Podiatry Malpractice :What is a Podiatrist ? (Cont.)

Posted on May 11, 2008 by Michael Quinn

SCOPE OF PRACTICE (Continued from entry below)

The traditional practice of podiatry (podiatric medicine and surgery) overlaps fields of orthopedic and vascular surgery, dermatology, neurology, infectious disease, rhuematology, physical therapy , emergency medicine and radiology as they relate to the foot, ankle and lower extremity.

However, as far as proper scope of practice, it is defined by the state law of each individual state.   In some states, the practice of podiatry may fall under the auspices of the state board of medical examiners.  In others, there may be a governing board of podiatric medical examiners. It is important to ascertain which agency governs the practice, since standards of practice may be generally adopted into the General State Board of Medical Examiners regulations or standards may be defined under a corresponding agency such as the State Board of Podiatric Medical Examiners.  

In some states the practice of podiatry may be limited to the foot.  In other states the scope of practice may include the ankle.  In some cases, the practice may include the entire lower extremity.  State law will further define whether the practice is to include bone and soft tissue and in some cases, serve to restrict to the practice to soft tissue only (no bony procedures).   For example, in New Jersey a podiatrist may treat disease in the lower leg, however s/he may not perform surgery on the bones of the lower leg (tibia & fibula)  The recent  case in Texas underscores the definitional disputes that may arise in a states respective statute.

Tip #2.  In addition to the restriction placed by state law on the podiatrist limiting the anatomical location of treatment, some states will also place a further restrict on on the types of procedures to be performed in any particular location.  For example,  bony procedures may be allowed on the forefoot, however procedures involving bone may not be allowed on the rear foot or ankle.

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$2M Verdict For PA Man has Corn Removed, Loses Both Legs (Pennsylvania)

Posted on April 2, 2008 by Michael Quinn

A jury has awarded more than $2 million to a man who had a corn removed from his toe and ultimately lost both legs after a series of infections. Donald Davis Sr., 59, of North Wales, Montgomery County, sued Pottstown podiatrist Therese M. Rinaldi, who removed the corn. Davis, who had circulation problems, developed an infection, gangrene and then a staph infection after the corn was removed. He was later treated for sores on both legs. Doctors ultimately decided to amputate his right leg above the knee and his left leg below the knee.

The Berks County jury set Davis' damages at $3.4 million, but found he was 40 percent responsible, lowering the award to almost $2.07 million. Davis did not tell Rinaldi about his circulation problems when he first visited her office, according to court records. Davis alleged that Rinaldi did not review his medical records before removing the corn from his small toe on Sept. 27, 2000, at Pottstown Memorial Medical Center.

Davis, who was also treated at St. Joseph Medical Center, also sued surgeons and both hospitals, but they were dismissed as defendants before the two-week trial. Rinaldi's attorney said he plans to appeal.

Source: Associated Press [10/7/06]
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Accused IL Podiatrist Claims Vaginal Exam is "Normal Procedure" (Illinois)

Posted on March 28, 2008 by Michael Quinn

A podiatrist from Olympia Fields sexually assaulted a 75-year-old woman during a medical exam then told her he'd done her "a favor," a judge heard in court this week. Dr. Anthony Overton, 63, claims he was following normal procedures for a foot doctor when he touched the woman's breasts and inserted his finger into her vagina and rectum. But as Overton's bench trial began before Judge Michael Toomin at the Cook County Criminal Court on Tuesday morning, Assistant State's Attorney Beth Pfeiffer said, "Those transgressions were a crime."

The victim, now 77, testified she had made an appointment with Overton about an ankle injury June 2, 2006, because her regular podiatrist had moved. Though Overton had her strip and change into a gown, violated her and ordered an x-ray, he did not examine the injured foot, she said. But defense attorney William Hooks said Overton "was within the standard of care for podiatric medicine." Overton's license to practice as a podiatrist was suspended in July last year after as many as six other women came forward with similar allegations.

Prosecution expert Dr. Adolph Galinski, a podiatrist for 40 years, testified there was "no reason" for Overton to have conducted a full physical exam on the victim. "A podiatrist is trained to deal with the ankle and the foot. If I started dealing with the elbow, the back and all the other parts of the body, I'd expect to be a defendant in this courtroom pretty soon," he said. Overton is free on $250,000 bail.

Source: Kim Janssen and Eric Herman, Southtown Star [3/27/08]

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Alleged Misdiagnosis - Cancer Wrongful Death (Michigan)

Posted on March 26, 2008 by Michael Quinn

FACTS: The estate of a patient who died from a rare form of cancer alleged the man's death was due to negligence of the man's treating podiatrist. Plaintiff claimed defendant violated the standard of care, but the jury disagreed with that argument and returned a verdict in favor of defendant.

Plaintiff's decedent, 59 year old Walter Chapton, presented to defendant podiatrist in May 2000 with a 3 cm. lump on the top of his right foot. Defendant diagnosed the lump as a ganglion cyst and was able to aspirate only a small amount of fluid from the lump. Defendant injected the lump with corticosteroids. Chapton returned to see defendant two weeks later. Defendant's notes indicated the cyst was somewhat decreased in size and he told decedent there was no need to undergo further treatment unless the cyst got bigger, became painful or changed in color. On May 17, 2001, Chapton returned to defendant as the lump had grown to 4" to 5" in length and 3" in diameter over the previous several months. Defendant recommended its removal, which was not accomplished until July 18, 2001. Pathologists identified the mass as a high-grade myxoid chondrosarcoma (cancer), for which surgery was futile as the cancer had already metastasized to Chapton's lungs. Chapton died in May 2002.

Plaintiff's experts opined that, had the cancer been diagnosed in or around May 2000, Chapton's chances of survival were 80% to 90%. However, when the diagnosis was made in July 2001, his survival chances were zero. Plaintiff alleged that, because defendant was unable to aspirate much fluid from the mass in May 2001, the standard of care required further testing, such as an MRI, ultrasound, or CT scan, or referral to an orthopedic surgeon.

Defendant contended that, despite retrospective knowledge that the diagnosis was incorrect, it was not a violation in the standard of care to miss the cancer. He claimed he was not negligent because primary cancerous lesions to the foot, , particularly chondrosarcoma, are extremely rare.

RESULT: Defense verdict

PLAINTIFF EXPERTS: Jonathan A. Haber, DPM, Caldwell, NJ, Charles F. Fenton, III, DPM, JD, Atlanta, GA, J. Sybil Biermann, MD, Ann Arbor, MI, Michael J. Kraut, MD, Southfield, MI

DEFENDANT EXPERTS: Charles G. Kissel, DPM, Warren, MI, Marshall Solomon, DPM, Farmington Hills, MI

Source; The Michigan Trial Reporter
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Alleged Failure to Order Bone Density Test (New Jersey)

Posted on March 13, 2008 by Michael Quinn

Facts: The female plaintiff in her late 20s had received overlapping treatment from the three defendants, including an internist, podiatrist and ob/gyn, with the ob/gyn seeing her last. The plaintiff contended that despite the weight of the 5 ft. 5 in. tall plaintiff, which dropped as low as 101 lbs., frequent rigorous exercise, the loss of her period and the suffering of two stress fractures to the feet, the defendants negligently failed to consider that the plaintiff might be suffering from an eating disorder.

The plaintiff further contended that the defendants negligently failed to send her for a bone density study and to institute other measures to correct the bone loss. The plaintiff maintained that after she ultimately suffered an ankle fracture, a non-party orthopedist sent her for a bone density study and that it was determined that the plaintiff suffered severe osteoporosis, which is particularly pronounced in the spine and hip, and that the condition of her bones was similar to that of a woman in her 70s.

The defendants maintained that the care was reasonable. The plaintiff contended that although the condition has stabilized, it will never improve and that she will permanently be very susceptible to compression fractures in the spine.

The defendant podiatrist maintained that he had a right to rely on the physicians and the internist maintained that any fault primarily rest with the ob/gyn.The ob/gyn contended that he acted appropriately, especially since he treated the plaintiff correctly with birth control pills and was able to achieve the return of her menstrual cycle.

Result: The case settled prior to trial for $ 375,000, with the most significant portion paid by the defendant ob/gyn.

Plaintiff Experts: Richard Luciani, M.D., Millburn, NJ, Myron Boxer, D.P.M., Woodmere, NY, Kevin Bell, M.D., Watchung, NJ

Source: Medical Litigation Alert Volume 16, Issue 2

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Alleged Failure To Properly Perform Removal of Neuroma on Foot (New York)

Posted on March 3, 2008 by Michael Quinn

In this medical malpractice case, the female plaintiff contended that the defendant podiatrist negligently failed to properly diagnose and treat a lump in her foot. The plaintiff also maintained that the defendant failed to perform an MRI prior to surgery, resulting in the defendant allegedly failing to completely excise the mass during the surgical removal of the neuroma.

As a result of the defendant's negligence, the plaintiff contended that she was forced to undergo two subsequent remedial surgical procedures to her foot in order to remove the remainder of the mass and correct and/or repair nerve damage allegedly caused by the initial surgery. The defendant contended that he performed the surgical excision of the mass appropriately and properly and that he had complied with the standard of care in all aspects of the procedure.

The evidence revealed that the female plaintiff was a nurse in her early 50's at the time of the surgery. The evidence indicated that the plaintiff had been treating with the defendant podiatrist for approximately four months prior to the surgery for a mass that was found in her right foot. The plaintiff was diagnosed with a neuroma in her foot requiring surgical excision that was performed on October 10, 2003. The plaintiff also maintained that prior to excision of the mass, the defendant failed to perform an MRI in order to properly determine the exact size and depth of the neuroma. As a result, the plaintiff contended that the defendant negligently left part of the neuroma in her foot during the surgery and that she ultimately required two additional surgeries to remove the remainder of the mass and repair nerve damage she allegedly sustained in the initial surgery. The plaintiff maintained that she missed some ten months of work due to her injuries. However, no lost wages claim was made.

The plaintiff related that she underwent a second surgical procedure in mid-2004 to remove the excess mass in her foot. The plaintiff then underwent a third surgery in 2005 to repair nerve damage allegedly sustained in the initial surgical excision of the mass. The plaintiff's expert podiatrist testified that the defendant departed from the standard of care in failing to perform a pre-surgical MRI to properly determine the size and position of the plaintiff's mass. In addition, the expert opined that the plaintiff's neurological injuries were causally related to the defendant's negligent performance of the procedure. The expert opined that the plaintiff suffered some permanency in that she is no longer able to stand for extended periods of time and/or apply complete pressure on her foot, as required in her nursing position.

The defendant introduced an expert podiatrist who opined that the defendant had, in fact, complied with the standards of care in performing the surgical excision of the plaintiff's neuroma. In addition, the defendant called a second expert podiatrist who opined that the plaintiff's injuries were not permanent and would resolve.

Result: The plaintiff made a pretrial demand of $75,000. The trial lasted three weeks with deliberations lasting approximately two hours. The jury returned with a 5-1 verdict awarding the plaintiff $300,000 for past pain and suffering and $ 50,000 for future pain and suffering for a total award of $450,000.

Plaintiff's Expert: John Mancuso, DPM, NY, NY
Defendant's Experts: Edwin Wolf, DPM, Michael Trepal, DPM, NY, NY

Source: New York Jury Verdict Review & Analysis, Volume 24, Issue 12

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