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Arkansas Hospitals ■ Winter 2002 3

Will We Be Ready? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Bob Bash Installed as AHA’s 70th Chairman. . . . . . . . . . . . . . . . . . . . . . . . 6Calendar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Arkansas Newsmakers and Newcomers . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Medicare Beneficiary Increases For ‘02 . . . . . . . . . . . . . . . . . . . . . . . . . . . 7OIG Work Plan Posted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Arkansas Insurer Increasing Anesthesia Rates . . . . . . . . . . . . . . . . . . . . . . . 8Bioterrorism Wall Chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Russ Harrington Presented Weintraub Award . . . . . . . . . . . . . . . . . . . . . . 13Governor’s Budget Cuts Affect Hospitals . . . . . . . . . . . . . . . . . . . . . . . . . 13Jones, Wilson Receive Distinguished Service Awards . . . . . . . . . . . . . . . . . 15AHA Elects New Board Members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Arkansas Resources for Disaster Readiness . . . . . . . . . . . . . . . . . . . . . . . . 21JCAHO Emergency Management Expectations. . . . . . . . . . . . . . . . . . . . . 21Curtis and Leopard Receive ACHE Regent’s Awards . . . . . . . . . . . . . . . . . 21AHA 2001 Diamond Awards Presented . . . . . . . . . . . . . . . . . . . . . . . . . . 22Reaffirming Our Commitment to Caring . . . . . . . . . . . . . . . . . . . . . . . . . 24Saluting the AHA’s 2001 Corporate Partners . . . . . . . . . . . . . . . . . . . . . . 26Bates Medical Center to Build New Facility . . . . . . . . . . . . . . . . . . . . . . . 27AAHQ Receives National Award . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Critical Access Hospitals Receive Grants. . . . . . . . . . . . . . . . . . . . . . . . . . 27Arkansas Medicaid Expansion Policies Implemented. . . . . . . . . . . . . . . . . 28Reminder: Nurse License Renewal Available Online . . . . . . . . . . . . . . . . . 28MedPAC Suggests Hospital Payment Changes . . . . . . . . . . . . . . . . . . . . . 33Cost Report, PS&R Due Dates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33Leapfrog Group Works to Improve Patient Safety. . . . . . . . . . . . . . . . . . . 33Arkansas DATABANK Enrollment Grows. . . . . . . . . . . . . . . . . . . . . . . . . . 33Boozman Elected to Represent Third District . . . . . . . . . . . . . . . . . . . . . . 34HIPAA Web Sites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34HIPAA Electronic Submissions Testing Requirements. . . . . . . . . . . . . . . . . 35CPT 2002 Coding Changes Affect All Specialties . . . . . . . . . . . . . . . . . . . 35JCAHO Reissues Sentinel Event Alert . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35Preparing for a Terrorist Attack: Mass Casualty Management . . . . . . . . . . 41

Our Advertisers, Our Friends

is published by

Arkansas Hospital Association419 Natural Resources Drive • Little Rock, AR 72205

501-224-7878 / FAX 501-224-0519www.arkhospitals.org

Beth H. Ingram, Editor

BOARD OF DIRECTORSRobert Bash, Booneville / ChairmanJeff Curtis, Malvern/Chairman-electEugene Zuber, Newport / Treasurer

Luther Lewis, El Dorado / Past-ChairmanFrank Wise, Salem/At-Large

Robert Atkinson, Pine BluffDavid Cicero, Camden

Randall Fale, Hot SpringsRussell D. Harrington, Jr., Little Rock

Michael D. Helm, Fort SmithTim Hill, Harrison

Ray Kordsmeier, ConwayDavid C. Laffoon, SearcyRay Montgomery, Searcy

Richard Pierson, Little Rock

Ron Rooney, Paragould

Bill Sparks, Russellville

Pattsy Yancy, Arkadelphia

EXECUTIVE TEAMJames R. Teeter / President and CEO

Phil E. Matthews / Executive Vice PresidentW. Paul Cunningham / Senior Vice President

Beth H. Ingram / Vice PresidentDon Adams / Vice President

DISTRIBUTIONArkansas Hospitals is distributed quarterly to hospital

executives, managers, and trustees throughout the UnitedStates; to physicians, state legislators, the congressional dele-

gation, and other friends of the hospitals of Arkansas.

Cover Photo Cedar Waxwing on a holly bush in Western Pulaski County

Photo by Ray Scott, Little Rock

To advertise contactDAVID BROWN

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AHA Services 6AMCO 14Amerinet 28Arkansas BlueCross BlueShield 5Arkansas Foundation for Medical Care 16Complete RX 45Crews & Associates, Inc. 26Document Depot 46Embassy Suites / Little Rock 46Hagan Newkirk Financial Services, Inc. 42

La-Z-Boy Concepts 46The MHA Group 47Moore Stephens Lovelace, PA 34Nabholz Construction 2NMHCRX 36Outsource Mailing 28Solucient 8TME Engineering 43Reciprocal of America 48VALIC 36Woodland Outsourcing 36

In this issue ...

4 Winter 2002 ■ Arkansas Hospitals

These are trying times in America, particularly in Washington where the Congress has been faced with weightymatters like aviation security, an economic stimulus package, appropriations bills, and, finding more money toprotect against terrorism, including bioterrorism.

Already, dollars have been earmarked to hike production of anthrax vaccine, improve and produce 300 mil-lion doses of smallpox vaccine, speed up production of antibiotics, modernize the CDC’s microbe research lab,and train medics to better and more quickly detect and respond to bioterrorist attacks.

Hospitals, too, need a huge infusion of federal dollars, since they would be at center stage in the event of alarge-scale, mass-casualty nuclear, biological, or chemical (NBC) terrorist attack. It is no secret that the over-whelming majority of the nation’s hospitals are ill prepared for an NBC attack. Years of shortsighted cost cuttingby government and other payers, along with masses of uninsured patients have dealt severe financial blows tohospitals precluding preparedness for the new era of terrorism in which we suddenly find ourselves.

As this fact sinks in, government movers and shakers are trying to bolster hos-pital preparedness. U.S. senators Ted Kennedy and Bill Frist have proposed $400million to aid hospital response to bioterrorism. And, senators John Edwardsand Chuck Hagel have proposed $100 million to strengthen hospital emer-gency, trauma, and intensive care units, and another $100 million for blockgrants to state and local governments for hospital NBC attack preparedness.

While their intentions are undoubtedly the best, the dollars proposed areentirely too few in number. Consider that New York City hospitals spent $340million responding to the September 11 attack on the World Trade Center. Hos-pitals in nearby New Jersey spent $36 million responding to the same disaster.

According to the American Hospital Association (AHA), it will cost $11.3 bil-lion if all of the nation’s 4,900 acute care hospitals are to acquire the resourcesneeded to achieve minimum levels of NBC attack readiness. Needed resourcesinclude instruments for detecting radiation and chemical/biological agents;hooded chemical resistant suits; decontamination tables; outdoor shower sys-tems; negative air machines and HEPA filters; expanded patient isolation facili-ties; adequate containment for run-off waste water; portable generators; respira-

tory ventilators; cyanide antidote kits; and Atropine, Pralidoxime chloride, and Diazepam to treat exposure tonerve agents.

The AHA has released a detailed list of these needs to members of Congress, the administration, and govern-ment agencies in efforts to ensure that each of America’s urban and rural hospitals could treat 1,000 patients and200 patients respectively for 24 to 48 hours. After that time, it is assumed the CDC’s Bioterrorism Preparednessand Response program would be mobilized, even though that program has not yet been fully implemented.

The AHA’s list of needed resources has also been sent to every hospital CEO in America. They have been urgedto study it carefully, and to conduct a thorough assessment of their own hospital-specific needs and the cost ofmeeting those needs. Preparedness improvement is at the top of the hospital agenda. It should be sky-high onthe Washington agenda, too. It is essential that the Congress and the White House—so quick to enact a $15 billionairline bailout after the September 11 terrorist attacks—also give top priority to funding hospital mass casualtypreparedness.

James R. TeeterPresident and CEO Arkansas Hospital Association

Will We Be Ready?


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Robert R. Bash, adminis-trator of Booneville Commu-nity Hospital (BCH), wasinstalled as chairman of theArkansas Hospital Associa-tion (AHA) board of directorsduring the group’s AnnualMeeting and Trade Show inLittle Rock October 8.

Bash succeeds LutherLewis, CEO of the MedicalCenter of South Arkansas inEl Dorado, and will serveuntil October 2003, becom-ing the first AHA chairman toserve a two-year term ofoffice. The association’sHouse of Delegates voted to change the term of office duringits annual business meeting October 8, approving a recom-mendation put forth by the bylaws committee.

Administrator of the Booneville facility since 1993,Bash has been in the healthcare field for 28 years. Prior tohis arrival at BCH, Bash was administrator of JohnsonCounty Regional Hospital in Clarksville, and held admin-istrative positions in Louisiana hospitals located inAlexandria and Pineville.

During his eight years at BCH, Bash has overseen about$900,000 in improvements, technology upgrades and addi-tions to the 32-bed facility located in rural west centralArkansas.

Bash has served on the AHA board for four years as repre-sentative from the Arkansas Valley District before being elect-ed as chairman-elect in October 2000. He has participated onthe Committee on Auxiliaries and the AHA Services, Inc.,board of directors. He is also a member of the American Col-lege of Healthcare Executives.

Bash and his wife, Linda, are parents of two daughters—Lottie, an attorney, and Heather, a graduate student at Hum-boldt State University in California.

When asked about his philosophy of hospital administra-tion and participation in the AHA, Bash said, “The hospitaladministrator is the hospital leader. He is responsible forselecting, leading, and developing the management team.

“Participating with the state and national hospital associa-tions is important for many reasons. First, for representationon the state and national legislative front. Second, for thebenefit of power and economy achievable through the groupthat is impossible by oneself. And, third, for education andcurrency for the administrator and the management team.There are many additional benefits, but these three are the pri-mary reasons that one should be a member, fully participate,and support the state and national hospital associations.”

Bob Bash Installed as AHA’s 70th Chairman

AHA Services is committed to providing

AHA member hospitals with access to

quality products and programs.

For information on any of our programs please contact Tina Creel or Phil Matthews

A wholly owned subsidiary of the Arkansas Hospital Association.

Phone 501-224-7878 Fax 501-224-0519http://www.arkhospitals.org/aha_services

Governor Mike Huckabee has appointed Ray Montgomery,president and CEO of White County Medical Center in Searcy, to theTobacco Prevention and Cessation Advisory Committee.

Lee Gentry, president of Lawrence Memorial Health Services inWalnut Ridge and an Arkansas Air National Guard captain in the 123rdIntelligence Squadron located at the Little Rock Air Force Base, has beenactivated as part of the presidential selective reserve call up. His emailaddress is [email protected]. Larry Morse, senior vice pres-ident at St. Bernards Healthcare in Jonesboro, will be acting administra-tor during Gentry’s absence.

John Tompkins has been named CEO and administrator of BaptistMemorial Hospital-Osceola, succeeding Joel North. Tompkins hasbeen with Baptist Memorial Health Care for more than 20 years, mostrecently serving as CEO and administrator for Baptist Memorial Hospi-tal-Union County in New Albany, Mississippi and Baptist MemorialHospital-Booneville in Booneville, Mississippi.

Susan Barrett, CEO of Mercy Health System of NorthwestArkansas, has been appointed by Arkansas Speaker of the House ShaneBroadway to a term on the Tobacco Prevention and Cessation AdvisoryCommittee. She also has been named to the Advisory Board for Perina-tal Health Services with a term ending November 15, 2002.

David Chumley, FACHE, president and CEO of the American RedCross Blood Services, Greater Ozarks—Arkansas Region, Little Rock, waselected president of the Arkansas Health Executives Forum during thegroup’s annual meeting October 8 in Little Rock. Also elected wereChristy Hockaday, vice president, Conway Regional Health System,president-elect; and Jason Spring, CHE, administrator, St. VincentRehabilitation Hospital, Sherwood, secretary-treasurer.

Don Beeler, president and CEO of CHRISTUS St. Michael HealthSystem in Texarkana, has been re-elected to a three-year term on theboard of the Arkansas State Chamber of Commerce.

Arkansas Newsmakers and Newcomers

CALENDAR■ January 9, Monticello

CPT 2002 Coding Update

■ January 10, BismarckCPT 2002 Coding Update

■ January 18, North Little RockArkansas Association of Hospital Engi-neering

■ January 31-February 1, Tunica, MSHealthcare Financial ManagementAssociation Tri-State Meeting

■ January 31-February 1, Nashville, TNContinuous Survey Readiness Workshop(CSR members only)

■ March 1, ConwayArkansas Society of HealthcareMarketing & Public Relations

■ March 6, Little RockCompliance Forum

■ March 17-21, ChicagoAmerican College of Healthcare Execu-tives Congress

■ April 7-9, Washington, DCAmerican Hospital Association AnnualMeeting

■ April 11-12, Hot SpringsHealthcare Financial Management Asso-ciation

■ June 12-14, Branson, MOArkansas Hospital Administrators ForumSummer Management Conference

Medicare beneficiaries will pay a higher deductible forPart A and a higher premium for Part B in 2002. The PartA deductible will increase 2.5% to $812 from $792 thisyear, the Department of Health and Human Servicesannounced October 18. The Part B premium will rise by8% to $54 per month from $50 per month in 2002.

Increases for extended hospital stays beyond the 60days covered by the Part A deductible will jump $203 perday for days 61 through 90 and $406 per day for hospitalstays beyond the 90th day in a benefit period—up from$198 per day and $396 per day, respectively.

For beneficiaries in skilled nursing facilities, thedaily co-insurance for days 21 through 100 will be$101.50, up from $99 in 2001. Medicare deductiblesand premiums are updated annually according to statu-tory formulas. For more, go to www.hhs.gov/news.

Medicare BeneficiaryIncreases For ‘02


The HHS Office of Inspector General has posted theagency’s Work Plan for Fiscal Year 2002 to the OIG’swebsite. The plan covers four chapters encompassingthe various projects to be addressed during Fiscal Year(FY) 2002 by the Office of Audit Services, Office ofEvaluation and Inspections, Office of Investigations,and Office of Counsel to the Inspector General.

Within the Department of Health and Human Ser-vices, ten areas—including use of evaluation and man-agement (E/M) codes, the appropriateness of billing forphysician consultation services, “incident to” services,and the use of advance beneficiary notices (ABN)—wereamong the areas that made the list. View the Work Planat www.hhs.gov/ oig/wrkpln/2002/Work_Plan_2002.htm.

OIG Work Plan Posted

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The Arkansas Hospital Association has learned thatArkansas Blue Cross Blue Shield (ABCBS) intends toincrease the unit rate it pays for anesthesia services.The increase will reportedly raise the base rate pay-ment to $42, up from the current $34 unit payment.

The rate increase will cost the company between $6million and $7 million annually and is expected to beunderwritten by policyholder premium increases. Nofuture implementation date for the new payment hasbeen announced, though, historically, ABCBS ratechanges are effective in January or February of the yearfollowing rate adjustment decisions.

The AHA has been working in conjunction with acoalition of hospital and physician representatives toaddress the issue of payments for anesthesia services,which tend to be lower in Arkansas than other states.The group will now turn its attention toward othercommercial insurance carriers and Medicare, with thegoal of achieving anesthesia rate increases on thosefronts, too.

Arkansas InsurerIncreasing Anesthesia Rates The North Carolina Statewide Program for

Infection Control and Epidemiology (SPICE), atthe University of North Carolina at Chapel Hill,has developed a wall chart on bioterrorist agents.A small version of this wall chart is online andavailable for your use for educational purposes aslong as you use the chart in its complete form,including the disclaimer and credit to the NorthCarolina Statewide Program for Infection Controland Epidemiology.

The purpose of the chart is for display forphysicians in emergency rooms, urgent care cen-ters, physicians’ offices, and other primary carefirst responders. The chart presents a concise sum-mary of signs and symptoms to assist with earlyrecognition and alert healthcare workers of thepotential for bioterrorist agents. Once a bioterror-ist agent is suspected, the healthcare worker willneed to consult more in-depth resources.

To see instructions for printing the chart, click onhttp://www.unc.edu/depts/spice/bioterrorism.html.The site also has other disaster resources listed.

Bioterrorism Wall Chart


Governor Mike Huckabee an-nounced November 14 that the statebudget for the remainder of fiscalyear 2002 will be cut by $142 million.The amount is substantially morethan the $100 million reduction orig-inally expected and represents thelargest mid-year state budget adjust-ment in history. Cuts for state fiscalyear 2003, the second year of thebiennial budget period, which beginsJuly 1, 2002, will total $161 millionless than approved by the ArkansasGeneral Assembly during the legisla-tive session that ended last April. Thecuts are a result of a general econom-ic downturn affecting most states.Through October 31, state generalrevenues for the year beginning July1, 2001 were $12.4 million less thancollected through the same periodlast year and $34 million under pro-jections for this year.

The Arkansas Medicaid programs willlose more than $50 million during the

remainder of state fiscal year 2002 aspart of the state spending reduction.Medicaid director Ray Hanley said mostof the 475,000 Arkansans who are eligi-ble for and use Medicaid benefits will beaffected to some degree.

The largest part of the savings—between $19 million and $20 million—will come from elimination of the state’smedically needy program that covershealthcare costs for about 33,000 lowincome people who wouldn’t normallyqualify for Medicaid, but who must havecare related to catastrophic illnesses.

Other significant cuts will be made inpayments for prescription drugs andpharmacy costs, day treatment andtherapy services for developmentallydelayed children, rehabilitation servicesfor the mentally ill and changes in theway patients are evaluated for nursinghome care.

Few of the spending reductionsshould directly affect payments to hos-pitals, though the indirect impact could

weigh heavily. In addition to loss of pay-ments for services to those who will nolonger have benefits under the medical-ly needy program, Medicaid will ceasepaying Medicare/Medicaid crossoverclaims for patients dually-eligible forboth programs at more than would havebeen paid had the dual-eligible patientbeen a Medicaid patient only. Severalyears ago, the state followed a “pay nomore than Medicaid” policy, but thatwas changed to pay at Medicare rateswhen more money was available.

Medicaid may also seek savings inthe mental health arena by putting outto bid inpatient psychiatric care. And agate-keeping system may be establishedfor children’s outpatient care. Theseprograms have been growing at double-digit rates, according to Hanley. Most ofthe announced cuts will take effect nextspring. Some require approval from thefederal Centers for Medicare & Medic-aid Services before changes can beimplemented.

Russell D. Harrington, Jr., FACHE,president of Baptist Health in Little Rock,was recognized with the Arkansas Hospi-tal Association’s A. Allen WeintraubMemorial Award during the AHA’s annu-al meeting October 8 in Little Rock.

The award, named for the late admin-istrator of St. Vincent Infirmary MedicalCenter (now St. Vincent Health System)in Little Rock, is the highest honorbestowed on an individual by the AHA.Harrington was selected for the award bythe AHA board of directors in recogni-tion of his dedicated service to hospitalsand to medical care in Arkansas.

President of Baptist Health since 1984,Harrington oversees the operations offive hospitals, a retirement community,skilled care facility, residential care facili-ty, and medical service organization. Hebegan his healthcare career in 1971 asdirector of outpatient and emergency ser-vices at UAMS, and continued as assis-tant administrator of Baptist Health Med-ical Center, executive director of Baptist

Memorial Hospital in Kansas City,administrator of Baptist Health MedicalCenter, and associate executive directorof Baptist Medical System, now BaptistHealth.

Harrington’s accomplishments in-

clude serving as chairman of the AHAboard of directors and as Arkansas’ dele-gate to the American Hospital Associa-tion’s Regional Policy Board; past presi-dent of the Arkansas Hospital Adminis-trators Forum and the Metropolitan Hos-pital District; a Fellow in the AmericanCollege of Healthcare Executives; a for-mer commissioner of the ArkansasHealth Services Commission; a boardmember of Parkway Village, Inc., BaptistHealth Foundation, Greater Little RockChamber of Commerce, and Fifty for theFuture; and past board member of VHAInc. and the Governor’s Arkansas StateQuality Award Program.

He has contributed many volunteerhours to the greater Little Rock commu-nity, serving as a board member of thePulaski County United Way, CentralArkansas Radiation Therapy Institute,and Arkansans for Drug Free Youth. Hewas named Arkansas’ Philanthropic Per-son 2000 by the Muscular DystrophyAssociation.

Russ Harrington Presented Weintraub Award

Governor’s Budget Cuts Affect Hospitals


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Jones, WilsonReceive Awards

The Arkansas Hospital Association’s 2001 Distin-guished Service Awards were presented to FlorenceJones, RN, of Jonesboro and to the family of the lateLarkin M. Wilson, Jr., MD, during the Association’sAnnual Meeting October 8 in Little Rock.

Throughout her 50-year nursing career, Mrs.Jones has worked to bring hospice care for the ter-minally ill as well as home care to northeastArkansas, helped to provide healthcare to the indi-gent and working uninsured through a non-profitclinic, and shared her knowledge of these services

with other coun-tries. She is alsoactively involvedin philanthropicservice throughthe United Way,Arkansas HospiceAssociation, St.Bernard’s Hos-pice, AmericanHeart Association,March of Dimesand others.

Dr. Wilson, who died in July from the results ofan automobile accident, began his medical careerin south Arkansas almost 40 years ago. Just priorto his death, he was chairman of the board of theMedical Center of South Arkansas (MCSA) in ElDorado where he began process improvement ini-tiatives; was instrumental in merging WarnerBrown Hospital andUnion Medical Centerinto MCSA and, as aresult, created theSHARE foundation;recruited many special-ty physicians to thearea; increased health-care access to the indi-gent; and enjoyed adistinguished medicalcareer.

Luther Lewis (left) and Florence Jones

Larkin M. Wilson, Jr., MD

At its October 8 annual business meeting, the Arkansas Hospi-tal Association’s House of Delegates elected Jeff Curtis, presidentand CEO of HSC Medical Center in Malvern, as the board’s chair-man-elect.

In addition, the membership ratified the election of two newdistrict representatives to the board. They are David Cicero, presi-dent of Ouachita County Medical Center in Camden, who suc-ceeds Jeff Curtis in representing the Southwest District, and RayMontgomery, president and CEO of Searcy’s White County Med-ical Center, who will represent the North Central District. He suc-ceeds Terry Amstutz, formerly of Calico Rock.

Pattsy Yancy of Arkadelphia succeeds Diana Ladmirault as pres-ident of the Arkansas Hospital Auxiliary Association, thereforebecoming its representative to the AHA board.

AHA Elects New Board Members


• Arkansas Governor’s OfficeAddress: Governor Mike Huckabee,State Capitol, Little Rock, AR 72201 E-mail: use form on websitePhone: (501) 682-2345 Website:www.accessarkansas.org/governor/index.html

• Arkansas Department of Emergency ManagementAddress: P.O. Box 758Conway, AR 72033 E-mail: [email protected]: 501-730-9750Fax: 501-730-9754 Website: www.adem.state.ar.us

• State Disaster Office, American Red CrossAddress: 401 S Monroe StLittle Rock, AR 72205-5410 E-mail: [email protected]: 501-614-1000 Fax: 501-666-5060 Websites: www.arkansasredcross.org andwww.disasterrelief.org

• Arkansas Department of HealthAddress: 4815 W. MarkhamLittle Rock, AR 72205Phone: 501-661-2000

• Arkansas Bioterrorism Command Center Phone: 501-280-4817 from 8 a.m. -4:30 p.m., Monday through Friday

After hours and weekends — 501-661-2136 or 1-800-554-5738.Website: www.healthyarkansas.com

• Arkansas Department of Environmental QualityAddress: 8001 National DriveLittle Rock, AR 72209 E-mail: [email protected]: (501) 682-0923 Website: www.adeq.state.ar.us

• Arkansas State PoliceAddress: #1 State Police Plaza DriveLittle Rock, AR 72209E-mail: [email protected]: (501) 618-8000Website: www.asp.state.ar.us

• Army Corps of EngineersAddress: 700 W. CapitolLittle Rock, AR 72203Phone: 501-324-5551E-mail: use form on website Website:www.swl.usace.army.mil

• Centers for Disease Control andPrevention: www.bt.cdc.gov

• U.S. Department of Energy:www.energy.gov

• U.S. Department of Health and Human Services:www.hhs.gov

Arkansas Resources forDisaster Readiness

At the October 8 American College of HealthcareExecutives Breakfast, ACHE Arkansas Regent TomSiemers, CEO, Rebsamen Medical Center, Jack-

sonville, presented awards totwo Arkansas hospital CEOsin recognition of theirachievements in the health-care profession.

The Senior Career Execu-tive Award was presented toJeff Curtis, president andCEO of HSC Medical Centerin Malvern. The Early Career Executive Award went toJimmy Leopard, CEO, Medical Park Hospital in Hope.

Curtis and Leopard Receive ACHE Regent’s Awards

Tom Siemers, Jeff Curtis

Tom Siemers, Jimmy Leopard

JCAHO EmergencyManagementExpectations

As a consequence of the events thatoccurred on September 11, increased focusis being given by the JCAHO to the emer-gency management standards.

The modified standards, implemented asof January 1, 2001, focus on four specificphases of disaster planning:

Mitigation activities—to eliminate orreduce the effects of hazards.Preparedness activities —to enhanceindividual and organization abilities tomanage the potential effects of hazardson a facility.Response activities — to directlyaddress the negative effects of emer-gency situations.Recovery activities—to begin almostconcurrently with response activitiesand are directed at restoring essentialservices and resuming normal operations.In addition, the standards require that

accredited organizations take an “all hazardsapproach” to planning. This requires thatorganizations conduct vulnerability analy-ses and develop emergency managementplans that contain a chain of commandapproach that is common to all hazards thatpose a credible threat. Finally, where a haz-ard analysis indicates a credible communitywide threat, the accredited organization isrequired to participate in at least one annu-al community-wide practice drill.

The JCAHO recently published a spe-cial issue of Joint Commission Perspectives(http://www.jcrinc.com/perspect ivesspe-cialissue) that focused on various aspectsof emergency management. Articlesaddressed the need for a national bioter-rorism response, JCAHO standards andtheir application during the surveyprocess, management of an emergencyand lessons learned from the recent emer-gencies of September 11.

While surveyors have been reviewingorganizational compliance with the modi-fied 2000 environment of care standards,the recent events of September 11 havecaused surveyors to more carefully scruti-nize how an organization plans, designs,implements, and improves its emergencymanagement plan, how that plan applies toa variety of possible events, and how welltrained hospital staff are in regard to theirroles and responsibilities as defined by theplan. Joint Commission staff has refinedthe survey probes and protocols that will beused by surveyors in their assessment ofcompliance with the Emergency Manage-ment standards.


Winners of the Arkansas Hospital

Association’s 2001 Diamond Awards

have been selected. The competition,

cosponsored by the Arkansas Society

for Healthcare Marketing and Public

Relations, is designed to recognize

excellence in hospital public relations

and marketing.

Diamond, Excellence, and Judges’

Merit Awards were possible in two

divisions (hospitals of 175 beds or less

and hospitals of more than 175 beds)

in twelve categories. The competition

drew a record 135 entries from 25

Arkansas hospitals.

The top awards (Diamond) were

presented during the Arkansas Hospi-

tal Association’s annual Awards Din-

ner Monday evening, October 8, 2001,

in Little Rock. The award-winning

hospitals are:

ADVERTISING-PRINT (newspaper or mag-azine advertising)

Diamond Award, Conway Regional HealthSystem, submitted by Lori Ross, for “We’veMore Than Doubled Our Staff”

Diamond Award, Jefferson Regional Med-ical Center, submitted by Wendy Talbot, for“Doctor’s Day”

Excellence Award, Conway RegionalHealth System, submitted by Lori Ross, for“We’ve Expanded Our Services”

Excellence Award, Sparks Regional MedicalCenter, submitted by Mary Jane Hennig, for“After Hours Pediatric Clinic”

Judges’ Merit Award, Jefferson RegionalMedical Center, submitted by Wendy Talbot,for “Smoke Out”

Judges’ Merit Award, Sparks Health Sys-tem, submitted by Anne Turner, for “TheWomen’s Center”

Judges’ Merit Award, St. Joseph’s RegionalHealth Center, submitted by Virginia Meek,for “Mercy Has Many Faces”

Judges’ Merit Award, St. Mary’s Hospital,submitted by Steve Voyak, for “Faces”

ADVERTISING-RADIO (advertisement orpublic service announcement developed orcommissioned to promote a hospital serviceor program)

Diamond Award, St. Mary’s Hospital, sub-mitted by Steve Voyak, for “3-D Ultrasound”

Diamond Award, St. Vincent Health Sys-tem, submitted by Scott Mosley, for “Show-case Excellence”

Excellence Award, Sparks Health System,submitted by Anne Turner, for “TheWomen’s Center”

ADVERTISING-SPECIAL VISUALS (specialvisuals such as billboards, benches, transit,posters, etc.)

Diamond Award, St. Mary’s Hospital, sub-mitted by Steve Voyak, for “Electronic BabyBillboard”

Diamond Award, St. Vincent Health Sys-tem, submitted by Scott Mosley, for “Show-case Excellence Billboard”

Excellence Award, Conway RegionalHealth System, submitted by Lori Ross, for“Growth Billboard”

Excellence Award, Jefferson Regional Med-ical Center, submitted by Wendy Talbot, for

A H A 2 0 0 1 D I A M O N D

Awards

Diamond


“Sports Medicine Van”

Judges’ Merit Award, Central ArkansasHospital, submitted by Joy Phillips, for “YourMost Important Decisions Billboard”

Judges’ Merit Award, Saline Memorial Hos-pital, submitted by Robin Horn, for “TotalTrust- Total Health Care Billboard”

Judges’ Merit Award, St. Bernards MedicalCenter, submitted by Valerie Daniel, for “DayPlace Billboard”

ADVERTISING-TELEVISION (advertise-ment or public service announcement devel-oped or commissioned to promote a hospitalservice or program)

Diamond Award, Saline Memorial Hospi-tal, submitted by Robin Horn, for “TotalTrust- Total Health Care”

Diamond Award, St. Joseph’s RegionalHealth Center, submitted by Virginia Meek,for “Future Babies”

Excellence Award, Conway RegionalHealth System, submitted by Lori Ross, for“Growth”

Excellence Award, UAMS Medical Center,submitted by Tim Irby, for “Olympics”

Judges’ Merit Award, Sparks Health Sys-tem, submitted by Anne Turner, for “SparksFirst

ADVERTISING-TOTAL CAMPAIGN(advertisement that includes more than onemedium)

Diamond Award, St. Joseph’s RegionalHealth Center, submitted by Virginia Meek,for “Speed of Life”

Diamond Award, St. Joseph’s RegionalHealth Center, submitted by Virginia Meek,for “Future Babies”

Diamond Award, St. Vincent Health Sys-tem, submitted by Scott Mosley, for “Show-case Excellence”

Excellence Award, Conway RegionalHealth System, submitted by Lori Ross, for“Image”

Excellence Award, Sparks Health System,submitted by Anne Turner, for “TheWomen’s Center”

Judges’ Merit Award, White County Med-ical Center, submitted by Cassandra Feltrop,for “Whole-Hearted Devotion To YourHealth”

ANNUAL REPORT (brochure, newspaperadvertisement/supplement, or traditionalformat)

Diamond Award, White River HealthSystem, submitted by Sheila Mace, for

“White River Health System”

Excellence Award, Arkansas MethodistHospital, submitted by Sherry Cunningham,for “AMH Annual Report”

Judges’ Merit Award, St. Edward MercyHealth Network, submitted by Chip Paris, for“2000 Report to the Community”

INTERNET WEB SITE (a Web site design,developed or commissioned to promote ahospital’s programs and services)

Diamond Award, Conway Regional Med-ical Center, submitted by Lori Ross, forwww.conwayregional.org

Diamond Award, St. Vincent Health Sys-tem, submitted by Scott Mosley, forwww.stvincenthealth.com

Excellence Award, Baptist Health, submit-ted by Steve Asmussen, for www.baptist-health.com

Excellence Award, Saline Memorial Hospi-tal, submitted by Robin Horn, forwww.scmc.com

Judges’ Merit Award, St. Bernards Behav-ioral Health, submitted by Valerie Daniel, forwww.sbbh.com

Judges’ Merit Award, St. Bernards Health-care, submitted by Lynn Parker, forwww.stbernardsfoundation.org

PUBLICATION-EXTERNAL (routine publi-cation designed primarily for external audi-ences such as patients, community, etc.)

Diamond Award, Arkansas Children’s Hos-pital, submitted by Terri Davidson, for “Par-enting in Arkansas”

Diamond Award, CARTI, submitted by Jen-nifer Armstrong, for “Focus”

Excellence Award, Conway RegionalHealth System, submitted by Lori Ross, for“Health Scene Today”

Excellence Award, St. Joseph’s RegionalHealth Center, submitted by Virginia Meek,for “HealthMatters”

Judges’ Merit Award, CARTI, submitted byJennifer Armstrong, for “CancerAnswers”

Judges’ Merit Award, St. Edward MercyHealth Network, submitted by Chip Paris, for“HealthMatters”

PUBLICATION-INTERNAL (routine publica-tion designed primarily for internal audiencessuch as employees, medical staff, volunteers,etc.)

Diamond Award, Arkansas Children’s Hos-pital, submitted by Terri Davidson, for “VitalSigns”

Diamond Award, Arkansas Methodist Hos-pital, submitted by Andre Watson, for “WellInformed”

Excellence Award, Arkansas MethodistHospital, submitted by Kitty Witcher, for“What’s Happening”

Excellence Award, University Hospital atUAMS Medical Center, submitted by MikeMottler, for “UAMS Update”

Judges’ Merit Award, Conway RegionalHealth System, submitted by Lori Ross, for“In Motion”

PUBLICATION-SPECIAL PURPOSE (publi-cation designed to meet a specific need orpurpose such as an open house, dedicationprogram, new service brochure, fund-raiser,patient information handbook, etc.)

Diamond Award, Jefferson Regional Med-ical Center, submitted by Wendy Talbot, for“HealthWorks Folder”

Diamond Award, St. Mary’s Hospital, sub-mitted by Steve Voyak, for “Care Guide”

Excellence Award, Conway RegionalHealth System, submitted by Lori Ross, for“Physician Directory”

Excellence Award, Jefferson Regional Med-ical Center, submitted by Wendy Talbot, for“Physician Reception Invitation”

Judges’ Merit Award, HSC Medical Center,submitted by Connie Cheatham, for “HSCMedical Center Care Guide”

Judges’ Merit Award, White County Med-ical Center, submitted by Cassandra Feltrop,for “River Oaks Village Brochure”

SPECIAL VIDEO PRODUCTION (videoproduction, other than television advertising,designed to meet a specific need or purposesuch as staff/patient information, hospitaltour, recruitment, etc.)

Diamond Award, Conway Regional HealthSystem, submitted by Lori Ross, for “CRMCPresentation Video”

Diamond Award, St. Vincent Health Sys-tem, submitted by Scott Mosley, for “St. Vin-cent HealthWatch Series”

Excellence Award, Baptist Health, submit-ted by Cara Wade, for “The Brock WilsonStory”

WRITING (entries may include a newsrelease, feature story, editorial, speech, etc.)

Diamond Award, White River MedicalCenter, submitted by Sheila Mace, for “Car-diac Surgery Program Begins at WRMC”

Judges’ Merit Award, Jefferson RegionalMedical Center, submitted by Wendy Talbot,for “Good News”

A W A R D S P R E S E N T E D

Reaffirming Our Commitment to Caring

Acknowledging October 14-20 as National Healthcare Quality Week, Governor MikeHuckabee (center) recognized the work of Arkansas quality professionals. Receiving theproclamation are Arkansas Association of Healthcare Quality members (from left), CarolCox, Little Rock; Debbie Hare, Searcy; Sandra Grinder, Benton; Anita Gottlieb, LittleRock; Karen Donaldson, Monticello, and Roseanne Hudoba, El Dorado.

AHA chairman Luther Lewis welcomesmembers of the Arkansas Hospital Associa-tion and the Arkansas Hospital AuxiliaryAssociation to the opening session of theAnnual Meeting.

Visiting duringan AHA recep-tion are (from

left), RogerFeldt, president

and CEO ofSaline Memori-

al Hospital inBenton, and

ArkansasSpeaker of the

House ShaneBroadway of

Bryant.

Enjoying the Awards Dinner are (from left)Sister Cabrini Arami,Sister Elaine Willett,

Sister Mary Ann Nuce,Sister Benedicta Boeck-mann, Sister CelestinePond, Sister Henrietta

Hockle, and Sister EileenSchneider, board mem-bers from St. Bernard’s

Healthcare in Jonesboro.

Arkansas Hospital AssociationAnnual Meeting and TradeShow, October 7-9, 2001

A new location, a streamlined agendaand exciting speakers contributed to thesuccess of the Arkansas Hospital Associa-tion’s 71st Annual Meeting and TradeShow held at Little Rock’s newly-remod-eled Statehouse Convention Center. Theprogram agenda was shortened to a two-day format, much to the delight of every-one.

Annual meeting attendees rated thespeakers, educational events and newformat very high. They enjoyed hearingkeynote speaker Ken Schmidt sharevaluable customer service tips from hisdays with Harley-Davidson MotorCompany; Terry Andrus tell how EastAlabama Medical Center achieved theranking of one of Fortune magazine’s“100 Best Companies to Work For;”political strategist Mark Allen discusshow the polls are treating PresidentBush; airline safety analyst John Nancediscuss comparisons between airlinesafety and patient safety; and LittleRock attorney Lynda Johnson illustratehow the Health Insurance Portabilityand Accountability Act of 1996 willaffect hospitals and patients. Over 40participants took advantage of theACHE Category I workshop on creativemanagement techniques that offeredvaluable continuing education creditswithout additional travel expense toArkansas executives.

For the first time, the AHA AnnualMeeting featured a closing lunch andwhat a powerful closing it was! AuthorJames Bradley enthralled the audiencewith details from his book Flags of OurFathers, the story of his father and theother young men who raised the flagon Iwo Jima, a photo of which becamethe most reproduced photo in the his-tory of photography.

And, as always, the AHA TradeShow was a highlight with the mem-bership featuring more than 100exhibits of healthcare products andservices from vendors and suppliersacross the country.


AHA executive vice president Phil Matthews (cen-ter) congratulates Statesmanship Award recipientsRep. Larry Teague (left) of Nashville and Rep. PhilJacobs of Clarksville.

Speaker Terry Andrus, CEO of EastAlabama Medical Center in Opelika,Alabama, explains how his hospitalwas selected one of Fortune maga-zine’s “100 Best Companies to WorkFor.”

Outgoing AHA chairman Luther Lewis(right) receives a plaque in appreciationfor his term of service from new chairmanRobert R. Bash.

Governor Mike Huck-abee (center) congrat-ulates Pattsy Yancy(left) of Arkadelphia,president of theArkansas Hospital Aux-iliary Association, andhis mother-in-law PatStephens of Hope,newly elected president-elect of the volunteer orga-nization.

Former AHA chair-men Mike Helm(left), president ofSparks Health Sys-tem in Fort Smith,and Ross Hooper,president and CEOof CrittendenMemorial Hospitalin West Memphis,share a lightermoment during a presentation.

An attentiveaudience listensto one of themanyeducationalsessions offeredduring the AHAAnnualMeeting.

AHA chair-man LutherLewis (left)and presi-dent JimTeeter dis-cuss annualmeetingevents.

The Boogie Woogie Babes, (from left) Suzie Nichols, Debra Walk-er, and Kim Nichols, of Jefferson City, Missouri, got the AHAAnnual Meeting off to a rousing beginning with their musicalpatriotic tribute during the annual Chairman’s Dinner.

Congratulating Russ Harrington (center), president of BaptistHealth in Little Rock and 2001 recipient of the AHA’s A. AllenWeintraub Memorial Award, are his father, Rev. Russell D.Harrington, Sr., and son, Brooks Harrington.


The Arkansas Hospital Associationwishes to thank the companies andorganizations participating in the 71stAnnual Meeting and Trade Show. Withtheir financial support, high qualityeducational programming is made pos-sible for the AHA membership.

AAMSCOAccess Control Integration, Inc.Administrative Consultant Service, Inc.AFLACAHA Services, Inc.******Alliant FoodserviceAlltelAlltel Business Continuity ServicesAmerican General Financial Grou– VALICAmerican Heart AssociationAmerican LIFECAREAngel Flight South CentralApollo MDARCOM SystemsArkansas Department of Health-Office of

Rural Health & Primary CareArkansas Blue Cross and Blue Shield

*****Arkansas Foundation for Medical Care

(AFMC) ****Arkansas Health Care Access

Foundation, Inc.

Arkansas Health Executives Forum **Arkansas Managed Care Organization

(AMCO)Arkansas Regional Organ Recovery

Agency (ARORA)AuctionMart.comBausch and LombBCX Technology, Inc.Behavioral Health Resources, Inc.BG Industries/MaxifloatBKD, LLP ****Boise Cascade Office ProductsBrasfield & GorrieCARSTENSChoice OneComplete RxCPSICrew Training InternationalCrews & Associates, Inc.Cromwell Architects EngineersCrothall Services GroupData Systems Management, Inc.Directory Assistants, Inc.Disability Determination for

Social SecurityEDSEDS/Arkansas MedicaidEmCareEngelkes, Conner, & Davis, Ltd. *Federation of Associated Health Sys-

tems, Inc.First UniformFORZA Marketing Group ***Franklin Collection Service, Inc.Friday, Eldredge & Clark **General Electric Medical SystemsGideons InternationalGoddard Healthcare Consulting, Inc.Hagan/Newkirk/MetLifeHealth Data SolutionsHealthcare Administration Technologies,

Inc. ****Healthcare Management Systems, Inc.Healthcare Strategic Initiatives


Saluting the AHA’s 2001 Corporate Partners

Representatives from Merritt, Hawkins and associates visit with Barry Brady (left) ofLittle Rock, former AHA chairman Gary Bebow (fourth from left) of Batesville, and LesFrensely (right) of Batesville.

Arkansas Attorney General MarkPryor awarded grants of $20,000 each tothe state’s fourteen Critical Access Hos-pitals during a ceremony held November14 at the Arkansas Hospital Association(AHA) headquarters in Little Rock. Thegrants will be used for a variety of pur-poses, including the purchase of equip-ment, upgrading services, communityhealth fairs, preventive care and com-munity health education programs.Funds came from a multi-state pre-litiga-tion settlement entered into betweenKnoll Pharmaceuticals and the AttorneyGeneral’s office after an investigationconducted by the Antitrust Division ofthe AG’s Public Protection Department.

Pryor had filed suit against Knoll,alleging the company used false, mis-leading, and deceptive claims in its pro-motion of a synthetic thyroid-hormone-replacement drug. In settling the law-suit, Knoll signed an Assurance of Vol-untary Compliance and agreed to payArkansas $826,957. Pryor’s office distrib-uted the funds gained through the set-tlement among several nonprofit organi-zations to be used for healthcare purpos-es. In addition to the Critical Access Hos-

pitals, which received $280,000 of thetotal, recipients included the Area Agen-cies on Aging located throughoutArkansas and the University of Arkansasfor Medical Sciences.

In awarding the grant funds, Pryornoted how important each of the smallrural hospitals are to their communitiesand expressed hope that the monieswould ease some of their current finan-cial challenges. The AHA worked closelywith Pryor’s office in establishing thegrant program. Hospitals receiving thegrants are Baptist Health Medical Cen-ter-Heber Springs, Community MedicalCenter of Izard County (Calico Rock),CrossRidge Community Hospital(Wynne), Dallas County Hospital(Fordyce), Dardanelle Hospital, EurekaSprings Hospital, Howard Memorial Hos-pital (Nashville), Lawrence MemorialHospital (Walnut Ridge), McGeheeDesha County Hospital, Mercy Hospitalof Scott County (Waldron), Mercy Hos-pital/Turner Memorial (Ozark), NorthLogan Mercy Hospital (Paris), OzarkHealth Medical Center (Clinton), andStone County Medical Center (Moun-tain View).


Healthworks Alliance, Inc.Hill-RomHorton’s Orthotic Lab, Inc.Hospital Building & Equipment Compa-

nyHughes, Welch & Milligan, CPAsHuntington Brand of EcolabIHC/AmeriNetInSiteOne, Inc.InterlinguaJ. Hugh Knight Instrument CompanyJay S. Stanley & Associates, Inc.Kol Bio-Medical Instruments, Inc.Kronos Inc.La-Z-Boy ConceptsMarshall Erdman & Associates, Inc.MASHMD NetworkMD ProductivityMed-Data Management, Inc.MedData ServicesMedical Doctor AssociatesMedical Management Consultants Inc.Medi-Man Rehabilitation Products, Inc.MEDITECH (Medical Information Tech-

nology, Inc.)Merritt, Hawkins & AssociatesMobile Instrument Service and RepairModern Biomedical and ImagingMultiPlan, Inc.Nabholz Construction CorporationNumed, Inc.Optus TelemationOsment Roofing Systems Inc.PhyAmerica Physician ServicesPinnacle Health GroupPress, Ganey Associates, Inc.PROMED AmbulancePsychManagement Partners, LLCPublishing Concepts, Inc. ***Pulaski Bank *Ramsey, Krug, Farrell & Lensing **Reciprocal of America *****RehabCare GroupRehabVisionsService Professionals, Inc.SiemensSign Systems, Inc.Snell Prosthetic & Orthotic LaboratorySOLUCIENT ****Swisslog TranslogicSYSCO Food Services of Arkansas, LLCThe St. Paul CompaniesTaylor Made AmbulanceTimeLine Recruiting, LLCTimeMed Labeling Systems, Inc.Tri-Tec MonitorsUALR Graduate Program In Health

Administration West-Com Hospital SystemsWittenberg, Delony & Davidson, Inc. Zenith Electronics Corp. Zoll Medical Corporation

* Sponsor** Host Sponsor*** Bronze Sponsor**** Silver Sponsor***** Platinum Sponsor****** Diamond Sponsor

The Arkansas Association for Health-care Quality (AAHQ), an affiliate of theArkansas Hospital Association, hasreceived the bronze level award for asso-ciation excellence from the NationalAssociation for Health Care Quality. Theaward recognizes state healthcare man-agement associations that provide excep-tional services and benefits. Over 40states participate in the national organi-

zation and Arkansas was one of threereceiving recognition.

Anita Gottlieb of Quorum HealthResources in Little Rock is the currentpresident of AAHQ and SandyGrinder, Saline Memorial Hospital inBenton, is president-elect. Representa-tives from forty hospitals or health-care organizations in Arkansas aremembers of AAHQ.

Bates Medical Center in Bentonville isbeing replaced with a new facility and willget a new name at the same time. TriadHospitals Inc. of Dallas, which owns andoperates Northwest Health System inSpringdale, officially announced Septem-ber 14 the new $63 million hospital wouldbe built and groundbreaking ceremonieswere held October 9. The Springdale healthsystem operates Northwest Medical Center

and Bates Medical Center.Once completed, the Bentonville hospi-

tal will be called Northwest Medical Centerof Benton County. The new facility willinclude 128 inpatient beds, doubling thesize of the 63-bed hospital it will replace.The entire campus will be constructed on a60-acre tract of land and will include a50,000 square-foot multistory medical com-plex and an office park for physicians.

Bates Medical Center to Build New Facility

AAHQ Receives National Award

Critical Access Hospitals Receive Grants

November 1 was the effective date fornew policies implementing two Medic-aid-expansion programs establishedunder the Arkansas tobacco settlementspending plan that was developed andsupported by the Coalition for a Healthi-er Arkansas Today (CHART).

Arkansas voters adopted the CHARTplan as Initiated Act 1, during the 2000general election a year ago. The Act is ablueprint for spending Arkansas’ share ofthe national tobacco settlement fund.The Arkansas Hospital Association is afounding member of the CHART organi-zation and took a lead role in assuring theAct passed.

The newly-implemented Act 1 pro-visions are aimed at expanding Medic-aid eligibility, increasing certain pro-gram benefits and helping the state’shospitals. The most significant changeprovides for Medicaid coverage of anadditional 4,000 pregnant women andnewborns annually, improving their

access to needed obstetrical care.The increase is accomplished by

broadening the income eligibilityrequirements. Previously, Medicaid cov-erage of pregnant women was limited tothose having annual incomes no morethan 133% of the federal poverty level.The November 1 change increased preg-nant women’s income eligibility thresh-old to 200% of the poverty level.

The increased eligibility limit willmake it easier for many women to seekout care for themselves and their babiesthat they may have overlooked other-wise. It also provides hospitals a new pay-ment source for most of those patientswho previously received services, butcouldn’t afford to pay.

In addition, the Medicaid program hasincreased the number of covered inpa-tient days for Medicaid-eligible patients.Under the new policy, Medicaid now cov-ers 24 inpatient days per year versus theprevious 20-day limit. And, direct Medic-

aid hospital payments will increase dueto Medicaid reducing its patient co-paypolicy. Medicaid patients will now beresponsible for paying 10% of the admit-ting hospital’s Medicaid per diem for thefirst covered day, rather than 22%.

Together, implementation of the newInitiated Act 1 provisions should addbetween $7 million and $9 million annu-ally to Medicaid hospital payments.


Arkansas Medicaid Expansion Policies Implemented

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Reminder: Nurse LicenseRenewal Available Online

Since July 1, 2000, over 2,300 RNs,LPNs, and LPTNs have renewed theirlicenses online with the Arkansas StateBoard of Nursing (ASBN). (Advancedpractice nurses and registered nursepractitioners will soon be able to renewonline.) Online renewal is a simple,step-by-step procedure requiring theuse of a credit card. To renew a nurselicense online or to change youraddress, visit the ASBN Web site atwww.state.ar.us/nurse

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INTERMOUNTAINHEALTH CARE


Last June, the Medicare PaymentAdvisory Commission (MedPAC) issueda report to Congress that included fiverecommendations for increasing pay-ments to rural hospitals. Among thosewas one for a “low-volume” adjustmentfor rural facilities that have negativemargins and treat few Medicare benefi-ciaries. At the time, the recommenda-tion was given little consideration whensome members of Congress suggested itwouldn’t help much.

Now, a more detailed analysis ofthat recommendation prepared byMedPAC for congressional staffers and

released October 31 indicates that theadjustment would be highly beneficialto those facilities. In fact, among allthe recommendations made in June,the low-volume adjustment would bethe biggest help for those very small,very isolated facilities, according to theanalysis. The recommendation pro-vides for a maximum 33% adjustmentfor hospitals with up to 600 dischargesper year.

MedPAC’s analysis says it would pro-vide a 6.2% increase in payments for theimpacted facilities, compared with 0.2%to 1.1% for the four other options.

Other MedPAC-recommended actionsincluded increasing the cap on dispro-portionate share hospital paymentsfrom 5.25% to 10%; completing thephase-out of wage data for teachingphysicians, residents, and certified reg-istered nurse anesthetists from the hos-pital wage index; and reducing the pro-portion of payments adjusted by thewage index (from 71% to 67% in thelatest analysis). MedPAC didn’t take aposition on a fifth policy, increasingthe base payment for other urban andrural areas to the level of the rate forlarge urban areas.

MedPAC Suggests Hospital Payment Changes

ArkansasDATABANKEnrollmentGrows

The Arkansas Hospital Association(AHA) has begun the enrollmentprocess for the DATABANK Program.Approximately 36 hospitals havesigned up to participate in the Web-based monthly survey that tracksselected hospital financial and utiliza-tion indicators. The program is beingoffered to AHA’s hospitals as a freemember service. There is no cost to par-ticipate, only a commitment to havesomeone in the hospital be responsiblefor entering data each month.

While DATABANK is a free memberservice, hospitals are required to signup to gain access to the secure Internetsite. The sign-up procedure allows par-ticipants to receive a user ID and pass-word needed to gain access to the sys-tem. Once into the system, participantsare advised to change their individualpasswords frequently, as is the casewith other limited-access Internet-based programs.

Questions about the DATABANK Pro-gram should be directed to Paul Cun-ningham at [email protected], or by calling (501) 224-7878.

Program Memorandum A-01-117,issued by the federal Centers forMedicare and Medicaid Services (CMS)September 26, 2001 establishes newdates for healthcare providers to submittheir Medicare cost reports (MCRs) anddates by which the program’s fiscalintermediaries are to produce and mailtheir Provider Statistics and Revenue(PS&R) reports.

The MCR due dates are dependent onproviders’ cost report ending dates, with

the soonest set at February 17, 2002 forall affected healthcare providers havingending dates between August 1, 2000and September 30, 2000.

Generally, the cost report due datesfall 37 days after the prescribed PS&Rmail dates to allow providers 30 days tocomplete their cost reports, plus an addi-tional seven days for the postal service todeliver the PS&R to the provider. For spe-cific due dates, click on www.hcfa.gov/pubforms/transmit/A01117.pdf.

Cost Report, PS&R Due Dates

More than 500 hospitals in sevenstates (not including Arkansas, butneighboring states Missouri and Ten-nessee are included) will be the first totake part in an Internet survey sponsoredby The Business Roundtable’s LeapfrogGroup. It is hoped that this survey willlead to improvements in patient safety.

The Leapfrog Group is a consortiumof approximately 90 Fortune 500 com-panies and other private and publichealthcare purchasers. It began its workin November 2000, developing plans toreward hospitals that make advances inpatient safety and in educating staff andpatients about related issues.

The current survey queries hospitalson three key issues: computerized med-

ication entry systems; physician staffingin the intensive care unit; and evidence-based hospital referral, which is thepractice of referring patients with com-plex medical needs to hospitals thatoffer the best survival rates for these pro-cedures.

When it is complete, Leapfrog plansto use the information for educationalpurposes and to “recognize and rewardproviders.” The results of the survey willbe made available to the public.

Any hospital can participate in thesurvey by requesting an identificationand security code at the group’s Website, https://leapfrog.medstat.com, or bycalling the survey help line at 734-913-3030.

Leapfrog Group Works toImprove Patient Safety


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Several Web sites have been developed toassist hospitals and other organizations intheir readiness for the Health InformationPortability and Accountability Act’s (HIPAA)deadlines. Some of the sites are:• www.hipaa.state.ar.us—Sponsored by the

Arkansas Department of Human Services,this site is a compendium of informationfor healthcare providers, consumers, andgovernment agencies.

• www.wecomply.com—Provides onlinecompliance training for all employeesincluding a test to determine employeeunderstanding and awareness. There is afee for this service.

• www.ehnac.org/stfcs.asp—Offers infor-mation on vendors that are HIPAAcompliant.

• www.aha.org/hipaa/resources.asp—Information from the American Hospi-tal Association with links to valuableresources.

HIPAA Web Sites

Boozman Elected toRepresent Third District

Voters in Arkansas’ 3rd Congressional Dis-trict have elected Republican John Boozmanto the U.S. House of Representatives. Booz-man, a Rogers optometrist and brother ofArkansas Department of Health director FayBoozman, defeated state Representative MikeHathorn in a November 20 special electionheld to decide the successor to Asa Hutchin-son. Last August Hutchinson was nameddirector of the federal Drug EnforcementAdministration.

Congressman Boozman has been assignedto the Transportation and Infrastructure, andVeterans’ Affairs Committees.

Hospital executives and trustees in the 3rddistrict are encouraged to visit with Rep.Boozman, while Congress is adjourned forthe year and members are home for the hol-idays, to familiarize him with items on hospi-tals’ advocacy agenda that are addressed inH.R. 1609 and H.R. 1556.

Those bills would place a floor on theMedicare Area Wage Index for all hospitals,equalize Medicare prospective payment sys-tem (PPS) base rates and provide for a full PPSupdate for hospitals.

Hospital officials across Arkansas also musteducate each of the state’s senators and con-gressmen about the need for money to doeverything necessary to ensure they are pre-pared for a potential chemical, biological ornuclear event.

Individually, hospital CEOs should knowand communicate how much it will costtheir facility to achieve a state of readiness.That includes having in place all the nec-essary equipment, communications sys-tems, drugs and other supplies to respondto a situation that might result in masscasualties.


According to Sentinel Event Alertnumber 24 issued in December, theJoint Commission on Accreditation ofHospitals (JCAHO) has taken a secondlook at surgical mistakes—surgeries onthe wrong site, the wrong patient orperformance of the wrong proce-dure—that are completely preventableand should never happen.

At the time of the first Alert inAugust 1998, the JCAHO reviewed 15cases reported to the organization.Today, the Sentinel Event databaseincludes 150 cases of surgical mis-takes. Of the 150 cases, 126 have rootcause analysis information notingthat 41% relate to orthopedic/podi-atric surgery; 20% to general surgery;14% to neurosurgery; 11% to urologicsurgery; and the remaining to den-tal/oral maxillofacial, cardiovascular-thoracic, ear-nose-throat, and oph-thalmologic surgery.

As the first line of defense in reduc-ing the risk of medical errors includingwrong site surgery, JCAHO advisespatients and family members to makesure that there is total agreementbetween themselves, their primarycare doctor and the surgeon aboutexactly what will be done and where.

A good resource is the Agency forHealthcare Research and Quality’sPatient Fact Sheet—20 Tips to Help Pre-vent Medical Errors (available atwww.ahrq.gov/comsumer/20tips.htm),which provides tips for patients tohelp prevent medical errors, includingwrong site surgery.

JCAHO reiterates the importance ofimplementing risk reduction strategiesas stated in the earlier issue of SentinelEvent Alert and suggests developingprocesses to assure the correct surgicalsite, patient and procedure by: 1)marking the surgical site and involv-ing the patient in the marking process;2) creating and using a verificationchecklist including appropriate docu-ments, for example, medical records,X-rays and/or imaging studies; 3)obtaining oral verification of thepatient, surgical site, and procedure inthe operating room by each memberof the surgical team; and 4) monitor-ing compliance with these procedures.Additionally, JCAHO recommendsthat 5) surgical teams consider taking a“time out” in the operating room toverify the correct patient, procedureand site, using active—not passive—communication techniques.

Arkansas Blue Cross Blue Shield(ABCBS), the state’s Medicare fiscalintermediary (FI), notified all its trad-ing partners in an October 19 mailingabout the need to test their electronicsubmission of Medicare claims utiliz-ing the X12N 4010 837 formatrequired under the Health InsurancePortability and Accountability Act(HIPAA) of 1996.

The federal Centers for Medicare andMedicaid Services (CMS) requires allelectronic claims submitters to pass theFI’s testing related to the new formatprior to moving into production. Blue

Cross is required to set up a scheduleand begin testing on January 2, 2002,and complete testing by September 30,2002. Submitters will not be allowed totest until January 2, 2002.

The letter from David Bailey, ABCBS’Electronic Data Initiative coordinator,encourages hospitals to begin testing assoon as possible in an effort to have alltesting complete by September 30, 2002and advises that they understand thetesting can be a long and lengthyprocess. Hospitals that utilize the ser-vices of vendors, billing service organi-zations, or claims clearinghouses should

contact those groups to determine atimeframe appropriate for testing.

ABCBS is requesting that hospitalscooperate in setting up a testing sched-ule by selecting the month and weekthey would like to begin testing andincluded a form with the letter for usein making the selection. Once a testdate is selected, Blue Cross will send aconfirmation letter with the testingrequirements. Failure to successfullytest with the new format by September30, 2002 will result in the loss of a hos-pital’s security and ability to submitclaims electronically.

HIPAA Electronic Submissions Testing Requirements

JCAHO Reissues SentinelEvent Alert

CPT 2002 Coding ChangesAffect All Specialties

The 2002 edition of the CPT cod-ing manual contains a significantnumber of changes, and, for somespecialties, they are dramatic. TheAmerican Medical Association added212 new codes to the system, 21 ofthem to the newly established Cate-gory III codes for emerging technolo-gies; 546 revisions; and 34 deletedcodes. General Surgery has the mostchanges—343—and Orthopaedicswith 213.

The new Category III codes are usedto track the use of emerging technolo-gies. According to the Centers forMedicare & Medicaid Services, no rela-tive value units will be assigned tothese codes. Instead, CMS will providepayment on a case-by-case basis onlyin specific situations where the agencyhas decided that the code representsservices that are not experimental (andtherefore are statutorily excluded) andhave been proven to be safe and effec-tive. The section will be updated semi-annually and new codes will be postedon the AMA Web site at www.ama-assn.org.

Preparing for a Terrorist Attack: Mass Casualty Management—Focus on Soft Targets

Henry J. Siegelson, MD, FACEP, Disaster Planning International, Atlanta, Georgia

The September 11, 2001 attack on thetwin towers of the NYC World Trade Cen-ter not only caused shock among thegeneral population, but also among dis-aster planners. Over the past six years, anumber of federal, state, and local effortsto prepare for a terrorist attack have yield-ed significant gains in awareness andplanning expertise.

This apparently did little to help thosethat were on suicide flights, at work at theTrade Center, or at work at the Pentagon.First responder personnel ran into theflaming buildings apparently unawarethat the enormous structures would sooncollapse killing all inside.

Building engineers, interviewed onCNN, appeared uniformly in agreementthat it was only a matter of time until thetowers collapsed.

Why were we so ill prepared? Couldwe have acted differently? Why wasthere a lapse in intelligence that enabledthis 2-year plan to be so brutally andefficiently achieved?

And now, the unending anthraxattacks. Exposures and deaths from Flori-da to Washington. Spores in embassies inPeru. The US Supreme Court is closed. Apostal worker dies 6 hours after admis-sion to a local hospital. A hospital workerin NY dead from inhalation anthrax, anelderly woman dead in her quiet neigh-borhood in Connecticut.

Businesses, hospitals, elected officials,and children in schools want to knowwhether they are safe. Can communitiesprotect its citizens from attack? Can hos-pitals care for biological casualties? Isthere a greater threat on the horizon inthe form of smallpox?

From the President to federal agenciesto state officials, it is clear that homelanddefense and domestic preparedness are amatter of national priority, national con-cern, and national security.

In the last decade, the public haslearned of the potential threat ofweapons of mass destruction (WMD).Historically, only the military and thosewithin the government with a need toknow understood the management ofthese weapons, (high explosives, nuclearweapons, radioactive materials, biologicweapons, and chemical weapons).

In the last few years, federal agencieshave supported a series of educationalevents that have made this informationavailable to first responders and the hos-pital community. Despite billions of dol-lars spent on national preparedness, it isgenerally accepted that the response to aterrorist attack will mainly involve local

first responders and health personnel, atleast for the first 4-36 hours. In order toprotect our cities and states, it is essen-tial that first responders (EMS, fire,police), emergency managers, publichealth officials, medical personnel, andhospitals understand the threats ofWMD and the medical consequences ofa terrorist attack.Threat

The community’s first responder andmedical systems must have the capacityto support medical operations in the faceof a list of hazards. A hazard assessmentmay determine that the community is atrisk due to floods, fires, tornadoes, andcommunity unrest. Accidental commu-nity exposure to hazardous chemicals is a24-hour threat. Naturally occurring infec-tious disease outbreaks have caused enor-mous loss of life in this century.

In the past decade, the intentionalrelease of hazardous chemicals by theAum Shinrikyo in Japan alerted authori-ties to the specter of mass casualties fromchemical exposure. The recent successfuluse of anthrax as a biologic terror weaponepitomizes the ruthlessness and effective-ness of biologic warfare.

Although there is an unlimited list ofweapons for the terrorist to use, the abili-ty for the community to respond to thesethreats is finite. First responder personnelresources are fairly fixed. Hospitalresources are shrinking, not expanding.Financial resources, although temporarilyreceiving a new influx of federal assis-tance, must be used efficiently in order tomaximize this once-in-a-lifetime oppor-tunity to expand equipment caches andtraining capabilities.

Communities should approach thisopportunity to improve preparedness inan “all-threat” or “all-hazards”approach. A generic mass casualty planwill enable communities to meet theneeds of victims.

The first step: focus on communitychemical preparedness. It is reasonable todo so because: • Chemicals are a 24-hour threat.• Chemicals can cause immediate effects.• Chemicals require the highest level of

personal protection.• Federal regulations mandate appropriate

training to wear chemical protectiveequipment.

• In most communities, there is a greaterrisk of a HazMat exposure than a terror-ist attack.

• A HazMat emergency is a common com-munity emergency.There is a considerable 24-hour risk

from exposure to hazardous chemicalsutilized by local industry, transported byrail or truck, sold in hardware stores andgrocery stores, and stored on the shelvesof our homes.

Traditionally, fire personnel have hadyears of training focusing on the responseto hazardous materials events. In manycities, specialized HazMat teams have thetraining and the capacity to assess chem-ical spills and releases, utilize equipmentto identify the offending chemical, andthe equipment limit the extent of thechemical spill. Although fire personnelhave equipment and training to deconta-minate victims, until the sarin release inJapan, most HazMat teams had notfocused on treating casualties. Thus thereis a gap: the fire system can recognizechemical injuries, but the available treat-ment is fairly limited.

Police and EMS have not tradition-ally had a large role in HazMatresponses. Thus, they are not trainedto wear protective gear that wouldenable them to safely participate in theevacuation and decontamination ofcontaminated victims. In many casesdocumented by the Agency for ToxicSubstances Disease Registry, police andEMS personnel have become victimsafter a chemical exposure.

It is essential that all first respondershave the appropriate training and equip-ment to enable them to operate safely ina potentially hazardous response zone.The Hospital Response to Terrorism: A Minimum Level of Preparedness

Every community must develop a sys-tem of response to deal with the medicalneeds of mass casualty victims of a terror-ist attack: explosives, chemicals, biologicagents, radioactive materials, and nuclearexplosions.

In particular, hospitals have a commu-nity responsibility to offer care to injuredHazMat victims.1, 2 In some cases, theinjury might be a result of an exposure toa hazardous chemical or infectious haz-ard. No matter the source of the injury,accidental or intentional, whether itoccurs at work, at home, or on the road,the hospital must have the capacity tosafely assess for injuries and to safely offercare. This responsibility extends to thevictims of a terrorist attack.

In this era of fiscal responsibility, hos-pital expenditures are often limited to themost critical needs. The recent terroristattacks, however, have alerted hospitalexecutives to the importance of hospitalpreparedness for community disasters.3


(continued on page 42)

The Joint Commission for the Accredi-tation of Healthcare Organizations(JCAHO)4 and OSHA recommend thathospitals have the capacity to safelyassess and treat patients exposed tohazardous materials. Any trainingmust be consistent with OSHA recom-mendations.5-9

How can cities prepare for thesethreats? What can the hospitals do tosupport the efforts of the community?How should a hospital reasonablyapproach the dilemma of managingpatients exposed to hazardous materials?Whether the result of an accident athome or at work, an industrial or trans-portation accident, or a terrorist attack, ifthe release of these hazards results inhuman casualties, they will come to thehospital for care.10

If the hospital CEO, the emergencyadministrative nursing staff, the physi-cian staff, and the facility and securitymanagers agree to develop a system ofresponse, how grand should the prepara-tions be? The Agency for Toxic Sub-stances Disease registry noted, in theirlandmark research11, that in most casesone or two victims seek medical care aftera HazMat event. Many in government,however, are reasonably concernedregarding the threats of a terrorist attackand recommend that hospitals preparefor mass casualties.

How many casualties should the hos-pital expect in a mass casualty event?10? 50? 100? 1000??? How shouldresponsible decision-makers approachthis problem?

A reasonable and cost-effectiveapproach should enable any hospitalwith an emergency department to reli-ably and safely care for victims of a Haz-Mat or terrorist event 24 hours a day, 7days a week. This preparedness shouldinclude policies that protect employees,victims, the institution, and the envi-ronment.

The hospital should, at the very mini-mum, be prepared to handle AT LEASTONE PATIENT EXPOSED TO A HAZ-ARDOUS MATERIAL.10 This level of pre-paredness requires OSHA Operationstraining, appropriate personal protectiveequipment, decontamination systems,policies and procedures, and the supportof security personnel. If the hospital canfunction and deliver care to a singlepatient, then the policies can be easilyconfigured to manage ten, thirty, or evena hundred patients. This step-wiseincrease in preparedness will enable thehospital to support the community in theevent of a mass casualty event. This is aminimum level of preparedness.

If a hospital is prepared for a definedminimum level of risk, then these poli-cies and systems can be used to treat thevast majority of exposures. Plan for a fewand train for many. This is a reasonable,cost-effective approach for hospital ter-

rorism preparedness. If hospital plannersfocus solely on the physical resourcesnecessary to manage the rare mass casu-alty event, these systems may unneces-sarily complicate preparations for thedaily threat of community HazMat. Startwith a small, cost effective system thatwill enable a hospital response for com-munity HazMat.12 Then, develop thecapacity to expand these services to meetthe needs of mass casualties.

Community HazMat exposures arelikely to involve small numbers of vic-tims exposed to hazardous chemicals inthe form of liquids or powders. This typeof exposure usually requires water decon-tamination. These victims often have sig-nificant injuries but suffer few deaths.They represent a significant risk of sec-ondary contamination for first respon-ders and hospital personnel.

There should be no short cuts.2 Prepa-rations should be consistent with feder-al and state OSHA regulations,9 NIOSHrules, JCAHO recommendations, andEPA regulations. Current recommenda-tions include:• Level B protection for personnel treating

victims exposed to unknown chemicalhazards7

• OSHA approved Operations level instruc-tion

• Respirator fit testing• Frequent training to maintain skills • Containment of decontamination run-

off to protect the environment• Development and activation of the hos-

pital incident command system

Chem/Explosives/Radiation:The Sentinel Event

It is important to distinguish betweenattacks that cause sudden, overt, recog-nizable injuries—”sentinel events”1, 8, 13,

14—and those that cause delayed injuries.Attacks using explosives and chemicalsgenerally present as an overt sentinelevent with associated “lights and sirens”community response and multipleinjuries. The victims and the communitywill know with certainty that an attackhas taken place. A biologic attack willhave more delayed effects.

After a sentinel or overt event, it is dif-ficult to rapidly prove that chemicalshave NOT been used in the initialmoments after an attack. Communityand hospital responders must initiallyassume victims are contaminated. Fireand HazMat responders have theresources to detect certain types of chem-icals. Frequently, however, patients willarrive at the ED before assessment bytrained first responders. It will take a sig-nificant time and resource dependenteffort for the fire department to deter-mine with certainty that there has beenno chemical exposure. Chemical detec-tion equipment exists, but these proce-dures are time-consuming. Often, the

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chemical is never identified. Hospitals donot have access to chemical identifica-tion equipment. Thus, the system mustbe prepared to protect responders andhealth facilities from exposure to the“unknown chemical.”

Since it is impossible to determinewith certainty whether or not the victimshave been contaminated, a MinimumLevel of Decontamination must bedefined. Victims from a sentinel eventshould not be allowed to enter a bus,ambulance, or the medical center with-out the removal of clothing. Removal ofclothing is the essential first step in thetreatment of the contaminated victim.Once the clothing has been removed, thevictim will remove over 80% of the con-taminant after liquid contamination andnearly 100% after vapor contamination.This may be the only decontamination pro-cedure that is required for those victimsexposed only to a chemical gas or vapor orbiologic exposure. Clothing removalshould be performed rapidly, as soon aspossible, and in a manner that ensuresthe protection of modesty. This proce-dure can be performed at the scene of theattack or at the hospital. Clothingremoval remains a reliable form of initialgross decontamination.

Some patients, after a clinical assess-ment, might require a soap and watershower if liquid exposure is suspected.This decontamination should be per-formed outdoors if possible with warmwater. If the decontamination is car-ried within the hospital, negative ven-tilation and containment of the runoffis required. It is much safer and lessexpensive to perform decontamina-tion outdoors. The decontaminationfacility or shower should enable deconfor both ambulatory and non-ambula-tory victims.Biologic Attacks

In October and November 2001, theUS has suffered numerous casualties dueto exposure to a highly lethal strain ofBacillus anthracis or anthrax. Due to thedaily changes in the recommendationsfor management of these victims, pleasenote that this document was revised onDecember 3, 2001.

As of December 3, 2001, there were23 cases of anthrax identified: 11 con-firmed cases of inhalational anthraxand 6 confirmed cases of cutaneousanthrax with 5 deaths. All cases werefrom the same strain of anthrax and themode of attack was through lettersmailed in the US. On November 2,2001, anthrax spores were found in Ger-many, Lithuania, and Pakistan.

Clinicians should be alert for evi-dence of anthrax symptoms in theirpatients. Currently, there is no reliabletest for clinicians that will identifyanthrax exposures and infections inpatients with minimal symptoms. Cuta-neous disease can be diagnosed with

cultures and gram stains.Early inhalational anthrax disease is

manifested with malaise, muscle aches,dry cough, and headache. These symp-toms mimic viral disease. To distinguishpatients with anthrax from those withthe flu, the CDC noted that anthraxpatients should not have nasal conges-tion. At this time, there are no recom-mendations that will enable clinicians todetermine which patients should betreated. In the past weeks, individualsthat handle mail, work for the govern-ment, or that work for the media wereconsidered at greater risk.

Communities should not, however,

limit awareness merely for the symptomsof anthrax infections. There are dozensof potential biologic weapons that couldcause a delayed death in humans.

The injuries from anthrax have thusfar been few. Anthrax is a bacteria that isvery stable and an excellent weapon ofMASS destruction. Tools such as hospitalcritical care bed monitoring and emer-gency department syndromic surveil-lance15 will assist public health personnelto recognize and respond to a mass expo-sure from anthrax.Mass Casualty Plan

All communities must have a rational(continued on page 44)

plan to manage casualties after a masscasualty event.1 The plan should bedesigned to organize communityresponse resources so that they can beefficiently utilized after a mass casualtyincident (MCI). The plan should begeneric in scope so that it can be used asa routine planning document to respondto community HazMat releases and nat-ural events such as storms, tornadoes,hurricanes, floods, and earthquakes aswell as terrorist attacks.

It is a matter of national security thatcommunities develop a rational plan tomanage mass casualties due to a terroristattack. This plan, formulated with inputfrom emergency management, fire, pub-lic health, EMS, police, and the hospitalcommunity should enable a 24-hourresponse utilizing existing responders.Since this threat rarely has a warning, thecommunity requires a rapid and orga-nized response.

The plan will have several objectives:• Protect the lives and health of the

responders• Offer appropriate medical assessment

and care to surviving victims• Enable appropriate utilization of com-

munity medical assets• Expand the role of triage at the scene

of the attack and the hospital• Expand assessment and treatment

capacity by utilizing fire and EMS per-sonnel through clear protocol-support-ed interventions

• Identify and harden soft targetsThe mass casualty plan must reason-

ably delineate protocols and proceduresfor delivering appropriate care to (1) thecritically injured, (2) the ambulatoryminimally injured and (3) worried-wellsurvivors. It is essential that the planaddress all three clinical groups. Theambulatory victims will likely over-whelm hospital and EMS resources. Amass casualty management plan candirect these patients away from the hos-pital and towards a lower level of assess-ment and care. This necessary triage willenable hospitals to care for the morecritically injured survivors. There arevery few beds available for treatment ofthe critically ill in the emergency depart-ment. These beds should be reserved forthose survivors that require an advancedlevel of medical care.

The plans should complement thesafety requirements described in OSHA’sHAZWOPER 1910.120 standards.7 OSHArequirements apply to EMS, fire, police,and hospital personnel.8, 16

An appropriate plan will enable thecommunity to efficiently utilize firstresponders, hospital personnel, hospitalemergency department facilities, emer-gency management resources, HazMatand fire resources, EMS ambulances, com-munity buses, and other resources.

The mass casualty plan will enablea cost-effective and manpower-effi-cient response to the attack. The plan

is divided into:• The Scene: Identify and harden soft

argets• The Response Zone: Improve triage for

a more efficient response• The Hospital: Mandate a minimum

level of preparedness

THE SCENEIdentify potential targets for MCI’s in

the community. Identify security person-nel in charge of these facilities. Includethese personnel in the community planand the response. Consider placing spe-cific disaster equipment at these potentialsites so that they might have the capacityto decontaminate ambulatory survivorsprior to the arrival of first responders.Industrial security professionals canimprove terrorism and mass casualty pre-paredness for their facilities by:• Exercising evacuation plans• Enabling on-site self-decontamination• Practicing and enabling shelter-in-place

maneuvers• Utilizing escape masks• Improving personal protection for per-

sonnel handling the mail• Establishing a one-switch capability to

shut down air handling.

THE RESPONSE ZONEAlter triage to enable utilization of off-

site treatment shelters or SecondaryAssessment Centers (SAC). Save the hos-pital for the treatment of the critically ill.Indemnify triage officers at the scene andthe hospital from civil and malpracticesuits. Offer ambulatory minimally ill andworried-well survivors kits that willenable them to self-decontaminate.Transfer the ambulatory survivors by busor non-ambulance transport vehicleaway from the site of the attack.THE HOSPITAL

All hospitals that have a 24-hour emer-gency department must have the capaci-ty to safely assess, decontaminate, andtreat victims exposed to a hazardousmaterial.10 Once this minimum level ofpreparedness has been achieved, expan-sion of services to include mass casualtiescan be performed in a rapid and reason-able fashion. Hospitals do not have thecapacity to manage mass casualties. Thus,communities must plan to offer treat-ment to victims in off-site treatment shel-ters or secondary assessment centers. Themanagement of mass casualties after aterrorist attack is not merely a hospitalproblem; it is a community problem. Dry Decon: A Mass Casualty Decon-tamination Alternative

Personal decon kits17, 18 enable HazMatvictims to remove clothing, in public,without unnecessary exposure to camerasor other observers. These kits, whichinclude a gown or poncho-like garment,provide an inexpensive and reliable alter-native to wet decon. In order to under-stand their utility, it is useful to under-stand the difference between routine orcommunity HazMat exposures and mass

casualty HazMat exposures.Studies have shown that “communi-

ty” HazMat exposures generally occurMonday through Friday, between thehours of 9am and 5pm.11 In most cases,no more than one or two victims requiremedical assessment and treatment. Thesecasualties are often exposed to liquid con-taminants. The current decontaminationstandard for such exposures is watercleansing. This high level of interventionis attainable because of the usually smallnumber of victims who require deconta-mination. Greater numbers of victimswill increase significantly the complexityand difficulty of a decon effort. It will alsoincrease the inconvenience and discom-fort experienced by the victims.

Mass casualty HazMat exposures,according to historical sources, usuallyinvolve chemicals in the form of vaporor gas. Experience has shown that insuch incidents 80-90% of the survivorsare ambulatory.19 These ambulatorysurvivors might have minimal symp-toms. Those survivors who are ambula-tory and exhibit no symptoms butwho are worried that they might havebeen exposed are referred to as the“worried-well.”

The major goal for responding agen-cies is to quickly identify, evacuate,decontaminate, and treat those victimswho had obvious exposure to the hazardand who suffered significant injury.Because their injuries and exposure aresignificant, many of these patients willnot be ambulatory. It will be very difficultto rescue and provide timely treatment tothe non-ambulatory if water decon,which is heavily reliant upon large man-power and equipment resources, is direct-ed towards the ambulatory survivors.

Because of the large number ofambulatory survivors in a mass casual-ty incident, it may be impossible tooffer soap and water decon to thosewho are minimally ill or worried well.If it is impossible to offer soap andwater decon because of the massivedemand from survivors (potentially inthe thousands), then it is ethicallyacceptable to offer an alternative.20, 21 Inaddition, if it is projected that a mas-sive number of casualties will make itimpossible to offer water decon, then itis ethically acceptable to PLAN not tooffer water decon and to make otherdecon alternatives available as a part ofthe mass casualty response plan.

Evacuation of victims and removal oftheir clothing has been proven to be themost important and effective means ofdecon because nearly all of the contami-nant will be in the clothing. This is a rea-sonable and minimally acceptable levelof decontamination. A report from theU.S. Army19 noted “since the most impor-tant aspect of decontamination is thetimely and effective removal of the agent,the precise methods used to remove the


agent are not nearly as important as thespeed by which the agent is removed.”

In this document19, victims and theirdecon priorities are divided into four cat-egories. Decon Priority 2 refers to non-ambulatory victims with moderate signsof illness associated with exposure to liq-uid or aerosol contamination. These vic-tims were likely close to the source of therelease. Decon Priority 2 patients shouldreceive water decon.

The Decon Priority 3 victims, thosewith minimal or no signs of injury andno exposure to liquid or aerosol, areambulatory and do not require imme-diate or significant treatment. Thesepatients are able to talk and walk unas-sisted.

The document suggests, “Immediatedecontamination may only involveremoval of clothing unless victim isgrossly contaminated with liquid agent.”“If responders do not have sufficientresources to decontaminate {with water}all potential victims, Decon Priority 3 vic-tims may not need to be showered. Theycan be immediately transferred to theCold (support) Zone {after removal ofclothing}.” “The Incident Commandermay make this allowance if it is believedthat such action will speed the deconta-mination process for genuinely contami-nated and symptomatic victims and ulti-mately result in more lives saved.”

For community or routine HazMat

exposures, the personal decon kit17

enables the victim to remove clothingprior to water decontamination or in lieuof water decontamination. After liquidHazMat contamination, the removal ofclothing will remove 80% or more of thecontaminant. This might provide someprotection for these patients as they awaitwater decon. At the scene of the exposureand at the hospital that is prepared toaccept and treat victims exposed to a haz-ardous material,1 these kits enable the vic-tims to rapidly remove their clothingwhile waiting for water decon. In addi-tion, once the clothing is removed, thevictim is unlikely to leave the scene andmore likely to wait for water decon andfurther processing.

For mass casualty HazMat incidentsin which the victims will likely beexposed to chemicals in the form ofvapor or gas, the personal decon kit willenable large numbers of ambulatory,minimally injured, or worried-well vic-tims to remove their clothing in a publicsetting while protecting their privacy.These ambulatory victims are likely tohave been exposed to a minimalamount of vapor or gas. After evacua-tion from the scene of the release andonce the clothing is removed, the chem-ical is essentially eliminated.

In October 2001, the Aurora, Coloradoemergency management agency utilizeddry decon kits in their Domestic Pre-

paredness Chemical Exercise. Ambulato-ry minimally ill and worried well sur-vivors were decontaminated in a matterof minutes using these kits.22 The proce-dure was well tolerated by the partici-pants and greatly speeded up the decont-amination process.

This process is neither absolute norperfect. After a mass casualty HazMatexposure, some small amount of vapormight contact the gown or poncho-likegarment, but it will more than likelyblow away. Vapor and gas will permeateclothing in an area of high vapor con-centration near the area of release, notjust by having the poncho-like garmenttouch the clothing. Remember, thesevictims have been triaged; they exhibitminimal or no signs of exposure andhave likely been exposed to little or nochemical. Therefore, this is a reasonablecompromise.

In any event, it is likely to be impos-sible to offer water decon to every vic-tim in a mass casualty incident. Toattempt to do so would put seriously illvictims who are non-ambulatory atgreater risk since critical resources—both human and logistic—would haveto be directed towards the minimallyill and worried-well. It is reasonable tooffer this high level of decon only tothose who might benefit most.20

Thus, dry decon offers a reasonablealternative to the usual practice of waterdecon. It is not a “sterile” or perfect pro-cedure, but it offers the opportunity torapidly decon and evacuate large num-bers of ambulatory survivors after a masscasualty incident. It enables a cost-effec-tive, manpower-efficient and achievablesolution for the incident commander, thehospital, and the community.

Dry decon can be achieved at thescene or the hospital. Local businesses,building security, police, fire, EMS, andhospital triage can all perform deconwith this manpower efficient modality.Summary

Communities must develop the capac-ity to evaluate, triage, decontaminate, andtreat victims of a terrorist attack. Thisplanning should be included in a genericmass casualty plan that enables commu-nity response to an “all-hazards” threat.Soft targets can participate in the commu-nity response by enabling security person-nel to exercise and train with local firstresponders. Soft targets can develop anevacuation plan and decontaminationplan consistent with the communitymass casualty plan.

References1. Siegelson HJ. Preparing for terrorism and haz-

ardous material exposures: A Matter of WorkerSafety. Health Forum J 2001; 44:32-5.

2. Wetter DC, Daniell WE, Treser CD. Hospital pre-paredness for victims of chemical or biologicalterrorism. Am J Public Health 2001; 91:710-6.

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ACCOMMODATIONSSurrounding the lush garden atrium are251 spacious, two-room suites. Each suiteincludes a separate vanity/dressing areaand large bedroom with the choice of twodouble beds or one king. Spacious livingrooms feature a sleeper sofa, a well-litdining/work table and a kitchen completewith a wet bar, refrigerator, coffeemakerand microwave.DINING AND ENTERTAINMENTFor lunch or dinner, dine in the comfortableatmosphere of the Athletic Club—A SportsBar and Grill. Guests of the hotel will alsoenjoy a complimentary, cooked-to-orderbreakfast each morning and an eveningmanager’s reception.*•Subject to state and local laws

MEETINGS AND CONVENTIONSFrom intimate meetings to lavish receptions,our 14,000 square feet of flexible meetingspace can accommodate events of everysize, including an impressive 11,000-square-foot ballroom, smaller conference roomsand two executive board rooms. And foryour added convenience, state-of-the-artaudiovisual equipment and a completebusiness center are also available.RECREATIONWork out all your tensions in our fullyequipped fitness center, complete withstationary bicycles, treadmills and weightmachines. Or relax with a refreshing swimin our heated indoor pool and unwind inour whirlpool and sauna. Our outdoor sundeck is the perfect place to enjoy thebeautiful weather.

HOTEL AND CONFERENCE CENTER(501) 312-90001-800-EMBASSY

www.jqhhotels.com11301 Financial Centre Parkway

Little Rock, AR 72211

• Secure off-site Storage of Paper Documents• Fireproof Media Vault for Computer Disks

& Tapes• Statewide Service• HIPAA Compliant

www.recordswarehouse.comor

(501) 316-0022Storage Pick-Up Delivery Destruction

Medical, Legal, and FinancialRecords Management

7/24/365

“Your Records Management Solution”


3. Evans M. America’s Ordeal. Newsday. New York,2001:A04.

4. Comprehensive Accreditation Manual for Hospi-tals: The Official Handbook. Environment of CareStandards, EC.1.5, Hazardous Materials. Oak-brook Terrace, Illinois: Joint Commission onAccreditation of Healthcare Organizations, 1999.

5. 29CFR1910.120, Hazardous waste operationsand emergency response. Occupational Safetyand Health Standards. Code of Federal Regula-tions: US Government Printing Office.

6. 29CFR1910.120, paragraph K, Decontamina-tion. Occupational Safety and Health Standards.Code of Federal Regulations: US GovernmentPrinting Office.

7. 29CFR1910.132, Personal Protective Equipment.Occupational Safety and Health Standards. Codeof Federal Regulations: US Government PrintingOffice.

8. Fairfax D. OSHA: Emergency response trainingnecessary for hospital physicians/nurses that maytreat contaminated patients. Standard Number:1910.120. OSHA Standards Interpretation andCompliance Letters: Directorate of CompliancePrograms, US Department of Labor, Occupation-al Safety and Health Administration, 1999.

9. Hospitals and Community Emergency Response— What You Need to Know: Occupational Safe-ty and Health Administration, 1997.

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11.Hazardous Substances Emergency Events Surveil-lance, Annual Report. Atlanta, Georgia: Agencyfor Toxic Substances Disease Registry, 1996.

12.Hospital HazMat and Terrorism Training, deconshowers and personal decon kits, regulatorycompliance, disaster planning. Indianapolis:HAZ/MAT DQE (www.hazmatdqe.com).

13.OSHA Standards Interpretation and ComplianceLetters: Emergency response training necessaryfor hospital physicians/nurses that may treat con-taminated patients: US Office for Safety andHealth Administration, 1999.

14.OSHA: Hospitals and Community EmergencyResponse: What You Need to Know: US Depart-ment of Labor, Occupational Safety and HealthAdministration, 1997.

15.Gerena-Morales R. First Nonmilitary Hospital ToTrack Outbreaks, Bioterrorism Symptoms. TheTampa Tribune. Tampa, 2001.

16.Dohms J. OSHA safety requirements for haz-ardous chemicals in the workplace. Radiol Man-age 1992; 14:76-80.

17.HAZ/MAT DQE, Doffit Kit, The Personal DryDecon Alternative. www.hazmatdqe.com. Indi-anapolis.

18.Sidell FR. Chemical agent terrorism. Ann EmergMed 1996; 28:223-4.

19.Lake W. Guidelines for Mass Casualty Decontam-ination During a Terrorist Chemical Agent Inci-dent: Chemical Weapons Improved ResponseProgram, Domestic Preparedness Program, U. S.Soldier Biological and Chemical Command,2000.

20.Brennan RJ, Waeckerle JF, Sharp TW, LillibridgeSR. Chemical warfare agents: emergency medicaland emergency public health issues. Ann EmergMed 1999; 34:191-204.

21.Pesik N, Keim ME, Iserson KV. Terrorism and theethics of emergency medical care. Ann EmergMed 2001; 37:642-6.

22.Straight B. Emergency Management Specialist,Office of Emergency Management, Aurora, Col-orado, 2001.

The MHA Group provides “Total Staffing Solutions” through a family ofstaffing companies including:

Merritt, Hawkins & Associates: Permanent Physician Staffing

Staff Care, Inc.: Temporary Physician Staffing (Locum Tenens)

Allied Consulting, Inc.: Permanent Allies Health Care Professional Staffing

Med Travelers: Temporary Allied Health Care Professional Staffing

American Medical Consulting: Medical Staff Development/ CommunityNeeds Assessments

A Preferred Provider of AHA Services

A Subsidiary of the Arkansas Hospital AssociationFor more information please call 800-876-0500 or

visit our web site at www.mhagroup.com

Presorted Standard

U.S. Postage PaidJackson, MS

Permit No. 80

Arkansas Hospital Association419 Natural Resources DriveLittle Rock, AR 72205