01/08/2013    Gino Scartozzi, DPM

NY Podiatrist Advises Against Cosmetic Foot Surgery (William Deutsch, DPM)

With this ongoing conversation of "cosmetic"
foot surgery, I read Dr. Deutsch's post and
final quote "why should a surgically-trained
podiatrist be less of a physician than a
surgically-trained cosmetic surgeon?"

I was in my office the other day treating a 15
year old male who presented with his nanny. The
boy presented with a paronychia of the left
hallux nail which has recurred since last seen
approximately six months ago. The mother of the
patient was unable to present to the visit since
she is an attorney and provided written and
verbal consent for treatment. The boy is 5 ft 11
inches in height and weighs 165 lbs. This places
the patient with a BMI (Body Mass Index) of 23.
The patient weighed 173 lbs six months prior.

I updated the patient's history to be told that
the patient had recently undergone liposuction
surgery three months prior. I was a bit troubled
by a clinical decision of a "surgically-trained
cosmetic surgeon" to feel that such a procedure
with complication rates reported as high as 10%
on a minor patient with no overt morbid obesity
history. Would this "surgically trained cosmetic
surgeon" feel that perhaps placement into a
sports program with diet modification and less
time with home gaming system would be a more
appropriate form of therapies to be attempted
initially?

I wonder how this consentual process lead to
such a clinical decision between
this "surgically-trained cosmetic surgeon" and
the patient's mother, an attorney who was
obviously "educated" enough to have passed the
bar? Forget that point! What parent would
consent to such a "cosmetic surgical treatment"
on their child with the potential complications?
What "educated" parent would see the
clinical "benefit" outweighing the "risks" in
this case?

The answer to Dr. Deutsch's question posed is
somewhat misworded. The difference between
a "physician and surgeon" and a person
who "cuts" is that he/she understands and knows
better when it is appropriate to surgically
intervene and when not to, despite the wishes or
pleadings of a patient. I wonder if the clinical
decision by some to surgically intervene
on "cosmetic and non-painful foot issues" just
an excuse to circumvent adverse financial
impacts on one's practice because of the current
healthcare environment? Enough said.

Gino Scartozzi, DPM, New Hyde Park, NY,
Gsdpm@aol.com

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01/07/2013    George R. Vito DPM, MBA

NY Podiatrist Advises Against Cosmetic Foot Surgery (William Deutsch, DPM)

Once again, there seems to be a discussion about
cosmetic surgery within the profession of
podiatry. In reference to the State of NY, in
which I do have a active license, I direct the
readers to the state law 7001.

Definition of practice of podiatry.

The practice of the profession of podiatry is
defined as diagnosing, treating, operating and
prescribing for any disease, injury, deformity
or other condition of the foot, and may include
performing physical evaluations in conjunction
with the provision of podiatric treatment.
Podiatrists may treat traumatic open wound
fractures only in hospitals, as defined in
article twenty-eight of the public health law.

Specifically read the first sentence, and I
quote "operating and prescribing for any
disease, injury, deformity or other condition of
the foot".

Once again, I ask the readers to look at the
case "Otero v. Vito, out of the state of
Georgia. The law defining the scope of practice
read very similar, however we do have a leg law.
However, a federal court judge ruled that based
on the Georgia law, a podiatrist could not
perform cosmetic surgery, but also stated that a
podiatrist has never could perform cosmetic
surgery on the foot. Therefore in reality, he
mandated his ruling to be backdated. This is a
precedent within the scope of cosmetic surgery
within the profession of podiatry, which only
hurts ones argument. Therefore, the plaintiffs
attorney will only have to refer to the case out
of Georgia.

An attorney who obtains a case, and the
podiatrist who treated a foot, without pain,
without disease, injury or deformity, or other
condition of the foot will not have a defense. I
would be more than happy to discuss with any
one, the rulings of my case, and the
consequences in reference to this case.

And of course the defense attorney will argue
that that the cosmetic procedure was performed
because the patient felt that her short toe was
in her mind a deformity, causing significant
mental anguish. This argument will not work.
Even in the defense that the patient had
suffered drug abuse, alcohol abuse, years of
mental anguish, the judge will refer to the
case "Otero v. Vito", in which the plaintiff did
in fact suffer all of the above based on his
short stature.

It is hard for me to believe, that there is not
enough work for podiatrists in the State of NY,
that they must have to start performing cosmetic
surgery. Once again, I please urge any
podiatrist who is contemplating performing
cosmetic surgery, to read your state law, and
obtain the opinion of your mal practice carrier.
I dare to say, you will be very surprised of
there recommendations.

Lets not recreate the wheel, or try to make a
name for ourselves in your area, been there,
done that, and believe me, it is not worth it.

George R. Vito DPM, MBA, Winston Salem, NC,
georgevito@aol.com