S T A T E O F N E W Y O R K ________________________________________________________________________ 4600--A 2015-2016 Regular Sessions I N S E N A T E March 30, 2015 ___________ Introduced by Sens. LIBOUS, PARKER -- read twice and ordered printed, and when printed to be committed to the Committee on Higher Education -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the education law, in relation to making technical changes to the scope of the practice of podiatry THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: 1 Section 1. Subdivisions 1 and 2 of section 7001 of the education law, 2 subdivision 1 as amended by chapter 23 of the laws of 2013 and subdivi- 3 sion 2 as amended by chapter 438 of the laws of 2012, are amended to 4 read as follows: 5 1. The practice of the profession of podiatry is defined as diagnos- 6 ing, treating, operating and prescribing for any disease, injury, 7 deformity or other condition of the foot, THE DIAGNOSING, TREATING, 8 OPERATING OR PRESCRIBING FOR CUTANEOUS CONDITIONS OF THE ANKLE TO THE 9 LEVEL OF THE TIBIAL TUBEROSITY, and may include performing physical 10 evaluations in conjunction with the provision of podiatric treatment. 11 THE PRACTICE OF PODIATRY SHALL NOT INCLUDE THE FOLLOWING TREATMENTS OR 12 PROCEDURES PERFORMED ABOVE THE LEVEL OF THE MALLEOLI, UNLESS OTHERWISE 13 PROVIDED: THE TREATMENT OF MELANOMA; PERFORMANCE OF MOHS SURGERY; MUSCLE 14 FLAPS OR MICROVASCULAR ANASTAMOSES. For the purposes of wound care 15 however, the practice of podiatry shall include the treatment of such 16 wounds if they are [contiguous with] RELATED TO A CONDITION OF THE FOOT 17 OR ANKLE TO THE LEVEL OF THE TIBIAL TUBEROSITY OR ARE wounds relating, 18 originating or in the course of treatment of [a wound on] the foot OR 19 ANKLE TO THE LEVEL OF THE TIBIAL TUBEROSITY within the podiatric scope 20 of practice. Wound care shall not, however, extend beyond the level 21 ending at the distal tibial tuberosity. The practice of podiatry may 22 also include diagnosing, treating, operating and prescribing for any 23 disease, injury, deformity or other condition of the ankle and soft EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD05334-05-5 S. 4600--A 2 1 tissue of the leg below the tibial tuberosity if the podiatrist has 2 obtained an issuance of a privilege to perform podiatric standard ankle 3 surgery or advanced ankle surgery in accordance with section seven thou- 4 sand nine of this article; PROVIDED, HOWEVER, THAT SUCH PRIVILEGE SHALL 5 NOT BE REQUIRED FOR THE DIAGNOSING, TREATING, OPERATING OR PRESCRIBING 6 FOR CUTANEOUS CONDITIONS OR WOUND CARE TO THE LEVEL OF THE TIBIAL TUBER- 7 OSITY OF THE ANKLE. Podiatrists may treat traumatic open wound fractures 8 only in hospitals, as defined in article twenty-eight of the public 9 health law. For the purposes of this article, the term "ankle" shall be 10 defined as the distal metaphysis and epiphysis of the tibia and fibula, 11 the articular cartilage of the distal tibia and distal fibula, the liga- 12 ments that connect the distal metaphysis and epiphysis of the tibia and 13 fibula and talus, and the portions of skin, subcutaneous tissue, facia, 14 muscles, tendons, ligaments and nerves at or below the level of the 15 myotendinous junction of the triceps surae. 16 2. The practice of podiatry shall not include treating any part of the 17 human body other than the foot, nor treating fractures of the malleoli 18 or cutting operations upon the malleoli unless the podiatrist obtains an 19 issuance of a privilege to perform podiatric standard ankle surgery or 20 podiatric advanced ankle surgery OR UNLESS OTHERWISE PROVIDED IN SUBDI- 21 VISION ONE OF THIS SECTION. Podiatrists who have obtained an issuance of 22 a privilege to perform podiatric standard ankle surgery may perform 23 surgery on the ankle which may include soft tissue and osseous proce- 24 dures except those procedures specifically authorized for podiatrists 25 who have obtained an issuance of a privilege for advanced ankle surgery. 26 Podiatrists who have obtained an issuance of a privilege to perform 27 podiatric advanced ankle surgery may perform surgery on the ankle which 28 may include ankle fracture fixation, ankle fusion, ankle arthroscopy, 29 insertion or removal of external fixation pins into or from the tibial 30 diaphysis at or below the level of the myotendinous junction of the 31 triceps surae, and insertion and removal of retrograde tibiotalocalcan- 32 neal intramedullary rods and locking screws up to the level of the 33 myotendinous junction of the triceps surae, but does not include the 34 surgical treatment of complications within the tibial diaphysis related 35 to the use of such external fixation pins. Podiatrists licensed to prac- 36 tice, but not authorized to prescribe or administer narcotics prior to 37 the effective date of this subdivision, may do so only after certif- 38 ication by the department in accordance with the qualifications estab- 39 lished by the commissioner. The practice of podiatry shall include 40 administering only local anesthetics for therapeutic purposes as well as 41 for anesthesia and treatment under general anesthesia administered by 42 authorized persons. The practice of podiatry by any licensee shall not 43 include partial or total ankle replacements nor the treatment of pilon 44 fractures. 45 S 2. Subdivision 1 of section 7009 of the education law, as added by 46 chapter 438 of the laws of 2012, is amended to read as follows: 47 1. For issuance of a privilege to perform podiatric standard ankle 48 surgery, as that term is used in subdivision two of section seven thou- 49 sand one of this article, the applicant shall fulfill the following 50 requirements: 51 a. Application: file an application with the department; 52 b. License: be licensed as a podiatrist in the state; 53 c. Training and certification: either: 54 (i) have graduated on or after June first, two thousand six from a 55 three-year residency program in podiatric medicine and surgery that was 56 accredited by an accrediting agency acceptable to the department, and be S. 4600--A 3 1 certified in reconstructive rearfoot and ankle surgery by a national 2 certifying board having certification standards acceptable to the 3 department; or 4 (ii) have graduated on or after June first, two thousand six from a 5 three-year residency program in podiatric medicine and surgery that was 6 accredited by an accrediting agency acceptable to the department, be 7 board qualified but not yet certified in reconstructive rearfoot and 8 ankle surgery by a national certifying board having certification stand- 9 ards acceptable to the department, and provide documentation that he or 10 she has acceptable training and experience in standard or [advance] 11 ADVANCED midfoot, rearfoot and ankle procedures that has been approved 12 by the department; or 13 (iii) have graduated before June first, two thousand six from a two- 14 year residency program in podiatric medicine and surgery that was 15 accredited by an accrediting agency acceptable to the department, be 16 certified in reconstructive rearfoot and ankle surgery by a national 17 certifying board having certification standards acceptable to the 18 department, and provide documentation that he or she has acceptable 19 training and experience in standard or advanced midfoot, rearfoot and 20 ankle procedures that has been approved by the department; 21 d. Fees: pay a fee to the department of two hundred twenty dollars for 22 the issuance of a privilege to perform podiatric standard ankle surgery. 23 S 3. Section 7010 of the education law, as added by chapter 438 of the 24 laws of 2012, is amended to read as follows: 25 S 7010. Ankle surgery limited permits. 1. A limited permit to perform 26 podiatric standard ankle surgery, as described in subdivision two of 27 section seven thousand one of this article, may be issued by the depart- 28 ment to a podiatrist who is licensed pursuant to this article and who 29 has met the residency and board qualification/certification requirements 30 set forth in subdivision one of section seven thousand nine of this 31 article in order to authorize such podiatrist to obtain the training and 32 experience required for the issuance of a podiatric standard ankle 33 surgery privilege pursuant to subdivision one of section seven thousand 34 nine of this article. Such permits shall authorize the performance of 35 podiatric standard ankle surgery only under the [direct personal] super- 36 vision of a licensed podiatrist holding a podiatric standard ankle 37 surgery privilege or a podiatric advanced ankle surgery privilege issued 38 pursuant to section seven thousand nine of this article or of a physi- 39 cian licensed pursuant to article one hundred thirty-one of this title 40 and certified in orthopedic surgery by a national certifying board 41 having certification standards acceptable to the department. 42 2. A limited permit to perform podiatric advanced ankle surgery, as 43 described in subdivision two of section seven thousand one of this arti- 44 cle, may be issued by the department to a podiatrist who is licensed 45 pursuant to this article and who has met the residency and board certif- 46 ication requirements set forth in subdivision two of section seven thou- 47 sand nine of this article in order to authorize such podiatrist to 48 obtain the training and experience required for the issuance of a podia- 49 tric advanced ankle surgery privilege pursuant to subdivision two of 50 section seven thousand nine of this article; PROVIDED, HOWEVER, THAT 51 BOARD QUALIFICATION SHALL BE DEEMED TO SATISFY THE CERTIFICATION 52 REQUIREMENTS SET FORTH IN SUCH SECTION FOR PURPOSES OF THIS SUBDIVISION. 53 Such permits shall authorize the performance of podiatric advanced ankle 54 surgery only under the [direct personal] supervision of a licensed 55 podiatrist holding a podiatric advanced ankle surgery privilege issued 56 pursuant to subdivision two of section seven thousand nine of this arti- S. 4600--A 4 1 cle or of a physician licensed pursuant to article one hundred thirty- 2 one of this title and certified in orthopedic surgery by a national 3 certifying board having certification standards acceptable to the 4 department. 5 3. For the purposes of this section, [direct personal] supervision 6 means supervision of procedures based on instructions given directly by 7 [the supervising] A LICENSED podiatrist HOLDING A PODIATRIC STANDARD OR 8 ADVANCED ANKLE SURGERY PRIVILEGE or physician who [remains in the imme- 9 diate area where the procedures are being performed] IS IMMEDIATELY 10 AVAILABLE TO FURNISH ASSISTANCE AND DIRECTION THROUGHOUT THE PERFORMANCE 11 OF THE PROCEDURE, authorizes the procedures and evaluates the procedures 12 performed by the holder of the limited permit OR WITH THE APPROVAL OF 13 THE CHAIR OF THE ORTHOPEDIC OR SURGERY DEPARTMENT OF THE HOSPITAL AT 14 WHICH THE PROCEDURE WILL BE PERFORMED. 15 4. The holder of a limited permit issued pursuant to this section 16 shall perform podiatric ankle surgery only in a hospital or health 17 facility licensed pursuant to article twenty-eight of the public health 18 law and appropriately authorized to provide such surgery. 19 5. Limited permits shall be issued for a period of one year, and may 20 be renewed for additional one year periods when necessary to permit the 21 completion of the training and experience required to obtain a podiatric 22 standard ankle surgery privilege or podiatric advanced ankle surgery 23 privilege, as applicable, provided that no permit may be renewed more 24 than four times for each such privilege. 25 6. The fee for a limited permit shall be one hundred five dollars and 26 the fee for a renewal shall be fifty dollars. 27 S 4. This act shall take effect immediately.