The Voice of Podiatrists

Serving Over 10,000 Podiatrists Daily

October 24, 2007 #3,074 Editor-Barry Block, DPM, JD

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CA Podiatrist and Silicon Advocates Hopes Science Can Finally Prevail Over Politics

The best way to prevent ulcers is to relieve pressure on the exposed parts of the feet. Doctors have historically prescribed special shoes or inserts, but few people remember to wear them because they are not in pain, says Sol Balkin, a podiatrist who recently retired from the Los Angeles California Medical Center.

Dr. Sol Balkin

After seeing a hospital lecture in 1963 about the use of injectable silicon to boost breast size, Balkin got an idea. Balkin injected a small amount of silicon into the ball of the foot to replace the lost fat pad. Patients were elated to find that it worked.

The treatment, however, has yet to make it to market, and Balkin contends it’s all politics. In 1998, silicon manufacturer Dow Corning settled a multi-billion dollar class action suit, which effectively shut down the implant business. The FDA ban was finally lifted in November 2006 after EBM debunked the alleged dangers of silicon. Balkin, who recently turned 82 has a good feeling this time that science might just prevail over politics.

Source: Melinda Wenner, Scientific American [November, 2007]

IN Podiatrist (and Daughter) Lead Shoe Drive

In the past 2 years, more than 2,400 pairs of shoes and socks were collected and distributed to underprivileged people in the Lafayette, IN area. This year, "Shoes for the Needy" organizer Brittany Oliver (daughter of Dr. William Oliver, III) said she hopes to pass out even more.

Dr. William Oliver, III and daughter Brittany

"The first year I did this I got an anonymous thank you from a lady who said that because of my project it was the first pair of shoes that she had in over a year because she's on disability and not able to work. That was really heart-warming knowing that a simple pair of shoes that somebody had in the back of their closet that they didn't even need really made a difference in somebody's life," said Oliver.

The collection is sponsored by the Indiana Podiatric Medical Association. In the Greater Lafayette area, shoes are distributed to citizens through organizations such as Salvation Army, Transitional Housing, Community and Family Resource Center, and It’s My Closet. .

Source: News 18 [10/21/07]

IL Podiatrist Charged With Hiding Camera in Changing Room

An East Dundee-based podiatrist was charged with felony eavesdropping after an employee found a hidden camera in a changing room in his office, authorities said today. Steven P. Loheide, 63, of Algonquin, also was charged with unauthorized video recording, unlawful solicitation of a sex act and battery, all misdemeanors, after a police search of his office Wednesday, according to an East Dundee police news release. He is free on $100,000 bail, set Friday by a Kane County judge.

Dr. Steven P. Loheide

Officers were sent Tuesday to Loheide's office at the Fox Valley Podiatry, 210 Penny Lane, East Dundee, after a female employee reported the discovery of a videotape of her undressing in an examination room in the office, police said.

After watching the tape, the woman found a camera hidden in the room and reported it to authorities, who with the assistance of the Kane County state's attorney's office got a search warrant, police said. The employee also reported that Loheide had solicited her for a sex act and touched her inappropriately.

Source: Chicago Tribune [10/22/07]

Query: Off-Shore Transcription Services

What experiences have PM News readers had with off-shore transcription services, and/or any similar services that one could utilize to load information from patient charts onto an EMR, keeping all the legalities in mind?

Michael DiGiacomo, DPM, Oakland, CA

RE: PM Jury Verdict Reporter
From: Multiple Respondents

I am compelled to comment on the latest "jury verdict" since I was the defendant. At the time of incident the plaintiff was 21 and she was treated for stress fractures that occurred 6 months apart on two different feet, each following vigorous high impact aerobics. Each stress fractured healed uneventfully within 4 weeks and she went on to continue to exercise without a problem. Two years after these incidents I was served with this case. Needless to say I was shocked, thinking I must have missed a malignant bone tumor.

Some of the blatant lies Myron Boxer proposed included that the orthotics I made were inappropriate (I had Northwest Labs certify that they made 22,000 pair of this type of neutral position device a year ) and that the x-rays clearly showed osteoporosis (refuted by a our radiologist (since there there must be 70% bone loss to diagnose osteoporosis on x-ray). Dr Boxer is clearly a lying, bottom-feeding hired gun who should be banished from our profession.

At the time I was insured by PHICO. They went bankrupt and my coverage converted to the state with a max coverage of 300K. My attorney was convinced that we had a excellent chance to "win" the case, however, he went ahead and settled the case without informing me. I had signed a “consent to settle” agreement, however I learned that the case was settled only when I was notified by the practitioner data bank. When I questioned the attorney, he told me he "did me a favor," however the reality is both attorneys probably milked the case for all it was worth!

As often as we are told to practice defensively and try to always do the right thing, there is always someone out there that will blame you for their problem and look for the easy buck. It was a painful lessoned learned and hopefully this will open the eyes of others who may be confronted with a case like this.

William A. Sachs , DPM, Toms River, NJ, wmasachs@gmail.com

This is an interesting case because it involves a mixed settlement. It unfortunately does not describe the “inner workings” of responsibility during the handling and management of the suit. For example, the most important question to DPMs reading this is: “How much did the podiatrist have to pay?” Other questions easily follow. They include: “How did the attorneys share the burden of management of the suit?” “What percentage of attorney’s management fees went to counsel defending the podiatrist?”

This was a negotiated settlement. Since the OBGYN’s attorney probably voted to settle, the podiatrist (who paid less anyway), had little or no vote. Despite the fact that the patient (apparently) had an eating disorder, there is a substantial laundry list of other potential causes for amenorrhea, which include bulimia, as well as various glandular abnormalities, depending on whether the condition is primary or secondary amenorrhea.

One questions whether or not the podiatrist had taken foot and ankle x-rays. It is highly likely that this patient had significant osteoporosis in her feet and ankles. Some podiatrists reduce or exclude x-rays for patients who are HMO members, feeling that they want to reduce patient-care costs, and have a higher likelihood of being “allowed to remain” on that panel. Could this have occurred here?

The most important lesson for doctors reading about this settlement may be:

1. Diluting patient responsibility by referral is no guarantee that a lawsuit will not occur.
2. When a lawsuit does occur, you will lose a portion of management of the suit.
3. Patients with psychological abnormalities are probably always a higher risk for suit.
4. If you feel that your patient has psychological problems, referral to a mental health professional is an essential part of care.
5. You are responsible for providing necessary care within your specialty. This responsibility exists even if your patient is in an HMO that discourages care and excludes providers whom they feel “extend” patient
care costs.

Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

While I am dead set against commenting on the shallow depth of the published Jury Verdict Reporter stories, the current issue reported something so outrageous (even admitting that I do not have the full story and may be errant in my conclusions)) that I feel compelled to comment.

First of all, I want to say that I refer all fractures without provocation in women, and any where bone density on plain films is questionable, for bone density evaluation. I also ask any adult woman who weighs 100 pounds or less about their nutritional status. But NOT doing these things, even in a 5'5" female weighing 100 pounds, cannot be podiatric malpractice.

Eating disorders, first of all, are characteristically hidden by the sufferers. People with anorexia or bulimia do not walk in and divulge it like they would a history of reflux or hypothyroidism. In my practice, those patients that indeed do reveal it have been under treatment for years, often discovered after a medical crisis arises in which they no longer can hide it. Furthermore, even knowing the diagnosis from the podiatric standpoint does not materially change the treatment required for the fracture. I do not know who defended the podiatrist involved here, but if it was me, I would have advocated for summary judgment for the podiatrist and detailed plans for recommending censure, reprimand, or whatever state remedies exist for testimony by plaintiff’s experts who testify that failure to diagnose a disease deliberately hidden by a patient could have violated any podiatric standard. I would have so stated at the deposition stage so as to put the plaintiff’s attorney on notice that his expert better be prepared.

A gynecologist however, faced with a 28 year old who has stopped menstruating, certainly has a different set of diagnoses he MUST consider. I am far more interested in who defended this podiatrist than who testified against him or her.

Bryan C. Markinson, DPM, New York, NY, bryan.markinson@mountsinai.org

RE: PM News Reaches 10,000 Subscriber Mark

Congratulations on the 10,000 subscriber mark. PM News is an outstanding source of information for our profession. I don’t go a day without it.

Charley Greiner, DPM, Columbus, OH

RE: Tablets for EMR (Samuel Cox, DPM)
From: Harry E Confer, DPM, Alan Kalker, DPM

Just make sure the Fujitsu laptop has the capability to increase the ram. I had one that I used daily. When the EMR program that I use upgraded my computer was not able to increase the ram according to what the company recommended. Thus, I had to purchase another laptop.

Harry E Confer, DPM, West Covina/ La Verne , CA, DRHEC@aol.com

We use the convertible. The primary issues for tablets are weight, battery life and glare. Some tablets are difficult to read under fluorescent light. The IBM Lenovo has been reliable and easy to use. Make sure you really want a tablet though. Some doctors prefer the desktop and it would then be a waste of money as tablets are costly and a bit slower if wireless. Although I have the convertible I rarely use the keys. My partners however do. Try them out in the store if you can and see what your own preference is. Also, be aware of the eyes glued to the computer screen problem. It is too easy to focus on the computer screen. Patients need that eye contact and you will need to make a special effort to maintain it - at least I find I do. A computer in the room is like having a third person there.

Alan Kalker, DPM, Middleton, WI, ajkalker@facstaff.wisc.edu

IMMEDIATE ASSOCIATE NEEDED - SOUTH MIAMI

Approximate $100,000 position available now. 6-doctor 8- Office group needs a replacement for a doctor who is leaving soon. 40 patients per day already scheduled for you. Partnership track available. Spanish speaking is a major benefit. Email CV and letter of intent to Liana 2441 SW 22nd street Miami, FL 33145 lianadpm2@aol.com

PRACTICE FOR SALE - BUFFALO, NY

Part Time Practice with full growth potential. Mix of conservative, biomechanics and diabetic foot care. Great surgical potential. Gross 170K. Willing to stay through transition. Call 716-432-7092.

ASSOCIATE POSITION - MINNESOTA

Prime Minneapolis suburb. Busy, well-established, full-scope podiatry practice, seeking highly motivated podiatrist for a full-time position. Looking for PSR 24+ individual. 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.

THE PERFECT CHRISTMAS GIFT

Super Luxurious Custom Oceanfront Dreamhouse on Caribbean island of Bocas del Toro, Panama. FULLY FURNISHED 5000 SQ FT, 5 BED, 5 BATH, 2 KITCHENS, Infinity Pool, satellite TVs, wireless internet, Lush Tropical landscape, NEVER hurricanes. NO TAXES for 20 YEARS. $875,000. photos & info drritarae@yahoo.com

Orthofeet is looking for independent sales reps to sell their line of shoes and orthotics. Orthofeet offers high end shoes and diabetic insoles that are covered by Medicare, along with competitive advantages and unique selling points. E-mail: mb@orthofeet.com

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