The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

May 12, 2007 #2,935 Editor-Barry Block, DPM, JD

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NYCPM Sells Vacant Lot For $39.5 Million

The New York College of Podiatric Medicine (NYCPM), the nation’s first and largest college of podiatric medicine, has sold a vacant piece of its property in East Harlem, on the southwest corner of Park Avenue and 125th Street for $39.5 million. The property, adjacent to NYCPM and its clinical affiliate, Foot Clinics of New York (FCNY), is bordered on the west by FCNY, on the east by the elevated tracks of the Metro-North Railroad, and on the north and south by East 125th and 124th Streets, respectively. The property has been used for many years as a parking lot for students, faculty and other personnel at the College. The site will now ultimately be home to more than 600,000 square feet of retailing and office space.

NYCPM President & CEO Louis L. Levine (center) signs documents at the closing of the sale of a vacant piece of the College’s property, as Chairman of the NYCPM Board of Trustees, Maj. Gen. William F. Ward, U.S. (Ret.) (sitting at left) and Joseph R. Erazo, Esq., NYCPM General Counsel (standing behind General Ward and President Levine), along with two lawyers from the firm of Winston & Strawn, look on.

“We are extremely pleased that many months of painstaking negotiations have at last come to fruition with this sale of our piece of vacant property,” said Maj. Gen. William F. Ward, A.U.S. (ret.), Chairman of the Board of NYCPM. “The Board and I are delighted that one of the nation’s foremost owners and managers of real estate has had the foresight to embrace this project, and will be taking the lead in bringing it to life.”

This sale of our parking lot property is a win for everyone concerned,” said Louis L. Levine, President and CEO of NYCPM. “The New York College of Podiatric Medicine gains an endowment that will ensure its ability to train generations of doctors of podiatric medicine for many years to come; the developer of the property gains access to a prime site at the crossroads of a resurgent Harlem, situated within walking distance of numerous modes of transportation; and the Harlem community gains new retail and office space to complement the burgeoning growth of new residential properties in the area. We are proud to be contributing to this exciting new chapter in the life of the Harlem community.”

CA Podiatrist Recommends Primary Group Exercise Certification

A primary group exercise certification is a good foundation for many other exercise fields, says Jodai Saremi, managing editor of American Fitness magazine, the trade journal for Aerobics and Fitness Association of America in Los Angeles. She has a doctorate in podiatric medicine. She is a certified fitness instructor in multiple specialties and a certified personal trainer.

Dr. Jodai Saremi

"When you want to teach a specific course type, such as step aerobics or kick boxing, you usually take a one- or two-day course to be certified in the field that includes being tested in a practical sense," Ms. Saremi says. "You have to show the master trainers that you can teach. Before they will give you a certificate, there is usually a written exam, too." When Ms. Saremi studied for her certifications, the toughest part was learning the choreography, she says.

Source: Jen Waters, The Washington Times [5/7/07]

AMA Supports Re-Introduced Health Care Truth and Transparency Act

Today's introduction of bipartisan legislation that would make it unlawful for health care providers to misrepresent their qualifications to patients was applauded by the American Medical Association and physician specialty societies. "It's important that patients know the qualifications of the health care professional caring for them," said AMA Board Member William Hazel Jr., MD. "The AMA and its medical specialty partners applaud Reps. John Sullivan and Jim McDermott for introducing legislation that protects patients by strengthening the Federal Trade Commission's authority to challenge misleading marketing by non-physician medical providers."

Joining the AMA in public support of the Health Care Truth and Transparency Act of 2007 (H.R. 2260) are the American Academy of Ophthalmology, American Academy of Otolaryngology – Head and Neck Surgery, American Psychiatric Association, American Society of Anesthesiologists, American Osteopathic Association, American College of Surgeons, American Academy of Orthopaedic Surgeons and the American Society of Plastic Surgeons.

Public confusion about the qualifications of various types of health care providers has led to the need for legislation that requires non-physicians to clearly state their professional credentials in advertisements. A nationwide survey found that more than 70 percent think a podiatrist and optometrist are medical doctors. More than 50 percent think chiropractors and psychologists are medical doctors.

Source: AMA

Query: Testimony of Plaintiff's Expert Witness David Widom, DPM

I have a few questions surrounding this issue and would like to pose them strictly for discussion purposes:

1. Since Dr. Widom demonstrated that he was not the expert that he had been believed to be, does that open up grounds for reporting to the respective state podiatric licensing board for action on his license and potential cite and fine?
2. For using a non expert or "flawed" expert, has the plaintiff's attorney opened himself up for a counter suit from the defendant doctor for malicious prosecution?
3. Does the plaintiff's attorney now have to face his own state bar to defend his using that particular non-expert?

Steve Wan, DPM, Torrance, CA

Editor’s comment: PM News Does not provide legal advice.

1) Yes, it is possible for the Florida Department of Health to sanction Dr. Widom. Such sanction would first require a formal complaint to this agency, including the transcript of his testimony.

2) While it is theoretically possible to win such a suit, it would be highly unlikely because it would be difficult, if not impossible, to show “malicious intent” on the part of the plaintiff’s attorney.

3) Yes, it would be possible to file a complaint with the appropriate New York Grievance Committee. It would, however, be necessary to provide evidence that the plaintiff’s attorney knew in advance that Dr. Widom was not qualified as an expert witness in this case. The legal issue would likely be whether a board certified podiatrist can testify to a procedure he has never studied or performed.

Query: L3020 Orthotic Code

Our office has been using different orthotics, and the doctor would like to know more information about the L3020 type, code. Can the casting code, CPT 29799, and material code A4580 be used with L3020? Are they payable with this code? Where can I find a listing or DME book or website that we can find this kind of information.

VIcki Hicks, Office of Daniel Brown, DPM, Herrin, IL

Response: L3000-L3060 are the appropriate codes for foot orthotics, each described in HCPSC.

L3000-L3060 foot orthotics are statuatorily non-covered under Medicare. To provide you with a universal policy for non-Medicare commercial carriers would be impossible because some non-Medicare payers don't reimburse foot orthotics, others may include the casting within the orthotic allowance, while others do not.

The nuances of the various different types of foot orthotics these codes describe may be found with excellent illustrations in "The Illustrated Guide to Orthotics and Prosthetics" published by the American Orthotic and Prosthetic Association (AOPA- http://www.aopanet.org/). You may also want to review previous articles in Podiatry Management (I did a series on DME's for podiatrists) or search the Codingline Forum either for "orthotics" or the specific L3000 through L3060 type (be sure to select "all dates" and "message bodies").

Paul Kesselman, DPM, Woodside, NY

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

RE: AOFAS Board Approves Policy Statement on Podiatry
From: Ross E. Taubman, DPM, Al Kline, DPM

The APMA was pleased to see the AOFAS Policy Statement on Podiatry that was recently made public. APMA received an advance copy after it was finalized by the AOFAS Board of Directors in March. The acknowledgment by the AOFAS of the value of podiatric physicians is, I believe, a major step forward in gaining acceptance and parity by our orthopaedic colleagues based upon our education, training and experience. This statement, as noted by the AOFAS, was a result of meetings held between AMA, AAOS, AOFAS and APMA, at our request. The purpose of that meeting was to continue our dialogue on substantive issues affecting patient care, most importantly the recognition of our members as physicians.

It bears repeating what was noted in the AOFAS statement, the path to parity will have to be earned when it is proved that our education, training and experience is comparable to MDs and DOs by uniform standards.

Vision 2015, established by your APMA, creates a carefully laid out detailed plan to achieve recognition of doctors of podiatric medicine as physicians. We are currently working within virtually every sector of the podiatric community to collect the data necessary to prove our comparability to the allopathic and osteopathic communities. We are also prepared to take whatever steps are necessary to ensure the comparability of our education, training and experience.

In addition to working with our internal stakeholders, APMA continues to maintain an ongoing dialogue with organized medicine, and all other appropriate and key external stakeholders. Positive and encouraging messages from organized medicine were already delivered to the APMA House of Delegates in March from both the American Medical Association and the American Osteopathic Association. Our discussions have been ongoing and productive. APMA welcomes AOFAS’ assistance in facilitating discussions with organized medicine's accrediting and credentialing bodies. We look forward to this exciting new relationship with the AOFAS and know that it is a foundation that we can build upon over the years to come. APMA is committed to serving its members and ensuring their appropriate and earned recognition as physicians.

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

I applaud the APMA , AMA , AAOS and AOFAS for sitting down at the same table and discussing such issues as podiatry training, residency training and uniform educational requirements and accreditation. It may be time to further discuss MD/DPM licensure as is seen with the MD/DDS licensure. I have always believed that there is a place for dual degree programs that is presently not available to podiatry. Now may be a great time to propose such a program.

Al Kline, DPM, Corpus Christi, TX, al@kline.net

RE: Pulse Dosing Lamisil in Patient With Hepatitis (James Clark, DPM)
From: Multiple Respondents

Dr. James Clark asks “Is it considered within the standard of care to treat onychomycosis with pulse dose Lamisil in a 24 y/o female with a medical history of hepatitis A infection? Her LFT's are WNL. “

There are no “standard of care” issues in this scenario. Hepatitis A, in the overwhelming majority of instances, results in complete return to normal liver function, which Dr. Clark has already documented. Pulse dosing of Lamisil is an OFF-LABEL use, and the patient should be informed of this. The decision to go ahead is totally up to the physician and the patient. The proper dosage is 250mg daily for seven days, every three months. That is a total of 28 tablets yearly which is a 68% reduction in total dosage, with 2 month and three week holidays in between. In some cases, where nail growth is slow, I have continued for two or three more pulses.

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

I consulted with Dr. Kenneth Josovitz, a respected gastroenterologist in the Washington, DC area on this issue. He said that since hepatitis A is an acute illness, and in most cases causes no residual liver problems, there would be no reason to exclude the patient from oral Lamisil so long as her liver enzymes were normal. The patient's liver enzymes should, however, be monitored regularly throughout the duration of treatment.

He did tell me he has treated patients in his practice who developed liver failure after being on oral Lamisil. In a couple of the cases the physicians prescribing the medication failed to take pre-medicating blood tests and the patients had underlying liver disease prior to starting the antifungal oral regimen. In another case, the patient took the medication for three months without having any blood tests to monitor his liver and toward the end of the three months went into liver failure.

Liver pathology in early stages might not have overt signs and symptoms and a healthy looking patient might have underlying pathology that is unknown to both the patient and the doctor. For these patients giving them a medication that is metabolized in the liver may be enough to cause a serious problem. He urged me to get the message to my colleagues that while oral antifungals may be very helpful in the treatment of mycotic nails, they should be treated with respect and medical monitoring with the appropriate blood tests is always necessary.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

As a paid speaker for Novartis, I have been educated to never advise a doctor treating a patient with hepatitis to undergo Lamisil therapy. However, please contact your local Novartis rep and they will have their medical director contact you for a more thorough explanation.

Frank Lattarulo, DPM, New York, NY, DOCLATT@aol.com

In a brief review of drug information associated with Lamisil , there is an interesting caveat in one summary I read regarding hepatic diseases and Lamisil:"liver failure (sometimes leading to death or liver transplant) has occurred rarely in patients with or without pre-existing liver disease who were receiving terbinafine for the treatment of onychomycosis.

Most reports of liver failure occurred in patients with serious underlying systemic conditions, and a causal relationship to terbinafine has not been established" Source AHFS Reference First data Bank. According to MicroMedix, it is a benefits and risks consideration for the medical condition of the patient and potential risk of drug-induced hepatic disease, as death has been reported. In addition, I found multiple case reports associated with hepatic injury, but nothing specific for treating a patient with history of hepatitis A and normal liver function.

Lawrence Kollenberg, RPh DPM, Jacksonville, FL, lkollenberg@hotmail.com

PRACTICE FOR SALE: IN THE HEART OF FLUSHING, QUEENS, NY

Busy practice, busy area, great location. Part of a multi-specialty practice, who are automatic sources of referral. In the same building as an ASSISTED LIVING FACILITY, automatic patients, call (212) 688-4680 or e-mail doctor4foot@aol.com for details.

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

POSITION AVAILABLE - METRO DETROIT

Looking for podiatrist to do podiatric house calls for multispecialty group. Large patient base. Part-time. Can make up own hours. Fax CV with salary expectations to (248) 723-8807.

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City. Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

ASSOCIATE POSITION - SOUTH CENTRAL PENNSYLVANIA

Beech Tree Podiatry Immediate opening for surgical and /or non-surgical podiatrist. Thirty-two year practice with full spectrum of patient care. Hospital/Surgical Center privileges available. Excellent benefits. Looking for motivated, personable podiatrist. Please fax CV to 717.854.6519 or e-mail Beechtreepod@aol.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

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

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