|
|
|
|
|
Search
01/18/2021
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 1A
From: Dieter J Fellner, DPM
After much consideration, I received the COVID-19 vaccination last week. I hardly felt the needle! The day after, my arm felt like a mule kicked it. So, is it worth it? Does it protect you 100% from getting sick?: No. Does it stop you carrying the virus and passing it on?: No. Can it provide protection against the mutations we now see?: No. So, what does it do? Well, if you get sick, maybe you will get a bit less sick. Why did I do it? I did it for the same reason we wear masks that often provide little protection, and 6-foot social distancing: the effect of social pressure and conditioning.
Dieter J Fellner, DPM, NY, NY
Other messages in this thread:
05/13/2023
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 1A
From: Jack Ressler, DPM
When you receive a request from Ciox, calculate the number of patient requests and multiply it by the amount of money per chart your office has set. Send them an invoice and move on. You will not likely receive payment and it had been my office policy not to send charts requested by Ciox until payment is received.
I retired a few months ago, but was never cancelled from any insurance company for not sending charts to Ciox until they send payment. This has been ongoing for several years. Your obligation should be to Medicare which is being completely ripped off by Ciox and other companies, which has been documented in previous posts.
Jack Ressler, DPM, Boca Raton, FL
05/04/2023
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 1A
From: Jessica Cortes
We also have been subject to Ciox Health's harassment. We fax back an invoice requesting $30 per chart, citing California Health & Safety Code section 123110 - allowing the fees for processing and preparing records.
We instruct staff to not answer any questions until payment is received. We fax the same letter each time we receive the same request. Payment is received each time. It won't stop the requests but at least we're being fairly compensated for it.
Jessica Cortes, San Francisco, CA
01/16/2023
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 1A
From: Robert Kornfeld, DPM, Michael Orosz, DPM
Dr. Williams, like others, will have his records "reviewed" so that insurance companies can come up with a "valid" reason to reject claims and demand refunds. I went through this many years ago. When money was demanded back from me by Medicare (after a review of 80 charts), I went to a lawyer, had my assets "protected", and then opted out of insurance and Medicare. That was 23 years ago.
Every day, I thank insurance companies for giving me grief over my extremely valuable protocols that have helped thousands of patients. I have no more stress and I work smart, not hard. The difference now is that my patients pay me and no insurance company gets to "review" my records.
Robert Kornfeld, DPM, NY, NY
We have had a few requests of around 75 patients. We also charged for each chart and refused to release the records until payment was received. We do get requests for a single patient only so it balances out.
Michael Orosz, DPM, Cedar Rapids, IA
12/07/2022
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 1A
From: Elliot Udell, DPM
It is not mandatory in most, if not all, states to have a DEA number. If you are not prescribing controlled substances, why give the government a thousand dollars to renew the number? Most insurance companies will not mind, but many will require you to provide the name and number of a colleague who can prescribe controlled substances if your patient needs it.
The only other problem is that a small number of companies such as Clint Pharmaceuticals will not do any business with you unless you have a DEA number. With pressure on doctors to limit the prescribing of controlled substances, these small niche companies are cutting their noses to spite their faces by not even selling "gauze" to a doctor who does not have a DEA number.
Elliot Udell, DPM, Hicksville, NY
06/01/2022
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 1A
From: Jim Shipley DPM
It’s my understanding that once licensed and practicing, the final say on what can be done in my practice and what can’t be done is decided upon by the State Board of Podiatry in my state. For me, that’s North Carolina. Please give me some feedback on this possibility: Why can’t our local state boards begin training and certifying individuals at our state conferences to treat hyperuricemia? We want parity.
If the schools won’t train us for parity, why not begin our parity training at the state level? I would happily take classes and take exams showing my ability to comfortably prescribe uric acid lowering medications. On the same train of thought, I would gladly accept the training and certification to take on the burden of the medical management of blood sugar levels in my patients as well.
Our predecessors fought long and hard for our scope within our state. I’m ready to continue the advancement. Showing we’re trained to advance is the first step. Please give me your thoughts and wisdom on this topic.
Jim Shipley, DPM, Mt. Airy, NC
05/31/2022
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 1A
From: Elliot Udell, DPM
This conversation on the prescribing of urate-lowering medications is not a new one, with many saying yea and others saying nay. The crux of the controversy is whether treating hyperuricemia is addressing a systemic condition or a local manifestation of gout. Those who argue that it’s systemic are quick to equate it with the management of diabetes. There are distinct differences between the two ailments. For example, if a patient presents with acute gout affecting an elbow or has hyperuricemia with no clinical manifestations, treating it or even telling a patient not to have it treated would be out of scope for us.
On the other hand, if a patient has pedal manifestations of gout and there is a direct link between the symptoms and hyperuricemia, then it...
Editor's note: Dr. Udell's extended-length letter can be read here.
05/26/2022
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 1A
From: Bruce Smit, DPM, W. David Herbert, DPM, JD
Kudos to Martin Girling, DPM for exercising sensible independent thinking regarding patient care for systemic conditions when urgent attention seems to be unavailable. It's a touchy subject. I have been faced with this dilemma many times in my career and have always been uncomfortable with my response to patients as to why I wouldn't comply with their request. He has summed up my frustration for 45 years in practice with one sentence - "Our job is clear, our license is not."
Bruce Smit. DPM, Frankfort, IL
I have suffered with gouty arthritis for years. I have been able to keep it under control with allopurinol for most of the time. The last time I had a gouty attack, I had my PCP put me on oral steroids. Of course, you must be weaned off of them gradually. I believe I was on the tabs a total of about 10 days or so. I believe other podiatrists have used this method for acute gouty attacks and let the PCP manage the uric acid situation. For me, oral steroids worked like a charm.
W. David Herbert, DPM, JD, Billings, MT
05/25/2022
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 1A
From: Bret Ribotsky, DPM
Dr. Girling is quite fortunate that I am not a member of the Florida Board of Podiatric Medicine. What Martin stated is clearly beyond what he is trained and licensed to provide. What’s next, birth control pills for those who are having a difficult time getting an appointment with an OB/GYN? Heart/BP meds, as getting to see a cardiologist is difficult?
All patients love you until an outcome or a bill that’s unexpected arrives. I very happy that his game of Russian roulette did not end poorly. Without a license (the most precious item you have professionally), you cannot help anyone. I caution all those who write on open forums that many others read and can search what is written here. NEVER, NEVER, NEVER take a chance with your livelihood.
Bret Ribotsky, DPM, Fort Lauderdale, FL
04/11/2022
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 1A
From: Donald R Blum, DPM, JD, Juli Weitzen, DPM
There can be issues related to not having a DEA registration. Although a DEA number is not required when ordering injectables such as steroid injectables, local anesthetics, and even antibiotics, there have been requests for a copy of the DEA registration from the pharmacy, asking for the DEA number. Before making the final decision, ask your medical supplier and check with a few pharmacies just to be prepared for any difficulties that might arise.
Donald R Blum, DPM, JD, Dallas, TX
I’d once dropped my DEA when time for renewal for the same reason Dr. Yack is considering. I received a call from the hospital which saw that I didn’t have a DEA registration on file, asking if it was revoked for disciplinary action (so then I arranged to have it again).
Juli Weitzen, DPM, Pottstown, PA
09/20/2021
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 1A
From: Jack Ressler, DPM
I applaud Dr. Kesselman’s recent query about this subject. Podiatrists are bombarded with these chart requests via annoying several page faxes and threatening phone calls. We take the time to request payment for these services and generally get no response. As I stated in an earlier query, my office protocol is to demand their chart requests be sent via certified mail, not annoying faxes or telephone calls. These companies are not Medicare. They only rip Medicare off!
Jack Ressler, DPM, Delray Beach, FL
08/11/2021
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 1A
From: Robert Fuerstman, DPM
Simply advise Ciox that if no payment for charts is received, no records shall be be released. Ciox and UHC tried that with me and they consented to pay. Additionally, your fee is too low. It should be at least $25 per record. This Medicare risk adjustment audit for Medicare advantage plans is a scam for the insurance company to try to upcode your records to obtain more reimbursement from CMS.
Robert Fuerstman, DPM, Kearny, NJ
07/28/2021
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 1A
From: Joe Hylinski, DPM, Richard A Simmons, DPM
I could not believe the context and numbers Dr. Smith used on his post about Covid vaccines. So I went to the CDC website and found that since the start of vaccine implementation, the VAERS (Vaccine Adverse Events Reporting System) reported not 9,000 but 6,200 deaths in those that received the vaccine. They noted, however, there was no causal link necessarily between the two. Many may have died from other causes.
This out of 339 million doses administered comes to 0.0018% We’ve had over 630,000 deaths from Covid. These are orders of magnitude different. I’m not a gambling man, but I sure know what odds I’d take.
Joe Hylinski, DPM, Blue Bell, PA
1. If you know anything about the AIDS epidemic around the early 1990s, this is Deja vu.
2. A million times over will I live with an American-made vaccine rather than die from a mysterious, novel virus from China.
Richard A Simmons, DPM, Rockledge, FL
07/27/2021
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 1A
From: Robert S Steinberg, DPM
Dr. Smith failed to fact check, which is reckless when it comes to COVID-19. From the CDC: Anaphylaxis after COVID-19 vaccination is rare and has occurred in approximately 2 to 5 people per million vaccinated in the United States.
Thrombosis with thrombocytopenia syndrome (TTS) after Johnson & Johnson’s Janssen (J&J/Janssen) COVID-19 vaccination is rare. As of July 19, 2021, more than 13 million doses of the J&J/Janssen COVID-19 Vaccine have been given in the United States. CDC and FDA identified 39 confirmed reports of people who got...
Editor's note: Dr. Steinberg's extended-length letter can be read here.
07/26/2021
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 1A
From: Alan Sherman, DPM
I admire Dr. Fox for taking steps to create a healthy safe environment in his healthcare facility. But the answer is not to limit a practice to only vaccinated patients. It is to accurately identify which patients are vaccinated and which are not, and to have both your staff and those patients wear masks. A further step should be taken based on the CDC directive issued last week, that vaccinated people who are immunocompromised or at great risk due to co-morbidities, should behave as if they are not vaccinated. So this subgroup of vaccinated patients should wear masks indoor.
Dr. Worman’s accusation of bullying and his statement, ”Don't you think your patients are capable of making their own decisions as to whether they want to come to your office or not?” is irresponsible. When have we ever let our patients guide our decisions as to how our offices are most safely run? Our patients look to us to make those decisions.
Alan Sherman, DPM, Boca Raton, FL
07/23/2021
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 1A
From: Jeff Worman, DPM
While I can certainly understand taking universal precautions in your office, to limit your practice to vaccinated only patients seems beyond ridiculous to me. If you are that afraid of the virus, maybe it’s time you take up a new profession where you can stay home for the next 10-12 years. Don't you think your patients are capable of making their own decisions as to whether they want to come to your office or not? Why do you feel the need to make that decision for them? This mere suggestion is a form of bullying and I would hope your state medical board would take action against you if you did this.
Jeff Worman, DPM, Largo, FL
01/19/2021
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 1A
From: Mark Spier, DPM
I appreciate the diversity of opinion offered in this forum as much as anyone, but I must take exception when personal opinions are disguised as scientific fact. Dr. Fellner stated that the current vaccines do not offer protection against some current mutations of the COVID-19 virus. There is no proof that this is true as of this writing.
Additionally, it has been conclusively proven that mask wearing and social distancing help to diminish aerosolized transmission of respiratory viruses; the degree of decreased transmission is directly related to the efficiency of the mask being worn. Posters on this and any other public forum need to be more cognizant of the science and not propagate nonsense.
Mark Spier, DPM, Reisterstown, MD
01/15/2021
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 1A
From: Elliot Udell DPM
For starters, we are not the only medical professionals dealing with this issue. My mom has nurses coming in every week and none have had the vaccination nor do they intend to get it. I went for a routine blood test this week and the phlebotomist told me she is afraid to get vaccinated. There is a greater issue here. Authorities, as of right now, are not certain whether a vaccinated individual is protected from catching and spreading the virus and hence they are advising people even after being vaccinated to keep wearing masks and practice social distancing.
Elliot Udell, DPM, Hicksville, NY
09/24/2020
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 1A
From: Roody Samimi, DPM, Elliot Udell, DPM
After a 14-day quarantine, treat as any patient with mask, social distancing, and appropriate hand hygiene. We do not treat anyone who tests positive for COVID-19 any differently if they've had their 14-day quarantine and more than 3 days since the last fever/acute symptoms.
Roody Samimi, DPM, Modesto, CA
The question raised is important and may affect all of us at some time. For starters, the patient may have been infected prior to being tested, so it is advisable for you and your entire staff to be tested. That being said, the question arises as to what degree are we morally and legally obligated to provide podiatric care to a patient who has a highly contagious infection such as COVID-19. This applies not just to post-operative care, but what if a patient comes to us with a serious foot infection requiring immediate attention and the patient has COVID-19? Can the doctor refuse to see the patient? It is certain that many of us will offer opinions on how to best approach this problem; the final answer will not be resolved by medical professionals, but unfortunately in the legal arena.
Elliot Udell, DPM, Hicksville, NY
03/21/2019
RESPONSES/COMMENTS (MEDICAL-LEGAL) - Part 1A
From: Steven Finer, DPM
Solution to DEA number. A limited number excluding schedule 2 drugs would solve it. The DEA can then charge a reasonable fee. Of course, we would be trusting a government agency to do something simplistic.
Steven Finer, DPM, Philadelphia, PA
03/15/2019
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 1A
From: Howard R. Fox, DPM
I assume you do not practice as part of a large group or hospital. If you do, your group or hospital would have a sexual harassment policy in place. It would detail what your exact steps would be.
If you’re not part of a large group or hospital and do not have a sexual harassment policy in place for your office (I assume you don’t or you wouldn’t be asking), your employee can call the police and file charges. You should memorialize your conversation with her in writing and also note the day, time, location and any witnesses. Different states have different reporting requirements. In New York, we have the Division of Human Rights. On a federal level, the 1964 Federal Civil Rights Act (codified as 42 U.S.C. § 2000e et seq.) covers this, but you must have at least 15 employees to be covered by the EEOC.
As far as your patient is concerned, I’d speak first with your attorney (many malpractice carries will allow you legal advice to protect you and advise on your actions) before discharging the patient based upon the allegation of sexual harassment. On the smallest level possible, a frank conversation with your patient letting him know his behavior will not be tolerated would be in order, and your patient’s response should also be incorporated on the written memo of the event. Chances are he won’t feel comfortable returning after that and you would avoid having to discharge him from your practice.
Howard R. Fox, DPM, Staten Island, NY
10/12/2018
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 1A
From: Lawrence Kobak, DPM, JD, Todd Lamster, DPM
Dr. Morelli has a kind heart. He is a fine example of what a podiatrist and human being should be! Unfortunately, treating a wart on a finger is clearly out of scope in most states. More than one podiatrist has lost his license to practice in more than one state for doing this.
Lawrence Kobak, DPM, JD, Uniondale, NY
I must admit that I am surprised by the number of my colleagues who perform this service. I, too, have elderly patients who ask me to trim their fingernails. I tell all of them that it is against the law because it is out of my scope of practice, and doing something out of my scope could put my license in jeopardy. Just because I am capable of doing something doesn't mean I have the right to do it. Every single patient completely understood and respected the answer.
To my colleagues who trim fingernails: Would you incise and drain an abscess on a hand or finger? Would you perform a biopsy of a suspicious lesion? Would you inject a symptomatic palmar fibromatosis?
Todd Lamster, DPM, Scottsdale, AZ
10/11/2018
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 1A
RE: Requests to Trim Fingernails (Maryann Trivlis, DPM)
From: Brian Kiel, DPM, Tom Silver, DPM,
Sorry folks.. I am not a manicurist. Debridement of toenails is a valid medical issue but the fingernails do not (qualify). People can go to a manicurist for their fingernails. Are you going to file and buff them as well?
Brian Kiel, DPM, Memphis, TN
Periodically, we get a request to trim a patient's fingernail that's split, thick, deformed/mycotic and if it just needs trimming, we take care of this as part of their visit-at no additional charge. When we notice that a patient's fingernails need trimming, as they are very long and they can't do it themselves-again we will do this at no additional charge. When we see a patient with dirty glasses...we clean them. If they need to have their shoes and socks taken off and put back on-no problem.
We are in the business of helping people and we need to think of these things as just part of taking care of our patients. They appreciate it and this goes a long way towards creating happy, trusting patients who would never think of going anywhere else or referring friends/family to anyone else for their foot care.
Tom Silver, DPM, Golden Valley, MN
10/10/2018
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 1A
From: Stephen Doms, DPM, Martin S. Lynn, DPM
Five states do include the medical and surgical treatment of hands in podiatric statutes: Alaska, Minnesota, Michigan, Ohio, and West Virginia. Source: ACFAS state scope of practice provisions. I practice in Minnesota, and while I could trim fingernails and be within my scope of practice, I choose not to.
Stephen Doms, DPM, Hopkins, MN
I treat patients exclusively in SNFs and will only debride/I&D fingernails if they are dystrophic, mycotic, or have a paronychia. The durable power of attorney (DPOA) or patient is then informed that they should follow up with a dermatologist.
Martin S. Lynn, DPM, Snohomish, WA
09/24/2018
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 1A
From: Richard Willner, DPM, Jeffrey Kass, DPM
While the reality is that the Data Bank reports to the NPDB are not meant to ever be removed except for a very limited number of occasions, based on the few facts that I have read in your publication of this date, I think that this podiatrist may fall into that area.
To begin to understand the NPDB, I suggest reading my latest article published on the NPDB. It was published in BC Magazine (originally called Billing and Coding Magazine).
Richard Willner, DPM, New Orleans, LA
Name Withheld asks a valid question. If the complaint against him was found as “without merit,” then I agree with name withheld that nothing should be put on their record. If something is then [reported], the accuser effectively “wins”. This is outright wrong! This is something that should be corrected and changed. Why is the doctor always wrong, even when innocent? I say it time after time - why do doctors take this constant abuse? When issues arise that we may previously were unaware of, why doesn’t leadership attempt to evoke change before history repeats itself? I empathize with the poster.
Jeffrey Kass, DPM, Forest Hills, NY
07/19/2018
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 1A
From: Donald R Blum, DPM, JD
Texas State Law effective 09/01/2019 (this applies to all physicians in Texas):
A new state law will require Texas physicians to check the Texas Prescription Monitoring database before prescribing opioids (hydrocodone, oxycodone, etc.); benzodiazepines (alprazolam or diazepam); barbiturates; or carisoprodol. Physicians must check each patient’s prescription history within the database for evidence of doctor-shopping or drug diversion.
This means that surgeons must query the database before prescribing for their post-operative patients; and a primary care physician must query the database before prescribing for their sprained ankle patients or their stressed-out patients who need alprazolam.
The law does not apply to physicians prescribing for patients diagnosed with cancer or patients receiving hospice care.
Donald R Blum, DPM, JD, Dallas, TX
|
| |
|
|
|
