A Closer Look At Scope Of Practice Battles In South Carolina

Michelle L. Butterworth DPM FACFAS

While I enjoy living in South Carolina, I do not enjoy its limited scope of practice for podiatry.

I did a four-year residency, which involved reconstructive rearfoot and ankle procedures, foot and ankle trauma, and limb salvage. I moved to South Carolina immediately after residency and have been here for 10 years now. I do not want to sound naïve. I knew the limitations of the state’s scope of practice before I moved and I chose to move to South Carolina regardless. I did however have high hopes — even though I knew it would be a tough battle — that our state law would eventually be changed so I could utilize the full extent of my surgical training.

Ten years have passed and our state law is exactly the same. This is not from lack of effort. South Carolina has been working effortlessly to change our scope of practice act before I even arrived in the state. In fact, our practice act has not been changed since the 1970s.

In 2006, a bill submitted to change our scope of practice to allow us to perform ankle surgery and amputations failed once again. It actually passed through the state House but subsequently failed when it was reviewed by a state Senate subcommittee comprised of only three people. (Actually, only two subcommittee members were present for the vote.) After many man hours, multiple people traveling to the state capitol countless times, several conference calls, numerous e-mails and significant time out of the office, we were right back at the starting line and significantly poorer.

We now have a new lobbyist and are trying once again to change our scope of practice. Last week, many of us traveled to Columbia, S.C. once again to testify in front of the House 3M (Medical, Military, Public and Municipal Affairs) subcommittee in hopes of passing our bill at this initial level so it could then go in front of the full 3M committee for approval. After we waited all afternoon, the subcommittee cancelled the meeting because the House was still in session and time had run out.

The meeting was rescheduled for April 29 and only two out of five of our speakers originally scheduled to testify were available to attend. There was exactly one hour available for the entire agenda of the 3M subcommittee. Our bill was only one of several items on the agenda.

When our bill was called, the chairman of the subcommittee called an opponent of our bill to come forward and speak. After about 5 to 10 minutes, he was cut off and asked several questions. The chairman then called forward someone to speak in favor of our bill. Again, after about 5 to 10 minutes, the speaker was cut off and was asked several questions. No further speakers were allowed to come forward due to a lack of time. The subcommittee chairman then instructed both sides to meet sometime next week to see if a compromise regarding our bill could be met.

We have yet to schedule a time where representatives from both sides are available. This will be the third week in a row many of us have traveled hours from our communities to the state capitol to fight for this bill. It is a very rigorous and tiring process that requires commitment and support from all state members. Unfortunately, we are few in numbers and few in dollars. I urge all practicing podiatrists in South Carolina to get involved and come forward to help fight our bill.

There are currently 44 states in the country enjoying the scope of practice that we desire in South Carolina. Congratulations to those states who have recently won victories with their scope of practice battles. Hopefully, someday soon we will be with the majority as well.

Let us take the scope of practice out of the hands of the state lawmakers and put it where it belongs: into the hands of those that can evaluate our individual education, training, and experience.

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