The Voice of Podiatrists

Serving Over 9,000 Podiatrists Daily

December 16, 2006 #2,767 Editor-Barry Block, DPM, JD

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Trial of NJ Podiatrist to Start in January

Jury selection in the criminal trial of Ronald Sollitto and Michael Casale, who are accused of plotting to gain control of the estate of Spring Lake widow Madeline Stockdale, will begin Jan. 9 in Freehold. Sollitto, 55, is a podiatrist and former neighbor of Stockdale, an eccentric and wealthy widow who died at age 91 in April 2000. She left behind an estate valued at between $4 million and $6 million. Three months before her death, Stockdale signed a will naming Sollitto as the primary beneficiary of her estate. On the same day, she also concluded the sale of her Spring Lake home to him. Both documents were prepared by Casale, 59, an attorney and friend of Sollitto's. But after Stockdale died, probate of the 2000 will was blocked by the Spring Lake First Aid Squad, which was named the primary beneficiary of an earlier Stockdale will, dated March 11, 1998.

Dr. Ronald Sollitto

In 2004 Superior Court Judge Ronald Lee Reisner ruled the 1998 will was valid. In his written opinion, he scolded both Sollitto and Casale as schemers out to hoodwink the elderly widow. Meanwhile, the Monmouth County Prosecutor's Office lodged criminal charges against both Sollitto and Casale, charging the pair with second-degree crimes of theft by deception and conspiracy. Sollitto was also named in lesser criminal counts.

"Dr. Sollitto is looking forward to an opportunity to finally put the entire controversy before a jury of his peers," John S. Furlong, Sollitto's attorney, said Wednesday. If convicted of all charges, Sollitto faces a potential combined prison sentence of 45 years. Additional fines could total $400,000.

Source: Bob Cullinane, Asbury Park Press [12/14/06]

Alarming Message From the 19th World Diabetes Congress

Diabetes is fast becoming the epidemic of the 21st century which, now affects a shocking 246 million people worldwide, and is expected to affect over 380 million by 2025 if no action is taken.

The International Diabetes Federation (IDF) closed the 19th edition of its World Diabetes Congress that was held in Cape Town, South Africa. With over 12,600 people registered for the Congress and 400 speakers, the 19th World Diabetes Congress was the first diabetes meeting of this magnitude to be organized outside Europe. This unique Congress, which unites the whole diabetes community, did not only give the opportunity to healthcare professionals, researchers, and healthcare providers such as educators and nurses to share their findings but also allowed people with diabetes to share their experiences of life, care and management.

Source: Diabetes in Control [12/13/06]

Topics: Medicare & CPT 2007 Update - NHIC LCD on Foot Care - E/M Service & Documentation - Surgical Coding - Using Forms in Practice - Modifiers - EMRs - Websites - Audits - Q&As

Speakers: Tony Poggio, DPM; Harry Goldsmith, DPM; Gaye Eaton (NHIC Representative)

click on www.codingline.com/events-oakland.htm for details and registration information.

For a list of all meetings go to: www.podiatrym.com/meetings.pdf

Query: ESWT Studies

I am currently battling an HMO to get ESWT approved. Does anyone have a good list of double-blind studies showing that ESWT is effective?

Peter Riznyk DPM, Orchard Park NY

Query: Multiple Mid- & Rearfoot Procedures

How would I code the following set of procedures?

- Calcaneal osteotomy (with a distraction lengthening of the calcaneus), left
- Primary repair of the posterior tibial tendon with advancement, left
- Transfer of flexor digitorium longus tendon to the navicular, left.

The diagnosis was a rupture of the posterior tibial tendon, instability of the medial column, internal derangement of joint, and pain.

Jon R Goldsmith, DPM, Omaha, NE

Response: I would suggest CPT 28300-59 for the calcaneal osteotomy, and CPT 28200-59 for the repair of the posterior tibial tendon. The tendon transfer would be billed as CPT 27691-LT (transfer or transplant of single tendon [with muscle redirection or rerouting]; deep).

Tony Poggio, DPM , Alameda, CA

Codingline subscription information can be found at
http://www.codingline.com/subscribe.htm

RE: Growth Hormone (Charles Morelli DPM)
From: Rahul Patel, DPM

HGH supplementation should theoretically decrease wound healing time, decrease rate of post-op infection and not have any interactions with NSAIDS or narcotics.

Rahul Patel, DPM, Flushing, NY, docrahulpatel@gmail.com

RE: Keloids (Tip Sullivan, DPM)
From: Robert K. Hall, DPM, Barry Mullen, DPM

While keloid may still occur, especially if pt is prone to them, perhaps making your incision in an area least likely to incur a problem-(i.e., avoid adjacent to extensors or very medially ) and perhaps trying subcuticular wire instead of traditional skin suture material may help. Be sure to stress on the consent regarding this keloid possibility.

Robert K. Hall, DPM, Ft. Lauderdale, FL, robertkhalldpm@bellsouth.net

When operating on known keloid-formers, I've generally tried to follow these guidelines:

1) Be mindful of skin tension lines with your incision planning. Try to orient incisions parallel to skin tension lines for the majority of your incision, if possible.
2) Avoid straight linear incisions- rather utilize lazy S or gentle curvatures
3) Avoid over dissection. Do not underscore skin or sub q tissue. Less is more.
4) Use natural fiber absorbable suture material (catgut) while avoiding synthetic suture material i.e., Dexon, Vicryl. Use the least amount of absorbable suture required to coapt deep tissue. Use the most inert skin suture material available (i.e., Prolene)
5) Minimize post op pedal trauma to control edema, i.e., Consider placing the patient non-weight bearing, and/or immobilizing joints proximal to the operative site for the 1st 2-3 post op weeks to reduce motion and skin shearing forces.
5) Leave skin sutures in several days longer than normal for a given incision. Maintain skin tension reduction with Steri-strips through the 1st 4 post op weeks.
6) Consider injecting an intermediate acting steroid at the conclusion of the surgery.

Barry Mullen, DPM, Hackettstown, NJ, YAZY630@aol.com

RE: Alleged Misdiagnosis - Cancer Wrongful Death (Elliot Udell, DPM)
From: Multiple respondents

The recent reporting of a successful defense verdict (wrongful death for failure to diagnose a rare malignant lesion) in PM News bears some lessons to be considered.

1. ALWAYS consider the worse possible diagnosis as possible, even if improbable. That means MRI or other appropriate imaging studies, even if you are certain you know the nature of a potential neoplasm. Ditto possible thrombophlebitis, ALWAYS perform a Doppler. Monday morning coaching is easy, and there is no shortage of "experts" such a Dr's Fenton, Haber, etc. to tell a jury (with the help of hindsight) how mismanaged your care was.

2. To accuse a colleague of "wrongful death" just to make a few dollars as an "expert witness" goes well beyond the old "I would have done an Austin, not a McBride" story. The successful litigation of a wrongful death suit could result in the professional and financial ruination of everything the defendant doctor worked for his/her entire life! I would hope the defendant doctor forwards the testimony of the plaintiff's "experts" to ACFAS, which now has a policy on truthfulness in testimony. Someone needs to test ACFAS to see if the new policy has any teeth. Condemnation or sanction, or withdrawal of Fellowship status for unethical or false testimony, is something which might be used in
future cases to discredit professional plaintiff's experts, ruining or at least calling into question their veracity to other juries. I think it might just ruin a few of these people as "experts"

3. Always remember that any lawyer so motivated, can hire professionals to say ANYTHING, and that these people will do so even under oath. The lawyers who knowingly pursue cases without merit and hire such legal prostitutes to testify, and the podiatrists who do so, deserve nothing but condemnation. Nevertheless, it is the way our system works.

Allen Jacobs, DPM, St. Louis, MO, Allenthepod@sbcglobal.net

When in doubt, I biopsy. But when I feel almost of the diagnosis - e.g., typical-appearing ganglion cyst, I share the burden with the patient. They are advised that the likelihood of it being something else is very small, but still possible. If they are comfortable knowing that, we leave it alone. They are also advised of the inherent small, but real risks involved in a biopsy or excision. If they want more certainty then a biopsy or excision is performed. The conversation is documented. I don't know what the legal ramifications are, but it seems reasonable and appropriate to engage an otherwise intelligent patient in the decision-making process where their own health is concerned. We don't need to make every decision for our patients. We do need to give them enough information so they can make their own informed decision.

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

As sad as I am that a patient died from cancer (and I bet that I am not one iota as upset as the treating podiatrist), I am equally sad that one of my teachers at NYCPM flew all the way out to Michigan to testify against one of our own.

Peter Smith, DPM, Stony Brook, NY, drpetersmith@optonline.net

ASSOCIATE POSITION – SOUTHERN WISCONSIN

Thriving Southern Wisconsin practice looking for an ethical, hard-working and highly trained podiatrists for an associate position at a well-established practice. Applicants must have completed a 2-year residency and be trained in all aspects of podiatric medicine. Strong potential for future partnership opportunity. Please fax CV and cover letter to (608)829-1319 or e-mail us at footdr@madisonpodiatrists.com.

ASSOCIATE POSITION - FINGER LAKES REGION UPSTATE NY

Leading regional group practice seeking ABPS residency-trained associate with partnership in mind. Excellent compensation/benefit package. Associate to see the same patient mix as partners, and will be involved in expanding the practice. State-of-the-art wound care center. Surgical privileges in nearby PA. Great opportunity for a well-trained, ethical podiatrist to work in a beautiful area that is great for family. NewYorkAssociate@comcast.net

ASSOCIATE POSITION – NEW YORK CITY

Looking for an enthusiastic well-trained foot and ankle surgeon to join busy Manhattan/Brooklyn practice leading to partnership. Candidate must have completed a minimum two-year surgical residency program, demonstrate qualities of self-motivation and have impeccable skills in forefoot and rearfoot surgery. Package includes malpractice ins. health ins. plus salary. Terms negotiable. Email Manfootcare@aol.com or call 917-756-3686

ASSOCIATE POSITION - CINCINNATI, OHIO

One of the largest podiatry practices in the United States is again in need of a PSR 24-36 Associate. All present doctors are in their thirties with similar training. Everyone is treated equally and there is definitely no limit to your success. Please submit resume or contact Karen Roesch via email or phone. Kroesch4poh@aol.com (513) 729-4455

ASSOCIATE POSITION- MEMPHIS, TN

30 year-old, high volume, multi-office practice in Memphis, looking for 24-36 PSR trained individual. Good opportunity for reconstructive surgery and wound care. No nursing homes or weekends. Potential partnership opportunity. Contact Footdok4@gmail.com

ASSOCIATE POSITION/ MANHATTAN AND LONG ISLAND

Seeking well trained podiatrist to help expand existing surgical practices. Candidate must be able to acquire staff privileges. Package and terms are negotiable, flexible hours. Email PODO2345@AOL.COM OR CALL (516) 476-1815

EQUIPMENT WANTED – USED X-CELL X-RAY UNIT

Used X-cell midbase Podiatry X-ray unit with orthoposer, Expected price. $3000.00 Mark Robson, DPM, Austin TX. 512 585-0242 mrobsondpm@aol.com

ASSOCIATE POSITION--PHOENIX SUBURB

Attractive opportunity for enthusiastic, proficient, and personable associate. Well-established modern practice with multiple newer spacious offices, technology and equipment. Solid referral base, close to hospitals, knowledgeable certified staff. 22% MCR. Practice and surgical center partnership potential opportunity. Prefer 24-36+ PSR. Send CV: AZpodassociate@aol.com

ASSOCIATE POSITION - CENTRAL CALIFORNIA

Central California multi-location practice looking for PSR-36 associate leading to partnership. PSR-36 trained podiatrist with great opportunity for reconstructive surgical practice. Practice has Medicare-approved surgery center. Must have excellent interpersonal skills. Excellent salary and incentive. Respond to: westsidefoot@yahoo.com

ASSOCIATE POSITION - LOS ANGELES/SOUTH BAY AREA

Multi-office, multi-doctor, well-established practice near the beach cities. Seeking a board eligible/certified PSR-24 or PSR-36 trained foot and ankle surgeon. Well-rounded practice requiring knowledge in biomechanics, pediatrics, sports medicine, diabetic wound care, trauma, and reconstructive foot and ankle surgery. Full-time position available immediately with generous compensation and benefits, including malpractice, and health insurance. Two-year commitment required with partnership opportunity. Send CV to akemfoot@sbcglobal.net or fax to (310) 838-0227.

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