Podiatrist sentenced to probation for drug charge (North Carolina)

 A Grifton podiatrist was sentenced to probation and a fine for a drug charge.

Dr. Paul Joseph Civatte, 52, was given a sentence of 12 months of probation and a  fine for a reduced charge of possession of drug paraphernalia. The case dated back to Dr. Civatte's 2007 arrest for possession of cocaine and maintaining a automobile for the use of controlled substances(CDS).

Dr. Civatee, who is a podiatrist at  Greenville Foot and Ankle Center,  was arrested for allegedly possessing two grams of cocaine while attempting to purchase drugs from undercover officers.

The cocaine possession charge was reduced to possession of drug paraphernalia. The other charge was dismissed.

Joseph Civatte, DPM was sentenced to a term of supervised probation and was fined $1,000. He was ordered to pay court costs in the amount of $541.50.

Source: ENCtoday.com (April 13, 2009)




Podiatrist accused in drugs for sex case (Missouri)

Dr. Dave Dai Quang Pham, a St. Louis podiatrist, is accused of trying to exchange prescription drugs for sex.

The St. Francois County Prosecutor charged 49-year-old Dr. Pham with possession of a controlled substance with intent to distribute, distribution of a controlled substance, and a misdemeanor, patronizing prostitution.

Source: Associated Press (April 2, 2009)

Missouri Podiatrist pleads guilty (MO)

A St. Louis, Missouri podiatrist has plead guilty to obstructing a federal audit when she provided the Medicare program with a false and backdated treatment record, U.S.  said Thursday.

Bic Chau Stafford, D.P.M., 59, who practices at the Family Foot and Ankle Care Center in Maryland Heights, as well as assorted assisted living facilities in St. Louis County and St. Louis City, plead guilty to one felony count of obstruction of a federal audit.  When sentenced Dr. Stafford faces fines of up to $250,000 and  maximum penalty of five years in prison. 

Prosecutors said that Dr. Stafford allegedly billed Medicare for complex foot surgeries provided to 39  Medicare beneficiaries when she was really providing these patients with only routine foot care, such as toenail clippings

Prosecutors said, in response to a Medicare audit, Dr. Stafford created new treatment records for the 39 patients in 2007 and backdated them to 2004, and claimed that she had provided these patients with podiatric surgery.

Source: St. Louis Business Journal (April 2, 2009)

Podiatrist arrested for insurance fraud (MS)

Larry Cruel, D.P.M., a Mississippi podiatrist,  has been arrested following an insurance fraud investigation, announced Attorney General.

Larry Cruel, D.P.M. (age 44), is a podiatrist at Advanced Foot Care in Jackson, MS.  He was recently arrested  by investigators with the Attorney General's Office and charged with one count of insurance fraud and one count of wire fraud for allegedly submitting false claims to Blue Cross Blue Shield. Dr. Cruel faces up to three years for the insurance fraud charge and up to five years for the wire fraud charge .

As with all cases, the defendant is presumed innocent until proven guilty in a court of law.

Source: Compnewsnetwork, March 27, 2009 (workerscompensation.com)

Missouri podiatrist pleads guilty to health care fraud (MO)

A St. Louis County podiatrist, Dr. Denise Hardy, 45,  recently plead guilty to a health care fraud charge in federal court in St. Louis and has admitted to over billing Medicaid and Medicare for unnecessary treatments.

Prosecutors said that Denise Hardy, D.P.M.,  lied on treatment notes from 2000 through 2005 so that Medicaid and Medicare would pay for foot care that would not otherwise have been reimbursed.

Dr. Hardy worked for South St. Louis Orthopedic Group between 1998  and 2005 and provided podiatric services at their office as well as at nursing homes, such as Lafayette Habilitation and at senior service centers at St. Anthonys Medical Center and  St. Alexius Hospital.

Denise Hardy was paid a salary of  $55,000  plus between 50 to 60 percent of the revenue she had billed each month over $12,000.

Source: St. Louis Post Dispatch 3-13-2009

Podiatrist Guilty of Healthcare Fraud (Ohio)

Ohio  podiatrist, Dr. Harold M. Jones, DPM,   has been found guilty in a scheme to defraud Medicare and Medicaid. Dr. Jones, 45, recently went on trial in Cleveland on 22 counts of healthcare fraud, six counts of aggravated identity theft and 26 counts of mail fraud. The jury found him guilty on three of the counts, after three days of deliberations and not guilty on the remainder of the charges.

According to Assistant U.S. Attorney Justin Roberts, Dr. Jones had used improper billing codes, billed for services that were not rendered and also billed under a false provider number. The doctor was also accused of using another medicare provider number and person’s name in order to submit false claims for reimbursement.

Source: The News-Herald (2-24-09)

Podiatrist admits submission of fraudulent Medicare Claims (Pennsylvania)

A  podiatrist from Scranton, PA,  plead guilty  to taking between $10,000 and $30,000 in Medicare payments for services he did not provide.

Podiatrist Thomas Rittenhouse, DPM, entered a guilty plea to one count of making a false statement in a health care matter. These charge carry up to five years in prison and fines of up to $250,000.

At the plea hearing, the Assistant U.S. Attorney said doctor Rittenhouse had filed claims with Medicare between  2003 and  2008 and was paid for services he never provided to patients.  Dr. Rittenhouse is accused of claiming to have performed "nail avulsions", a procedure in which a toenail is removed, but actually just provided routine foot care.

Although the exact amount has not yet been calculated, Dr. Rittenhouse admitted the amount  was between $10,000 and $30,000, and in likely the doctor will be required to pay back the amount that he had received  through filing the fake claims.

Thomas Rittenhouse, DPM,  remains free while awaiting sentencing in Federal Court which is currently set for May 26.

Source: The Times Tribune - 2-18-09

Podiatrist arrested for distributing CDS (LA)

A  podiatrist in Shreveport, Louisianna and his office manager turned themselves into the Caddo Correctional Center.

60-year-old Podiatrist  Dale Fazio, D.P.M.,  is being charged with the unlawfull distribution of  controlled substances and 49-year-old Leighton Fazio is also charged with obtaining a controlled substance by fraud.

The arrests stem from an investigation  by the New Orleans Drug Enforcement Agency.

Dr. Fazio is not licensed to dispense controlled substances, he can only write prescriptions for them and can give them by injection, but cannot dispense controlled substances.

 It was learned that approximately 1,500 hydrocodone tablets and 100 codine tablets were ordered under Dr. Fazio's Drug Enforcement Agency (DEA) number.

It was learned that the drugs were ordered by Mrs. Fazio and that Dr. Fazio knew about the orders. Investigators also learned that the pills ordered were taken by Mrs. Fazio.  

He surrendered his DEA license. He can still practice medicine.

KSLA - 2-19-09




Defense Verdict- Unecessary & Unsterile Foot Surgery (KY)

A  62 year old women  underwent a surgery  by her podiatrist on her ankle in 2004 to remove a cyst. It was performed by a podiatrist. Several weeks later at a post op visit, the defendant had removed the sutures. Plaintiff recalled that the defendant droped the instrument used to remove the sutures on the floor and then continued to use it without cleaning. At a following visit, there were signs of  infection. Shortly thereafter plaintiff was admitted to a hospital with a diagnosis of infection. Plaintiff  underwent a surgery for a skin graft.

Plaintiff alleged that  the surgery was not needed and that the defendant operated in a surgical enviornment and there was  a delay by the defendant in sending her to the hospital.
The podiatrist-defendant contended that the surgery was proper. He also argued that while there was an infection complication,  he responded to it properly and it was managed.

A defense verdict was entered and there was no recovery by the plaintiff.

Experts: David Widom, DPM,  Alan Catanzariti, DPM, Pittsburgh, PA

$750,000 Verdict - Failure To Obtain Informed Consent For Foot Surgery (NY)

A damages-only case in New York involved the plaintiff's right to decide whether or not to receive additional medical treatment/surgical procedures to the feet, which established the podiatrists' duty to inform the patient (informed consent).

The plaintiff maintained that the two defendant podiatrists misrepresented her rights as to the nature of the surgery that they proposed to perform. She alleged that the surgeons did not obtain informed consent and that they negligently performed the surgeries, leaving her with a fused joint in her large and small toes, ataxic gait and ongoing pain and in her smaller toes, preventing her from walking properly, enjoy jogging, and race walking, as she once did, and to live a pain-free life.

The trial lasted three days and the trial judge entered a verdict in favor of the plaintiff. He awarded her $ 250, 000 for past pain and suffering and $ 500,000 for future pain and suffering, for a total award of $ 750,000.

Source: Jury Verdict Review Publications, Volume 16, Issue 11 [PM NEWS]



The plaintiff, who was a healthy woman and an avid jogger and race walker, was a female in her mid-50's at the time she visited the two defendant podiatrists. She contended that she had two office visits prior to surgery. She maintained that the defendants advised her that she needed an in-office surgical repair of her feet due to all the years of jogging, which had caused bursitis on the balls of her feet, as well as, hammertoes. The procedure, called Arthrodesis, is usually reserved for more rigid toes or severe cases, such as when there are multiple joints or toes involved. It is a procedure that involves a fusing of a small joint or joining in the toes to straighten them. A pin or other small fixation device is typically used to hold the toe in position while the bones are healing. She alleged that she signed a pre-operative consent form. However, she claimed that during the procedure, the doctors failed to advise her that they would be performing additional invasive surgery, which involved the fracturing of her toes on both feet. As a result, she has been diagnosed with ataxic gait and experiences continual pain in both feet and toes and can no longer enjoy jogging.

The plaintiff testified that if she had been made aware of the extensiveness and invasiveness of the procedure, she would not have consented to it. She also produced testimony that the defendants failed to obtain consent for the additional surgery. As a result, the plaintiff claimed she has difficulty walking, is no longer able to jog and experiences pain in both feet and all of her toes. The plaintiff's expert podiatrist testified that the plaintiff has since been diagnosed with ataxic gait, and will have pre-mature arthritis as a result of the surgery. In addition, he testified that the extensive procedure was unnecessary and that she would someday be a candidate for "salvage" surgery. Plaintiff's counsel also testified that the plaintiff's insurance company was overcharged.

The defendants testified that they did, in fact, inform the plaintiff of the surgical procedure, both before and during the surgery. They maintained that the phalanges and metatarsal surgical repair was necessary. In addition, they testified that the additional surgery was necessary in order to properly correct the plaintiff's abnormalities in her toes. They maintained that the patient signed a consent form and they produced what they claimed was the plaintiff's signature on a consent form. The defendant surgeons maintained that the procedure was minimally invasive. Counsel for the defense argued that the surgery did not worsen her condition.

Podiatrist Sentenced for Medicare and Medicaid Fraud (IL)

West Peoria podiatrist was sentenced Friday to one year in federal prison for bilking Medicare out of thousands of dollars over the past decade by writing bills for medical procedures he didn't perform. Dr. Ernest Nwani, 57, also was ordered to repay $109,127 to Medicare and Medicaid for the bogus operations, some 400 of them in all.

Nwani, the sole medical provider for Footworld Medical Center, which he operated out of his house, admitted he defrauded the government by billing for services he didn't provide or didn't provide to the level that he charged Medicare. A company hired by the U.S. Department of Health and Human Services to combat fraud last year noted irregular billing practices by the doctor. An investigation revealed patients did not have procedures or even surgeries for which Nwani had billed Medicare.

From 2002 until 2006, Nwani submitted claims, which Medicare paid, for 539 surgical procedures of various types regarding 442 patients and claims for the permanent removal of 1,082 toenails from 394 patients, according to court records. Medicare paid $171,760 for the surgeries and $100,180 for the toenail removals. Thirty-three patients were interviewed and of those, "none of the surgeries billed for these 33 patients and for which Medicare paid, could be verified as having been performed," court records state.


$8.1 Million Verdict for Lost Cancer Biopsy Specimen (IN)

Eric and Renee Flora felt reassured in the spring of 2004 when a local podiatrist removed a growth from her big toe and life for the New Carlisle couple returned to normal.

But when the growth resurfaced a year later, they received some frightening news. Renee Flora, a then 33-year-old nurse's aide and mother of two young girls, had malignant melanoma.

A St. Joseph Superior Court jury has found podiatrist Dr. W. Douglas Kolmodin liable for medical malpractice, concluding that Renee Flora's odds at beating the cancer were greatly reduced because he failed to have tissue from the excised growth tested for cancer.

Now in stage three of the cancer, she has just a 17 percent chance of living another 12 years, according to national cancer statistics, said her attorney, Rob Gonderman.

After a five-day trial last week, the jury awarded the Floras more than $8.1 million in damages.

The couple declined to comment on the verdict, as did Kolmodin.

Kolmodin's attorneys, W. Todd Woelfer and Georgianne Walker, did not return calls seeking comment.

During the trial and in sworn affidavits contained in court records, the Floras testified they saw Kolmodin place the lesion in a container, and he told them he would send it for testing.

That was the last day Kolmodin practiced in his office at 711 W. McKinley Ave. During the firm's move several days later to a building in the Edison Lakes area in Mishawaka, the specimen was apparently lost, Gonderman said.

Kolmodin, 37, testified in a deposition that a local boy's baseball team helped with the move, partly to show their gratitude for a donation he had made to the team.

Kolmodin denied the specimen was lost, according to court records. Rather, he said, it disintegrated upon removal, and there was nothing left to have tested. However, the three podiatrists who reviewed the case for the Indiana Department of Insurance concluded there should have been enough tissue for the test, Gonderman said.

Gonderman said he was pleased with the verdict, but noted he has a long fight ahead in trying to recover the damages.

Fortunately for the Floras, Gonderman said, it appears Kolmodin's former practice, Northern Indiana Foot & Ankle Associates, had failed to participate in the state program that caps malpractice damages at $1.25 million for all care providers involved in a case.

Kolmodin will be shielded by Indiana's $250,000 damages cap against individual doctors under the law.

Gonderman said Northern Indiana Foot & Ankle Associates' status is unclear. Kolmodin now works for South Bend Clinic, which has acquired the firm, Kolmodin testified at trial.

South Bend Tribune [2/24/08]

Podiatry Settlement: Failure To Timely Diagnose Charcot's Joints in Diabetic Patient (NJ)

The plaintiff in her late 50s, a diabetic with peripheral neuropathy, contended that clinical signs including deformations in the bone, the collapse of the arch, an increase in pain and swelling and redness, should have led to a timely diagnosis of Charcot's joints, a degenerative condition that can result in the breakdown of bones and tissues of the foot. The plaintiff also contended, that she was sent for a bone scan three to four months later and that the defendant should have realized that early stages of the condition were evident. The plaintiff maintained that if diagnosed after the bone scan, more conservative treatment modalities such as the use of a total contact cast would probably have enabled the condition to resolve in the absence of surgery and the implantation of hardware which will permanently cause increased pain and difficulties ambulating.

The defendant maintained that the clinical signs prior to the bone scan were consistent with diabetes and peripheral neuropathy and denied that the failure to diagnose the condition this time constituted a deviation.

The defendant also contended that he recognized the early stages of the condition after the bone scan was taken and acted appropriately by prescribing a walking boot and referring her to her family physician. The plaintiff underwent the surgery approximately one year later.

Result: $ 300,000 Settlement

Source: Jury Verdict Review Publications, Volume 29, Issue 2 [PM News]

New Jersey Podiatrist admits involvment in fake Medicare Claims scheme (N.J.)

Authorities said that  podiatrist Michael Schmierer, D.PM. from Holmdel  ran clinics in Middlesex and Union counties in New Jersey has admitted to obstructing a federal health-care audit.

Dr. Michael Schmierer is a partner in Advantage Foot and Ankle Centers.  On August 7, he  plead guilty  in U.S. District Court in Trenton to one count of obstructing a federal audit.

Schmierer's podiatry practice had centers in Linden, South Amboy, East Brunswick,  Linden and Oldbridge. 

Advantage Foot and Ankle Center was audited by a Medicare contractor responsible for detecting Medicare fraud.  Medicare requested 25 original medical records of patients who had been treated at Advantage and had submitted claims for reimbursement for those treatments.

Authorities determined that Schmierer and co-conspirators re-wrote patient notes in 7 of the 25  files to in order to enhance the claims sent to Medicare. Schmierer admitted that the seven records had been altered to justify the billing.

Dr. Schmierer's sentence is scheduled for November 18 and he  faces a maximum of five years in prison and as much as a $250,000 fine, however sentencing guidelines call for a 12 to 18 months sentence in prison.

Source: mycenteraljersey.com [8/7/08]

Podiatry Malpractice : What is a Podiatrist (internship, residency and fellowship)


A majority of states do require one year of podiatric residency training for licensure after matriculation from podiatry school. However, this training is in no way standardized or uniform and can vary from state to state as well as from program to program.

Podiatry residency programs range from one to four years and fall within four different categories; Rotating Podiatric Residency (RPR); Primary Podiatric Medical Residency (PPMR) ; Podiatric Orthopedic Residency (POR) or Podiatric Surgical Residency (PSR). An internship is essentially defined as the first year of training.  The PSR programs are further numerically differentiated as PSR-12, PSR-24, PSR-36 and PSR-48 which simply denote the number of months in the program. As their titles denote, each type of program exposes the resident to different aspects of podiatric care. Generally, a graduate of orthopedic and medical programs have limited surgical experiences.

Tip : Since extent and level of training may vastly differ amongst practitioners, the degree of training should be investigated in order to determine whether or not a defendant / expert was formally trained in the practice area or procedure.  The resident log book may provide some insight into the exposure obtained during training.

Residents are required to keep logs of patient encounters, surgical cases scrubbed and their level of participation. Upon completion of the program, the program director certifies the accuracy of the logs. In order to complete a surgical program, the resident must satisfy a specific number of cases in different surgical categories. Upon completion, the log of procedures is submitted to the program director in order to satisfy certification requirements by the CPME and is usually kept by the individual resident for reference during the board certification process.


Podiatrist Defense Verdict: Diabetic Foot Ulcer (IN)

From November 1996 to February 2000  defendant podiatrist had treated Ronald Vice in connection with diabetic foot ulcers. Vice alleged that defendant’s lack of treatment, patient education and diagnostic studies  led to bilateral, below-the-knee amputations.

The plaintiffs alleged that defendant failed to recognize the seriousness of a diabetic foot ulcer, and refer the patient to a vascular surgeon, order vascular and arterial pressure studies and make proper assessments of right foot wounds while attempting to treat the left foot. Other allegations included failures to order antibiotics, blood work, x-rays, MRIs, bone scan, CBC, metabolic panel, sedimentation rate and serum protein with albumin; moreover, the plaintiffs asserted that defendant had failed to hospitalize plaintiff, and inform him of the seriousness of potential leg loss. The plaintiffs further argued defendant failed to perform incision and drainage procedures with deep debridement and order bone and soft tissue biopsies and wound cultures.

According to a medical review panel opinion dated Feb. 10, 2003, the medical review panel found evidence supported the conclusion that defendant had failed to meet the appropriate standard of care as charged in the plaintiffs' complaint. However, the panel found defendant's conduct was not a factor in the plaintiffs' resulting damages. Moreover, the panel determined evidence did not support the conclusion defendant had failed to meet the appropriate standard of care.

In their answer, the defendants generally denied the plaintiffs' allegations. By way of affirmative defense, the defendants argued Vice had been contributorily negligent and had incurred the risk of a known danger. The podiatrist, in denying negligence, asserted Vice had suffered from several other medical conditions besides foot ulcers, including uncontrolled diabetes, congestive heart failure, coronary artery disease, hypertension, renal insufficiency and peripheral vascular disease. Defendant contended her care and treatment met or exceeded the applicable standard of care in all respects.

Result: Defendant’s verdict

Plaintiff’s Experts: Stephen G. Lalka, MD; Michael A. Salcedo, DPM, South Bend, IN; Robert E. Clemency, MD, South Bend, IN.; Sheree L. Peglow, MD, South Bend, IN; Stephen F. Mitros, MD, South Bend, IN; Charles E. Petersen, MD, South Bend, IN; R. Gregory Credi, MD, South Bend, IN.

Defendant’s Experts: Maria F. Curfman, MD, Fort Wayne, IN; Bruce L. Gewertz, MD, Los Angeles, CA; Michelle Cervin, DO, South Bend, IN; Daniel E. Scherb, MD, South Bend, IN; Frank C. Toepp, DPM, South Bend, IN; Jeff Niespodziany, DPM, Mishawaka, IN; Theodore A. Vorenkamp, DPM, South Bend, IN; Brian Rolfe, DPM, South Bend, IN; William Fox, DPM, Niles, MI; Nelson Worden, DPM, Mishawaka, IN; John Grady, DPM, Oak Lawn, IL, Thomas Wicks, DPM, New Castle, IN; Richard M. Hilker, DPM, Fort Wayne, IN.; Randolph J. Ferlic, MD, South Bend, IN; Bruce J. Brincko, DPM, Knox, IN.

Source: West's Jury Verdicts - Indiana Reports

$3.5 Million Dollar Verdict- CRPS and Partial Foot Amputation (VA)

A jury in Virginia has entered a $3.5 million verdict in favor of Donita Franklin who sued her foot doctor, podiatrist, Dr. Jennifer Feeny,  over a 2003 surgery that she says caused incurable chronic pain  (crps) and led to the amputation of the front of her right foot.

The pain Franklin suffered became a permanent condition that didn't go away even after she had the front of her right foot amputated, Fennell said. Franklin, who used to be a factory worker, now lives on disability and uses a wheelchair or crutches to get around. "She used to be very active before this" and liked to ride horses, the lawyer said. "Now she can't do anything." Steven Feeny, Jennifer Feeny's husband and office manager, said Monday that he and his wife could have settled the suit but felt that "she did nothing wrong and she just had to have her day in court."

Source: Mike Alle, Roanoke Times (VA) [6/3/08]

Podiatry Malpractice: What is a Podiatrist ? (podiatry education)


I find that questions always arise with respect to the education and training of a podiatrist when compared with allopathic (M.D.) and osteopathic (D.O) physicians.  Both curriculums are 4 years in length however there are clear differences and that is purposeful. 

The first two years of podiatric medical education parallel allopathic and osteopathic education concentrating in basic science education with classes in biochemistry, gross anatomy, medical physiology.  Ultimately culminating in the administration of the NBPME I (National Board of Podiatric Medical Exam I) which is the podiatric equivalent of the USMLE I.

The following two years are clinical in nature distinguished by rotations devoted to podiatry practice (ie. podiatric medicine and podiatric surgery)  with exposure to allopathic medical disciplines including rotations in general surgery, pediatrics and medicine. Notably absent are traditional rotations in obstetrics and psychology. Matriculation is confirmed upon passage of the NBPME II, the equivalent of the USMLE II, and granting of the Doctor of Podiatric Medicine (D.P.M.) degree.

There are currently seven (8) podiatry schools located in the United States that grant the D.P.M. degree.  They are the (1) Arizona Podiatric Medicine Program, (2) Barry University School of Podiatric Medicine, (3) California School of Podiatric Medicine, (4) Des Moines University College of Podiatric Medicine and Surgery, (5) Dr. William M. Scholl College of Podiatric Medicine, (6) Ohio College of Podiatric Medicine, (7) New York College of Podiatric Medicine and (8) the Temple University School of Podiatric Medicine.  Some schools will offer an accelerated program granting an undergraduate degree.  Other schools may confer a combined medical and podiatric degrees upon completion of special programs. 

I will continue with a discussion of Internships and Residency in Podiatry in my next post.

Podiatrist sentenced to five years of probation for phony painkiller prescription scheme (PA)

Stuart Deitcher, D.P.M., a podiatrist from Reading, Pennsylvania was sentenced to five year of probation for writing  phony prescriptions to obtain painkillers for himself.

Dr. Deitcher’s license to practice podiatric medicine has been suspended, and according to his attorney his licensee status will come  before a state review board.

the investigation began after reports that the doctor had difficulty standing and walking, recognizing members of staff, slurred speech, frequently dropping items, falling asleep and appeared confused and unable to perform his duties.

The investigation further revealed that on least one hundred occasions Dr.  Deitcher prescribed large amounts of hydrocodone, a painkiller to himself. Deitcher prescribed hydrocodone for himself and had the prescriptions filled at a local pharmacy.  Deitcher had received nearly 40,000 doses of hydrocodone from medical supply companies over four years.

Unnecessary Podiatric Bunion Surgery (Hohmann Osteotomy) to Treat Bunion $400,000 Settlement (IL)

A female plaintiff alleged that the podiatrist-defendant had deviated from the podiatric standard of care by performing a Hohmann osteotomy that involved cutting through the right great toe bone to treat the plaintiff's mild bunion. The plaintiff also contended that the defendant was negligent by advising the patient that she could partially bare weight on the foot  four days following the surgery.

The plaintiff maintained that based on pre-operative X-rays and findings, a Hohmann osteotomy was not indicated since the pre-operative intermetatarsal angle was nine degrees which was normal.  It was further contended that the technique used to fixate the bones was unstable resulting in a malunion and hallux elevatus (elevation) along with shortening of the toe and of the foot. The plaintiff maintained that, despite consulting with over ten different doctors and undergoing six surgical revisions in her continuing efforts to have her right foot deformity and some residual sequelae corrected, she will permanently suffer pain, disfigurement, and disability. The plaintiff incurred $ 120,000.00 in lost income and $ 55,913in medical expenses.

The defendant contended that plaintiff's intermetatarsal angle was abnormally large, that it warranted the Hohmann procedure and that the procedure was well-recognized and accepted. He further contended that if he had only shaved the bunion down that it was likely to return. He also contended that plaintiff contributed to her own injury by stepping onto a step ladder to paint and by dropping a hair dryer on her foot. The plaintiff would have responded that she only got up on the first step with her left foot, did not put any pressure on the right foot and that the hair dryer was a small, travel size dryer that she dropped onto the top of her foot, not onto any of her toes.

Result: The case settled, at mediation, shortly before trial, for $ 400,000.

Plaintiff's Expert: Harold Schoenhaus, DPM, Philadelphia, PA

Defendant's Expert: Louis A. Sorto, Jr., DPM, Chicago, IL

Source: National Jury Verdict Review & Analysis, Volume 23, Issue 2

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

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.

Podiatrist Pleads Guilty to Medicare Health Care Fraud (Illinois)

A podiatrist from Illinois pleaded guilty Friday to bilking Medicare out of thousands of dollars over the past decade by writing bills for medical procedures not performed. The podiatrist's  attorney Ron Hamm contends the amount is less than $20,000, however the government is claiming the amount is closer to $270,000.

From 2002 through 2006, Ernest Nwani, D.P.M. submitted claims, which Medicare paid, for 539 surgical procedures of various types regarding 442 patients and claims for the permanent removal of 1,082 toenails from 394 patients, according to court records. Medicare paid $171,760 for the surgeries and $100,180 for the toenail removals. Thirty-three patients were interviewed and of those, "none of the surgeries billed for these 33 patients and for which Medicare paid, could be verified as having been performed," court records state.

The charge of healthcare fraud, which he pleaded to, has a maximum prison term of 10 years.

Source: Andy Kravetz, Peoria Journal Star [4/26/08]

Podiatrist Pleads Guilty to Rx Drug Charges (Ohio)

An Ohio podiatrist pleaded guilty Thursday to a federal charge of conspiring to distribute oxycodone. Dr. Mark Stieby, 37, faces up to 20 years in prison when U.S. District Judge Danny Reeves sentences him on July 14 in Covington. Dr. Stieby admitted to writing prescriptions for oxycodone to three patients in exchange for some of the pills to feed his own addiction to pain medications. According to court records,  the podiatrist took at least 610 pills.

Stieby was also writing Percocet prescriptions for the patient's girlfriend, according to court records. The prescription was originally for 40 pills per week, but was bumped up to 60 pills per week in October. Sometimes Stieby would pay the patients for a portion of the pills, according to court records. One patient told agents he received $20 for each deal.

Source: Jim Hannah, The Enquirer, [4/18/08]

Podiatrist pleads guilty in drugs-for-sex case (Illinois)

A disciplinary action is violation of the podiatrist's ethical code of conduct.  The professional ethical code governs  professional conduct for those within the organization in order to provide guidelines and/or rules by which the podiatrist is expected to practice.  

The American Podiatric Medical Association (A.P.M.A.) sets forth a Code of Ethics (2005) that governs areas such as  physician patient relationship, billing, and standards of practice.  Although not malpractice per se, many times unethical conduct on part of a podiatrist may reveal elements of an underlying malpractice action.   In addition, some disciplinary actions against a podiatrist may lead to and support a criminal case against the doctor, such as found in the following case. 

Clearly, not only is an intimate relationship with a patient violative of the Code, but the exchange of intercourse for narcotics and taping the encounters, would constitute violations of the code as well.    For instance, yesterday,

a podiatrist in Illinois who had been accused of providing prescription painkillers to patients in exchange for sex—and illegally recording the encounters—was sentenced Wednesday to 6 years in prison after pleading guilty to drug and eavesdropping charges.

Under a deal with prosecutors, Dr. Steven P. Loheide, 64, of Algonquin pleaded guilty in Kane County Circuit Court to one count of illegal delivery of a controlled substance and three counts of illegal eavesdropping.

Loheide, who had offices in East Dundee, also agreed to never again practice medicine.

"I consider your conduct in this case an enormous betrayal of your trust as a physician," Judge Donald Hudson said.

Revocation of Medical License of Ming Tung, D.P.M. (New Jersey)

It is always desirable to research the background of any professional that you may consider engaging for professional services.  In New Jersey, physicians and podiatrists are regulated and governed by the New Jersey State Board of Medical Examiners. At their website you can research and obtain information about physicians and podiatrist who may have been disciplined by the Board.  While not always an indicator of the competence of the practitioner, it is often the case where a significant history can serve as barometer of the ethical and medical aptitude of the provider.   

For example, in the medical  license of podiatrist Dr. Ming Tung, D.P.M. was recently revoked  as a result of fraudulent insurance activity.  The FINAL ORDER OF REVOCATION OF LICENSE was filed September 26, 2007 and viewable at the site. This matter was presented to the Board by way of settlement of an investigation into the conduct of the Doctor. He was the subject of a federal civil and criminal investigation involving fraud on the Medicare Program. Dr. Tung agreed to pay $868,313.38 in settlement of civil claims alleged by the Department of Justice and the Office of Inspector General of the Department of Health and Human Services. He also pled guilty to a one Count Information, in the District Court of New Jersey. Dr. Tung in a plea agreement agreed to make restitution in the amount of $350,000.00.

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

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 left leg above the knee and his right 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]

Accused IL Podiatrist Claims Vaginal Exam is "Normal Procedure" (Illinois)

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]

Alleged Misdiagnosis - Cancer Wrongful Death (Michigan)

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

NY Podiatrist Arrested For Allegedly Billing Dead Patients (New York)

A Long Island podiatrist was arrested and charged with bilking federal and state healthcare programs by billing them for treatments on patients who had died.

Dr. Alan Cantor was arraigned Wednesday on charges including grand larceny and scheming to defraud. Bail was set at $3,000 bond or $1,500 cash.

Nassau County District Attorney Kathleen Rice said that the East Meadow podiatrist had bilked Medicare and Medicaid programs of more than $30,000 over a year-and-a-half by billing them for treatments on patients who had died.

Source: Associated Press [3/13/08]

Alleged Failure to Order Bone Density Test (New Jersey)

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


Podiatrist Charged with Drug Procurement and Insurance Fraud (Connecticut)

A podiatrist from Burlington faces multiple counts of illegal drug procurement and possession and insurance fraud for allegedly illegally filling prescriptions at a Simsbury pharmacy and then trying to pay for them using insurance, police said Wednesday. Dr. Robert Januska, 65, who police said is not licensed to prescribe drugs in Connecticut, turned himself in March 3 after police issued a warrant for his arrest, according to Sgt. Fred Sifodaskalakis, head of the detective division of the Simsbury police.

Januska is accused of making repeated visits to the CVS Pharmacy in Simsbury to have the prescriptions filled, the sergeant said. A pharmacist who suspected the transactions were fraudulent alerted drug control agents at the state Dept. of Consumer Protection in late January, Sifodaskalakis said. Those agents then notified Simsbury police, he said. Charges against Januska include 25 counts of obtaining or attempting to obtain controlled drugs by fraud or forgery, 17 counts of illegally possessing prescription narcotics, eight counts of illegally possessing a level four controlled drug, and 23 counts of insurance fraud.

Source: Loretta Waldman, The Hartford Courant [3/5/08]

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

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