NY State Senate Bill 2013-S1908

Senate Bill S1908

2013-2014 Legislative Session

Expands the definition of podiatry to include conditions of the ankle and all soft tissue structures of the leg below the knee affecting the foot and ankle; repealer

download bill text pdf

Archive: Last Bill Status - Stricken

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 23, 2013	recommit, enacting clause stricken
Jan 09, 2013	referred to higher education

2013-S1908 (ACTIVE) - Details

Law Section:: Education Law
Laws Affected:: Amd §7001, rpld §§7009 & 7010, Ed L; amd §230-d, rpld & add §2995-d sub 4-a, Pub Health L; amd §3101, CPLR
Versions Introduced in Other Legislative Sessions:: 2009-2010: S2992
2011-2012: S583, S3758

2013-S1908 (ACTIVE) - Summary

Expands the definition of the practice of podiatry to include conditions of the ankle and all soft tissue structures of the leg below the knee anatomically affecting the foot and ankle; establishes podiatrists licensed prior to the effective date of this act need to be certified to operate on the ankle; provides for the conducting of office based surgery by podiatrists; directs the department of health to study the feasibility of a podiatrist profiling program

2013-S1908 (ACTIVE) - Sponsor Memo

                                BILL NUMBER:S1908

TITLE  OF BILL:  An act to amend the education law and the public health
law, in relation to the practice of podiatry; to  repeal  sections  7009
and  7010  of the education law relating to ankle surgery; and to repeal
subdivision 4-a of section 2995-d of the public health law, relating  to
a healthcare practitioners database

PURPOSE  OR  GENERAL IDEA OF BILL: The purpose of this bill is to expand
the scope of the practice of podiatry in New York State.  Expanding  the
scope  of podiatric practice in New York will bring it more in line with
the vast majority of other States in the country which already allow the
scope of practice to include the treatment of the ankle and soft  tissue
areas associated with the ankle, in addition to structures of the foot.

SUMMARY  OF  PROVISIONS: Section 1: Amends Education Law section 7001 to
expand the scope of practice for podiatry to include, in addition to the
treatment of the foot, conditions of the  ankle,  and  all  soft  tissue
structures  related  to  the  ankle that go up the leg to just below the
knee cap. To limit the scope of practice, Podiatrists may perform surgi-
cal treatments of the rear foot and ankle, but such  treatment  may  not
extend beyond the calf of the leg, unless it is related to the treatment
of the ankle.

The bill revises Education Law section 7001(2) to update the law.  First
enacted  in  1996  to  allow  newly licensed or certified podiatrists to

prescribe  narcotics  related  to  their  treatment  of  patients,  this
provision did not allow formerly licensed podiatrists to prescribe drugs
until  they  had been certified. After 13 years, this phase-in period of
time between old and new podiatrists is  not  needed  and  is  therefore
eliminated.

This  bill  section also adds a new subsection (3) to apply the expanded
scope of practice related to ankle surgery (1) to  only  newly  licensed
podiatrists and (2) to currently licensed podiatrists who have completed
a  course,  of  study  and  are  deemed competent by the State Education
Department to practice the new expanded scope of  practice.    The  bill
also  authorizes all podiatrists to treat soft tissue structures related
to the ankle. All podiatric schools in this country, including  the  New
York College of Podiatric Medicine, teach the expanded New York scope of
practice  (as  provided  for under this bill). In fact, by enacting this
bill, New York will join at least 38 other states that now allow  Podia-
trists to treat areas above the foot to include the ankle, and sometimes
up to the knee cap.

Amends  Public  Health  Law  section 230-d (1) to include podiatrists of
professions (Physicians, Physician Assistants, and Specialists  who  are
subject to the rules regarding office based surgery.

Section  3:  Amends  public  Health  Law  section  2995-d to request the
Department of Health, in cooperation with the Education  Department,  to

study health care practitioner data related to podiatrists and determine
if  the  provisions related to physician profiling should be extended to
podiatrists so that the public has additional information on the quality
of care provided by individual podiatrists.

Section  4:  Amends  the  civil  practice Laws and Rules section 3101 to
allow a physician to be called as  an  expert  witness  in  a  podiatric
medical malpractice action.

JUSTIFICATION:    New  York  State,  is  the  home of one of the largest
colleges of podiatric Medicine in the country. Further, there  are  only
eight  other  such colleges in the country. However, New York has one of
the most restrictive scope of podiatric practice statutes in the  nation
being  one of only twelve States that limit the scope of podiatric medi-
cine to the foot. The other  states  being,  Alabama,  Indiana,  Kansas,
Kentucky,  Louisiana,  Massachusetts, Mississippi, South Carolina, South
Dakota, Texas, and Washington.

The NYS Education Department has  certified  the  New  York  College  of
podiatric  Medicine  to  offer degrees in the proposed expanded scope of
podiatric medicine (foot, ankle, and leg). This means that students  who
earn  degrees  from  this in-state college, can relocate to the other 38
states that authorize the practice of podiatric care which includes  not
only the foot, but also the ankle, and soft tissues related to the ankle
up to the knee cap.

Two  disturbing  trends  are  occurring  in  New York with regard to the
training and location of new podiatric physicians.  First,  due  to  New
York's very restrictive definition of podiatric scope of practice, those
graduating  from  podiatric  medical  colleges, on a national basis, are
electing to start their practices in States  other  than  New  York.  In
1999, The State Education Department provided 145 new licenses, in 2000,
127  licenses were issued, in 2001, 69 licenses, in 2002 and in 2003, 51
licenses were issued, and in 2007, only 52 licenses were issued  to  new
Podiatrists.  This  decrease  in  the  number  of  new podiatrists being
licensed in New York is beginning to result in a shortage of those capa-
ble of providing podiatric care.

Second, while the number of-students who have enrolled in the  New  York
College  of  podiatric  Medicine  has  been gradually increasing from 85
students to 92 students for class of 2010  to.the  class  of  2013,  the
number  of New York residents who have elected annually to enroll in New
York's only  podiatric  college  has  decreased  substantially  from  55
students to 32 students. Generally, students tend to enroll in a college
in the State in which they plan to practice. With New York's very limit-
ed  scope  of practice laws, prospective New York podiatric students are
electing to be trained outside of New York and  then  setting  up  their
practices  outside of New York. unfortunately, this trend indicates that
in the future, there were will be even  fewer  candidates  who  wish  to
apply for licensure for podiatric medicine in New York. This will clear-
ly  exacerbate  the  current trends that have reduced the number persons

who have wished to become licensed to practice podiatric medicine in New
York.

Under  current  law,  essentially,  New York trains podiatrists and then
encourages them to relocate elsewhere to practice because such graduates
cannot practice the full scope of  podiatric  medicine  that  they  were
taught  in New York. Under current rules, students of podiatric medicine
who Intern or are Residents at the NY College of podiatric Medicine  may
practice  the expanded scope of podiatric medicine, as contained in this
bill, but only while being trained at  the  College.  After  graduation,
their  practices must be limited to the foot, and not include the ankle.
Therefore, under current law, podiatric students are  able  to  practice
the  expanded scope of practice as contained in this bill, but not those
who have completed their training and are licensed by the State  of  New
York. This bill would rectify that dichotomy.

Of  the 38 states that allow podiatrists to treat the ankle and portions
of the leg above the ankle, 6 States  allow  Podiatrists  to  treat  the
entire  leg. Those states are Florida, Georgia, Idaho, Nevada, New Hamp-
shire, and Vermont. This bill merely expands the scope of  practice  for
podiatrists  so  that it more closely mirrors the scope of practice used
in at least 75 percent of all other states in the nation.

For those who might maintain that podiatrists should not be  allowed  to
expand their scope of practice, because it will lead to a higher rate of
patient injury, this supposition is not true. The bill sponsor contacted
the  Podiatry Insurance Company of America (PICA) and inquired about the
rate of injury by podiatrists who were limited by their scope  of  prac-
tice  to  the foot, and those who were authorized to treat the ankle and
above. This insurer, which covers approximately 750 of  all  podiatrists
in  the nation, maintained that the loss experience between those podia-
trists who only treat the foot and those who treat the ankle  and  above
was  the  same.  Hence, expanding the scope of podiatric practice should
not lead to more injuries to patients.

The underlying goal of this bill is:

1) to ensure that the New York College of podiatric Medicine can contin-
ue to attract a sufficient number of quality students, particularly  New
York  resident  students, to continue to be a leading medical college in
this important area of medical care, and

2) to ensure that podiatric medical colleges in the State  of  New  York
and  around  the  country graduate students, who in the ond will want to
choose t.0 practice podiatric medicine in this  State  to  provide  this
important services to our residents.

LEGISLATIVE HISTORY:  2010: S.2992-3 Passed Senate 2012: 5.3758-A Passed
Senate

FISCAL IMPLICATIONS: None to the State.

EFFECTIVE DATE: 18 months after it shall have become law.

2013-S1908 (ACTIVE) - Bill Text download pdf

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  1908

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                               (PREFILED)

                             January 9, 2013
                               ___________

Introduced  by  Sen.  LIBOUS -- read twice and ordered printed, and when
  printed to be committed to the Committee on Higher Education

AN ACT to amend the education law and the public health law, in relation
  to the practice of podiatry; to repeal sections 7009 and 7010  of  the
  education law relating to ankle surgery; and to repeal subdivision 4-a
  of  section  2995-d of the public health law, relating to a healthcare
  practitioners database

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  Section  7001 of the education law, as amended by chapter
677 of the laws of 1996, is amended to read as follows:
  S 7001. Definition of practice of podiatry. 1.  The  practice  of  the
profession of podiatry is defined as diagnosing, treating, operating and
prescribing for any disease, injury, deformity or other condition of the
foot,  [and may include] ANKLE AND ALL SOFT TISSUE STRUCTURES OF THE LEG
BELOW THE DISTAL TIBIAL TUBEROCITY.  SURGICAL  TREATMENT  OF  THE  ANKLE
SHALL NOT EXTEND BEYOND THE TIBIAL METAPHYSEAL FLAIR; PROVIDED, HOWEVER,
THAT  SUCH SURGICAL TREATMENT MAY EXTEND TO THE DISTAL TIBIAL TUBEROCITY
AS NECESSARY FOR THE TREATMENT OF THE ANKLE, INCLUDING, BUT NOT  LIMITED
TO,  THE  APPLICATION  OF EXTERNAL FIXATION; AND PROVIDED, FURTHER, THAT
SUCH TREATMENT SHALL NOT INCLUDE PILON FRACTURES. THE PRACTICE OF PODIA-
TRY INCLUDES performing physical evaluations in  conjunction  with  [the
provision  of]  podiatric treatment.  Podiatrists [may] SHALL ONLY treat
traumatic open wound fractures [only] AND PROVIDE SURGICAL MANAGEMENT OF
COMPLICATED FRACTURES OF THE ANKLE in hospitals [,  as  defined  in]  OR
AMBULATORY SURGERY CENTERS CERTIFIED PURSUANT TO article twenty-eight of
the  public  health  law.    FOR  THE PURPOSES OF THIS ARTICLE, THE TERM
"ANKLE" SHALL BE DEFINED AS THE DISTAL METAPHYSIS AND EPIPHYSIS  OF  THE
TIBIA AND FIBULA, THE ARTICULAR CARTILAGE OF THE DISTAL TIBIA AND DISTAL
FIBULA,  THE  LIGAMENTS THAT CONNECT THE DISTAL METAPHYSIS AND EPIPHYSIS

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.

                                                           LBD05263-01-3

S. 1908                             2

OF THE TIBIA AND FIBULA AND TALUS, AND THE PORTIONS OF SKIN,  SUBCUTANE-
OUS TISSUE, FASCIA, MUSCLES, TENDONS AND NERVES AT OR BELOW THE LEVEL OF
THE MYOTENDINOUS JUNCTION OF THE TRICEPS SURAE.
  2.  [The  practice  of podiatry shall not include treating any part of
the human body other than  the  foot,  nor  treating  fractures  of  the
malleoli  or  cutting operations upon the malleoli. Podiatrists licensed
to practice, but not authorized to  prescribe  or  administer  narcotics
prior  to  the  effective date of this subdivision, may do so only after
certification by the department in accordance  with  the  qualifications
established by the commissioner.] The practice of podiatry shall include
administering only local anesthetics for therapeutic purposes as well as
for  anesthesia  and  treatment under general anesthesia administered by
authorized persons.
  3. PODIATRISTS LICENSED TO PRACTICE PRIOR TO  THE  EFFECTIVE  DATE  OF
THIS  SUBDIVISION MAY PERFORM SURGICAL TREATMENT OF THE ANKLE ONLY AFTER
CERTIFICATION BY THE DEPARTMENT IN ACCORDANCE  WITH  THE  QUALIFICATIONS
ESTABLISHED BY THE COMMISSIONER. QUALIFICATIONS TO OPERATE ON THE ANKLE,
PURSUANT  TO THIS SUBDIVISION, SHALL INCLUDE, BUT NOT BE LIMITED TO: THE
SUCCESSFUL COMPLETION OF A RESIDENCY PROGRAM OR  PROGRAMS,  APPROVED  BY
THE COUNCIL ON PODIATRIC MEDICAL EDUCATION; OR COMPLETION OF A POST-SEC-
ONDARY  ACCREDITED  EDUCATIONAL  PROGRAM  ACCEPTABLE TO THE COMMISSIONER
WITH DEMONSTRATED COMPETENCY IN THE SURGICAL TREATMENT OF THE REAR  FOOT
AND  ANKLE;  OR CERTIFICATION BY THE AMERICAN BOARD OF PODIATRIC SURGERY
OR A NATIONAL CERTIFYING BOARD HAVING CERTIFICATION STANDARDS ACCEPTABLE
TO THE COMMISSIONER.
  S 2. Section 7001 of the education law, as amended by chapter  438  of
the laws of 2012, is amended to read as follows:
  S  7001.  Definition  of  practice of podiatry. 1. The practice of the
profession of podiatry is defined as diagnosing, treating, operating and
prescribing for any disease, injury, deformity or other condition of the
foot, [and may include] ANKLE AND ALL SOFT TISSUE STRUCTURES OF THE  LEG
BELOW  THE  DISTAL  TIBIAL  TUBEROCITY.  SURGICAL TREATMENT OF THE ANKLE
SHALL NOT EXTEND BEYOND THE TIBIAL METAPHYSEAL FLAIR; PROVIDED, HOWEVER,
THAT SUCH SURGICAL TREATMENT MAY EXTEND TO THE DISTAL TIBIAL  TUBEROCITY
AS  NECESSARY FOR THE TREATMENT OF THE ANKLE, INCLUDING, BUT NOT LIMITED
TO, THE APPLICATION OF EXTERNAL FIXATION; AND  PROVIDED,  FURTHER,  THAT
SUCH TREATMENT SHALL NOT INCLUDE PILON FRACTURES. THE PRACTICE OF PODIA-
TRY  INCLUDES  performing  physical evaluations in conjunction with [the
provision of] podiatric treatment.  [For  the  purposes  of  wound  care
however,  the  practice  of podiatry shall include the treatment of such
wounds if they are contiguous with wounds relating,  originating  or  in
the  course  of  treatment  of  a wound on the foot within the podiatric
scope of practice. Wound care shall not, however, extend beyond  to  the
level  ending  at the distal tibial tuberosity. The practice of podiatry
may also include diagnosing, treating, operating and prescribing for any
disease, injury, deformity or other condition  of  the  ankle  and  soft
tissue  of  the  leg  below  the tibial tuberosity if the podiatrist has
obtained an issuance of a privilege to perform podiatric standard  ankle
surgery or advanced ankle surgery in accordance with section seven thou-
sand nine of this article.] Podiatrists [may] SHALL ONLY treat traumatic
open  wound  fractures [only] AND PROVIDE SURGICAL MANAGEMENT OF COMPLI-
CATED FRACTURES OF THE ANKLE in hospitals[, as defined in] OR AMBULATORY
SURGERY CENTERS CERTIFIED PURSUANT TO article twenty-eight of the public
health law. For the purposes of this article, the term "ankle" shall  be
defined  as the distal metaphysis and epiphysis of the tibia and fibula,
the articular cartilage of the distal tibia and distal fibula, the liga-

S. 1908                             3

ments that connect the distal metaphysis and epiphysis of the tibia  and
fibula  and talus, and the portions of skin, subcutaneous tissue, facia,
muscles, tendons, ligaments and nerves at or  below  the  level  of  the
myotendinous junction of the triceps surae.
  2.  [The  practice  of podiatry shall not include treating any part of
the human body other than  the  foot,  nor  treating  fractures  of  the
malleoli  or  cutting operations upon the malleoli unless the podiatrist
obtains an issuance of a privilege to perform podiatric  standard  ankle
surgery  or  podiatric  advanced  ankle  surgery.  Podiatrists  who have
obtained an issuance of a privilege to perform podiatric standard  ankle
surgery  may  perform surgery on the ankle which may include soft tissue
and osseous procedures except those procedures  specifically  authorized
for  podiatrists  who  have  obtained  an  issuance  of  a privilege for
advanced ankle surgery. Podiatrists who have obtained an issuance  of  a
privilege  to  perform  podiatric  advanced  ankle  surgery  may perform
surgery on the ankle which may include ankle  fracture  fixation,  ankle
fusion,  ankle  arthroscopy,  insertion  or removal of external fixation
pins into or from the tibial diaphysis at or  below  the  level  of  the
myotendinous junction of the triceps surae, and insertion and removal of
retrograde tibiotalocalcanneal intramedullary rods and locking screws up
to the level of the myotendinous junction of the triceps surae, but does
not  include  the  surgical treatment of complications within the tibial
diaphysis related to the use of such external fixation pins. Podiatrists
licensed to practice, but not  authorized  to  prescribe  or  administer
narcotics  prior  to  the  effective date of this subdivision, may do so
only after certification by the department in accordance with the quali-
fications established by the commissioner.]  The  practice  of  podiatry
shall  include  administering  only  local  anesthetics  for therapeutic
purposes as well as for anesthesia and  treatment  under  general  anes-
thesia  administered by authorized persons. [The practice of podiatry by
any licensee shall not include partial or total ankle  replacements  nor
the treatment of pilon fractures.]
  3.  PODIATRISTS  LICENSED  TO  PRACTICE PRIOR TO THE EFFECTIVE DATE OF
THIS SUBDIVISION MAY PERFORM SURGICAL TREATMENT OF THE ANKLE ONLY  AFTER
CERTIFICATION  BY  THE  DEPARTMENT IN ACCORDANCE WITH THE QUALIFICATIONS
ESTABLISHED BY THE COMMISSIONER. QUALIFICATIONS TO OPERATE ON THE ANKLE,
PURSUANT TO THIS SUBDIVISION, SHALL INCLUDE, BUT NOT BE LIMITED TO:  THE
SUCCESSFUL  COMPLETION  OF  A RESIDENCY PROGRAM OR PROGRAMS, APPROVED BY
THE COUNCIL ON PODIATRIC MEDICAL EDUCATION; OR COMPLETION OF A POST-SEC-
ONDARY ACCREDITED EDUCATIONAL PROGRAM  ACCEPTABLE  TO  THE  COMMISSIONER
WITH  DEMONSTRATED COMPETENCY IN THE SURGICAL TREATMENT OF THE REAR FOOT
AND ANKLE; OR CERTIFICATION BY THE AMERICAN BOARD OF  PODIATRIC  SURGERY
OR A NATIONAL CERTIFYING BOARD HAVING CERTIFICATION STANDARDS ACCEPTABLE
TO THE COMMISSIONER.
  S 3. Sections 7009 and 7010 of the education law are REPEALED.
  S  4.  Paragraph  (i)  of subdivision 1 of section 230-d of the public
health law, as added by chapter 365 of the laws of 2007, is  amended  to
read as follows:
  (i)  "Licensee" shall mean an individual licensed or otherwise author-
ized under [articles] ARTICLE one hundred thirty-one [or],  one  hundred
thirty-one-B OR ONE HUNDRED FORTY-ONE of the education law.
  S  5.  Paragraph  (i)  of subdivision 1 of section 230-d of the public
health law, as amended by chapter 438 of the laws of 2012, is amended to
read as follows:
  (i) "Licensee" shall mean an individual licensed or otherwise  author-
ized  under  article  one hundred thirty-one, one hundred thirty-one-B[,

S. 1908                             4

individuals who have obtained an issuance  of  a  privilege  to  perform
podiatric  standard  or  advanced ankle surgery pursuant to subdivisions
one and two of section seven thousand nine] OR ONE HUNDRED FORTY-ONE  of
the education law.
  S  6.  Subdivision  4-a  of section 2995-d of the public health law is
REPEALED and a new subdivision 4-a is added to read as follows:
  4-A. IN COOPERATION WITH THE EDUCATION DEPARTMENT, STUDY  HEALTH  CARE
PRACTITIONER  DATA  RELATING  TO  PODIATRISTS.  SUCH STUDY SHALL INCLUDE
CONSIDERATION OF WHETHER  AN  INDIVIDUAL  PODIATRIST  PROFILING  PROGRAM
SHOULD  BE  ESTABLISHED AND OUTLINE AN APPROPRIATE METHOD TO DEVELOP AND
IMPLEMENT SUCH A PROFILING PROGRAM IF SUCH A PROGRAM  IS  DETERMINED  BY
THE  DEPARTMENT TO BE IN THE PUBLIC INTEREST. SUCH PROGRAM AND RECOMMEN-
DATIONS MAY BE SIMILAR TO THE PHYSICIAN PROFILES ESTABLISHED PURSUANT TO
SECTION TWENTY-NINE HUNDRED NINETY-FIVE-A OF THIS TITLE. SUCH A PROPOSED
PODIATRIST PROFILING PROGRAM, IF SUCH A PROGRAM  IS  DETERMINED  BY  THE
DEPARTMENT  TO  BE IN THE PUBLIC INTEREST, SHOULD BE CAPABLE OF PRESENT-
ING, IN A COST EFFECTIVE MANNER, RELEVANT MEDICAL AND TREATMENT INFORMA-
TION IN A FORMAT THAT IS EASILY UNDERSTOOD BY AND MADE AVAILABLE TO  THE
GENERAL  PUBLIC.   SUCH STUDY AND ITS FINDINGS SHALL BE SUBMITTED TO THE
GOVERNOR, THE TEMPORARY PRESIDENT OF THE  SENATE,  THE  SPEAKER  OF  THE
ASSEMBLY,  THE  MINORITY LEADER OF THE SENATE AND THE MINORITY LEADER OF
THE ASSEMBLY ON OR BEFORE JUNE FIRST, TWO THOUSAND NINETEEN;
  S 7. This act shall take effect 18 months after it shall have become a
law, except that sections two and five of this act shall take effect  on
the  same date and in the same manner as chapter 438 of the laws of 2012
takes effect; provided, however, that effective immediately,  the  addi-
tion,  amendment  and/or  repeal of any rule or regulation necessary for
the implementation of the provisions of this act on its  effective  date
are  authorized  and directed to be made and completed on or before such
effective date.

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