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i am a practitioner in the state of florida.there is a seminar being offered in my state by both podiatrists and orthopods with regards to teaching pods how to medically treat the knee.now florida has our scope of practice as encompassing the foot and leg.however,i don't think anyone ever intended this to mean the knee.the course syllabus mentions courses on casting knee braces,injection techniques,and diagnostics.
i tried contacting the course organizers but have had no success.does anyone know anything about these courses? and this idea of inclusion of the knee.

Is this the course: Remember the Knee ?

Bret Ribotsky is one of the organizers.

yes,this is the course i was mentioning.i realize that the director is a respected surgeon in my community.however,i still can't find any mention in the state statue that podiatrist can treat the knee.please let me know what you think.

IF anyone wants any of the specific infomation on this course you can email me at ribotsky@doctorbret.com or go to email page www.podiatricsuccess.com and see the brochure. The LAW in florida is below and has not changed for years. What has changed is the interperation of the word "LEG"

I can email the offical documentation to anyone who wants.

This is a GREAT new begining for Podiatry. At my meeting I will be having in addition to the Orthopedics and Rheumatologists teaching, the president of the florida board of podiatric medicine and the florida Medicare represenative. ALL IS GOOD TO TREAT THE KNEE IN FLORIDA (non surgical)

Bret Ribotsky, DPM, FACFAS, FACFAOM, FAPWCA, ABCDEFG.........



Florida Statute governing the practice of podiatric medicine is below:

Chapter 461:

http://www.flsenate.gov/Statutes/ind...461/ch0461.htm

5) "Practice of podiatric medicine" means the diagnosis or medical, surgical, palliative, and mechanical treatment of ailments of the human foot and leg. The surgical treatment of ailments of the human foot and leg shall be limited anatomically to that part below the anterior tibia tubercle. The practice of podiatric medicine shall include the amputation of the toes or other parts of the foot but shall not include the amputation of the foot or leg in its entirety. A podiatric physician may prescribe drugs that relate specifically to the scope of practice authorized herein.

History.--ss. 1, 6, ch. 79-229; ss. 2, 3, ch. 81-318; ss. 3, 12, 13, ch. 86-71; s. 4, ch. 91-429; s. 116, ch. 94-218; s. 73, ch. 97-264; s. 200, ch. 98-166; s. 111, ch. 99-397.


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Bret:

We have been treating iliotibial band syndrome, patellar tendinitis, patellofemoral syndrome, pes anserinus bursitis, medial compartment and lateral compartment osteoarthritis of the knee, and medial collateral ligament strain of the knee for over twenty years here in California. Is this something that podiatrists in Florida have not been doing for the past twenty years?

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

forgive me for pushing the clarity envelope.but you mean to tell me that the board of medicine or any other regulatory agency in florida is not going to have a problem with podiatrists in the state of florida adding invasive (injections) therapy of the knee as part of their medical expertise.i mean has anyone consulted an attorney or some of the agencies governing these matters.one thing is how something is phrased in a statue and another is how it is viewed in a practical setting.
another issue is which podiatrists are going to be qualified to treat the knee.i mean i am a psr 24 trained surgeon and quite frankly i didn't see that much exposure to knee pathology in my training.
finally,how many podiatrists in florida are actually treating the knee and what treatments are they offering?

The Law is on our side. The legal challanges have be won ! The Knee (non-surgical) is clearly allowed. What was lacking is a course to "remember the knee" I have asked the state and they were not interested. I wanted to learn how to treat the knee; thus, the course was born.

Registration is going well. I expect to sell out at 150 DPM's.

Yes there will be some in medicine who are againist this. I can remember many MD's not wanting DPM's in their hospitals.

I hope you will register to aid you practice and your patients.

www.podiatricsuccess.com

Bret Ribotsky

dr. ribotsky,

the battles you are referring to with regards to hospital staff participation by d.p.m.'s were waged on both an individual,but more importantly organizational level.both local and national organizations lobbying the courts and regulating bodies.
this effort with inclusion of the knee as scope of practice,seems to be spearheaded by a group of doctors trying to build a seminar.
i have contacted both the local and state podiatry associations here and they have expressed no comment,nor could they provide me the names of any podiatrists in the state of florida performing or attempting to perform any invasive medicine (injection,arthrocentesis) of the knee.
i believe i am raising some legitimate concerns here.if a practitioner were to take a course such as this not sanctioned by any state or local society and put the interpretation of this scope of practice statue to the test on his own.it could be a very costly mistake indeed.
i would appreciate some commentary from some practitioners in leadership positions with regards to this matter.

Let me state the Facts.
1. I did not fight the battle for treatment of the leg in Florida.

2. The Knee course is being offered for $ 125. The cost of the hotel (rental space, meals and breaks) and marketing to get the word out combined with producing a handout will exceed this cost. The cost of Orthopedic surgeons ect lecturing are not cheap. I could of charged hundreds more, but my quest is to educate.

3. The seminar is accredited by the only approved non-surgical professional college in Podiatry, The American College of Foot and Ankle Orthopedics and Medicine www.acfaom.org

4. President of the Florida Board of Podiatric Medicne will be in Attendance.

5. Florida's Medicare liasion will be in Attendance.

Now for my opinions.
1 Grow or Die.... this is the law of nature. Podiatry has a tremendous opportunity to HELP many patients.

2. If every one is going one way, go the other, the odds are better. You should not be affraid of change, I see you are on the internet. Do you think this internet thing will work?

Who are you?? Tell us all.

Bret Ribotsky

my dear dr. ribotsky,
this an open forum where we all put forth ideas and yes concerns.i noticed some aggression in your tone,i mean dude chill.my name is rick perez,i practice in miami,very close to you.i have been in solo practice,with two offices for twelve years.i graduated from the Barry program,i did my psr 24 in the miami program.incidentally,i graduated from USF a year after you did, 1984.there satisfied,"i have now told you all who i am."
you on the other hand have not answered any of my questions.first of all,i am glad that the FPMA president is going to the seminar,may be he can write in to this forum and let us know why his organization has no position on this matter.secondly,you have not addressed the issue of just how many podiatrists are pursueing this type of knee practice or at least advertised to do so. lastly,you did not verify whether or not an attorney or rep from the state had been contacted to confirm what you are claiming in this seminar.
i wish you well in your noble effort.i am in no way trying to attack or destroy your project.however,my concerns are not directed against any change.but quite frankly,out of concern for the public good and that of our profession.a knee fellowship can not be learned in some courses.inspite of whatever orthopedic background a well trained psr36 pod thinks he has.we are still all podiatrist and our expertise is the foot.this is how we sell ourselves to the public.if we start doing something we are not trained to do the damage could do great harm to our profession.

Rick,
Once again, please read what I am writting. I did not say FPMA president, I said the Florida Board of Podiatric Medicine's president. These are the people who give you your license to practice. It is their rules which govern the LAW in Florida. And YES I have the OFFICIAL legal determination as set into law by the judge.

With reguards to "how many Podiatrists are .... knee practice" I do not know. I do know of at least seven who I can name. That is not the question that is important. The question is why the balance have not? I will be treating the knee the moment that I feel comfortable to do so. I do not expect DPM's to be at the level of a Orthopedic surgeon or a Rheumatologist. They will be at or above the level of a nurse practionier or a physician's assistant. I would expect many to be a a level above a family practiontioner with reguards to skill, knowledge and appitude (sp?)

Over one hundred DPM's are attending.......... You might want to attend as there are only a few open seats available. (I am not overselling the meeting as I want the workshops to be valuable)

Bret Ribotsky

Bret:

What will be your scope of practice to treat the knee in Florida? Will you be able to give injections or perform knee aspirations? Will you be able to do arthroscopy or surgery of the knee? As I mentioned earlier, we treat knee pathology non-surgically here in California but I don't know anyone who is doing knee injections, aspirations or surgery. How broad will your scope of treatment be in Florida?

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

Kevin,
The law in Florida is rather well stated. It limits surgical intervation to that area below the tibial tuberical. It goes on to say, that Injections are not surgical. Thus, injections of the knee are OK as well as braces. I guess diagnostic arthroscopy would be ok, but I would lobby against it.

With reguards to the course, I think it is important for the audience to know that many are treating the knee without any specific training.
I am trying to create a baseline of education where there has been a vacuum before.

Be well,
Bret

Bret:

I think your course is a good idea. As I mentioned earlier, we have been treating the knee for at least the last twenty years here in California but I don't know of any podiatrists giving knee injections in California.

Even though most podiatrists don't know much about the knee, many sports podiatrists routinely treat knee injuries in their practice and are quite knowledgeable about its anatomy and specific injuries. I have been teaching knee examination techniques, knee anatomy and treatment of knee pathology for the past 20 years to podiatrists and have been quite surprised that even the smarter podiatrists know very little about knee anatomy, clinical tests and how to do a good knee examination.

Keep up the good work. I think it is about time a podiatrist offered a course dedicated to learning about the knee.

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

dr.ribotsky,

let me preface my comments by first apologizing for my error on who would be attending your seminar.my last note was also an attempt at humor and sarcasm.i have nothing but great respect for you as a surgeon and as a leader in our profession.
however,with that said,i reiterate my original objections with regards to invasive medical treatment of the knee.i believe that even dr.kirby,who stated that they treat the knee biomechanically in california,was surprised to know that you are advocating that podiatrist's scope of practice in florida include invasive treatments,i.e. injections.
i checked with CMS,the agency governing medicare and medicaid,podiatrists are not reimbursed for any knee treatments.obviously,this can affect how private insurance and palmetto GBA sets policies on reimbursing DPM's for treating the knee.
i believe this issue should have been addressed before setting up this seminar.quite frankly,the brochure and the way it was harped,gave the impression that this wasn't an issue.this is the problem i have with this seminar.

Rick:

I don't think that I ever said that I "was surprised" that podiatrists in Florida will now be able to do injections. I just said that podiatrists here in California do not do that.

However, I do think that learning more about the knee is very important for podiatrists since the knee is the next joint above the ankle, and is commonly injured with mechanical pathologies of the foot. In this regard, I applaud Bret for assembling a cast of educated individuals for a seminar to help train podiatrists more on knee pathology.

Personally, however, I would be reluctant to give any knee injections in any state as a podiatrist unless I had first cleared this with my medical malpractice carrier and my state podiatric medical association. What's going to happen if knee injections are said to be approved by one state authority, you give a knee injection, the patient has an adverse reaction to the knee injection, goes to another doctor who can't believe that a podiatrist gave a knee injection, patient goes to attorney, malpractice action is started and then the malpractice insurance company says you were practicing outside your scope of practice and says, "Sorry, doctor,you're on your own on this one." ????

Maybe this is not a problem in Florida with the change in law, but it certainly would make me be fearful of proceeding into such waters until a few others stuck their toes in first.

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

dr.kirby,

let me first apologize for implying that i knew what your were thinking with regards to your comments about the knee seminar in our state.
however,i believe you feel the way i do when it comes to implying that just because the scope of practice in this state states the foot and leg,that we can take a leap to include the knee.
this is especially pertinent,considering that neither medicare nor palmetto gba(d.m.e.) will reimburse d.p.m.s for these services.let's face it in a state like florida,90% of the patients pods treat, are medicare patients.so in essence they are telling doctors here, to get ready to treat an area of the body that their patient's primary insurance program,doesn't think they should treat.
furthermore,i would invite you to take a look at their brochure for this seminar.it makes no mention of these facts and even gives you the impression that once you complete this course you are ready to go out and do arthrocentesis on the knee and/or be reimbursed for knee braces.legally,as far as medicare and medicaid is concerned we are not.
it would seem to me that they should have first attempted to persuade medicare to reimburse us for legally treating the knee,before setting up this seminar.i think i understood you correctly this time,when you stated that if anything goes"...your are on your own."i couldn't have said it better myself.

take care

i find this latest development to vindicate my ealier objections to dr. ribotsky's knee seminars being offered in the state of florida, for podiatrists.i just received notification from mr.jeff stonage,of smith-nephew the maker of a joint fluid replacement agent (sodium hyaluronate) and more importantly a sponsor of this seminar.i quote,"the florida d.p.m. medicare liason dr.steven merritt has made the appropriate representations,but unfortunately there appears to be some issue concerning reimbursement in fl." they go on to state," we apologize for the short notice,but in light of the reimbursement situation we feel it would be inappropriate to continue with our proposed courses and have taken the decision to postpone them until this issue is resolved."
believe me when i state that i am not happy this happened,inspite of my differences of opinions with dr.ribotsky.however,this proves that this whole seminar business was very poorly thought out.and would have resulted in a lot of practitioners wasting their time and money for no real reason