The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

October 29, 2008 #3,386 Editor-Barry Block, DPM, JD

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MN Court Rules That Non-Disciplinary Settlement Can’t be Used In Liability Case

A Minnesota appeals court clarified for the first time in the state that non-disciplinary settlements made between doctors and health-related licensing boards cannot be used as evidence in medical liability cases. Like many states, Minnesota excludes the use of settlements in civil actions. But the plaintiff in the case argued that an agreement for corrective action -- in which a doctor typically consents to certain practice improvements to resolve a board complaint without disciplinary action -- was not a typical settlement because it was imposed by the board.

Dr. Roy W. Buckmaster

The case stemmed from a complaint that Sandra O'Rourke filed with the Minnesota Board of Podiatric Medicine against Roy W. Buckmaster, DPM, after complications arose following two surgeries he performed. Buckmaster and the board agreed in 2004 to resolve the matter through a corrective action, which was finalized in March 2005. That June, O'Rourke filed a negligence case against Buckmaster and attached the corrective action to support her claim. Despite the podiatrist's objections, a trial court allowed the move.

In a Sept. 9 opinion, the Minnesota Court of Appeals established that corrective actions -- which involve a voluntary, negotiated compromise between state licensing boards and physicians and other health care professionals -- constitute a settlement. Recognizing broader public policy concerns, judges said that keeping such evidence from reaching a jury "promotes settlement by relieving parties of the fear that statements made in furtherance of settlement could later be used against them."

Source: Amy Lynn Sorrel, AMNews [11/3/08]

15 Years Later, SD Podiatrist’s Clothes/Shoes Drive Better Than Ever

More than 100 area residents will be a little warmer this winter thanks to the annual Make A Difference Day Coat and Shoe Giveaway, held Saturday in Yankton, South Dakota.

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Dr. Scott Shindler

The giveaway was started approximately 15 years ago by local podiatrist Scott Shindler, and was focused primarily on boots and shoes. Children’s boots, as well as coats, are still the items most in need when the collection takes place. Webster Elementary School soon began collecting children’s coats, and the Yankton Volunteer Leaders began collecting sweaters, following a national plea by Fred Rogers of PBS’ “Mr. Rogers’ Neighborhood.” The United Way and other organizations also began collecting winter coats.

Source: Travis Gulbrandson, Yankton Press and Dakotan [10/27/08]

FTC Suspends “Red Flag Rules” Until May, 2009

The Federal Trade Commission (FTC) is suspending enforcement of the "Red Flag Rules" until May 1, 2009, a prepared statement issued Oct. 22 by the agency says. The suspension will give organizations time to develop and implement their written identity theft-prevention programs. The rules require that financial institutions and creditors have a written program to prevent, detect and mitigate identity theft.

The rules also will apply to many healthcare organizations and originally were scheduled to take effect Nov. 1. During the FTC's outreach efforts about the rules, officials learned that some entities were not aware that they were covered and had not yet begun efforts to comply with the rules, the statement explains.

Source: Report on Medicare Compliance, [10/27/08]

Query: 4th Ray Resection or Transmet?

I have a patient who currently has 1st, 2nd, and 3rd toe amputations, as well as partial 5th ray resection. He recently developed an ulcer submet 4th after many years of no ulcers. The ulcer progressed to osteo of the 4th MPJ.

4th Ray Resection or Transmet?

At this point, I am considering a partial 4th ray resection. This would leave him with first second and third mets. My question is - will this invariably break down or can someone walk with a first second and third met? Is he better off with a transmet? (The contralateral limb is a prosthetic BK).

Jeffrey Kass, DPM, Forest Hills, NY

Query: Ultrasound Course

Is there a course for ultrasound of the foot or a list of meetings with courses that have a session on training with ultrasound?

Ronnie Bateh, DPM, Jacksonville, FL

RE: Ketamine/Ketoprofen/Gabapentin Topical for Treatment of Neuropathy (Nat Chotechuang, DPM)
From: Bob Kornfeld, DPM, Michael L. Gerber, DPM

This is a formula I have used on many patients in the early stages of neuropathy treatments. However, I also add in lidocaine in my prescription. You will find a majority of patients reporting at least some relief with this approach, some report profound relief. I use this until our therapeutic approach begins to heal the neuropathy and then we discontinue its use. The amount of lidocaine sometimes needs to be adjusted as per subjective report by the patient.

Bob Kornfeld, DPM, Lake Success, NY, holfoot153@aol.com

I have used a combination of ketoprofen-lidocaine-gabapentin transdermal gel for a long time. I have had good results in compliant patients. It is also a good alternative to PO meds in those patients that are adverse to taking pills.

Michael L. Gerber, DPM, Sterling Heights, MI, Mgfoot@aol.com

RE: Plate System for Osteotomy (Jason Serpe, DPM)
From: Dan Waldman, DPM, Paul Bassi, DPM

I have used Wright Medical's opening base wedge plate on a male mid-40's, marathon runner with great outcome radiographically and functionally. He is back to running without problems; of course the orthotics were part of the plan.

Dan Waldman, DPM, Asheville, NC, DPMcareer@aol.com

I am quite familiar with the Wright Medical BOW plate and have done several opening wedge procedures using this system over the past 8 months. I agree with Dr. Weiner in that you have to be extremely careful when performing the osteotomy. It is very easy to be overly aggressive and crack through the lateral cortex, thereby creating a very unstable distal fragment. I typically go no further than 2/3rds of the way across with my cut and then attempt to open the wedge. I then press from lateral to medial at the hinge to open the osteotomy site for plate placement medially.

Patient selection is the key with this procedure. I have had excellent results with younger patients, some of whom I’ve done both feet about 8 weeks apart. Despite the osteotomy site being very stable with the plate in most cases, I still recommend a period of immobilization. Cast immobilization seems to work best, as the patients I have placed in CAM-walkers have begun ambulating prematurely despite my strict NWB instructions. I also use the Allomatrix as a bone filler and have had excellent results with it. My correction has been about 1.5 to 2 degrees per mm of wedge, and I have used the 3 mm. and 4 mm. plates in most cases.

Paul Bassi, DPM, Wichita, KS, Paul@ksfootdoc.com

RE: Corticosporin Otic Suspension Discontinued (Richard Rettig, DPM)
From: Marc Katz, DPM

I think several people have suggested alternatives to the otic suspension and that is what the person asking the question wanted to know. My experience has been excellent doing sodium hydroxide matrixectomies and having the patient use Silvadene and a Band-aid. There is no need for soaking, and they heal quickly. I even get good results with triple antibiotic.

Why have a patient use Amerigel, which adds to the cost. OK, it is nice that they support the profession but there are options that are much less costly. OK, so it adds to your pocket, but does the patient really need this well-marketed product to heal a simple matrixectomy? I think not.

Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com

RE: Hospital Credentialing (Paul Bishop, DPM)
From: Howard R. Fox, DPM

While I certainly don’t mean to diminish the soundness of ABPS certification, I believe the cornerstone for granting surgical privileges is competence above all else. While board certification may be an excellent means by which to objectively determine competency, it is not foolproof, and there are exceptions. I know of podiatrists who are excellent, competent surgeons who are not board certified, and likewise, there are also podiatrists I know who have their boards and exhibit questionable surgical ability. When I served as chief of podiatry at Bayley Seton Hospital, the standard I imposed was surgical competence, as demonstrated by observation and prior case history, irrespective of ABPS certification. While an applicant with ABPS certification certainly held a good deal of weight, no one was accepted or rejected by that one yardstick.

With respect to non-APMA recognized boards, such certifications did not hold the same weight as ABPS, but again, the measure of surgical competence was prior experience, cases performed and observation. No one was granted surgical privileges based on the presence or absence of board certification with one board or another, and surgical privileges were delineated predicated on prior experience, regardless of any certification.

The purpose of credentialing is to protect the public. If a hospital were to grant privileges based on board certification alone, should the podiatrist be sued, the hospital is likely to be a codefendant with the allegation of inadequately or improperly maintaining unqualified and unskilled surgeons. Such an allegation cannot be transferred to a certifying board, and the state offices of professional discipline have files filled with board certified doctors.

Howard R. Fox, DPM, Staten Island, NY, foxhr@yahoo.com

POSITION - NORTHERN VIRGINIA/DC SUBURB

Excellent associate practice opportunity leading to partnership 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

SUBLET SPACE WANTED - NORTHERN NEW JERSEY

I am looking to sublet space in the Tenafly, Teaneck, Fair Lawn or general area. I need the office two 1/2 days per week or 2 full days, whichever is available. I can supply equipment, if needed, but prefer a turn-key operation. 516 476-1815 podo2345@aol.com

PODIATRISTS NEEDED - CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. Full and part-time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail Visit our website

PRACTICE FOR SALE – DALLAS TEXAS

10 year old practice for sale. All phases of podiatry: routine care, diabetic foot care, surgery, etc. Grossing $185,000 on three days per week. Could easily be full-time. Located in busy shopping center. Great Potential. Start making money from day one!! Owner will stay for transition. All serious offers considered. MUST SELL!! please respond to: footdoc8390@yahoo.com

PRACTICE FOR SALE or SHARED SPACE FOR RENT - CORAL GABLES FLORIDA

Well-known practice for over 20 years. Excellent location on Coral Way: heavy traffic, great visibility and plenty of parking. Busy, fully-equipped, full- time office with established patients. Grossing over 300K with tremendous growth potential. Office is currently open and ready to take over immediately. Contact QVAN@aol.com or 305-975-5516.

EQUIPMENT FOR SALE – NEW ERGO HANDPIECES

New Storz-Ergo Sagittal Saw and Reciprocating Saw. 25% of price donated to Musella Brain Tumor Foundation. Bid on E-Bay by clicking on links above.

ASSOCIATE WANTED – NORTH CENTRAL PENNSYLVANIA

Excellent associate practice opportunity leading to a partnership for PSR 24-36 trained foot and ankle, surgically trained podiatrist. A well-established, ethical and academic, successful, solo, half-time and multi-faceted podiatric practice wishes to expand surgical services. No competition with foot fellows. Need diabetic limb salvage, plastic surgery techniques, strong surgical rear foot and ankle reconstruction, ABPS qualified certification required. Practice has state-of-the-art orthopedic surgical environment and plenty of future expansion capabilities for a bright, eager, reliable associate. Excellent salary and benefits; no nursing homes. Present doctor is podiatric chief of three hospitals. Mail CV with current references to fgsddpm@verizon.net

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.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

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