Gettysburg Medical Clinic
 The Clinical View
 by P.E. Hoffsten, MD
 26 October 2005

AN UPDATE ON RURAL HEALTH CLINICS

            I last wrote about the various health clinics in Central South Dakota in November of 2001.  Since then, many of the names have changed and several of the clinics themselves have changed. This column is an update of healthcare facilities available in Central South Dakota.

            To preface the description of the clinics below, some history is appropriate.  As I mentioned in a previous column, there was a day when there was a physician who lived in Highmore, one who lived in Murdo, and one who lived in Onida.  Until recently, Dr. Crandall lived in Kennebec but now he has retired.  The economics of medicine, the pressures of managed care, the onus of paperwork from Medicare and various insurance companies along with the lure of the big city has essentially gutted small rural communities in South Dakota in regard to physicians who live in those communities.  At this time, Gettysburg is the only small community in central South Dakota with a resident physician.  His name is Dr. Mohsen Arani and he is a board certified internist and geriatrician.

            Dr. Arani was born in Kuwait, educated in Hungary and finished his medical education in the United States.  As a foreign medical graduate on a training visa he was eligible to stay in the United States if he would practice medicine in an underserved area.  Gettysburg qualified as such an underserved area and Dr. Arani with his wife and three children arrived there three years ago.  He is an outstanding physician who I would give an unqualified high recommendation to.  Fortunately for Gettysburg, he is very happy living in their community and continues to practice there at the Community Care Clinic.

            There are now twenty-three physicians who are board certified or board eligible in Family Practice, Internal Medicine, Obstetrics and Gynecology, General Surgery, Orthopedic Surgery, Neurosurgery, Podiatrics, Pediatrics, and Emergency Medicine at Medical Associates Clinic in Pierre.  There are two Family Practitioners at the Dakota Plains Clinic in Pierre and two internists at the Linn Medical Clinic in Pierre that also serves as a Veterans Administration Clinic.

            In the mid 1980’s, the Federal Government acted on its awareness of the medically underserved communities in our rural areas.  They made grant money available to organizations that would provide care to small medically underserved communities.  In 1987, Murdo and Highmore already had clinics in place that were financially strained and receiving financial support from St. Mary’s Hospital.  With the availability of increased federal funding from grants to support these clinics, a separate entity and corporation was begun.  It is called Rural Health Care, Inc.  Its stated mission was to provide access to quality medical care in small rural communities and serve as a conduit to more specialized care as needed.  A strong emphasis was placed on preventive considerations including well-baby care, adequate immunizations for child, high blood pressure control, cholesterol control, and intermittent programs such as screening for skin cancer.  The staffing at a local clinic in Highmore, Murdo, Presho, Onida and Gettysburg all include a Physicians Assistant or a Nurse Practitioner who is sponsored by a physician based in Pierre. These clinics also have nurses available to address immunizations, and individuals to help with insurance and other administrative considerations.

            In Murdo, Jim McNealy is nurse practitioner who has staffed the Murdo Clinic for many years.  He is a resident of Murdo.  He is sponsored by the physicians from Medical Associates Clinic.  Family practitioner, Mike Holland, internist physician Imran Khawaja, and internist Dr. Phil Meyer each rotate through the Murdo Clinic on a weekly basis to see consults or other patients.

            In Highmore, the clinic is staffed by physician’s assistants April Crago and Cindy Erwin.  Family practitioner Michael Richardson, pediatrician Joan Gibson, obstetrician Shelley Nielsen, and internist Phillip Hoffsten all rotate through the Highmore Clinic on a weekly basis to see patients and sponsor the two physician assistants there.

            In Presho the clinic is staffed by Physician Assistant Diane Urban who is sponsored by family practitioner Dr. Mike Holland, internist Dr. Phil Meyer, and internist Imran Khawaja.  These three physicians each rotate through the Presho Clinic on a weekly basis to see patients.

            In Onida the Rural Health Care, Inc. Clinic is served by physician assistant Rose Marie Hoiten.  She is sponsored by Dr. Mohsen Arani who also sees patients there.  Dr. Phillip Hoffsten also goes to the Onida Clinic on a weekly basis.

            Physician Assistant Marvel Buhler previously worked at the Rural Health Care, Inc. clinic in Onida.  She elected to open her own clinic and is currently sponsored by Dr. Buron Lindbloom.  Dr. A.J. Tieszen and Dr. Rob Allison also rotate through her clinic.

            As mentioned above, the Gettysburg Clinic has the good fortune to be served by Dr. Mohsen Arani.  In addition, nurse practitioner Rena Robbennolt continues her excellent care at that clinic.  She is sponsored by Dr. Phillip Hoffsten who rotates through the Gettysburg Clinic once a week.  Physician assistant Stephen Knoble is also in the Gettysburg Clinic sponsored by Dr. Hoffsten.

            The Rural Health Care, Inc. Clinics have grown by an additional site since 2001.  Previously they served Murdo, Highmore, Onida, and Gettysburg.  On November 1 2005 Presho will be added to that list and there are plans to place a Rural Health Care, Inc. clinic in Fort Pierre in the next year.  Ms. Rita Wagner continues to serve as executive director and is the person instrumental in holding this group together and writing the grants for the federal support.  Ms. Cindy Erwin is a physician’s assistant who coordinates the medical aspects of care and sees to the medical needs of each clinic.  Ms Bernie Ripperger is now the financial officer for Rural Health Care, Inc.; she makes sure that the bills get paid.  Kari Eisenzimmer is also in the office at Rural Health Care, Inc. in Pierre and manages business operations.  There are 12 board members on Rural Health Care, Inc.  There are four from each community.  Presho will be joining Rural Health Care, Inc. on November 1^st and three board members will be sought from that community also.

            An additional medical clinic available in Pierre is the Urban Indian Health Clinic.  They have recently opened a new building out near the mall.  Their clinic is served by John VanderMaten, physician assistant.  Two of the clinics mentioned above have a sliding fee scale to accommodate individuals with limited financial means.  The Urban Indian Health Clinic in Pierre is one of these.  The other is all of the clinics of Rural Health Care, Inc.  The sliding fee schedule is something somebody finally got right.  It provides access to quality medical care in the small communities around Pierre and in Pierre.

            The physicians in Pierre drive out to the clinics run by Rural Health Care, Inc. in Murdo, Presho, Highmore, Onida, and Gettysburg on a weekly basis.  They sponsor the nurse practitioners and physician assistants in these clinics and in addition provide specialty care in obstetrics, pediatrics, general surgery, internal medicine and orthopedic surgery.  Speaking for myself, these clinics provide excellent care through the physician assistants, the nurse practitioners, the nurses and administrative personal that staff the clinics.  They manage those medical problems that can be managed in a small town facility.  When needed, they refer patients on to more specialized clinics such as Pierre or other major medical centers.  Most importantly, the small town clinics are staffed by local resident healthcare providers who care as much about their community as you do.  To those of you who have yet to experience the Rural Health Care, Inc. Clinics in your local communities, you are going to second best, pay more and are taking longer to get there.