03/31/2025    Paul Kesselman, DPM

Podiatrist's Breach of Standard of Care Proved Fatal (PA) (Allen Jacobs, DPM)

Dr. Jacobs once again has hit the nail on the
head. As for Dr. Chaskin, it’s readily apparent
that his posting is not in touch with reality. A
case in Queens county where Dr. Chaskin practices,
supports the fact that even though a particular
pathology may be out of your scope of practice,
you still have a due diligence to do something
basic. Pick up the phone and make a call to
someone with the expertise to treat that
condition.

DPMs have been screaming about becoming part of
the mainstream healthcare team, yet Dr. Chaskin
seems to want to hide behind an archaic wall,
based solely on the NY licensure system. It seems
he supports shirking from a duty to care even when
we are faced with something which may be beyond
our skills or is out of our state scope of
practice. When was picking up the phone to call a
colleague of another specialty or the ER not
within our scope of practice?

When unsure, make the referral. To drive this
point home, a case from about 20 years ago comes
to mind. An orthopedist placed a patient who had
sustained a first metatarsal base fracture into a
cast. A few weeks later, the patient developed
significant cast pain with no SOB. The patient saw
a podiatrist as the orthopedist was away on
vacation. The podiatrist cut the cast in half and
took x-rays of the foot to monitor the healing
(which was poor as the base had shifted). But
that became a secondary insignificant issue as the
calf was quite taught and Hohman's sign was
positive.

According to Dr. Chaskin, the DPM had no standard
of care to follow as DPMs don't treat DVT. What
may have saved the patient's life, was the action
of the DPM, who urged the patient to seek care
immediately in an ER. This was all very well
documented as were numerous calls over the next
few days to the patient by the DPM. The patient
finally sought care in an ER a few days later when
he did finally develop SOB. Fortunately, the
patient recovered and, in a suit, filed later,
both the DPM and Orthopedic surgeon were named as
defendants. After many months if not years of
angst, the case was dismissed against the DPM with
the judge instructing the plaintiff and
plaintiff's counsel in open court, to apologize to
the DPM and instead thank him for saving his life.

That same day the MD orthopod's case was also
dismissed. An expert witness for the plaintiff who
was a vascular surgeon actually testified that he
agreed that orthopedists generally do not treat
DVT as it is not within their scope of practice
(notice I did not say license). The vascular
surgeon also agreed that he saw no medical
rationale for this patient to be anticoagulated as
the patient did not have other risk factors for
DVT and that cast immobilization is a known factor
in possible development of a DVT.

How do I know all this? Well, I will let you all
figure that out! This case as well as the one
cited by Chaskin and Jacobs all point to some
simple thoughts! Do No Harm and "share the wealth"
all come to mind. The bottom line is that you as a
physician, whether determined by state licensure
or your own skill set, have a duty to refer to
someone who is trained to treat a condition that
you are ill equipped to provide. That is the
standard of care which all health care providers
must subscribe to! Where is the harm in referring
to others?

Paul Kesselman, DPM, Oceanside, NY

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