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* AHA #1 Winter 2001-2
Page 1

Page 2
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Page 3
Arkansas Hospitals
Winter 2002
Will We Be Ready?
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Bob Bash Installed as AHA's 70th Chairman
. . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Arkansas Newsmakers and Newcomers
. . . . . . . . . . . . . . . . . . . . . . . . . . .
Medicare Beneficiary Increases For `02
. . . . . . . . . . . . . . . . . . . . . . . . . . .
OIG Work Plan Posted
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Arkansas Insurer Increasing Anesthesia Rates
. . . . . . . . . . . . . . . . . . . . . . .
Bioterrorism Wall Chart
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Russ Harrington Presented Weintraub Award
. . . . . . . . . . . . . . . . . . . . . .
Governor's Budget Cuts Affect Hospitals
. . . . . . . . . . . . . . . . . . . . . . . . .
Jones, Wilson Receive Distinguished Service Awards
. . . . . . . . . . . . . . . . .
AHA Elects New Board Members
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Arkansas Resources for Disaster Readiness
. . . . . . . . . . . . . . . . . . . . . . . .
JCAHO Emergency Management Expectations
. . . . . . . . . . . . . . . . . . . . .
Curtis and Leopard Receive ACHE Regent's Awards
. . . . . . . . . . . . . . . . .
AHA 2001 Diamond Awards Presented
. . . . . . . . . . . . . . . . . . . . . . . . . .
Reaffirming Our Commitment to Caring
. . . . . . . . . . . . . . . . . . . . . . . . .
Saluting the AHA's 2001 Corporate Partners
. . . . . . . . . . . . . . . . . . . . . .
Bates Medical Center to Build New Facility
. . . . . . . . . . . . . . . . . . . . . . .
AAHQ Receives National Award
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Critical Access Hospitals Receive Grants
. . . . . . . . . . . . . . . . . . . . . . . . . .
Arkansas Medicaid Expansion Policies Implemented
. . . . . . . . . . . . . . . . .
Reminder: Nurse License Renewal Available Online
. . . . . . . . . . . . . . . . .
MedPAC Suggests Hospital Payment Changes
. . . . . . . . . . . . . . . . . . . . .
Cost Report, PS&R Due Dates
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Leapfrog Group Works to Improve Patient Safety
. . . . . . . . . . . . . . . . . . .
Arkansas DATABANK Enrollment Grows
. . . . . . . . . . . . . . . . . . . . . . . . . .
Boozman Elected to Represent Third District
. . . . . . . . . . . . . . . . . . . . . .
HIPAA Web Sites
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
HIPAA Electronic Submissions Testing Requirements
. . . . . . . . . . . . . . . . .
CPT 2002 Coding Changes Affect All Specialties
. . . . . . . . . . . . . . . . . . .
JCAHO Reissues
Sentinel Event Alert
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Preparing for a Terrorist Attack: Mass Casualty Management
. . . . . . . . . .
Our Advertisers, Our Friends
is published by
Arkansas Hospital Association
419 Natural Resources Drive * Little Rock, AR 72205
501-224-7878 / FAX 501-224-0519
Beth H. Ingram, Editor
Robert Bash
, Booneville / Chairman
Jeff Curtis
, Malvern/Chairman-elect
Eugene Zuber,
Newport / Treasurer
Luther Lewis
, El Dorado / Past-Chairman
Frank Wise
, Salem/At-Large
Robert Atkinson
, Pine Bluff
David Cicero
, Camden
Randall Fale
, Hot Springs
Russell D. Harrington, Jr.
, Little Rock
Michael D. Helm
, Fort Smith
Tim Hill
, Harrison
Ray Kordsmeier
, Conway
David C. Laffoon
, Searcy
Ray Montgomery
, Searcy
Richard Pierson
, Little Rock
Ron Rooney
, Paragould
Bill Sparks
, Russellville
Pattsy Yancy, Arkadelphia
James R. Teeter / President and CEO
Phil E. Matthews / Executive Vice President
W. Paul Cunningham / Senior Vice President
Beth H. Ingram / Vice President
Don Adams / Vice President
Arkansas Hospitals is distributed quarterly to hospital
executives, managers, and trustees throughout the United
States; 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 contact
Arkansas Hospitals
Arkansas Hospitals
Arkansas Hospitals
reated by
AHA Services
Arkansas BlueCross BlueShield
Arkansas Foundation for Medical Care
Complete RX
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Page 4
Winter 2002
Arkansas Hospitals
These are trying times in America, particularly in Washington where the Congress has been faced with weighty
matters like aviation security, an economic stimulus package, appropriations bills, and, finding more money to
protect 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 a
large-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 cutting
by government and other payers, along with masses of uninsured patients have dealt severe financial blows to
hospitals 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 $400
million to aid hospital response to bioterrorism. And, senators John Edwards
and Chuck Hagel have proposed $100 million to strengthen hospital emer-
gency, trauma, and intensive care units, and another $100 million for block
grants to state and local governments for hospital NBC attack preparedness.
While their intentions are undoubtedly the best, the dollars proposed are
entirely too few in number. Consider that New York City hospitals spent $340
million 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 resources
needed to achieve minimum levels of NBC attack readiness. Needed resources
include 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 to
nerve 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 and
200 patients respectively for 24 to 48 hours. After that time, it is assumed the CDC's Bioterrorism Preparedness
and 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 urged
to study it carefully, and to conduct a thorough assessment of their own hospital-specific needs and the cost of
meeting those needs. Preparedness improvement is at the top of the hospital agenda. It should be sky-high on
the Washington agenda, too. It is essential that the Congress and the White House-so quick to enact a $15 billion
airline bailout after the September 11 terrorist attacks-also give top priority to funding hospital mass casualty
James R. Teeter
President and CEO
Arkansas Hospital Association
Will We Be Ready?

Page 5
Arkansas Hospitals
Winter 2002
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Page 6
Winter 2002
Arkansas Hospitals
Robert R. Bash, adminis-
trator of Booneville Commu-
nity Hospital (BCH), was
installed as chairman of the
Arkansas Hospital Associa-
tion (AHA) board of directors
during the group's Annual
Meeting and Trade Show in
Little Rock October 8.
Bash succeeds Luther
Lewis, CEO of the Medical
Center of South Arkansas in
El Dorado, and will serve
until October 2003, becom-
ing the first AHA chairman to
serve a two-year term of
office. The association's
House of Delegates voted to change the term of office during
its 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 to
his arrival at BCH, Bash was administrator of Johnson
County Regional Hospital in Clarksville, and held admin-
istrative positions in Louisiana hospitals located in
Alexandria 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 central
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 on
the 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 hospital
administrator is the hospital leader. He is responsible for
selecting, leading, and developing the management team.
"Participating with the state and national hospital associa-
tions is important for many reasons. First, for representation
on the state and national legislative front. Second, for the
benefit of power and economy achievable through the group
that is impossible by oneself. And, third, for education and
currency 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 501-224-0519

Page 7
Mike Huckabee
has appointed
Ray Montgomery
president and CEO of White County Medical Center in Searcy, to the
Tobacco Prevention and Cessation Advisory Committee.
Lee Gentry
, president of Lawrence Memorial Health Services in
Walnut Ridge and an Arkansas Air National Guard captain in the 123rd
Intelligence Squadron located at the Little Rock Air Force Base, has been
activated as part of the presidential selective reserve call up. His email
address is 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 Baptist
Memorial Hospital-Osceola, succeeding
Joel North
. Tompkins has
been with Baptist Memorial Health Care for more than 20 years, most
recently serving as CEO and administrator for Baptist Memorial Hospi-
tal-Union County in New Albany, Mississippi and Baptist Memorial
Hospital-Booneville in Booneville, Mississippi.
Susan Barrett
, CEO of Mercy Health System of Northwest
Arkansas, has been appointed by Arkansas Speaker of the House Shane
Broadway to a term on the Tobacco Prevention and Cessation Advisory
Committee. 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 Red
Cross Blood Services, Greater Ozarks-Arkansas Region, Little Rock, was
elected president of the Arkansas Health Executives Forum during the
group's annual meeting October 8 in Little Rock. Also elected were
Christy Hockaday
, vice president, Conway Regional Health System,
president-elect; and
Jason Spring
, CHE, administrator, St. Vincent
Rehabilitation Hospital, Sherwood, secretary-treasurer.
Don Beeler
, president and CEO of CHRISTUS St. Michael Health
System in Texarkana, has been re-elected to a three-year term on the
board of the Arkansas State Chamber of Commerce.
Arkansas Newsmakers
and Newcomers
January 9, Monticello
CPT 2002 Coding Update
January 10, Bismarck
CPT 2002 Coding Update
January 18, North Little Rock
Arkansas Association of Hospital Engi-
January 31-February 1,
Tunica, MS
Healthcare Financial Management
Association Tri-State Meeting
January 31-February 1, Nashville, TN
Continuous Survey Readiness Workshop
(CSR members only)
March 1, Conway
Arkansas Society of Healthcare
Marketing & Public Relations
March 6, Little Rock
Compliance Forum
March 17-21, Chicago
American College of Healthcare Execu-
tives Congress
April 7-9, Washington, DC
American Hospital Association Annual
April 11-12, Hot Springs
Healthcare Financial Management Asso-
June 12-14, Branson, MO
Arkansas Hospital Administrators Forum
Summer Management Conference
Medicare beneficiaries will pay a higher deductible for
Part A and a higher premium for Part B in 2002. The Part
A deductible will increase 2.5% to $812 from $792 this
year, the Department of Health and Human Services
announced October 18. The Part B premium will rise by
8% to $54 per month from $50 per month in 2002.
Increases for extended hospital stays beyond the 60
days covered by the Part A deductible will jump $203 per
day for days 61 through 90 and $406 per day for hospital
stays beyond the 90th day in a benefit period-up from
$198 per day and $396 per day, respectively.
For beneficiaries in skilled nursing facilities, the
daily co-insurance for days 21 through 100 will be
$101.50, up from $99 in 2001. Medicare deductibles
and premiums are updated annually according to statu-
tory formulas. For more, go to
Medicare Beneficiary
Increases For `02
Arkansas Hospitals
Winter 2002
The HHS Office of Inspector General has posted the
agency's Work Plan for Fiscal Year 2002 to the OIG's
website. The plan covers four chapters encompassing
the various projects to be addressed during Fiscal Year
(FY) 2002 by the Office of Audit Services, Office of
Evaluation 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 for
physician consultation services, "incident to" services,
and the use of advance beneficiary notices (ABN)-were
among the areas that made the list. View the Work Plan
at oig/wrkpln/2002/Work_Plan_2002.htm
OIG Work Plan Posted

Page 8
An innovative decision support system, managed by Solucient*, the market leader in health care
information, the Network integrates statewide patient database services to help you:
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Negotiate managed care contracts
Improve quality
Develop sound strategic plans
To find out how the Arkansas Hospital Association Health Information Network can help you,
call Solucient's Wendy Karain at 615.232.8766,
Powering Health Care Decisions
*Solucient was formed by the merger of HCIA-Sachs and HBS International.
Leverage your ability to make
sound decisions for your hospital
Leverage your ability to make
sound decisions for your hospital
Participate in the
Arkansas Hospital Association
Health Information Network
Winter 2002
Arkansas Hospitals
The Arkansas Hospital Association has learned that
Arkansas Blue Cross Blue Shield (ABCBS) intends to
increase 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 $6
million and $7 million annually and is expected to be
underwritten by policyholder premium increases. No
future implementation date for the new payment has
been announced, though, historically, ABCBS rate
changes are effective in January or February of the year
following rate adjustment decisions.
The AHA has been working in conjunction with a
coalition of hospital and physician representatives to
address 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 other
commercial insurance carriers and Medicare, with the
goal of achieving anesthesia rate increases on those
fronts, too.
Arkansas Insurer
Increasing Anesthesia Rates
The North Carolina Statewide Program for
Infection Control and Epidemiology (SPICE), at
the University of North Carolina at Chapel Hill,
has developed a wall chart on bioterrorist agents.
A small version of this wall chart is online and
available for your use for educational purposes as
long as you use the chart in its complete form,
including the disclaimer and credit to the North
Carolina Statewide Program for Infection Control
and Epidemiology.
The purpose of the chart is for display for
physicians in emergency rooms, urgent care cen-
ters, physicians' offices, and other primary care
first responders. The chart presents a concise sum-
mary of signs and symptoms to assist with early
recognition and alert healthcare workers of the
potential for bioterrorist agents. Once a bioterror-
ist agent is suspected, the healthcare worker will
need to consult more in-depth resources.
To see instructions for printing the chart, click on
The site also has other disaster resources liste
Bioterrorism Wall Chart

Page 9
Arkansas Hospitals
Winter 2002
Governor Mike Huckabee an-
nounced November 14 that the state
budget for the remainder of fiscal
year 2002 will be cut by $142 million.
The amount is substantially more
than the $100 million reduction orig-
inally expected and represents the
largest mid-year state budget adjust-
ment in history. Cuts for state fiscal
year 2003, the second year of the
biennial budget period, which begins
July 1, 2002, will total $161 million
less than approved by the Arkansas
General Assembly during the legisla-
tive session that ended last April. The
cuts are a result of a general econom-
ic downturn affecting most states.
Through October 31, state general
revenues for the year beginning July
1, 2001 were $12.4 million less than
collected through the same period
last year and $34 million under pro-
jections for this year.
The Arkansas Medicaid programs will
lose more than $50 million during the
remainder of state fiscal year 2002 as
part of the state spending reduction.
Medicaid director Ray Hanley said most
of the 475,000 Arkansans who are eligi-
ble for and use Medicaid benefits will be
affected to some degree.
The largest part of the savings-
between $19 million and $20 million-
will come from elimination of the state's
medically needy program that covers
healthcare costs for about 33,000 low
income people who wouldn't normally
qualify for Medicaid, but who must have
care related to catastrophic illnesses.
Other significant cuts will be made in
payments for prescription drugs and
pharmacy costs, day treatment and
therapy services for developmentally
delayed children, rehabilitation services
for the mentally ill and changes in the
way patients are evaluated for nursing
home care.
Few of the spending reductions
should 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 no
longer have benefits under the medical-
ly needy program, Medicaid will cease
paying Medicare/Medicaid crossover
claims for patients dually-eligible for
both programs at more than would have
been paid had the dual-eligible patient
been a Medicaid patient only. Several
years ago, the state followed a "pay no
more than Medicaid" policy, but that
was changed to pay at Medicare rates
when more money was available.
Medicaid may also seek savings in
the mental health arena by putting out
to bid inpatient psychiatric care. And a
gate-keeping system may be established
for children's outpatient care. These
programs have been growing at double-
digit rates, according to Hanley. Most of
the announced cuts will take effect next
spring. Some require approval from the
federal Centers for Medicare & Medic-
aid Services before changes can be
Russell D. Harrington, Jr., FACHE,
president of Baptist Health in Little Rock,
was recognized with the Arkansas Hospi-
tal Association's A. Allen Weintraub
Memorial 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 Medical
Center (now St. Vincent Health System)
in Little Rock, is the highest honor
bestowed on an individual by the AHA.
Harrington was selected for the award by
the AHA board of directors in recogni-
tion of his dedicated service to hospitals
and to medical care in Arkansas.
President of Baptist Health since 1984,
Harrington oversees the operations of
five hospitals, a retirement community,
skilled care facility, residential care facili-
ty, and medical service organization. He
began his healthcare career in 1971 as
director 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 Medical
Center, and associate executive director
of Baptist Medical System, now Baptist
Harrington's accomplishments in-
clude serving as chairman of the AHA
board 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 American
College of Healthcare Executives; a for-
mer commissioner of the Arkansas
Health Services Commission; a board
member of Parkway Village, Inc., Baptist
Health Foundation, Greater Little Rock
Chamber of Commerce, and Fifty for the
Future; and past board member of VHA
Inc. and the Governor's Arkansas State
Quality Award Program.
He has contributed many volunteer
hours to the greater Little Rock commu-
nity, serving as a board member of the
Pulaski County United Way, Central
Arkansas Radiation Therapy Institute,
and Arkansans for Drug Free Youth. He
was named Arkansas' Philanthropic Per-
son 2000 by the Muscular Dystrophy
Russ Harrington Presented Weintraub Award
Governor's Budget Cuts Affect Hospitals

Page 10
Winter 2002
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Page 11
Arkansas Hospitals
Winter 2002
Jones, Wilson
Receive Awards
The Arkansas Hospital Association's 2001 Distin-
guished Service Awards were presented to Florence
Jones, RN, of Jonesboro and to the family of the late
Larkin M. Wilson, Jr., MD, during the Association's
Annual 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 northeast
Arkansas, helped to provide healthcare to the indi-
gent and working uninsured through a non-profit
clinic, and shared her knowledge of these services
with other coun-
tries. She is also
actively involved
in philanthropic
service through
the United Way,
Arkansas Hospice
Association, St.
Bernard's Hos-
pice, American
Heart Association,
March of Dimes
and others.
Dr. Wilson, who died in July from the results of
an automobile accident, began his medical career
in south Arkansas almost 40 years ago. Just prior
to his death, he was chairman of the board of the
Medical Center of South Arkansas (MCSA) in El
Dorado where he began process improvement ini-
tiatives; was instrumental in merging Warner
Brown Hospital and
Union Medical Center
into MCSA and, as a
result, created the
SHARE foundation;
recruited many special-
ty physicians to the
area; increased health-
care access to the indi-
gent; and enjoyed a
distinguished medical
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, president
and CEO of HSC Medical Center in Malvern, as the board's chair-
In addition, the membership ratified the election of two new
district 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 Ray
Montgomery, 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, therefore
becoming its representative to the AHA board.
AHA Elects New
Board Members

Page 12

Page 13
Arkansas Hospitals
Winter 2002
Arkansas Governor's Office
Address: Governor Mike Huckabee,
State Capitol, Little Rock, AR 72201
E-mail: use form on website
Phone: (501) 682-2345
Arkansas Department of
Emergency Management
Address: P.O. Box 758
Conway, AR 72033
Phone: 501-730-9750
Fax: 501-730-9754
State Disaster Office,
American Red Cross
Address: 401 S Monroe St
Little Rock, AR 72205-5410
Phone: 501-614-1000
Fax: 501-666-5060
Arkansas Department of Health
Address: 4815 W. Markham
Little Rock, AR 72205
Phone: 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.
Arkansas Department of
Environmental Quality
Address: 8001 National Drive
Little Rock, AR 72209
E-mail: Help-
Phone: (501) 682-0923
Arkansas State Police
Address: #1 State Police Plaza Drive
Little Rock, AR 72209
Phone: (501) 618-8000
Army Corps of Engineers
Address: 700 W. Capitol
Little Rock, AR 72203
Phone: 501-324-5551
E-mail: use form on website
Centers for Disease Control and
U.S. Department of Energy:
U.S. Department of Health
and Human Services:
Arkansas Resources for
Disaster Readiness
At the October 8 American College of Healthcare
Executives Breakfast, ACHE Arkansas Regent Tom
Siemers, CEO, Rebsamen Medical Center, Jack-
sonville, presented awards to
two Arkansas hospital CEOs
in recognition of their
achievements in the health-
care profession.
The Senior Career Execu-
tive Award was presented to
Jeff Curtis, president and
CEO of HSC Medical Center
in Malvern. The Early Career Executive Award went to
Jimmy Leopard, CEO, Medical Park Hospital in Hope.
Curtis and Leopard Receive
ACHE Regent's Awards
Tom Siemers, Jeff Curtis
Tom Siemers, Jimmy Leopard
JCAHO Emergency
As a consequence of the events that
occurred on September 11, increased focus
is being given by the JCAHO to the emer-
gency management standards.
The modified standards, implemented as
of January 1, 2001, focus on four specific
phases of disaster planning:
Mitigation activities
-to eliminate or
reduce the effects of hazards.
Preparedness activities
-to enhance
individual and organization abilities to
manage the potential effects of hazards
on a facility.
Response activities -
to directly
address the negative effects of emer-
gency situations.
Recovery activities-
to begin almost
concurrently with response activities
and are directed at restoring essential
services and resuming normal operations.
In addition, the standards require that
accredited organizations take an "all hazards
approach" to planning. This requires that
organizations conduct vulnerability analy-
ses and develop emergency management
plans that contain a chain of command
approach that is common to all hazards that
pose a credible threat. Finally, where a haz-
ard analysis indicates a credible community
wide threat, the accredited organization is
required to participate in at least one annu-
al community-wide practice drill.
The JCAHO recently published a spe-
cial issue of
Joint Commission Perspectives
( ivesspe-
that focused on various aspects
of emergency management. Articles
addressed the need for a national bioter-
rorism response, JCAHO standards and
their application during the survey
process, management of an emergency
and lessons learned from the recent emer-
gencies of September 11.
While surveyors have been reviewing
organizational compliance with the modi-
fied 2000 environment of care standards,
the recent events of September 11 have
caused surveyors to more carefully scruti-
nize how an organization plans, designs,
implements, and improves its emergency
management plan, how that plan applies to
a variety of possible events, and how well
trained hospital staff are in regard to their
roles and responsibilities as defined by the
plan. Joint Commission staff has refined
the survey probes and protocols that will be
used by surveyors in their assessment of
compliance with the Emergency Manage-
ment standards.

Page 14
Winter 2002
Arkansas Hospitals
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:
(newspaper or mag-
azine advertising)
Diamond Award
, Conway Regional Health
System, submitted by Lori Ross, for "We've
More Than Doubled Our Staff"
Diamond Award
, Jefferson Regional Med-
ical Center, submitted by Wendy Talbot, for
"Doctor's Day"
Excellence Award
, Conway Regional
Health System, submitted by Lori Ross, for
"We've Expanded Our Services"
Excellence Award
, Sparks Regional Medical
Center, submitted by Mary Jane Hennig, for
"After Hours Pediatric Clinic"
Judges' Merit Award
, Jefferson Regional
Medical Center, submitted by Wendy Talbot,
for "Smoke Out"
Judges' Merit Award
, Sparks Health Sys-
tem, submitted by Anne Turner, for "The
Women's Center"
Judges' Merit Award
, St. Joseph's Regional
Health Center, submitted by Virginia Meek,
for "Mercy Has Many Faces"
Judges' Merit Award
, St. Mary's Hospital,
submitted by Steve Voyak, for "Faces"
(advertisement or
public service announcement developed or
commissioned to promote a hospital service
or 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 "The
Women's Center"
visuals such as billboards, benches, transit,
posters, etc.)
Diamond Award
, St. Mary's Hospital, sub-
mitted by Steve Voyak, for "Electronic Baby
Diamond Award
, St. Vincent Health Sys-
tem, submitted by Scott Mosley, for "Show-
case Excellence Billboard"
Excellence Award
, Conway Regional
Health 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

Page 15
Arkansas Hospitals
Winter 2002
"Sports Medicine Van"
Judges' Merit Award
, Central Arkansas
Hospital, submitted by Joy Phillips, for "Your
Most Important Decisions Billboard"
Judges' Merit Award
, Saline Memorial Hos-
pital, submitted by Robin Horn, for "Total
Trust- Total Health Care Billboard"
Judges' Merit Award
, St. Bernards Medical
Center, submitted by Valerie Daniel, for "Day
Place Billboard"
ment or public service announcement devel-
oped or commissioned to promote a hospital
service or program)
Diamond Award
, Saline Memorial Hospi-
tal, submitted by Robin Horn, for "Total
Trust- Total Health Care"
Diamond Award
, St. Joseph's Regional
Health Center, submitted by Virginia Meek,
for "Future Babies"
Excellence Award
, Conway Regional
Health System, submitted by Lori Ross, for
Excellence Award
, UAMS Medical Center,
submitted by Tim Irby, for "Olympics"
Judges' Merit Award
, Sparks Health Sys-
tem, submitted by Anne Turner, for "Sparks
(advertisement that includes more than one
Diamond Award
, St. Joseph's Regional
Health Center, submitted by Virginia Meek,
for "Speed of Life"
Diamond Award
, St. Joseph's Regional
Health 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 Regional
Health System, submitted by Lori Ross, for
Excellence Award
, Sparks Health System,
submitted by Anne Turner, for "The
Women's Center"
Judges' Merit Award
, White County Med-
ical Center, submitted by Cassandra Feltrop,
for "Whole-Hearted Devotion To Your
(brochure, newspaper
advertisement/supplement, or traditional
Diamond Award
, White River Health
System, submitted by Sheila Mace, for
"White River Health System"
Excellence Award
, Arkansas Methodist
Hospital, submitted by Sherry Cunningham,
for "AMH Annual Report"
Judges' Merit Award
, St. Edward Mercy
Health Network, submitted by Chip Paris, for
"2000 Report to the Community"
(a Web site design,
developed or commissioned to promote a
hospital's programs and services)
Diamond Award
, Conway Regional Med-
ical Center, submitted by Lori Ross, for
Diamond Award
, St. Vincent Health Sys-
tem, submitted by Scott Mosley, for
Excellence Award
, Baptist Health, submit-
ted by Steve Asmussen, for
Excellence Award
, Saline Memorial Hospi-
tal, submitted by Robin Horn, for
Judges' Merit Award
, St. Bernards Behav-
ioral Health, submitted by Valerie Daniel, for
Judges' Merit Award
, St. Bernards Health-
care, submitted by Lynn Parker, for
(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 Regional
Health System, submitted by Lori Ross, for
"Health Scene Today"
Excellence Award
, St. Joseph's Regional
Health Center, submitted by Virginia Meek,
for "HealthMatters"
Judges' Merit Award
, CARTI, submitted by
Jennifer Armstrong, for "CancerAnswers"
Judges' Merit Award
, St. Edward Mercy
Health Network, submitted by Chip Paris, for
(routine publica-
tion designed primarily for internal audiences
such as employees, medical staff, volunteers,
Diamond Award
, Arkansas Children's Hos-
pital, submitted by Terri Davidson, for "Vital
Diamond Award
, Arkansas Methodist Hos-
pital, submitted by Andre Watson, for "Well
Excellence Award
, Arkansas Methodist
Hospital, submitted by Kitty Witcher, for
"What's Happening"
Excellence Award
, University Hospital at
UAMS Medical Center, submitted by Mike
Mottler, for "UAMS Update"
Judges' Merit Award
, Conway Regional
Health System, submitted by Lori Ross, for
"In Motion"
cation designed to meet a specific need or
purpose such as an open house, dedication
program, 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 Regional
Health 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 "HSC
Medical Center Care Guide"
Judges' Merit Award
, White County Med-
ical Center, submitted by Cassandra Feltrop,
for "River Oaks Village Brochure"
production, other than television advertising,
designed to meet a specific need or purpose
such as staff/patient information, hospital
tour, recruitment, etc.)
Diamond Award
, Conway Regional Health
System, submitted by Lori Ross, for "CRMC
Presentation 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 Wilson
(entries may include a news
release, feature story, editorial, speech, etc.)
Diamond Award
, White River Medical
Center, submitted by Sheila Mace, for "Car-
diac Surgery Program Begins at WRMC"
Judges' Merit Award
, Jefferson Regional
Medical Center, submitted by Wendy Talbot,
for "Good News"

Page 16
Reaffirming Our Commitment to Caring
Acknowledging October 14-20 as National Healthcare Quality Week, Governor Mike
Huckabee (center) recognized the work of Arkansas quality professionals. Receiving the
proclamation are Arkansas Association of Healthcare Quality members (from left), Carol
Cox, Little Rock; Debbie Hare, Searcy; Sandra Grinder, Benton; Anita Gottlieb, Little
Rock; Karen Donaldson, Monticello, and Roseanne Hudoba, El Dorado.
AHA chairman Luther Lewis welcomes
members of the Arkansas Hospital Associa-
tion and the Arkansas Hospital Auxiliary
Association to the opening session of the
Annual Meeting.
Visiting during
an AHA recep-
tion are (from
left), Roger
Feldt, president
and CEO of
Saline Memori-
al Hospital in
Benton, and
Speaker of the
House Shane
Broadway of
Enjoying the Awards
Dinner are (from left)
Sister Cabrini Arami,
Sister Elaine Willett,
Sister Mary Ann Nuce,
Sister Benedicta Boeck-
mann, Sister Celestine
Pond, Sister Henrietta
Hockle, and Sister Eileen
Schneider, board mem-
bers from St. Bernard's
Healthcare in Jonesboro.
Arkansas Hospital Association
Annual Meeting and Trade
Show, October 7-9, 2001
A new location, a streamlined agenda
and exciting speakers contributed to the
success of the Arkansas Hospital Associa-
tion's 71st Annual Meeting and Trade
Show held at Little Rock's newly-remod-
eled Statehouse Convention Center. The
program agenda was shortened to a two-
day format, much to the delight of every-
one.Annual meeting attendees rated the
speakers, educational events and new
format very high. They enjoyed hearing
keynote speaker Ken Schmidt share
valuable customer service tips from his
days with Harley-Davidson Motor
Company; Terry Andrus tell how East
Alabama Medical Center achieved the
ranking of one of
"100 Best Companies to Work For;"
political strategist Mark Allen discuss
how the polls are treating President
Bush; airline safety analyst John Nance
discuss comparisons between airline
safety and patient safety; and Little
Rock attorney Lynda Johnson illustrate
how the Health Insurance Portability
and Accountability Act of 1996 will
affect hospitals and patients. Over 40
participants took advantage of the
ACHE Category I workshop on creative
management techniques that offered
valuable continuing education credits
without additional travel expense to
Arkansas executives.
For the first time, the AHA Annual
Meeting featured a closing lunch and
what a powerful closing it was! Author
James Bradley enthralled the audience
with details from his book
Flags of Our
, the story of his father and the
other young men who raised the flag
on Iwo Jima, a photo of which became
the most reproduced photo in the his-
tory of photography.
And, as always, the AHA Trade
Show was a highlight with the mem-
bership featuring more than 100
exhibits of healthcare products and
services from vendors and suppliers
across the country.
Winter 2002
Arkansas Hospitals

Page 17
AHA executive vice president Phil Matthews (cen-
ter) congratulates Statesmanship Award recipients
Rep. Larry Teague (left) of Nashville and Rep. Phil
Jacobs of Clarksville.
Speaker Terry Andrus, CEO of East
Alabama Medical Center in Opelika,
Alabama, explains how his hospital
was selected one of
zine's "100 Best Companies to Work
Outgoing AHA chairman Luther Lewis
(right) receives a plaque in appreciation
for his term of service from new chairman
Robert R. Bash.
Governor Mike Huck-
abee (center) congrat-
ulates Pattsy Yancy
(left) of Arkadelphia,
president of the
Arkansas Hospital Aux-
iliary Association, and
his mother-in-law Pat
Stephens of Hope,
newly elected
of the volunteer orga-
Former AHA chair-
men Mike Helm
(left), president of
Sparks Health Sys-
tem in Fort Smith,
and Ross Hooper,
president and CEO
of Crittenden
Memorial Hospital
West Memphis,
share a lighter
moment during
a presentation.
An attentive
audience listens
one of the
sessions offered
during the AHA
AHA chair-
man Luther
Lewis (left)
and presi-
dent Jim
Teeter dis-
cuss annual
The Boogie Woogie Babes, (from left) Suzie Nichols, Debra Walk-
er, and Kim Nichols, of Jefferson City, Missouri, got the AHA
Annual Meeting off to a rousing beginning with their musical
patriotic tribute during the annual Chairman's Dinner.
Congratulating Russ Harrington (center), president of Baptist
Health in Little Rock and 2001 recipient of the AHA's A. Allen
Weintraub Memorial Award, are his father, Rev. Russell D.
Harrington, Sr., and son, Brooks Harrington.
Arkansas Hospitals
Winter 2002

Page 18
The Arkansas Hospital Association
wishes to thank the companies and
organizations participating in the 71st
Annual Meeting and Trade Show. With
their financial support, high quality
educational programming is made pos-
sible for the AHA membership.
Access Control Integration, Inc.
Administrative Consultant Service, Inc.
AHA Services, Inc.******
Alliant Foodservice
Alltel Business Continuity Services
American General Financial Grou­ VALIC
American Heart Association
Angel Flight South Central
Apollo MD
ARCOM Systems
Arkansas Department of Health-Office of
Rural Health & Primary Care
Arkansas 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
Arkansas Regional Organ Recovery
Agency (ARORA)
Bausch and Lomb
BCX Technology, Inc.
Behavioral Health Resources, Inc.
BG Industries/Maxifloat
BKD, LLP ****
Boise Cascade Office Products
Brasfield & Gorrie
Choice One
Complete Rx
Crew Training International
Crews & Associates, Inc.
Cromwell Architects Engineers
Crothall Services Group
Data Systems Management, Inc.
Directory Assistants, Inc.
Disability Determination for
Social Security
EDS/Arkansas Medicaid
Engelkes, Conner, & Davis, Ltd. *
Federation of Associated Health Sys-
tems, Inc.
First Uniform
FORZA Marketing Group ***
Franklin Collection Service, Inc.
Friday, Eldredge & Clark **
General Electric Medical Systems
Gideons International
Goddard Healthcare Consulting, Inc.
Health Data Solutions
Healthcare Administration Technologies,
Inc. ****
Healthcare Management Systems, Inc.
Healthcare Strategic Initiatives
Winter 2002
Arkansas Hospitals
Saluting the AHA's 2001 Corporate Partners
Representatives from Merritt, Hawkins and associates visit with Barry Brady (left) of
Little Rock, former AHA chairman Gary Bebow (fourth from left) of Batesville, and Les
Frensely (right) of Batesville.

Page 19
Arkansas Attorney General Mark
Pryor awarded grants of $20,000 each to
the state's fourteen Critical Access Hos-
pitals during a ceremony held November
14 at the Arkansas Hospital Association
(AHA) headquarters in Little Rock. The
grants will be used for a variety of pur-
poses, including the purchase of equip-
ment, upgrading services, community
health fairs, preventive care and com-
munity health education programs.
Funds came from a multi-state pre-litiga-
tion settlement entered into between
Knoll Pharmaceuticals and the Attorney
General's office after an investigation
conducted by the Antitrust Division of
the 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 pay
Arkansas $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 the
total, recipients included the Area Agen-
cies on Aging located throughout
Arkansas and the University of Arkansas
for Medical Sciences.
In awarding the grant funds, Pryor
noted how important each of the small
rural hospitals are to their communities
and expressed hope that the monies
would ease some of their current finan-
cial challenges. The AHA worked closely
with Pryor's office in establishing the
grant program. Hospitals receiving the
grants are Baptist Health Medical Cen-
ter-Heber Springs, Community Medical
Center of Izard County (Calico Rock),
CrossRidge Community Hospital
(Wynne), Dallas County Hospital
(Fordyce), Dardanelle Hospital, Eureka
Springs Hospital, Howard Memorial Hos-
pital (Nashville), Lawrence Memorial
Hospital (Walnut Ridge), McGehee
Desha County Hospital, Mercy Hospital
of Scott County (Waldron), Mercy Hos-
pital/Turner Memorial (Ozark), North
Logan Mercy Hospital (Paris), Ozark
Health Medical Center (Clinton), and
Stone County Medical Center (Moun-
tain View).
Arkansas Hospitals
Winter 2002
Healthworks Alliance, Inc.
Horton's Orthotic Lab, Inc.
Hospital Building & Equipment Compa-
Hughes, Welch & Milligan, CPAs
Huntington Brand of Ecolab
InSiteOne, Inc.
J. Hugh Knight Instrument Company
Jay S. Stanley & Associates, Inc.
Kol Bio-Medical Instruments, Inc.
Kronos Inc.
La-Z-Boy Concepts
Marshall Erdman & Associates, Inc.
MD Network
MD Productivity
Med-Data Management, Inc.
MedData Services
Medical Doctor Associates
Medical Management Consultants Inc.
Medi-Man Rehabilitation Products, Inc.
MEDITECH (Medical Information Tech-
nology, Inc.)
Merritt, Hawkins & Associates
Mobile Instrument Service and Repair
Modern Biomedical and Imaging
MultiPlan, Inc.
Nabholz Construction Corporation
Numed, Inc.
Optus Telemation
Osment Roofing Systems Inc.
PhyAmerica Physician Services
Pinnacle Health Group
Press, Ganey Associates, Inc.
PROMED Ambulance
PsychManagement Partners, LLC
Publishing Concepts, Inc. ***
Pulaski Bank *
Ramsey, Krug, Farrell & Lensing **
Reciprocal of America *****
RehabCare Group
Service Professionals, Inc.
Sign Systems, Inc.
Snell Prosthetic & Orthotic Laboratory
Swisslog Translogic
SYSCO Food Services of Arkansas, LLC
The St. Paul Companies
Taylor Made Ambulance
TimeLine Recruiting, LLC
TimeMed Labeling Systems, Inc.
Tri-Tec Monitors
UALR Graduate Program In Health
West-Com Hospital Systems
Wittenberg, 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 the
Arkansas Hospital Association, has
received the bronze level award for asso-
ciation excellence from the National
Association for Health Care Quality. The
award recognizes state healthcare man-
agement associations that provide excep-
tional services and benefits. Over 40
states participate in the national organi-
zation and Arkansas was one of three
receiving recognition.
Anita Gottlieb of Quorum Health
Resources in Little Rock is the current
president of AAHQ and Sandy
Grinder, Saline Memorial Hospital in
Benton, is president-elect. Representa-
tives from forty hospitals or health-
care organizations in Arkansas are
members of AAHQ.
Bates Medical Center in Bentonville is
being replaced with a new facility and will
get a new name at the same time. Triad
Hospitals Inc. of Dallas, which owns and
operates Northwest Health System in
Springdale, officially announced Septem-
ber 14 the new $63 million hospital would
be built and groundbreaking ceremonies
were held October 9. The Springdale health
system operates Northwest Medical Center
and Bates Medical Center.
Once completed, the Bentonville hospi-
tal will be called Northwest Medical Center
of Benton County. The new facility will
include 128 inpatient beds, doubling the
size of the 63-bed hospital it will replace.
The entire campus will be constructed on a
60-acre tract of land and will include a
50,000 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

Page 20
November 1 was the effective date for
new policies implementing two Medic-
aid-expansion programs established
under the Arkansas tobacco settlement
spending plan that was developed and
supported by the Coalition for a Healthi-
er Arkansas Today (CHART).
Arkansas voters adopted the CHART
plan as Initiated Act 1, during the 2000
general election a year ago. The Act is a
blueprint for spending Arkansas' share of
the national tobacco settlement fund.
The Arkansas Hospital Association is a
founding member of the CHART organi-
zation and took a lead role in assuring the
Act passed.
The newly-implemented Act 1 pro-
visions are aimed at expanding Medic-
aid eligibility, increasing certain pro-
gram benefits and helping the state's
hospitals. The most significant change
provides for Medicaid coverage of an
additional 4,000 pregnant women and
newborns annually, improving their
access to needed obstetrical care.
The increase is accomplished by
broadening the income eligibility
requirements. Previously, Medicaid cov-
erage of pregnant women was limited to
those having annual incomes no more
than 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 will
make it easier for many women to seek
out care for themselves and their babies
that they may have overlooked other-
wise. It also provides hospitals a new pay-
ment source for most of those patients
who previously received services, but
couldn't afford to pay.
In addition, the Medicaid program has
increased 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 the
previous 20-day limit. And, direct Medic-
aid hospital payments will increase due
to Medicaid reducing its patient co-pay
policy. Medicaid patients will now be
responsible for paying 10% of the admit-
ting hospital's Medicaid per diem for the
first covered day, rather than 22%.
Together, implementation of the new
Initiated Act 1 provisions should add
between $7 million and $9 million annu-
ally to Medicaid hospital payments.
Winter 2002
Arkansas Hospitals
Arkansas Medicaid Expansion
Policies Implemented
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Reminder: Nurse License
Renewal Available Online
Since July 1, 2000, over 2,300 RNs,
LPNs, and LPTNs have renewed their
licenses online with the Arkansas State
Board of Nursing (ASBN). (Advanced
practice nurses and registered nurse
practitioners will soon be able to renew
online.) Online renewal is a simple,
step-by-step procedure requiring the
use of a credit card. To renew a nurse
license online or to change your
address, visit the ASBN Web site at
Contact Tina Creel

Page 21
Arkansas Hospitals
Winter 2002
Last June, the Medicare Payment
Advisory Commission (MedPAC) issued
a report to Congress that included five
recommendations for increasing pay-
ments to rural hospitals. Among those
was one for a "low-volume" adjustment
for rural facilities that have negative
margins and treat few Medicare benefi-
ciaries. At the time, the recommenda-
tion was given little consideration when
some members of Congress suggested it
wouldn't help much.
Now, a more detailed analysis of
that recommendation prepared by
MedPAC for congressional staffers and
released October 31 indicates that the
adjustment would be highly beneficial
to those facilities. In fact, among all
the recommendations made in June,
the low-volume adjustment would be
the biggest help for those very small,
very isolated facilities, according to the
analysis. The recommendation pro-
vides for a maximum 33% adjustment
for hospitals with up to 600 discharges
per year.
MedPAC's analysis says it would pro-
vide a 6.2% increase in payments for the
impacted facilities, compared with 0.2%
to 1.1% for the four other options.
Other MedPAC-recommended actions
included increasing the cap on dispro-
portionate share hospital payments
from 5.25% to 10%; completing the
phase-out of wage data for teaching
physicians, residents, and certified reg-
istered nurse anesthetists from the hos-
pital wage index; and reducing the pro-
portion of payments adjusted by the
wage index (from 71% to 67% in the
latest analysis). MedPAC didn't take a
position on a fifth policy, increasing
the base payment for other urban and
rural areas to the level of the rate for
large urban areas.
MedPAC Suggests Hospital Payment Changes
The Arkansas Hospital Association
(AHA) has begun the enrollment
process for the DATABANK Program.
Approximately 36 hospitals have
signed up to participate in the Web-
based monthly survey that tracks
selected hospital financial and utiliza-
tion indicators. The program is being
offered to AHA's hospitals as a free
member service. There is no cost to par-
ticipate, only a commitment to have
someone in the hospital be responsible
for entering data each month.
While DATABANK is a free member
service, hospitals are required to sign
up to gain access to the secure Internet
site. 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, participants
are advised to change their individual
passwords frequently, as is the case
with other limited-access Internet-
based programs.
Questions about the DATABANK Pro-
gram should be directed to Paul Cun-
ningham at
, or by calling (501) 224-7878.
Program Memorandum A-01-117,
issued by the federal Centers for
Medicare and Medicaid Services (CMS)
September 26, 2001 establishes new
dates for healthcare providers to submit
their Medicare cost reports (MCRs) and
dates by which the program's fiscal
intermediaries are to produce and mail
their Provider Statistics and Revenue
(PS&R) reports.
The MCR due dates are dependent on
providers' cost report ending dates, with
the soonest set at February 17, 2002 for
all affected healthcare providers having
ending dates between August 1, 2000
and September 30, 2000.
Generally, the cost report due dates
fall 37 days after the prescribed PS&R
mail dates to allow providers 30 days to
complete their cost reports, plus an addi-
tional seven days for the postal service to
deliver the PS&R to the provider. For spe-
cific due dates, click on
Cost Report, PS&R Due Dates
More than 500 hospitals in seven
states (not including Arkansas, but
neighboring states Missouri and Ten-
nessee are included) will be the first to
take part in an Internet survey sponsored
by The Business Roundtable's Leapfrog
Group. It is hoped that this survey will
lead to improvements in patient safety.
The Leapfrog Group is a consortium
of approximately 90 Fortune 500 com-
panies and other private and public
healthcare purchasers. It began its work
in November 2000, developing plans to
reward hospitals that make advances in
patient safety and in educating staff and
patients about related issues.
The current survey queries hospitals
on three key issues: computerized med-
ication entry systems; physician staffing
in the intensive care unit; and evidence-
based hospital referral, which is the
practice of referring patients with com-
plex medical needs to hospitals that
offer the best survival rates for these pro-
When it is complete, Leapfrog plans
to use the information for educational
purposes and to "recognize and reward
providers." The results of the survey will
be made available to the public.
Any hospital can participate in the
survey by requesting an identification
and security code at the group's Web
, or by
calling the survey help line at 734-
Leapfrog Group Works to
Improve Patient Safety

Page 22
Winter 2002
Arkansas Hospitals
When you are faced with difficult decisions,
you should choose from as many opportunities
as the recipe for success
Frank Butts * Joe Newman * Phil McLaughlin
11500 Rodney Parham Road * Suite 9 * Little Rock, AR 72212 * (800) 683-5401
MSL offers both national and international services through membership in
Moore Stephens North America, Inc. and Moore Stephens International Limited.
It is a network of independently-owned and operated member firms with a com-
bined strength of 11,000 partners and employees and 380 offices in 80 countries.
Several Web sites have been developed to
assist hospitals and other organizations in
their readiness for the Health Information
Portability and Accountability Act's (HIPAA)
deadlines. Some of the sites are:
-Sponsored by the
Arkansas Department of Human Services,
this site is a compendium of information
for healthcare providers, consumers, and
government agencies.
-Provides online
compliance training for all employees
including a test to determine employee
understanding and awareness. There is a
fee for this service.
-Offers infor-
mation on vendors that are HIPAA
Information from the American Hospi-
tal Association with links to valuable
HIPAA Web Sites
Boozman Elected to
Represent Third District
Voters in Arkansas' 3rd Congressional Dis-
trict have elected Republican John Boozman
to the U.S. House of Representatives. Booz-
man, a Rogers optometrist and brother of
Arkansas Department of Health director Fay
Boozman, defeated state Representative Mike
Hathorn in a November 20 special election
held to decide the successor to Asa Hutchin-
son. Last August Hutchinson was named
director of the federal Drug Enforcement
Congressman Boozman has been assigned
to the Transportation and Infrastructure, and
Veterans' Affairs Committees.
Hospital executives and trustees in the 3rd
district are encouraged to visit with Rep.
Boozman, while Congress is adjourned for
the year and members are home for the hol-
idays, to familiarize him with items on hospi-
tals' advocacy agenda that are addressed in
H.R. 1609 and H.R. 1556.
Those bills would place a floor on the
Medicare Area Wage Index for all hospitals,
equalize Medicare prospective payment sys-
tem (PPS) base rates and provide for a full PPS
update for hospitals.
Hospital officials across Arkansas also must
educate each of the state's senators and con-
gressmen about the need for money to do
everything necessary to ensure they are pre-
pared for a potential chemical, biological or
nuclear event.
Individually, hospital CEOs should know
and communicate how much it will cost
their 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 respond
to a situation that might result in mass

Page 23
Arkansas Hospitals
Winter 2002
According to
Sentinel Event Alert
number 24 issued in December, the
Joint Commission on Accreditation of
Hospitals (JCAHO) has taken a second
look at surgical mistakes-surgeries on
the wrong site, the wrong patient or
performance of the wrong proce-
dure-that are completely preventable
and should never happen.
At the time of the first
August 1998, the JCAHO reviewed 15
cases reported to the organization.
Today, the Sentinel Event database
includes 150 cases of surgical mis-
takes. Of the 150 cases, 126 have root
cause analysis information noting
that 41% relate to orthopedic/podi-
atric surgery; 20% to general surgery;
14% to neurosurgery; 11% to urologic
surgery; 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 including
wrong site surgery, JCAHO advises
patients and family members to make
sure that there is total agreement
between themselves, their primary
care doctor and the surgeon about
exactly what will be done and where.
A good resource is the Agency for
Healthcare Research and Quality's
Patient Fact Sheet-20 Tips to Help Pre-
vent Medical Errors
(available at
which provides tips for patients to
help prevent medical errors, including
wrong site surgery.
JCAHO reiterates the importance of
implementing risk reduction strategies
as stated in the earlier issue of
Event Alert
and suggests developing
processes to assure the correct surgical
site, patient and procedure by: 1)
marking the surgical site and involv-
ing the patient in the marking process;
2) creating and using a verification
checklist including appropriate docu-
ments, for example, medical records,
X-rays and/or imaging studies; 3)
obtaining oral verification of the
patient, surgical site, and procedure in
the operating room by each member
of the surgical team; and 4) monitor-
ing compliance with these procedures.
Additionally, JCAHO recommends
that 5) surgical teams consider taking a
"time out" in the operating room to
verify the correct patient, procedure
and site, using active-not passive-
communication techniques.
Arkansas Blue Cross Blue Shield
(ABCBS), the state's Medicare fiscal
intermediary (FI), notified all its trad-
ing partners in an October 19 mailing
about the need to test their electronic
submission of Medicare claims utiliz-
ing the X12N 4010 837 format
required under the Health Insurance
Portability and Accountability Act
(HIPAA) of 1996.
The federal Centers for Medicare and
Medicaid Services (CMS) requires all
electronic claims submitters to pass the
FI's testing related to the new format
prior to moving into production. Blue
Cross is required to set up a schedule
and begin testing on January 2, 2002,
and complete testing by September 30,
2002. Submitters will not be allowed to
test until January 2, 2002.
The letter from David Bailey, ABCBS'
Electronic Data Initiative coordinator,
encourages hospitals to begin testing as
soon as possible in an effort to have all
testing complete by September 30, 2002
and advises that they understand the
testing can be a long and lengthy
process. Hospitals that utilize the ser-
vices of vendors, billing service organi-
zations, or claims clearinghouses should
contact those groups to determine a
timeframe appropriate for testing.
ABCBS is requesting that hospitals
cooperate in setting up a testing sched-
ule by selecting the month and week
they would like to begin testing and
included a form with the letter for use
in making the selection. Once a test
date is selected, Blue Cross will send a
confirmation letter with the testing
requirements. Failure to successfully
test with the new format by September
30, 2002 will result in the loss of a hos-
pital's security and ability to submit
claims electronically.
HIPAA Electronic Submissions Testing Requirements
JCAHO Reissues
Event Alert
CPT 2002
Coding Changes
Affect All
The 2002 edition of the CPT cod-
ing manual contains a significant
number of changes, and, for some
specialties, they are dramatic. The
American Medical Association added
212 new codes to the system, 21 of
them to the newly established Cate-
gory III codes for emerging technolo-
gies; 546 revisions; and 34 deleted
codes. General Surgery has the most
changes-343-and Orthopaedics
with 213.
The new Category III codes are used
to track the use of emerging technolo-
gies. According to the Centers for
Medicare & Medicaid Services, no rela-
tive value units will be assigned to
these codes. Instead, CMS will provide
payment on a case-by-case basis only
in specific situations where the agency
has decided that the code represents
services that are not experimental (and
therefore are statutorily excluded) and
have been proven to be safe and effec-
tive. The section will be updated semi-
annually and new codes will be posted
on the AMA Web site at

Page 24
Winter 2002
Arkansas Hospitals

Page 25
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 the
twin towers of the NYC World Trade Cen-
ter not only caused shock among the
general population, but also among dis-
aster planners. Over the past six years, a
number of federal, state, and local efforts
to prepare for a terrorist attack have yield-
ed significant gains in awareness and
planning expertise.
This apparently did little to help those
that were on suicide flights, at work at the
Trade Center, or at work at the Pentagon.
First responder personnel ran into the
flaming buildings apparently unaware
that the enormous structures would soon
collapse killing all inside.
Building engineers, interviewed on
CNN, appeared uniformly in agreement
that it was only a matter of time until the
towers collapsed.
Why were we so ill prepared? Could
we have acted differently? Why was
there a lapse in intelligence that enabled
this 2-year plan to be so brutally and
efficiently achieved?
And now, the unending anthrax
attacks. Exposures and deaths from Flori-
da to Washington. Spores in embassies in
Peru. The US Supreme Court is closed. A
postal worker dies 6 hours after admis-
sion to a local hospital. A hospital worker
in NY dead from inhalation anthrax, an
elderly woman dead in her quiet neigh-
borhood in Connecticut.
Businesses, hospitals, elected officials,
and children in schools want to know
whether they are safe. Can communities
protect its citizens from attack? Can hos-
pitals care for biological casualties? Is
there a greater threat on the horizon in
the form of smallpox?
From the President to federal agencies
to state officials, it is clear that homeland
defense and domestic preparedness are a
matter of national priority, national con-
cern, and national security.
In the last decade, the public has
learned of the potential threat of
weapons of mass destruction (WMD).
Historically, only the military and those
within the government with a need to
know understood the management of
these weapons, (high explosives, nuclear
weapons, radioactive materials, biologic
weapons, and chemical weapons).
In the last few years, federal agencies
have supported a series of educational
events that have made this information
available to first responders and the hos-
pital community. Despite billions of dol-
lars spent on national preparedness, it is
generally accepted that the response to a
terrorist attack will mainly involve local
first responders and health personnel, at
least for the first 4-36 hours. In order to
protect our cities and states, it is essen-
tial that first responders (EMS, fire,
police), emergency managers, public
health officials, medical personnel, and
hospitals understand the threats of
WMD and the medical consequences of
a terrorist attack.
The community's first responder and
medical systems must have the capacity
to support medical operations in the face
of a list of hazards. A hazard assessment
may determine that the community is at
risk due to floods, fires, tornadoes, and
community unrest. Accidental commu-
nity exposure to hazardous chemicals is a
24-hour threat. Naturally occurring infec-
tious disease outbreaks have caused enor-
mous loss of life in this century.
In the past decade, the intentional
release of hazardous chemicals by the
Aum Shinrikyo in Japan alerted authori-
ties to the specter of mass casualties from
chemical exposure. The recent successful
use of anthrax as a biologic terror weapon
epitomizes the ruthlessness and effective-
ness of biologic warfare.
Although there is an unlimited list of
weapons for the terrorist to use, the abili-
ty for the community to respond to these
threats is finite. First responder personnel
resources are fairly fixed. Hospital
resources are shrinking, not expanding.
Financial resources, although temporarily
receiving a new influx of federal assis-
tance, must be used efficiently in order to
maximize this once-in-a-lifetime oppor-
tunity to expand equipment caches and
training capabilities.
Communities should approach this
opportunity to improve preparedness in
an "all-threat" or "all-hazards"
approach. A generic mass casualty plan
will enable communities to meet the
needs of victims.
The first step: focus on community
chemical preparedness. It is reasonable to
do 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 protective
* In most communities, there is a greater
risk 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 chemicals
utilized by local industry, transported by
rail or truck, sold in hardware stores and
grocery stores, and stored on the shelves
of our homes.
Traditionally, fire personnel have had
years of training focusing on the response
to hazardous materials events. In many
cities, specialized HazMat teams have the
training and the capacity to assess chem-
ical spills and releases, utilize equipment
to identify the offending chemical, and
the equipment limit the extent of the
chemical spill. Although fire personnel
have equipment and training to deconta-
minate victims, until the sarin release in
Japan, most HazMat teams had not
focused on treating casualties. Thus there
is a gap: the fire system can recognize
chemical injuries, but the available treat-
ment is fairly limited.
Police and EMS have not tradition-
ally had a large role in HazMat
responses. Thus, they are not trained
to wear protective gear that would
enable them to safely participate in the
evacuation and decontamination of
contaminated victims. In many cases
documented by the Agency for Toxic
Substances Disease Registry, police and
EMS personnel have become victims
after a chemical exposure.
It is essential that all first responders
have the appropriate training and equip-
ment to enable them to operate safely in
a 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 medical
needs of mass casualty victims of a terror-
ist attack: explosives, chemicals, biologic
agents, radioactive materials, and nuclear
In particular, hospitals have a commu-
nity responsibility to offer care to injured
HazMat victims.
1, 2
In some cases, the
injury might be a result of an exposure to
a hazardous chemical or infectious haz-
ard. No matter the source of the injury,
accidental or intentional, whether it
occurs at work, at home, or on the road,
the hospital must have the capacity to
safely assess for injuries and to safely offer
care. This responsibility extends to the
victims of a terrorist attack.
In this era of fiscal responsibility, hos-
pital expenditures are often limited to the
most critical needs. The recent terrorist
attacks, however, have alerted hospital
executives to the importance of hospital
preparedness for community disasters.
Arkansas Hospitals
Winter 2002
(continued on page 42)

Page 26
The Joint Commission for the Accredi-
tation of Healthcare Organizations
and OSHA recommend that
hospitals have the capacity to safely
assess and treat patients exposed to
hazardous materials. Any training
must be consistent with OSHA recom-
How can cities prepare for these
threats? What can the hospitals do to
support the efforts of the community?
How should a hospital reasonably
approach the dilemma of managing
patients exposed to hazardous materials?
Whether the result of an accident at
home or at work, an industrial or trans-
portation accident, or a terrorist attack, if
the release of these hazards results in
human casualties, they will come to the
hospital for care.
If the hospital CEO, the emergency
administrative nursing staff, the physi-
cian staff, and the facility and security
managers agree to develop a system of
response, how grand should the prepara-
tions be? The Agency for Toxic Sub-
stances Disease registry noted, in their
landmark research
, that in most cases
one or two victims seek medical care after
a HazMat event. Many in government,
however, are reasonably concerned
regarding the threats of a terrorist attack
and recommend that hospitals prepare
for mass casualties.
How many casualties should the hos-
pital expect in a mass casualty event?
10? 50? 100? 1000??? How should
responsible decision-makers approach
this problem?
A reasonable and cost-effective
approach should enable any hospital
with an emergency department to reli-
ably and safely care for victims of a Haz-
Mat or terrorist event 24 hours a day, 7
days a week. This preparedness should
include policies that protect employees,
victims, the institution, and the envi-
The hospital should, at the very mini-
mum, be prepared to handle AT LEAST
This level of pre-
paredness requires OSHA Operations
training, appropriate personal protective
equipment, decontamination systems,
policies and procedures, and the support
of security personnel. If the hospital can
function and deliver care to a single
patient, then the policies can be easily
configured to manage ten, thirty, or even
a hundred patients. This step-wise
increase in preparedness will enable the
hospital to support the community in the
event of a mass casualty event. This is a
minimum level of preparedness.
If a hospital is prepared for a defined
minimum level of risk, then these poli-
cies and systems can be used to treat the
vast majority of exposures. Plan for a few
and train for many. This is a reasonable,
cost-effective approach for hospital ter-
rorism preparedness. If hospital planners
focus solely on the physical resources
necessary to manage the rare mass casu-
alty event, these systems may unneces-
sarily complicate preparations for the
daily threat of community HazMat. Start
with a small, cost effective system that
will enable a hospital response for com-
munity HazMat.
Then, develop the
capacity to expand these services to meet
the needs of mass casualties.
Community HazMat exposures are
likely to involve small numbers of vic-
tims exposed to hazardous chemicals in
the form of liquids or powders. This type
of 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.
rations should be consistent with feder-
al and state OSHA regulations,
rules, JCAHO recommendations, and
EPA regulations. Current recommenda-
tions include:
* Level B protection for personnel treating
victims exposed to unknown chemical
* OSHA approved Operations level instruc-
* 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
The Sentinel Event
It is important to distinguish between
attacks that cause sudden, overt, recog-
nizable injuries-"sentinel events"
1, 8, 13,
-and those that cause delayed injuries.
Attacks using explosives and chemicals
generally present as an overt sentinel
event with associated "lights and sirens"
community response and multiple
injuries. The victims and the community
will know with certainty that an attack
has taken place. A biologic attack will
have more delayed effects.
After a sentinel or overt event, it is dif-
ficult to rapidly prove that chemicals
have NOT been used in the initial
moments after an attack. Community
and hospital responders must initially
assume victims are contaminated. Fire
and HazMat responders have the
resources to detect certain types of chem-
icals. Frequently, however, patients will
arrive at the ED before assessment by
trained first responders. It will take a sig-
nificant time and resource dependent
effort for the fire department to deter-
mine with certainty that there has been
no chemical exposure. Chemical detec-
tion equipment exists, but these proce-
dures are time-consuming. Often, the
"Serving Arkansas Hospitals'
employee benefits needs for over
20 years. Anyone can give you a
price, but only a few will give you
the service"
Online Enrollment/
Information Systems
Cafeteria Plans
Health Insurance
Life Insurance
Long Term Disability
Short Term Disability
Long Term Care
Supplemental Insurance
Cancer, Cardiac, Accident
Vision Insurance
Retirement Plans
Group Auto & Home Insur-
Group Legal
Business Insurance
Buy/Sell; Key Man; Split Dollar
Deferred Compensation
A Subsidiary of the Arkansas Hospital Association
Suite 365 * 1501 N. University * Little Rock, Arkansas * (501) 664-9381
Employee Benefits
Securities & Advisory Services Offered Through InterSecurities, Inc.
Form #LD 5413-08/01
Winter 2002
Arkansas Hospitals

Page 27
Arkansas Hospitals
Winter 2002
chemical is never identified. Hospitals do
not have access to chemical identifica-
tion equipment. Thus, the system must
be prepared to protect responders and
health facilities from exposure to the
"unknown chemical."
Since it is impossible to determine
with certainty whether or not the victims
have been contaminated, a Minimum
Level of Decontamination must be
defined. Victims from a sentinel event
should not be allowed to enter a bus,
ambulance, or the medical center with-
out the removal of clothing. Removal of
clothing is the essential first step in the
treatment of the contaminated victim.
Once the clothing has been removed, the
victim will remove over 80% of the con-
taminant after liquid contamination and
nearly 100% after vapor contamination.
This may be the only decontamination pro-
cedure that is required for those victims
exposed only to a chemical gas or vapor or
biologic exposure.
Clothing removal
should be performed rapidly, as soon as
possible, and in a manner that ensures
the protection of modesty. This proce-
dure can be performed at the scene of the
attack or at the hospital. Clothing
removal remains a reliable form of initial
gross decontamination.
Some patients, after a clinical assess-
ment, might require a soap and water
shower if liquid exposure is suspected.
This decontamination should be per-
formed outdoors if possible with warm
water. If the decontamination is car-
ried within the hospital, negative ven-
tilation and containment of the runoff
is required. It is much safer and less
expensive to perform decontamina-
tion outdoors. The decontamination
facility or shower should enable decon
for both ambulatory and non-ambula-
tory victims.
Biologic Attacks
In October and November 2001, the
US has suffered numerous casualties due
to exposure to a highly lethal strain of
acillus anthracis
or anthrax. Due to the
daily changes in the recommendations
for management of these victims, please
note that this document was revised on
December 3, 2001.
As of December 3, 2001, there were
23 cases of anthrax identified: 11 con-
firmed cases of inhalational anthrax
and 6 confirmed cases of cutaneous
anthrax with 5 deaths. All cases were
from the same strain of anthrax and the
mode of attack was through letters
mailed 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 their
patients. Currently, there is no reliable
test for clinicians that will identify
anthrax exposures and infections in
patients 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 distinguish
patients with anthrax from those with
the flu, the CDC noted that anthrax
patients should not have nasal conges-
tion. At this time, there are no recom-
mendations that will enable clinicians to
determine which patients should be
treated. In the past weeks, individuals
that handle mail, work for the govern-
ment, or that work for the media were
considered at greater risk.
Communities should not, however,
limit awareness merely for the symptoms
of anthrax infections. There are dozens
of potential biologic weapons that could
cause a delayed death in humans.
The injuries from anthrax have thus
far been few. Anthrax is a bacteria that is
very stable and an excellent weapon of
MASS destruction. Tools such as hospital
critical care bed monitoring and emer-
gency department syndromic surveil-
will assist public health personnel
to recognize and respond to a mass expo-
sure from anthrax.
Mass Casualty Plan
All communities must have a rational
(continued on page 44)

Page 28
plan to manage casualties after a mass
casualty event.
The plan should be
designed to organize community
response resources so that they can be
efficiently utilized after a mass casualty
incident (MCI). The plan should be
generic in scope so that it can be used as
a routine planning document to respond
to community HazMat releases and nat-
ural events such as storms, tornadoes,
hurricanes, floods, and earthquakes as
well as terrorist attacks.
It is a matter of national security that
communities develop a rational plan to
manage mass casualties due to a terrorist
attack. This plan, formulated with input
from emergency management, fire, pub-
lic health, EMS, police, and the hospital
community should enable a 24-hour
response utilizing existing responders.
Since this threat rarely has a warning, the
community requires a rapid and orga-
nized response.
The plan will have several objectives:
* Protect the lives and health of the
* 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 targets
The mass casualty plan must reason-
ably delineate protocols and procedures
for delivering appropriate care to (1) the
critically injured, (2) the ambulatory
minimally injured and (3) worried-well
survivors. It is essential that the plan
address all three clinical groups. The
ambulatory victims will likely over-
whelm hospital and EMS resources. A
mass casualty management plan can
direct these patients away from the hos-
pital and towards a lower level of assess-
ment and care. This necessary triage will
enable hospitals to care for the more
critically injured survivors. There are
very few beds available for treatment of
the critically ill in the emergency depart-
ment. These beds should be reserved for
those survivors that require an advanced
level of medical care.
The plans should complement the
safety requirements described in OSHA's
HAZWOPER 1910.120 standards.
requirements apply to EMS, fire, police,
and hospital personnel.
8, 16
An appropriate plan will enable the
community to efficiently utilize first
responders, hospital personnel, hospital
emergency department facilities, emer-
gency management resources, HazMat
and fire resources, EMS ambulances, com-
munity buses, and other resources.
The mass casualty plan will enable
a cost-effective and manpower-effi-
cient response to the attack. The plan
is divided into:
* The Scene: Identify and harden soft
* The Response Zone: Improve triage for
a more efficient response
* The Hospital: Mandate a minimum
level of preparedness
Identify potential targets for MCI's in
the community. Identify security person-
nel in charge of these facilities. Include
these personnel in the community plan
and the response. Consider placing spe-
cific disaster equipment at these potential
sites so that they might have the capacity
to decontaminate ambulatory survivors
prior to the arrival of first responders.
Industrial security professionals can
improve terrorism and mass casualty pre-
paredness for their facilities by:
* Exercising evacuation plans
* Enabling on-site self-decontamination
* Practicing and enabling shelter-in-place
* Utilizing escape masks
* Improving personal protection for per-
sonnel handling the mail
* Establishing a one-switch capability to
shut down air handling.
Alter triage to enable utilization of off-
site treatment shelters or Secondary
Assessment Centers (SAC). Save the hos-
pital for the treatment of the critically ill.
Indemnify triage officers at the scene and
the hospital from civil and malpractice
suits. Offer ambulatory minimally ill and
worried-well survivors kits that will
enable them to self-decontaminate.
Transfer the ambulatory survivors by bus
or non-ambulance transport vehicle
away from the site of the attack.
All hospitals that have a 24-hour emer-
gency department must have the capaci-
ty to safely assess, decontaminate, and
treat victims exposed to a hazardous
Once this minimum level of
preparedness has been achieved, expan-
sion of services to include mass casualties
can be performed in a rapid and reason-
able fashion. Hospitals do not have the
capacity to manage mass casualties. Thus,
communities must plan to offer treat-
ment to victims in off-site treatment shel-
ters or secondary assessment centers. The
management of mass casualties after a
terrorist attack is not merely a hospital
problem; it is a community problem.
Dry Decon: A Mass Casualty Decon-
tamination Alternative
Personal decon kits
17, 18
enable HazMat
victims to remove clothing, in public,
without unnecessary exposure to cameras
or other observers. These kits, which
include 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 or
community HazMat exposures and mass
casualty HazMat exposures.
Studies have shown that "communi-
ty" HazMat exposures generally occur
Monday through Friday, between the
hours of 9am and 5pm.
In most cases,
no more than one or two victims require
medical assessment and treatment. These
casualties are often exposed to liquid con-
taminants. The current decontamination
standard for such exposures is water
cleansing. This high level of intervention
is attainable because of the usually small
number of victims who require deconta-
mination. Greater numbers of victims
will increase significantly the complexity
and difficulty of a decon effort. It will also
increase the inconvenience and discom-
fort experienced by the victims.
Mass casualty HazMat exposures,
according to historical sources, usually
involve chemicals in the form of vapor
or gas. Experience has shown that in
such incidents 80-90% of the survivors
are ambulatory.
These ambulatory
survivors might have minimal symp-
toms. Those survivors who are ambula-
tory and exhibit no symptoms but
who are worried that they might have
been exposed are referred to as the
The major goal for responding agen-
cies is to quickly identify, evacuate,
decontaminate, and treat those victims
who had obvious exposure to the hazard
and who suffered significant injury.
Because their injuries and exposure are
significant, many of these patients will
not be ambulatory. It will be very difficult
to rescue and provide timely treatment to
the 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 of
ambulatory survivors in a mass casual-
ty incident, it may be impossible to
offer soap and water decon to those
who are minimally ill or worried well.
If it is impossible to offer soap and
water decon because of the massive
demand from survivors (potentially in
the thousands), then it is ethically
acceptable to offer an alternative.
20, 21
addition, if it is projected that a mas-
sive number of casualties will make it
impossible to offer water decon, then it
is ethically acceptable to
not to
offer water decon and to make other
decon alternatives available as a part of
the mass casualty response plan.
Evacuation of victims and removal of
their clothing has been proven to be the
most important and effective means of
decon because nearly all of the contami-
nant will be in the clothing. This is a rea-
sonable and minimally acceptable level
of decontamination. A report from the
U.S. Army
noted "since the most impor-
tant aspect of decontamination is the
timely and effective removal of the agent,
the precise methods used to remove the
Winter 2002
Arkansas Hospitals

Page 29
agent are not nearly as important as the
speed by which the agent is removed."
In this document
, victims and their
decon priorities are divided into four cat-
egories. Decon Priority 2 refers to non-
ambulatory victims with moderate signs
of illness associated with exposure to liq-
uid or aerosol contamination. These vic-
tims were likely close to the source of the
release. Decon Priority 2 patients should
receive water decon.
The Decon Priority 3 victims, those
with minimal or no signs of injury and
no exposure to liquid or aerosol, are
ambulatory and do not require imme-
diate or significant treatment. These
patients are able to talk and walk unas-
The document suggests, "Immediate
decontamination may only involve
removal of clothing unless victim is
grossly contaminated with liquid agent."
"If responders do not have sufficient
resources to decontaminate {with water}
all potential victims, Decon Priority 3 vic-
tims may not need to be showered. They
can be immediately transferred to the
Cold (support) Zone {after removal of
clothing}." "The Incident Commander
may make this allowance if it is believed
that 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 kit
enables the victim to remove clothing
prior to water decontamination or in lieu
of water decontamination. After liquid
HazMat contamination, the removal of
clothing will remove 80% or more of the
contaminant. This might provide some
protection for these patients as they await
water decon. At the scene of the exposure
and at the hospital that is prepared to
accept and treat victims exposed to a haz-
ardous material,
these kits enable the vic-
tims to rapidly remove their clothing
while waiting for water decon. In addi-
tion, once the clothing is removed, the
victim is unlikely to leave the scene and
more likely to wait for water decon and
further processing.
For mass casualty HazMat incidents
in which the victims will likely be
exposed to chemicals in the form of
vapor or gas, the personal decon kit will
enable large numbers of ambulatory,
minimally injured, or worried-well vic-
tims to remove their clothing in a public
setting while protecting their privacy.
These ambulatory victims are likely to
have been exposed to a minimal
amount of vapor or gas. After evacua-
tion from the scene of the release and
once the clothing is removed, the chem-
ical is essentially eliminated.
In October 2001, the Aurora, Colorado
emergency management agency utilized
dry decon kits in their Domestic Pre-
paredness Chemical Exercise. Ambulato-
ry minimally ill and worried well sur-
vivors were decontaminated in a matter
of minutes using these kits.
The proce-
dure was well tolerated by the partici-
pants and greatly speeded up the decont-
amination process.
This process is neither absolute nor
perfect. After a mass casualty HazMat
exposure, some small amount of vapor
might contact the gown or poncho-like
garment, but it will more than likely
blow away. Vapor and gas will permeate
clothing in an area of high vapor con-
centration near the area of release, not
just by having the poncho-like garment
touch the clothing. Remember, these
victims have been triaged; they exhibit
minimal or no signs of exposure and
have likely been exposed to little or no
chemical. Therefore, this is a reasonable
In any event, it is likely to be impos-
sible to offer water decon to every vic-
tim in a mass casualty incident. To
attempt to do so would put seriously ill
victims who are non-ambulatory at
greater risk since critical resources-
both human and logistic-would have
to be directed towards the minimally
ill and worried-well. It is reasonable to
offer this high level of decon only to
those who might benefit most.
Thus, dry decon offers a reasonable
alternative to the usual practice of water
decon. It is not a "sterile" or perfect pro-
cedure, but it offers the opportunity to
rapidly decon and evacuate large num-
bers of ambulatory survivors after a mass
casualty incident. It enables a cost-effec-
tive, manpower-efficient and achievable
solution for the incident commander, the
hospital, and the community.
Dry decon can be achieved at the
scene or the hospital. Local businesses,
building security, police, fire, EMS, and
hospital triage can all perform decon
with this manpower efficient modality.
Communities must develop the capac-
ity to evaluate, triage, decontaminate, and
treat victims of a terrorist attack. This
planning should be included in a generic
mass 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 first
responders. Soft targets can develop an
evacuation plan and decontamination
plan consistent with the community
mass casualty plan.
1. Siegelson HJ. Preparing for terrorism and haz-
ardous material exposures: A Matter of Worker
Safety. Health Forum J 2001; 44:32-5.
2. Wetter DC, Daniell WE, Treser CD. Hospital pre-
paredness for victims of chemical or biological
terrorism. Am J Public Health 2001; 91:710-6.
The CompleteRx team focuses on the
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Arkansas Hospitals
Winter 2002

Page 30
Comfort heals
1000 S. Shackleford Road, Little Rock AR 72211
(501) 224-4655
Fax (501) 224-6208
Surrounding the lush garden atrium are
251 spacious, two-room suites. Each suite
includes a separate vanity/dressing area
and large bedroom with the choice of two
double beds or one king. Spacious living
rooms feature a sleeper sofa, a well-lit
dining/work table and a kitchen complete
with a wet bar, refrigerator, coffeemaker
and microwave.
For lunch or dinner, dine in the comfortable
atmosphere of the Athletic Club-A Sports
Bar and Grill. Guests of the hotel will also
enjoy a complimentary, cooked-to-order
breakfast each morning and an evening
manager's reception.*
*Subject to state and local laws
From intimate meetings to lavish receptions,
our 14,000 square feet of flexible meeting
space can accommodate events of every
size, including an impressive 11,000-square-
foot ballroom, smaller conference rooms
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audiovisual equipment and a complete
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Work out all your tensions in our fully
equipped fitness center, complete with
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(501) 312-9000
11301 Financial Centre Parkway
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* Secure off-site Storage of Paper Documents
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* Statewide Service
(501) 316-0022
Medical, Legal, and Financial
Records Management
"Your Records Management Solution"
Winter 2002
Arkansas Hospitals
3. Evans M. America's Ordeal. Newsday. New York,
4. Comprehensive Accreditation Manual for Hospi-
tals: The Official Handbook. Environment of Care
Standards, EC.1.5, Hazardous Materials. Oak-
brook Terrace, Illinois: Joint Commission on
Accreditation of Healthcare Organizations, 1999.
5. 29CFR1910.120, Hazardous waste operations
and emergency response. Occupational Safety
and 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 Government
Printing Office.
7. 29CFR1910.132, Personal Protective Equipment.
Occupational Safety and Health Standards. Code
of Federal Regulations: US Government Printing
8. Fairfax D. OSHA: Emergency response training
necessary for hospital physicians/nurses that may
treat contaminated patients. Standard Number:
1910.120. OSHA Standards Interpretation and
Compliance Letters: Directorate of Compliance
Programs, 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.
10.Levitin HW, Siegelson HJ. Hazardous materials.
Disaster medical planning and response. Emerg
Med Clin North Am 1996; 14:327-48.
11.Hazardous Substances Emergency Events Surveil-
lance, Annual Report. Atlanta, Georgia: Agency
for Toxic Substances Disease Registry, 1996.
12.Hospital HazMat and Terrorism Training, decon
showers and personal decon kits, regulatory
compliance, disaster planning. Indianapolis:
13.OSHA Standards Interpretation and Compliance
Letters: Emergency response training necessary
for hospital physicians/nurses that may treat con-
taminated patients: US Office for Safety and
Health Administration, 1999.
14.OSHA: Hospitals and Community Emergency
Response: What You Need to Know: US Depart-
ment of Labor, Occupational Safety and Health
Administration, 1997.
15.Gerena-Morales R. First Nonmilitary Hospital To
Track Outbreaks, Bioterrorism Symptoms. The
Tampa 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 Dry
Decon Alternative.
. Indi-
18.Sidell FR. Chemical agent terrorism. Ann Emerg
Med 1996; 28:223-4.
19.Lake W. Guidelines for Mass Casualty Decontam-
ination During a Terrorist Chemical Agent Inci-
dent: Chemical Weapons Improved Response
Program, Domestic Preparedness Program, U. S.
Soldier Biological and Chemical Command,
20.Brennan RJ, Waeckerle JF, Sharp TW, Lillibridge
SR. Chemical warfare agents: emergency medical
and emergency public health issues. Ann Emerg
Med 1999; 34:191-204.
21.Pesik N, Keim ME, Iserson KV. Terrorism and the
ethics of emergency medical care. Ann Emerg
Med 2001; 37:642-6.
22.Straight B. Emergency Management Specialist,
Office of Emergency Management, Aurora, Col-
orado, 2001.

Page 31
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Page 32
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