The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

October 31, 2008 #3,388 Editor-Barry Block, DPM, JD

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The PICA Group Will Become Part of ProAssurance

ProAssurance Corporation has announced that the PICA Group will become part of ProAssurance through an all cash, sponsored demutualization. The PICA Group (PICA) is the nation's leading provider of professional liability to doctors of podiatric medicine, insuring approximately 9,800 podiatric physicians in 47 states and the District of Columbia. PICA insures other healthcare professionals and provides E&O insurance for a small, but growing, number of independent insurance agents through its PACO subsidiary. PICA wrote $99 million in premiums in 2007, has $284 million in total assets and has maintained an A.M. Best rating of "A-" (Excellent) for the past 13 years.

Dr. Jerry D. Brant

Jerry D. Brant, DPM, the Chief Executive Officer of PICA, is enthusiastic about the proposed combination. He said, "We have found the ideal partner in ProAssurance -- we've known their management team for years and we know they are committed to treating every stakeholder fairly. This underscores the dedication to claims defense, underwriting excellence and meaningful risk management that have made PICA the dominant insurer of podiatric physicians."

Dr. Brant said he's also excited that the ProAssurance-sponsored demutualization of PICA will allow policyholders to realize the benefits of building a strong company over the years. When the demutualization is approved by the Illinois Division of Insurance and PICA's mutual policyholders, a total of $120 million will be paid to current and certain former policyholders in accordance with the approved plan of demutualization. The plan of demutualization also provides a total of $15 million in premium credits to eligible renewing PICA policyholders beginning in 2010 and spread over three years. ProAssurance will pay cash to purchase the PICA stock authorized in the demutualization; PICA will then use that cash to fund the cash distribution and premium credits to be paid to its policyholders.

The transaction has been approved by the Boards of both companies and now requires the approval of PICA policyholders and approval of insurance regulators in Illinois, where PICA is domiciled. The transaction is expected to close in the first quarter of 2009.

Source: Tec Trends [10/28/08]

APMA Launches "Elect to Save Your Feet" Campaign

The American Podiatric Medical Association is launching a national campaign titled "Elect to Save Your Feet." This campaign, run during Diabetes Awareness Month in November, aims to educate the public about the importance of seeing a podiatrist regularly to prevent diabetic, lower limb amputations.

Dr. Ross Taubman

"Getting your feet examined by a physician during an annual checkup is one of the easiest ways to prevent most foot complications related to diabetes," said Dr. Ross Taubman, president of the APMA. "The rate of amputation for those with diabetes is 10 times higher than those without the disease. Being vigilant in your personal foot care, and including your podiatrist in your diabetes management team, can save both your limbs and your life."

Those with diabetes are more prone to develop foot infections, called foot ulcers, which can result in amputation. Preventing amputation means knowing all of the main warning signs. A comprehensive foot care treatment plan can reduce amputation rates by 45 to 85 percent.

Source: Great Falls Tribune [10/28/08]

TUSPM Diabetic Support Group Teaches Patient to Deal With Their Disease

Christopher Bailey used to be a boxer. He was scrappy, he says, but strong, which helped him beat guys twice his size. But in 1993 Bailey took on his toughest opponent yet — diabetes. Bailey began attending Temple University School of Podiatric Medicine’s diabetic support group, started by Kathya Zinszer, D.P.M. and Carol Otte, C.R.N.P., C.D.E., to learn the tools he needed to effectively manage his diabetes.

Kathya Zinszer, D.P.M., discusses blood sugar numbers with Christopher Bailey, a participant at Temple podiatry's diabetic support group. (Photo Kelly & Massa)

The group, which was formed in August, offers expertise from healthcare professionals such as certified diabetic educators, endocrinologists, nutritionists, podiatrists and physical therapists, combined with the life experiences of fellow diabetics, to enable participants to take control of their disease.In a recent session, Zinszer, director of community outreach at Temple’s podiatry school, and participants dispelled some common myths about diabetes. “As physicians and healthcare providers, we’re able to act as a guiding tool and provide a forum where patients can share real life struggles and triumphs of the everyday reality of living with the disease,” said Zinszer.

Zinszer notes that education is an important part of treatment for diabetics, especially in Philadelphia, where the rate of new diabetic cases is 2 percent higher than the national average. “Diabetes has flown under the radar here for so many years,” says Zinszer. “It’s so important to learn how to effectively manage the disease. And what better way to do it than with people who have already been down the same path? Diabetes can definitely take a part of your life if you don’t take care of it.”

Source: Renee Cree, Temple University News [10/28/98]

Attorney for Convicted Murderer Alleges Juror Misconduct by NY Podiatrist

Convicted murderer Peter Wlasiuk was not sentenced in Chenango County Court on Tuesday, as his attorney, Randel Scharf of Cooperstown, argued the verdict should be set aside and a third trial granted. On Tuesday, Wlasiuk was scheduled to be sentenced, but Scharf filed papers with the court late last week, asking that the verdict be overturned because of an alleged error by Judge Martin Smith, as well as juror misconduct.

Scharf said juror No. 6, Norwich podiatrist James Lentini, had violated rules of how jurors should conduct themselves by offering medical opinions about the evidence during deliberations with his fellow jurors. “This is a wholly circumstantial case, and the jury was deadlocked," said Scharf. “If Dr. Lentini is in there dispensing medical opinions, that would be misconduct."

Smith, a Broome County judge who was assigned to the retrial, asked what advice Lentini allegedly offered. Scharf said another juror told him Lentini spoke authoritatively about bruises on the victim's face, asphyxiation “and his experience doing autopsies."

Source: Tom Grace, The Daily Star (Oneonta, NY) [10/29/08]

Query: Severe Foot Pain Associated With Injections of Forteo

One of my patients is getting daily injections of Forteo which is a parathyroid hormone. In small doses, it has been shown to reduce osteoporosis and she has not responded to any other drugs commonly used to treat osteoporosis. The problem is that after taking a daily injection, she develops severe pain in one of her feet that not only keeps her up all night but prevents her from ambulating without crutches. The severe symptoms develop several hours after taking an injection. They lessen a bit during the day and return again after another injection. Has anyone come across this side-effect with any of your patients who may be on this drug?

Elliot Udell, DPM, Hicksville, NY

Query: Alara Ortho Scan

Does anyone have any experience/comments with the Alara Ortho Scan by Pacific Medical Technologies?

William J. Tronvig, DPM, Aberdeen, WA

RE: Fixation S/P Fracture (Dale Berkley, DPM)
From: Multiple Respondents

How much fracture callus/radiographic healing would you expect to see at 6 weeks? Not much. The x-ray shows good position of the fracture. She does not need ORIF. I would continue non-operative treatment and protect her with a fracture/CAM walker until clinical and radiographic union occurs.

Duane Brann, DPM, Palos Heights, IL, d.brann@comcast.net

Dr. Berkley may want to try Exogen bone stimulation from Smith and Nephew for this fracture before going into surgery. If this does not work, then the surgery would certainly be justified.

Steven H. Goldstein, DPM, Royal Palm Beach, FL, stevefootdr1@cs.com

I would advise Dr. Berkley to give this patient more time to heal, at least 6-8 weeks.....use an adjustable elastic met-ankle binder and/or orthotic while waiting.

Stanton C. Southward, DPM, Colorado Springs, CO, sbsouthie@comcast.net

RE: 4th Ray Resection or Transmet? (Jeffrey Kass, DPM)
From: Multiple Respondents

I would do the TMA as a primary procedure. However, Dr. Kass's patient already has a BKA; so as an alternative option, in addition to a TAL and a 4th met. head resection, I would also resect the 2nd and 3rd met. heads in an attempt to equalize the length pattern and hopefully prevent further tissue breakdown.

S. Jeffrey Siegel, DPM, Philadelphia, PA, Heeldoc1@aol,com

A trans met with Achilles tendon lengthening would probably be your best bet. The patient will function well in a shoe with filler. I would maintain the metatarsal parabola and bias my cuts from dorsal distal to plantar proximal as to minimize the potential for further ulceration.

Gerald Mauriello Jr., DPM, MA, Toms River NJ, mauriellodpm@gmail.com

Based upon Hx and clinical status, a proximal TMA, with well-contoured parabola and appropriate reduction of any distal osseous "spikes" would be my goal. The base of the 5th presumably has the peroneal insertion and medial soft tissue insertions are also assumed to be non-disrupted. TAL, immediate post-op bracing, rehabilitation and surveillance for contractures with Botox, and consideration for release residual deformity have been very positive for many of our patients in similar scenarios.

Alan Cantor, DPM, East Meadow, NY, ajcdpm@aol.com

RE: 7 NJ Podiatrists Named as Top Docs
From: Sloan Gordon, DPM

Congratulations to all those chosen. There are not enough magazines that give credit to our best practitioners. I'm glad to see this group noticed and awarded such an honor. I'm very proud that my classmate, Wayne Caputo was chosen - he was a great student and is justifiably honored by his peers.

Sloan Gordon, DPM, Houston, TX, sgordondoc@sbcglobal.net

RE: Hospital Credentialing (Myron Bergman, DPM)
From: Edwin Oghoorian, DPM, Howard Lazar, DPM

I am amazed at how no one has bothered to mention the fact that NO hospital (That participates with Medicare) can require their medical staff to be board certified. As for such hospitals that do (such as the ones mentioned by Dr. Myron Bergman), it is only a matter of time until a doctor that is aware of the law applies and when denied, files suit against the hospital. I had a local hospital try to pull the same certification requirement on me and after a letter from me notifying them of the above policy, they removed the policy from their bylaws and sent me a letter of apology. For anyone who is interested, here is what it says:

Interpretive Guidelines §482.12(a)(6)
The governing body ensures that the criteria for selection of both new medical staff members and selection of current medical staff members for continued membership must be based on: Individual character; Individual competence; Individual training; Individual experience; and Individual judgment.

§482.12(a)(7) Ensure that under no circumstances is the accordance of staff membership or professional privileges in the hospital dependent solely upon certification, fellowship or membership in a specialty body or society.

Edwin Oghoorian, DPM, Glendora, CA, DNA2RNA@AOL.COM

Editor's Note: Dr. Lazar's extended-length letter can be read at: http://www.podiatrym.com/letters2.cfm?id=22860&start=1

ASSOCIATE WANTED – NORTH CENTRAL PENNSYLVANIA

ASSOCIATE POSITION –GEORGIA

A well-established practice in South Georgia seeks a full time PSR-24/36 trained podiatrist. Excellent benefit package. Please send CV to agriffin@southernpodiatry.com. For more information, visit our website

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

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.

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