Questions & Answers
The following information is made available by the Texas
State Board of Podiatric Medical Examiners as guidance only (resource). If
the public or licensees have any question or confusion about the
interpretation of the information or for further scope of practice inquiries, please contact the
Board's Executive Director at
Hemant.Makan@tsbpme.texas.gov to submit a written request.
Response times can vary (with associated delays) due to staffing
levels/budget reductions, pending priorities, the nature of
the request, need for further staff review and/or review by the
full Board at the next regularly scheduled Board Meeting.
Unless otherwise specifically cited, this
response by the Texas State Board of Podiatric Medical Examiners
is not intended to supersede the authority of any other
regulatory Board or entity that may have jurisdiction on these
issues. Additionally, this information is not intended to be
construed as a "Rule" respective to the rule making process
published in the Texas Register. Furthermore, this information
is not a formal legal opinion nor advisory opinion, which
this Board does not issue.
- What is a Podiatrist’s scope of practice in Texas?
What specific procedures can a Podiatrist perform?
- Are Board Actions reportable to the
NPDB-HIPDB?
- What is the penalty for practicing Podiatric Medicine without a license?
- Do Podiatrists write prescriptions?
- Do Podiatrists conduct “History & Physicals”?
- For regulatory and compliance purposes, what portions of the Board Statute
and Rules should Podiatrists make sure they know?
- What does it mean if a Podiatrist’s license is in a “Delinquent”
or "Cancelled" status;
can they still practice?
- Do Podiatrists sign the written statement that accompanies the application for
disabled person placards and license plates?
- Can Podiatrists use the word "Ankle" in an advertisement?
- Where can I find information regarding the Diabetic Shoe Bill?
- I'm "Retiring"! What do I need to do in order to properly close my practice?
- I am a prospective patient, what can I do to research the background of a podiatrist or healthcare provider?
- I am a Podiatrist who would like to include Hyperbaric Oxygen (HBO) therapy as part of my Wound Care treatments. What are the requirements, scope and regulations for me to perform HBO? What else should I know?
- I am a Podiatrist who is the subject of a complaint investigation filed by one of my patients. Is it o.k. for me to contact the patient to discuss his/her complaint while the Board investigates the matter?
- I am a Podiatrist who is having problems with an (private) Insurance Company. I have been denied payment, my payments are not timely and I am having other business problems with the carrier which is having a negative impact on my practice. Who can assist me in filing a complaint to resolve these matters?
- Can a Podiatrist order
and/or supervise the administering of anesthesia by a CRNA (Certified Registered Nurse Anesthetist)?
- I am a patient who has been the victim of a sexual impropriety/act/crime and boundary violation by a physician. Where can I find assistance and information with victims rights beyond solely filing a complaint with the Board or Law Enforcement?
- As a patient or podiatric physician, where can I find information related to "Informed Consent Forms"?
- I suspect Child Abuse/Neglect/Sexual
Exploitation. What do I do?
- What are the Medicare regulations relating to Podiatrist orders and debridement of mycotic/dystrophic nail tissue in a nursing home setting?
What about "Healthcare Fraud" prevention and creating a
"Compliance Program" to prevent the same?
- I am a patient with a billing problem. I had seen my doctor who is an out of network provider for my insurance plan. I am now stuck with a large bill for "usual and customary" rates that are not covered and I can't afford this. What can be done?
- Can a Podiatrist advertise and promote an off-label non-FDA approved use of lasers (& other drugs/devices) for toenail fungus treatment?
- Can a Podiatrist employ/supervise an
Advanced Practice Nurse (APN) or Physician Assistant (PA)
and delegate podiatric/medical treatments to an APN/PA
(Physician Extenders)?
- Can a Podiatrist be a "Medical Director"
of a clinic?
- Can a Podiatrist be a "Surgical
Assistant" for non-podiatry procedures?
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Please click on the following for:
"Friday; August 6, 2010
- Wednesday; August 25, 2010 - Monday; October 11, 2010" Podiatry Scope of Practice Updates in
response to the Friday; July 30, 2010 Texas Supreme Court final
decision in "Case No. 08-0485 - Texas State Board of Podiatric
Medical Examiners, Texas Podiatric Medical Association and Bruce
A. Scudday, DPM v. Texas Orthopaedic Association, Texas Medical
Association, and Andrew M. Kant, MD."
[Posted
08/06/2010 @ 4:55 pm; Revised 6:45 pm; Revised 8:00 pm.
Updated 08/25/2010 @ 1:00 pm. Updated 10/11/2010 @ 12:00
pm.]
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All Board Actions are reportable to the National Practitioner
Data Bank and Healthcare Integrity and Protection Data Bank (NPDB-HIPDB)
as required by Federal Law (in part,
TITLE IV OF PUBLIC LAW 99-660; the Health Care Quality
Improvement Act of 1986, as amended 42 USC Sec. 11101 01/26/98).
What's reportable: NPDB. With regard to the NPDB, "adverse
licensure actions" involving certain disciplinary actions
related to "professional competence" or "professional conduct"
must be reported for physicians (MD's/DO's) and dentists. HIPDB.
With regard to the HIPDB, "adverse actions" that must be
reported include licensure and certification action. State
licensing agencies must report final adverse licensure actions
taken against healthcare practitioners. A reportable final
adverse licensure action must be a formal or official action; it
need not be specifically related to professional competence or
conduct. Nevertheless, according to the HIPDB, "a settlement
agreement which imposes the monitoring of a practitioner for a
specified period of time, unless such monitoring constitutes a
restriction on the licensee, or is considered to be a reprimand"
should not be reported to the HIPDB.
Otherwise, all Board Actions, as a service to the citizens of
Texas (Open Record), are published on this website pursuant to
Board Rule §376.27(d) which provides: "Licensee's
Record. All actions taken by the Board against a licensee shall
be made a permanent part of the licensee's record at the Board
office reportable on the Board's website and reportable to the
NPDB-HIPDB (National Practitioner Databank - Healthcare
Integrity Protection Databank)," and
Texas Occupations Code §202.201 “PUBLIC INTEREST INFORMATION”
which provides: “(a) The Board shall prepare information of
public interest describing the functions of the Board and the
Board's procedures by which complaints are filed with and
resolved by the Board. (b) The Board shall make the information
available to the public and appropriate state agencies.” All
T.S.B.P.M.E. investigations resulting in sustained violations of
the Podiatric Medical Practice Act of Texas, the Board Rules and
any other applicable law are adjudicated via a Board
Order/Agreed Order. Those Orders are approved and executed at a
Public Meeting, at which time they become a Public/Open Record;
Permanent Record (operation of law/rule).
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What is the penalty for practicing Podiatric Medicine without a license?
Any persons suspected of treating any disease, disorder, physical injury, deformity,
or ailment of the human foot by any system or method, other than a Podiatrist or Medical Doctor, will be viewed
as practicing Podiatric Medicine without a license (criminal offense). Section 202.605.
"General Criminal Penalty: Practicing Without a License" of the Texas
Occupations Code, states:
A person commits an offense if the person professes to be a podiatrist or practices or assumes the
duties incident to the practice of podiatry without holding a license to practice podiatry.
An offense under this section is punishable by:
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A fine of not less than $50 or more than $500
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Confinement in the county jail for not less than 30 days or more than six months; or
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Both the fine and confinement.
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Yes, for a valid medical purpose & within the limits
of "Podiatry" scope of practice, Podiatrists can write prescriptions to treat any disease, disorder, physical injury, deformity or ailment of
the human foot.
Podiatrists writing "Controlled Substances"
prescriptions should be on the look-out for "Drug
Diversion" & "doctor-shopping" patients, and must
ensure that they themselves are not diverting
controlled substances. Furthermore, all proper
medical records must be maintained. The TSBPME
recommends that Podiatrists utilize a
"Pain Management" checklist as part of patient
treatment and record-keeping to safeguard against
"Drug Diversion" and to ensure prescriptions are
only for a valid medical purpose.
All "Controlled Substances"
prescriptions are subject, in part, to related U.S. Drug
Enforcement Administration, Texas Department of
Public Safety and Texas Health & Safety Code
provisions. For further information, please click on
the following
"License Verifications" page. Texas
Department of Public Safety - Title 37/Part 1 -
Chapter 13 "Controlled Substances" rules can be
found
HERE.
Texas Health & Safety Code
§481.067
"Records" provides: "(a) A person who is registered to
manufacture, distribute, analyze, or dispense a controlled
substance shall keep records and maintain inventories in
compliance with recordkeeping and inventory requirements of
federal law and with additional rules the director adopts.
(b) The pharmacist-in-charge of
a pharmacy shall maintain the records and inventories
required by this section. (c) A record required by this
section must be made at the time of the transaction that is
the basis of the record. A record or inventory required by
this section must be kept or maintained for at least two
years after the date the record or inventory is made."
Texas
Health & Safety Code §481.071 "Medical
Purpose Required Before Prescribing, Dispensing,
Delivering, Or Administering Controlled Substance"
provides, in part, that: "(a) A practitioner
defined by Section 481.002(39)(A) may not prescribe,
dispense, deliver, or administer a controlled
substance or cause a controlled substance to be
administered under the practitioner's direction and
supervision except for a valid medical purpose and
in the course of medical practice."
Texas Health & Safety Code
§481.072
"Medical Purpose Required Before Distributing or Dispensing
Schedule V Controlled Substance" provides that: "A person
may not distribute or dispense a controlled substance listed
in Schedule V except for a valid medical purpose."
http://www.statutes.legis.state.tx.us/Docs/HS/pdf/HS.481.pdf
United States Code of Federal Regulations; 21 CFR
§1306.03 "Persons
Entitled to Issue Prescriptions" provides that: "(a)
A prescription for a controlled substance may be
issued only by an individual practitioner who is:
(1) Authorized to prescribe controlled substances by
the jurisdiction in which he is licensed to practice
his profession and (2) Either registered or exempted
from registration pursuant to 1301.22(c) and 1301.23
of this chapter. (b) A prescription issued by an
individual practitioner may be communicated to a
pharmacist by an employee or agent of the individual
practitioner. [36 FR 7799, Apr. 24, 1971, as amended
at 36 FR 18732, Sept. 21, 1971. Redesignated at 38
FR 26609, Sept. 24, 1973, as amended at 62 FR 13966,
Mar. 24, 1997]"
With regard to "Dangerous Drugs," Texas Health & Safety
Code §483.001(2) "Definitions" provides that: "In this
chapter: 'Dangerous drug' means a device or a drug that is
unsafe for self-medication and that is not included in
Schedules I through V or Penalty Groups 1 through 4 of
Chapter 481 (Texas Controlled Substances Act). The term
includes a device or a drug that bears or is required to
bear the legend: (A) 'Caution: federal law prohibits
dispensing without prescription' or 'Rx only' or another
legend that complies with federal law; or (B) 'Caution:
federal law restricts this drug to use by or on the order of
a licensed veterinarian.'"
Furthermore, with regard to "Dangerous Drugs," the Texas
Health & Safety Code provides for the following:
"Texas Health & Safety Code §483.045.
FORGING OR ALTERING PRESCRIPTION.
(a) A person commits an offense if the person: (1) forges a
prescription or increases the prescribed quantity of a
dangerous drug in a prescription; (2) issues a prescription
bearing a forged or fictitious signature; (3) obtains or
attempts to obtain a dangerous drug by using a forged,
fictitious, or altered prescription; (4) obtains or attempts
to obtain a dangerous drug by means of a fictitious or
fraudulent telephone call; or (5) possesses a dangerous drug
obtained by a forged, fictitious, or altered prescription or
by means of a fictitious or fraudulent telephone call. (b)
An offense under this section is a Class B misdemeanor
unless it is shown on the trial of the defendant that the
defendant has previously been convicted of an offense under
this chapter, in which event the offense is a Class A
misdemeanor. Acts 1989, 71st Leg., ch. 678, Sec. 1, eff.
Sept. 1, 1989."
"Texas Health & Safety Code §483.046. FAILURE TO RETAIN PRESCRIPTION.
(a) A pharmacist commits an offense if the pharmacist: (1)
delivers a dangerous drug under a prescription; and (2)
fails to retain the prescription as required by Section
483.023. (b) An offense under this section is a Class B
misdemeanor unless it is shown on the trial of the defendant
that the defendant has previously been convicted of an
offense under this chapter, in which event the offense is a
Class A misdemeanor. Acts 1989, 71st Leg., ch. 678, Sec. 1,
eff. Sept. 1, 1989."
"Texas Health & Safety Code §483.047. REFILLING PRESCRIPTION WITHOUT
AUTHORIZATION. (a)
Except as authorized by Subsection (b), a pharmacist commits
an offense if the pharmacist refills a prescription unless:
(1) the prescription contains an authorization by the
practitioner for the refilling of the prescription, and the
pharmacist refills the prescription in the manner provided
by the authorization; or (2) at the time of refilling the
prescription, the pharmacist is authorized to do so by the
practitioner who issued the prescription. (b) A pharmacist
may exercise his professional judgment in refilling a
prescription for a dangerous drug without the authorization
of the prescribing practitioner provided: (1) failure to
refill the prescription might result in an interruption of a
therapeutic regimen or create patient suffering; (2) either:
(A) a natural or manmade disaster has occurred which
prohibits the pharmacist from being able to contact the
practitioner; or (B) the pharmacist is unable to contact the
practitioner after reasonable effort; (3) the quantity of
drug dispensed does not exceed a 72-hour supply; (4) the
pharmacist informs the patient or the patient's agent at the
time of dispensing that the refill is being provided without
such authorization and that authorization of the
practitioner is required for future refills; and (5) the
pharmacist informs the practitioner of the emergency refill
at the earliest reasonable time. (c) An offense under this
section is a Class B misdemeanor unless it is shown on the
trial of the defendant that the defendant has previously
been convicted under this chapter, in which event the
offense is a Class A misdemeanor. Acts 1989, 71st Leg., ch.
678, Sec. 1, eff. Sept. 1, 1989. Amended by Acts 1993, 73rd
Leg., ch. 789, Sec. 22, eff. Sept. 1, 1993."
"Texas Health & Safety Code §483.048. UNAUTHORIZED COMMUNICATION OF
PRESCRIPTION. (a) An
agent of a practitioner commits an offense if the agent
communicates by telephone a prescription unless the agent is
designated in writing under Section 483.022 as authorized by
the practitioner to communicate prescriptions by telephone.
(b) An offense under this section is a Class B misdemeanor
unless it is shown on the trial of the defendant that the
defendant has previously been convicted of an offense under
this chapter, in which event the offense is a Class A
misdemeanor. Acts 1989, 71st Leg., ch. 678, Sec. 1, eff.
Sept. 1, 1989."
"Texas Health & Safety Code §483.022. PRACTITIONER'S DESIGNATED AGENT;
PRACTITIONER'S RESPONSIBILITIES.
(a) A practitioner shall provide in writing the name of each
designated agent as defined by Section 483.001(4)(A) and
(C), and the name of each healthcare facility which employs
persons defined by Section 483.001(4)(B). (b) The
practitioner shall maintain at the practitioner's usual
place of business a list of the designated agents or
healthcare facilities as defined by Section 483.001(4). (c)
The practitioner shall provide a pharmacist with a copy of
the practitioner's written authorization for a designated
agent as defined by Section 483.001(4) on the pharmacist's
request. (d) This section does not relieve a practitioner or
the practitioner's designated agent from the requirements of
Subchapter A, Chapter 562, Occupations Code. (e) A
practitioner remains personally responsible for the actions
of a designated agent who communicates a prescription to a
pharmacist. (f) A practitioner may designate a person who is
a licensed vocational nurse or has an education equivalent
to or greater than that required for a licensed vocational
nurse to communicate prescriptions of an advanced practice
nurse or physician assistant authorized by the practitioner
to sign prescription drug orders under Subchapter B, Chapter
157, Occupations Code. Acts 1989, 71st Leg., ch. 678, Sec.
1, eff. Sept. 1, 1989. Amended by Acts 1991, 72nd Leg., ch.
14, Sec. 201, eff. Sept. 1, 1991; Acts 1991, 72nd Leg., ch.
237, Sec. 11, eff. Sept. 1, 1991; Acts 1993, 73rd Leg., ch.
789, Sec. 19, eff. Sept. 1, 1993; Acts 1999, 76th Leg., ch.
428, Sec. 4, eff. Sept. 1, 1999; Acts 2001, 77th Leg., ch.
1420, Sec. 14.797, eff. Sept. 1, 2001."
"Texas Health & Safety Code §483.049. FAILURE TO MAINTAIN RECORDS.
(a) A person commits an offense if the person is required to
maintain a record under Section 483.023 or 483.024 and the
person fails to maintain the record in the manner required
by those sections. (b) An offense under this section is a
Class B misdemeanor unless it is shown on the trial of the
defendant that the defendant has previously been convicted
of an offense under this chapter, in which event the offense
is a Class A misdemeanor. Acts 1989, 71st Leg., ch. 678,
Sec. 1, eff. Sept. 1, 1989."
http://www.statutes.legis.state.tx.us/Docs/HS/pdf/HS.483.pdf
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Do Podiatrists conduct “History & Physicals”?
Yes, it falls within a Podiatrist's scope of practice and licensure to conduct “History and Physicals,” limited
only by the position of the hospital/surgery center/entity/facility
where privileges are granted (See Q&A #1 - Scope of
Practice). Please click on
the following to view the
"November 27, 2006 Federal Register; Section
482.22(c)(5) Condition of Participation: Medical
Staff" which provides, in part,
that a
physician (as defined in section 1861(r) of the Act), oromaxillofacial surgeon,
or other qualified
individual could complete the H&P in accordance with
State law and hospital policy. These updated federal regulations become
effective on January 26, 2007.
Furthermore, Texas Health & Safety Code §241.102
"Authorizations and Restrictions In Relation To Physicians
and Podiatrists" provides that: "(a) This chapter does not
authorize a physician or podiatrist to perform medical or
podiatric acts that are beyond the scope of the respective
license held. (b) This chapter does not prevent the
governing body of a hospital from providing that: (1) a
podiatric patient be coadmitted to the hospital by a
podiatrist and a physician; (2) a physician be responsible
for the care of any medical problem or condition of a
podiatric patient that may exist at the time of admission or
that may arise during hospitalization and that is beyond the
scope of the podiatrist's license; or (3) a physician
determine the risk and effect of a proposed podiatric
surgical procedure on the total health status of the
patient. (c) An applicant for medical staff membership may
not be denied membership solely on the ground that the
applicant is a podiatrist rather than a physician. (d) This
chapter does not automatically entitle a physician or a
podiatrist to membership or privileges on a medical staff.
(e) The governing body of a hospital may not require a
member of the medical staff to involuntarily: (1) coadmit
patients with a podiatrist; (2) be responsible for the care
of any medical problem or condition of a podiatric patient;
or (3) determine the risk and effect of any proposed
podiatric procedure on the total health status of the
patient."
Ultimately, privileging is a local matter between the
applicant and medical staff. Nevertheless, within
licensure/scope, a Podiatrist MAY perform a full H&P (i.e.
head-toe) for podiatric admission, but only if credentialed
to do so by medical staff (local control) and of course, if
prudent to do so understanding that most facilities take a
multi-disciplinary admission approach for patient safety.
This "full H&P" would include addressing "other elements in
a full H&P such as cardiac, medical and/or other non
podiatric related elements." But, the Podiatrist would have
to demonstrate his/her competency to medical staff to
perform full H&P's (i.e. head-toe).
The limitation here is that a Podiatrist could NOT
perform a full H&P for a patient NOT undergoing podiatric
medical (foot/ankle) treatment. For example, a facility
could not authorize a Podiatrist to do a full H&P on a
patient for "medical" conditions such as knee, hip, back,
heart, brain surgery, etc. Meaning, while a Podiatrist can
do a full H&P for foot/ankle surgery, that is not a waiver
for a Podiatrist to do full H&P's for non-foot/ankle
conditions.
Credentialing is a matter for
local determination and community standards.
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For regulatory and compliance purposes, what portions of the Board Statute and Rules should Podiatrists make sure they know?
Although the entire Podiatric Medical Practice Act
(Texas Occupations Code - Chapter 202), the Board
Rules (Texas Administrative Code - Title 22 / Part 18)
and related other State/Federal Laws/Rules are quite extensive, from a "complaint"
prevention perspective, it would be in a licensee’s
best interest to be aware of the following "Board
Statute & Rules Regulatory Hi-Lites."
Please click here for a PDF
document. NOTE: Formal “Disciplinary Actions” (Board Orders) are reported to the National Practitioner Databank-Healthcare Integrity Protection Databank
(NPDB-HIPDB) and on the Board's website.
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What does it mean if a Podiatrist’s license is in a “Delinquent”
or "Cancelled" status; can they still practice?
- If your license is EXPIRED ("DELINQUENT")
or CANCELLED please read the following
carefully.
- Licensees who have submitted late renewals or have
yet to submit a renewal have been placed in a
“Delinquent” status. Please call the Board
(512-305-7000) to determine if the renewal was
received and if the license is “Active.” PENALTY
FEES ACCRUE AFTER November 1st of each
year.
- Subject to certain limitations, a licensee in a “Delinquent” status is not
fully prohibited from practicing during a 30-day grace
period from November 1st - December 1st.
If any entity providing the licensee clinical
privileges wishes to restrict a licensee in a
“Delinquent” status, for liability reasons, they may
do so. Beginning on December 1st
of each year, the Board will enforce
practicing without a license penalties to include
the issuance of "Cease & Desist Notices or Orders."
There will NO longer be a one year grace period.
However, "Delinquent" license holders will have one
year to renew their license with PENALTY FEES from
November 1st before their
license is "Cancelled."
[Posted
09/09/2007 @ 5:00 pm]
- Again, a licensee can be in a “Delinquent” status
for one year from the time of the renewal period (deadline is November
1st of each year) expiration, accruing
penalty fees. [Posted
09/09/2007 @ 5:00 pm]
- All "Delinquent" licenses
are nevertheless subject to all administrative/criminal
penalties of "Practicing Without A License." Any licensee in
a "Delinquent" status shall not practice Podiatric Medicine
after December 1st;
criminal act pursuant to Texas Occupations Code §202.605.
[Posted
09/09/2007 @ 5:00 pm]
- If a person's "Delinquent" license has been
expired for one year or longer, the person may not
renew the license. For purposes of public
verification, the license is then considered to have
been "Cancelled."
[Posted 09/09/2007 @ 5:00 pm]
- Any
licensee in a "Cancelled" status shall not practice
Podiatric Medicine; criminal act pursuant to Texas
Occupations Code §202.605.
"Cancelled" licensees are required to fully re-apply for
licensure. That includes re-taking the TSBPME
jurisprudence examination and having completed a one-year
residency program accredited by CPME. [Posted 09/09/2007 @
5:00 pm]
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Do Podiatrists sign the written statement that accompanies the application for disabled person placards and license plates?
Yes. Effective September 1, 2001, the 77th Texas Legislature, 2001, Regular Session passed Senate Bill 777
(Texas Transportation Code Chapter 681) which states
that the required notarized written statement or written prescription that accompanies the
initial application for a disabled person identification placard or license plate can be
issued by a person licensed to practice podiatry in this state or a state adjacent to this
state. The application must be made by on or behalf of a person with a mobility problem
caused by a disorder of the foot. For more information, you may contact the Board or the
Texas Department of Transportation
at (512)-465-7719; (512)-465-7923.
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Can Podiatrists use the word "Ankle" in an advertisement?
Effective April 1, 2001 the restrictions on using the word "Ankle"
in advertisements were lifted, pursuant to Board
Rule §375.1(2) definition of "Foot."
Although that Rule has since been deemed to be
invalid effective July 30, 2010, the presiding Texas
3rd Court of Appeals May 23, 2008 Opinion does not
prohibit "Ankle" treatments.
However, any such advertisements or trade names must
be approved (Board Rule Chapter 373) by the Board. Any advertisements or trade names NOT approved by the Board are subject to
investigation and administrative penalties.
The Board approves practice/trade names from the
standpoint that the name remains within the
advertising scope of practice for podiatry. The
final registration and utilization of any Board
(scope) approved name rests upon the civil
jurisdiction of the local County Clerk's office or
the Texas Secretary of State.
Additionally, with regard to "Advertising" in
general and proper identification of a licensee's
practice as being one of "Podiatry," each podiatric
physician shall publish his/her own name and
professionally identify himself/herself (i.e. DPM,
Podiatrist, Etc.).
The purpose
of the Board's "Advertising" rules and of so
limiting the professional designations of a
podiatric physician and his/her practice's business
is to ensure that the public and all prospective
patients are reasonably informed of the distinction
between podiatric physicians and other medical
practitioners as is reflected by the difference in
training and licensing, and the scope of practice.
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Where can I find information regarding the Diabetic Shoe Bill?
You may visit the following CMS website which explains
coverage and legal requirements:
http://www.cms.hhs.gov/DiabetesSelfManagement/02_ProvResources.asp
November 2010 CMS - Therapeutic Shoe Policy Changes
Physician Letter
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I'm "Retiring"! What do I need to do in order to properly close my practice?
Ultimately, the expectation is that the decisions to
be made during a practice departure will be of best
benefit to the patients involved and their
continuity of care; no matter who is treating them
and where ... in the delivery of health care
services. These guidelines are also responsive to
other practice departure scenarios other than
retirement, such as leaving a group practice or
termination of a professional business relationship.
Board Rule §375.3(b) states: “A licensed podiatric physician shall conduct his practice on the
highest plane of honesty, integrity, and fair dealing and shall not
mislead his patients as to the gravity of such patient's podiatric
medical needs. A podiatric physician shall not abandon a patient he has
undertaken to treat. He may discontinue treatment after reasonable
notice has been given to the patient by the podiatric physician of his
intention to discontinue treatment and the patient has had a reasonable
time to secure the services of another podiatric physician or all
podiatric medical services actually begun have been completed and there
is no contract or agreement to provide further treatment.”
The Board does NOT intervene in
civil/business/contractual/employment disputes; those
are (peer-to-peer) civil or labor matters outside the
Board's jurisdiction. Furthermore, doctors have taken an
oath to heal and ultimately want successful patient
encounters for patient well-being and the continuance of
such relationships for the sake of the continuity of
care. Patients want to be trusted and doctors want the
trust of their patients together with following proper
treatment plans. Patients may always discuss their
concerns directly with their doctor verbally or in
writing to seek a doctor-patient resolution; for overall
best outcomes. These personal-professional and civil
remedies are available for reasonable people to resolve
reasonable disputes without government intervention.
Medical Records. Be advised, common
complaints received by the Board include the release of
Medical Records (inability to obtain) or fees charged for
the same. Be advised, Board Rule §375.21 relate to
"Records;" the following is noted. The records of the
identity, diagnosis, evaluation, or treatment of a patient
by a podiatric physician that are created or maintained by a
podiatric physician are the property of the podiatric
physician. A podiatric physician shall furnish copies of
medical records or a summary or narrative of the medical
records pursuant to a written request. The podiatric
physician providing copies of requested medical records or a
summary or a narrative of such medical records shall be
entitled to payment of a reasonable fee prior to release of
the information unless the information is requested by a
health care provider licensed in Texas or licensed by any
state, territory, or insular possession of the United States
or any State or Province of Canada if requested for purposes
of emergency or acute medical care. Complaints which involve
the inability to obtain medical records must evidence proof
that a proper written request and payment was made in
accordance with these rules. Verbal requests by patients to
obtain records and refusal to pay do not meet proper release
standards; such complaints will not be pursued.
Regarding the actual cessation/leaving of
one's practice, please be advised of the following General
Considerations. This also applies to scenarios involving any
discontinuance of practice, retirement and termination of
employment.
a)
Although the Podiatric Medical Practice Act of Texas and the Board’s Rules do not
contain specific language addressing the closing/transferring of one’s
practice, the Podiatrist should have an attorney draw up the contract for
the practice transfer. He/she should be sure to include, in the contract,
specific, common sense language to ensure that his/her current patients
are provided with an opportunity for continuity of care.
b)
Board Rule §375.21(a) "Records" provides that: “All podiatric physicians shall make, maintain, and keep
accurate records of the diagnosis made and the treatment performed for
and upon each of his or her patients for reference and for protection of
the patient for at least five years following the completion of
treatment.”
c)
Normally, when closing a practice, the Podiatrist advises his/her patients of the closure by
sending them a postcard. That postcard would advise the patient: 1) of
the closure; 2) where their medical records will be maintained, where
the patients can access them & by what deadline and 3) where the patient can secure
continuity of Podiatric care by contacting the appropriate healthcare
practitioner/Podiatrist. Each patient should at least receive a letter
or post card. A postcard may be the least expensive form of written
notification. The Podiatrist can contact a local publisher for any bulk
productions.
d) However, if the items in "C" are not
feasible, visible signage in and around the closing practice
is standard, to alert active patients of the change. A voice
message on the office answering machine/service giving
information on the office status, who will be taking over
the practice, and information on patient records, etc. is
also recommended.
e)
Newspaper/radio/television/internet-website/etc. advertising would be optional and
covered by the “reasonableness” of the time selected for the
advertisement to run. A time period of “one week” would be considered
reasonable for a small municipality. A time period
of several days a week, for several weeks to a month
should be considered for larger/major
municipalities.
However, given the circumstances,
if this is not feasible, then "D" suffices.
f) Podiatrists MUST also notify the
Board of any change of address via signed letter (Facsimile:
512-305-7003, ATTN: "Change of Address") or via our website
at:
http://www.foot.state.tx.us/agencydocuments/TSBPME-AddressChangeForm.pdf.
g) Board Rule
§375.27 "Report Change of Practice Address and/or Phone
Number to the Board" provides that: "It shall
be the responsibility of each licensee to ensure that any
change of address or phone number(s) for each licensees
location(s) are reported in writing, via e-mail, facsimile
or mail to the Board no later than 10 business days after
the change is made. Failure to give written notification to
the Board of these changes writing the required 10 business
days shall result in an automatic administrative penalty of
$10, for each business day that the information is not
reported to the Board. The maximum penalty shall not exceed
$300."
In a group departure scenario (where practitioner(s)
leave but other(s) stay), experience with such practice
departure scenarios yields that once the departure occurs,
patients are initially surprised at the change and then
there is either communication or miscommunication amongst
the practitioners involved as to what occurred and
why...to/with patients. This is unfortunate and patients
then can find themselves caught in the middle of a
business/contractual dispute. This should be avoided by
degreed professionals for the sake of their patients'
health, well-being and safety. "Patient Abandonment" does
not occur when the remaining/existing practice retains
custody of patients/charts and assumes continuity of care.
With notification to the Board of a
CHANGE OF ADDRESS for the departing practitioners and
the related upload (as a resource) of new practice
information to the Board's website
(i.e.
"Physician Profile"), patients can then at least be
directed to the departing practitioners new location or have
access to their new contact information to obtain a copy of
their medical records (upon proper written request).
Following the aforementioned guidelines would serve the
most prudent approach for a practice departure scenario to
satisfy all parties involved.
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I am a prospective patient, what can I do to research the background of a podiatrist or healthcare provider?
As a patient, you are also responsible for the quality of your healthcare
(to include following pre-/post-operative
instructions and/or the doctor's plan of care). One way of ensuring you receive medical care commensurate
to your needs is to research your doctor or healthcare provider. There are several ways of doing this:
You may verify basic Podiatry licensure information at:
http://www.foot.state.tx.us/verification.online.htm.
You may verify and print Podiatry Board Actions in the form of Agreed/Board Orders at:
http://www.foot.state.tx.us/verification.disciplinary.htm.
You may conduct a Public Criminal History Search via the Texas Department of Public Safety at:
https://records.txdps.state.tx.us/DPS_WEB/Portal/index.aspx
You may review your doctor's Physician Profile at:
http://www.texasonline.state.tx.us/NASApp/txops/ProfilingSearchManager?AGENCY=tsbpme.
This is a "Texas Online.com" service.
You may obtain Federal Healthcare Exclusion information via the United States Department of Health and Human Services - Office of Inspector General at:
http://exclusions.oig.hhs.gov.
You may obtain Texas Medicaid Exclusion information via the Texas Health and Human Services Commission - Office of Inspector General at:
http://www.hhsc.state.tx.us/ or
https://oig.hhsc.state.tx.us/Exclusions/Search.aspx. You may obtain Federal Student Loan Default information at: http://www.defaulteddocs.dhhs.gov/.
You may visit your or your doctor's County Clerk's Office to Obtain Civil and/or Malpractice Litigation information. For most counties,
you will have to physically appear at the Clerk's Office to conduct a query. Some larger counties have that same information available on-line.
To determine if your county has an on-line service, you may click on the following link to obtain a list of county websites:
http://www.texas.gov/en/discover/Pages/topic.aspx?topicid=%2Fgovernment%2Fcounties.
This is a "Texas Online.com" service.
You may view a list of State Agencies, who may also have jurisdiction over your doctor at:
http://www.texas.gov/en/Discover/Pages/agency-finder.aspx. This is a "Texas Online.com" service.
You may contact your Insurance Carrier to determine if they have any information on your doctor responsive to your request.
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For Medicare beneficiaries, you can search
"Facilities & Doctors" (& much more) and can
also conduct "Drug/Health Plan/Hospital/Facility
- Comparisons" at:
http://www.medicare.gov/default.aspx.
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I am a Podiatrist who would like to include Hyperbaric Oxygen (HBO) therapy as part of my Wound Care treatments. What are the requirements, scope and regulations for me to perform HBO? What else should I know?
Hyperbaric Oxygen therapy involves placing (diving) a patient in a chamber filled with 100% oxygen, the atmospheric pressure of which has
been increased. Be advised of the following concerning the scope of practice for Podiatric Medicine in the State of Texas regarding Hyperbaric
Oxygen Therapy:
Section 202.001(4) of Texas Occupations Code (Statute) states: "Podiatry" means the treatment of or offer to treat any disease, disorder,
physical injury, deformity, or ailment of the human foot by any system or method. The term includes podiatric medicine. Section 375.5 of the Texas Administrative Code, Title 22, Part 18, (Rules) states: A Podiatric physician shall be recognized and permitted to
supervise and administer hyperbaric oxygen following the published recommendations of the Undersea and Hyperbaric Medical Society, Inc. (UHMS)
and within the credentials and bylaws of the hospital that operates the hyperbaric unit with the following stipulations:
A podiatric physician practicing hyperbaric oxygen must do so in a hospital setting. The Podiatric physician must, in addition, show evidence of attendance and successful completion of a course of hyperbaric training that is
recognized by the Undersea and Hyperbaric Medical Society. That person may only utilize hyperbaric oxygen in the treatment of the foot as
recognized by the Podiatric Medical Act, Texas Civil Statutes, Article 4567, et seq. A person shall be regarded as practicing podiatric
medicine within the meaning of this law and shall be deemed and construed to be a podiatric physician, who shall treat or offer to treat any
disease or disorder, physical injury, or deformity, or ailment of the human foot by any system or method Prior to administering hyperbaric oxygen, a podiatric physician must have on file with the Texas State Board of Podiatric Medical Examiners
documentation certifying compliance with the above requirements. [Note: CPR
Requirements. Pursuant to Board Rule §378.1(e),
proof of current C.P.R. training (basic or A.C.L.S.) must be
hands-on; NO on-line CPR will be accepted.] A copy of the published recommendations of the Undersea and Hyperbaric Medical Society, Inc., are available from the Texas State Board of
Podiatric Medical Examiners, P.O. Box 12216; Austin, Texas 78711-2216.
The utilization of HBO by a Podiatrist, pursuant to the aforementioned
requisite Board certification, is an approved modality pursuant to Board Rule
Chapter 375 and Attorney General Opinion DM-423 (11/06/1996). As long as the Podiatrist is performing dives on the "foot/ankle," he/she
is authorized to utilize HBO.
Due to the nature of HBO complications, it is required that the HBO facility be in a "hospital setting" to allow for other health professionals
to be present in the event of a patient emergency. Location of the HBO facility within a "hospital campus" suffices the requirement that a "podiatric
physician practicing HBO must do so in a hospital setting." Furthermore, in a large hospital (campus) setting, it is understood that the
Podiatrist my have to leave the HBO facility to attend to matters at the main hospital
building. Leaving the HBO facility would be allowable as long as appropriately trained staff could attend to the patient
in a dive and that the Podiatrist be available when needed. Otherwise, the expectation is that the HBO facility be appropriately staffed at all times
for the patient's well-being and the Podiatrist is responsible for his/her patients (at all times).
In the past, it has been asked whether or not a Podiatrist can perform dives on conditions (hips, backs, torsos, etc.)
beyond the scope of
Podiatric Medicine. In response, the answer is "NO," unless he/she acting under the delegation or orders of a Medical Doctor or Doctor of Osteopathic
Medicine (MD/DO) pursuant to Texas Occupations Code Section 157.001. Even if a Podiatrist is acting under the delegation/order of a MD/DO for
non-scope treatments, a MD/DO needs to be on-site at the HBO facility in the event there is a complication of the non-podiatric wound and that the
Podiatrist's medical records need to be sure to document their (co-)management of the patient with him/her and co-signatures. There is nothing
in the law that precludes a Podiatrist from working together with Doctors of Medicine for the common goal of patient welfare; wound care can be
well managed together, by both professionals. However, it is imperative that the patient medical records accurately record the totality of the
provision of HBO therapy and by whom.
Medical Staff at hospitals can enact their own restrictions/controls (by-laws) with respect to HBO treatments by a Podiatrist but they can NOT
expand the scope set forth by the Board's laws/rules. Meaning, Medical Staff cannot authorize a Podiatrist to perform non-podiatric HBO treatments
in the absence of a MD/DO delegation/order. For podiatric HBO treatments, the Podiatrist would be well within the scope to perform such treatments,
upon Board certification/registration pursuant to Chapter 375. For those "medical" treatments delegated by an MD/DO to the Podiatrist, be advised of
the potential liability involved to the Podiatrist if the MD's/DO's do not adequately delegate/order, co-sign, co-manage and co-document their
care. Again, proper medical record keeping is imperative or the Podiatrist will be subject to Board disciplinary action.
Lastly, pursuant to Medicare rules, another physician also trained in HBO must be readily available in case there is a problem in the chamber
that is outside the scope of podiatric care. From Trailblazer LCD on Hyperbaric Oxygen therapy: "Limited license physicians performing Hyperbaric
Medicine services must have an unlimited license physician who is also credentialed in Hyperbaric Medicine by the hospital entity readily available
to render assistance if needed." Furthermore, per Trailblazer, the chamber must
be a "full-body" chamber and not just an "oxygen tent" set-up.
The health and safety of patients shall be the first consideration of the Podiatric Physician.
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I am a Podiatrist who is the subject of a complaint investigation filed by one of my patients. Is it o.k. for me to contact the patient to discuss his/her complaint while the Board investigates the matter?
No. It is recommended that you do not contact the patient during an on-going investigation. If you contact the patient (complainant) a situation may be created where the complainant feels they are being harassed or intimidated by you (doctor/licensee); they may fear retaliation. Unnecessary contact only confounds & complicates the investigation for both parties. Once a case has been initiated by the Board, it is expected that the doctor/licensee cease all communications that are the subject of the complaint, with the complainant, unless necessary for the continuity of the patient's (complainant's) medical care or directed otherwise by your legal counsel.
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I am a Podiatrist who is having problems with an (private) Insurance Company. I have been denied payment, my payments are not timely and I am having other business problems with the carrier which is having a negative impact on my practice. Who can assist me in filing a complaint to resolve these matters?
The Texas State Board of Podiatric Medical Examiners has NO authority to proceed against an insurance company. However, you can file a complaint with the Texas Department of Insurance; click on the following link for more information:
http://www.tdi.state.tx.us/hprovider/index.html.
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Can a Podiatrist order and/or supervise the administering of anesthesia by a CRNA (Certified Registered Nurse Anesthetist)?
The administration of anesthesia by a CRNA is under the regulation of the
Texas
Board of Nursing (TBON) and the Texas Medical Board (TMB). We recommend that
requestors contact the TBON & TMB for further information. Podiatrists do
request the provision of anesthesia services from the appropriate provider in
consideration of the safety and well being of a patient.
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I am a patient who has been the victim of a sexual impropriety/act/crime and
boundary violation by a physician. Where can I find assistance and information
with victims rights beyond solely filing a complaint with the Board or Law
Enforcement?
The Texas State Board of Podiatric Medical Examiners in
conjunction with Law Enforcement authorities investigates any allegations of
sexual misconduct/crimes committed by a podiatric physician. While the Board
focuses on the investigation, patients/victims can seek advocacy
assistance/services or learn more information by contacting the following.
Rehabilitation, continuing education (CME) and awareness information/services are also available for
physicians through "Professional Boundaries Incorporated."
In any instance involving victimization, "No Means NO!"
CONTACTS FOR
PATIENTS/VICTIMS:
CONTACTS FOR PHYSICIANS (ONLY):
GENERAL CONTACTS / INFORMATION:
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As a patient or podiatric physician, where can I find information related to "Informed Consent Forms"?
The Texas Medical Disclosure Panel publishes rules and forms related to "Informed Consent" under Title 25; Part 7; Chapter 601 of the Texas Administrative Code. Please click on the link for more information.
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I suspect Child Abuse/Neglect/sexual exploitation. I also suspect Elder Abuse/Neglect. What do I do?
Whether or not you are a Podiatric Physician, under Texas Family Code Chapter
261, ANYONE having cause to believe that a child's physical or mental health or
welfare has been or may be adversely affected by abuse or neglect MUST REPORT
the case IMMEDIATELY to a state or local law enforcement agency or the Texas
Department of Family and Protective Services
(TDFPS).
Click here for a "General Guide" published by the Texas Office of
the Attorney General. Also, TDFPS has a toll-free, 24-hour Family Violence
Hotline: 1-800-252-5400 to report Child/Elder Abuse/Neglect. Click on the
following link to read more about Elder Abuse/Neglect:
"Elder Abuse is
Everyone's Business"
In addition, Texas Penal Code §38.17 "Failure to Stop or Report Aggravated Sexual
Assault of Child" and Texas Penal Code §38.171 "Failure to Report Felony"
provides criminal penalties for other failures to act.
Furthermore, with regards to
Sexual
Exploitation of Children, any person may contact the
National Center for
Missing and Exploited Children and report concerns as well to
The Cyber TipLine.
These public efforts are coordinated with the appropriate law enforcement
agencies.
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What are the Medicare regulations relating to Podiatrist orders and debridement of mycotic/dystrophic nail tissue in a nursing home setting? What about "Healthcare Fraud" prevention and creating a
"Compliance Program" to prevent the same?
[Medicare is a federal health insurance program established by Congress in 1965
to provide health care insurance for seniors and people with disabilities (added
in 1972). The Medicare program has two components, Part A and Part B.
Part A provides coverage for services from institutional providers such
as hospitals and skilled nursing facilities. Part B provides
coverage for services from physicians, non-physician practitioners, laboratories
and suppliers.]
For reference, requestors can visit Trailblazer Health Enterprises, LLC directly at
http://www.trailblazerhealth.com for further information. TrailBlazer Health Enterprises, LLC is an independent licensee of the Blue Cross and Blue Shield Association and administers the Medicare program under contracting arrangements with the Centers for Medicare & Medicaid Services (CMS). On their website, one can access “Local Coverage Determinations” (LCD) under the “Policies” link for “Part B & J4” policies. “Routine Foot Care and Debridement of Mycotic Nail” provisions can be found under “R.” The following is provided:
- ... Documentation of foot-care services to residents of nursing homes not performed solely at the request of the patient or patient’s family/conservator must include a current nursing facility order (dated and signed with date of signature) for routine foot care service issued by the patient’s supervising physician that describes the specific service necessary. Such orders must meet the following requirements:
- The order must be dated and must have been issued by the supervising physician prior to foot-care services being rendered.
- Telephone or verbal orders not written personally by the supervising physician must be authenticated by the dated physician’s signature within a reasonable period of time following issuance of the order.
- The order must be consistent with the attending physician’s overall plan of care.
- The order must be for medically necessary services to address a specific patient complaint or physical finding.
- Routinely issued or “standing” facility orders for routine foot-care services and orders for non-specific foot-care services that do not meet the above requirements are insufficient.
- Documentation of foot-care services to residents of nursing homes performed solely at the request of the patient or patient’s family/conservator should name the person who requested the services and should identify the requesting person’s relationship to the patient ...
Medical necessity withstanding, when any orders are written (hospital or nursing home), those orders are addressed to a "specific" physician (i.e. by name). Therefore, the order cannot state “…Podiatrist to ... do something….” The order must also specify what the ordering physician expects the latter physician to treat or do.
The aforementioned Medicare LCD provisions from Trailblazer Health Enterprises, LLC can be found
HERE. For further inquiries, requestors will need to contact Trailblazer Health Enterprises, LLC or requestors may also contact the Texas Podiatric Medical Association (TPMA) at 512-494-1123 and ask for their “Medicare Liaison.” Nevertheless, since these are federal provisions and due to
high exposure for “Healthcare Fraud” in the event Local Coverage Determinations are not met as stipulated, it is recommended that Trailblazer Health Enterprises, LLC be contacted for further education/information.
With regard to "Healthcare Fraud" prevention and creating a "Compliance
Program" to prevent the same, it is recommended that licensees review and follow
the
"OIG Compliance Program for Individual and Small Group Physician Practices"
(PDF). This is a product of the United States
Department of Health and Human Services - Office of Inspector General: "This
Federal Register notice sets forth the recently issued Compliance Program for
Individual and Small Group Physician Practices developed by the Office of
Inspector General (OIG). The OIG has previously developed and published
voluntary compliance program guidance focused on several other areas and aspects
of the health care industry. We believe that the development and issuance of
this voluntary compliance program guidance for individual and small group
physician practices will will serve as a positive step towards assisting
providers in preventing the submission of erroneous claims or engaging in
UNLAWFUL CONDUCT involving the Federal health care programs."
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I am a patient with a billing problem. I had seen my doctor who is an out of network provider for my insurance plan. I am now stuck with a large bill for "usual and customary" rates that are not covered and I can't afford this. What can be done?
First, the Texas State Board of Podiatric Medical Examiners has NO authority
to proceed against an insurance company. However, you can
file a complaint with the Texas Department of Insurance.
The following is from the Office of the New York State Attorney General: "...In February 2008, the Attorney General announced an industry-wide investigation into allegations that health insurers unfairly saddle consumers with too much of the cost of out-of-network health care. Seventy percent of insured working Americans pay higher premiums for insurance plans that allow them to use out-of-network doctors. In exchange, insurers often promise to cover up to eighty percent of the 'usual and customary' rate of the out-of-network expenses, and consumers are responsible for paying the balance of the bill..." Please
CLICK HERE to view the related State of New York press release.
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Can a Podiatrist advertise and promote an off-label non-FDA approved use of lasers (& other drugs/devices) for toenail fungus treatment?
With regard to laser devices, all lasers are regulated by the Texas Department of State Health Services - Radiation Control Program (DSHS). We suggest that they be contacted with regard to registration, use and safety standards for such a device. http://www.dshs.state.tx.us/radiation/laser.shtm
Podiatrists in Texas can treat the "foot/ankle" by "any system or method" and this COULD include the use of laser devices so long as it is properly registered with DSHS, used safely & for its intended purpose and not prohibited by any other regulatory agency. The possibility exists that some “Laser” treatments may be the practice of "Medicine" (the field regulated by the Texas Medical Board), such as when it comes to laser treatments and possibly cosmetic surgery, depending on what actually will be occurring. There is also a Texas Spa Act (Texas Occupations Code Chapter 702) that could have an applicability of jurisdiction. Therefore, the use of “Lasers” are subject not only to Podiatry Regulations, but also to those of the Texas Cosmetology Commission
(i.e. the Texas Department of Licensing & Regulation), the Texas Department of State Health Services, the Texas Medical Board, the Texas Spa Act and the U.S. Food & Drug Administration (FDA).
With regard to podiatrists advertising and promoting an off-label use of lasers for toenail fungus treatment, the U.S. Food & Drug Administration has regulations (http://www.fda.gov/cdrh/devadvice/3315.html) that govern misbranding, mislabeling and false advertising by manufacturers. Medical providers are restricted from advertising or promoting an off-label indication to attract patients for an off-label procedure; such promotion and inducement of an off-label therapy is misleading/deceptive. Patients should be notified by the Podiatrist of any off-label use of (drugs &) devices and informed consent should be obtained for the safety of the patient.
Board Rule §373.13 “Advertising” provides, in part, that: “(a) A podiatric physician may advertise. A podiatric physician shall not, however, use or participate in the use of any publication, including advertisements, news stories, press releases, and periodical articles, that contains a false, fraudulent, misleading, deceptive, scientifically unsupported or generally unaccepted, or unfair statement or claim, or that are exaggerations or are untrue. (b) A false, fraudulent, misleading, deceptive, scientifically unsupported or generally unaccepted, or unfair statement or claim includes but is not limited to, a statement or claim that: (1) contains a misrepresentation of fact, or claims as fact something that has not been generally accepted among the podiatric community or by the Board as having been proven or
established as fact; (2) is likely to mislead or deceive or entice or persuade a reasonable person because it fails to make full disclosure of relevant facts whether regarding fees, modes of treatment, conditions or techniques of surgery, post-operative conditions such as degree of pain, length of time of recovery, mobility and strength during recovery, and the like; (3) is intended or likely to create in an ordinary reasonable person false or unjustified expectations of favorable results; (4) states or implies educational or professional attainments or licensing recognition not supported in fact; (5) states or implies that the podiatric physician has received formal recognition as a specialist, or has any specialized expertise if this is not the case; (6) contains any laudatory statement, or other statement or implication
that the podiatric physician's services are of exceptional quality; (7) contains statistical data or information that reflects or is intended to reflect quality or degree of success of past performance, or prediction of future success; (8) represents that podiatric services can or will be completely performed for a stated fee amount when this is not the case, or makes representations with respect to fees that do not disclose all variables affecting the fees, or makes representations that might reasonable cause an ordinary prudent person to misunderstand or be deceived about the fee amount; (9) contains a testimonial; (10) represents that health care insurance deductibles or co-payments may be waived or are not applicable to health care services to be provided if the deductibles or co-payments are required; (11) represents that
the benefits of a health benefit plan will be accepted as full payment when deductibles or co-payments are required. (f) If a publication by or for a podiatric physician includes mention of a particular surgical technique or device, such as laser surgery, minimal incision surgery, laser bunion surgery or similar particular techniques or devices, the publication must also include a specific and true statement that reveals to an ordinary reasonable person the limits and scope and specific purpose of the technique so as not to mislead an ordinary reasonable person regarding the difficulty, pain or discomfort, length of time for surgery or recuperation, or possibility of complications.”
Board Rule §373.15 “Violations” provides that: “(a) Any person who violates this chapter et seq., or a determination of the Board hereunder is subject to a administrative penalty of up to $500 for each day of violation. (b) In addition, failure of a podiatric physician licensed by the Board to identify his practice consistent with this chapter is subject to the penalties provided by Chapter 376 of this title (relating to Violations and Penalties). (c) At the request of the board, the attorney general shall institute and conduct the action in the name of the state.”
Board Rule §375.19 "Fees and Informed Consent" provides that: "The podiatric physician has special knowledge which his patient does not have; therefore, to avoid misunderstanding he should advise his patient in advance of beginning treatment of the nature and extent of the treatment needed; the approximate time required to perform the recommended treatment and services; and any further or additional services or return by the patient for treatment, adjustments, or consultation and the time in which this shall occur. A podiatric physician should inform his patients as to the fees to be charged for services before the services are performed, regardless of whether the fees are charged on a case basis, on the basis of a separate charge for each service, or a combination of these two methods, or some other basis. If an exact fee
for a particular service, as in extended care cases, cannot be quoted to a patient, a fair and reasonable estimate of what the fee will be and the basis on which it will be determined should be given the patient. (b) A podiatric physician shall not tender or receive a commission for a referral."
Engaging in grossly unprofessional or dishonorable conduct of a character that in the Board's opinion is likely to deceive or defraud the public and using any advertising statement of a character tending to mislead or deceive the public is prohibited in accordance with Texas Occupations Code §202.253(a)(4)(6).
The American Podiatric Medical Association (APMA) provides the following:
“Refresher on "Off-Label" Use of Marketed Drugs and Medical Devices Sound medical practice and the best interests of the patient require that podiatrists use legally available drugs and devices according to their best knowledge and judgment. However, podiatrists may routinely utilize a Food and Drug Administration (FDA)-approved drug or medical device to treat a condition or perform a surgical procedure for which the product has not yet been approved. Podiatrists may receive information about the success of such off-label use from colleagues, seminars, medical literature, and, in some cases, from the manufacturer itself. In these cases, the podiatrist has the responsibility to be well-informed about the product; to base its use on firm, scientific rationale and on sound medical evidence; and to maintain records of the product's
use and effects. When using a drug or device for an off-label use, DPMs should inform the patient of this use, advise the patient of possible complications, and document this conversation in the patient's medical record.
While off-label use of a prescription drug or device by medical practitioners can contribute to a manufacturer's success, FDA regulations allow manufacturers to promote only approved indications for drugs and devices. FDA permits a manufacturer to disseminate only educational, "non-promotional" materials about non-approved indications or uses, such as peer-reviewed medical journal articles and reports of clinical studies. FDA also requires that if a manufacturer wants to disseminate information about the new use, it must have a pending application to FDA for approval of the new use, provide the FDA-approved labeling for the current indications, or use and make it clear that the off-label use of the product described in materials is not yet FDA-approved. Similarly, podiatrists cannot promote or advertise the off-label use of a drug
or device. The podiatrist can, however, advise a patient seeking treatment of the off-label medication or device when the patient presents with a condition for which the podiatrist determines that the off-label medication or device is in the patient's best interest.
If you have questions about the appropriateness of devices used in your practice, visit www.fda.gov for more information."
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- With regard to Advanced
Practice Nurses (APN; which include Nurse
Practitioners) & Physician Assistants (PA), the
answer is "NO," a Texas Podiatrist (DPM)
can NOT employ an APN nor PA.
Advanced Practice Nurses and Physician
Assistants can only work under the delegation of
a Medical Doctor (MD) or Doctor of Osteopathic
Medicine (DO) (i.e. "Physicians")
licensed by the Texas Medical Board. This is due
to State Law: Texas Occupations Code Chapter 157
(Subchapter B. Delegation To Advanced Practice
Nurses and Physician Assistants; §157.051.
Definitions; et. al.) found within the Medical
Practices Act; Texas Occupations Code Chapter
100's relating to the practice of "Medicine"
(MD/DO) & the Texas Medical Board. In the
Medical Practices Act, there are statutory
provisions that establish relationships between
MD's/DO's and APN's/PA's. The virtue of APN/PA
practice is the contingency of their activities
under the delegation/licensure of a MD/DO.
However, in the Podiatric Medical Practice Act
of Texas (i.e. Texas Occupations Code Chapter
202; Texas State Board of Podiatric Medical
Examiners), there are NO statutory
references/provisions establishing relationships
amongst DPM's and APN's/PA's. Again, there is NO
provision in the Podiatric Medical Practice Act
of Texas (Texas Occupations Code Chapter 202)
that allows a Texas Podiatrist to
employ/supervise an APN/PA or to delegate
podiatric/medical treatments to an APN/PA
(Physician Extenders).
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24. Can a
Podiatrist be a "Medical Director" of a clinic?
-
Although the Board does not have any
law/rule/regulation prohibiting a podiatrist
from acting as a "Medical Director" for a
facility, the podiatrist MUST still only act
within the foot/ankle scope of practice for
podiatry/podiatric medicine. A podiatrist's
position as a "Medical Director" can NOT
supersede the scope of practice limitations for
podiatry/podiatric medicine. In other words, the
position of "Medical Director" is NOT a license
for a podiatrist to practice "Medicine" (the
field for Medical Doctors and Doctors of
Osteopathic Medicine licensed by the Texas
Medical Board) in the State of Texas. A
podiatrist can only practice podiatry/podiatric
medicine.
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Consideration of facility bylaws should also
be given regarding a "Podiatrist Medical
Directorship." Such a possibility would appear
to be further defined by bylaws of the facility.
For example, in a "Wound Care" facility
scenario, while one could argue that a
podiatrist could act as a "Medical Director" due
to the fact that any "doctor" at the facility
would be their own practitioner with their own
license/scope, a problem could arise if a (wound
care) facility is staffed with non-doctors
(nurses for example). In such a scenario, a
nurse would have to obtain orders for all (body)
wounds. If orders for (body) wounds beyond the
foot/ankle were made by a podiatrist, then that
would be outside the scope of practice for
podiatry/podiatric medicine. Again, the practice
of podiatry/podiatric medicine is limited to
treatment of the foot/ankle.
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Top
- 25. Can a
Podiatrist be a "Surgical Assistant" for
non-podiatry procedures?
-
First and foremost, a podiatrist is licensed
to practice podiatry/podiatric medicine and the
first consideration of the podiatric physician
is the health and safety of patients. For
surgical assisting in non-podiatry procedures, a
DPM license is NOT a "Surgical Assistant"
license.
-
"Surgical Assistants" are licensed by the
Texas Medical Board (Texas Occupations Code
Chapter 206 and related Texas Medical Board
rules.) "Physicians" (i.e. MD/DO;
licensed by the Texas Medical Board) have the
statutory authority to delegate certain medical
acts (Texas Occupations Code
§157.001 "General Authority
of Physician to Delegate") to other
persons but that is the business of the Texas
Medical Board.
- If called upon and delegated by a
"Physician" (i.e. MD/DO), subject also to
hospital credentialing, a podiatrist could
assist in non-podiatry procedures while under
the direct supervision/order of the "Physician"
but only if not in violation of any other law
(business of the Texas Medical Board).
Individuals would also need to consider their
malpractice coverage
allowances/limitations/risks. Nevertheless,
should a podiatrist assist in any (MD/DO
authorized/delegated) non-podiatry procedure,
he/she is considered to be a "technical
assistant." Podiatrists in such a scenario
cannot be considered a primary
"Physician/Surgeon" nor can they be considered a
secondary "Physician/Assistant Surgeon." In the
event the secondary surgeon/assistant surgeon
has to assume the responsibilities of the
primary, it is not within a podiatrist's
scope/licensure to take over as the podiatrist
would be a "technical assistant." Billing for
the podiatrist's "technical assistant" role
would also need to follow accordingly.
-
Again, Texas Occupations Code Chapter 206
sets forth license requirements for "Surgical
Assistants" and makes the field of "Surgical
Assistant" licensure/practice the business of
the Texas Medical Board. The term "Physician"
means a Medical Doctor (MD) or Doctor of
Osteopathic Medicine (DO) licensed by the Texas
Medical Board.
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