The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

July 26, 2007 #2,999 Editor-Barry Block, DPM, JD

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NJ Podiatrist Educates Diabetics on the Importance of Foot Care

More than 18 million American adults suffer from diabetes, a disease, which over time, can cause poor blood circulation and nerve damage in the feet, making them vulnerable to ulcers, infections, deformities and brittle bones. Dr. Jasen Langley, a podiatrist with Kimball Medical Center in Lakewood, is trying to create public awareness of this growing problem. In cooperation with the hospital, he heads diabetes education classes and a monthly support group, designed to help individuals manage their diabetes.

Dr. Jasen Langley

"People with diabetes are 10 times more likely to have a lower limb amputated than people without diabetes," said Langley, whose office is in Howell. "They must always be vigilant and should see a podiatrist at the first sign of trouble. Early treatment can keep diabetic foot problems from progressing and reduce the risk of amputations."

At a recent program, Langley talked about the key factors in preventing serious damage to the foot and ankle areas. "The most important thing a diabetic can do is have good blood sugar control," Langley said. "Once the sugar is under control, the manifestations of problems will actually slow down. You won't see them as quickly as you do in an uncontrolled diabetic." Langley said many younger doctors are being more aggressive in their treatment of diabetics, which can help prevent surgery and reduce the financial toll. "If a foot becomes bad enough that you need surgery, that can run in the neighborhood of $50,000, $60,000," Langley said. "That really takes a toll on the family and the insurance companies. That is why you are seeing the media and the Diabetes Association embarking on a more aggressive campaign to get the word out on the disease."

Source: Michael Amsel, Asbury Park Press [07/24/07]

New NY Law Will Regulate In-Office Surgeries

A new state law will provide more oversight of doctors who perform surgeries outside a hospital. It requires physicians' offices to be state-accredited and to report deaths and other critical information to authorities within one business day. The law protecting patients who undergo in-office surgeries was signed by Gov. Eliot Spitzer Wednesday and takes effect in January.

Under the new rules, any surgical or invasive procedure requiring moderate or deep sedation or general anesthesia will need to be performed in an approved setting. Minor procedures and those requiring minimal sedation are exempt. If a doctor learns a patient has died with 30 days of an in-office procedure, he or she has one day to report it. The same is true if an unscheduled hospital visit occurs within 72 hours of treatment and the hospital stay lasts more than 24 hours. Any other serious or life-threatening event following surgery will require immediate reporting as well.

Dr. John Turano

Canandaigua, NY podiatrist Dr. John Turano favors guidelines protecting patients, but says state and federal laws and insurance company requirements are frequently at odds. For example, let's say Turano needs to perform joint-replacement surgery. The feds may say it is an in-office procedure, the state says hospital, insurers say in-office.

More than a year ago, some insurers implemented a "site of service" plan wherein doctors or their staffs had to justify via a checklist why hospitalization was warranted. Turano, who has practiced medicine here for about 25 years, said if a doctor insists on hospitalization, his fee for surgery is automatically cut 15 percent. "I absorb that loss because I don't want to jeopardize my patients," he said. "There's not a patient on the planet who wants joint-replacement surgery done in an office."

Source: Billie Owens, Messenger Post [7/24/07]

Top Government Privacy Group Tells HHS to Abandon HIPAA Business Associates

The nation's top privacy advisory committee is recommending that the business associate (BA) provision under HIPAA be discarded, and that all entities handling protected health information (PHI) be treated as equals under a federal privacy rule or law, be it HIPAA or something new. If adopted, this recommendation could potentially wreak havoc on the health care industry, while no doubt providing some extra layer of privacy protection for consumers.

The practical effect of making everyone from an athletic trainer at a gym to huge medical records vendors to every provider who now bills on paper comply with some federal privacy law boggles the mind. And with the office's present manpower and workload, it is difficult to imagine that the already beleaguered HHS Office for Civil Rights (OCR) could police these entities.

Regardless, the National Committee on Vital and Health Statistics (NCVHS) feels strongly enough to have formally made its sweeping recommendation to expand entities covered by a federal privacy mandate in a letter sent to HHS Sec. Michael O. Leavitt on June 26. HHS has not yet publicly responded to the recommendation.

Source: Report on Patient Privacy [July 2007]

Query: Os Trigonum Syndrome and Neuritis

I have a 16 y.o. female patient who plays softball competitively. Her past medical history includes hip, shoulder and L4-S1 pain. She has been treated by orthos with PT. She presented with what she thought was shin splints. I determined she has saphenous neuritis and deep peroneal neuritis. Marcaine and Celestone injections to these two areas at the shin relieved the pain for only a short time. I recommended a visit with a neurologist for evaluation and treatment recommendations. The os trigonium responded to an injection as well, but did not relieve the pain completely. I made the orthotics out of a procarbelene shell to the met heads and posted the heel to 4 degrees varus and the forefoot at 0 degrees varus. The orthotics helped some. I feel I need to make a change to the orthotics, but am unsure as to what to use other than a deep heel cup Does anyone have any recommendations as to treatment options for both of these conditions?

Charleen Handzel, DPM, Southlake, TX

RE: Obituaries in PM News
From: Peter Smith, DPM

I appreciate the printing of obituaries in PM News, as I think it is a nice way to remember and celebrate some of our colleagues. Although I understand that it the wishes of PM News that donations be made to the APMA's Education Student's endowment fund, it may not be the wishes of the deceased (I know it would not be my wish). Many people share a passion for a charity or organization, and on their passing, wish to have donations made to that cause in their memory. Those donations are often requested in lieu of flowers sent to the families. I think that if PM News is going to make the effort to locate and print these obituaries, then they should finish the job by finding out the wishes of the deceased, and printing that as well. That would be a truly sincere way of honoring our deceased colleagues.

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

Editor’s comments: PM News receives over 100 death notices each year, of which only about 10% are afforded the honor of an obituary tribute. These are usually podiatrists who have contributed to the podiatric profession or their community. We attempt to contact the families of these individuals to express our condolences, acquire details, and inform the family of PM’s policy.

Of over 100 families contacted over the past 13 years, we know of only one who objected to our policy. Since we had personally discussed PM News policy with the deceased podiatrist at an earlier seminar, we were confident that we were following his wishes.

PM News subscribers are free to personally contact any family of a deceased podiatrist to determine where they wish donations to be made. We would urge our readers to let your family know now what your final wishes are. We encourage all podiatrists to consider to add the APMA Educational Foundation to your Will.

RE: 2 Vs. 3 Year Residency (Jeff Merrill)
From: Richard Gosnay, DPM

My reaction is that a student or resident should always choose to obtain as much education and training as possible. Assuming that all other aspects of the training are equal, he should opt for the biggest, baddest, longest residency program that he/she can find. We have different opportunities at different points in our careers. And the best opportunity to be trained is during those years immediately after school. How many podiatrists take a year off to get more training after they have been practicing? Few...almost none. Once Dr. Merrill has been practicing for five years, he will have huge financial obligations that will preclude his going back for more training.

The quality of a residency is more than a matter of duration. A student should spend time observing the residency. He should ask questions. He should try to extern at programs that interest him. When a student visits a residency, the residents should be busy! Do the residents rotate through many departments? Do the residents have excellent surgical numbers? Some residencies pad their numbers by making junior residents log "A" cases. This means that the resident merely observes something like a hammertoe or an I&D so he can log the case as an "A." Are the residents really doing surgery, or are they just observing or retracting and cutting suture?

Residency is not a long period of a new podiatrist's life. It is a unique opportunity. A smart student will choose the most challenging residency he/she can get. There will be plenty of time to practice after residency. But there is only one best opportunity for post-graduate training. All other considerations being equal, the longer residency is better.

Richard Gosnay, DPM, Danbury, CT, beautifulbaldhead@hotmail.com

ASSOCIATE/OWNERSHIP GROUP PRACTICE- IMMEDIATELY - PHOENIX

Requires Arizona License NOW. Full scope of podiatry requiring usual skills in surgery and medicine. Once-in-a-lifetime financial opportunity for the right person. Practice has been established in the same location for over 25 years. SurgiCenter on premises and ownership included. Email CV and letter of intent to: PPRAC@cox.net

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. Full and part time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-292-4800. Fax 773-486-3548 ---------------------E-Mail sschneider@homephysicians.com -- www.homephysicians.com

ASSOCIATE POSITION-SOUTHERN CALIFORNIA

Full scope of podiatry. Requires usual skills in surgery, medicine and biomechanics. Must be self-starter and highly motivated. Two full days per week. May soon increase to three days per week. All billing and administrative aspects handled by staff. Can practice autonomously. footguy1@pacbell.net

ASSOCIATE WANTED - IMMEDIATE OPENING- NEW YORK

Associate Position with immediate opening in the Hudson Valley (NY) for multi-office well rounded podiatric practice including general podiatry, high volume orthotics, and reconstructive surgery. Looking for well trained (PSR- 24/36. Outstanding opportunity to work into partnership. Competitive starting salary, bonus incentives, benefits, and pension. PER DIEM also available for immediate placement. Please submit: CV, letter of intent and references to: footassociate@yahoo.com

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 SANTA FE, NEW MEXICO

Immediate opening for PSR 24/36 individual in three office practice. We are looking for an ethical, hard working, well trained Podiatrist. Partnership available. Please Fax CV to sfpodiatry@aol.com

ASSOCIATE POSITION – MISSOURI

One of our long term associates needs to relocate due to family reasons. Step into full schedule. Five locations in growing population area without HMO's. Partnership available. Missouridpm@yahoo.com

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

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