Author Archives: Joshua Lager

This article has been published with the gracious consent of the Mountrail County Promoter.

You assume that you know the face of opiate addiction. You believe you can tell just by looking at a person, but that is not true. A person is  often struggling in plain sight. It affects all ages and demographics and could be anyone that you know.
Addiction to opioids can happen quickly and easily. Many times, it persists with that person not looking for the “high” but rather just struggling to feel normal. Withdrawal is so profound and so deep that the only way they can get by is to have that opiate on board. They seek it out just to try to have a normal life. It snowballs and takes over their life.
That is where a new program at the Mountrail County Medical Center’s Rural Health Clinic is looking to help. Abbey Ruland, PA and Tammie Braaflat, FNP are offering a MAT Program to help patients looking to move forward and through addiction to a successful and healthy life.
MAT stands for Medication-Assisted Treatment, a strategy for combating opioid use disorders that combines behavioral counseling with prescription medications containing buprenorphine, such a Suboxone.
By the time patients come to them, they say, they are often desperate. They may have lost their job or relationships to the drug addiction. They may have used up their financial resources to get more drugs. They say it is not in an attempt to get high, but rather to take away the horrible pain that comes with the addiction.
Both have taken the required coursework on how to prescribe the medications that will help and credit current CEO Ben Bucher for also having providers on staff in Cando that are part of the MAT programs. They are also working with them with the ECHO Project. Through the University of North Dakota School of Medicine and Health Sciences, the North Dakota Opioid Use Disorder TeleECHO gives providers a virtual learning network with other treatment providers. This program gives collaboration, support and ongoing learning with subject-matter experts and healthcare staff as they look for new ways to support patients in their home communities.
Ruland started her training while still working with Trinity in New Town. She finished that just before returning to practice in Stanley. Braaflat took her training in Bismarck in November and finished the online portion in December. They say that much of the training was in pharmacology and the science of chemical addiction. They learned about the different medications that could be used to treat the addiction and how each works, as well as the side effects and things to watch for during treatment.
It covered how to start the process, known as induction, and the protocols to follow so they do not cause sudden severe withdrawal. It included skills for interviewing and counseling patients. It is about spending the time getting to the bottom of the issue, including the “whys” and “hows” and how to change going forward.
They say it opened their eyes to the differences in the traditional ways to look at addiction and slip ups. Instead it needs to be treated like any other disease. Rather than condemning for a slip up or relapse, instead it is creating open dialog about the ups and downs in the process. It is about not condemning the patient, but rather helping them to avoid those issues in the future. They want to build honest and open relationships to be a pillar of hope for the patient.
Opioid addiction needs to be treated like any other disease. You don’t look at a diabetic and ask why they don’t stop eating or why they don’t just do what is necessary. You work with them. Addiction needs to be treated the same way.
The goal  is to help patients get their lives back on these medications. They want them to be able to regain a sense of normalcy that will allow them to function within their relationships and jobs.
Treatment with MAT will help patients in their own community. In the past patients have had to travel as far away as Bismarck. That is  not realistic if their whole life  then revolves on going that far to get the help they want.
Opioid addiction often starts with a prescription. The addiction happens so fast. For many it is a prescription after a surgery and then the patient finds they can’t go without it. It happens quickly and unexpectedly. It then turns into the need to get more pills, often on the street. It can also turn to a heroin addiction rather than pills because that is cheaper and easier to find.
The buprenorphine works to bind tightly to the receptors while providing no altered sense or euphoria. It allows the patient to get through the painful, profound withdrawal from the opioids.
The MAT program is open to patients ages sixteen and up. The buprenorphine can be used by pregnant patients. It is recognized by all major medical organization. Research shows that this treatment method shows better outcomes. It is not substituting one drug for another, but rather finding a way to help patients reach their goals.
Depending on where the patient is in their addiction and what opiates they are using, they will work with them as they stop and then start the buprenorphine. It is all timed out and dosages will be adjusted as needed. They say that everyone’s story is different, so they are focusing on helping each patient meet their goals. It is not an overnight fix, but they can get there.
It is hope in a hopeless situation. They want their patients to be able to see the light and help them get there. Like any other medical problem, the patient has to have the desire to get better. With open and honest conversation, they can help them get there. They will guide you through this to feel good again. They stress that  they want their patients to know that they are there with compassionate open minds to help. They want them to know they do not need to be scared or ashamed to ask for the help.
Although the program in Stanley has only started in the past few weeks, they already have patients that are benefitting from the program. Opioid addiction is a large issue in Mountrail County, but both are quick to point out that if  you are dealing with it or have a family member dealing with it just losing a single person is a big deal.
They have made sure that the pharmacy is carrying the medication that is dispensed by prescription. At the beginning of treatment, patients will likely be seen twice a week until they are stabilized with their withdrawal and treatment. It will then be based on patient needs, but likely at least monthly.
The length of treatment with buprenorphine will also depend on the patient. For some it could be a lifelong prescription. For others it could be working on a plan to get off it as well once the addiction is treated and their situation changes. That is no different than any other medical diagnosis like diabetes, heart conditions, blood pressure and more that require long-term or lifelong treatments.
You can schedule appointments with either Ruland or Braaflat by calling the clinic at 628-2505. If you are concerned about discussing addiction as the reason for making the appointment, they say that you can tell the scheduler you are looking for medication review or a checkup. They say that discretion is one of their highest priorities as they work towards their goal of wanting people to feel better and find hope for a better future.

October is Breast Cancer Awareness Month and that’s something that staff at Mountrail County Medical Center would like their patients to remember. Getting a mammogram is easier for patients in the Stanley area thanks to a Mammomat Revelation 3-D mammogram that was added to the radiology department last August.

Now a year into serving patients Mammography Technologist Beth Johnson, RT, says they have seen more than double the patients they thought they would see when they started offering the services last year. She says that patients are really happy with the ability to have the 3D mammogram done compared to the 2D that is offered with the mobile unit.

The 3D slice technology is especially valued by patients with dense or fibrous breast tissue. Many of those patients who receive a recall or follow up recommendation after having the 2D mammogram. That would mean a wait to get in to have the 3D mammogram done and result in a drive to at least Minot to have it done.

Because of the 3D technology, Johnson says, it is possible to catch issues earlier because they see deeper into the breast tissue. She says that dense tissue and cancerous tissues sometimes look the same, so the thin slices make it easier to differentiate.

Johnson says that patients are still scheduled one day per week, but if the demand rose additional days could be scheduled. She says that she has also been able to offer the services in the evening when she has two or three patients making the request. She says that makes it easier for women who work during the day with her ability to adjust the schedule.

She also wants patients to know that they do not need to feel self-conscious coming in for the mammogram. They have made the unit as pleasant, private and comfortable for patients as possible.

Mammogram recommendations call for a baseline at age 40 unless there is a family history or current issue that has a doctor recommending an earlier scan. There is not a “cut off” or “age out” date for mammograms, which are recommended yearly.

Johnson says that patients are grateful to have the 3D services. She says that patients should feel and know that they are getting the latest technology possible with the machine. The machine was purchased through funding from the Reiarson Trust. That money was set aside with specific conditions. It cannot help with operations at all for the hospital or clinic but can aid them by purchasing different equipment for the facility.

Getting a mammogram is a unique opportunity because it allows for early detection or peace of mind for patients. With Breast Cancer Awareness in October, now is the perfect time to schedule your mammogram, especially if you have been putting it off over concerns of travel time for a relatively short test.

This article is reprinted with the gracious consent of the Mountrail County Promoter.

A collaborative effort between Mountrail County Medical Center and McKenzie County Healthcare Systems will mean good things for Stanley area patients. As part of their efforts to bring more specialists into the T. H. Reiarson Rural Health Clinic, Dr. Ravindra Joshi and Dr. Leah Brewster, FNP-C will begin seeing patients in Stanley on Thursday, Feb. 28.

Joshi is bringing his many years of experience and prior service in northwestern North Dakota and northeastern Montana to McKenzie County Healthcare in Watford City and now also in Stanley. Certified in orthopedic surgery by American, Canadian, British and Indian examining bodies, Joshi received his Master of Orthopedic Surgery degrees from the University of Liverpool and the University of Bombay. He completed his orthopedic residency at St. Thomas and Guy’s Hospital Orthopedic program in London. He received advanced medical education through fellowship training in total joint replacement surgery at Columbia Presbyterian Medical Center and New York Orthopedic Hospital.

In 2000 he moved to practicing medicine in North Dakota, specializing in total joint replacements of hip, knee and shoulder, sports related surgery, trauma surgery, shoulder rotator cuff repairs and related surgery, hand and foot surgery as a general specialist in Orthopedic Surgery.

Brewster, a Stanley High School graduate, earned her Associates Degree in Nursing from NDSCS in Wahpeton in 2003 and then her Bachelors Degree in Nursing from UND in Grand Fords in 2005. Her Doctorate Degree in Nursing was earned at NDSU in Fargo in 2013. She is certified by the American Association of Nurse Practitioners and is trained in Family Practice, so she can see patients of all age ranges. She worked cardiac and vascular medicine for four years after graduating and then went on to do orthopedic medicine. She has also done some walk in clinic work over the past year.

Having relocated his practice to Watford City in December last year, Joshi says that he has a goal of creating a rural network to take care of patients in their own communities. That is what will bring he and Brewster to Stanley each Thursday of the month. They plan to start out seeing patients from 9 a.m. to 3 p.m. and increase the times from there if patient load demands.

Surgeries would be done in Watford City, but they say that the patient oriented and focused care they can offer in a rural community like Stanley helps provides those services locally and help local clinics and hospitals flourish.

He started seeing patients in December in Watford City. He is involved in creating the orthopedic related portion of the surgical suites and equipment needed. They have been putting together the team needed to operate the surgical suites and should be able to offer the surgical procedures starting in mid-March with same day surgeries and then expanding into the in-patient procedures.

The outpatient satellite services offered in Stanley’s clinic will include orthopedic care for injuries, arthritis, sports injuries, carpal tunnel, rotator cuff, bunions and more. While any needed surgeries would be done in Watford City, patients will be able to have office procedures such as joint injections with cortisone and lubricant done in Stanley. They will also be able to offer testing including x-rays, labs, MRI, CT scans and physical therapy. Post-surgical visits will also be able to be done in Stanley.

Joshi says this will allow patients to recuperate and heal at home with their families rather than being in distant facilities. With the exception of surgery itself, examinations,  treatments and joint injections can be done close to home.

Joshi also says that his goal  in life is to do something for the communities and give back. With rural networking he says as a specialist he can do the majority of the work and then designate the right  person he trusts for the rest of the project. Creating rural networks makes it easier for residents to connect with what they need. A prime example is the adding of a good source of providers so people do not have to go elsewhere for medical care. That in turn supports the local community.

Brewster says that she serves as the peri-operative medical and orthopedic specialist provider. She  will coordinate the surgery with a patient’s primary care provider as well as considering any other factors or specialists that may be involved in the patient’s care. She will take care of scheduling the lab studies, x-rays, etc. and then  be involved in the risk assessment of patients making sure the patient is cleared and safe to proceed with the surgery. While in Stanley she will also be involved in seeing the patients for their orthopedic and trauma related needs.

While Joshi and Brewster continue to live in Minot, Brewster is doing most of her work remotely as the liaison and coordinator from Minot. She will be making the trip to the clinic in Stanley. Joshi is in Watford City Monday through Wednesday and then Stanley on Thursdays. He is holding Fridays for rural networking appointments.

The pair has a goal of offering high value and patients satisfaction outcome. They say they are there for the patients, providing the best orthopedic care to achieve that outcome. By rural facilities working together, they believe that there are many ways to provide better care for everyone while also realizing some cost savings.

Stephanie Everett, Foundation Director/P.R. and Marketing Director/Administrator in Training at MCHC, says that when the T.H. Reiarson Rural Health Clinic was built the goal was to host specialists and improve patient care in Stanley. This opportunity with Dr. Joshi and Brewster is one more step in offering patients the ability to receive the best quality care locally.

To schedule appointments, patients are asked to call  the Specialty Clinics of McKenzie County Health Systems at 701-444-8730. Patients contacting the Stanley clinic will be directed to that number for scheduling.

The Stanley Lions Club presented checks totaling $2,750 as the  proceeds from their Super Bowl Raffle Boards last week. Recipients this year were the Mountrail County Health Foundation, Ina Mae Rude Aquatic Center, the Stanley Park District and the Will Athletic Complex Renovation project.

Pictured above, left to right, are Lowell Vedaa, past Lions President; LuWanna Meiers, representing the Aquatic Center; Brandi Larson, representing the Park District; Roger Gjellstad, Lions Vice-President; Heath Hetzel, representing the Will Athletic Complex; and Steph Everett, representing the Health Foundation.

When Rocky Zastoupil submitted his resignation as MCHC Administrator/CEO on October 29 of this year, the boards of MCHC began the work to fill the vacancy. Zastoupil’s resignation will be effective on December 31, 2018. The boards have met, and the vacancy will be filled over the next year by interim Administrator/CEO Benjamin Bucher of Rolla. That will give time for Mountrail County Health Foundation Director Steph Everett to complete the training necessary to take over the position as the next Administrator/CEO of MCHC.

The selection process began when HR Director Janet Chastain reached out to the Long-Term Care Association. The association maintains a list of administrator’s potentially available to serve as interim administrators. With eight names on the list, she reached out to the boards and Bucher, asking if they could meet. At that meeting held on November 7, the boards felt that Bucher was an impressive candidate both in his response, resume and the interview process.

Bucher is the current CEO/Long-Term Care Administrator for Towner County Medical Center and Towner County Living Center in Cando. He is the Board Chair of the North Dakota Hospital Association, a member of the Heartview Foundation Board of Directors and on the CAH Quality Executive Committee Board.

Bucher says, “This is not a unique situation, having a CEO or Administrator resign. It is important to come together and help each other out, especially as part of small town rural healthcare.” The same situation occurred in Cando with them needing an interim administrator for eight months. The board there appreciated the assistance and said that they would be willing to offer the same assistance if the need arose.

Bucher holds a Masters in Business Administration with Specialization in Healthcare as well as a Masters of Science in Nursing, FNP-BC. He has a current practice as a Family Nurse Practitioner, family practice, emergency department and hospital inpatient at Towner County Medical Center in Cando and Presentation Medical Center in Rolla. His past work experience includes clinical nursing instructor for public health nursing at UND; and a registered nurse, patient care coordinator/supervisor at Altru Health System in Grand Forks. His honors include being named the ND Emerging Rural Health Leader the same year Dr. Mark Longmuir was named the Rural Health Care Professional.

Bucher will be splitting his time between the facilities, saying that his time in Stanley will likely be a few days every few weeks. However, when he is not on site, he will still be available 24/7 by phone or email.

This situation will put responsibility on staff in both facilities, but he says that he knows that the staff is in place in both to assure that they will run well. The managers, supervisors and all staff will have to buy in to the arrangement. “I wouldn’t do it if I didn’t think that both facilities were able to do that,” he says.

MCHC board president Heath Hetzel says, “We are very thankful for the years of service that Rocky gave us.  He navigated us through some tough situations over the past 3 years.  We are now moving to a new chapter with Rocky’s retirement.  We are looking forward to having Ben as our interim administrator/CEO and the wealth of knowledge and experience he will bring to our facility.  We are also excited for the opportunity to have local interest in becoming the next CEO/Administrator for Mountrail County Health Center.  I have worked with Steph over the past 5 years while she has been the Foundation Director and have been impressed with how she conducts business and the energy that she brings to her job.”

For Everett, the work will begin right away as she will need 480 hours of training, and then complete all national and state testing. Dan Kelly of Watford City will oversee her hours as preceptor. He will oversee her training in Stanley’s facility and Cando’s with Bucher when he is there, along with his facility in Watford.

The training and testing are necessary for administrator of a nursing home. It breaks it down all areas of running the facility. The goal is that by May or June she will have the working knowledge necessary to begin assuming leadership roles at MCMC. By training with both Bucher and Kelly she believes she will have the necessary understanding to run the critical access hospital.

Everett says, “I want to thank the board members of the: Mountrail Bethel Home, Mountrail County Medical Center and Mountrail County Health Foundation/SCH for having the confidence in me to take on the position of CEO/Administrator. In the five plus years I have been the Foundation Director, we have seen tremendous growth. As I look ahead, I see awesome opportunity, and a great team that I am excited to lead to higher levels of growth. I wholeheartedly believe in our community and working together to ensure that Mountrail County and the City of Stanley has a thriving Health Center that will take care of the residents of our community for over another half century. I look forward in working with Ben over the next year to make this all happen!”

Everett has served as the Foundation Director since October of 2013. She says that she will still fill that position as well with the help of an assistant that will be hired by the Foundation Board. She loves that job and does not want to give it up. In fact, she says that by combining that with the administrator/CEO it will unify all the boards. She is emotionally vested in the facilities and the belief that they are a local facility that serves the communities around them.

Foundation board president Wade Enget says, “The Mountrail Health Foundation Board fully supports the hiring of interim Administrator/CEO Benjamin Bucher of Rolla, and the long-term plan to hire Steph Everett for the position of Administrator/CEO of MCHC.  In the past five years, Ms. Everett, as the Executive Director of the Mountrail County Health Foundation, has shown strong support for providing quality health care for our community and the surrounding area.  Ms. Everett brings the energy, ability and commitment needed to meet the Foundation’s goal:  “Your Health”.”

She and her husband Jim will be building a home in Stanley, something that also shows her commitment to the facility and the community. Her belief structure stresses the importance of the survival of healthcare facilities in Stanley. It is not only the jobs that the facilities provide, but also the access to healthcare with the clinic, emergency room, hospital, swing bed and nursing home.

She is concerned that at this point, the nursing home is down to 26 residents. She says that it could also be a sign of the times as the population is essentially between the generations that are using nursing homes. However, she says that it is important to keep that nursing home and all of the facilities vital and used by the community. The new assisted living under construction is a needed service for the community. She also recognizes that updates are needed for the nursing home in the future.

Access to healthcare is critical to the future of a community. Everett looks forward to being a part of that well into the future.

This article is republished with the gracious consent of the Mountrail County Promoter.