SATURDAY, OCT. 19, 2013
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TIMES RECORD
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A Stephens Media LLC Newspaper Serving Fort Smith, Western Arkansas and Eastern Oklahoma
SPECIAL SESSION
Teacher
Insurance
Fix OK’d
STATE LAWMAKERS REJECT
SCHOOL TAX PROPOSAL
By Rob Moritz and John Lyon
ARKANSAS NEWS BUREAU
[email protected]
LITTLE ROCK — While a
measure to allow the state
to collect excess property
tax revenue from wealthy
school districts failed to get
traction during the special
session Friday, lawmakers
reconvened just after midnight to give final approval
to a plan to stabilize healthinsurance premiums for
teachers and other school
employees.
The decision to meet at
12:01 a.m. today was made
to meet the minimum
three-day requirement for
the Legislature to meet
and pass bills. The special
session convened at 3 p.m.
Thursday.
“It’s imperative that we’re
here,” House Speaker Davy
Carter, R-Cabot, told House
members about returning
to the chamber early today.
“Staff is going to be here,
a lot of preparation is going to go into being here
that time of the evening …
so, it really would be a bad
scenario if we got here and
there wasn’t a quorum.”
While the House and
Senate overwhelmingly
supported identical bills
for comprehensive reforms
to avert steep increases in
school employees’ healthinsurance premiums, a mea-
sure that would require any
school district that collects
revenue from a statewide
25-mill property tax in excess of the state-mandated
per-student funding level to
turn the excess money over
to the state Department of
Education, stalled in the
House Education Committee.
Friday morning, House
bill 1007 by Rep. Joe Jett, DSuccess, was tabled in a 10-8
vote by the committee.
An attempt in the same
meeting to bring the bill off
the table failed in a voice
vote. The committee met
again later Friday, and a
third attempt to bring the
bill off the table failed in
an 8-8 vote. The committee has no more meetings
scheduled.
“Pretty much, URT is
dead this session,” Jett told
reporters after the final
attempt to revive the bill
failed.
Jett said some legislators were concerned that
the eight school districts
that would be affected by
the measure did not have
enough time to mobilize
their forces against the bill.
Those districts are Armorel, Eureka Springs,
Fountain Lake, Mineral
Springs, Nemo Vista, South
Side, Quitman and West
Side.
CHAD HUNTER • TIMES RECORD
McClure Amphitheater at Chaffee Crossing, seen Friday, is scheduled to reopen next month, according to
the Fort Chaffee Redevelopment Authority.
Amphitheater Set To Reopen
STONE STRUCTURE CLOSED FOR NEW ROAD BUILT AT CHAFFEE CROSSING
By Chad Hunter
TIMES RECORD • [email protected]
A 60-year-old stone amphitheater that was rebuilt
in 2011 then shuttered a
year later for a new road
at Chaffee Crossing will
reopen in early November.
The Fort Chaffee Redevelopment Authority and
city of Fort Smith will hold
a joint ribbon-cutting ceremony at 4:30 p.m. Nov. 8
to officially open McClure
Drive and reopen McClure
Amphitheater, which was
closed in late 2012 for construction of the road.
“McClure Drive, believe
it or not, is finally finished,” FCRA Executive
Director Ivy Owen said.
“The amphitheater will be
reopened. It’s in a state of
disarray now because it’s
been closed for a year, but
it will be cleaned by Nov. 8.
It will look as good as the
rest of it.”
Commissioned by Col.
George McClure, the out-
door amphitheater overlooking Fort Smith was
originally constructed in
1953 at what was then Camp
Chaffee, according to the
city. It was used extensively as a combat training site
during World War II before
falling into disuse and disrepair.
An effort by the FCRA
to rebuild the amphitheater, located near Massard
Road, culminated in a rededication on Sept. 17, 2011.
It reopened the following
month but was closed in
late 2012 for the road project, designed to improve
accessibility to the amphitheater and open the area
around it to further development.
“It was one of the Army’s
access trails, so basically
we built a new road,” Fort
Smith City Administrator
Ray Gosack said. “It’s now
a concrete street versus
what used to be a gravel
road.”
SEE REOPEN PAGE 8A
MEDICAL COVERAGE
IN BUSINESS
Mercy
Hospital
Winning
Sepsis War
SEE SESSION PAGE 8A
By John Lovett
TIMES RECORD • [email protected]
death rates for stroke in
the United States.
Within an hour of
Smallwood’s stroke, Drs.
Margeret Tremwel and
Clint Wood were waiting
at Sparks Regional Medical Center in Fort Smith
for Smallwood to arrive
by Tulsa Life Flight helicopter. A certified training center for Advanced
Stroke Life Support, Sparks
is on the road to becoming
the only other comprehensive stroke center in the
state besides the University of Arkansas for Medical Sciences in Little Rock.
The phrase “miracle of
modern science” is one most
often heard at a hospital,
where advances are put into
life-saving practice with hightech equipment and highly
trained doctors and nurses.
Less visual, but still
saving lives,
is the computer science behind
an advanced
electronic
medical reBritton
cords program used by Mercy hospitals.
At the recent Mercy Hospital Community Roundtable,
with community leaders and
hospital executives from Fort
Smith to the company headquarters in St. Louis, Mercy
President and CEO Lynn
Britton pointed to the hospital organization’s computer
program that cut down on
sepsis infection by 60 percent in the ER in its first six
weeks.
Severe sepsis and septic
shock are more common
worldwide than breast cancer, colon cancer and AIDS
combined and killing one
patient in four, he said.
SEE STROKE PAGE 8A
SEE MERCY PAGE 8A
PHOTO COURTESY SPARKS HEALTH SYSTEM
Drs. Clint Wood, left, and Margaret Tremwel are seen at Sparks
Regional Medical Center in Fort Smith where stroke patients are treated.
THE ASSOCIATED PRESS
Senators and staff members gather in the
Senate chamber at the state Capitol in Little Rock on Friday
to discuss a plan to stabilize health insurance premiums
for teachers and other school employees.
GETTING STARTED
I N
T H E
N E W S
Obama Budget Goal Elusive As Talks Begin
WASHINGTON — Forget talk of a budgetary grand bargain
when members of Congress sit down to meet a December
deadline for progress on a revenue-and-spending plan.
Lawmakers say even a mini-bargain to carry the government
through the next year or two would be difficult.
FULL STORY, 6A
States Demanding Federal Land Back
WASHINGTON — The shutdown may have ended, but not
before refueling an old demand among some Western states:
It’s time for Washington to turn over some land.
FULL STORY, 8D
INDEX
TIMES RECORD
Volume 131, Number 292, 32 Pages
Sparks Center On Edge
Of Care In ‘Stroke Belt’
By John Lovett
TIMES RECORD • [email protected]
Christopher Smallwood,
an active and seemingly
healthy 28-year-old rock
quarry worker, fell to the
kitchen floor at his home
near Waldron Sunday
morning. His body was
numb, and the back of his
neck hurt.
He didn’t know it, but
he was having a stroke.
A 1½-inch blood clot had
formed in the right side
of his brain that could kill
him in a matter of hours.
Fort Smith lies on the
edge of what’s called the
“Stroke
Belt,”
covering
most of
the southeastern
states.
A study
published Smallwood
in 2012 by
the medical journal Neurology showed that between 1995 and 2008 there
had been a 23 percent increase of strokes among
people between ages 5 and
44. According to the Centers for Disease Control
and Prevention, Arkansas has one of the highest
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SATURDAY, OCT. 19, 2013
SESSION: Governor Supported Bill To Collect Excess Property Taxes From Wealthy Schools
CONTINUED FROM PAGE 1A
“I do believe it’s going to
be something that at some
point the Legislature will
have to come back and address, possibly next session,”
Jett said.
A matching Senate version of the bill was endorsed
Thursday by the Senate
Education Committee, but
the sponsor of that bill, Sen.
Bruce Maloch, D-Magnolia,
said he did not plan to introduce the bill on the Senate
floor.
“They tabled it in the
House committee, which effectively is a way to kill it,
so if it can’t get through the
House there’s no need for us
to spend time on the floor de-
bating it here,” Maloch said.
The measure was a response to a state Supreme
Court ruling last year that
said districts are not required
to turn excess revenue over
to the state, although the
court said the Legislature
could change the law if it
wished. Gov. Mike Beebe
supported the bill.
“It’s effectively done,”
Beebe told reporters Friday.
“I believe it’s the right thing
to do … but it’s a democratic
process.”
Beebe added, “What I said
after (last year’s state Supreme Court) decision was
that it could signal the slow
unraveling of Lake View.
Some people thought that
STROKE: Waldron Man Flown
By Helicopter To Sparks
CONTINUED FROM PAGE 1A
Its stroke care has been
rated No. 1 in the state
of Arkansas by a leading
health-care ranking company, the Delta Group’s
CareChex.
Smallwood was one of
the lucky ones, living as
close as he does to a stroke
center and with the right
people around him to get
him to the hospital in time.
“At first I didn’t want to
call anybody,” Smallwood
said Tuesday from his hospital bed at Sparks.
His girlfriend thought
otherwise and called his
mother, Kim Page, who was
in Poteau at the time with
her husband, Malcom Page.
Kim Page called their
neighbor, Terry Nix, a first
responder with Stateline
Volunteer Fire Department
who lives near both Smallwood and the Pages.
Nix, who was getting
ready for church, rushed
over to find Smallwood on
the floor but still awake.
“I wasn’t positive, but I
thought he might have had
a stroke,” Nix said. “He was
lying funny, and I knew
he’d fallen and tried to get
up a couple times. But you
just don’t think of a young
man having a stroke.”
Nix had Smallwood grab
his hands and squeeze.
“There was no reaction
on his left side. He was
real weak and wanting to
doze off,” Nix said.
Nix wasn’t sure if anyone had called an ambulance so he rang the dispatcher. By then Nix knew
Smallwood was having a
stroke and that every second counted.
The Life Flight helicopter based in Poteau was
alerted and within seven
minutes it had landed in a
field nearby.
An ambulance delivered
Smallwood to the helicopter, and 24 minutes later
it had flown the 50 or so
miles to Sparks in Fort
Smith.
“Someone from the flight
crew said it would be best
to take him to Sparks,” Kim
Page said. “I said ‘OK. Take
care of him.’ I really think
God had a hand in it.”
Sparks is northwest Arkansas and eastern Oklahoma’s only Gold Seal accredited Primary Stroke
Center offering complete
neurovascular medical and
surgical care for patients
suffering strokes and/or
aneurysms, the hospital’s
website states. Tremwel
also provides emergency
stroke telemedicine service to more than 15 regional hospitals.
The emergency room
received a “code stroke”
alert from the in-bound
helicopter.
Tremwel, recognized by
many as being the foremost stroke expert in the
area, had guided doctors to
save three other 30-something stroke patients in the
same week through the
telemedicine program.
Upon Smallwood’s arrival, a clot-dissolving drug tPA (tissue plasminogen ac-
tivator) was given, but because of the severity of the
blood clot, the drug could
not open up the blood flow.
Tremwel knew the “time
last well” was under 4½
hours, so the patient was
a potential candidate for
“invasive therapy.” Within
minutes, Wood and his
team were ready to work
a clot-grabbing device in
a 6 mm tube through a
major artery; beginning in
the groin, then through the
heart and up into the brain.
It takes hours of intense
navigation.
For a little more than a
year, since it was approved
by the FDA, Wood has
used a new type of blood
clot extraction tool called
a Solitaire FR Revascularization Device. A previous
device used was more of
a “corkscrew” guided by
a balloon-tipped wire to
snare and remove the clot,
Wood explained.
The Solitaire, in contrast, is a kind of columnar
metal cage and when expanded engages the clot at
multiple strut points. The
procedure was successful,
and got most of the blood
clot. To finish up, they
used a “penumbra” device to remove additional
plaque that had built up in
the artery.
Strokes in younger patients are more deadly
than in older patients,
Tremwel said, because
the brain has not shrunk
as much and there is less
room for swelling.
“Compression often ends
up in younger people to be
fatal,” Tremwel said. “The
bottom line is that this is
something very treatable
if you know the symptoms
and get to the hospital in
that window.”
The stroke team may only be called upon to do this
extent of “invasive therapy” for stroke patients
five to six times per year,
Wood said, but they could
do more if people who are
having a stroke come in
within that 4½-hour window.
“The best way is to call
911, and EMS will alert us
to activate the ‘code stroke’
so we’ll be all set up by the
time they get here,” Wood
said. “It’s one of the more
gratifying things to see
someone wake up and be
able to talk after coming in
completely occluded.”
The staff can be ready
to accept a stroke patient
within five minutes, Wood
added.
After little more than
48 hours in the hospital,
Smallwood was back in
his street clothes ready to
go home and play with his
2-year-old son, Braiden.
He will have to take a
week off from work, Tremwel said, and then take
blood thinners, as well as
stay away from fried foods.
But over the course of
the coming weeks, he will
regain the strength in his
arms, and may eventually return to lifting 16,000
pounds of rocks a day in
the Ouachita Mountains.
REOPEN: Descendants Coming
CONTINUED FROM PAGE 1A
The city partnered with the
FCRA to pave the 1,400-foot
street from Massard Road to
the McClure Amphitheater.
Total cost of the project was
just more than $1 million.
“The city did an excellent
job building the entrance to
this thing,” Owen said. “It’s
really something to be proud
of.”
Owen said descendants
of Gen. McClure will be on
hand at the Nov. 8 ceremony
to cut the ribbon.
was hyperbole at the time,
but this is evidence of what
can happen. A basic precept
of the reason we got sued in
the first place … was the unequalization of the state tax,
the state uniform rate of tax,
and the unequalization that
occurred with varying values
of millages, and this is a further example of that.”
The Senate and the House
on Friday approved identical
bills related to the primary
stated purpose of the special
session: Implementing shortterm and long-term fixes to
the state’s teacher insurance
crisis. The health-insurance
premiums of teachers and
other school employees
could increase by as much as
50 percent on Jan. 1 without
legislative action.
The measures were later
approved by committees in
the House and Senate. House
bills passed by the Senate and
Senate bills passed by the
House early today are:
• Senate Bill 2 by Sen. Jason Rapert, R-Conway, which
would use $43 million in state
surplus funds as a short-term
fix to avoid the looming spike
in teachers’ insurance premiums. HB 1003 by the Joint
Budget committee is the
matching House bill.
• SB 4 by Rapert, which
would use state funds now
going to school facilities programs that are being phased
out to help with school em-
ployees’ insurance premiums,
beginning in the 2014-15 fiscal year. HB 1012 by Rep. Ann
Clemmer, R-Benton, is the
matching House bill.
• SB 5 by Sen. Jonathan Dismang, R-Beebe, which would
reduce funding for professional development from $54
to $32.20 per student in each
district and would eliminate
a requirement that teachers
complete 60 hours of professional development per year,
beginning in the 2014-15 fiscal
year. HB 1009 by Rep. James
McLean, D-Batesville, is the
matching House bill.
• SB 6 by Sen. Johnny Key,
R-Mountain Home, which
would create a task force to
study all aspects of insurance
programs for state employees, including teachers and
other school personnel. HB
1011 by Rep. Tommy Wren,
D-Melbourne, is the matching House bill.
The House also approved
HB 1002 by Rep. Andy Davis,
R-Little Rock, which would
repeal Act 954 of this year’s
regular session.
Act 954, also sponsored by
Davis, eased regulatory requirements on municipalities
and industries that discharge
minerals into Arkansas waterways not used for drinking water. The federal Environmental Protection Agency
objected to the law and said
it will step in and begin reviewing all water permits.
MERCY: Computer Algorithm Used To Treat Sepsis, Save Lives
CONTINUED FROM PAGE 1A
It can begin with the tiniest
bacterial infection and spread
through the body, rapidly
escalating into major organ
failure, loss of blood flow
to tissues, and finally death.
While sepsis crosses all age
barriers, people over 65 and
those with weak immune
systems are especially at risk.
A computer algorithm,
a step-by-step procedure
used for data processing and
automated reasoning, was
programmed to highlight patients who were most susceptible to sepsis. When put into
action, the information saved
lives at Mercy hospitals.
“This is the kind of thing
the CIA was using,” Britton
told the audience.
Eventually, he said, Mercy
will have the computer program available with even the
smallest of its hospitals like
the Booneville Community
Hospital, which it will begin
managing Nov. 1.
“If you don’t identify and
treat sepsis quickly, it becomes untreatable and deadly,” says Dr. Robert Taylor, a
Mercy critical care physician
who has researched sepsis
for nearly two decades. “If
we intervene early, we can
dramatically improve the
patient’s condition in a short
period of time. As clinicians,
we have the ability and the
responsibility to turn this
tide.”
During a nine-month period, Mercy in St. Louis closely
tracked six specific patient
elements by a “robust integrated electronic health record” and use of Mercy SafeWatch — “one of the largest
electronic intensive care
units (ICU) in the nation.”
Mercy SafeWatch is wired
to provide 24-hour vigilance
to critically ill patients. As an
example, when lactic acid accumulates in a patient’s blood
beyond a certain threshold,
septic shock treatment protocols are quickly triggered
to increase blood flow to tissues.
Mercy in St. Louis has decreased septic shock deaths
from 46.7 percent to 18.5
percent, severe sepsis deaths
from 28 percent to 14.5 percent, and ICU length of stay
from eight days to 3.4 days.
It also has increased compliance of gold standard prac-
tices upwards of 94 percent.
Besides the loss of lives,
the money spent on sepsis
is significant and expected
to mushroom by 2020 with
an aging population. In 2001,
care for the average severe
sepsis patient cost $22,100
with a total annual price tag
of $16.6 billion, information
provided by Mercy states.
“The payoff in saving lives
is tremendous and so is the
savings,” said Dr. Tim Smith,
vice president of research at
Mercy’s Center for Innovative Care. “We have already
proven we can make a difference in sepsis by intervening
quickly and using Mercy’s
telemedicine capabilities.”
The program in place in
St. Louis has been expanded
via telemedicine, creating a
virtual sepsis unit for more
than 300 communities that
Mercy serves in Arkansas,
Kansas, Missouri and Oklahoma. Mercy also submitted
a grant proposal on sepsis
management to the National
Institutes of Health to assist in establishing a virtual
sepsis unit and studying the
outcomes.
The virtual unit assists in
building sepsis protocols into
Mercy’s integrated electronic
health record that will red
flag patients at risk, define
daily treatments and monitor
whether treatment is being
followed. In addition, Mercy
SafeWatch runs algorithms
alerting staff to patients at
risk for severe sepsis or septic shock.
“This is another gigantic
step forward in developing
innovative initiatives to improve the health and lives or
our patients,” said Britton.
“We began implementing
an electronic health record
almost a decade ago and because of that, we now have
the ability to optimize patient
data. This is about better care
for all patients.”
Mercy is the sixth-largest
Catholic health-care system
in the U.S. and serves more
than 3 million people annually. Mercy includes 31 hospitals, 300 outpatient facilities, 38,000 co-workers and
1,700 integrated physicians
in Arkansas, Kansas, Missouri and Oklahoma. Mercy
also has outreach ministries
in Louisiana, Mississippi
and Texas.
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