by Jamil Ragland CTNewsJunkie
HARTFORD, CT – The Public Health Committee heard testimony Monday regarding whether it should move forward on a bill to allow podiatrists to perform certain surgeries.
HB 5196 would revise the scope of practice for podiatrists in the state to perform a broader range of surgical procedures. Proponents of the bill said that allowing podiatrists to perform these procedures would increase access for patients, especially for patients on Medicaid.
Under current law, podiatrists are allowed to perform some types of surgery, but there are several procedures that they are prohibited from attempting. The new law would allow podiatrists to perform surgeries related to total ankle replacements and amputations within the foot. Podiatric doctors are also calling for permission to perform pilon fracture surgery. As it stands now, only orthopedic surgeons are allowed to perform these procedures.
According to a Scope of Practice Review conducted by the Department of Public Health at the request of the Connecticut Podiatric Medical Association (CPMA), 44 states and the District of Columbia allow podiatrists to perform total ankle replacement surgery.
Dr. Kristin Winters, President of the CPMA, spoke in favor of the bill and also called for full foot amputation to be added into the bill.
“Our current amputation law is a proven obstacle to delivering complete care for our patents,” she said. Winters also pointed out that the bill would keep new podiatric doctors in the state.
“This bill will also attract our residents to stay here. We train them, we want them to stay and practice in the state of Connecticut, and help deliver this care for patients. These residents are being trained to replace ankles, coming back to the state, getting board certified, and simply can’t do it here because the law prohibits it,” she said.
Dr. Amanda Fantry, an orthopedic surgeon at St. Francis hospital, questioned the lack of access to ankle replacement as a reason to allow pediatric surgeons to perform the procedure.
“If people are only doing ankle replacements 10 times a year as high volume in the state, there’s not a shortage of people available to do these surgeries,” Fantry said. “I think [orthopedic surgeons] are well-trained in the biomechanics of joint replacements.”
The members of the committee had many questions about the ability and training of podiatrists to perform ankle replacement and other procedures. Sen. Saud Anwar, a South Windsor Democrat who co-chairs the committee and is also a medical doctor, cited a study from January 2022 that found a higher rate of complications after surgery from procedures performed by podiatrists when compared to procedures performed by orthopedic surgeons.
Dr. Winters countered that these studies contained “profound biases” that skewed the results, although she did not elaborate on what those biases were.
Dr. Peter Blume, a podiatric foot and ankle surgeon and podiatric medical director at Yale New Haven health system, pointed out that podiatric doctors who have the expertise to perform procedures must sometimes leave the state to do so.
“I’ve got three podiatrists in the New London country area, they operate at Lawrence Memorial Hospital. When they are going to perform the ankle replacement procedure, they have to take the patient to Rhode Island. This must stop. We should be able to provide this care to our community and these populations in the state of Connecticut,” Blume said.
The Scope of Practice Review that was conducted by the Department of Public Health did not reach any consensus on whether podiatric surgeons should be permitted to perform any currently prohibited procedures.
Looney Testifies In Favor Of Two Bills
Senate President Pro Tempore Martin Looney, D-New Haven, testified in favor of two bills during Monday’s hearing.
Senate Bill 180, “An Act Concerning Adverse Determination And Utilization Reviews,” would require that health carriers implement a utilization review plan to determine whether their decisions to deny benefits or coverage, known as an adverse determination, are clinically sound.
Looney testified that SB 180 “would provide a number of innovative protections for patients” and “would benefit all parties involved and make our healthcare system more effective.”
Senate Bill 182 would prevent insurance companies and other health carriers from requiring step therapy “to treat a mental or behavioral health condition or a chronic, disabling or life-threatening condition.”
“While there may be legitimate uses of step therapy, too often it is implemented in a manner that interferes with patient care and leads to insurers preventing physicians from providing the best care for patients,” Looney said.
“SB 182 would ensure that the physician is able to provide the best treatment for patients who have disabling conditions as well as cancer and behavioral health conditions. It would improve the lives of many of our citizens,” he said in a statement.