Senate Bill S2992

                                 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.

 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
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.

                                BILL NUMBER:S2992B

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
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 restric-
tive 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, Loui-
siana, 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 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 a.t 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 75% 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 end will want to
choose t.o 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.