The Voice of Podiatrists

Serving Over 10,700 Podiatrists Daily

March 04, 2008 #3,184 Editor-Barry Block, DPM, JD

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New High-Tech Camera a Boon to Diabetic Wound Care: IA Podiatrist

Diabetic ulcers are the number cause of foot amputations. That’s where the Silhouette mobile camera comes in. “It can look at a wound on a patient’s limb or foot and give you a three-dimensional structure of the wound”, says Dr. Lee Rogers, Director of the Amputation Center at Broadlawns.

Dr. Lee Rogers

The information is then shared as a picture and a graph, so the patient and the doctor can see how the wound is progressing. Dr. Rogers started using the camera about a month ago. It’s one of only forty in the country and it’s already become an important tool in his work.

Siloutte Mobile Camera

“It helps everyone. It helps me so that I see we are on the right track to healing the wound. It helps the patient so that they can actually have a visual clue that their wounds are improving”, says Rogers.

Source: Sarah Danik, ABC News 5 [2/28/08]

Alleged Failure To Properly Perform Removal of Neuroma on Foot (New York)

Facts: In this medical malpractice case, the female plaintiff contended that the defendant podiatrist negligently failed to properly diagnose and treat a lump in her foot. The plaintiff also maintained that the defendant failed to perform an MRI prior to surgery, resulting in the defendant allegedly failing to completely excise the mass during the surgical removal of the neuroma. As a result of the defendant's negligence, the plaintiff contended that she was forced to undergo two subsequent remedial surgical procedures to her foot in order to remove the remainder of the mass and correct and/or repair nerve damage allegedly caused by the initial surgery. The defendant contended that he performed the surgical excision of the mass appropriately and properly and that he had complied with the standard of care in all aspects of the procedure.

The evidence revealed that the female plaintiff was a nurse in her early 50's at the time of the surgery. The evidence indicated that the plaintiff had been treating with the defendant podiatrist for approximately four months prior to the surgery for a mass that was found in her right foot. The plaintiff was diagnosed with a neuroma in her foot requiring surgical excision that was performed on October 10, 2003. The plaintiff also maintained that prior to excision of the mass, the defendant failed to perform an MRI in order to properly determine the exact size and depth of the neuroma. As a result, the plaintiff contended that the defendant negligently left part of the neuroma in her foot during the surgery and that she ultimately required two additional surgeries to remove the remainder of the mass and repair nerve damage she allegedly sustained in the initial surgery. The plaintiff maintained that she missed some ten months of work due to her injuries. However, no lost wages claim was made.

The plaintiff related that she underwent a second surgical procedure in mid-2004 to remove the excess mass in her foot. The plaintiff then underwent a third surgery in 2005 to repair nerve damage allegedly sustained in the initial surgical excision of the mass. The plaintiff's expert podiatrist testified that the defendant departed from the standard of care in failing to perform a pre-surgical MRI to properly determine the size and position of the plaintiff's mass. In addition, the expert opined that the plaintiff's neurological injuries were causally related to the defendant's negligent performance of the procedure. The expert opined that the plaintiff suffered some permanency in that she is no longer able to stand for extended periods of time and/or apply complete pressure on her foot, as required in her nursing position.

The defendant introduced an expert podiatrist who opined that the defendant had, in fact, complied with the standards of care in performing the surgical excision of the plaintiff's neuroma. In addition, the defendant called a second expert podiatrist who opined that the plaintiff's injuries were not permanent and would resolve.

Result: The plaintiff made a pretrial demand of $75,000. The trial lasted three weeks with deliberations lasting approximately two hours. The jury returned with a 5-1 verdict awarding the plaintiff $300,000 for past pain and suffering and $ 50,000 for future pain and suffering for a total award of $450,000.

Plaintiff's Expert: John Mancuso, DPM, NY, NY
Defendant's Experts: Edwin Wolf, DPM, Michael Trepal, DPM, NY, NY

Source: New York Jury Verdict Review & Analysis, Volume 24, Issue 12

NY Takes on United Over Tactics as Industry Arbiter of Physician Pay

An investigation into how a UnitedHealth Group subsidiary determined reimbursement for out-of-network physicians across multiple insurers alleges to show a pattern of under-pricing services to shift the payment burden from insurers to patients.

New York Attorney General Andrew Cuomo on Feb. 13 announced his intent to sue United, after a six-month investigation focusing on its Ingenix subsidiary. Ingenix operates a database used by most insurers to determine the so-called usual, customary and reasonable rates for physician services. Cuomo, speaking at a news conference in New York City, said Ingenix had manipulated UCR rates to keep them artificially low, resulting in additional profit for United and unnecessary costs for consumers.

Cuomo's investigation is extending to other plans that use Ingenix. He said he is issuing subpoenas to 16 other health plans, including WellPoint's Empire BlueCross BlueShield, Cigna, Humana and Aetna.

Source: Emily Berry, AMNews [3/3/08]

RE: Ankle Bursitis in Hockey Player

I have a hockey player with an extreme bursitis over the lateral malleolus 4-5 cm. in size. I have tried compression aspiration, stretching the skate, etc. Has anything been used topically which will allow this player to keep skating?

Carroll Kratzer, DPM, Raleigh, NC

Query: Podiatric Assistants Performing Routine Foot Care

It has been said that there will be a need for three times the number of podiatrists in the next decade. Podiatry is ever-expanding, doing procedures that heretofore were within the purview of the orthopedic surgeon. I believe we will find that more and more podiatrists will not have the time or have the inclination to do the routine care that has built our profession. Some podiatrists are already using podiatric assistants to do this type of work for many years.

I’m thinking of contacting one of the junior colleges in our area about developing a podiatric assisting course where these young people will be taught how to perform routine care. This has many good and bad aspects and I would like to hear how my colleagues would feel about this.

Michael Forman, DPM, Cleveland, OH

RE: Transfer Lesions S/P Bunionectomy (Scott Werter, DPM)
From: Multiple Respondents

An orthotic with a first ray extension (Morton's extension) will get some of that transferred weight back where it belongs under the first met. This sort of patient should especially be discouraged from wearing high heels, which exacerbates the problem by putting even more pressure on the met heads.

Paul Busman DPM, RN Cohoes, NY, BREWERPAUL@aol.com

I would get a good H&P on the real origin of the pain. Then make orthotics. Be sure to look really hard at the gait cycle, especially midstance - right when the forefoot becomes loaded. Try to determine what part of the foot has pain during what part of the gait cycle. After the patient gets orthotics, that patient will say that it is better, but still painful to some degree. Tell the patient that is what you expect to happen. Now recommend that the patient take the orthotics and get new shoes.

I recommend Aetrex for casual wear because they are moderately stiff-soled and a low-cut but moderate heel lace up with fairly stiff sole for dress. More surgery for the next five+ years might just make things worse.

James Fisher, DPM, Eureka, CA, jimf@humboldt1.com

Editor's Note: An extended-length note from Dr. Huppin appears at: http://www.podiatrym.com/letters2.cfm?id=18235&start=1

RE: CME and Scope of Practice (Remember the Knee)
From: Stephen M. Meritt, DPM

Editor’s Note: Dr. Meritt’s extended-length note appears at:
http://www.podiatrym.com/letters2.cfm?id=18236&start=1

RE: Medical Director For Tattoo Studio (Ashley Ledger, DPM)
From: Bob Kuvent, DPM, David S. Wolf, DPM

One question for Dr. Ledger...Medical Director of a tattoo studio...Are you nuts? If you need money that bad, consider a career change.

Bob Kuvent, DPM, Chandler, AZ, ftfixr@hotmail.com

I would run, not walk away, from this "opportunity" as fast as you can. The studio is probably using your credentials so they can be licensed.

David S. Wolf, DPM, Houston, TX, RebDovid@aol.com

RE: Ethical Dilemma
From: Richard Gosnay, DPM

I thought that an expert witness would be somebody whom the lawyers consulted on a case because of his expertise, not because of his participation in the patient care. It sounds to me like this podiatrist is an eyewitness, not an expert witness. Maybe I am naive, but I don't think this podiatrist has much choice. If push comes to shove, he cannot ignore a subpoena just because he does not want to testify (Ask Andy Petitte). A hired gun from out of state may refuse to participate in a case, but if the court tells this podiatrist to testify about what he saw, that podiatrist must do so. Isn't that true?

As for his testimony, I would only suggest that he do what I would do. Tell the truth. Stay away from opinions and judgments. Only give an opinion when it is specifically solicited. Do not shade your answers in favor of the patient because you have a relationship with him. Do not shade your answers in favor of the surgeon because you are intimidated. State your objective findings as documented in the chart. You may anger the patient. You may make an enemy of that surgeon. You may anger the hospital board. But you will be true to yourself. You will be able to go home and look your kids in the eye. And you will be
able to sleep at night.

Richard Gosnay, DPM, Danbury, CT, glabroushead@gmail.com

RE: Are Those Orthotics Really Custom-Made? (Dennis Shavelson, DPM)
From: Robert Scott Steinberg, DPM, Paul Kesselman, DPM

Editor’s Note: These notes appear at: http://www.podiatrym.com/letters2.cfm?id=18238&start=1

ASSOCIATE POSITION – SEATTLE, WA

Seattle area podiatric medical practice established and growing - needs associate. Great partnership potential for well-trained podiatric physician. Costco - Corporate Headquarters + Microsoft & Boeing. 386 597-5766

PRACTICE FOR SALE - EASTERN WASHINGTON

Magnificent natural scenery in unique area of Washington state. Seller owns condo with ASC built for podiatry practice. The layout was designed to provide maximum efficiency for patient, doctor, and staff. Located within sight of hospital and medical community. Over 25 years established podiatric medical practice with potential to grow beyond $400K gross. 386 597-5766

PRACTICE FOR SALE - MINNESOTA: PRIME LAKES AREA

Great place to live and raise a family. $400+K yearly gross with continued growth and potential. Good mix of general podiatry & surgery. Hospital privileges available. Fully computerized, electronic notes, with capability to go completely paperless. Recently remodeled office, 5 tx/procedure rooms, well-equipped in owner-occupied building (for sale or lease). 260 402-7490

PRACTICE FOR SALE - AUSTIN, TEXAS

15 year established practice with good mix of surgery and clinical patients. Nice office condo for sale with practice or lease. Current female Podiatrist will transition the practice. 300-400K yearly gross. Currently keeping two part-ime podiatrists very busy, Turn-key for one full-time physician. MRobsonDPM@aol.com

EQUIPMENT FOR SALE

Tab type legal size records shelving (5 units) $50 each, MinXray P202 works OK, $1000 2 Wolf xray viewboxes (24x12) $50 each, Walker $15, Star x-ray copier $100, 3 xray Paper safe boxes $20 each, Fisher x-ray processor -will do 10x12 $500, 1.5mm moveable x-ray shield on casters $250 Contact Beth @ 919-850-9111 or btl1963@aol.com

FULL-TIME ASSOCIATE WANTED - CHATTANOOGA,TN

Well established, well-respected surgical/medical practice seeking full time associate. Send CV/ inquiries to: chattfootdoc@yahoo.com

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.com

ASSOCIATION POSITION - MONTANA

Two Doctor group seeks individual with three years of surgical training with emphasis on the forefoot. Diabetic foot fellowship desirable. Practice includes two physical therapists that work on site. Rural setting with excellent outdoor activities. Competitive salary and benefit packages with opportunity for partnership. Respond to: jclough@sofast.net or Fax to: 406-761-7219

PRACTICE FOR SALE - DALLAS TX

10 year old general podiatry practice, including, geriatric care, diabetic care, surgery, biomechanics, etc. Grossing approximately $185,000 part-time, can be made full-time. Hospital privileges available. Will stay for transition. Please reply to: footdoc8390@yahoo.com

P/T ASSOCIATE POSITION - QUEENS, NY

10 yr old practice seeks motivated, surgically-trained individual. Fax CV with hours available to (718) 458-0053.

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City . Currently four (4)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

ASSOCIATE WANTED -BOCA RATON-DELRAY BEACH AREA

Great opportunity-must be hard-working, reliable, Responsible and good with patients & staff-surgical Training a plus-partnership after 1yr. Florida License required fax resume to 561-865-2225.

ASSOCIATE POSITION - NEW YORK CITY

Excellent opportunity for foot/ankle surgeon, Manhattan and Brooklyn Associate position leading to possible partnership. Requirements: Two years enrollment in a surgical residency program Qualities of self-motivation and impeccable skills in forefoot and rear-foot surgery. Package Includes: Malpractice insurance, Health Insurance plus salary, Incentives. Terms negotiable Email CV to Manfootcare@aol.com 212-349-7676

ASSOCIATE POSITION- KANSAS CITY, MO

Excellent opportunity for a hard working, ethical podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. Dedicated, supportive staff with strong marketing and medical knowledge. Must be board eligible/certified. PSR/24. Partnership opportunity. Competitive salary, bonus structure, benefits. Wonderful place to raise a family. Fax CV to 816-455-8901.

ASSOCIATE POSITION - NEW YORK STATE

ASSOCIATE Wanted To Be fast tracked into PARTNERSHIP. 6 doctor group with one partner anxious to retire. DON'T MISS THIS OPPORTUNITY. Check out our website www.footcaregroup.com then e-mail me to arrange a visit mhudes@footcaregroup.com

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