What is the right thing to do?

[Morris Gallo]

Hi
As a prosthetist I will tell you what I would do.
You said delivery was in December.  At that time the prosthetist was
entitled to payment.  He finished and delivered the prosthesis.  No one
anticipates the socket not fitting after you begin to use it full time so
it is not reasonable to expect the prosthetist to wait until you know all
possible future problems are resolved.
If the prosthetist made another socket it appears he is making a good faith
effort to correct any deficiencies.  What does concern me is having this
being an ongoing process since 10/00.  If the prosthetist does not have the
expertise or experience necessary to provide you with a comfortable fit he
should have either had another prosthetist see you in his behalf or
referred you to another facility.  My brother and I are both prosthetists,
and with several other prosthetist friends we have network of expertise to
draw upon.  With this system we can solve any problem.  I believe this is a
common practice.  I know that many practitioners ask advise from others on
the professional list.
Finally a plug for my pet peeve, LICENSURE.  If you live in a state with
licensure you have recourse through the license board.  Besides
establishing a minimum level of education and training to achieve licensure
the board develops standards of practice.  This involves financial
procedures, record keeping, warranty, advertising, and patient safety and
satisfaction.  If you live in a state without licensure you will need to
discuss your problem with your insurance carrier or with an attorney.
Best of luck
Morris Gallo, CPO

Esther wrote:

> All -
>
> What do you do when a prosthetist has been paid before completing
> a prosthesis, and it looks like he will not be able to create a
> successful limb?
>
> I've been having a new B/K prosthesis constructed since Oct 2000,
> and the prosthetist is having a lot of trouble fitting me. The
> current socket puts a very painful amount of pressure on the
> fibula head area.  This is the 2nd socket.  One of the problems
> with the previous limb was excessive pressure on fibula head;
> it wasn't this bad in the previous leg, and my prosthetist had
> trouble adjusting to fix that pressure.  "Delivery" was in
> December, when I took leg home with socket #1 and tried to
> walk on it.  I took home socket #2 in Februrary.
>
> My prosthetist has already filed with my insurance company, and
> has received payment.   This is the first limb from this prosthetist
> and they did not tell me their "delivery" and billing policy up
> front.  They assumed I knew because I've been an amputee a long
> time and "everyone does it this way".
>
> My dilemma is this:  my prosthetist has demonstrated trouble with
> relieving pressure on fibula head before.  This socket produces
> more fibula head pain than I've ever had before.  There are
> biomechanical problems with the way I'm walking - excessive hip
> rotation is straining the piriformis muscle.  These biomechanical
> problems are paining the ITB tendon, and are contributing to
> serious lower back pain.
>
> I have no confidence that this prosthetist can create a 3rd socket
> that fill fit well enough, and will be aligned properly.  I am thinking
> about looking for another prosthetist to complete this leg.
>
> What is my position, ethically?  Can I tell the prosthetist to
> give some portion of what he's been paid back to my insurance
> company, keep the liner, sleeve, and foot components, and go
> somewhere else to get the leg completed?  Should I ask him to
> reverse the financial transaction with my insurance company
> and we'll haggle on a fee for his labor so far?  Would it be
> fair to say prosthetist gets zero payment because nothing is
> satisfactory?  Should I just leave the insurance payment already
> made as-is, and negotiate a price with a new prosthetist to
> create a leg using the existing components?  I do not want to
> commit insurance fraud.
>
> I have not been in this situation before.  Does anyone have
> suggestions?
> Thanks, Esther
>
> --  Esther   esther_l at ieee.org    Speaking only for myself.
> If you're not part of the solution, you're part of the precipitate.