From: Allen Jacobs, DPM
I am hopeful that the comment by Dr. Roth, in which he suggests that he would place a spinal cord neuromodulator in a patient with foot or ankle neurological pain, was submitted in humor. If a patient has a drop foot from L4-L5, would he perform a decompression surgery with fusion? What about an anterior cerebral artery aneurysm affecting only the leg and foot, or an aortic aneurysm causing blue toe syndrome or digital infarction? Is Dr. Roth prepared to treat potential complications such as spinal hemorrhage?
By the way, Dr. Roth, I suspect the placement of a spinal neuromodulator may not be comparable with your no insurance cash-only practice you profess to have mastered. You completed a non-ACGME approved podiatry residency, which you believe provided you with adequate training to place anything in a spinal cord? Please tell us you were joking.
Allen Jacobs, DPM, St. Louis, MO
From: Richard J. Manolian, DPM
Assuming you can do a thigh biopsy in California, is that the best place to do a biopsy for diagnosis of peripheral neuropathy? The answer is no. Next question is when you implant this device, completely out of the scope of your practice, will your malpractice carrier cover you? The answer is no.
Again, I ask when you post such things, why would a patient pay out-of-pocket for this in your office when an actual pain specialist or neurosurgeon will be covered by their insurance? The answer, well you get it by now. If I’m wrong, somebody please elucidate!
Richard J. Manolian, DPM, Boston, MA
RE: Denied ABPM Eligibility Because of Semantics (Marc A. Benard, DPM)
From: Bryan C. Markinson, DPM
I have read the appeal by ABPM to the JCRSB regarding this disaster. The appeal letter was well crafted, reasonable, and truthfully re-iterates the reason why this unintended consequence took place. It also relates how affected residents making a certain choice at a certain time could in no way predict these consequences. They need immediate relief as the consequences are truly potentially devastating and limiting to their careers for ABSOLUTELY NO REASON. Certainly, none of them, from the moment they applied to podiatry school to the day they finished training, could ever plan for a position where their own profession would be hurtful.
Alan Tinkleman's response on the other hand was short, and curt; the only interpretation of which is "this is what you wanted" ...which is anemic, insulting, unfair and disgraceful, and further compounded by the remark about "no one" commenting in opposition. How can you comment in opposition to a rule for which the unintended consequence is not yet known? That is the meaning of unintended consequence.
No one in this field is more proud and grateful to be a DPM than me. However, this profession has wanted to cull the "cream of the crop" from the undergraduate world, and has wanted that since I entered the profession as a student. Well, we don't deserve their consideration. There, I said it!
Bryan C. Markinson, DPM, NY, NY
