The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

September 01, 2008 #3,338 Editor-Barry Block, DPM, JD

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IL Podiatrist Uses Special Anchor to "Shore-Up" Ankle Injuries

Anna Hunt's gymnastics career was on shaky ground. She rolled her ankle at a meet in December 2006, knocking her out of club competition. She returned a month later, but the ankle wasn't right. She rolled it three more times in a matter of weeks—an all-too-common story with ankles, which tend to be reinjured easily. When her ankle didn't improve by last summer, she underwent a procedure developed by a Chicago-area surgeon. Today, she says, "It hasn't bothered me since I had the surgery. It's like I had a completely new ankle put in."

Dr. Robert Lim

The procedure was performed by Dr. Robert Lim, who came up with the idea about 10 years ago to treat a semi-pro football player who had ankle instability. Since then he has refined it and performed it on about 150 patients. And although the lateral ankle instability procedure isn't revolutionary—doctors have done a simpler version in the past—Lim has tweaked it.

Explaining the procedure, Lim said that when the ankle ligament gets stretched, "It's not like a rubber band, where it'll snap back. It stays stretched and the space fills in with scar tissue. So you're more prone to re-injury. It causes instability." Essentially, Lim uses a special anchor and suture to create a new ligament. "It doesn't take much to put it in, so the [recovery] time is shorter and it provides immediate stability, which is slightly different than the old-fashioned way," Harper said.

Source: William Hageman, Chicago Tribune, [8/31/08]

3 Podiatrists Appointed to MI Board of Podiatric Medicine and Surgery

Governor Jennifer M. Granholm today announced the following recent appointments and reappointments:

Dr. Louis Geller

Louis J. Geller of Huntington Woods, president and podiatrist of Geller Foot Clinic, is appointed to represent podiatrists for a term expiring June 30, 2010. He succeeds Charles G. Kissel whose term has expired.

Dr. Scott Hughes

Scott E. Hughes, DPM, of Monroe, president and podiatrist of Foot + Ankle Specialists, is appointed to represent podiatrists for a term expiring June 30, 2010. He succeeds Michael S. Schey whose term has expired.

Tara L. Scott, DPM of Southfield, president of the Foot & Heel Pain Institute of Michigan, is reappointed to represent podiatrists for a term expiring June 30, 2011.

Source: Michigan Governor’s Office [8/28/08]

MA Law Requires Drug Firm Gift Details, Uniform Billing Codes

A new law in Massachusetts will standardize health plan billing codes, increase disclosure of pharmaceutical company gifts to doctors and provide more support for attracting physicians to the primary care field, among other provisions.

The adopted bill was generally supported by the Massachusetts Medical Society, said MMS President Bruce Auerbach, MD. Initially, a provision would have eliminated the possibility of drug industry support for accredited continuing medical education, a move the society opposed. So language was amended to require drug firms simply to report annually any gift, fee, payment or subsidy worth $50 or more given to physicians or other health professionals. The MMS supported the amended language.

in addition to requiring public reporting of drug company gifts and standardized billing codes for Medicaid and private health plans, the law also:

• Creates a healthcare quality and cost council in the Massachusetts Dept. of Health and Human Services to develop evidence-based performance measures for physicians and hospitals. The measures will be publicly reported on a Web site for healthcare consumers.
• Forms the Massachusetts E-Health Institute, which will create and update annually a statewide electronic health records plan. The goal is adoption of a statewide interoperable health records system by Jan. 1, 2015.
• Charges the Massachusetts Dept. of Public Health with developing an evidence-based education program on the effective utilization of prescription drugs by physicians.

Source: Doug Trapp, AMNews [9/1/08]

Practical Steps for Dealing with Surprise Visits from Government Agents - Part 2

Here are some issues (provided by Ohio State University Medical Center’s Compliance Director Julie Chicoine) to think about when a government official shows up unexpectedly:

• Cooperation and collaboration are often essential to resolving whatever issue brought the agents to your practice and minimizing the financial risk to your practice. For example, you may be able to help make the investigative process more efficient for both sides by explaining what records are relevant and dissuading officials from seizing records that aren't. Always document everything taken by the government, Chicoine adds.

• Don't assume that your organization will be accused of a crime just because the feds serve a search warrant, she says. The warrant gives them the right to seize documents, "but it doesn't mean a crime was committed." She says you can ask the agents to wait for your attorney, and they may be willing to do it. Chicoine advises copying the search warrant. "It might help you determine which documents will be most helpful to resolve the issues, what your defenses are, whether there is a whistle-blower and what the government's next steps will be." Also, if the government wants to enter an area that is beyond the scope of the search warrant, you can say no.

• If the records being seized are electronic, get the IT person to provide them in CD or other formats. "Otherwise, [the agents] will cart off the whole computer," she says.

Source: Nina Youngstrom, Health Business Daily

Failure To Obtain Informed Consent From Plaintiff For Surgery (NY)

Facts: This damages-only case involved the plaintiff's right to decide whether or not to receive additional medical treatment/surgical procedures to the feet, which established the physicians' duty to inform the patient. The plaintiff maintained that the two defendant podiatrists misrepresented her rights as to the nature of the surgery that they proposed to perform. She alleged that the surgeons did not obtain an informed consent and that they negligently performed the surgeries, leaving her with a fused joint in her large and small toes, ataxic gait and ongoing pain and in her smaller toes, preventing her from walking properly, enjoy jogging, and race walking, as she once did, and to live a pain-free life.

The plaintiff, who was a healthy woman and an avid jogger and race walker, was a female in her mid-50's at the time she visited the two defendant podiatrists. She contended that she had two office visits prior to surgery. She maintained that the defendants advised her that she needed an in-office surgical repair of her feet due to all the years of jogging, which had caused bursitis on the balls of her feet, as well as, hammertoes. The procedure, called Arthrodesis, is usually reserved for more rigid toes or severe cases, such as when there are multiple joints or toes involved. It is a procedure that involves a fusing of a small joint or joining in the toes to straighten them. A pin or other small fixation device is typically used to hold the toe in position while the bones are healing. She alleged that she signed a pre-operative consent form. However, she claimed that during the procedure, the doctors failed to advise her that they would be performing additional invasive surgery, which involved the fracturing of her toes on both feet. As a result, she has been diagnosed with ataxic gait and experiences continual pain in both feet and toes and can no longer enjoy jogging. (See Part 2 Below)

The plaintiff testified that if she had been made aware of the extensiveness and invasiveness of the procedure, she would not have consented to it. She also produced testimony that the defendants failed to obtain consent for the additional surgery. As a result, the plaintiff claimed she has difficulty walking, is no longer able to jog and experiences pain in both feet and all of her toes. The plaintiff's expert podiatrist testified that the plaintiff has since been diagnosed with ataxic gait, and will have pre-mature arthritis as a result of the surgery. In addition, he testified that the extensive procedure was unnecessary and that she would someday be a candidate for "salvage" surgery. Plaintiff's counsel also testified that the plaintiff's insurance company was overcharged.

The defendants testified that they did, in fact, inform the plaintiff of the surgical procedure, both before and during the surgery. They maintained that the phalanges and metatarsal surgical repair was necessary. In addition, they testified that the additional surgery was necessary in order to properly correct the plaintiff's abnormalities in her toes. They maintained that the patient signed a consent form and they produced what they claimed was the plaintiff's signature on a consent form. The defendant surgeons maintained that the procedure was minimally invasive. Counsel for the defense argued that the surgery did not worsen her condition.

Result: The trial lasted three days and the trial judge entered a verdict in favor of the plaintiff. He awarded her $ 250, 000 for past pain and suffering and $ 500,000 for future pain and suffering, for a total award of $ 750,000.

Plaintiff’s Expert: Ovidio J. Falcone, DPM, Astoria, NY

Source: Jury Verdict Review Publications, Volume 16, Issue 11

Query: Obligation to Treat Medicaid Patient

Yesterday, a patient who has Medicaid came into my office for podiatric care. We turned away the patient because we do not accept Medicaid because it pays so poorly. Is this illegal or ethically wrong?

Name Withheld

Editor’s comment: PM News does not provide legal advice. While it is likely legal to refuse care to a Medicaid patient, it raises ethical questions of discrimination. The 2008 APMA Code of Ethics contains the following section as Medicaid patients fall within the socioeconomic category:

ME4.2 Nondiscrimination

ME4.21 The podiatrist shall not discriminate against any patient because of race, religion, ethnicity, gender, sexual orientation, disability, socioeconomic status, or health status.

One additional option is to provide a Medicaid patient with a list of podiatrists or facilities which accept this insurance.

RE: Alcohol Percentage and Success Rate (Lloyd Smith, DPM)
From: Larry Kollenberg, R.Ph.

Lloyd Smith asked an interesting question which I posed to a drug information (DI) service. This is the preliminary response that I received from Auburn University Drug Information Service.

Question: What are the different percentage dilutional strengths of 100% ethanol used in injections for sclerosing agents in nerve injections such as motor neuroma?

Background: Dr. Kollenberg was contacted by a podiatrist in regard to an article from AJR where radiologists are using a 20% concentration of ethanol. Dr. Kollenberg’s previous experience has been with 4% ethanol and he wants to know what different percentage dilutional strengths of 100% ethanol are used for nerve injections.

Response: Intermetatarsal neuroma, or Morton’s neuroma, is....

Editor's note: This full note can be read at: http://www.podiatrym.com/letters2.cfm?id=21641&start=1

IMMEDIATE POSITION AVAILABLE TN/GA

We're in search of a motivated, well-trained DPM who is great with patients. Our well-established multi-doctor, multi-office practice is located in Southeast Tennessee/North Georgia. Must have Tennessee or Georgia license. Please reply via email to ikraus@sprynet.com

ASSOCIATE POSITION – ILLINOIS

Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings available. If interested fax curriculum vitae to 312 225-9366 or e-mail feetwork@aol.com

PRACTICE FOR SALE – CALIFORNIA

Practice is available immediately for sale in sunny Capitola, CA. The office space is available for lease or month-to-month for $750/month. The practice has a loyal patient base which is mostly home visits and skilled nursing facilities in Santa Cruz county. The practice can be moved to another location or merged with an existing practice. Asking price $35,000.00.

ASSOCIATE POSITION AVAILABLE- NEW YORK

Full-time associate position in our well-established Midtown Manhattan and Forest Hills practices. Well-rounded practice with hospital based surgery and all phases of podiatric care. We are seeking PSR 24/36 trained podiatrist with good surgical background. Compensation to also include malpractice expenses. Forward CV to slurie@papapc.net or Fax to # 212-753-3521

ASSOCIATE POSITION - BOSTON, MA

Associate wanted, Full-time or part-time, for busy long time, well established, and well rounded practice. Good mix of general podiatry and surgery. Office will generate approximately 100+ surgical cases per year. Must have surgical background for this practice, ABPS Qualified minimum needed to obtain hospital privileges. Associate position is open for partnership or purchase. Contact robert.nunberg@comcast.net

PODIATRY ASSISTANT - SOUTH FLORIDA

Attention podiatric assistants relocating to South Florida We are looking for an experienced podiatric assistant to work in a busy geriatric podiatry practice. Our office provides a very warm and friendly atmosphere. I am looking for a person who is dependable, mature, friendly and caring. Office hours are from 8:30 to 5:00 with an hour for lunch. Friday's are from 8:30 to 1:30. Job description includes: Patient histories, brief charting, assisting with procedures and minor surgeries, filing nails, applying pads, creams, and tapings, X-ray set-up, dispensing diabetic shoes, etc. Please call;(954) 650-8637 or e-mail resume to REDWINGCRZY@AOL.COM

PRACTICE FOR SALE -TEXAS

10 year old Dallas practice for sale. General podiatry practice including: surgery, routine care, orthotics, diabetic care, etc. Grossing $185,000 on 3 days per week, can easily be made full time. Middle to upper income area with great hospitals nearby. All serious offers considered. Please respond to: footdoc8390@yahoo.com

ASSOCIATE POSITION - NAPLES

Immediate opening for full-time associate position in SW FL. Surgical practice seeking PSR 24+ trained individual who is self-motivated and must be BQ/BC in Rearfoot and Ankle Surgery. Current FL license a plus for immediate start. Ilizarov or AO fellow a plus. Please email CV to: KLAMDPM@hotmail.com

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-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

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