The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

May 09, 2007 #2,932 Editor-Barry Block, DPM, JD

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We've just posted the complete trial testimony of retired podiatrist and plaintiff's expert witness David Widom, DPM of Plantation, FL in a recent case tried in New York Supreme Court, which resulted in a defendant's verdict. The cross examination begins on Page 21 of the transcript.

http://www.podiatrym.com/pmarticle.cfm?id=108

PM News believes that this testimony should be of interest to the podiatric community.

Flip-Flops Could Lead to Foot and Back Pain: TN Podiatrist

Some medical experts say the simple footwear could lead to foot and back pain. "There is no arch support or anything surrounding the toes," said Rodney Staton. He is a Jackson (TN) podiatrist. "They don't hold the foot to the shoe. A good shoe needs to close the foot in and offer support for the arch of the foot."

Dr. Rodney Staton

Support for the arches is important, he said. "The arch in your foot helps the tendons keep the foot in an anatomically correct position." They take on one to one and a half times the body's weight with each step, Staton said. "The faster a person walks, the more weight the foot takes on, sometimes four or five times the weight of the person," he said.

Other hazards for flip-flop wearers involve damage to the toes. They are exposed to the elements. "Sometimes, a toenail can catch on something and break off," Staton said. "Or toes can be broken. I've seen plenty of patients who ran into something and broke a toe. If you're walking too fast, the shoes can come off and cause you to trip and break something else. Flip-flops don't offer any sort of protection."

Source: Tracie Simer, The Jackson Sun, [5/7/07]

Alleged Improper Endoscopic Plantar Fasciotomy (New York)

Below is some text excerpted from the plaintiff’s expert witness, retired podiatrist David Widom, DPM of Plantation, FL. The full text of his sworn testimony appears at: http://www.podiatrym.com/pmarticle.cfm?id=108

.

Q Doctor, have you received training in the performance of endoscopic plantar fasciotomies? That's a yes or no.

A I looked into it and --

Q That's a yes or no, doctor.

A And the answer is no.

Q And, doctor, would it be fair to say that you have not performed endoscopic plantar fasciotomies, is that correct? A That is correct.

Q So you have never done the surgical procedure that Doctor ------- performed on this patient, is that correct? A Yes.

Q Okay. So, you have no personal knowledge as to how the type of procedure should be done, isn't that correct?

A No, that's not correct.

Q So even though you have got no training and no experience at doing it, you maintain you know how the surgery should be done?

A There is basic --

Q That's a yes or no, doctor.

A Well, it calls for a bit of an explanation.

Q I am sure your attorney can ask you that, but my question was very simple; even though you have got no training in it, even though you have never done the procedure, you know how it should be performed? That's a yes or a no.

A Well, I can't do it yes or no. I know where the basic incision should be made, regardless of which procedure you are using, you want to get the same effect. And you want to make the incision in the same place, whether you are using any one of the three procedures that we do.

MR. MILLIGRAM: Move to strike as not responsive, your Honor. -

THE COURT: It shall be stricken and the jury shall disregard the answer.

.

Result: Defendant’s Verdict

Edwards Promoting Universal Healthcare on Campaign Trail

Former Sen. John Edwards (D-NC) has "made healthcare reform one of his signature issues in his quest for the White House" and is the "only major candidate who has laid out a specific plan for making sure that everyone is insured," the Raleigh News & Observer reports. Edwards sent a DVD outlining his plan to every active Democratic household in Iowa. Edwards' proposal would mandate that all U.S. residents have health insurance by 2012 and would use both public and private strategies. He has "defied conventional political wisdom" by saying that he would increase taxes to fund his plan, according to the News & Observer.

Opposition from the insurance companies and conservatives helped derail former President Clinton's plan to implement universal healthcare in the 1990s, but "the political climate has rapidly changed," in part because of rising health care costs and growing numbers of uninsured, the News & Observer reports.

Source: Raleigh New & Observer via American Health Line [5/7/07]

Query: Review Course for ABPS Oral Section

Does anyone know of any good review courses for the oral section of June ABPS Foot Surgery certification exam?

J. John Hoy, DPM, Seattle, WA

Query: Ultrasound-Guided Injections

I have been performing diagnostic ultrasound in the office for nearly 6 years, and I am going to start using ultrasound guided injections on a limited basis. Should I bill the ultrasound needle guidance code, CPT 76942 (ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation), in addition to both the injection procedure and "J" therapeutic medication code?

Example: If I am injecting a plantar fibroma using ultrasound guidance, would I bill the procedure(s) as:

CPT 76942, CPT 20550, "J" code for the therapeutic medication, or

CPT 76942 "J" code for the therapeutic medication only?

David E. Gurvis, DPM, Avon, IN

Response: Localization for a therapeutic injection in the foot and ankle can easily be performed without ultrasonic guidance. There is hardly ever any medical necessity for using this technique, and, therefore, it is not a surprise that a number of insurance carriers will most likely reject the additional coding for the ultrasonic (or fluoroscopic) injection guidance when billing CPT 20550 (injection, plantar fascia) and the therapeutic "J" medication code.

You may wish to use this technique, for example, when injecting plantar fascia fibromas, but personally, I don't think it would be good to bill for it.

Howard Zlotoff, DPM, Camp Hill, PA

Codingline subscription information can be found at
http://www.codingline.com/subscribe.htm

RE: Ethics of Dealing With Impaired Partner (Editor’s Comment)
From: Peter Smith, DPM

A 70 year old Pod cuts a few patients, and his partner is worried that he might be impaired, so he correctly confronts his partner. When the older guy says he's fine, you invoke the Podiatry Code of Ethics. How, exactly, is this younger partner supposed to intercede? Should he jump his partner from behind and sit on his chest until the patients "escape"? Should he report the guy to the state licensing agency, and ruin his career? I think that quoting the code of ethics in this case is self-righteous and unhelpful. Surely, there must be a more delicate, and dignified, way to handle this. If the guy is really slipping, then the patients will stop seeing him. This alone may help him to "see the light." We should all try to remember that we live in a real world with real people with feelings, and striking the moral gong is always easier from far away.

Peter Smith, DPM, Stony Brook, NY, ps84@bc.edu

Editor’s Response:

It is certainly sad when any practitioner becomes impaired, whether it be from age, alcohol, or drugs. Our efforts should always be directed at helping our colleagues deal with their impairment. The bottom line, however, is that we have an even higher responsibility to our patients .

Cutting a few patients might seem trivial, but it represents a problem, particularly in diabetic patients. Our citing of the APMA Code of Ethics was not the initial step recommended, but rather a last resort to a scenario where he had tried to discuss this matter with his partner . Aside from the APMA Code of Ethics, most state licensing agencies would hold that if you are aware of an impaired practitioner and do not report it, you too are guilty of professional misconduct.

Re: AAOS Provides Grants to Limit Podiatrists’ Scope of Practice (Robert Steinberg, DPM)
From: Multiple Respondents

APMA has and will continue to pursue dialogue with other national medical organizations to recognize DPMs as physicians based upon our education, training and experience. Several of these meetings have already occurred between your APMA leadership and the highest levels of leadership within the AMA, AOA. AAOS, and AOFAS. We have identified numerous areas of common interest and a few contentious areas, and future meetings are planned to continue our dialogue on all the issues.

On a state level, every state component and APMA affiliated organization must take the lead of our components in California and New York (to name a few), to initiate, foster and secure meaningful relationships with state and local medical and specialty societies.

On a grassroots level, every podiatric physician must do their part for parity to be achieved First, there is no longer any valid excuse for any podiatric physician to remain a non-member of APMA. Whatever your past reasons for not becoming a member were, they are dwarfed, in my opinion, by necessity for unity in our profession to achieve parity. Secondly, you, as an individual, must interact with your allopathic and osteopathic colleagues in your daily practices, including at your hospitals. They must know who you are and what your practice means to the care of patients in this country.

Finally, political action is central to ensuring that State and Federal legislators know who we are and what we do for our patients. You have an obligation to contribute to the APMA PAC and your local State PAC. Most importantly, you must get to know your local Representatives and Senators so that you can be a trusted confidant when health care issues arise. You must continue to keep them abreast of our issues through APMA’s eAdvocacy. The time for action is now. This requires a team effort.

Ross E. Taubman, DPM, APMA President-Elect, Clarksville, MD, retaubman@apma.org

Editor’s Note: The complete text of this letter can be read at: http://www.podiatrym.com/letters2.cfm?id=13972&start=1

Several years ago the Feds entered into a “consent agreement” with the North Carolina Orthopaedic Society regarding a “restraint of trade” issue wherein the Orthopaedic Society had formally conspired to “limit access to hospital privileges” across North Carolina to podiatrists. I would presume that since the goal is to “limit” podiatry’s scope of practice, in particular, to “decrease” the scope, that this would also be subject to anti-trust laws.

Tim Vogler, DPM, Treasurer, North Carolina Foot and Ankle Society, Timothy.Vogler@cornerstonehealthcare.com

I agree with Dr. James DiResta. Why CAN'T we go down this avenue and it IS TRUE it is in the best interest of the public which are the buzz words every politician loves to hear to support something.

Unfortunately this would probably just hurt the specialists who DO support us like the OB/Gyns, internists, anesthesiologists, etc rather than the orthopedists and there are many orthopedists who do support us to some degree or at least don't fight us too hard. In some cases I think it is the "party line" and they are like sheep and have to follow.

Gerald Peterson, DPM, West Linn, OR, drp@ifixft.com

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

PRACTICE FOR SALE – OHIO – SOUTHEASTERN

Reputable, thriving, well-rounded practice available with EMR. Grossing over $320K over the last 3 years. Priced to sell. Owner relocating. Email inquiries and CV to podsx@yahoo.com

ASSOCIATE POSITION – SOUTHERN KENTUCKY

Southern Kentucky's largest and most respected foot and ankle group is looking for an associate to start in July 07. An amazing opportunity to grow with an established four provider practice on beautiful Lake Cumberland, Kentucky. Very competitive salary/bonus with a buy in opportunity will be offered. Established satellite offices will make for immediate patient base ready to be nourished and grown by a friendly, well-trained associate. Excellent benefit package. Lexington, KK is 1.5 hours North while Nashville, Tennessee is 2.5 hours South. Please fax CV to 606-679-4626.

ASSOCIATE POSITION- KNOXVILLE, TN

PT/FT, multiple positions to fill, surgically and non-surgically trained, immediate and in near future. State-of-the-art facilities with in office surgical suites as well as full privileges at all area hospitals. Area nationally ranked as fifth best place to live and work. davidphawk@adelphia.net

ASSOCIATE POSITION – BOSTON, MA

20 year old, well established, modern practice with 2 locations just out of Boston, looking for associate, P/T or F/T, motivated 24/36 trained or ABPS-Certified or eligible to start immediately. Strong surgically-based practice. Looking for motivated individual, able to practice all facets of podiatry practiced. Electronic scanning for orthotics and voice activated EMR already in office. Fax CV to (617) 567-0822

ASSOCIATE POSITION WANTED -SOUTHEAST

Board Certified PSR/36 trained in FF/RF with clinical experience looking for a practice opportunity in the South East. Ethical, well trained with great bedside manners. Looking to join a large multispecialty group or a practice with a large referral base. Practice must be ethical and well respected in the community. Please contact flyfishingdoc@yahoo.com.

ASSOCIATE POSITION AZ - METRO PHOENIX

Busy expanding practice seeking surgical and/or non-surgical podiatrist. F/T or P/T. Motivated, personable, ethical. Send CV along with salary expectations to email dpmpcaz@yahoo.com

WELL ESTABLISHED PODIATRY PRACTICE IN MT. AIRY, NC

Dr. John H. Hodges had a well established practice in Mt. Airy, NC that is either for sale or in need of an associate/partner to take over patient care. Dr. Hodges unexpectedly passed away, leaving approximately 3,500 patients. This is a unique opportunity to be able to begin work in a busy podiatric practice. If interested, contact Carolyn McMackin at (336)577-2886 or cmcmackin@triad.rr.com

POSITION AVAILABLE - SOUTHEAST TENNESSEE/ NORTH GEORGIA

Immediate position available or will wait for the right individual. Unique practice opportunity in growing multi-physician/multi-office practice. Well established/cutting edge within the medical community. Close proximity to hospitals as well as opportunity to become involved with a free standing podiatric surgical center. Must be BQ/BC. Minimum PSR/24. Competitive salary, bonus structure and benefits. E-mail CV to afcjen@hotmail.com

OFFICE TO SHARE AND RENT - PLAINVIEW, LONG ISLAND (S. OYSTER BAY RD.)

3 treatment rooms, JACHO certified operating room, MRI extremity unit and x ray equipment on premises, turn-key operation -no investment- call 516- 4761815 or email podo2345@aol.com

ASSOCIATE POSITION – PHILADELPHIA AREA

Looking for licensed motivated medical or surgical podiatrist in Philadelphia or surrounding area to take over a clinic in west Philadelphia. Looking to develop a mutually rewarding relationship. call 215-665-9225 Dr. Smith

NORTHERN CALIFORNIA- PRACTICE FOR SALE

Great opportunity to own a well-established turn-key podiatry practice located in modern medical office building in East Bay; Electronic billing, good payor base, no HMO contracts; Biomechanics, general podiatry with great potential for surgery. Please send CV and letter of interest to: norcalpod@hotmail.com

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