Bill S7800-2011

Relates to podiatry and the scope of podiatric practice

Relates to podiatry and the scope of podiatric practice.

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  • Jun 21, 2012: SUBSTITUTED BY A9293A
  • Jun 20, 2012: ORDERED TO THIRD READING CAL.1453
  • Jun 19, 2012: REFERRED TO RULES

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VOTE: COMMITTEE VOTE: - Rules - Jun 20, 2012
Ayes (21): Skelos, Alesi, Farley, Fuschillo, Johnson, Larkin, LaValle, Libous, Marcellino, Maziarz, Nozzolio, Saland, Seward, Sampson, Dilan, Duane, Montgomery, Parker, Perkins, Smith, Stewart-Cousins
Ayes W/R (2): Breslin, Krueger
Nays (2): Hannon, Hassell-Thompson

Memo

BILL NUMBER:S7800

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 podiatric scope of practice

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 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 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.

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 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 3B 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 750 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 t.O practice podiatric medicine in this State to provide this important services to our residents.

LEGISLATIVE HISTORY: 2010: S.2992-B Passed Senate - A.2518-B Referred to Higher Education

FISCAL IMPLICATIONS: None to the State.

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


Text

STATE OF NEW YORK ________________________________________________________________________ 7800 IN SENATE June 19, 2012 ___________
Introduced by Sen. LIBOUS -- read twice and ordered printed, and when printed to be committed to the Committee on Rules AN ACT to amend the education law, the public health law, and the civil practice law and rules, in relation to the podiatric scope of practice 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 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 treat traumatic open wound fractures only in hospitals, as defined in 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, 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 ISSU- ANCE 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 PODIA- TRISTS 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 TIBIOTALO- CALCANNEAL 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 certif- ication by the department in accordance with the qualifications estab- lished 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. THE PRACTICE OF PODIATRY BY ANY LICENSEE SHALL NOT INCLUDE PARTIAL OR TOTAL ANKLE REPLACEMENTS NOR THE TREATMENT OF PILON FRACTURES. S 2. The education law is amended by adding two new sections 7009 and 7010 to read as follows: S 7009. PODIATRIC ANKLE SURGERY PRIVILEGES. 1. FOR ISSUANCE OF A PRIV- ILEGE TO PERFORM PODIATRIC STANDARD ANKLE SURGERY, AS THAT TERM IS USED IN SUBDIVISION TWO OF SECTION SEVEN THOUSAND ONE OF THIS ARTICLE, THE APPLICANT SHALL FULFILL THE FOLLOWING REQUIREMENTS: A. APPLICATION: FILE AN APPLICATION WITH THE DEPARTMENT; B. LICENSE: BE LICENSED AS A PODIATRIST IN THE STATE; C. TRAINING AND CERTIFICATION: EITHER: (I) HAVE GRADUATED ON OR AFTER JUNE FIRST, TWO THOUSAND SIX FROM A THREE-YEAR RESIDENCY PROGRAM IN PODIATRIC MEDICINE AND SURGERY THAT WAS ACCREDITED BY AN ACCREDITING AGENCY ACCEPTABLE TO THE DEPARTMENT, AND BE CERTIFIED IN RECONSTRUCTIVE REARFOOT AND ANKLE SURGERY BY A NATIONAL CERTIFYING BOARD HAVING CERTIFICATION STANDARDS ACCEPTABLE TO THE DEPARTMENT; OR (II) HAVE GRADUATED ON OR AFTER JUNE FIRST, TWO THOUSAND SIX FROM A THREE-YEAR RESIDENCY PROGRAM IN PODIATRIC MEDICINE AND SURGERY THAT WAS ACCREDITED BY AN ACCREDITING AGENCY ACCEPTABLE TO THE DEPARTMENT, BE BOARD QUALIFIED BUT NOT YET CERTIFIED IN RECONSTRUCTIVE REARFOOT AND ANKLE SURGERY BY A NATIONAL CERTIFYING BOARD HAVING CERTIFICATION STAND- ARDS ACCEPTABLE TO THE DEPARTMENT, AND PROVIDE DOCUMENTATION THAT HE OR SHE HAS ACCEPTABLE TRAINING AND EXPERIENCE IN STANDARD OR ADVANCE MIDFOOT, REARFOOT AND ANKLE PROCEDURES THAT HAS BEEN APPROVED BY THE DEPARTMENT; OR (III) HAVE GRADUATED BEFORE JUNE FIRST, TWO THOUSAND SIX FROM A TWO-YEAR RESIDENCY PROGRAM IN PODIATRIC MEDICINE AND SURGERY THAT WAS ACCREDITED BY AN ACCREDITING AGENCY ACCEPTABLE TO THE DEPARTMENT, BE CERTIFIED IN RECONSTRUCTIVE REARFOOT AND ANKLE SURGERY BY A NATIONAL CERTIFYING BOARD HAVING CERTIFICATION STANDARDS ACCEPTABLE TO THE DEPARTMENT, AND PROVIDE DOCUMENTATION THAT HE OR SHE HAS ACCEPTABLE
TRAINING AND EXPERIENCE IN STANDARD OR ADVANCED MIDFOOT, REARFOOT AND ANKLE PROCEDURES THAT HAS BEEN APPROVED BY THE DEPARTMENT; D. FEES: PAY A FEE TO THE DEPARTMENT OF TWO HUNDRED TWENTY DOLLARS FOR THE ISSUANCE OF A PRIVILEGE TO PERFORM PODIATRIC STANDARD ANKLE SURGERY. 2. FOR ISSUANCE OF A PRIVILEGE TO PERFORM PODIATRIC ADVANCED ANKLE SURGERY, AS THAT TERM IS USED IN SUBDIVISION TWO OF SECTION SEVEN THOU- SAND ONE OF THIS ARTICLE, THE APPLICANT SHALL FULFILL THE FOLLOWING REQUIREMENTS: A. APPLICATION: FILE AN APPLICATION WITH THE DEPARTMENT; B. LICENSE: BE LICENSED AS A PODIATRIST IN THE STATE; C. EXPERIENCE AND CERTIFICATION: EITHER: (I) HAVE GRADUATED ON OR AFTER JUNE FIRST, TWO THOUSAND SIX FROM A THREE-YEAR RESIDENCY PROGRAM IN PODIATRIC MEDICINE AND SURGERY THAT WAS ACCREDITED BY AN ACCREDITING AGENCY ACCEPTABLE TO THE DEPARTMENT, BE CERTIFIED IN RECONSTRUCTIVE REARFOOT AND ANKLE SURGERY BY A NATIONAL CERTIFYING BOARD HAVING CERTIFICATION STANDARDS ACCEPTABLE TO THE DEPARTMENT, AND PROVIDE DOCUMENTATION THAT HE OR SHE HAS ACCEPTABLE TRAINING AND EXPERIENCE IN ADVANCED MIDFOOT, REARFOOT AND ANKLE PROCE- DURES THAT HAS BEEN APPROVED BY THE DEPARTMENT; OR (II) HAVE GRADUATED BEFORE JUNE FIRST, TWO THOUSAND SIX FROM A TWO-YEAR RESIDENCY PROGRAM IN PODIATRIC MEDICINE AND SURGERY THAT WAS ACCREDITED BY AN ACCREDITING AGENCY ACCEPTABLE TO THE DEPARTMENT, BE CERTIFIED IN RECONSTRUCTIVE REARFOOT AND ANKLE SURGERY, BY A NATIONAL CERTIFYING BOARD HAVING CERTIFICATION STANDARDS ACCEPTABLE TO THE DEPARTMENT, AND PROVIDE DOCUMENTATION THAT HE OR SHE HAS ACCEPTABLE TRAINING AND EXPERIENCE IN ADVANCED MIDFOOT, REARFOOT AND ANKLE PROCE- DURES THAT HAS BEEN APPROVED BY THE DEPARTMENT. D. FEES: PAY A FEE TO THE DEPARTMENT OF TWO HUNDRED TWENTY DOLLARS FOR THE ISSUANCE OF A PRIVILEGE TO PERFORM PODIATRIC ADVANCED ANKLE SURGERY. 3. DURATION AND REGISTRATION OF PRIVILEGES. A PRIVILEGE ISSUED UNDER THIS SECTION SHALL BE VALID FOR THE LIFE OF THE HOLDER, UNLESS REVOKED, ANNULLED, OR SUSPENDED BY THE BOARD OF REGENTS. SUCH A PRIVILEGE SHALL BE SUBJECT TO THE SAME OVERSIGHT AND DISCIPLINARY PROVISIONS AS LICENSES ISSUED UNDER THIS TITLE. THE HOLDER OF A PRIVILEGE ISSUED UNDER THIS SECTION SHALL REGISTER WITH THE DEPARTMENT AS A PRIVILEGE HOLDER IN THE SAME MANNER AND SUBJECT TO THE SAME PROVISIONS AS REQUIRED OF A LICENSEE PURSUANT TO SECTION SIX THOUSAND FIVE HUNDRED TWO OF THIS TITLE, PROVIDED THAT, AT THE TIME OF EACH REGISTRATION, THE PRIVILEGE HOLDER SHALL CERTIFY THAT HE OR SHE CONTINUES TO MEET THE REQUIREMENTS FOR THE PRIVILEGE SET FORTH IN THIS SECTION. THE FEE FOR SUCH REGISTRATION SHALL BE TWO HUNDRED TEN DOLLARS. THE REGISTRATION PERIOD FOR A PRIVILEGE HOLDER SHALL BE COTERMINOUS WITH HIS OR HER REGISTRATION AS A PODIA- TRIST. S 7010. ANKLE SURGERY LIMITED PERMITS. A LIMITED PERMIT TO PERFORM PODIATRIC STANDARD ANKLE SURGERY, AS DESCRIBED IN SUBDIVISION TWO OF SECTION SEVEN THOUSAND ONE OF THIS ARTICLE, MAY BE ISSUED BY THE DEPART- MENT TO A PODIATRIST WHO IS LICENSED PURSUANT TO THIS ARTICLE AND WHO HAS MET THE RESIDENCY AND BOARD QUALIFICATION/CERTIFICATION REQUIREMENTS SET FORTH IN SUBDIVISION ONE OF SECTION SEVEN THOUSAND NINE OF THIS ARTICLE IN ORDER TO AUTHORIZE SUCH PODIATRIST TO OBTAIN THE TRAINING AND EXPERIENCE REQUIRED FOR THE ISSUANCE OF A PODIATRIC STANDARD ANKLE SURGERY PRIVILEGE PURSUANT TO SUBDIVISION ONE OF SECTION SEVEN THOUSAND NINE OF THIS ARTICLE. SUCH PERMITS SHALL AUTHORIZE THE PERFORMANCE OF PODIATRIC STANDARD ANKLE SURGERY ONLY UNDER THE DIRECT PERSONAL SUPER- VISION OF A LICENSED PODIATRIST HOLDING A PODIATRIC STANDARD ANKLE SURGERY PRIVILEGE OR A PODIATRIC ADVANCED ANKLE SURGERY PRIVILEGE ISSUED
PURSUANT TO SECTION SEVEN THOUSAND NINE OF THIS ARTICLE OR OF A PHYSI- CIAN LICENSED PURSUANT TO ARTICLE ONE HUNDRED THIRTY-ONE OF THIS TITLE AND CERTIFIED IN ORTHOPEDIC SURGERY BY A NATIONAL CERTIFYING BOARD HAVING CERTIFICATION STANDARDS ACCEPTABLE TO THE DEPARTMENT. 2. A LIMITED PERMIT TO PERFORM PODIATRIC ADVANCED ANKLE SURGERY, AS DESCRIBED IN SUBDIVISION TWO OF SECTION SEVEN THOUSAND ONE OF THIS ARTI- CLE, MAY BE ISSUED BY THE DEPARTMENT TO A PODIATRIST WHO IS LICENSED PURSUANT TO THIS ARTICLE AND WHO HAS MET THE RESIDENCY AND BOARD CERTIF- ICATION REQUIREMENTS SET FORTH IN SUBDIVISION TWO OF SECTION SEVEN THOU- SAND NINE OF THIS ARTICLE IN ORDER TO AUTHORIZE SUCH PODIATRIST TO OBTAIN THE TRAINING AND EXPERIENCE REQUIRED FOR THE ISSUANCE OF A PODIA- TRIC ADVANCED ANKLE SURGERY PRIVILEGE PURSUANT TO SUBDIVISION TWO OF SECTION SEVEN THOUSAND NINE OF THIS ARTICLE. SUCH PERMITS SHALL AUTHOR- IZE THE PERFORMANCE OF PODIATRIC ADVANCED ANKLE SURGERY ONLY UNDER THE DIRECT PERSONAL SUPERVISION OF A LICENSED PODIATRIST HOLDING A PODIATRIC ADVANCED ANKLE SURGERY PRIVILEGE ISSUED PURSUANT TO SUBDIVISION TWO OF SECTION SEVEN THOUSAND NINE OF THIS ARTICLE OR OF A PHYSICIAN LICENSED PURSUANT TO ARTICLE ONE HUNDRED THIRTY-ONE OF THIS TITLE AND CERTIFIED IN ORTHOPEDIC SURGERY BY A NATIONAL CERTIFYING BOARD HAVING CERTIF- ICATION STANDARDS ACCEPTABLE TO THE DEPARTMENT. 3. FOR THE PURPOSES OF THIS SECTION, DIRECT PERSONAL SUPERVISION MEANS SUPERVISION OF PROCEDURES BASED ON INSTRUCTIONS GIVEN DIRECTLY BY THE SUPERVISING PODIATRIST OR PHYSICIAN WHO REMAINS IN THE IMMEDIATE AREA WHERE THE PROCEDURES ARE BEING PERFORMED, AUTHORIZES THE PROCEDURES AND EVALUATES THE PROCEDURES PERFORMED BY THE HOLDER OF THE LIMITED PERMIT. 4. THE HOLDER OF A LIMITED PERMIT ISSUED PURSUANT TO THIS SECTION SHALL PERFORM PODIATRIC ANKLE SURGERY ONLY IN A HOSPITAL OR HEALTH FACILITY LICENSED PURSUANT TO ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH LAW AND APPROPRIATELY AUTHORIZED TO PROVIDE SUCH SURGERY. 5. LIMITED PERMITS SHALL BE ISSUED FOR A PERIOD OF ONE YEAR, AND MAY BE RENEWED FOR ADDITIONAL ONE YEAR PERIODS WHEN NECESSARY TO PERMIT THE COMPLETION OF THE TRAINING AND EXPERIENCE REQUIRED TO OBTAIN A PODIATRIC STANDARD ANKLE SURGERY PRIVILEGE OR PODIATRIC ADVANCED ANKLE SURGERY PRIVILEGE, AS APPLICABLE, PROVIDED THAT NO PERMIT MAY BE RENEWED MORE THAN FOUR TIMES FOR EACH SUCH PRIVILEGE. 6. THE FEE FOR A LIMITED PERMIT SHALL BE ONE HUNDRED FIVE DOLLARS AND THE FEE FOR A RENEWAL SHALL BE FIFTY DOLLARS. S 3. 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, 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 of the education law. S 4. 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, ESTABLISH A HEALTH CARE PRACTITIONER DATABASE RELATING TO PODIATRISTS. SUCH DATABASE SHALL INCLUDE INFORMATION SIMILAR TO THE PHYSICIAN PROFILES ESTABLISHED PURSU- ANT TO SECTION TWENTY-NINE HUNDRED NINETY-FIVE-A OF THIS TITLE. THE DATABASE SHALL BE CAPABLE OF PRESENTING RELEVANT MEDICAL AND TREATMENT INFORMATION IN A FORMAT THAT IS EASILY UNDERSTOOD BY AND MADE AVAILABLE TO THE GENERAL PUBLIC.
S 5. 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 6. This act shall take effect eighteen months after it shall have become a law. Effective immediately, the addition, amendment and/or repeal of any rule or regulation necessary for the implementation of the provisions of this act on its effective date is authorized to be made on or before such effective date.

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