The Voice of Podiatrists

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March 15, 2008 #3,194 Editor-Barry Block, DPM, JD

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CA Podiatrist Aids Runner’s Olympic Dream

Shalane Flanagan ran the 5,000 meters in the 2004 Olympics in Athens and the 2005 world championships in Helsinki. But her left foot hurt so badly in 2005 she could hardly train, and after Helsinki she decided not to run again until she found what was wrong. She went from doctor to doctor, looking for an answer. Finally, in April 2006, a breakthrough occurred. Dr. Amol Saxena, a podiatric surgeon in Palo Alto, CA, said that Flanagan’s tendon appeared to be tearing, and he was about to operate.

Dr. Amol Saxena

Minutes before, he took a standing x-ray and found the answer. She had an extra bone in the foot. He operated, removed the bone, repaired a torn tendon under the big toe and implanted a screw to hold everything together. After three months of rehabilitation, including hours in the swimming pool, Flanagan was running again on the roads.

In February 2007, in her first race in 17 months, she set an American record of 8 minutes 33.25 seconds for 3,000 meters indoors. In April, she set an American record of 14:44.80 for 5,000 meters outdoors. She has won United States championships in outdoor track, indoor track and cross-country. If she makes this year’s Olympic team, she could be a medal contender in Beijing.

Source: Frank Litsky, New York Times [3/13/08]

NYCPM Holds Combined Residency Match and Senior Awards Ceremony

For the fourth consecutive year, the New York College of Podiatric Medicine combined two of its most highly anticipated events for fourth-year students, holding them on the same day, one right after the other. Anticipation and excitement were rampant on March 11th as NYCPM’s fourth-year students heard their names called to receive merit-based scholarships and awards. More than $60,000 in scholarships and awards was given out. All told, across all four classes, NYCPM annually awards more than $600,000 in financial aid.

NYCPM fourth year student Naomi Blatt, last to draw, holds her match envelope and her jar of winnings as Louis L. Levine (left), NYCPM President and CEO, and Michael J. Trepal, DPM, Vice President for Academic Affairs look on.

Immediately following the Senior Awards Ceremony, the students’ names were drawn, one by one, for the Residency Match. As in the past, each student put a dollar in a jar at the front of the room as he or she picked up his or her Residency Match envelope and drew the next name. The mounting suspense was finally broken as the last student whose name was drawn – Naomi Blatt – strode purposefully up to the front of the room and claimed the entire jarful of dollars.

NY Podiatrist Arrested For Allegedly Billing Dead Patients

A Long Island podiatrist was arrested and charged with bilking federal and state healthcare programs by billing them for treatments on patients who had died.

Dr. Alan Cantor

Dr. Alan Cantor was arraigned Wednesday on charges including grand larceny and scheming to defraud. Bail was set at $3,000 bond or $1,500 cash.

Nassau County District Attorney Kathleen Rice said that the East Meadow podiatrist had bilked Medicare and Medicaid programs of more than $30,000 over a year-and-a-half by billing them for treatments on patients who had died.

Source: Associated Press [3/13/08]

RE: Alleged Failure to Order Bone Density Test
From Bryan Markinson, DPM

This represents the second "podiatrist should have diagnosed anorexia" case in recent months highlighted. 5 feet 5 inches tall and 101 lbs? I see this all the time. I directly ask the patient if they are eating properly and in normal amounts, no matter what their chief complaint. Guess what.... "The anorexics say "absolutely." That is part of the illness.

I suppose that plaintiff's expert feels that we should hire Mr. T. to beat the truth out of her. Twice in my professional life, once a parent and once a spouse present in the room revealed the problem against the protestations of the patient. There are lots of reasons why a female may stop menstruating...not a common investigation for the DPM, if he indeed knew about it.

Although sustaining fractures without provocation is a tip off to possible bone density issues, after the fact, when it is seen that the patient was under care of three physicians, it may be easy to criticize how the causative problem could be missed. My own investigations for bone density in these cases most often fail to reveal a density issue. If the notes reflect communication between internist, ob/gyn, and DPM, then maybe there is an issue of failure to put two and two together. But everyone knows that these events do not unfold this way. I have not gotten any calls I can recall from an OB/GYN or an internist regarding any menstruation or low weight issues in their patients.

But the disease is purposely hidden by the sufferer. That matters in the case of the DPM. The best that should come out of this is possibly some greater vigilance regarding multiple fractures without provocation. But supporting allegations of podiatric malpractice in this instance should be censured by the appropriate body. And I ask again, where was the podiatric legal defense in this case? They settled. Why?

Bryan C. Markinson, DPM, New York, NY, bryan.markinson@mountsinai.org

RE: Keloid Scar on Plantar Surface (Mike Carroll, DPM)
From: Steven H. Goldstein, DPM

I have used a product manufactured by Blaine Lads called ScarCare; It is a complete system of a scarcer gel pad and a liquid E-Sil liquid gel it is FDA-approved and there is even a CPT-4 code for it A6025 gel sheet for scar application. I have seen dramatic results within 6-8 weeks.

Steven H. Goldstein, DPM, Royal Palm Beach, FL, stevefootdr1@cs.com

RE: Unilateral Deep Itching Pain (Alan Mauser, DPM)
From: Laurence C. Rogers, DPM

If the condition of the deep itching responds to local blockade then there is another product that seems to work very well for all nerve related dysfunctions. It is Lidoderm 5% patch. One just cuts a portion of the `patch’ and apply it to the nerve distribution you desire. It works for 24 hours and can be replaced as often as needed.

Laurence C. Rogers, DPM, Rochester, IN, larrydpm@rtcol.com

RE: NV Podiatrists Act to Prevent Needle and Syringe Misuse (Elliot Udell, DPM)
From: Martin G. Miller, DPM, Howard L. Lazar, DPM

I believe Dr. Udell's statement, "No one with any basic understanding of microbiology would take a needle used to inject medication into one patient and reinsert that same needle into a 50 cc. vial of lidocaine and then use that same vial to inject into a new patient." , is incorrect as regards the case of the local pain specialist.

There has been a lot of misunderstanding in this case as to what actually happened. The original story as reported in Newsday correctly relayed the sequence of events that led to the contamination. Almost every follow-up story got it wrong as the headline became more and more sensational. What this doctor did incorrectly was subtle, and hence potentially more dangerous. He used a sterile needle & syringe to draw medication from a multi use vial. He used a different needle on the syringe to do the injection. During the injection, the contents of the syringe become contaminated when he aspirated prior to injecting. He then switched back to the original "sterile" needle to draw more medication from the multi use vial. At this point, he contaminated the vial.

Once you use the contaminated syringe to draw more meds from the vial, you contaminate the vial even though the needle was never used on a patient. Neither the needles, nor the syringes were reused across patients and the needle used to inject the patient was not used to draw medication from the multi-use vial.

Martin G. Miller, DPM, Freeport, NY, mgmiller@optonline.net

Are there really any podiatrists in Nevada, or elsewhere, who need to be told that used disposables, particularly needles and syringes, are not reusable? No. I do not believe there are any podiatrists who are that ignorant. Anyone who reuses disposables does so for the money he expects to save. Having already weighed the 'savings' against the risk, a needle recycler will not cease this cost-containment measure just because a professional organization takes a position against it.

The healthcare consuming public is shocked by the news that some unscrupulous clinics reuse disposable needles and syringes. They know it presents serious health risks. If the laity knows such practices are inappropriate, it is monumentally embarrassing that one of our professional organizations finds it necessary to publish instructions for us on the proper use of needles, syringes and multi-dose vials. One could reasonably infer that we suspect there are podiatrists who engage in recycling used disposables. I would rather see an article condemning such recycling, than an instructive article that suggests we do not know the dangers of this practice.

Needle recyclers know what they are doing, and if found out, should, at the very least, lose their licenses. There is no more compelling evidence of a licensee's disregard for the health and welfare of his patients than to treat them with previously used disposables.


Howard L. Lazar, DPM, Bloomfield Hills, MI howardlazar@comcast.net

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

ASSOCIATE POSITION - FLORIDA PANHANDLE

We are looking for a hardworking, ethical physician to join our busy practice. We are well-established and looking to expand. Must be a PS24+ with interest in all aspects of podiatric medicine and surgery. Partnership available. Fax resume to (850) 478-5227, call (850) 477-9015 or email PenFootAnk@aol.com

TEXAS - SEEKING ASSOCIATE TO FULL PARTNER

Busy multi-physician podiatric group with 2 locations seeking BQ/BC surgically trained doctor. Applicant should be well-trained in all aspects of surgical and conservative care. Seeking ethical, hard working and outgoing physician to join our 4-physician group. Excellent quality of life in suburban Houston, near NASA and the Gulf of Mexico. Email CV and cover letter to Dr. M. Rockett at Mrockettman@comcast.net

FULL-TIME ASSOCIATE WANTED - CHATTANOOGA,TN

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

PART OR FULL TIME ASSOCIATE POSITION - NEW YORK, NY

Busy, thriving Manhattan Podiatry offices looking to hire part or
full-time in-network Podiatrist for growing private practice. Please, only in-network doctors apply. Send resume and list of in-network plans that you participate in to: Rachel@FootCareofNewYork.com

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