The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

September 16, 2008 #3,349 Editor-Barry Block, DPM, JD

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IN Podiatrist Returns to Iraq to Train Local Doctors

When Thomas Landino first went to Iraq, he was in the business of fixing — and occasionally jumping from — airplanes. That was during Operation Desert Storm in 1991, when the Granger resident was just 22 and a soldier in the Army's 82nd Airborne Division. Now 39, and a successful doctor, he returned to Iraq recently. But this time, Landino wasn't fixing planes — he was helping heal people.

Dr. Thomas Landino

At the request of some of his longtime friends and colleagues, the married father of two spent several days recently in the northeastern Iraq city of Erbil, where he was a presenter at a seminar designed to help train Iraqi doctors. Despite concerns about his safety from some family members and friends, Landino said he wouldn't have missed the opportunity.

Landino's program, which was arranged by an organization called the International Medical Corps, allowed doctors from more developed countries to not only meet Iraqi medical providers, but go with them into hospitals and clinics, allowing for an up-close view into the realities faced by the physicians trying to rebuild the healthcare system in Iraq. The event, Landino said, helped to forge bonds between doctors from both Iraq and the West.

Source: Adam Jackson, South Bend Tribune [9/14/08]

Zelen Elected as VPMA President

The Virginia Podiatric Medical Association has elected Charles M. Zelen, DPM of Salem as President of their state professional society. The organization represents over 70% of Virginia's actively practicing doctors of podiatric medicine and surgery.

Dr. Charles Zelen

Dr. Chuck Zelen received his undergraduate degree from the University of California at Riverside and then his doctorate in podiatric medicine from the California College of Podiatric Medicine, where he was valedictorian of his class. He completed his residency training through the Northern Virginia Podiatric Surgical Residency Program and is now in private practice with Foot and Ankle Associates of Southwest Virginia, with locations in downtown Roanoke and at Lewis Gale Hospital in Salem.

Additionally, Zelen is the Podiatry Section Chief for the Department of Surgery at Carillon Roanoke Memorial Hospital and the Podiatry Section Chief of the Department of Orthopedics at Lewis Gale Hospital. In addition to general pediatric and adult podiatric care, Dr. Zelen specializes in foot and ankle reconstruction, diabetic limb salvage, and wound healing. He is a member of the Roanoke Chamber of Commerce.

Source: Mainstreet Newspapers (VA) [9/13/08]

Legal Risk For Prescribing Painkillers Is Small: Study

Primary care doctors say the greatest obstacle they face in prescribing opioids to treat chronic pain is scrutiny from regulators and law enforcement, according to a survey released earlier this year. But that fear is misguided, says a study in the September issue of Pain Medicine, the journal of the American Academy of Pain Medicine.

Researchers reviewed nine years of medical board and local, state and federal law enforcement charges against doctors for improperly prescribing opioid analgesics. They found that 725 doctors were accused of criminal or administrative offenses from 1998 to 2006. The figure represents about one-tenth of 1% of practicing physicians, or one of every 954 doctors. "The conclusion of our study is that there is risk [in prescribing opioids]; we're not denying that," said study co-author Myra Christopher. "But the risk is manageable and the risk has been exaggerated."

Physicians have long worried that the U.S. Drug Enforcement Administration's fight against prescription drug diversion has had a chilling effect on doctors' willingness to appropriately treat severe chronic pain. The DEA responded to these concerns in October 2006 with guidance for physicians. The agency declined to issue a list of do's and don'ts for doctors but said a red flag is "prescribing an inordinately large quantity of controlled substances or writing large numbers of prescriptions, compared with other physicians in an area."

Source: Kevin B. O'Reilly, AMNews [9/8/08]

How to Write Recommendations

A valued former employee has asked you for a letter of recommendation to aid the person’s job search. Follow these tips as you write:

• State how long you have known the person and in what capacity. That information belongs in the letter’s first paragraph.
• Explain why the person is talented, experienced, or gifted. Briefly detail anything that is outstanding about the person that would appeal to the employer.
• Outline the person’s outside interests, intellectual pursuits or special skills. Mention that the person volunteers, reads avidly or plays a team sport, and you could pique a prospective employer’s interest.
• Share your personal opinion. Include subjective comments if you mean them sincerely. Let readers know that they have the opportunity to hire a good employee who is likable and who gets along well with others.
• Offer a follow-up on the telephone or via E-mail. Invite readers to call you if they would like further information before making their employment offer.

Source: Communications Briefings [November 2008]

RE: Hurricane Ike
From: Neil A Burrell, DPM

I, like many of our fellow podiatrists, have been affected by Hurricane Ike. We are blessed that our family and friends are all safe, but will be displaced for weeks, if not months. You won't see many of the affected areas on the national news. Our city is expected to be "closed" for 2-4 weeks. No electricity, no water, no sewers, no basic services. In fact, officials are asking people to leave the area until basic services can get re-established. Many of us may not be able to work anywhere from 2-4 weeks. We ask for your prayers as we rebuild our communities along the Texas and Louisiana gulf coast.

Neil A Burrell, DPM, Beaumont, TX, nburrell@gt.rr.com

Editor's comment: Our hearts go out all those affected by this natural disaster. As in previous devastating hurricanes, such as Katrina, PM News stands ready to serve as a clearinghouse for offers of supplies or employment opportunities for any displaced podiatrist. We urge those podiatrists in need of help, as well as those wishing to volunteer their assistance, to forward your request to pmnews@podiatrym.com.

Query: Restrictive Covenant

I am in a contract right now until January but have been offered a position at another local group within the restrictive covenant/no-compete area for a significant increase in salary. The buy-out is $100,000. Can the restrictive covenant be avoided or eliminated legally? I would like to keep an amicable relationship with the current practice.

Name Withheld

Editor’s Comment: PM News does not provide legal advice. A properly-drafted restrictive covenant is generally enforceable. Like everything in life, contracts can be negotiated. Your best course of action may be to meet with the practice owner and explain your situation. Although your boss may not be happy with the prospect of your leaving, she/he may be willing to work out an amicable arrangement if you stay until a suitable replacement is found.

RE: Harkless to Receive Georgetown Distinguished Achievement Award
From: Michael M. Rosenblatt, DPM

Even though it was over 20 years ago, I still remember a stunning lecture given by Dr. Harkless at a seminar I attended on studies of diabetic reconstructive surgery. The clarity and precision of the presentation, as well as the content of the material were superb. I learned more listening to Dr. Harkless in two hours than I had by 20 hours reading and studying.

Frankly, I am jealous of his students and residents. They had an opportunity that they will recognize as "unprecedented" as they get older.

Michael M. Rosenblatt, DPM, San Jose, CA, ROSEY1@prodigy.net

RE: Fat Grafting for Atrophied Feet (Ivar Roth, DPM)
From: Ira Meyers, DPM, James Breedlove, DPM

GraftJacket is being promoted for soft tissue augmentation. I have no personal experience, but this may be an option for your patient.

Ira Meyers, DPM, Huntingdon Valley, PA, idmrun@aol.com

Some years ago, Nicholas Grumbine, DPM attempted to transfer fat from the abdominal area to the feet. I attended his discussion about it. You may want to contact him.

James Breedlove, DPM, San Luis Obispo, CA, bigmanzotz@aol.com

RE: Chiropractors and Orthotics (Bob Kornfeld, DPM)
From: Multiple Respondents

The problem with orthotics is that the word is generic, used widely and open to inaccurate interpretation. Because the profession of podiatric medicine is responsible for the vast knowledge of lower extremity biomechanics and is the most informed in the creation of foot orthoses, it is a shame that the profession has not trademarked or copyrighted a term that specifically identifies an APMA-certified, biomechanical foot device. If the AMA can copyright the CPT codes, certainly the APMA can come up with something. Notice how chiropractors have "Foot Levelers" as theirs?

Richard A. Simmons, DPM, Viera, FL, RASDPM32822@aol.com

Foot Levelers donate a large amount of money to the chiropractic colleges. I think we have all seen foot inserts dispensed by DC's that are nothing more than pre-made devices. When they don't help, or as often is the case, make a patient's foot or ankle condition worse, they find us. When a "real" orthotic (think posted and functional) is necessary, and I find that the DC has already billed for a pair, and another has to come out of a patient's pocket, I ask for the patient to bring in their EOB for the orthotics from their DC. Do you know what I find? Most of the time they have billed for L3000, when all they dispensed was something in the correct size.

I then call the DC and tell them I found a mistake in their billing that is preventing me from giving the patient a functional, custom-molded to a patient model, orthotic and say they need to refund the patient. If they are hesitant, I tell them I will write the patient a letter stating that the DC billed improperly. As for who is the expert, who do you think? Go ahead, take a look at Foot Levelers and decide for yourself (foot levelers.com).

Robert Scott Steinberg, DPM, Schaumburg, IL, doc@footsportsdoc.com

Being that Dr. Kornfeld and I both practice in the same geographic area, we both hear stories from our patients that their chiropractors interceded and tried to tell the patients that the orthotics they make are better than the orthotics we make. Unless we can prove to the patients themselves that the orthotic made by the chiropractor is not helping their feet, there is little we can do. Chiropractors, orthotists and many others have the right to dispense orthotics. The advantage we as podiatrists have is the advanced training we have in biomechanics and our ability to choose different types of orthotics and materials for different foot conditions.

Many years ago, a major podiatry orthotic lab tried to get involved in teaching chiropractors biomechanics so that they would use their lab and dispense the same products that we did. Outcry from the profession put a stop to that, but it could happen again.

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

RE: False Testimony by Expert Witness (Craig J. Campbell, DPM)
From: Michael Rosenblatt, DPM, Walter Perez, DPM

The transcripts of the trial against Dr. Doolan are crystal clear. Dr. Saphire insisted that "there was no conservative care" provided to the patient prior to surgery. During cross-examination, it was clearly brought out and demonstrated that, in fact, conservative care was provided and orthotics were recommended, but refused.

It would have been very helpful if, prior to the trial, Dr. Saphire had carefully read the materials (including the patient's chart) that were provided to him. Prior to this unnecessary trial, Dr. Saphire could have advised plaintiff's counsel that conservative care was provided.

This is important because the transcripts indicate a significant percentage of the case against Dr. Doolan was based upon the "absence of conservative care." This was verified because the patient had not only no damages from the surgery, but rather significant improvement! Trials are expensive for the entire profession. Malpractice rates are distributed across the podiatric community based on previous trial, awards, settlements and administrative costs. This trial was wasted time and money for the profession and grief for Dr. Doolan.

Anyone can make a mistake. At this time, with or without his friends trying to stand up for him during his absence, it is appropriate for Dr. Saphire to render a public apology to Dr. Doolan and the rest of the profession for his spurious and un-prepared testimony. Testimony against a fellow professional is a very serious choice which must be taken with the utmost care and detailed evaluation. In some cases, it is necessary. In this case, it was not.

Michael M. Rosenblatt, DPM, San Jose, CA, rosey1@prodigy.net

Editor’s note: An extended-length letter from Dr. Perez appears at: http://www.podiatrym.com/letters2.cfm?id=21943&start=1

ASSOCIATE POSITION – VIRGINIA

ASSOCIATE POSITION – NEW JERSEY

Part-time podiatrist 1-2 days per week for busy medical/surgical practice in Englewood, NJ. Must have New Jersey license and malpractice. Must have excellent skills in both C&C and surgery. Must be very personable, friendly and ethical. Could lead to a good opportunity for the right person. Please Contact By Email: LADYFOOTDOCTOR@AOL.COM

PARTNER WANTED - COLORADO

State-of-the-art practice with EMR and digital x-rays, in our physician-owned Medical Office Building and Surgical Hospital. Focus on Sports Medicine, pediatric and adult flatfoot, bunion surgery, and homeopathic care. Great opportunity for self starter. Please send CV and letter of introduction to: greg@stilwellfeet.com.

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for full-time podiatrist in a multi practice location in the Chicagoland and Northwest Indiana area. Must have two years of surgical residency. Please e-mail resume to d-kitchens@footexperts.com

ASSOCIATE POSITION - NORTHERN VIRGINIA/DC SUBURB

Excellent practice associate leading to partnership opportunity for PSR 24-36 foot and ankle surgically-trained physician. Currently 4-doctor/2 office practice in fast-growing area, expanding to 5 doctors. Hard working, personable, highly-motivated individuals needed. Great opportunity with excellent salary and benefits. No nursing homes.Top hospitals. Fax CV with references to 703-491-9994

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. 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. dtarsky@gmail.com

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

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