Response from Mark Levy to Mike Veder

From: Levy, Mark B Subject: RE: OPP Licensure BillTo: "michael veder" Date: Tuesday, April 1, 2008, 6:59 PM

Mr. Veder, thank you for your letter, and I will of course share it verbatim with the Board. I would invite your telephone call to discuss directly the processes and initiatives that are within the Board's scope of authority and responsibility. However, in order to assure we are looking at the same issues from the same basis -- or at least with an understanding of the different domains we may be addressing -- please allow me to offer some points for your consideration.

1. The Board has not recently "suggested changes to the language of the OPP Licensure Bill." The Board has suggested revisions to the administrative code rules which are developed to more effectively implement the provisions of the OPP Practice Act. This is an important distinction, because the Board has no authority to alter the language of the statute, i.e., the Practice Act -- Chapter 4779 of the Ohio Revised Code. The Board's legal responsibility is to administer, seek compliance with and, if necessary, enforce the statutory provisions. The Board does have the authority and responsibility to promulgate, amend, and/or rescind rules in the administrative code series, but those rules must be in "agreement" with and cannot exceed the scope of the statutory language.

2. The letter the Board issued to ABC for their consideration as they address the "inherited" BCP Pedorthist Scope of Practice document and the appropriate educational initiatives and protocols to guide the certification of pedorthists post-BCP sought to bring focus to the language of the Ohio statute. As you may be aware, we have also faced the challenge of articulating and seeking compliance with statutory language that imposes supervision standards that are more restrictive and exacting than is common in unlicensed jurisdictions (i.e., no provisions for licensing or independent practice of fitters). I think you will find upon a review of the code of ethics of ABC, BOC, or PFA, that there is an acknowledgement and understanding that, where there is any conflict between practice standards and state law, practitioners must conform their professional activities to the legal requirements in their respective jurisdictions.

3. The Board has, as a separate but clearly related action, suggested an addition to the Definitions section of the Administrative Code rule series, seeking to more clearly articulate the Board's understanding of the requirements of Ohio Revised Code Section 4779.01 (G):
(G) “Pedorthics device” means a custom fabricated or fitted therapeutic shoe, shoe modification for therapeutic purposes, prosthetic filler of the forefoot, or foot orthosis for use from the apex of the medial malleolus and below.

There is a very long series of Ohio court decisions that instruct state agencies to apply the plain meaning of plain language within the revised code whenever that language is apparently capable of "reasonable person" understanding. Proceeding from that principle, the Board has proposed the following language to be added to the Definitions section of the rules:

The phrase "for use from the apex of the medial malleolus and below" means that the pedorthic device does not physically extend proximal to the apex of the medial malleolus, meaning not extending higher than the middle of the ankle bone.

4. It is helpful to have an understanding as to where the profession may be headed in terms of educational scope and initiatives, and I appreciate the information you are able to provide in this regard.

5. A new "Medical Board Member" has just been appointed to serve on the Board, and the Board looks forward to her constructive input on professional practice issues such as this.

6. The rules promulgation process is detailed in the document linked here: http://opp.ohio.gov/pdf/OPPrulemaking.pdf

Having said all that ... again, thanks for taking the time to express your concerns. Feel free to follow-up this email with further thoughts, or give me a call to discuss as well.


Mark B. Levy
Board Director
State Board of Orthotics Prosthetics and Pedorthics
77 S. High St., #`1854
Columbus, OH 43215-6108
tel: 614-466-1157
fax: 614-387-7347
http://opp.ohio.gov/

A personal story

Accreditation, Licensure, Certification, Pedorthists, Orthotists, Prosthetists,
Competitive Bidding, CMS, DMEPOS, HIPAA, ABC, BOC, PFA, KPFA.....
Whoooa! What is the acronym for Whooa! Stop! Wait a Minute!
I'm scratching my head, but I think I am catching up......! What am I
doing? I'm not a politician. I'm not a teacher! I'm not a secretary! I'm
not a treasurer! I'm not a lawmaker, judge or jury.... What am I doing here?
I am a Certified Pedorthist in the state of Kentucky.
Why am I involved in all of these other professions?
Because I believe in helping my patients and providing the best care possible.
To create and continue that trust and confidence that my patients have in
me and where I work, I must stand up for what is right in our state legislation.
I must teach and present to the patient with diabetes, the material
needed on how to properly care for their feet. I must teach other clients how
to comply with proper support in footwear ranging from custom orthotics to
therapeutic shoes. I must interact with other C.Peds in KY to stay on top of
pedorthic education in order to provide the best patient care and to expect the
best patient outcomes.
What better way to keep in touch than to take Minutes at each KPFA
meeting and communicate any necessary information to all other Kentucky credentialed pedorthists!!
Sometimes these meetings involve discussion of happenings in our
Pedorthic worlds. Sometimes we meet and experience heartfelt, genuine discussions
regarding the future of Pedorthics in this state.
When a client has come to you and you do the best you can and they come
back in 2 weeks for that follow-up appointment and say Thank You, you
know it's all worthwhile.
So, why do you do what you do??

Cindy Mattingly Cped/BOCpedorthist
Shoe Stop Clinic
Owensboro KY

Letter from Michael D. Veder, LO, LPed to Mark Levy

March 28, 2008

 

Dear Mr. Mark Levy,

Recently, I became aware of some opinions of the Board and suggested changes to the language of the OPP Licensure Bill.  Both of these items are concerning from several standpoints and I would like to clarify the inaccuracies.

 

First of all, it may be beneficial for the Board to have a clear understanding of the course curriculum currently being taught for pedorthic education.  For example, Temple University and Oklahoma State University in conjunction with the PFA curriculum provide Sub Talar Control Orthoses, as well as Ankle Foot Orthoses education and both of these devices extend proximal (above) to the ankle.  Therefore, it is not necessary to restrict the scope of practice for Pedorthists because they are competently taught how to design and dispense these appliances.

 

Secondly,   no objective evidence has been presented to support the current scope of practice limitation. The limitations have a distinct feel of restraint of trade.  A logical person would therefore assume that this is a politically driven agenda.  In addition, it appears that the Board does not have an impartial Medical Director Representative to bring an unbiased objective view.

 

Thirdly, to continue this narrow scope will distinctly limit Ohio citizens’ access to care that they deserve. Obviously, this limited accessibility is not in the patients’ best interest.

 

Your thoughtful consideration of these points is appreciated. Please let me know how I can support the change.

 

Sincerely,

 

 

Michael D. Veder, LO, LPed,

PFA, Board Member

937-336-2000

gaitwell@yahoo.com

Kentucky Licensure

I first heard of licensure in KY and read a copy of the proposed legislation, in Dec 2006. Initially it seemed all inclusive, yet the more I digested the language of the bill and compared it to standards set forth by the federal government I began to see serious problems not just for practitioners but mostly for patients. My first reaction was to dig into other states and see what had happened and what was being proposed. The details of all of these bills initially seemed similar and most people would look over them and say okay they are a lot alike, but their eyes would begin to glaze over when you started to get into the details of the fine print and the legal ramifications.

One of the problems is that people in our profession are mostly craftspeople, not lawyers. And it’s been my experience that most of them are for some type of legislation that protects the patient and elevates the profession. But we must not be like the pioneers who were so thirsty they were willing to drink poison water.

There is a very real danger to the pedorthic profession, and this assertion that “oh you’ll be grand fathered in and your individual practice or business is safe”, is no reason to turn a blind eye and let the profession dry up or be shoved under the bus.

Anyone who has been around long enough knows that historically the scope of practice is developed first by practice surveys (role delineation surveys).

What practitioners are actually doing in their place of business. This information sets the scope and is used to develop the educational requirements to support the profession to patients and to the people who pay us.

BCP did these surveys every five years and it is my understanding that when everything was surrendered to ABC these were part of the package.

However just like the vote count they are never to be seen again. If everything is in the pedorthic best interest and is open and honest lets see them and discuss what is wrong, lets do another one, or anything besides just write up what ABC THINKS it should be. It took more than 100 years to wipe out most of the guilds of the 18^th century, but it is clear that at least one has survived. With closed executive meetings, a self appointed board and everything hidden behind confidentiality agreements you can see why I am at least skeptical about ABC’s intentions.

One need only to go to the Ohio OP&P website http://opp.ohio.gov/new.stm

And read the letter from their chairman of the board to ABC’s executive director and you will see a scary scenario playing itself out in Ohio.

Now if all you want to do is dispense diabetic shoes, then you and the pedorthic representation to ABC are on the same page and you should be okay. But if you are a pedorthist that embraces your full scope of practice as defined by BOC, which is developed by traditional standards and is transparent for all to see, then you had better step up to the plate and make yourself known in the state where you live to legislators before something happens like is happening in KY. Mostly because the one thing ABC has more of than pedorthists is money. And when it comes to a state general assembly, lobbyists are very successful at misinforming legislators and it can take a lot of time to undo misinformation. Especially when they use mutilated vets, and disabled children to make their case.

Now ABC claims to have no “position” in any state practice act, however with one of it’s board of directors spear heading the state licensure movement in KY there is at least reasonable doubt to suspect otherwise.

If you see horse manure in the road, you know there has to be a horse up there somewhere.

I think the case needs to be made that all of the OP&P community is better served by BOC, especially pedorthists. They have the exact same credentials as ABC, but all of their actions are transparent. They have a democratically elected board, their facility accreditation is cheaper, and their leadership and staff are working diligently to give practitioners (customers) what they pay for. Their founder Dr Don Fedder has taken a beating for more than 30 years defending qualified practitioners right to practice and serve a growing population of mobility challenged people. Their current president Greg Safko is just as honorable and is working very hard to protect the professions and to represent us to CMS, as well as to federal and state legislators. And without his help BOC practitioners, especially pedorthists would already be eating grass. BOC sent Dr Fedder to testify, as well Rick Sevier, pedorthic educator at OSU and BOC board member came of his own accord because this bill disturbed him about the future of pedorthics in KY, and the danger of setting a precedent for other states to follow.

As well the PFA has really stepped up to shed light on the facts surrounding the profession that have been misrepresented to legislators. Brian Lagana, PFA’s executive director, has personally made two trips to KY to lend a hand forming the Kentucky Pedorthic Footwear Association, and to testify to the Senate licensing and occupation committee. Randy Stevens PFA president has taken late night phone calls, early morning phone calls and has answered every email promptly to help develop a strategy to protect our interests here. Mike Veder who is also on PFA’s board has made numerous trips to the state capital as well as meeting with the bill’s sponsor at his home to try and dispel some of the half truths and lies supported by the people who wrote the bill. He is a far better diplomat than I. And I appreciate his patience with me.

The bottom line is that CMS (who writes the rules for payment) recognizes BOC and ABC equally and I can only hope that practitioners, not just pedorthists refuse to continue to support (send money) to ABC.

Dennis Hagan BOC pedorthist / cped

Family Shoe

Bardstown KY

familyshoe@alltel.net