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; authorizes the calling of a physician as an expert witness in a podiatric medical malpractice cause of action.
BILL NUMBER: S2992A
TITLE OF BILL :
An act to amend the education law, the public health law and the civil practice law and rules, in relation to the practice of podiatry
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 surgical treatments of the 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 Podiatrists 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.
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 medicine 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, 81 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 capable 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 limited 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 clearly 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 Hampshire, 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 practice to the foot, and those who were authorized to treat the ankle and above. This insurer, which covers approximately 75% of all podiatrists in the nation, maintained that the loss experience between those podiatrists 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 continue 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 end will want to choose to practice podiatric medicine in this State to provide this important services to our residents.
FISCAL IMPLICATIONS :
None to the State.
EFFECTIVE DATE : 18 months after it shall have become law.
STATE OF NEW YORK ________________________________________________________________________ 2992--A 2009-2010 Regular Sessions IN SENATE March 9, 2009 ___________Introduced by Sens. KLEIN, ONORATO, THOMPSON -- read twice and ordered printed, and when printed to be committed to the Committee on Higher Education -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the education law, the public health law and the civil practice law and rules, in relation to the practice of podiatry 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 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 theThe 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 ANKLE; OR CERTIFICATION BY THE AMERICAN BOARD OF PODIATRIC SURGERY OR A NATIONAL CERTIFYING BOARD HAVING CERTIFICATION STANDARDS ACCEPTABLE TO THE COMMISSIONER. S 2. 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 underEXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD02162-04-0 S. 2992--A 2
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.]
[articles]ARTICLE one hundred thirty-one [or], one hundred thirty-one-B OR ONE HUNDRED FORTY-ONE of the education law. S 3. Section 2995-d of the public health law is amended by adding a new subdivision 4-a 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 FIFTEEN; S 4. Paragraph 1 of subdivision (d) of section 3101 of the civil prac- tice law and rules is amended by adding a new subparagraph (iv) to read as follows: (IV) IN AN ACTION FOR PODIATRIC MEDICAL MALPRACTICE, A PHYSICIAN MAY BE CALLED AS AN EXPERT WITNESS AT TRIAL. S 5. This act shall take effect 18 months after it shall have become a law; provided, however, that effective immediately, the addition, amend- ment and/or repeal of any rule or regulation necessary for the implemen- tation of the provisions of this act on its effective date are author- ized and directed to be made and completed on or before such effective date.