Physician accused of reusing devices has license suspended

Patients who underwent prostate biopsies by Dr. Michael Kaplan could be at risk for blood-borne diseases that include HIV and hepatitis C, the head of the Southern Nevada Health District said Tuesday.

Kaplan is accused of reusing medical devices that were intended for only a single use during the procedures, said Dr. Lawrence Sands, chief health officer for the district.

After a joint investigation by the Nevada Board of Medical Examiners and the Food and Drug Administration's Office of Criminal Investigation, Kaplan's medical license was summarily suspended Monday because "the health, safety and welfare of the public is at imminent risk of harm," said Doug Cooper, executive director of the board.

Health officials aren't sure of the number of patients who might be involved.

"We need to notify patients" to get tested, Sands said.

The investigation of a breach of infection control comes less than five years after Las Vegas was rocked by a hepatitis outbreak stemming from reuse of syringes and single-dose vials of anesthetics.

After a health district investigation of practices at Dr. Dipak Desai's endoscopy center, more than 40,000 of the clinic's patients were notified that they might have been exposed to hepatitis C and HIV, the largest such notification in American history.

"I'm sure the notification will be nowhere near what we did with the Endoscopy Center (of Southern Nevada)," Sands said. "Right now we're not sure about the time frame involved in the present case. Until we get that determined and send the letters off, if people have concerns, they should see their personal physicians."

Kaplan was unavailable for comment Tuesday. He has been practicing medicine in the Las Vegas Valley since 1989, according to his website, which lists a primary office in Henderson and practices in Las Vegas and Boulder City.

Cooper said Kaplan reused endocavity needle guides, the plastic sheath through which needles are directed to obtain biopsy material. The procedure, often used to test for prostate cancer, is invasive, going through the anus to the rectum.

The guides regularly come into contact with blood and bodily fluids, which could be passed to another patient if the guides are reused.

The gravity of the situation was evident Tuesday as representatives of the Centers for Disease Control, the FDA, the Nevada State Health Division and Southern Nevada Health District participated in a conference call in Carson City.

Sands said his agency is working to get information out as soon as possible to patients.

If someone has a blood-borne disease, early treatment is critical, health officials say.

Sands stressed that there is no known outbreak of either HIV or hepatitis in the community. But both diseases often take years to surface. Health officials learned of the outbreak at Desai's clinic because of a few cases of acute hepatitis, but most cases of the virus are chronic and often only become known many years later because of liver disease.

Cooper said the medical board received a complaint but would not say who filed it or how authorities learned of the allegations that guides were being reused. FDA officials did not reply to e-mails asking how they learned of the accusations against Kaplan or whether undercover work was involved in the investigation.

News of the allegations involving Kaplan comes just as the Safe Injections public health campaign has hit the airwaves in Nevada.

That campaign was spawned by unsafe injections given at Desai's clinics. More than 100 of the clinic's patients now are thought to have contracted hepatitis C.

Desai and some colleagues are accused of felonies in the hepatitis outbreak, which still sees many of clinic patients undergoing excruciating anti-viral treatment that is often compared to the worst kind of chemotherapy for cancer.

"What we have here is not an injection, but what we do have is a breach of infection control," Sands said.

Cooper said representatives of the medical board personally served notice on Kaplan of his suspension.

"He had to stop practicing immediately," he said.

Cooper said patient files were taken by the medical board and could be helpful in determining how many patients will have to be notified. He did not say how authorities would know when Kaplan began the behavior that they have alleged.

"I can tell you that it was a relatively short time between when we were notified to his suspension," Cooper said

Cooper said the suspension of Kaplan should not be seen as "an indictment of all urologists who practice in Nevada. This only happened at one practitioner's shop."

It's not clear why Kaplan reused the needle guides, said Cooper, who doesn't know whether it was done to save money.

Several people who worked for Desai said he reused syringes that cost only pennies to save money.

Officials and physicians contacted by the Review-Journal did not know the cost of the needle guides used by Kaplan. Industry officials who make the devices refused to return phone calls.

Companies that make the devices stress they are to be used only one time to contain the spread of infections.

News of what authorities said transpired under Kaplan angered and shocked local doctors.

"Jesus Christ, I can't believe it," said Dr. Joseph Thornton, an associate professor of surgery with the University of Nevada School of Medicine. "You would think one of the last things a medical practitioner would do in this town after the hepatitis outbreak would be to reuse single-use only devices. I'm still hearing people say they won't get a colonoscopy after what happened at Desai's clinics. I can't believe it."

All gynecologic oncologist Nick Spirtos could say was: "Oh, my God. How can this happen?"

Dr. Ronald Kline, president of the Nevada State Medical Association, seemed to find the subject demoralizing.

"If a product is labeled single use, it should be used a single time and be disposed of. ... People take shortcuts that they shouldn't. But we have to remember that this is a single doctor out of 2,500 in Southern Nevada."

According to his website, Kaplan is a board-certified urologist with subspecialty training in urologic oncology. He attended the Baylor College of Medicine in Houston and completed both his internship and residency at Letterman Army Medical Center Presidio of San Francisco.

Kaplan has been a defendant in at least nine medical malpractice cases since 1995, the most recent coming in 2007, according to District Court records.

In that case, a woman sued the doctor after her husband bled to death following a 2006 operation to remove his prostate.

According to the lawsuit, a robot Kaplan used to help in the procedure mistakenly cut an artery and vein, causing massive loss. The case was dismissed two years later after an apparent settlement.

In a 2002 case, a woman sued Kaplan after he operated on the wrong side during a 2001 surgery to fix an obstructed ureter, which connects the kidney to the bladder. During a follow-up surgery two weeks later, he mistakenly punctured the woman's bowel, she alleged.

The woman settled her lawsuit against Kaplan for a total of $1.25 million, according to medical board records.

Contact reporter Paul Harasim at pharasim@reviewjournal.com or 702-387-2908. Review-Journal reporter Brian Haynes contributed to this report.