The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

May 14, 2007 #2,936 Editor-Barry Block, DPM, JD

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First-Time Runners at Higher Risk For Injuries: Palamarchuk

First time runners, more likely to ignore foot and ankle pain, are at higher risk of injury, warns Temple podiatrist Howard Palamarchuk. For the past 23 years, Palamarchuk has cared for runners’ feet at the finish line of some of the most difficult races in the country, including the Boston Marathon. He sees injuries from sprains to blisters to shin splints, always more common in beginner or average runners.

Dr. Howard Palamarchuk

Beginning or average runners take nearly twice as long to finish the same course and also tend to weigh more than experienced runners, leading to more stress on feet and ankles. “Because the legs, feet and ankles bear up to one million pounds of pressure during one hour of strenuous activity, they are most vulnerable to injury,” said Palamarchuk, who stresses the importance of stretching and strength training to prevent injury.

However, if an injury should occur, Palamarchuk advises his patients to “PRICE” the injury; that is, treat the affected area with protection, rest, ice, compressive wraps and elevation. Any ankle or foot injury with pain and swelling beyond 24 hours should be checked out by a podiatric physician. Palamarchuk advises beginner runners to listen to the signals their bodies give them. “If the ‘weekend warrior’ messes up, he won’t return to work and loses income that feeds his family,” he said. “Err on the side of caution.”

WV Podiatrist Receives 1-3 Years, 10 K Fine, and Loss of License

A West Virginia podiatrist who operated a pill mill was sentenced this week in Logan Circuit Court. Dr. Dan Lee Johnson, 58, of Anchor Road near Danville in Boone County, was sentenced to prison time and a fine by Logan County Circuit Judge Roger Perry on Tuesday. “He received a one to three year sentence and a $10,000 fine,” Prosecutor Brian Abraham told The Logan Banner. “He previously forfeited $5,000 of his $10,000 bond.”

Johnson entered a guilty plea on Feb. 27, 2007. On his agreement he wrote that he “gave prescriptions without respect to proper examination and medical history,” and entered a guilty plea to delivery of schedule IV controlled substances.

As part of his plea agreement Johnson forfeited his medical license. A police investigation determined that over the past three years Johnson wrote over 50,000 prescription for schedule II and schedule III drugs which made him one of the highest prescribers in the state.

Source: J.D. Charles, Logan Banner [5/11/07]

CMS Seeks To Begin 'Profiling' Inefficient Physicians

CMS has the data and computer capacity to identify physicians who are inefficient compared with their colleagues and as early as mid-2008 might begin to contact those physicians and ask them to become more efficient, Herbert Kuhn, acting deputy administrator of the agency testified on Thursday at a House subcommittee hearing, CQ HealthBeat reports. At a House Ways and Means Subcommittee on Health hearing, Kuhn said that identification of inefficient physicians, or "profiling," would involve a comparison of the number of tests ordered by physicians for certain types of patients with the number ordered by colleagues in cases that have the same outcome.

Kuhn said that the largest concern about implementation of profiling involves the determination of how to use the results to educate physicians to become more efficient and whether to involve medical societies, Medicare quality improvement organizations or other groups in the process. He added that he expects CMS to implement profiling on a "broad scale" and target as many physicians as possible, "if not all physicians." In addition, Kuhn said that CMS could implement profiling without the passage of legislation.

Bruce Steinwald, director of health care at the Government Accountability Office, said that profiling would reduce costs for Medicare, although the practice would require additional funds for CMS. He added that the ability of profiling to reduce costs for Medicare requires a link between the practice and reimbursement rates, a move that likely would require the passage of legislation. Kuhn said profiling is "an ambitious goal," adding, "I think we need to set ambitious goals if we're moving forward in this important reform area."

Source: CQ Healthbeat via American Health Line [5/11/07]

Query: Obligation to Perform Surgery?

I have a new patient who had surgery by another podiatrist that now requires revisional surgery. I have also learned that she has been involved in litigation against previous treating physicians for lumbar and cervical spine procedures. This information came from her primary care physician. She has a long history of narcotic use and chronic pain from both her previous foot surgery and spine surgery. I am now reconsidering her revisional surgery. Am I obligated to treat her surgically?

William Vondette, DPM, Freeland, MI

Editor’s comment: PM News does not provide legal advice. Once you establish a physician/patient relationship, you are obligated to continue treatment of that patient until you discharge the patient. This rule, however, does not obligate you to perform surgery on a patient you deem unfit for surgery. Based on her history, it seems appropriate to refer this patient to an orthopedist, who may be able to treat both her back and foot problems.

RE: Query: L3020 Orthotic Code
From: Bret Ribotsky, DPM

I would also suggest that ALL practitioners who dispense prescription custom foot orthoses in their practices have a copy of the guidelines that were created by ACFAOM years ago and updated last, in 2004. This is the most complete, unbiased report on this subject. I have used this document to send to insurance companies many times and I have been victorious each time.. Below is the link, add it to your office documents. This is another value of being a member of ACFAOM (American College of Foot and Ankle Orthopedics and Medicine.) http://www.acfaom.org/pg1103.pdf

Bret Ribotsky, DPM, Boca Raton, FL, Ribotsky@doctorbret.com

RE: Plaintiff's Expert Witness David Widom, DPM
From: Ronald A. Freireich, DPM, Bryan C. Markinson, DPM

I was blown away to see the postings regarding Dr. Widom because I too had the pleasure of being a defendant in a law suit where Dr. Widom was hired as an "expert" witness. My attorney filed a Motion for Summary Judgment and won, and the case was thrown out before going to trial. I felt Dr. Widom's "expert" report in my case, provided false and misleading testimony and violated the APMA Code of Ethics (section ME5-2, Accountability in Providing Expert Testimony).

Dr. Widom happens to be an APMA life member. I have since filed a formal complaint against Dr. Widom with the Florida Podiatric Medical Association 2 1/2 months ago and have yet to receive a response regarding resolving my complaint. I will continue to follow-up with the FPMA and post their actions.

Ronald A. Freireich, DPM, Cleveland, OH, rafdpm@sbcglobal.net

It took only one statement from Dr. Widom to seriously doubt him…and that is that he had done “several hundred” heel spur surgeries in his 27 year career. Now several hundred is certainly more than 100, and if he had done 200, he wouldn’t call it “several hundred.” So we can agree that he has done at least 300 by his sworn testimony. That’s about 11 heel spur surgeries per year. Allowing for vacation of 2 weeks, which means he has done a minimum of one heel surgery every 4.5 weeks for 27 years. Credible? I would like to know, since surgery for this problem truly is a last resort procedure.

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

RE: Pulse Dosing Lamisil in Patient With Hepatitis (Larry Kollenberg, RPh, DPM)
From: Elliot Udell, DPM

Dr. Kollenberg in his review of the literature on whether there is or is not an association between oral terbenifine and serious liver pathology quotes the following: “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." It’s time to discuss the problem of how much we can depend upon the medical literature to determine if a drug is safe enough to prescribe.

If a physician suspects a drug-induced side-effect , the problem is supposed to be addressed via what is called: the post-marketing surveillance system of monitoring drug safety. The doctor is supposed to report it to the manufacturer, who is supposed to inform the FDA . Drs. Fontanaros, Rennie and Diangeles in a paper published in the JAMA,*cited the following four problems with this system: 1. Reporting is voluntary, 2. Inadequate documentation, 3. Underreporting 4. Drug manufacturers may be tempted to conceal data that may signal the possibility of major risks.

The stinging editorial was published in part in response to the debacle with Merck over Vioxx and another case where a state attorney general had to sue to uncover evidence that certain SSI inhibitors were implicated in teenage suicides.

The bottom line is that scanning the literature might not be the way to determine if a drug is safe enough. It is unfortunate, but until a drug is taken off of the market we have to keep our eyes and ears open to other sources for this information which includes what our colleagues say about potential side-effects in PM News.

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

ASSOCIATE POSITION- SOUTH JERSEY

Associate PT/FT wanted for progressive (EMR, Digital x-ray, Diag U/S ), ethical, full scope group practice. A motivated team player with very good surgical and routine skills. ABPS cert and 24/36 PSR preferred but will take experience into consideration. A very fair benefits /compensation package. CV and references Dalilfeet@AOL.com

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

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

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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.

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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.

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