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ACA’s Paddy Rossbach,RN: Consumer Expert Airs Views
By Miki Fairley Paddy Rossbach, RN, president and CEO of the Amputee
Coalition of America (ACA) knows what to look for in a
prosthetist.
 As a registered nurse, Rossbach is familiar with
the healthcare arena, and since 1984 she has specialized in
educating, supporting, and advocating for persons with amputations
or born with limb differences. She also consults for Landmine
Survivors Network (LSN), traveling to its network countries and
teaching outreach workers about peer visitation. She has been an
amputee since the age of six, but this has not slowed her down. She
has competed in marathons, horsemanship events, and she skis and
scuba dives. Having studied the effects of an aerobic conditioning
program on the energy cost of amputees at The Hospital for Special
Surgery in New York, New York, she co-founded and is the president
of ASPIRE Inc., a nonprofit organization which encourages young
amputees to be active through sports.
"As an educated consumer, I would look for someone who is
currently certified or state-licensed," says Rossbach. "I would
look for someone with a clean, accessible facility and friendly,
people-oriented staff." She also would ask to meet some of the
prosthetist's clients who have a similar amputation to see if they
were comfortable, happy with the care received, and able to have
the function they wanted.
Having a good personal relationship with the prosthetist and
feeling comfortable and confident with him or her are also
essential, Rossbach believes. "Just because somebody can fit you
doesn't mean you can have a good relationship with them for the
rest of your life. You have to be able to interact and communicate
with them and feel they are listening to you. You have to feel sure
that what they are telling you is correct."
Rossbach is appreciative of the quality of care she has
received, but painfully realizes that not everyone is able to have
the same high standard of care. "Because I've had really good care,
I have been able to achieve what I want to do and stay as healthy
as I am. But I look at some other people and see that they are not
getting that sort of care, so their outcome is going to be far
different than mine."
Consumers: Know Your Options
Rossbach continues, "Like any other profession, there are
excellent prosthetists and some that are not so good. That's why
it's so important for patients to make an educated choice regarding
their prosthetist."
Rossbach does not agree with the idea of a prosthetist simply
being brought into the hospital to fit that patient. "If that
person is the best one for the job, then that's okay, but if not,
the patient needs to be aware of their option to have someone
else." With elective amputations, Rossbach encourages patients to
arrange in advance for a prosthetist of their choice. Not only is a
good patient-prosthetist relationship important, but with the
difficulties of insurance coverage, if the patient receives an
uncomfortable, ill-fitting prosthesis, he or she may not be able to
obtain another one in a timely way.
How common are ill-fitting prostheses? "You just have to look
around at some of our meetings and see some of the prostheses,
which are not aligned and fitted correctly," says Rossbach. "You
hear about people that have four prostheses in their closets before
they finally find someone who fits them correctly and
comfortably."
Of course, an enormous limiting factor for amputees is the
extent of their insurance coverage. Prosthetic and orthotic
coverage often is something people are unaware of until they need
it. "A good facility will be able to give them an answer regarding
what their insurance will cover and what they will have to pay
out-of-pocket," says Rossbach. And insurance coverage can be a
determining factor in choice of prosthetist-for instance, is their
provider of choice in or out of the provider network used by the
insurer?
Often, amputees find themselves feeling lost, especially if the
amputation is a sudden, unexpected one due to accident or other
injury. Rossbach recalls a time when she talked to an amputee who
was given no help at all after leaving the hospital. The amputee
looked for a prosthetist in the Yellow Pages. "That turned out to
be disastrous," remembers Rossbach. "That is why we are trying to
get our Because We Care program into hospitals, so
patients and parents with limb-deficient children will have the
information they need at the right time. Thus, they will not be
floundering or simply going to the prosthetist contracted with the
hospital."
Prosthetic Parity Laws
The ACA, along with other advocates, is striving to achieve
prosthetic parity laws in all states. The ACA defines "prosthetic
parity" as "insurance companies covering appropriate prosthetic
care."
Discussing prosthetic parity, Rossbach says, "Right now we are
working very hard, but it's going to be a very long, difficult
struggle. It's certainly not going to happen this year." Currently,
three states have passed slightly different versions of a parity
law based on Colorado's experience, and several more are in the
process of getting bills introduced, notes Rossbach.
On its website, www.amputee-coalition.org, the ACA provides
updates on what's happening with prosthetic parity legislation in
the various states and a Prosthetic Parity Law State Organizer's
Toolkit, which can be downloaded in PDF format. For more
information, visit http://www.amputee-coalition.org/aca_advocacy_stateparity.html.
Improving Prosthetic Care
To help elevate the prosthetic profession and standards,
Rossbach says, "First of all, I think they need to unify, if they
want to be thought of as professionals on a level with other
healthcare providers, and stop fighting amongst themselves when
they could be spending their time trying to do a better job.
"There needs to be a better way of assessing their skills before
they are let out into the field than is being done at present," she
adds. "They need to continue their training; it is a very
specialized field. It's not just a matter of book learning; it's
definitely a very hands-on profession."
'Team Approach Best'
Rossbach is a strong proponent of the team approach to
amputation and rehab care. "Each member of the team should
understand the role and responsibilities of the others, and someone
needs to be in charge of the program to see that each part takes
place, and that a patient doesn't get dropped through the cracks.
Everyone needs to know what everyone else is doing-and that doesn't
always happen. Sometimes the different disciplines act in
isolation: for instance, the surgeon does his job, and that's it.
Then someone else picks up the physical therapy, and that's the end
for them. Then the prosthetist works with the patient for awhile,
and then finds another physical therapist to do the gait
training.
"But it should be one long seamless plan of care," she
declares.
Rossbach emphatically stresses the need in elective amputation
and, if possible, in traumatic amputation, for the surgeon and
prosthetist to discuss and work together to coordinate surgery and
prosthetic fitting. For instance, she says, "It's too late three
weeks later to say, 'If the limb length were longer or shorter, I
could put much better componentry on this patient, etc.'"
The prosthetists doing the best jobs are the ones who have a
good relationship with the surgeons who refer patients to them, she
believes. "They interact together so that each one respects the
other's job and is able to do a program of care that is best for
the patient."
Physical therapists too need to know enough about prosthetics to
help the patient best use their new limbs, says Rossbach. "They
don't need to know how to build or adjust them, but they do need to
know when a prosthesis is fitting, not fitting, or needs
realignment or other adjustment, so they can call this to the
attention of the prosthetist."
A problem Rossbach see with various members of the rehab team is
that other disciplines frequently know little about prosthetics.
"Unfortunately, healthcare providers get most of their education
about amputation in their initial training. Amputees make up a
small percentage of their practice, and they don't get continuing
education in up-to-date technology and techniques." She cites the
situation in which a new amputee may have a physical therapist say,
"Oh, I'm so happy I'm going to rehab you! I've never rehabbed an
amputee before, and this is so exciting for me!"
"Well, I wouldn't want someone learning on me!" Rossbach
exclaims.
Encouraging Others
Although recognizing current problems in insurance coverage,
prosthetic care, and other challenges amputees must confront,
Rossbach is upbeat. She encourages other amputees: "Amputation can
either destroy you or you can make it work for you. You are not
defined by the fact you have lost a limb. You are defined by what
you make of your life with what you have." 
Table Of Contents - August 2005
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