigade.

Tim's rank is the result of continuous study through a variety of programs available through the National Guard.

A native of Albemarle and graduate of Albemarle Senior High, he attended Pembroke State University for a year and then joined the Air Force and became a medic. When he finished his tour of duty, he took a one-year physician's assistant course for former military medics.

But to be a physicians assistant in the National Guard, he needed a bachelor of science degree.

So he continued correspondence courses through the military that were certified by the University of New York and additional courses through the National Guard's education office in Raleigh and was awarded a BS degree in general science.

He also took a National Guard two-year course in the Command and General Staff College in Charlotte, with summer study at Fort Dix, N.J.

And they all prepared him for the rank he now has and the duties before him -- and to wear the "Warrior Ethos" which hangs on dog tags around his neck.

It says:

"I will always place the mission first,
"I will never accept defeat,
"I will never quit,
"I will never leave a fallen comrade."

Their addresses are:

n Lt. Col. Tim Mauldin, C-CO; 230th Spt. Bn.; 30th HSB, 1st ID; Operation Iraqi Freedom; FOB KMTB; APO AE 09392.

n Spc. Clint Mauldin; HHC, 252 AR; 30th HSB, 1st ID; Operation Iraqi Freedom; FOB COBRA; APO AE 09391.

"And both of us," he said, "will appreciate mail from home."

Armstrong Atlantic State University and South University will make significant announcements this week. Armstrong Atlantic will detail a major expansion and South University the addition of a master of science in anesthesiology program. 

AASU says it will be taking over the neighboring 98,088-square-foot retail center known as Publix and Shops at Savannah Mall. The university will initially occupy 65,000 square feet of which 15,000 square feet will be used for plant operations and the remainder will by the university's College of Arts and Sciences.

South University says it will begin offering the anesthesiology physician assistant program in June as part of a consortium with the Mercer University School of Medicine. It will be only the third anesthesiologist assistant program in the country, joining Emory University in Atlanta and Case Western Reserve University in Ohio.

The cooperative program pairing a medical school with another university to offer the MMSc Anesthesiology is the first of its kind in the country.

An anesthesiologist assistant works as a member of the anesthesia care team under the direction of a qualified physician anesthesiologist, administering the whole spectrum of drugs used in the contemporary practice of anesthesiology. Prospective entrants to the South University program will have completed a bachelor's degree from an accredited college or university, including more than 50 hours of specific prerequisite coursework required of students entering medical school and will submit scores from the Graduate Records Examination.

A. William Paulsen, Ph.D., a former associate professor of anesthesiology at the Emory University School of Medicine and program director for academic affairs in the anesthesiology assistant program at Emory University, has been appointed to chair the Department of Anesthesia Sciences that will house the new anesthesiologist assistant program. In addition to working as a practicing anesthetist for almost 30 years, Dr. Paulsen's experience includes administrative positions and professorships at several major universities, including the University of Mississippi at Oxford, where he studied with renowned physiologist Arthur Guyton, MD. 
source:http://www.savannahbusiness.com/main.asp?FromHome=1&TypeID=1&ArticleID=534&SectionID=50&SubSectionID=96

Personnel at Neighborhood Health Care hold a flag that flew “in the face of the enemy for nine minutes and 11 seconds over Camp Phoenix, Kabul, Afghanistan, during Operation ‘Enduring Freedom’ on Sept. 11, 2003.” 

It flew in honor of the Cleveland clinic. The flag was sent last month to the clinic from physician assistant and U.S. Army Capt. Steven S. Gay, who worked with Northeast Georgia Primary Care Network, mainly at the Cleveland office before going to Texas for emergency room training. He was sent to Afganistan while in Texas. He hopes to return to the area this spring or in 2005, when he anticipates being discharged. In addition to working at the Cleveland office, Gay was the primary health care provider at the U.S. Army Ranger School in Dahlonega and also worked with Dahlonega offices that also are part of Primary Care Network. The flag will be on display in the lobby of the center, 1331 Helen Highway. (Staff photo/Will Godfrey)

source  http://www.whitecountynewstelegraph.com/articles/articles.asp?ID=2434

Rebekah Morgan, left, and Bethany Peters, right, are shown with children of the orphanage in Jeremie, Haiti, where they worked during their Christmas vacation. 

ONAWA, Iowa -- How did you spend Christmas vacation?

If you're a member of the Morgan family of Onawa, you'd answer by saying you spent three weeks working with orphans and AIDS victims in Haiti. You did so without a phone, running water or TV. And you beat malaria and the worst of conditions to show that the human spirit can -- and will -- prevail.

Meet physician assistants Tom and Sarah Morgan, former Peace Corps members who have continued their missionary work for years.
 

The Morgans met years ago at Northern Arizona University; Sarah Morgan was from Indiana while Tom hailed from Michigan. Both had a desire to help people and acted on it one year after they wed in 1984 by joining the Peace Corps.

They returned to the United States after serving two years in Sierra Leone, West Africa, and went on to earn master's degrees from the University of Iowa Carver College of Medicine Physician Assistant Program.

A P.A. program directed the Morgans to the Monona County seat, asking them to work two years in an area termed "medically underserved."

"We've been in Onawa 10 years," said Sarah, who works at Family Medicine Clinic in Onawa.

Tom works with the Omaha Tribe of Nebraska in Macy, Neb. Both spend their days evaluating, diagnosing, educating and treating patients.

Work around the world

The Morgans don't limit their work to Siouxland, however. Tom has been to Tanzania, East Africa three times, and to Sierra Leone. He helped perform surgeries when traveling with the Siouxland Tanzania Education Medical Mission. Daughter Rebekah (Bekah), twice accompanied him to Africa.

Since then, voluntary missionary service trips have become an annual family tradition. But their last trip was different -- they took the whole family over the Holidays to Haiti. Tom and Bekah, 15, were joined by Sara, Matthew, 5, and family friend, Bethany Peters, 14, daughter of Onawa's Tim and Brenda Peters.

"I had been to Haiti in 2002 and worked with the Haitian Health Foundation," Sarah Morgan said. "We found that the Haitian Health Foundation was well organized. It utilized the volunteers effectively. We thought this would be a good place to try to take the whole family. It was less expensive to go to Haiti than Africa and it was closer to home."

The family was provided with a place to stay, and was asked to pay air fare and food expenses only. What the Morgans hadn't counted on was that the health clinic, where they thought they would be working, was closed for two weeks over Christmas.

So, Tom spent his days there working in construction.

"This was the first time I was doing construction overseas and not working in a medical capacity," he said. "We did a lot of material gathering, provided trucks and supervised the construction. It is mind-boggling to see the slums and to see how they (Haitians) live. People crammed together in shacks with cardboard roofs. We'd go crazy, literally, if we had to live that way. It's a whole different mindset. You really appreciate what you have."

The Onawa contingent lived for three weeks without indoor plumbing or hot water. They did not have phone access most of the time; no TV reception; no schedules; and no home computers. So, they were able to spend a lot more time together as a family.

Upon reflection, Sarah said this experience centered around Bekah's and Bethany's opportunities. "They had a lot of work to do and were very productive," Sarah said.

Bethany said, "It was pretty shocking to see how needy they are there."

Bekah responded, "It was satisfying to feel like you were helping. It was great to feel useful."

The girls said the best experience involved working in an orphanage in the town of Jeremie. Children there were orphaned via AIDS, or were HIV positive themselves.

"It was good to be able to give them the attention that they needed so desperately," Bekah said.

"They crave love," Bethany added. "We got to help them decorate for Christmas."

When the Haitian Health Foundation clinic opened after Christmas, the Iowa teens helped with filing and entered charts into the computer. At the Center of Hope they weighed and measured pregnant mothers, did more office work and made food cards.

"The food cards allowed the mothers to pick out some food when they came for a checkup; a reward for coming to get a checkup," Bekah explained. "You feel like you're making a difference."

The worst part? Leaving.

There was a trouble spot before that time, though. Three or four days before departing, Bekah woke up with body aches. By that evening she had a high fever.

"Classic malaria," one doctor said.

She was treated, but remained ill two days. Bekah was weak and moved via wheelchair through airports on the trip home.

Her condition was similar to that of Sarah, who contracted dengue fever on her last missionary trip. Both are mosquito-borne illnesses and not contagious.

"I didn't like the mosquitoes," said Matthew Morgan, a kindergarten student who still shows off his bug bites.

"There is such a discrepancy between the rich and poor in third-world countries," Tom concluded. "The Dominican Republic is a lot better off because of its governmental structure and it shares the same island with Haiti. Yet, Haiti is so much more depressed. But when you get down to a personal level, person to person, it strips away a lot of pretexts (we have) about people. I often receive more than I give."

"We don't go alone," Sarah added. "The journey is a result of everyone supporting us. The community is very helpful in supporting us -- not just financially. We have received grants in previous years, and, the response at garage sales has been wonderful. Some people donated money and some donations were toward medicines."

"Where we go and where we have gone overseas, the Americans are considered to be very generous," Tom said.

"We have been revered, respected, and held in high esteem at the personal level," Sarah said. "America is a very positive force in the world."

For more information about the Haitian Health Foundation go to www.haitianhealthfoundation.org

source http://www.siouxcityjournal.com/articles/2004/01/25/news/regional/ac95fc3bfe16047d86256e2600159877.txt

The new clinic will be at 104 Busy Bee with Tommie Seymore, Physician Assistant in family practice, staffing the clinic. 

"This new location will be very convenient for patients who live in Alto, Wells and other communities nearby in Cherokee County," Chad Trammell, M.D. and a family practice physician with Trinity Clinic-Jacksonville, said.

He will see patients Wednes-days at the Alto clinic. "It will also help those who have difficulty finding transportation or experience discomfort while traveling," he said.

"I grew up in Wells, so this is home to me," said Ms. Seymore. "Since the age of 5, I knew that I would work in the medical field. Medicine has always interested me and it is rewarding to know that you can make a difference in people's lives," she added. 

source http://www.zwire.com/site/news.cfm?newsid=10863450&BRD=1994&PAG=461&dept_id=341384&rfi=6

Robert Tebben a Physician Assistant in Cardiology at BMC 
PITTSFIELD - Berkshire Medical Center announces the appointment of Robert Tebben as a Physician Assistant in Cardiology. Tebben provides cardiology services with Peter Zwerner, M.D., David Finck, M.D., Jeffrey Leppo, M.D. and Rebecca Takis-Smith, another Physician Assistant, with offices located in the BMC Medical Arts Complex.

Tebben also assists the physicians in their work at the Berkshire Medical Center Cardiovascular Center, also located in the Medical Arts Complex, on the first floor. 

A member of the Massachusetts Association of Physician Assistants, Tebben graduated from the Physician Assistant program at Northeastern University in Boston, where he earned a Master of Science in Physician Assistant Studies. He has an undergraduate degree from the University of Rhode Island. 

Tebben served as senior paramedic for Rural Metro Medical Services in Syracuse, New York, providing advanced life support and 911 services in the City of Syracuse. 

He also served as a paramedic for South Kingston Emergency Medical Services in Kingston, Rhode Island and was paramedic supervisor for the Brown University Emergency Medical Service in Providence. 

Tebben began his healthcare career as a surgical services orderly at Kent County Hospital in Warwick, Rhode Island. 

For an appointment with Dr. Zwerner, Dr. Finck, Dr. Leppo, Robert Tebben or Rebecca Takis-Smith, call 413-499-8555.

STAR-TELEGRAM/KELLEY CHINN 
Michael Smith adopted Sudanese refugees Paul Nyok Smith, 17, left, and James Dhieu Smith, 14, right. Michael Smith was working as a medical missionary when the boys' grandmother, who lived in a mud hut with 17 other children, asked him if he would take the two.
 

EULESS - Two years ago, in a tribal ceremony beneath some mango trees in southern Sudan, a native woman fearful for her grandsons' safety entrusted them to a Euless man.

Medical missionary Michael Smith, 58, a physician's assistant, and his wife, Susan, adopted the two boys. They took them from a world in which boys as young as 15 are inducted into the civil-religious war against Muslim northern Sudan.

"They are very good parents," said Paul Nyok Smith, 17, a junior at Trinity High School in Euless. "I miss some of my friends. I saw many of them killed. But people are nice here. Life is better."

In their African homeland, he and brother James Dhieu Smith, 14, lived in their grandmother's mud hut with 17 other children.

"People don't stay in one place many years. There was always war zones," Paul said. "Airplanes would come and bomb."

Sometimes, children tried to escape the horror by playing soccer. Even on soccer fields, war posed a threat.

"The Arabs plant mines," Paul said. "People look for them, and some are not found. Sometimes people step on them, and that is dangerous, always."

"There are many snakes, like the cobra and a small, green, poisonous snake, that crawl on the soccer field," he said. "But we decided to take the chance to play."

Things began to change three years ago, when Michael Smith arrived to rehabilitate a 150-bed hospital. A retired commander with the U.S. Navy Medical Department, he volunteers through Missouri-based Outreach International and Highland Meadows Christian Church in Colleyville.

Each day, he walked 2 miles from his hut to the hospital, followed by Sudanese children curious about his light skin and white beard.

"They liked to touch me -- I'm very fuzzy. One little girl called me 'the man with no skin,'" he said. "Most would get tired, but James would keep walking. After three days, he said, 'I'm going to teach you Arabic and Dinka,'" his tribal language.

James introduced Michael Smith to his brother. When southern Sudan's deputy governor saw Smith's fondness for them, he suggested that Smith move Paul, who had turned 15, into his hut, which was off-limits to the army. Three days after Smith did so, the army came through to induct more fighters. The boys' grandmother, one of Michael Smith's patients, asked that he take responsibility for both boys.

He spent a year obtaining adoption, immigration and naturalization documents. He secured letters from missionaries and the Sudan People's Liberation Movement verifying that Paul was not a terrorist. Smith and the boys arrived in Euless in February -- the first time Susan Smith saw them.

Michael Smith home-schools James, and Paul has a 3.5 grade-point average at Trinity High. He plays soccer on the junior varsity team, and teammates like the soft-spoken boy, said Tracy Duren, coach of the varsity soccer team.

When temperatures dipped into the 20s recently, his teammates offered Paul a lift after practice. Paul assured them that he would be fine on his bike, but "they grabbed it, and threw it in the truck and took him home," Duren said. "I thought they were going to tackle him."

Team captain Andrew Bordelon, 15, said Paul "always tries his hardest. It's crazy how someone who has had all those things happen to him can be so optimistic and always have that smile."

The boys say their Christian faith has helped.

Their mother is in a displacement camp in Uganda, and "my dad was one of the first to fight. He was an army captain, and he refused to run," Paul said. "He fought until he was killed. In 1990, when he died, we were not believers. We worshiped the cobra, our ancestors' god. But we came to be believers and were baptized. He [ Smith] talked about God."

Paul said he plans to become a doctor and return to Sudan. While his mother has given up rights to the boys under Ugandan law, Michael Smith said that Paul hopes to return to visit his grandmother the summer after he graduates and before he begins college in the United States.

"Had we not taken Paul, he'd be carrying an AK-47 and fighting a war instead of playing soccer," Smith said. "It's a true blessing of God to have these boys in our family."

source:http://www.dfw.com/mld/startelegram/news/local/states/texas/northeast/7684844.htm

01/06/04
 

First-year students from Pacific University's Physician Assistant Studies Program will conduct basic health checks from 10 a.m. to 6 p.m. on Monday, Jan. 19 at Lloyd Center Mall. 

The fourth annual Martin Luther King Jr. Multicultural Health Fair is free to the public. 

"The intent of the Multicultural Health Fair is to improve Oregonians' health and to emphasize the importance of preventative healthcare," said Mary Von, at Pacific. 

The School of Physician Assistant Studies hosts the annual event to commemorate Dr. King's birthday. 

According to organizers, students believe that healthcare is a fundamental right for all people and the event helps carry out Dr. King's dream of equal opportunity for everyone. 

Students will check blood pressure, blood sugar, iron, body mass and, for children, weight and height. 

Information on quitting smoking, obesity, cholesterol issues and holistic medicine will be available. 

The following organizations also will be represented: 
American Diabetes Association 
National Kidney Foundation 
The Ruth J. Spear Breast Center 
American Cancer Society 
American Heart Association 
Legacy Foot Care 
Oregon Donor Program
Cascade AIDS Project 
Kaiser Bike Helmet Program 
African American Health Coalition 
More information on the fair is available at 503-352-2898. 
http://www.oregonlive.com/news/argus/index.ssf?/base/news/1073428236202880.xml