Paddy Rossbach, RN, president and CEO of the Amputee Coalition of America (ACA) expressed ACA's views to the Negotiated Rulemaking Committee in a public statement April 7. The Negotiated Rulemaking (NegReg) Committee is charged with assisting Health & Human Services (HHS) Secretary Tommy Thompson in implementing the qualified provider provisions of the Benefits Improvement & Protection Act (BIPA). Here are some highlights from her statement. In my more than 45 years practicing as a licensed registered nurse, and 59 years as an amputee, I have never encountered a physical or occupational therapist who either wished, or felt that they were trained, to fit and fabricate prostheses. Each individual on [the rehabilitation] team has a unique skill for which they have been trained. It is the combination of those skills that leads to a successful outcome for the amputee. However, the surgeon must have a basic understanding of prosthetics and a close relationship with a prosthetist so that he or she can make an educated decision about the type of surgery or placement of incision to ensure a positive prosthetic outcome. In the same way, physical and occupational therapists must have a basic understanding of how prosthetic components work so that they can train the amputee in their use. But that basic knowledge in no way prepares them to make the prosthesis. Of course there is a common path in the education process. As a nurse I also studied anatomy, physiology, surgical techniques etc, but does that qualify me to be a surgeon?&Today, with the tremendous advances in techniques and technology, healthcare providers are becoming more and more specialized even within their own field of expertise and certainly would not want to practice outside of that field&.How many of you know that many amputees expend two and one-half times the energy of someone without an amputation to walk at half the pace, and, although there are many reasons for this, several are simply due to poor fit and alignment of the prosthesis? Fabricating a prosthesis is not just a matter of putting a few components together like a tinker toy&Prosthetics is a very specialized field, the practitioner must be able to clinically assess each individual's specific physical and emotional needs at a particularly vulnerable time in their life. They must recommend care and technology-appropriate prosthetic components, and in addition, must design, fabricate, fit and maintain increasingly complex artificial limbs that will maximize the amputee's current and potential physical needs and activity level&we all have the need to be as active as possible, as it is well documented that people living sedentary lifestyles are at risk for a range of secondary conditions which include: obesity, diabetes, the loss of a further limb, cardiovascular disease, depression, back pain, and even some forms of cancer&to be active we must have access to comfortable, technology-appropriate prostheses. While I have the greatest respect for the work of physical and occupational therapists in fact I firmly believe that a successful outcome for amputees is as much due to the prosthetic rehabilitation carried out by these individuals as it is to the work of fabricating and fitting a prosthesis by the prosthetists I do not believe they have the knowledge or the training to successfully fabricate and fit artificial limbs&I, [along with] many others in this room today, am an example of what can be achieved with appropriate care and technology. I trained as a nurse, specialized in the OR, where I frequently pulled double shifts, on my feet for 16 hours at a time. I ski, scuba dive, run marathons, show horses, and recently learned to rollerblade. I am a fully functional, wage-earning, taxpaying human being--because I have benefited from the best of care&I believe everyone should have the same opportunity&Losing a limb is indeed a tragedy, but not being cared for by a healthcare professional trained to perform a specific intervention, such as surgery, prosthetics, rehabilitation, etc., is a far greater tragedy, and one that is completely avoidable. For more information visit www.amputee-coalition.org.
