West River Health Services

In the 1960’s when Dr. Paul Retzer set up his clinic in Hettinger, he convinced his UND classmate, Dr. Jerry Seiler to join him. The doctors wanted to practice medicine as they had been taught to practice medicine – with caring and commitment. They also wanted to provide an urban level of care in a rural environment. The clinic opened its doors as a progressive practice and has become a model system of rural health care.

The system consists of eleven primary care clinics enhanced with specialty services in mental heath, diabetes, optometry, and podiatry; a state of the art hospital, the West River Regional Medical Center; the West River Nurse Corps providing home health care; and Home Medical Services which offers the sale, rental, service, delivery and set-up of home medical equipment and supplies, and an the West River Ambulance Service.

To be progressive, to provide an urban level of care, the doctors had to generate attract a larger client base in order to be able to afford to acquire and support the technology that modern medicine requires. They also had to attract the right mix of physicians with both general and specialty knowledge.

Known as the “little Mayo” for because of its expertise and progressive approach to care, West River Health Services boasts eight family practitioners, three with dual-boarded in geriatrics), two internal medicine/geriatric physicians, one general surgeon, one radiologist, one optometrist, two internal medicine, one podiatrist, and one pediatrician. The center also has eleven satellite clinics, covering over 25,000 square miles, providing services to over 37,000 people. Technology in service to those residents rivals that of more metropolitan areas with a complete radiology lab, cardiac rehab, CAT scanner, nuclear medicine, and color flow ultrasound equipment. To round out services, West River maintains a strong clinical affiliation with specialty physicians from the PrimeCare Group in Bismarck who provide regular on-site clinical visits in cardiology, orthopedics, ENT, ophthalmology, urology, neurology and nephrology.

West River Health Services Administrator, Jim Long, describes one of the many innovative, service-oriented aspects of the rural practice. “Each clinic gets one full-time position. But on one day, you’d get an internist with a high interest in diabetes. On another you’d get a doc with a specialty in asthma. Then you’d get someone with a little bit more pediatrics. So you get these different interests and specialties with the equivalent of one FTE position. In an urban environment, your family doc has to refer you out. We can do lots of things right here.”

One of the most unique aspects of the West River Health Services program is its “Good Neighbor Project” which is a grassroots campaign committed to ensuring continued access to high-quality health care for people in the region who can no longer afford health insurance and the access to primary care that such insurance provides. The faltering rural economy combined with declines in Medicare reimbursements led to the creation of the Good Neighbor Project which raises funds to assist rural families with “first dollar” health care costs. The Good Neighbor Project takes its name and its mission from rural traditions where neighbors help each other in times of need – whether it be at harvest, for a barn raising, or in the wake of a tornado.

The Clinics
Recognized as a leader in rural health care, the West River Health Clinics have received the highest award for excellence from the National Rural Primary Care Association. The eleven primary care clinics in the system are located in:

Bison
Bowman
Buffalo
Dickinson
Hettinger (2)
Lemmon
McIntosh
Mott
New England
Scranton

The System oversees two additional clinics in Isabel and Faith, South Dakota.

One of the things that makes West River Health Services notable is its pro-active approach to rural health care. As a part of its clinic services, the West River Regional Medical Center monthly Diabetes Management educational clinics for individuals diagnosed with diabetes. The Diabetes Management Team including a certified diabetes nurse educator, a dietitian educator, podiatrist, internist, optometrist, physical therapist and counselor meet with individual diabetic patients to complete tests, develop a detailed medication history, complete diet and monitor checks, and discuss health needs. The individuals’ primary care physician is also an important part of the team and provides help with day-to-day concerns.

The nine primary care clinics are enhanced by three specialty clinics – the West River Eye Center, the West River Family Center, and the West River Foot and Ankle Center.

The Eye center, located in the Hettinger Clinic building, provides optometric services including the treatment and management of glaucoma and ocular diseases. Special interests include children’s visual systems, macular degeneration, and difficult-to-fit contact lens patient needs.

The West River Family Center provides a broad range of services in individual, family, and marriage counseling. Both therapy and medical consultation are available with payment options on a sliding fee scale based on income and family size.

The West River System provides primary foot and ankle care as well as general podiatric surgery as part of its clinic services. The podiatric specialist travels anywhere from two to four days per week to provide healthcare options to clinic clients across the 25,000 square mile coverage area. Because it saw a rise in the number of patients from Dickinson, South Heart, Richardton and Belfield who had to travel to West River Clinics in Mott and New England for services, the West River Health System expanded its services and opened the West River Foot and Ankle Center in Dickinson.

While not quite “home visits”, the fact that West River Health System doctors travel to the patients rather than the patient always traveling long distances to the doctors, makes a difference in the quality of rural care.

Designed to ease the transition from hospital to home, the West River Nurse Corps offers multiple services for residents in Slope, Hettinger, Bowman and Adams counties in North Dakota. The Corps provides nursing staff to meet home health care needs including disease education, medication administration and wound care. Home health aides provide personal care including home-based physical and speech therapy. A social worker helps residents access resources such as homemaker services and financial assistance.

Home Medical Services offers the sale, rental, service, delivery and set-up of home medical equipment and supplies. The service includes monthly in-home assessments of respiratory patients by credentialed therapists and nurses, oxygen concentrators, respiratory medications, 24 hour emergency service, claims processing for Medicare, Medicad and insurance, and a direct mail service. The Home Medical Services is designed to fill the gap in durable medical equipment offered in the West River Region.
An innovative service since its inception in 1944, the West River Ambulance Service was the first volunteer ambulance service in North Dakota to receive formalized emergency training, the first to employ a full time Paramedic, the first to provide Advanced Life Support in the region. The ambulance service crew, which consists of 2 full time and 2 part time paramedics, 6 EMT Basics, 6 EMT Intermediates, 1 North Dakota First Responders and 7 CPR drivers, responded to over 300 ambulance runs in 2001.

The 2,500 square mile coverage area requires an average of 300 ambulance runs each year.

For more information about the West River Health Services system, visit their web site at www.wrhs.com

Funding for Life Support is provided by a grant from USDA Rural Development