June 20, 2006 #2,610 Editor-Barry Block, DPM, JD

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NJ DPM Cherishes His Role in Baseball History

Of course, Dr. James Ricketti remembers the day like it was yesterday. It was the kind of day that no one who’s experienced it could possibly forget. The date was May 15, 1981. "It was a cold, rainy evening -- a typical spring night in Cleveland," Ricketti recalls. Ricketti, then a recent graduate of the Ohio College of Podiatric Medicine was the Cleveland Indians team podiatrist. The Indians were scheduled to face the Toronto Blue Jays that night and Ricketti remembers being summoned by the team trainer.

Len Barker, who was scheduled to be the pitcher, was complaining of tight hamstrings. Perhaps a podiatrist could help. Ricketti knew exactly what to do. "I showed the trainer a new technique," he said. "Stretch and relax. You pick up the legs and stretch them, then relax them. It’s common today. You often see it done just before a basketball game. But back then it was something new. Lenny said he never felt so relaxed."

A few hours later Ricketti could see how relaxed Barker was. Before the night was over Barker was in the record book. He retired all 27 Toronto batters to become only the 10th pitcher in baseball history to log a perfect game. Barker became an instant celebrity and a number of Cleveland merchants shipped him gifts and coupons. He was glad to share with them with the young doctor he thought had contributed to his achievement. "He gave me a lot of his free dinners," Ricketti remembers.

In 1985, Roger Clemens, then a second-year pitcher for the Red Sox, was sidelined and required arm surgery. The Red Sox were concerned that the injury would recur. They felt his stride might be causing his arm to drop down dangerously during the delivery. The Indians team physician recommended they contact Ricketti. "I analyzed his motion and realized he was putting too much pressure on his great toe joint," Ricketti recalls. "I developed an appliance for the shoe so he could push off. It re-distributed the weight so it didn’t affect his upper mechanics." With the new shoe, Clemens posted a 24-4 record in 1986 and won the first of his seven Cy Young Awards.

Instead of major league players, Ricketti now treats high school athletes, along with his very busy private practice. "I cherish the memories," he says. "But I enjoy what I’m doing with high school kids."

Source: Jay Dunn, The Trentonian [6/1/8/06]

Alleged Unnecessary and Negligent Performance of Foot Surgery (FL)

Facts: The plaintiff, a 45-year-old disabled female at the time, testified that she went to the defendant podiatrist to discuss foot pain. The plaintiff claimed the defendant failed to conduct a complete examination and rushed the plaintiff to undergo right foot surgery which he performed five weeks after the initial examination. The surgery involved simultaneous performance of five separate procedures designed to straighten the bones and align the plaintiff's right foot. The plaintiff's medical expert opined that the defendant deviated from the required standard of care in failing to implement a longer period of conservative treatment and was negligent in the performance of the surgery itself.

One of the pins placed into the plaintiff's foot during the surgery entered a joint. The plaintiff had delayed healing of the second metatarsal and a piece of bone in her toe chipped off following the surgery. The plaintiff underwent two subsequent surgeries performed by non-party podiatrists, including removal of the orthopedic pins and insertion of a plate and screws. The plaintiff complained of continuing problems with her right foot. The defendant argued that the plaintiff had been diagnosed with numerous problems with both feet. According to the defense, the right foot exhibited a bunion, a short first metatarsal, a long second metatarsal, the metatarsal were angled inward, the toes were angled outward and the plaintiff had hammertoes.

The defendant's expert podiatrist testified that if there is a bunion, the bunion must be surgically removed. He also testified that if the structure of the plaintiff's foot was not changed, the bunion would return. This expert opined that the plaintiff's foot alignment had to be changed, with the bones straightened. Thus, the defendant's expert asserted that the five procedures performed by the defendant to straighten the plaintiff's foot were appropriate, quite common and performed by the defendant within the required standard of care.

The defense argued that delayed healing is an inherent risk of any surgery. The defendant's podiatrist testified, assisted by the plaintiff's x-rays, that the plaintiff's second metatarsal ultimately healed and the subsequent surgery to insert a plate and screws was not required. The defense maintained that the plaintiff's x-ray at two-months post-surgery indicated no problems. Then, records indicated that the plaintiff stubbed her foot. The defense contended that the next x-ray showed the chipping of the bone and the disruption to the foot. The defendant also contended that records showed the plaintiff was exercising, which she was told not to do. All the testifying physicians agreed that exercise can cause a disruption in healing.

Evidence showed that the plaintiff signed a consent form at the defendant's office, but that form was lost. On the day of the surgery, she signed another consent form at the surgery center which provided that alternative forms of treatment and risks had been discussed.

Result: Defendant’s verdict for both informed consent and negligence

Plaintiff’s Expert: Jack B. Gorman, DPM, Warminster, PA

Defendant’s Expert: Michael S. Downey, DPM, Moorestown, NJ

Source: Jury Verdict Review

Friday July 14- Sunday July 16, 2006.

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Query: Patient Extortion?

I performed a medial heel injection of a female who had plantar fascial pain. She did well with the injection, but as she was leaving the office had a vasovagal response. My two assistants helped her to the chair and placed her in the Trendelenburg position. Ammonia spirits were applied and 911 called. Portable EKG showed sinus bradycardia, and patient was transferred to the ER with all vitals stable, where she refused treatment. She was D/C
with a diagnosis of vasovagal response.

Two days later, I got a letter stating that she wants $2,000 or she will commence a malpractice suit. She stated all the reasons why my treatment was wrong in the letter (which were bogus). My malpractice insurer was notified, but apparently didn't think much of it, but did provide a letter format to be sent to the patient.

1) Has anyone really been sued and lost in this kind of scenario? 2) Isn't this legally extortion and shouldn't the doctor, being a citizen have the right to file a complaint with authorities with a written note to extort money? 3) Should I just let this go, as well as her balance, and pray that she doesn’t get an attorney?

Name Withheld

Editor’s comment: PM News does not provide legal advice. Your letter presents a strong reason to have malpractice insurance. Given the small amount demanded, it is unlikely that any attorney would take such a case. In order to prevail in a malpractice action, a plaintiff must prove both negligence and damages. Even if she could prove negligence (which is unlikely), damages would be extremely hard to prove.

You did the correct thing in notifying your malpractice carrier. While we would send a single bill, we would not further provoke this patient by sending her account to collections.

RE: MPJ Implant to Reverse Fusion (Gregory Stilwell, DPM)
From: Lowell Weil, Jr., DPM, MBA

I have had the opportunity to put in hinged toe silastic implants with titanium grommets for a number of failed fusions. Given some courage after hearing a lecture by Sigvard Hansen, MD of Seattle at an Annual ACFAS Meeting on converting successful ankle fusions to implant arthoplasty, I first performed this procedure on a woman who had three years of unsuccessful surgeries and failed fusions begging for her hallux to be amputated. After hearing Dr. Hansen's lecture, I offered her a salvage procedure with implant. She accepted and while not terribly functional, it completely eliminated her pain and allowed her to get on with her life. Based on that success, I have taken a handful of non-unions and converted them successfully to implants.

However, I have never taken a successful fusion and converted it to an implant. I would be very cautious about attempting that. There is a chance that the conversion could fail miserably and cause more problems than she has now. Then you are left with converting it back to a fusion with a large bone deficit. That is a particularly difficult revisional surgery and recovery.

Lowell Weil, Jr., DPM, MBA, Fellowship Director, Weil Foot & Ankle Institute, WeilJr@aol.com

RE: Severe Cramping of Feet & Legs (Jean Bainbridge, DPM)
From: Barry Mullen, DPM

To help one's patient, first, one needs to determine the leg cramping's etiology. Several etiologies immediately come to mind 1. Vascular intermittent claudication- 4 possibilities- macro or microarterial, an embolic phenomenon, or venous insufficiency. 2. Orthopedic claudication. 3. Electrolyte disturbances- most commonly hypokalemia. The type of onset, the timing of when symptoms occur, whether they occur irrespective of weight bearing, if they are dependent on leg/lower extremity position or not, how long symptoms last, whether they exacerbate, improve or completely resolve when the suspected etiology is either tested for in some fashion, buffered in some way, or treated short term, will dictate the long-term treatment plan.

Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com

TEMPORARY POSITION – LONG ISLAND

Doctor broke arm and needs a NY-Licensed DPM to cover for a period of time. (516) 637-2671 Mel2222@peoplepc.com

EQUIPMENT FOR SALE - ESWT

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ASSOCIATE POSITION - NAPLES- FLORIDA

Great opportunity for PSR- 24/36 BE/BC podiatrist with strong surgical skills. Hospital privileges available at 548 bed hospital system and multiple surgical centers. Candidate should want to perform rearfoot surgery including Charcot reconstruction. Candidate needs to be ethical and motivated and have a current Florida license. Established practitioner or new practitioner OK. Base, percentage, benefits including insurance and 401K. Fax CV to (239) 566-8778.

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 – MIAMI DADE COUNTY FLORIDA

Part time work available. Clinic sessions-nice environment / assistants supplied 8am-12pm / 1pm-5pm. Miami Dade County. Hourly Salary. E-mail response to: podoffice@aol.com

PRACTICE FOR SALE - NORTHWESTERN US

Selling 3 well developed satellite offices with substantial potential of continued growth. All offices in areas of abundant outdoor recreational activities including skiing, fishing, hiking, etc. These offices are priced to sell quickly! Please only serious inquires only and contact via e-mail: offmgr4464@hotmail.com

RESIDENCY POSITION – VIRGINIA

One Year Foot and Ankle/Rearfoot Surgical Fellowship with excellent salary/benefits available July 1, 2006. If you are finishing a PSR-24 and don't have a job yet, this is an excellent way to learn additional surgical and business skills. Please fax resume to 703-
491-9994.

ASSOCIATE POSITION - PITTSBURGH, PA AREA

Excellent opportunity for a hard working, surgically trained podiatrist to join a well-established, high volume, multi/location practice in the suburbs of Pittsburgh. Must be willing to perform all aspects of podiatry. Incentive-based salary, compensation package, with potential for partnership. Must presently have Pennsylvania license. Would like to fill position asap. Fax resume to 412-831-2115.

ASSOCIATE POSITION - MINNESOTA – MINNEAPOLIS SUBURB

Busy, well-established, full-scope podiatry practice, seeking highly motivated podiatrist for a full-time position with buy-in opportunity. Looking for PSR 24/36 trained individual, to help increase surgical volume. Excellent opportunity for long-term growth with unlimited income potential. E-mail CV to employment@associatedpodiatrists.com or fax to (612) 866-5875 Attn. Jennifer.

RESIDENCY POSITION - HOUSTON, TX

RPR, PSR-24, Houston Podiatric Foundation, Starting ASAP. Must have successfully completed PARTS 1 & 2 of National Boards. Contact: Dr. Randal M. Lepow, Director (281-348-3338) (713-725-8988)

PRACTICE FOR SALE - COLUMBUS, OHIO AREA

Fully furnished practice, open ONLY 14 hours a week with an average yearly gross of 235K. 75% primary care, 20% surgical, 5% Nails. Plenty of opportunity for growth and surgery. Changing locations. Financials available upon request. Kyle_DPM@Yahoo.com

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