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03/14/2025
RESPONSES/COMMENTS (MEDICAL MALPRACTICE)
From: Daniel Chaskin, DPM
In my opinion, a podiatrist would have a defense in the following situation: If a patient dies of a pulmonary embolism, the physician who medically cleared the patient for foot surgery should be responsible, not the podiatrist who referred the patient for medical clearance and relied on the MD or DO to perform the medical clearance.
Even if it is argued that a podiatrist should suspect a pulmonary embolism, the counter argument is that the physician who is licensed to treat the pulmonary embolism knew better because the state licensed them to treat such a condition. The podiatrist is not expected to know more about this complication than an MD or DO, and should rely on their opinion based on what the state deems them to be licensed to treat.
The same situation should apply to any situation the podiatrist is not licensed to treat yet makes a referral to for the purpose of medical clearance.
Daniel Chaskin, DPM, Ridgwood, NY
Other messages in this thread:
03/20/2025
RESPONSES/COMMENTS (MEDICAL MALPRACTICE) - PART 1B
From: Jay S. Grife, DPM, JD, MA
Dr. Jacobs is 1,000% correct in his discussion. As podiatrists, you can rest assured that if a patient suffers a post-operative DVT episode, you, as captain of the ship, will be a named Defendant should a lawsuit ensue. It is also likely the clearing physician will be a Defendant but not a certainty by any means because the clearing physician will claim exactly what Dr. Jacobs suggested.
An example is a client who had an obvious Factor V Leiden mutation which had been previously diagnosed, and the podiatrist performed her own H & P but simply did not realize what Factor V Leiden mutation entailed. End of story and case. It behooves all podiatrists to follow Dr. Jacobs’ suggestions as to management of potential DVT issues.
Jay S. Grife, DPM, JD, MA, Jacksonville, FL
03/20/2025
RESPONSES/COMMENTS (MEDICAL MALPRACTICE) - PART 1A
From: Rod Tomczak, DPM, MD, EdD
I think the "pre-op clearance" is to "stratisfy" (sic) the patient, similar to the ASA classification of patients and to satisfy the internist or GP when surgery was done in earlier times when the family doctor knew the patient and the podiatrist was not able to act like an independent contractor and take over the patient's care without notifying the family doc.
Historically, and by that I mean everyone before you and I, and most podiatrists before the 3-year residency programs who do not recognize a subtly sick patient and the pre-op anesthesia visit was not much more than a discussion of a golf handicap or how the grandkids were doing. I was perfectly happy knowing that my conversations and examinations of patients revealed a sick patient. I was pleased to know I could call the family doctor and talk physician speak explaining my...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
03/18/2025
RESPONSES/COMMENTS (MEDICAL MALPRACTICE) - PART 1B
From: Steven Kravitz, DPM
The on-going dispute by a small number of podiatrists seeking the ability to perform their own medical clearance for surgical intervention in hospitals has always baffled me. I fully support increasing education and increasing the diagnostic ability of our graduates to diagnose systemic diseases affecting the lower extremity and having knowledge as to how to manage them as well. But at the end of the day, treating these medical conditions is out of our scope of practice... and by all means should be. We do not have the medical education that an allopathic physician has.
Until that day arrives, we should not be performing medical clearance for conditions we are not licensed to treat. Additionally, there is a concern with the business aspect of providing medical clearance for our surgical patients, as this increases our malpractice risk and raises the cost for all of us trying to provide good quality medicine in the challenging business environment. We certainly do not need increased cost in this regard.
At the end of the day, it is best for the patient and best for our practice to have medical clearance provided by allopathic physicians who are licensed to treat and manage these problems when they arise. It is for that reason that they also assume the medical liability in providing this clearance for our patients--and we should be thankful for them for doing this.
Steven Kravitz, DPM, Winston-Salem, NC area
03/18/2025
RESPONSES/COMMENTS (MEDICAL MALPRACTICE) - PART 1A
From: Allen M. Jacobs, DPM
The question of who is responsible for thromboembolic episodes in the podiatry patient is an important one, with reference to patient safety and secondarily malpractice allegations. DVT and pulmonary embolism are a major cause for alleged medical negligence against podiatric physicians. Dr. Chaskin posits, and Dr. Udell comments, on the suggestion that the physician who "cleared the patient" is responsible for the thromboembolism. I believe the problem is a bit more complex.
Many physicians maintain the position that they do not "clear" a patient for surgery, but rather "risk stratify" the patient, as the need for surgery and the decision to proceed with surgery are generally that of the surgeon. Under certain circumstances, in theory, an argument could be advanced that the "clearing physician" may be partially to totally liable for an episode of DVT/pulmonary embolism. As a hypothetical, you might refer a patient with known Factor V Leiden mutation or...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
03/17/2025
RESPONSES/COMMENTS (MEDICAL MALPRACTICE)
From: Elliot Udell, DPM
Dr. Chaskin’s point that the clearing physician should be the one who is held responsible if a patient develops a pulmonary embolism brings us back to the long hashed discussions on PM News. Those discussions germinated from those of us who took courses in general physical examinations, who wanted to do their own medical clearances.
The counter argument was that most orthopedic surgeons, ophthalmologists, and other medical surgical subspecialists would always defer to an internist or family practitioner to do his or her pre-op examinations. So why should podiatrists not follow this? The answer lies in Dr. Chaskin's reasoning that if the patient should have a post-op medical complication, only the clearing MD or DO should be held accountable, not the podiatrist.
Elliot Udell, DPM, Hicksville, NY
03/11/2025
RESPONSES/COMMENTS (MEDICAL MALPRACTICE)
RE: "Nuclear" Malpractice Awards
From: Allen M. Jacobs, DPM
So-called "nuclear" malpractice awards may be outliers, but statistical protection is not absolute protection. As podiatrists do more and more surgery, engage in more complex surgeries, treat more patients with diabetes, manage more ulcerations, and treat more patients who have multiple co-morbidities, the potential for poor outcomes and large malpractice judgment would be expected to increase. I was a defense expert in a recent case in which the plaintiff asked for $76,000,000. The jury came back with a $4,000,000 verdict.
According to AI-generated data, in 2023 there were 57 malpractice verdicts greater than $10,000,000. According to the international reassurance company TransRe, mega malpractice awards are increasing in number. According to author Alicia Gallegos, 2023 "blew away every record previously set among high malpractice verdicts." Although Florida, New York,...
Editor's note: Dr. Jacobs' extended-length letter can be read here
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