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March 22, 2008 #3,200 Editor-Barry Block, DPM, JD

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John Ziegler, D.P.M.

Dr. John R. Ziegler, 79, of Conneaut Lake, PA died unexpectedly Tuesday, March 18, 2008. He received his doctor of podiatric surgery degree from the Ohio College of Podiatric Medicine in 1951. He was a U.S. Army veteran during the Korean War from 1951 to 1953, where he served in the Medic Corps in France and Austria.

Dr. John R. Ziegler

Upon returning to civilian life, Dr. Ziegler started practicing in Oil City and moved his practice to Meadville, where he practiced until his retirement in 1994. He was a member and past president of the Pennsylvania Podiatry Association. Survivors, in addition to his wife, Emma Lou, of 19 years, and five children, include Dr. John Ziegler, who is also a podiatrist.

PM News policy is to request that memorial donations be made to the APMA Education Foundation Student Scholarship Program, 9312 Old Georgetown Rd. Bethesda, MD 20814.

Source: Meadville Tribune [3/20/08]

TX Podiatrist Receives $10M Grant to Study Therapeutic Socks

Lawrence Lavery, DPM, podiatrist at Scott & White Memorial Hospital in Temple, Texas, clearly understands the diabetic foot. That skill has resulted in the award of $10 million in private and government grants for Lavery’s projects over the years, and has helped create a body of work that, arguably, has prevented many deaths, as well as thousands of amputations, among people with diabetes.

Dr. Lawrence Lavery at work

Indeed, says Andrew Boulton, professor of medicine at the University of Manchester (England) and at the Diabetes Research Institute at the University of Miami (Florida), the findings from Lavery’s research garner high marks at home and in international circles.

“He’s one of the brightest podiatrists for clinical research around,” says Boulton, who is collaborating with Lavery on an international study funded by the National Institutes of Health to determine the efficacy of a commercially-available therapeutic sock. Some 400 subjects from the United Kingdom and Texas will participate in a $1.4 million study whose main objective, says Lavery, “is to see if this relatively simple but novel intervention can reduce foot ulcers.”

Judith Curtis, Diabetes Health Professional [3/19/08}

STS Company Commits to $100,000 Donation to Podiatric Education

The STS Company of Mill Valley, CA has announced a donation of casting socks and other products to the New York College of Podiatric Medicine for clinical use by their students for a five-year period. “It is our great pleasure to make this type of donation of STS products”, says Peter Graf, DPM, CEO of the STS Company. “By providing our casting socks to the students we can enhance their training experience by assuring that they are exposed to the most current products and application techniques available.

Michael Trepal, DPM (left), Dean of Academic Affairs, NYCPM and Peter Graf, DPM, CEO STS Company, discuss the STS Company's donation to the New York College of Podiatric Medicine at the New York Clinical Conference.

The STS casting products are widely used and are becoming a leading method by podiatrists for negative casting of most custom foot orthotic devices and AFO’s. The STS Company is currently developing a nationwide program of donations to colleges of podiatric medicine. The STS Company has committed in excess of $100,000 toward podiatric education for the next five years. The founders of the STS Company, Peter Graf, DPM and Richard Stess, DPM are both CCPM graduates.

Query: Sexual Harassment of Employee

A patient recently touched one of my staff members inappropriately while she was attempting to take x-rays of his foot. It involved touching her butt with one of his crutches. He then proceeded to make several lewd comments and she was very offended. She finished taking the x-rays and placed him back in a room. He also made a few suggesting comments to the receptionist as he checked out. I found out about all of this after the patient had already left the office.

How do I deal with this patient? He is currently being treated for a fractured 2nd digit and 2nd metatarsal and is in a BK cast for the next 4 weeks. He is a very non-compliant patient and has been walking on his previous cast and playing golf. This cast was being applied because he completely broke down the plantar aspect of his last cast. The patient also is the type of person that is always joking around with everyone in the office to the point that he actually annoys most of the staff and myself, however, this time he went past annoying and was completely out of line.

Robert Lagman, DPM, Mandeville, LA

Editor’s response: PM News does not provide legal advice. Patient behavior of this type is totally unacceptable in any office. After appropriate documentation, this patient should be discharged from your practice. Since you are treating a healing fracture, you are probably better off removing the cast, and taking x-rays of the foot to determine that this patient is healed enough to discharge. Naturally you’ll want to be with him throughout the visit.

Query: Vascular Exams in SNF/Rehab Centers

My partner has been asked/told by the medical director of one of the skilled nursing facility/rehab centers that we are affiliated with, to do non-invasive vascular testing ON ALL NEW residents that are either diabetic, admitted with a diagnosis of peripheral vascular disease, have an open lower extremity wound, or have a high potential for a lower extremity wound. The exam requested is to consist of an ankle-brachial indices and biphasic Doppler tracings of the posterior tibial and dorsalis pedis pulses.

How should we code/bill this? Is there a difference if we do this with/the same time as the initial consult, or would it be better for this to be in its own subsequent encounter?

Arden Smith, DPM,Great Neck, NY

Response: Any test run as "a matter of routine" (all new admissions, all diabetic patients, all patients with wounds, etc.) in a nursing home is considered a standing order written without individual evaluation and without individual determination of medical necessity. While it sounds good from the standpoint of obtaining baselines or catching the occasional vascularly signficiant compromised patient, it is a screening tool. And Medicare does not reimburse these types of screenings. Tests must be ordered as a matter of medical necessity, individualized for each patient per their medical circumstance. In an audit situation, you would not be able to justify the Medicare payment based on a demand from the nursing facility medical director. Your partner needs an order to see, and only after evaluating the patient, determine whether the patient further warrants non-invasive vascular study performance (see your carrier local coverage determinations).

There is an alternative. Have the nursing home/rehabitation pay your group a fair and reasonable fee (outside contracted service), and let them worry about getting it reimbursed.

Tony Poggio, DPM, Alameda, CA

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RE: Bunion Surgery Has Less Than 1% Complication Rate: PA Podiatrist
From: Keith Gurnick, DPM, Steven H. Silvers, DPM

I just read your posted synopsis of the article in the Pittsburgh Post-Gazette quoting Dr. Mendocino regarding his complication rate associated with hallux valgus surgery.Quoting a 1% bunion surgery complication rate to the public does a disservice to the profession of podiatry and can be misleading. Dr. Mendicino should be more careful when he is interviewed and should also be more honest in his bunion complication criterion, because I can assure you that after 26 years in practice and doing bunion surgery on a very diverse population (biomechanically speaking), and with the best of training, equipment, skills and continued education, the true complication rate of bunion surgery is certainly much higher.

I would be surprised to find any other podiatrist on this planet who performs a significant number of bunion surgeries to agree with Dr. Mendicino. If his complication rate is truly 1%, then we have finally found the absolute best bunion surgeon or he really knows how to cherry pick his surgical patients.

Keith Gurnick, DPM, Los Angeles, CA, keithgrnk@aol.com

Editor’s note: Dr. Silvers’ extended-length note can be read at: http://www.podiatrym.com/letters2.cfm?id=18576&start=1

RE: Scope of Practice and APMA Membership (Michael A. Conway, DPM)
From: Bob Kornfeld, DPM,

Dr. Conway may have an axe to grind with the "non-members" of our profession, but the slew of e-mails I received from these very same "non-members" speaks loudly for what is missing in our associations. Rather than make assumptions that I was "not involved in the profession of podiatry for 12+ years" because I was not a member, it behooves those in political position who really want to create a cohesive profession to learn to ask questions. Had Dr. Conway asked, he would have discovered that I have been trying to re-join the society for the past few years. Unfortunately, chronic mishandling of the situation has thwarted that from happening. But he should take comfort in the fact that I will be a member soon because of the professionalism and maturity of Dr. Scott Altman, who saw to it personally that things got taken care of appropriately. Instead of being angry at the "non-members", start asking why they are "non-members". Find out what you need to do to truly represent the entire profession. Anyone can be courted when they feel they will be heard. Most will support an association that they feel supports them.

A society works for the profession it represents, not just its dues-paying members. A society that wants to thrive and succeed reaches out to non-members. It doesn't further antagonize them as you have done to me. That, to me, is just "shooting yourself in the foot."

Bob Kornfeld, DPM, Lake Success, NY, Holfoot153@aol.com

RE: Plantar Warts Among Plants (Art Hatfield, DPM)
From: Michael M. Rosenblatt, DPM

As a brief reminder on the very humorous take on: "You can't make these things up," plants DO actually get and transmit viruses. Some are transmitted by sap, and other methods include insect transmission, which I would describe as an STD.

I'm sure this will give you all pause when you look at a honey bee or wasp anew.

Michael M. Rosenblatt, DPM, San Jose, CA, ROSEY1@prodigy.net

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

CASE CONSULTING PRACTICE FOR SALE - LAWRENCE, KANSAS

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds 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

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 – 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 – WESTERN 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

Great place to live and raise a family (college town). 250+ K yearly gross with good potential for growth. Good mix of general podiatry, sports medicine, and surgery. Hospital privileges available. 4 treatment/procedure rooms and well-equipped. Fully computerized. Partnership in a 4-office medical building. Partnership is for sale. Inquires to foothlr@sunflower.com 785-842-4225.

ASSOCIATE POSITION – GREATER MILWAUKEE, WI

Great opportunity: our busy multi-physician, podiatric group practice, with multiple locations, strong hospital affiliations and faculty positions with PM&S-36 residency program, is seeking a full-time RRA BQ/BC, PM&S-36 surgically trained doctor. Applicant should be well trained in all aspects of surgical and conservative care. Candidate should be ethical, hard working and outgoing physician to join our practice. Commensurate pay with incentives and benefit package. Definitive plan leading to partnership tract. Contact: Daniel Hellman, M.D. @ 414.831.0512 or by e.mail @ hellmandr@gmail.com

PRACTICE FOR SALE -ORANGE COUNTY, NEW YORK

Busy, part-time, twenty-two year old practice for sale. Easily expandable to full time. Grossing over $225,000 on three days a week. Great potential for growth. Price negotiable for immediate sale. Please reply to ASB310924@aol.com

Podiatry chairs, X-Cel x-ray machine, extremely reasonable prices. E-mail reversoman@aol.com

PRACTICE FOR SALE – GULF COAST TEXAS

If you enjoy palm trees, beaches and outdoor sports then why not live and work on the sunny coast of Texas . 17-year established practice grossing approximately 500K, with a 4 day work week. Located across from major trauma center and in the most heavily populated part of town. Large diabetic population. Office can support 2 podiatrists easily. Serious inquiries only. oda512a@aol.com

EXPANDING IN SOUTH-WEST FLORIDA

Seeking an associate for a well-established, busy, multiple-office practice. All aspects of podiatric medicine and surgery. Must have completed a 24-36 month residency and at least board eligible in forefoot surgery, preferably in forefoot and rearfoot surgery. Competitive salary with excellent benefit package. If interested, please fax CV to 941-639-0026 or e-mail it to Awilliam33@aol.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

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

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

ASSOCIATE POSITION - FT. MYERS/CAPE CORAL FL

Great opportunity for BE/BC established DPM or podiatric surgical resident with strong surgical skills. Well-established podiatric practice offering high surgical volume, advanced wound care, PT, vascular diagnostics and large diabetic population. Exceptional pay with incentives for high performers. Generous benefit package. Relaxed lifestyle, golfing, boating, fishing, close to beautiful SW FL beaches. Please send CV with references to janekelly331@msn.com

PART TIME PRACTICE W/ PROPERTY FOR SALE, BLOOMFIELD, NJ

Very busy 3 days/week. All modern equipment including digital x-ray and recently remodeled office suite. Office over 1300sf with 3 treatment rooms, large consultation room and second private office suite with full bathroom. Located in a professional building with plenty of parking on a main road. Bus stop in front. 2 blocks off Garden State Parkway. Please contact doccapo@yahoo.com

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