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From: Gary S Smith, DPM


It seems that most people don't understand how the vaccine works. It is not a "vaccine". It is a therapy. It is like injecting Tamiflu. If the "vaccine" works, you can still get Covid and you can still spread Covid. You just won't get symptoms. "Vaccinated" Covid people are like "Typhoid Mary". They can spread the illness without even showing symptoms. If science was really a "thing" anymore, vaccinated people are the ones who would have to wear a mask.


It should also be noted that the CDC has recorded over 9,000 deaths and 500,000 "documented" adverse reactions to the vaccine. According to the CDC, 33% more people died from the vaccine the second week of July than died from Covid. Since the vaccine has come out, so many people have gotten blood clots and pulmonary embolisms, there is a shortage of the test tubes to collect blood for the D-Dimer test. If you require a patient or a staff member to get an experimental therapy and they die, can you be sued? You should be. 


Gary S Smith, DPM, Bradford, PA

Other messages in this thread:



From: Philip J. Shapiro, DPM, Jack Ressler, DPM


The issues always come down to motive and opportunity, and the need for a secure system to prevent employee theft of financial assets. Under the circumstances, it would be advisable to contact an attorney who specializes in employment law for guidance as to how you should respond.


Philip J. Shapiro, DPM, Ormond Beach, FL


Yes, the employee should be confronted and fired. $25 to $50 (a week) is not a great deal of money but you have a dishonest employee in your office working in a position that could cost you thousands even with a balanced bank statement. An employee like that could do many things that would cost you money. From not filling an open appointment slot to laziness in insurance billing, your practice could be bleeding money without you ever knowing.


Personally, I briefly had a front office staff person that would get a cancellation in the book and never take out the patient from the schedule. To me, it looked like a no-show when in actuality it was an open slot never filled. According to the employee, "who cares? My doctor lives in a nice house, drives an expensive car, and goes on great vacations." On the other hand, and I hope I only speak for a few, if your staff knows things that aren't kosher in your practice, they can hold you and your practice ransom. 


Jack Ressler, DPM, Delray Beach, FL



From: Jack Ressler, DPM


You are allowed to get paid for your services from Ciox. Just make sure you send them an invoice for this time-consuming service. $30-50 per chart is reasonable. Do not take the time to copy and send your charts until payment is received. I got a request two weeks ago. They called my office and their number came up as SCAM! 


I did fax them an invoice for my services. Did you hear from them? Moving forward I will only respond to a request via certified mail. I will explain to them that because their number comes up as scam, I need to have confirmation that they are who they say they are.


Jack Ressler, DPM, Delray Beach, FL



From: Mark Spier, DPM


The real data from the CDC is: As of 6:30 PM CT on July 21, 2021, the CDC's website stated through July 19, 2021, Vaccine Adverse Event Reporting System (VAERS) had received 6,207 reports of death (0.0018%) among people who received a COVID-19 vaccine. Since more than 338 million doses of COVID-19 vaccines were administered in the USA, this data reflects a vaccination-death ratio of 0.0018%.The CDC’s website says, ‘Reports of adverse events to the (VAERS) following vaccination, including deaths, do not necessarily mean that a vaccine caused a health problem. 


This is because the U.S. FDA requires healthcare providers to report any death after a COVID-19 vaccination to VAERS, even if it’s unclear whether the vaccine was the cause. Furthermore, a review of available clinical information, including death certificates, autopsy, and medical records, has not established a causal link to COVID-19 vaccines, says the CDC.


Mark Spier, DPM, Reisterstown, MD



From: Thomas Hooke, DPM


Denying podiatric medical care to patients based on their vaccination status has ethical (and probably legal) implications. (I'm not a lawyer so I won't discuss legality). While the targets of your policy would likely be those people who simply choose not to get vaccinated, the policy would exclude many pregnant women, pediatric patients, those who have had prior adverse reactions/allergy to vaccines or ingredients thereof, and those with religious or ethical objections. With the abundance of resources dedicated to screening and infection prevention now readily available to medical practitioners, this seems like more of a punitive policy than a precautionary policy. I don't know if that is the case, but on its face that is how it appears. 


A recent column from your neck of the woods, by New York Times ethicist Kwame Anthony Appiah provides a good response to your question: "Once certain patients are committed to non-vaccination, however, you are not free to make decisions that could reasonably be viewed as punitive. You can certainly insist on their keeping away from the premises if they pose a genuine risk to others in your practice. But that shouldn’t be the case, given that your patients are mostly vaccinated (and your staff entirely so) and that you’ll presumably require unvaccinated patients to wear masks and practice social distancing.


When unvaccinated patients ask for an appointment, you can routinely offer teleconsultations (in circumstances where this is a medically sound option), explaining that, in your view, every trip puts them at further risk of contracting or transmitting infection."


Thomas Hooke, DPM, Bullhead City, AZ



From: Robert Scott Steinberg, DPM


Thirteen months ago, we had not heard about SARS-CoV-2. By now, I am sure many of us are reading all we can to keep us, our families, and our patients safe. We are doctors and many people each day ask about the new COVID-19 vaccines. As physicians, we have an obligation to follow the science and not fall for wild and crazy conspiracy theories. 


I am saddened that a colleague can rationalize their decision not to be vaccinated. Where are they getting their information? It seem illogical and dangerous. There is no shortage of accurate information about the COVID-19 injectable products. 


Robert Scott Steinberg, DPM, Schaumburg, IL



From: Name Withheld


I got my private clinic signed up for priority vaccinations with our 1st vaccination this Saturday at the hospital. This is exciting as we have been living in fear of getting sick from being exposed to patients on a daily basis. 


In the post regarding "When Office Staff Refuse to Get Immunized", it was mentioned that one option is to reassign the staff that doesn't want to get immunized to non-patient duties. Unfortunately, my main medical assistant who can't be reassigned has refused to get the vaccination based on her religious convictions and what she's heard from her church. I have tried to show her the data and literature on the vaccination to no avail. Any ideas on how to persuade her to get vaccinated?


Name Withheld



From: Corey Fox, DPM


I agree that there is little to be concerned about with liability. The bigger and more likely problem is what happens if this employee contracts the virus and tests positive. Now you have to shut your office for a week. You may also have to call all the patients that were in the office and had contact with this employee for 72 hours prior to his/her symptoms or positive test. It's a headache you don't need.


Corey Fox, DPM, Massapequa, NY



From: Christopher Orlando, DPM


This is a conversation that should not be happening. The DEA license should be retained until the doctor is fully retired and out of practice. The cost in New York is $731.00 for 3 years (243.67 per year). This is nominal. The cost of membership in ABPM, ABPS, etc. is three times the cost. Why cheap out on a small number? Historically, we as a profession worked very hard to earn the right to have the DEA license. This was a long hard battle that was finally won in 1971. Prior to that, we could not write any prescriptions at all. Our profession has been climbing a steep hill (and gaining) for the past 100 years. Let's not give it back.  


While we are on the subject of prescriptions, our DEA license allows for schedule 2, 2N, 3, 3N, 4, 5 medications. Therefore, if doctors are allowed by their DEA license to prescribe medical marijuana, each doctor would then make an individual decision as to whether to prescribe it or not. I would not want that decision taken away from me by those who would elect to decline to prescribe it.


Christopher Orlando, DPM, Hartsdale, NY



From: Richard A. Simmons, DPM 


Jack, I faced the same dilemma about eight years ago. I contacted our State of Florida Podiatric Licensing Board and was told it was not necessary. I contacted my professional liability insurance carrier and they were more than enthusiastic that it was not necessary.  So, I have not had an active DEA for about 8 years. I could not tell you the last time prior to then that I wrote for a narcotic, but I do know that since I discontinued my DEA license that I have no longer been called by patients in acute pain that could “only be resolved by Oxycontin, etc.” Save yourself time and money, but for peace of mind call the Licensing Board and your insurance carrier to get their 2019 opinion.


Richard A. Simmons, DPM  Rockledge, FL



From: Timothy P. Shea, DPM


One of your primary responsibilities as a professional business owner is the safety of your employees. Inappropriate behavior, such as language, physical activities, or any actions by patients, or anyone else, which you or your staff deem inappropriate is immediate cause for dismissal from the practice. My office manager is an ex-ER nurse and she does not tolerate anything, even over the phone, that falls into this category.


There is a fine template available from PICA Insurance for dismissing patients. We use the term "inappropriate action" in the letter to explain the reason for being let go. There is no second chance, and I have had a few call backs to request an opportunity to make amends to no avail. Your staff must feel safe in your work environment. Fortunately, this does not happen that often. I recommend you take immediate action in this matter.


Timothy P. Shea, DPM, Concord, CA



RE: Requests to Trim Fingernails

From: Bryce Karulak, DPM, Charles Morelli, DPM


I truly think we are hyper-focusing with respect to trimming patients' fingernails. I am willing to bet that if anyone of us cut a patient's fingernails and went to the majority of the PCPs in our respective areas, they would not care and even say, "Great!" 


Where this conversation should really focus on is enhancing our scope. I work in Texas and the law for podiatry basically reads, "A podiatrist may treat...


Editor's Note: Dr. Karulak's extended-length letter can be read here.


My question is very simple and I look forward to hearing from our legal scholars. Why is it that anyone can trim a fingernail but a podiatrist cannot? Why was my wife able to trim our daughter's nails? Why is a granddaughter not placed in peril if she cuts the nails of her grandmother in a nursing home? These examples are endless. Why might this not be covered under the Good Samaritan law which "provides basic legal protection for those who assist a person who is injured or in danger." I once had to pry open the hand of a patient in severe contracture, only to find a nail that was on the verge of puncturing his palm. Does that qualify him as being in "danger"? I submit to you that it does. 


Charles Morelli, DPM, Mamaroneck, NY



From: Paul Busman, DPM, RN


Like Dr. Morelli, I would very occasionally trim a patient's fingernails. These were generally patients that I had treated for a long time, had fingernails that were already pressing into their skin, and had severe disabilities. This made them unable to go to a nail salon. Some had such severe finger contractions that a nail salon would not likely want to treat them. Yeah, I know, scope of practice, liability, blah, blah, blah. I just didn't have it in me to refuse such a simple request which I was eminently qualified to fulfill. I never once had a problem doing this, just very grateful patients. Not that it legally meant anything, but I always told patients that their podiatry treatment was over, but I was cutting their nails as a friend might do. They got the message.


I never did treat warts on a patient's finger or any other area but the foot. However, I did tell them that if the warts on their feet were cured, there was a good chance that the warts would all go away. Know what? In a fair number of cases, that actually happened. Also, if I was treating a patient with some home applied remedy, e.g. Sal acid under occlusion, I'd point out to them that if they went to a dermatologist for their other warts, he/she might well prescribe a similar treatment for their other warts, wink, wink.


Paul Busman, DPM, RN, Frederick, MD



RE: Requests to Trim Fingernails (Maryann Trivlis, DPM)

From: Charles Morelli, DPM


While I completely appreciate and understand Dr. Block's measured and legal response to this query, part of me is in complete agreement with him but the other part is rolling my eyes at this. While a podiatrist is limited in scope (which does not include the trimming of fingernails), and medical malpractice does not cover these treatments, please don't tell me that a medically trained podiatrist who went through 3 years of medical and surgical training who is now a doctor and/or a surgeon would say no to an incapacitated and frail senior citizen who asks you to help them cut their fingernails.


Back when I made home visits, I did it whenever I was asked. In my heart I could never say no. In my private practice, I have stroke patients, or patient afflicted with Dupuytren's who are unable to do it and have nails that are on the verge of breaking the skin of their hand and their wife or husband would ask (sometimes plead) for it to be done. How could you possible say no. At least I could never and still don't. Anyone ever treat a wart on one of your patient’s fingers? 


Was I out of scope and was I opening myself up to the possibility of a malpractice case when they could have gone on to a massive fingernail infection and lose their finger or arm? Yes, I was, but my odds of hitting lotto or being struck by lightning were better than that. If you fear this, then just don't do it. 


Charles Morelli, DPM, Mamaroneck, NY



From: Elliot Udell, DPM


Yes, hardly a month goes by when a patient does not ask me to cut his or her fingernails. On Friday, another tenant in our medical building came in an asked me to cut one of his fingernails. I refused. I still remember one of my professors at NYCPM, over thirty years ago, boasting to the class at what a good deed he did for an indigent patient by cutting her fingernails. The problem is that in most states, it’s against the law. Dr. Block said it well when he said that such an action could subject a podiatrist to professional discipline. 


I see no reason why our local state societies should not push for legislation which would allow podiatrists to cut fingernails but until this happens, we need to refuse.


Elliot Udell, DPM, Hicksville, NY



From: Donald R Blum, DPM, JD


When a complaint is filed with TSBPME/TDLR, Name Withheld should have been notified of the complaint. Assuming it was from a patient, you would have received a letter requesting a copy of chart notes and x-rays (at your expense).  At that point, you would have been made aware of who was the complainant. At that point, you have a limited [time] to forward the information to the TSBPME/TDLR.


Typically, your Medical Liability Company (I know PICA offers this service/benefit) will offer a defense for board complaints, or you can try to resolve this yourself. My issue to you is whether the information about the board complaint is whether it come from the National Practitioner Data Bank or from the TSPME/TDLR?  Did you tell the hospital that a complaint had been filed, the nature of the complaint, and that it had been resolved with finding the complaint showed no merit? You might consider going the NPDB website and do a self-search. If there is incorrect information, see if they have a mechanism to correct that faulty info. Did the NPDB show that the complaint was resolved finding no merit and was dismissed?


My recommendation has always been to send a letter to the TSPME/TDLR requesting a copy of the complaint with allegations filed with the board.


Donald R Blum, DPM, JD, Dallas, TX



From: Elliot Udell, DPM


There is a larger elephant sitting in the living room. When we use our e-prescribing tools, they automatically let us know what medications the patients has been prescribed by all of the patient's doctors. On the one hand, it is good because it would alert us if there is a dangerous drug interaction, even if the patient does not remember what medications he or she is taking. On the other hand, this represents an invasion of privacy and confidentiality.


Does this mean that any of us can punch in the name of any patient and find out what medications he or she is taking? What if a patient has a history of an embarrassing medical condition such as a sexually transmitted disease and does not want, "Dr. Jones" who is also a family friend to not know about that episode in his or her life? Don't the HIPAA laws protect this aspect of patient privacy?


Elliot Udell, DPM, Hicksville, NY



From: Daniel Chaskin, DPM


"The doctor must  provide such records at no cost to the carrier (usually stated in contract)." 


I disagree with Ms. Moracka-Sawaki's statement. My guess is that HMOs are getting paid a rate per patient that includes all administrative costs. One of those administrative costs includes the fees required to pay for the release of records. 


1. If podiatrists are not being reimbursed for the release of such records, then the actual fee received by the HMO from the federal government should be proportionately reduced by such an amount since the HMO is not paying for such records.


2. There are Stark laws that may come into play. To have access to a patient population by a contractual provision that waives the right for a provider to charge for a record release just might depart from federal law. As a suggestion, perhaps the APMA can investigate if all podiatrists are legally entitled to bill for such records. It just might be illegal to deny payment as per a contractual clause that might not be in compliance with federal law. 


Daniel Chaskin, DPM, Ridgewood, NY 



From: Elliot Udell, DPM


In my 35+ years of practice, I have seen many patients who presented with foot pain along with a history of working in a warehouse all day on hard concrete floors. Since the query involves a legal matter, the question must be asked as to why "that" one employee developed the problem in that particular work environment and other workers did not. Were there other contributing factors such as abnormal biomechanics, loss of a plantar fat pad, obesity, or an employee willing to work all day in shoes with little to no padding.


Because most, if not all of the cases, I have treated with that same presenting history were not involved in litigation or seeking workers compensation, I was able to attain great clinical outcomes with these patients by prescribing either a better shoe and/or making them good custom orthotics with built-in cushioning. One caveat is that if you choose to go the route of orthotics, choose a lab that can and will make an orthotic with sufficient cushioning. Prescribing a rigid device for a patient as described, unless the problem is purely biomechanical, could make a bad situation worse. 


Elliot Udell, DPM, Hicksville, NY



From: Name Withheld, Frank Marullo 


I and numerous other podiatrists in New York have received this type of letter from this carrier. Contact the New York State Podiatric Medical Association as I have done.

Name Withheld 

There are several variables that will decide whether or not you may or may not owe this money back. 


1. Are you an Out-of-Network provider? If so, this is to your ABSOLUTE advantage and you stand a much higher chance of winning this argument. Obviously, as an Out-of-Network provider, this would mean you provide services to commercially insured patients where 8-9 out of 10 have self-funded plans versus fully funded plans (FACT!). When treating patients who present a self-funded policy with Out-of-Network benefits, the insurance carrier’s (or Third Party Administrator/”TPA” in this scenario) “medical policies” are 100% irrelevant. They mean nothing to you. Their rules do not apply whatsoever. 


What matters is the beneficiary’s employer master summary plans description (Better known as the “SPD”). For every surgery you did on each patient, does...


Editor's note: Mr. Marullo's extended-length letter can be read here



From: Ayne Furman, DPM


I closed my office about 6 months ago. Here are some of the steps I have taken so patients can contact me in the future 1) transferred my office phone number to a VOIP line which is a less expensive monthly charge than a business line. I have this line coming into my home 2) posted a notification on my website (which I plan to keep active for several years) for patients to call or email me with questions 3) set-up a post office box so patients have an address to mail their requests for records. 4) maintained a fax number.


Ayne Furman, DPM, Alexandria, VA



From: Michael M. Rosenblatt, DPM


Dr. Schneider asked a question concerning publishing about "podiatry and Medicare fraud." The Editor replied: "that these are posted to "try to educate podiatrists not to get caught in the web created by OIG (and others.)"  I have worked with a number of DPMs who have been accused of Medicare fraud. The largest number of these have been "nail wedge resections billed as surgery WITHOUT injected local anesthesia or post-op follow-up." In almost all such cases, the charts have been inadequate, without a discussion of history, circulatory, cutaneous status or detailed examination. Unfortunately, inadequate charting does not allow defense to "convert" those billings into RFC or E&M. There's just no data in the charts.


I have written at least one major article in Podiatry Management Magazine on "Documenting Nursing Home Care." Investigators can easily demonstrate nail wedge resections with a computer search of billings. They just look for the largest numbers. This is a direct line to DPMs who are doing these in nursing homes. Prosecutions are easy. Your career as a DPM is finished. The fallout to affected families is beyond desperation. The irony is that it is NOT difficult to effectively document NH visits. But you need to know the rules: About 30-60% of such visits are not paid. If you cannot accept this, don't go.


I strongly support the Editor publishing news about these prosecutions against DPMs. If reading about these saves just one DPM and his/her family, it is well worth it. It is no exaggeration to suggest that the Editor is performing a function that could saves lives.


Michael M. Rosenblatt, DPM, San Jose, CA



From: Michael M. Rosenblatt, DPM


The DPM who bills separately for his/her services regards himself as a "private contractor." This DPM needs to contact a healthcare attorney with knowledge of healthcare and Federal billing practices immediately. The healthcare attorney will then advise the client on how to handle this.


This is classified as a so-called "legal emergency" and must be dealt with immediately. Failure to deal with this issue could result in one or more charges of healthcare/Medicare fraud against both the clinic and the DPM. In the meantime, don't throw ANYTHING out. If you have any copies of the clinic charging, keep them.


You will likely soon be separating yourself from the wound clinic. They will throw you under the bus and will not protect you. Don't disclose to anyone there that you are seeing an attorney. Say nothing to them without competent legal advice. Chances are that your attorney will be contacting them. Be sure you pay for your attorney yourself, preferably by giving them a retainer, or pay the office charge by check before you leave. Your healthcare attorney must only represent YOU. By paying him, you are cementing that representation.


Michael M. Rosenblatt, DPM, San Jose, CA


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