The Voice of Podiatrists

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November 06, 2007 #3,085 Editor-Barry Block, DPM, JD

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WI Podiatrist Charges $4,378.93 For Hour Long Visit

The nail that slid into the bottom of his right heel didn't faze him. Neither did the pulsing that ran through his foot a few days later. What stunned Cliff Blake was the podiatrist's bill for $4,378.93. That was for an hour long visit with John S. Lanham. The Milwaukee podiatrist performed an array of procedures, gave Blake a cortisone shot and sent him out the door with an armful of foot and ankle support products. His foot still aching a week later, Blake went to see a different podiatrist. That doctor did fewer tests but many of the same procedures. The bill came to $315.

Dr. John Lanham

The podiatrist's billing procedures are not new to the Wisconsin Society of Podiatric Medicine, a trade group that developed a code of ethics for its members. That's the group that investigated Lanham a few years ago after complaints rolled in. Lanham quit the society during the investigation, said Frydman. The investigation was then turned over to the state.

Lanham was suspended 10 months ago after the state said he created false bills and submitted false claims to insurance companies. In its investigation, the state found that the podiatrist billed for procedures he did not perform on patients, according to a final decision and order filed by the state. In settling with the state, Lanham denied that he knowingly submitted false claims for payment. He did acknowledge that he had "reckless coding errors in his billings," according to the stipulation.

Source: Ellen Gabler. Milwaukee Journal Sentinel [11/4/07]

MPMS Elects Dr. Donald Adams as President

The Massachusetts Podiatric Medical Society (MPMS) has elected Donald Adams, DPM, FACFAS as president for the Society's 2007 - 2008 year. Dr. Adams succeeds Dr. James Ioli, who served as MPMS president from 2006 - 2007. Dr. Adams is a member of the medical staff and chief of podiatry at the Metro West Medical Center (MWMC) in Framingham, MA. Dr. Adams is also the director of the podiatric residency program at MWMC. He also currently serves as legislative chair for MPMS.

Dr. Donald Adams

The following slate of officers/executive committee members and trustees was elected for 2007-8:

Dr. Donald Adams, President
Dr. Jay Phillips, President-elect,
Dr. Scott Aronson, 1st Vice President
Dr. Louis DeCaro, 2nd Vice President
Dr. Richard Eisner, Treasurer
Dr. Paul Peicott, Secretary
Dr. James Ioli., Immediate Past President
Mr. Gary Adams, Executive Director

MPMS Trustees: Dr. Gregory Catalano, Dr. Paul Peicott, Dr. Teresa Burtoft, Dr. James DiResta, Dr. Yena Do, Dr. Dominick Garibaldi, Dr. Stephen Pidgeon, Dr. Charles Ross

FL Podiatrist and Alleged Unlicensed Employee Arrested

Two Florida doctors are in custody Saturday. According to police, one was arrested for practicing without a license the other was arrested for employing him. Police said Wayne Finelli, who went by the name Dr. Thomas Grillo, was practicing podiatry without a license.

Dr. Syed Amouzegar

He was working out of Advanced Foot and Ankle Inc. in Winter Park under the supervision of Dr. Syed Amouzegar, police said. Both are in the Orange County jail.

Source: WESH-TV [11/3/07]

Query: Level of Amputation

I have a 57 Year old diabetic patient with a failed hallux amputation who presented with several foot ulcers and osteomyelitis. To date, nothing done by his previous doctor has healed the foot despite providing good care (hallux amputation, Apligraf application, GraftJacket application along with supportive topical and systemic care). His infectious disease doc wants me to perform a ransmetatarsal amputation, but his vascular surgeon says it will fail. CTA shows very poor blood supply below the ankle without the ability to revascularize (per non-invasive, invasive vascular testing results). Blood sugars are under good control.

I am in favor of referring the patient out for a BK amputation rather than subject the patient to another failed surgery to preserve part of the foot. Would anyone still try the transmet amputation first in an attempt to keep part of this man's foot even though all tests should that a BK amputation is the level most likely to heal?

David Gurvis, DPM, Avon, IN

Query: Environmentally Safe Chair Cleaner

We use non-porous paper roll drapes and a plastic foot drape on our naugahyde covered chairs in the office and wipe them down between patients. I'm concerned that environmentally, some of the chemicals we are using are not the best for the environment or for our staff.

Can someone suggest what they use between patients to clean the chairs?

Sloan Gordon, DPM, Houston, TX

RE: Assessing Risk of DVT/PE (Jane E. Graebner, DPM)
From: Multiple Respondents

While losing a patient after elective surgery is always a tragedy, in this case, it was the long-term use of birth control medication that probably put her at risk of developing the pulmonary embolism and not from the surgery that was performed. That been said, this is another reminder of how important is a thorough history and physical examination, even on the healthiest of patients, when it comes to screening them pre-operatively.

Again, in retrospect as of this case, even though you could have performed all of the appropriate preoperative evaluations and screenings, the post operative rest period of relative inactivity, which is usually recommended to minimize pain and swelling, could have contributed to the event. This could be the subject for a research project to evaluate the effectiveness of prophylactic Lovenox injections vs. recommending the intake of a simple aspirin post-operatively.

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

There is a known link between birth control pills and smoking causing DVT. One should consider a stat venous duplex Doppler, especially post-operatively. I order this for all my patients with these complaints and fortunately have a 25% success in confirming DVT. It is difficult to pre operatively check for DVT, but certain factors can increase the likelihood of it occurring. Fortunately, DVT complications are rare in podiatry. The orthopedic community experiences a much higher rate of post-op DVT and they do use Lovenox and compression pump post-operatively to reduce their risk.

Simon Young, DPM, New York, NY, Simonyoung@juno.com

The commentary regarding DVT was interesting, but someehat inaccurate.

There is a difference between risk factors for DVT in the general population or while in bed for treatment of medical problems, and DVT associated with surgery. Smoking is not a risk factor for DVT in surgery patients (contrary to what one might think) and in fact EBM suggests, oddly enough, a slight protective effect of smoking for DVT in surgery patients. Ditto obesity. The only EBM established risk factor for DVT in foot surgery is advanced age. Three large studies of DVT following foot surgery in ambulatory, non-immobilized patients conclude that no prophylaxis is necessary

Allen Mark Jacobs, DPM, St. Louis, MO, allenthepod@sbcglobal.net

RE: Plantar-Flexed Halluces (James Fisher, DPM)
From: Carl Ganio, DPM

With all this talk of implants that are doomed to fail, MPJ fusions, etc. why not think a little more conservatively? I saw that one person had mentioned an AFO. Certainly, if the deformity is spastic, but reducable...than an AFO with a full foot plate may work. Additionally, sometimes one can ask for "tone reduction" when they have the brace fabricated. It loads the first metatarsal, and may reduce the flexion. I also note, that no one has suggested a percutaneous FHL tenotomy. I have done FHL or EHL tenotomies in patients with success, provided the benefits outweigh the risks...and you are willing to deal with the biomechanical implications of the lost power. Certainly, a patient would agree to an isolated tenotomy in the office prior to considering bilateral MPJ fusion.

Carl Ganio, DPM, Vero Beach, FL, drcarlganio@bellsouth.net

RE: James Bates, DPM

I am very sad to learn of Dr. Bates passing. He was one of my interviewers during my application process and the President of PCPM my four years there. I would always enjoy talking with him about the students long after my graduation. He was definitely a great influence in my podiatric life and I will enjoy fond memories of him. To his family, I extend my deepest sympathies.

Sam Bell, DPM, Schenectady, NY

RE: NPI Database
From: Roger Friedman, DPM

A free, very easy-to-use NPI number database lookup is available here:
http://npinumberlookup.org

Roger Friedman, DPM, Sheffield Village, OH, Roger@RogerFriedman.com

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