Swedish Medical Center named Comprehensive Stroke Center by Joint Commission

Denver-area Hospital is First and Only Credentialed Facility in Both State and Rocky Mountain Region

jointcommissionseal(Denver, CO) Swedish Medical Center has been named the first and only Comprehensive Stroke Center in Colorado and the Rocky Mountain Region by the Joint Commission, the prestigious national medical accreditation organization. This new level of certification recognizes the advanced technology, staff and training that comprehensive stroke centers must have to provide state-of-the-art complex stroke care.

“Colorado takes great pride in recognizing Swedish Hospital’s status as a Comprehensive Stroke Center, ” said Colorado Gov. John Hickenlooper. ” Efforts like these go a long way to giving Coloradans the best possible medical treatment and to making our state the healthiest in the country.”

The certification underscores the hospital’s long-standing commitment to health and wellness for citizens across the state, and throughout the region.

“Our new designation acknowledges the exemplary care we have provided to patients in Colorado and the region for years,” said Chris Fanale, M.D., Stroke Medical Director at Swedish Medical Center. “This is a true example of collaboration and innovation. We have the most outstanding team and technology this region has to offer.”

The 14th hospital in the country to achieve this certification, Swedish Medical Center was awarded this high-performance credential by the Joint Commission for its advanced integrative stroke team and outstanding patient outcomes. Simply stated, Swedish treats more strokes faster than anyone in the region.

“Our quality metrics at Swedish Medical Center have exceeded national benchmarks and consistently outperformed other area stroke programs,” said Mary M. White, President and CEO of Swedish Medical Center.

By the numbers, Swedish offers some very impressive statistics: Incoming stroke patients have a neurologist at their bedside in an average 4.8 minutes, compared to the national target of 20 minutes. Patients receive vital CT imaging within 14.6 minutes on average compared to the national goal of 25 minutes, and medically appropriate patients will receive IV t-PA within 40.8 minutes against the national goal of 60 minutes. The national average of ischemic stroke patients treated with IV t-PA is 5%, while Swedish treats 26%.

“Swedish was a pioneer in developing and providing comprehensive care through our stroke telemedicine program,” White added. “This innovation in healthcare has allowed us to provide exceptional care for the stroke patients in our community as well as throughout the 31 stroke telemedicine partner hospitals across the Rocky Mountain Region. Our certification is a result of the dedication and hard work of many who collaborate to offer this award-winning care.”

The Joint Commission recently developed the criteria for designating Disease-Specific Care Advanced Certification for Comprehensive Stroke Centers in collaboration with the American Heart Association and the American Stroke Association. The requirements are rigorous, officials say, and require additional technology, resources and expertise in comparison to other Primary Stroke Centers. This ranks Swedish Medical Center among the most well-known academic institutions across the country, including Cedars-Sinai Medical Center, Los Angeles, CA; Stanford Hospital, Stanford, CA; Ronald Reagan UCLA, Los Angeles, CA; Hospital of the University of Pennsylvania, Philadelphia, PA; and University of North Carolina Hospitals, Chapel Hill, NC.

“The Swedish neurosciences community is proud to have achieved designation as the first Comprehensive Stroke Center in Colorado,” said J. Paul Elliott, M.D., Neurosurgeon at Swedish Medical Center. “It reflects the long-standing commitment of Swedish nurses, physicians and administration to the provision of extraordinary care for our patients with complex neurological illness.”

The Comprehensive Stroke Center certification specifically looks at advanced endovascular procedures and technologies, the presence of a dedicated neuro-critical care unit and highly skilled staff, as well as proven patient outcomes that surpass national standards.

Comprehensive certification also requires that hospitals have the latest high-tech surgical equipment for complex aneurysm clipping and endovascular coiling techniques to find and remove clots. In fact, hospitals receiving the certification must perform at least 15 endovascular coiling or surgical clipping procedures per year. Centers must also hold dedicated neuro-intensive care unit beds and maintain specific procedures for communicating with paramedic EMS teams. They must be capable of evaluating two or more stroke patients simultaneously and perform specific follow-up tasks after discharge. They also have a requirement to enroll patients in clinical trial stroke research, use a stroke registry, and have certain peer review processes. Swedish Medical Center enjoys a long standing partnership with the Colorado Neurological Institute to provide community education, patient navigation and research.

In addition to achieving the certification, Swedish Medical Center received the following accolades from the Joint Commission surveyors:

• Commitment to regional telemedicine site partners was a notable ‘best practice’

• Dedicated leadership of the Stroke Program

• Solid clinical foundations for care

• Program integration with AirLife, specialty trained air transport team for stroke patients

• The stroke peer review process at Swedish Medical Center was the ‘best they have ever seen’

• Stroke data collection methods were noted as a ‘best practice’

“This certification is a message to the community and surrounding region, patients and EMS providers that we are the place to go for acute stroke services,” said Don Frei, M.D., Interventional Neuro Radiologist at Swedish Medical Center.

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About Swedish Medical Center (www.SwedishHospital.com)
Swedish Medical Center in Englewood, Colorado serves as the Rocky Mountain Region’s referral center for neurotrauma and as the region’s only Joint Commission certified Comprehensive Stroke Center, a recognized leader in the most advanced stroke care. Swedish offers patients the highest quality care and the most advanced technologies and treatments in nearly every medical specialty and is an eight time winner of the National Research Corporation Consumer Choice Award and a Top 100 Hospital recognized by Reuters.

An acute care hospital with 368 licensed beds, Swedish is located in the south metro Denver area where it has been a proud member of the community for more than 100 years. Annually, Swedish cares for more than 200,000 patients with a team of 2,000 dedicated employees, 500 volunteers and more than 1,300 physicians.

 About The Joint Commission (www.jointcommission.org)
An independent, not-for-profit organization, The Joint Commission accredits and certifies more than 20,000 health care organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards.

Medical Technology Helps Save Stroke Patient

“Technology saved my life!”

Leroy Luraschi wouldn’t consider himself a “tech-savvy” person but someone who occasionally likes to surf the web or play a game on his home computer. Leroy was doing just that one evening at his Montrose home when all of a sudden he felt an unexpected sensation in his head. “It felt like something broke. I felt like someone was poking something through my eye,” he explains.

Leroy got up from his computer, walked into his bedroom and collapsed onto the floor. “All I remember is my 19-year old son Jacob running into the room, he called 9-1-1,” says Leroy.  Paramedics took Leroy to Montrose Memorial Hospital. Immediately upon arrival to the emergency room Leroy says he knew he was having a stroke. “I couldn’t talk or move my whole right side,” he explains. Staff at Memorial Hospital dialed in Swedish Medical Center Neurologist Dr. Chris Fanale by tele-medicine technology and he was up on a screen within minutes ready to consult with doctors about Leroy. “It’s pretty wild that there was a specialist hundreds of miles away in Denver helping me in the ER,” says Leroy.

Leroy was transferred shortly after to Swedish Medical Center in Denver by helicopter where he was assessed in person by Dr. Fanale and the stroke team. According to Dr. Fanale, “stroke can happen to anyone, anywhere, at any time.  Stroke does not discriminate with age. Being close to a certified stroke center or a hospital with telemedicine capabilities allows you to get stroke treatment rapidly and efficiently. Sometimes patients in non-urban communities need a higher level of care due to the severity and complicated nature of their strokes. At Swedish Medical Center, we have the multidisciplinary team with the stroke specialists that can care for patients such as these on a 24/7/365 basis. The quicker we can treat, the better the outcome. We can only do that with seamless clinical collaboration between hospitals, as was displayed in the care of this patient. ”

Leroy, who is 49-years old, didn’t expect he’d ever have a stroke. “I was completely caught off guard that I was having a stroke. But I’m so glad that I had the Swedish stroke team right there with me. They made my life worth living again and they sure know what they’re doing!” says Leroy.


Off-Duty Swedish Nurse Helps Save Man’s Life

“I don’t remember much but from what I heard, I was saved by some

Sixty-eight year old James Southard was out and about on a normal Thursday afternoon with his wife Michele and his 8-month old grandson and their two dogs. They had just finished up a routine visit at the veterinary clinic and were on their way home.  Getting into the car, James says he felt normal, nothing out of the ordinary but as he was pulling out of the parking lot he stepped on the break and yelled out  “oh no!”  The next thing his wife Michele knew, James was passed out in the driver’s seat. “I was so scared, I put the car in park and got out to start screaming for help,” she explains.

At the same moment that James passed out, off-duty Swedish Emergency Department RN Debora Rewerts was across the street gassing up her car. She pulled out of the parking lot when she noticed traffic wasn’t moving and there was a man lying on the ground. “I didn’t think twice and ran over to him. There were already people there trying to help. One man in particular was there trying to speak to him and kept things calm,” says Debora.  At first she thought James was having a stroke. Someone had already called 9-1-1 so Debora called into the Emergency Department at Swedish Medical Center to warn them a stroke patient was soon to be on their way.

Shortly after the call to the ED, James stopped breathing. The Englewood Fire Department on the way, Debora and another man started administering CPR. “Being a nurse and reacting to emergencies is what I’ve done for 24 years. It’s like second nature,” says Debora.  James was taken to Swedish by ambulance.

“Everyone played a prime part in saving his life. It was just a sense of relief that I wasn’t alone,” says his wife Michele.  She explains that once James was transported to the hospital, a stranger helped to bring her, and her grandson along with the two dogs to the emergency waiting room. “There were so many strangers who helped in this situation. They are truly our angels and I’m so grateful they were there for us,” Michele explains.  Upon arrival to the hospital it was determined that James wasn’t having a stroke but was suffering from a heart attack and he was rushed to the Cardiac Cath Lab where he immediately received a stent and was then taken to the Critical Care Unit.

“God protected me, that is all I can say,” says James.  Debora and James were reunited the day after the incident and it couldn’t have been a better moment for everyone involved. “He looks great! It’s so rewarding to see him,” Debora said with a smile.

“Life is short, Debora expanded mine, that’s for sure!” says James.

When a Headache is more than a Headache

If you have ever suffered from the symptoms of a migraine headache, you may be well aware of their ability to completely disrupt your daily activities. Fortunately, these headaches occur only temporarily and can be reversed with adequate rest and treatment.

However, there are times when a headache is more than just an inconvenience. You may experience pain that can be described as the “worst headache of your life” and that is accompanied by other physical and sensory problems, such as weakness on one side of the body and vision changes. If this occurs, your head pain is not just a headache—it is one of the common symptoms of stroke and requires emergency medical treatment.

A stroke, or brain attack, occurs when a region of the brain is deprived of oxygenated blood due to the obstruction or hemorrhage of a cranial artery. When unable to receive the oxygen and nutrients in blood, brain tissue quickly begins to die. Without immediate treatment, this dangerous medical event can lead to permanent disability and even death. You can help yourself and your loved ones avoid the dangers of stroke by learning the stroke symptoms and seeking treatment quickly if symptoms arise. The signs occur very suddenly and often include:

  • Severe headache with no known cause.
  • Weakness or numbness on one side of the face and body.
  • Trouble speaking or understanding language.
  • Blurry vision in one or both eyes.
  • Loss of balance and coordination.

“Headaches described as the worst in a person’s life or head pain with sudden onset weakness or numbness can signal that a bleeding stroke it happening. It’s best to call 911 and get to a stroke center right away. A CT Scan is the best way for healthcare providers to determine if a bleeding stroke has occurred. Migraine headaches can mimic stroke also by causing stroke-like symptoms. Whenever a person experiences sudden onset stroke symptoms, with or without a headache, get to the hospital right away and let our experienced team get to the bottom of what is happening,” says Michelle Whaley, CNS, Swedish Stroke Coordinator.

According to the National Stroke Association, these events are the fourth leading cause of death and the number one cause of long-term adult disability in the United States. Do not become a part of these statistics—speak with your doctor about your potential risk factors and take the necessary steps to improve your health today. If you are in need of a primary care physician or medical specialist in the Denver area, contact Swedish Medical Center at (303) 788-5000. Our medical facility offers comprehensive healthcare services to promote the continued health of our community.

A Father’s Day Miracle

Father’s Day is more than just a day to celebrate being a father for 75-year old David Smith.  He has five children, 16 grandchildren and 14 great grandchildren who all make the day extra special for him. But this past Father’s Day, David didn’t receive the chance to attend the usual reunion with his family. Instead, he ended up spending the day with them at Swedish Medical Center.

“It was the day before Father’s Day. I was in the kitchen and David was in the garage. I heard something unusual and ran to go see if everything was alright. David was on the floor of the garage with blood all around him. He had hit his head on something. I rushed over to him and knew instantly he was having a stroke. I immediately dialed 9-1-1,” explains David’s wife, Mary Smith.

David was breathing but couldn’t speak; one of the signs of stroke. “I just knew it was a stroke, I was holding his hand and telling him to just stay with me,” says Mary. David was rushed to Swedish Medical Center where the stroke team was waiting for him. He was given a clot-busting medication within 27 minutes. “The stroke team reacted so fast when David arrived to the hospital. He wouldn’t be here without them!” explains Mary.

David woke up in the CCU and couldn’t remember much. He was told he’d have to be in the hospital for a couple of days then transfer to Swedish Acute Rehab to regain his strength. The care here has been great! I knew Swedish was a trauma center but I had no idea they had such an amazing stroke team,” says David. “I know it’s a miracle that I’m here today, that I can talk, walk and be with my family.”

His family calls him a “Father’s Day miracle.” This is the second time David has faced a medical emergency after suffering a heart attack 10 years ago. His wife says she believes it’s just not his time yet and that he’s meant to watch the three generations underneath him grow up and follow in his footsteps. “Our time together is so precious, he really has dodged the bullet twice but I honestly thank God and the team at Swedish for saving my husband’s life.”

A Patient’s Comfort Through Technology

“It was reassuring to have the doctor right there with me even though I was hundreds of miles away!”

Gunnison resident Chris Tanning is well aware of the warning signs related to stroke. She suffered a minor one two years ago. Chris was rushed to Gunnison Valley Hospital where she was treated and released. “It was a very freighting time for me. After being released from the hospital I needed additional testing with a specialist so I had to drive to Denver to receive it. Thankfully, I fully recovered,” explains Chris.

Since the time of Chris’s stroke, Gunnison Valley Hospital has implemented new technology into their facility which would make it easier for stroke patients to correspond with specialists in Denver. Little did Chris know that she would be one of the first patients to use this technology called the RP-Lite. RP-Lite is a remote device that allows physicians to perform comprehensive real-time consults with hospital patients.  “The RP-Lite technology has allowed us to assess the patient quickly, which leads to better patient outcomes. This technology allows for 72% of patients who are assessed with the RP-Lite to be treated and stay in their communities. We strive every day to take the best care of all our stroke patients, regardless of the distance,” says Dr. Chris Fanale, HealthONE Stroke and CO-DOC Medical Director.

Earlier this year Chris experienced pre-stroke symptoms and again was rushed to the hospital. “I had arm numbness, vertigo, a migraine, severe chills; I thought I was having another stroke,” says Chris. This time around her experience in the ER was much different than from two years ago. Within minutes she had a quick series of tests and lab work, a high-field short-bore MRI and MRA and was face-to-face with stroke specialist Dr. Judd Jensen from Swedish Medical Center in Denver. “I was very impressed with the technology! For the doctor to be able to interact with me in real-time was very impressive!”

“The greatest advantage is having the ability to talk to the patient and their family members and ask questions that can determine an accurate diagnosis in order for them to receive rapid treatment,” says Dr. Judd Jensen, Swedish Stroke Neurologist.

Fortunately, Chris was not having a stroke. “I had instant reassurance it wasn’t a stroke!” says Chris. Her symptoms were caused by something less onerous and she was relieved to have her diagnosis so quickly. “This technology is amazing. It was an emotional relief to have that interaction with the doctor and to hear I was going to be just fine!”

Take Me to Swedish

It was a relaxed evening of sewing for Sandra Arreola.  At seventy-one years old, her favorite pastime was rarely interrupted. There may have been an occasional, brief conversation with her husband Phillip or a quick pause to answer the phone but this evening something interrupted Sandra that was unexpected. “As I was sewing, my arm all of a sudden wouldn’t move, my leg then wouldn’t move and as I opened my mouth to call out for my husband who was in the other room, I couldn’t talk,” explains Sandra.

In that moment, Sandra knew exactly what was happening to her; she was having a stroke. “I heard this groaning from Sandra’s room so I decided to go check on her. I went into the room and immediately called 9-1-1,” says Phillip Arreola, Sandra’s husband.  “One neighbor of mine who is a nurse told me to tell the paramedics to take Sandra to Swedish. She assured me, Swedish had the best stroke care in the state,” explains Phillip.

Sandra was cared for by Dr. Chris Fanale and his team. “Everyone was just wonderful at Swedish!” says Sandra. “He was very knowledgeable and his team was ready for me when I got there,” she explains. “It is through the collaboration among physicians, nurses, therapists and staff at Swedish Medical Center that such great patient outcomes can happen. We strive every day to take the very best care of all of our stroke patients,” says Dr. Chris Fanale, HealthONE Stroke and CO-DOC Medical Director.

Sandra’s door to needle time was 34 minutes. Door to needle time is the total amount of time it takes to assess the patient, transport the patient to CT, identify stroke, and initiate aggressive clot busting treatment. She also suffered no paralysis and had no major side effects. She was back at home within the week. “It was miraculous, I’m so glad I had the paramedics take her to Swedish, they really do have the best stroke team,” says Phillip.

A Look at How High Blood Pressure Affects the Body

“It is often called the “silent killer” because many people experience no symptoms with high blood pressure.”— Dr. Lee MacDonald, Swedish Interventional Cardiologist

High blood pressure, or hypertension, occurs when the pressure of blood against the walls of the arteries reaches an unhealthy level. In addition to increasing a person’s risk for heart disease and stroke, hypertension can lead to other serious medical conditions such as kidney disease, heart failure and blindness. If you are interested in seeking treatment for hypertension, visit Swedish Medical Center. Our hospital is home to one of the leading heart care centers in Denver.

The arteries are composed of muscle and semi-flexible tissue that allows for a certain amount of stretching when blood flows through. If these vessels are continuously stretched beyond their healthy limit by the forces of high blood pressure, a variety of issues can occur.

  • Vascular weakness: Continuous stress on the arteries eventually causes weaknesses to occur in certain parts of the vessels, making them more prone to tears. Aneurysms and strokes are both caused by ruptured vessels.
  • Vascular scarring: Overstretching can lead to micro-tears in the vessel wall that heal over and form patches of scar tissue. This scar tissue acts like a net by trapping blood cells, cholesterol, plaques and other debris that travel through the bloodstream. This leads to a narrowing of the arteries and possible blockage.
  • Increased stress on the heart: As the arteries get narrower and narrower, the heart must work harder to push blood to the rest of the body. This compounds the problem and further weakens the circulatory system.
  • Tissue and organ damage: When the arteries become blocked and narrowed, less blood is able to reach organs and peripheral tissues. Without enough of the oxygen and nutrients that are carried in blood, these tissues become damaged.

By keeping your blood pressure in the healthy range, you can help to reduce your risk for vascular injury and cardiovascular disease. “Getting your blood pressure checked is a simple and potentially lifesaving one minute test that everyone should have done on a routine basis,” explains Dr. Lee MacDonald.

If you have questions about maintaining healthy blood pressure and preventing heart disease, call the heart specialists of Swedish Medical Center today at (303) 788-5000.

HealthOne Stroke Care Debuts Online Stroke Assessment During National Stroke Awareness Month

Denver Residents Urged to Be Aware of Signs and Symptoms
(Denver, CO)  Nearly 800,000 Americans will suffer a stroke this year, yet most people in the U.S. cannot identify stroke warning signs or risk factors. HealthONE Stroke Care hopes to change that during May’s National Stroke Awareness Month with the introduction of its new Stroke Risk Profiler, an online assesment tool for adults of all ages.

Denver-area residents looking for more information about their risk of stroke, as well as what to look for, can visit http://www.healthonecares.com/stroke_center/stroke-assessment.htm to take the short assessment. There, individuals can learn about the impact of strokes, explore their personal risk factors and learn how to mitigate the risks. Many strokes – some studies indicate that up to 80 percent – can be prevented through risk factor management, says Dr. Chris Fanale, HealthONE Stroke and CO-DOC Medical Director. Unfortunately, public awareness of stroke warning signs and risk factors continues to lag behind, but May is a time to change this startling statistic, he says.

“A Stroke is an emergency! It’s important to learn stroke warning signs and how to respond to them,” Dr. Fanale says. “Emergency treatment may be available by acting FAST and calling 9-1-1.”

HealthONE is asking all Denver residents to remember the FAST test as a method of recognizing warning signs:

F – Face: Ask the person to smile, is one side of the face drooping down?
A – Arm: Can the person raise both arms?
S – Speech: Is speech slurred or confusing? Is the person able to speak?
T – Time: Time is critical. Call 9-1-1 immediately.

Every second counts in minimizing the damage a stroke can cause to the brain – quick assessment and personalized care are key, says Dr. Fanale. In fact, HealthONE recently introduced new technology that offers remote stroke care. Its InTouch Health Remote Presence® telemedicine technology includes a camera and microphone for live two-way audio and video, and a computer, on a sleep, wheeled cart that is placed in an ER room. A CO-DOC/HealthONE Stroke Care specialist can connect a computer and joystick to the Remote Presence® unit via the Internet, and appear instantly on screen at the bedside of patients, much like video conferencing, interacting with family members and clinical staff in the room. The stroke specialist can control and zoom the camera to get closer to the patient, while accessing remote medical devices like electronic stethoscopes, otoscopes and monitoring.

Dr. Fanale reminds Denver residents that stroke is the third leading cause of death in the U.S. Nearly three-quarters of all strokes occur in people aged 65 years or older. However, the CDC reports that strokes are hitting younger individuals too, raising concerns about an entirely new group of the U.S. population. The chances of having a stroke double each decade after the age of 55. Nearly 25 percent of strokes occur in people younger than age 65. For decades, the southeastern United States has had the highest stroke mortality rates in the country, although it’s not completely clear what factors contribute to the higher incidence of and mortality from stroke in this region. People with a family history of stroke are more likely to have a stroke, and by 2030, it is estimated that 4 million people will have had a stroke. This is nearly 25 percent higher than 2010 estimates.

“Immediate medical care of stroke can mean the different between life and death,” Dr. Fanale says. “During a stroke, an estimated 30,000 brain cells die per second; a patient’s outcomes and recovery are far better the quicker you can evaluate and treat the stroke.”

About HealthONE

HealthONE is the largest healthcare system in the metro Denver area with 8,700 employees and 3,000 affiliated physicians. The health system is a Colorado company created in 1995 as a 50/50 joint venture between non-profit The Colorado Health Foundation, Colorado’s second largest charitable foundation, and various affilites of HCA (NYSE: HCA).

HealthONE includes: The Medical Center of Aurora and Centennial Medical Plaza; North Suburban Medical Center; Presbyterian/St. Luke’s Medical Center (P/SL) and Rocky Mountain Hospital for Children; Rose Medical Center; Sky Ridge Medical Center; Spalding Rehabilitation Hospital; Swedish Medical Center and Swedish Southwest ER; 13 ambulatory surgical centers; more than 30 occupational medicine/rehabilitation, specialty, and outpatient diagnostic imaging clinics; and AIRLIFE Denver, which provides critical care air and ground transportation for an eight-state region.

May is National Stroke Awareness Month

Help us raise awareness during National Stroke Awareness Month. Swedish Medical Center offers expert stroke treatment. In fact, on average we treat more patients quicker than any other hospital in Colorado.

  • What is a Stroke?

“A stroke or “brain attack” occurs when a blood clot blocks an artery (a blood vessel that carries blood from the heart to the body) or a blood vessel (a tube through which the blood moves through the body) breaks, interrupting blood flow to an area of the brain.  When either of these things happen, brain cells begin to die and brain damage occurs.”

Stroke Facts:

  • Stroke is the fourth leading cause of death in the U.S.
  • Approximately 795,000 strokes will occur this year.
  • Stroke can happen to anyone, regardless of age, sex or race.
  • More women than men have a stroke each year.
  • Two million brain cells die every minute during stroke.
  • Women are twice as likely to die from stroke verses breast cancer.

During a stroke, it’s important to act as quickly as possible. At Swedish, we act on the fact that TIME IS BRAIN. If you even think you or a loved one is having a stroke, you shouldn’t wait a second. Why? Because during a stroke, 30,000 brain cells die per second.

Learn more about Swedish’s Stroke Treatment Program, the ONLY Stroke Center in the Rocky Mountain region four-times certified by The Joint Commission as a Primary Stroke Center. For more information, please call (303) 788-5000.

Meet our Stroke Team:

Front row: (left to right) Katie Leonard, NP; Stacy Shine, NP; Michelle Whaley, CNS; Rod Spencer, MD; Ira Chang MD; Chris Fanale MD

Back row: Becky Urquhart, PA; Marc Wasserman, MD; Bob Pratt, MD; Judd Jensen MD; Jeff Wagner, MD