The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

October 01, 2010 #3,972 Publisher-Barry Block, DPM, JD

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Reserve Extreme Shoes for Special Occasions: PA Podiatrist

Dr. Eric Ricefield, of Your Next Step Podiatry in Ardmore, PA, and other podiatrists say that this has been a busy year for shoe-related foot pain. "All of these extreme shoes are placing the body in an abnormal position." Super-high heels put all the body weight on the front of the foot. "This can exacerbate bunion, and hammertoe deformities and can create neuroma, or nerve irritations."

Dr. Eric Ricefield

And very flat shoes don't have enough support, so they overstrain the Achilles tendon at the heel. Dr. Ricefield says you can have fashion without killing your feet by reserving extreme shoes for special occasions and when you won't be on your feet for long hours. Also, invest in several pairs that combine style with good support. Plus, he says, even some dressy shoes now make room for custom-fit orthotics or arch supports. They can help shift weight from the ball of the foot back to the heel, correcting the imbalance.

Source: Ali Gorman, ABC-TV (Phila, PA) [9/28/10]

Medicaid Cut for Podiatry in AZ

Health benefits for low-income adults enrolled in the state's Medicaid program will be significantly scaled back beginning this week. The Arizona Health Care Cost Containment System will cut coverage for basic health services such as physicals, most dental care, podiatry, some organ transplants, and other programs.

Administrators say the cuts, which take effect Friday, are necessary to deal with the state's budget crisis and an increase in the number of enrollees during the bad economy. The benefits cuts will save an estimated $20 million through the end of June. More than 1.3 million Arizonans were enrolled in the state's Medicaid program as of Sept. 1.

Source: Ken Alltucker, The Arizona Republic [9/26/10]

NY Podiatrist’s Medicare Fraud Sentencing Delayed Amid New Allegations

The sentencing of a former Gates podiatrist who bilked Medicare of at least $400,000 was postponed today to investigate allegations that he is practicing medicine without a license. Michael L. Akyuz was scheduled to be sentenced for his guilty pleas in March to healthcare fraud and mail fraud, both felonies, for submitting fraudulent bills for foot-care services he provided at Rochester area nursing homes and independent living facilities.

U.S. District Judge Charles J. Siragusa halted the proceeding after the prosecution argued that Akyuz, who has surrendered his license for at least three years, has continued to trim toenails at the facilities and collect fees directly from patients. Assistant U.S. Attorney Craig R. Gestring said he believed Akyuz, 44, of Greece was falsely holding himself out as a doctor. Akyuz told Siragusa under oath that he clearly told patients that he is no longer a physician and claimed he was trying to build a new business in which he trimmed toenails without providing services that require a medical license.

Source: Michael Zeigler, DemocratandChronicle.com [9/28/10]

AZ Podiatrist Back in Jail on New Drug Charges

A Tucson podiatrist charged with prescription fraud is back in jail this morning because a U.S. Drug Enforcement Administration special agent believes she recently forged a prescription for a co-defendant. Corina Maya Hollander and seven others are pending trial on charges ranging from conspiracy and participating in a criminal syndicate to fraud, trafficking in the identity of another person, forgery and acquisition of a narcotic drug by fraud.

Hollander was released from jail to the county's pretrial services division, but  Assistant Attorney General Christina Vejar asked Judge Christopher Browning to put her back in jail today based on a more recent DEA investigation. The DEA learned on Sept. 13 that Hollander's co-worker/roomate Aaron Michael Garner had recently obtained 30 tablets of a painkiller with a prescription purportedly written by Hollander's former husband, Vejar told the judge. Dr. Steven Hollander denied writing the prescription and identified the signature as his former wife's, Vejar said in court documents.

Source: Kim Smith, Arizona Daily Star [9/28/10]

OH Podiatrist Convicted in Wine Theft

Dr. Dominic Rizzo, the former program director for Christ Hospital’s foot and ankle clinic,  pleaded no contest to and was convicted Tuesday of two counts of theft for changing the bar code on pricey bottles of wine and buying them for as little as $1.59.

Hamilton County Municipal Court Judge Brad Greenberg convicted Rizzo, 38, of Madeira, and sentenced him to a year of probation. The judge also ordered the podiatrist to stay out of all Kroger stores.

Source: Kimball Perry, Cincinnati Enquirer [9/28/10]

Query: Wound VAC with HBO

I am curious to if anyone is being told that using a wound VAC and having HBO is a bad combination because the VAC has to be disconnected for about two hours during therapy which causes further maceration of the periwound skin due to back leakage. I haven't read or seen anything about this and wanted to know if anyone is having issues with this. This came from a home healthcare wound nurse.

Doug Mason, DPM, Kingston, NY  

Query: Ethical Dilemma

A 30 year old patient came in who had previous ankle surgery, and definite malpractice occurred. She liked the doctor and did not sue, and the Dr. was able to get her on permanent disability. She came in to see me and does not want any more surgery, even though I explained she has a 90% chance to get better. The previous surgeon cut the sural nerve and she was referred to a neurologist who implanted a nerve stimulator which has kept her symptoms under control. I explained to her that burying the sural nerve should solve her problem and offered to refer her to a nerve specialist for this operation which again she refused.

It seems that the original podiatrist avoided liability by helping her go on permanent disability. It does not seem right that he avoided the hit and now we, the public, are responsible to take care of her for the rest of a very long life. I would like to see what the advice is from those who have ethical experience in this area. Should the doctor be brought up on charges for helping put her on disability when he was the one who made the problem? 

Ivar Roth, DPM, MPH, Newport Beach, CA  

RE: Rotation Flap for Squamous Cell Cancer (David E. Gurvis, DPM)
From: Multiple Respondents

Dr. Gurvis asks about a rotational flap, "guided by frozen sections" to excise the lesion without amputating the toe. First of all, if the entire lesion is indeed in-situ, amputation is not required. However, the risk exists that when pathology of the whole lesion is done, some of it may be invasive. Second, frozen section is not a reliable technique for proper analysis of skin cancers, as the technique obscures nuclear detail.

The best procedure for this lesion, to achieve the stated aims, is Mohs surgery, which will result in resection with reliable margins, with each section analyzed after its removed by the Mohs surgeon, until the excision specimens are free of tumor. This is done by dermatologists who are trained in dermatologic surgery and dermatopathology. This will result in as minimal a defect as possible, with reliable removal of the lesion.

Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@mountsinai.org

When excising a similar squamous cell carcinoma lesion from a toe, I perform a two semi-elliptical incision technique and then harvest a rhomboid-shaped, full-thickness autograft transplant from the "creased" area of the sinus tarsi of the same foot, which I then close primarily. The transplanted autograft can  be sutured in place with the thinnest nylon or other monofilament.

Narmo L. Ortiz, Jr., DPM, Cape Coral, FL, nlortizdpm@embarqmail.com

Although a bi-lobed rotational flap would be acceptable, I have had good success with a full-thickness pinch graft obtained from the dorsolateral foot. It is less risky, and you can custom fit the graft size since you want clean borders and the topography is larger. If it fails, then your back-up could be the bi-lobed flap.  
 
S. Jeffrey Siegel, DPM, Philadelphia, PA, heeldoc@verizon.net  

RE: Rotation Flap for Squamous Cell Cancer (David E. Gurvis, DPM)
From: Multiple Respondents

I agree that once you excise that lesion along with a sufficient margin, you are going to be left with very little skin on the plantar surface of the toe. So, I like the idea of the flap to cover the defect.

If that were my foot, I might like to have a full-thickness skin graft placed there instead. If successful, it will eventually regain some sensation, and I think it will be less problematic because of the crease in the sulcus. You should be able to “hide” a nice bolstered dressing under the toes and give the patient a wedge surgical shoe to walk around while it heals up.

Eric Edelman, DPM, Syracuse, NY, ericedelman@gmail.com

I think you have to give up the idea of a flap here. Keep it simple, but not stupid. Excise the lesion then use either Dermagraft if you can get it covered. Wright has a product that allows you to take  a graft from the calf and mince it up and then put it on the wound. It is called Xpansion and it will grow skin.

Peter Bregman, DPM, Tewksbury, MA, footguru@comcast.net

RE: Extortion By Patient (Name Withheld)
From: Multiple Respondents

I did have a similar incident. I immediately called my malpractice insurance carrier and let them handle it. Rates did not go up and nothing ever happened. More importantly, your malpractice carrier would probably require you to contact them (at least that is what my lawyer friends tell me).

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

You have received a demand for money from a disgruntled patient. Check your malpractice contract. This has all the aspects of a malpractice action, just not yet filed. The patient may actually have an attorney. If you do not notify your carrier immediately, it is highly likely you will be in violation of that coverage contract. You pay for this coverage, and this is a time to use it.
 
Harry A Harbison, DPM, Long Beach, CA, harbih@verizon.net

Name Withheld's logic is greatly understood. The stress and time lost could certainly be worth $1,500, but you are not an attorney. If you do not exercise this transaction correctly, it could backfire. I suggest contacting your liability carrier and discuss your concerns. They can guide you through the process. On the other hand, if you want to really handle it yourself, contact a healthcare or trial attorney who is familiar with laws in your state. You want an iron-clad release and no admission of negligence. I was told years ago that a patient cannot waive negligence and a smart attorney could pierce your document. With legal representation, you will at least be protected should it backfire and he sue you anyway. Remember that anyone can sue anybody for anything, even if you sign a document saying you won't sue. Sorry about that, but it is what it is. 
 
George Jacobson, DPM, Hollywood, FL, fl1sun@msn.com

RE: Extortion By Patient (Name Withheld)
From: Multiple Respondents

Name withheld is not alone. About three years ago, I treated a patient for a cuboid fracture via MicroVas therapy and casting. After eight weeks follow-up, MRI showed bony union. She admittedly stated that she felt about 90% relieved of pain and the edema had diminished dramatically. She had even begun walking for exercise again. She was discharged from care. As it turned out, her insurance company decided that she did not have PT coverage, and although they paid the first four weeks of therapy, they denied coverage for the rest of the visits.

Since I do not participate with insurance (and a contract was signed by the patient holding her responsible for any non-covered services), the patient was promptly sent a bill for services. I then received a letter from the patient telling me that if I continued to bill her for the treatments, she would sue me for malpractice. I forwarded her letter to a healthcare attorney. He then sent a letter to her explaining the ramifications of her threat. She then paid my bill in full. By the way, her husband is an oral surgeon.
 
Bob Kornfeld, DPM, Manhasset, NY, Holfoot153@aol.com

I have heard of similar cases. Paying 1,500 dollars is cheaper than loss of revenue because of work missed for hearings, visits to attorneys and the general aggravation associated with defending a frivolous lawsuit. I not an attorney nor an expert on insurance laws. A call to your carrier's attorneys should be made. These lawyers  might feel that the case is so baseless that no attorney would take it and there is no need to pay the patient. Also by  paying the bill, the patient might think that you feel you are guilty, see "pie in the sky", and decide to sue anyway. If you opt to pay the patient's doctor bills, legal advice is certainly needed in order have the proper documents drawn up and signed by the patient so that the patient does not decide down the road to take you to court. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

Don't give in to this extortion. As long as you have everything documented properly, and that includes the extortion attempt, then by all means you should not pay this idiot. I think you should go immediately to your malpractice company, tell them what has transpired and let them begin by having their attorney tell this guy to cease and desist. If he continues to pursue this course and your documentation clearly shows his non-compliance, I would find it hard to believe that any attorney would even take his case.

David Krausse, DPM, Flemington, NJ, footdr68@verizon.net  

RE: Tough Times
From: Jeffrey Kass, DPM

A patient came into my office today for a visit. I see him every 3-4 months. The last time he came in, his check bounced. He was well aware of it as he told my secretary immediately. He then gave her two checks, one to cover the last one, and a new one. When I came into the treatment room, he apologized. He then asked me if I could spare 25 dollars as he was hungry and had no money for food. He is a disabled accountant with a history of seizures. He recently had to pay 125 bucks for Keppra (medication) which ended up not agreeing with him.

Many thoughts went through my mind when this man asked me for the 25 dollars and not particularly in this order: 1) Don't cash the two checks until clearing them with the bank. 2) Is it only me who has outrageous encounters with patients? 3) How quickly one can fall from grace - or how quickly one's world can be turned upside down. 4) I so don't want to hear about this 21.2% Medicare decrease ever again - they should simply put "fix the damn problem."

I opened my wallet, but unfortunately I only had 14 bucks on me, which I gave to my patient. I then told him to call the pharmaceutical company who makes Keppra and ask for a refund.
 
Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

RE: Scope of Practice (Robert Bijak, DPM)
From: Alison D. Silhanek, DPM

Dr. Bijak, as a podiatrist who graduated from our school system more than 10 years ago, I must testify that it is the strength of both our schools and our residency programs that have given me the strong clinical skills I have today. In addition, it is these skills that I feel provide me a strong future despite declining insurance reimbursements. While I currently compete with local orthopedic surgeons, I continue to gain ground in that regard because of the support of other respected local podiatrists, such as Charles Lombardi.

I must admit that, without my residency training through Dr. Lombardi, I could not claim the same comprehensive foot and ankle knowledge or have created the award-winning research studies on which we now pride ourselves. Given his continual involvement in the American Board of Podiatric Surgery, of which he is past President, as well as his involvement in the Joint Residency Review Committee, your allegations are uninformed and unfounded.

Finally, Dr. Lombardi's current and increasingly positive fight to obtain a full scope of practice in New York negates your pessimism.  While I respect your opinion regarding these issues, I would at least request that you fully inform yourself before publicly posting them.

Alison D. Silhanek, DPM, Medford, NY, adspod@aol.com

ASSOCIATE POSITION - WEST CENTRAL FLORIDA 
 
A great opportunity to join a  very busy, well established, diversified practice in Clearwater, Florida. We are seeking an Associate who is BC/BE and highly motivated, minimum PSR24+. We offer a competitive salary and benefits. Please send your resume to Jaye@fdn.com

PART-TIME PODIATRIST NEEDED ASAP CHICAGO

Part-time podiatrist needed for 2 offices in Chicago with an average of 20 hours/week. Must have Illinois license. Must have completed 2 years of surgical residency. If qualified, email to f-massuda@footexperts.com

NORTHEAST OHIO PODIATRY OPPORTUNITY

Western Reserve Senior Care, an innovative home visit practice that makes visits to seniors in assisted living facilities and SNF’s, is recruiting for a Part-Time Podiatrist. Make a true difference as you make visits to homebound seniors while managing the full scope of podiatric disease. This opportunity offers a perfect balance of superb lifestyle and excellent compensation. Practice is affiliated with world class health systems in Cleveland, OH. Email CV to wmills@westernreserveseniorcare.com

IMMEDIATELY AVAILABLE- ASSOCIATE POSITION -CT (FAIRFIELD AND NORTH HAVEN)

Great opportunity. Join one of the largest podiatric groups in Connecticut. Well-established and progressive offices. Electronic medical records, digital x-ray, diagnostic ultrasound, Padnet vascular studies, nerve conduction studies, pinpoint and CO2 lasers, electrical stimulation and ultrasound therapies. Seeking a well-trained, personable, and highly motivated individual. Please send resume and current photo to dr.kassaris@yahoo.com

ASSOCIATE POSITION – LONG ISLAND, NY

Associate full-time. Well-established, busy, well-rounded podiatry practice looking for a motivated podiatrist. Suffolk Co. LI NY. Board eligible, Board certified PSR-24/36 trained. Fax resume to 631-581-0857

ASSOCIATE POSITION - WEST COAST, FLORIDA

Outstanding opportunity for PSR-36 graduate to join successful group podiatry practice in Summer 2011. Seeking a sociable, articulate graduate who is confident in rearfoot and ankle reconstructive cases but also enjoys all phases of podiatry. Long-term opportunity for the right candidate with generous pay and benefits. Reply to jwicks@cortezfootandankle.com

ASSOCIATE WANTED - DELRAY BEACH FLORIDA AVAILABLE IMMEDIATELY

Rapidly growing well established practice seeking part-time leading to full-time. PSR 12-36. Great opportunity for highly motivated, personable individual. Please reply by emailing a CV to nursebsf@aol or fax (561) 498-9068.

PRACTICE FOR SALE - NORTHEAST COLORADO/SOUTHWEST NEBRASKA 
 
Practice is a good mix of biomechanics, diabetic care and surgery.  Revenue could be increased by well-trained surgeon. No HMO's. Low overhead. Only podiatrist in the area. Please contact mld9439@live.com for more information.

PRACTICE FOR SALE - MARYLAND, DC SUBURB

Great opportunity. Retiring after 38 years in practice at the same location. Practice is fully equipped with digital x-ray, diagnostic ultrasound, computer network, orthotic scanner and state licensed ambulatory surgical center that is fully equipped. Owner will stay on as needed for easy transition. dpmpracticeforsale@yahoo.com

AMBULATORY SURGICAL CENTER PRIVILEGES AVAILABLE - NJ

Privileges available in a new 2 ORs. New certified multi-specialty ambulatory surgical center in Fairlawn, NJ - 8 minutes to the George Washington bridge. Specializing in podiatric surgery. Center will pick up and return patient home. Syndication is available. Center will accommodate doctors in Manhattan, Queens, Brooklyn, Bronx, Staten Island, and long Island. Will assist in getting NJ License. Call for information (516)476-1815 e-mail podo2345@aol.com. To view center, go to FAIRLAWNASC.SHUTTERFLY.COM

MEDICAL SPACE AVAILABLE- MANHATTAN

Multispecialty Medical Building with 24/7 doorman. Prime Luxury Building and Location, Gramercy, Stuyvesant, Peter Cooper Area. 305 Second Avenue (17th-18th). Prior tenants past 23 years; podiatrist, dentist (plumbing/electric intact), internist. Ideal for podiatry, co-share with dentist, MD, etc. (flexible lease terms). E-Mail; jbdrun@aol.com

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