Sara Openshaw Begins Family Medicine Practice in Her Hometown

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Sara Openshaw, FNP

Sara Openshaw, FNP

There’s no doubt about it, Sara Openshaw has local connections.

Sara grew up on a dairy farm outside of Mountain Grove. She was a Walker, before she married her husband, Nick, also from the area with Wright and Texas County family connections.

“I know what it’s like to get up every morning and get the cows to the barn to be milked,” Sara Openshaw, explains with a smile. She doesn’t miss the work required to run a dairy farm, and that’s partially how she ended up in the healthcare field.

“I knew I wanted to go to college and get a degree to do something besides working on the farm,” Openshaw said.

A high school experience with a local nurse practitioner piqued Openshaw’s interest in providing healthcare to others.

Openshaw wanted to get a college degree but not be too far from home, so she obtained her associates degree in nursing through Missouri State University-West Plains campus, followed up by a bachelor’s degree in nursing from Missouri State University in Springfield.

While going to school, Sara worked as a nurse in the obstetrics unit at Ozarks Medical Center in West Plains and later as nurse for Intrepid USA, a home health agency. Sara also served a stint as a clinical instructor for Texas County Technical College, teaching the obstetrics and gynecology course.

“I loved my time as nurse, but I wanted to do more one on one patient care in my community,” Openshaw said.

Maryville University’s family nurse practitioner program seemed to be the perfect fit for Sara, providing her with the opportunity to obtain an advanced nursing degree without having to be too far from home.

“My home health job provided me with the flexibility I needed to do clinical rotations for my nurse practitioner degree,” Openshaw explained. Openshaw was also able to do her clinical rotations in locations not too far from home, including at Texas County Memorial Hospital.

For a full-time position after graduation, Openshaw sought a local job.

“I wanted to provide healthcare for the people in my community,” Openshaw said, explaining that she hoped to find a job within a 30-mile radius of Mountain Grove.

Finally, after several years of school and working as a nurse in the healthcare field, Openshaw’s dream has come true. She took the full-time family nurse practitioner position at the TCMH Mountain Grove Clinic because the location was close to home and long-term employment opportunities with TCMH “seemed very positive”.

Openshaw is passionate about providing care to her friends and neighbors in rural America. “I believe that everyone deserves to be treated with respect, and I believe they should have access to the care they need,” Openshaw said.

As a family nurse practitioner, Openshaw sees patients of all ages—from birth through the end of life. Openshaw currently collaborates with Dr. William Wright, a family medicine physician that sees patients at the TCMH Mountain Grove Clinic and the TCMH Medical Complex in Houston.

Tracey Arwood, a certified nurse midwife, also sees patients, including OB patients, at the Mountain Grove Clinic. Next summer, Cory Offutt, MD, a family medicine and obstetrics physicians will also see patients at the clinic.

“I hope that together we can grow the clinic practice,” Openshaw said.

Through the TCMH Mountain Grove Clinic, Openshaw is able to provide vaccines for children, routine diagnostic services through the laboratory and X-ray unit, as well as low-cost prescriptions for uninsured patients through the 340b prescription drug plan available to patients with a TCMH healthcare provider.

Openshaw sees patients Monday through Friday, and if scheduling allows, she will see patients on a same-day basis, too.

When Openshaw isn’t working, you will find her spending time with her husband and their almost two-year old son, Camden. Nick Openshaw is a math teacher at Mountain Grove high school, and he’s the assistant high school basketball and baseball coach.

“I try to attend all of Nick’s games, so that keeps us pretty busy,” Openshaw said.

The Openshaw’s have a farm and some beef cattle, but Sara’s opposed to owning any cattle that require milking twice a day. “I put my foot down about dairy cattle,” she said with a laugh.

With her new career as a family nurse practitioner, Openshaw is excited to finally have her name and her credentials on a clinic door in her hometown.

“This is what I’ve always wanted to do,” Openshaw said.

For additional information to make an appointment with Openshaw, contact the TCMH Mountain Grove Clinic at (417) 926-1770.

Medicare Open Enrollment Underway

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Open enrollment for Medicare health and drug plans begins on October 15.

Every year between October 15 and December 7 Medicare recipients must decide if their current coverage will continue to meet their needs through the upcoming year. Changes must be made by December 7, 2015 to be effective in 2016.

The prescription drug coverage plan that is part of Medicare coverage can cause confusion. All Medicare recipients are required to sign up for a prescription drug coverage plan which is known as “Medicare Part D”.

Due to the required Medicare Part D coverage, many seniors find themselves looking at various insurance options.

Because Medicare covers about 55 percent of the patients seen at Texas County Memorial Hospital, TCMH offers to help area residents in the enrollment process, particularly with Medicare Part D.

Wes Murray, chief executive officer at TCMH, noted that Medicare coverage can be very confusing for the elderly population.

“Anyone in the market for supplemental Medicare coverage should contact his or her healthcare provider prior to purchasing the coverage,” Murray said. “Ask your healthcare provider if they accept the insurance you plan to purchase.”

Murray cautioned that some enrollees have been told that TCMH accepts certain insurance, but the information is incorrect.

“Before signing up for anything, please make sure the insurance is accepted by your healthcare provider,” Murray stressed.

Additionally, enrollees shouldn’t sign anything without knowing exactly what they are signing for. Copies of any signed papers should be obtained and retained by enrollees, too.

Anita Kuhn, controller at TCMH, is available to consult at no charge with area residents until December 7 each year. Kuhn will assist those interested in re-enrolling in Medicare Part A and B, if they left it for a Medicare Advantage Plan. She also can assist in determining the best Medicare Part D coverage for each individual.

Please contact Kuhn for a consultation appointment by calling her office at 417-967-1277 or 1-866-967-3311, ext. 4052.

If TCMH is a person’s hospital of choice, information about the insurance carriers they contract with can be obtained by calling the TCMH Business Office at 417-967-1298 or 1-866-967-3311.

Stein Named as September Employee of the Month

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Texas County Memorial Hospital has named LeaAnn Stein of Houston the September employee of the month.

Stein is a medical assistant to Dr. Linda Milholen in the TCMH Outpatient Surgery Clinic. Stein has worked at the hospital since 1999. She was nominated for the award by Hope Best, clinic manager at TCMH.

“LeaAnn’s goal is that all patients should know her name and how their visit or procedure will go. She wants all patients to be as comfortable as possible,” Best said, adding that Stein takes pride in providing excellent customer service and in the work she does at TCMH.

Stein does the hospital surgical billing, and she helps out with making appointments and answering phones in the office, too.

“LeaAnn always tries to stay one step ahead of the physician she’s working for, anticipating the physician’s needs for the office visit or the procedure before they arise,” Best said.

As employee of the month, Stein received a certificate honoring his achievement; a pin; a special parking place in the TCMH lot; one day of paid vacation; a $50 gift card, and gift certificates to Paws N Claws, D&L Florist, Janstiques and Blissful Nirvana Massage. A reception will be held at the hospital in honor of Stein.

Stein is eligible for the 2015 TCMH employee of the year award.

LeaAnn Stein (right), Texas County Memorial Hospital September employee of the month, with her clinic manager, Hope Best.

LeaAnn Stein (right), Texas County Memorial Hospital September employee of the month, with her clinic manager, Hope Best.

Minor Citations from State Following Comprehensive Survey

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Texas County Memorial Hospital received minor citations in seven areas following a three-day, comprehensive facility survey, hospital board members heard at their monthly meeting on September 22nd.

“On August 24th, seven surveyors from the Missouri Department of Health and Senior Services arrived to survey our compliance with federal, state, swing bed, and patient safety initiative condition of participation regulations,” Wes Murray, TCMH chief executive officer at TCMH, said.

The surveyors arrived unannounced, the custom for DHSS surveys and most site visits.

“We had three days of intense scrutiny of policies, operational procedures and patient care,” Murray said, adding, “Surveyors also interviewed staff and patients before exiting the hospital on August 27th.”

Written citations were delivered to the hospital on September 10th and included:
• providing pricing on the list of items not covered by Medicare for swing bed patients;
• updating policies in medical records and environmental services;
• scheduling fire drills annually and testing off campus building emergency lighting annually;
• updating credentialing and medical staff bylaws;
• addressing patient care plans, hand hygiene and registered nurse supervision of patients in nursing departments;
• increasing quality assurance reporting for some departments and including that information in the monthly board of trustees report,
• and updating menus and manuals and sanitation procedures in dietary.

“On September 18th we submitted to DHSS a plan of corrections for the citations that were issued,” Murray said.

Murray noted that the number of surveyors on site during the survey was challenging for the hospital and small departments where many of the department managers also provide patient care in addition to managing their departments.

“While it was a challenge, our staff again rose to the occasion and did their best in providing the information the surveyors needed as quickly as possible,” Murray said.

DHSS surveyors have not fully surveyed the hospital in a few years and since the new construction was completed.

“We continually ask our department managers to stay on top of their policies and procedures so we are prepared when surveyors arrive at our hospital,” Murray said. “A big thank you to Doretta Willis and our department managers for stepping up to the task when we needed them during the survey process.”

TCMH officials expect that DHSS surveyors will be back on site in the near future to assess how the hospital has responded to citations.

TCMH has not been successful in recruiting any additional physicians to the hospital medical staff during recent site visits, but recruiting for additional full-time physicians is underway.

Murray reported that Kim Kemnitzer, FNP has been seeing patients at the TCMH Walk In Clinic.

“With the addition of Kim in the Walk In Clinic, we’ve been able to free up additional appointment space for patients to get in to see Holly Atterberry,” Murray said.

Sara Openshaw of Mountain Grove has passed the board certification exam for family nurse practitioners, and she will begin seeing patients at the TCMH Mountain Grove Medical Complex when her license arrives.

“We are very excited about having Sara join our team,” Murray said. “Sara and her family live in Mountain Grove and have ties in the community. She will be a great asset in our clinic.”

Dr. William Wright, family medicine physician at TCMH, will collaborate with Openshaw and continue to see patients one day a week at the Mountain Grove Clinic. Tracey Arwood, CNM sees women and provides obstetrical care at the clinic two days a week.

Dr. Cory Offutt, a third-year family medicine resident will join TCMH next summer after completing residency. He recently contacted TCMH about doing his final surgical and clinical rotations at TCMH under members of the TCMH medical staff.
“Dr. Offutt is very enthusiastic about getting to TCMH and learning our electronic medical records system and getting his clinic set up in advance,” Murray said. He added, “And we are all looking forward to helping him get off to a strong start in his new practice.”

Murray reported that with the relocation of the Wri-Tex 911 office from the hospital’s campus, the vacated space is being renovated into a biomedical engineering shop and office.

Murray also explained that TCMH is looking at self-funded options for employee health insurance.

“We are the only hospital in our Ozarks Independent Health Alliance that has a fully insured health insurance plan,” Murray said.

Murray and Jennifer Hugenot, human resources director at TCMH, are looking at health insurance options.

“With a self-funded plan we could possibly provide insurance that more of our employees and their families could afford,” Murray said, adding, “And we can make TCMH the healthcare provider of choice for services that we are able to offer.”

Murray explained to board members that he and other TCMH directors were present at the September Houston Chamber of Commerce meeting where Senator Mike Cunningham spoke.

“Senator Cunningham specifically asked me for questions, and again, we asked him to support Medicaid reform and expansion to benefit the rural hospitals in his district,” Murray said.

According to Cunningham’s report to the Houston Chamber of Commerce, Medicaid expansion is not an agenda item for the State Senate.

“Senator Cunningham told us that our hospital’s fate was to be bought out by a larger healthcare system because that’s what happens to small businesses,” Murray said, explaining that all of the TCMH directors present engaged Cunningham, challenging his position on Medicaid expansion in the state.

“Again, we asked Senator Cunningham to please represent the people and businesses in his district in Jefferson City,” Murray said.

Linda Pamperien, TCMH chief financial officer, presented the August financial report. Overall revenues were down during the month of August. Expenditures for the month were down, too.
TCMH ended the month of August with a negative bottom line of $153,955.52 and a negative year to date balance of $1,339,353.80.

Present at the meeting were Murray; Pamperien; Dr. Jonathan Beers; Amanda Turpin, quality assurance nurse manager; April Steele, administrative secretary, and board members, Dr. Jim Perry, OD; Mark Hampton; Janet Wiseman, and Omanez Fockler.

Board member, Russell Gaither, was not present at the meeting.

The next meeting of the TCMH board of trustees is Tue., Oct. 27 at 12 p.m. in the hospital board room.

Take Charge of Your Health by Talking with Your Pharmacist

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Anne Kennedy, Pharmacist at TCMH Hutcheson Pharmacy

Anne Kennedy, Pharmacist at TCMH Hutcheson Pharmacy

More than 30 million Americans take five or more prescription drugs regularly, so it’s very important for prescription drug users to be active participants in their healthcare.

“Many people don’t know where to turn when they have questions regarding their prescription medications,” Anne Kennedy, registered pharmacist at Texas County Memorial Hospital’s Hutcheson Pharmacy, said.

Kennedy and her staff at Hutcheson Pharmacy welcome questions from their customers regarding the medications they take. Here are some tips regarding important questions to ask your local pharmacist:

• Ask your pharmacist how to take specific medications. Certain medications need to be taken with food or liquid, and some medications require an empty stomach. Some medications will not work effectively when used with certain foods or drinks.

• Ask for a generic or lower cost medication. Sometimes generic versions of medications are available at a lower price and are safe and effective. TCMH Hutcheson Pharmacy is also part of the low-cost 340-B drug prescription program which is available for patients without insurance coverage that use TCMH physicians or mid-level providers.

• Ask how your medication should be stored. All medications should be stored within certain temperature ranges. Most medications should be stored at room temperature, but some have cold or other storage requirements.

• When picking up medications, ask if there are any changes in the color, size, markings or dose of the medication.

• Ask for help with Medicare Part D prescription drug plan. During the annual open enrollment, TCMH can assist patients that want to compare prescription drug plans. The patient can compare options and choose the plan that’s right for him or her.

For additional information about prescription drugs and services at TCMH Hutcheson Pharmacy, contact the pharmacy at (417) 967-4139.

When is the Time Right for Comfort Care?

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Sometimes a body fails due to a natural progression of age or a chronic illness. Sometimes a young person fails to respond to the best medical treatment possible for a disease. Regardless of how it happens, a body does not last forever.

Courtney Owens, director of Texas County Memorial Hospital Hospice of Care, has seen patients of all ages and their family members face decisions about healthcare as their body fails. Owens and her hospice team oversee comfort care for patients and their family members.

“Hospice care is ‘comfort care’,” Owens said. “Comfort care is when a patient and their family decide to put all of their energy, hopes and actions toward quality of life with freedom from pain and distress.”

Owens described comfort care as treatment of the whole person and the whole family, taking into consideration the emotional, social and spiritual well-being of the patient.

“There is no right or wrong answer regarding when it’s time to seek comfort care,” Owens said, adding, “It’s a personal decision.”

Owens recommends that families talk with their physician or ask for a consult from a member of the Hospice of Care team.

“You can always simply ask your physician about comfort care and when it would be beneficial,” Owens said. “Many doctors find it easier to talk about hospice services when the patient or their family members ask about it first.

Owens noted that her staff will consult with a family and discuss the patient’s situation and the options available at no cost or obligation to the patient.

“Medicare, Medicaid and private insurance cover the services of Hospice of Care, and with our Hospice Fund, we are able to assist patients that don’t have a way to pay for their care,” Owens said.

Research indicates that hospice care can prolong a patient’s life.

“Most insurance will cover hospice care for the last six months of life, but most patients don’t receive our benefits for that long,” Owens said.

Hospice care is available for anyone with terminal illness, including heart disease, Alzheimer’s disease, liver disease, lung disease and more.

“Most hospice care is provided in the home of a patient or in the home of the patient’s primary caregiver,” Owens said. “Patients don’t have to change physicians, and they can stop hospice care at any time.”

Owens explained that the hospice team of nurses, doctors, social workers, volunteers and chaplains provides care for the patient and for the family members of the patients while they are in hospice care.

“There is no option that is right for everyone, but everyone should know that comfort care is an available option in the area,” Owens said.

For additional information about comfort care through TCMH Hospice of Care, contact them at (417) 967-1279.

Improve Your Life with a Better Night of Sleep

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Seventy million Americans suffer from a sleep disorder. Ninety percent of sleep disorders remain undiagnosed, and for every undiagnosed sleep disorder the quality of life for that person is decreased.

“Not only does a sleep disorder decrease the quality of a patient’s life,” Lauren Toman, director of the Texas County Memorial Hospital cardiopulmonary department, said, “Sleep disorders are linked to cardiovascular disease, diabetes glucose regulation, sudden death at night from fatal arrhythmia and increased morbidity and mortality.”

Risk factors for a sleep disorder include snoring, daytime sleepiness, obesity, hypertension and the use of hormone replacement therapy for menopause.

“The cycle of breathing at night leads to excessive daytime sleepiness, impaired concentration and memory loss and mood and behavioral changes,” Toman explained.

One of the best tools for detecting a sleep disorder is the basic sleep study, medically referred to as a polysomnogram.

cardipulmonary sleep roomSleep studies are performed at special medical facilities set up as sleep laboratories. While a person sleeps in a room set up like a home bedroom, sensors are placed on the body to monitor how the body reacts while the person sleeps. A computer records physical measurements during sleep including brain waves, heartbeats and breathing.

TCMH opened a sleep studies laboratory in 2008 to accommodate the growing need for sleep studies in the area. The two-bed laboratory is part of the TCMH cardiopulmonary department.

“With our lab, area residents don’t have to drive long distances or wait a long time to get a sleep study,” Toman said.

A patient must have a physician’s order for a sleep study. TCMH takes appointments for studies which are done on Monday, Tuesday and Wednesday evenings.

Patients are asked to come to the sleep lab in the evening and go through their normal bedtime rituals such as reading or watching television prior to falling asleep.

“You can’t ‘fail’ a polysomnogram,” Toman explained, noting that while most people fall asleep, some people do not sleep as well at the sleep lab as they sleep at home. “How well you sleep will not affect the results of the test.”

A polysomnogram doesn’t require a full eight hours of sleep to find the source of the sleep disorder. “Patients need just four hours of continuous sleep for the study to be effective,” Toman said.

To run day to day operations in the sleep lab, TCMH employs registered sleep technologists to assist patients by helping them get comfortable in the sleep study rooms, hooking up the various sensors, and monitoring the patients while they participate in the study.

During the test, computers record the patient’s sleep in 30 second “pages” of results. The test results are scored by the technologist. Scoring involves going through the pages of the study to find various “stages of sleep”.

“Technologists look for things like leg jerks and when patient’s stop breathing,” Toman said. “They prepare a summary of what happened during the study before the test is sent to the doctor.”

The scored tests are then sent to Essam Elkady, MD, pulmonologist with The Ferrell Duncan Clinic of Springfield for an interpretation and diagnosis. Elkady is a board certified pulmonologist that sees patients at TCMH.

Typically, it takes about two weeks to receive the results of a sleep study. Results are sent to the patient’s referring physician, and usually the patient needs to be seen by Elkady for proper treatment of the sleep disorder.

Sometimes the polysomnogram doesn’t completely diagnose a patient’s condition, so he or she may be required to come back for additional, more in-depth sleep studies.

“Unlike some medical treatments, patients don’t return for another sleep study until they become symptomatic again,” Toman explained. Weight gains or losses or other physiological changes may determine a patient’s need for future sleep studies.

The TCMH sleep study lab sees patients of all ages. “As patients discover the benefits of a good night’s sleep after having a sleep disorder diagnosed, sleep studies continue to gain in popularity,” Toman said.

Additional information about the sleep study lab and appointments can be made by contacting the TCMH Cardiopulmonary department at, 417/967-1247.

Local Option Provides Full Spectrum Home Health Care

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new home health officeTexas County Memorial Hospital’s Home Health of the Ozarks provides in-home healthcare services for patients of all within a 40-mile radius of Houston. Services include nursing, physical therapy, nurse aide and personal home care.

“Our goal is help our patients recover and stay healthy and safe in the comfort of their own home,” Krista Elliott, Home Health of the Ozarks director, said.

In Texas County many seniors do not want to give up the independence of being in their own home, and according to Elliott, many medical experts agree that “aging in place” is healthy and provides flexibility.

Sometimes the home health agency works in conjunction with family caregivers, providing additional care or a level of care the family member may not be able to provide.

“We are here to help patients with chronic healthcare conditions such as heart failure or diabetes,” Elliott said, explaining that Home Health of the Ozarks nursing staff will visit the patient’s home for physical assessments and to provide nursing care.

Nursing staff can assist patients with diabetic foot care, wound care, home infusion therapy, ostomy care or infection prevention.

“Some of our patients have been hospitalized for surgery and after discharge from the hospital, our staff will visit the patient in their home to change dressings and monitor the patient’s health following surgery,” Elliott said.

Nursing staff can help patients learn how to monitor and record their blood sugar or blood pressure. Nurses provide one-on-one information regarding patient diagnoses, too.

“We have a nurse on call 24 hours a day, seven days a week, so while you’re in home health care, we can answer any questions or help if problems arise,” Elliott said.

A physical therapist and physical therapy assistant provide physical therapy in the home.

“A patient may return home from the hospital or nursing home after a joint replacement, and they will find that home surfaces are much different than those in the hospital or nursing home,” Elliott said. “Physical therapy can help the patient continue to gain strength in their limbs, and they will also help the patient learn to navigate uneven surfaces or stairs in the home.”

Patients that have personal needs such as bathing, grooming, cleaning house or paying bills can receive help from the Home Health of the Ozarks personal aides.

“If you notice weight loss or diminished appetite, confusion or memory loss, a loss of interest in socializing or problems with balance or walking, these are all situations where in-home care may provide benefits,” Elliott said.

For insurance to cover home health care, it must be ordered by a physician. Home Health of the Ozarks accepts most forms of private insurance including Medicare and Medicaid.

For additional information about TCMH Home Health of the Ozarks, contact Elliott at (417)967-1240.

Wedding Held at TCMH for Hospitalized Patient

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The chapel at Texas County Memorial Hospital held its first nuptials on Saturday, September 5th at the 2 p.m. wedding of Robert and Ruth Koehler.

On September 1, Mr. Koehler, a Texas County resident, was in a serious one-vehicle accident on Highway 17 near Success. Koehler’s accident left him hospitalized and unable to attend his planned wedding to Ruth in the Wright County community of Evening Shade.
“When we heard that Mr. Koehler was going to cancel his wedding due to his hospitalization, our med surg department sprang into action to help the Koehler’s utilize our chapel for their ceremony,” Wes Murray, TCMH chief executive officer, said.

Ruth Koehler’s children came to the wedding. Nursing staff took photos and helped Robert Koehler put on his Sunday clothes for the event.

The Koehler’s pastor came to the hospital and performed the ceremony. Rings were exchanged. A reception was held in Evening Shade after the ceremony.

Mr. Koehler remains hospitalized due to his accident, but he’s looking forward to his discharge. He and Ruth plan to reside at his home in Texas County.

Ruth & Robert Koehler

Ruth & Robert Koehler

Fockler Named as August Employee of the Month

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Texas County Memorial Hospital has named Paul Fockler of Houston the August employee of the month.

Fockler is a registered nurse in the intensive care unit at TCMH where he’s worked since 2011. Fockler was nominated for the award by John Sawyer, medical surgical and ICU nurse manager at TCMH.

“Paul is a team player and an excellent representative of the values we hold at TCMH,” Sawyer said, adding that other employees often tell him how Fockler assisted them when needed.

Fockler works the night shift at TCMH, and he’s known for filling in whenever help is needed. He also helps with orientation of new nursing staff.

“Paul is known for going above and beyond to be helpful and supportive,” Sawyer said.

As employee of the month, Fockler received a certificate honoring his achievement; a pin; a special parking place in the TCMH lot; one day of paid vacation; a $50 gift card, and gift certificates to Paws N Claws, D&L Florist, Janstiques and Blissful Nirvana Massage. A reception will be held at the hospital in honor of Fockler.

Fockler is eligible for the 2015 TCMH employee of the year award.

Paul Fockler (right), the Texas County Memorial Hospital August employee of the month, with his supervisor, John Sawyer.

Paul Fockler (right), the Texas County Memorial Hospital August employee of the month, with his supervisor, John Sawyer.

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