Patients of suspended doctor advised to speak with personal physicians

Dr. Michael Kaplan only stopped reusing what were supposed to be single-use only needle guides for prostate and rectal biopsies when they became "too bloody," the Nevada State Board of Medical Examiners revealed in its order suspending Kaplan’s license.

"Staff members have verified that per Dr. Kaplan’s directives, the needle guides were used on an average of three to five times before being discarded after becoming too bloody," reads the order of summary suspension .

That order also discloses that Kaplan admitted to investigative staff and to Food and Drug Administration investigators "he had reused the endocavity needle guides during biopsy procedures."

Why the physician reused the single-use guides, which cost about $10 each, is unknown, said Doug Cooper, the medical board’s executive director.

Dr. Lawrence Sands, chief health officer of the Southern Nevada Health District, said Tuesday that patients who underwent prostate biopsies by Kaplan could be at risk for blood-borne diseases that include HIV and hepatitis C.

The prostate biopsy procedure, often used to test for prostate cancer, is invasive, going through the anus to the rectum.

The needle guides, plastic sheaths through which needles are directed to obtain biopsy material, regularly come in contact with blood and body fluids, which could be passed to another patient if reused.

According to the suspension order, the needle guides would be washed between patients, but the buildup of blood eventually was too much, and the devices would be discarded.

Health district officials announced Wednesday that the time frame when patients of Kaplan were at risk for contracting blood-borne diseases was between Dec. 20, 2010, and March 11, 2011.

Patients of Kaplan who underwent a prostate biopsy during that time period should speak with their physicians about any concerns they may have, district spokeswoman Stephanie Bethel said.

The medical board’s suspension order does not spell out specifically why Kaplan’s patients were only in jeopardy during the three-month time frame, only that "it was discovered … through a joint investigation with the Food and Drug Administration."

But a source familiar with the medical board’s investigation of Kaplan said the time frame was settled on because "it appears that’s when he started using the disposable needle guides for prostate biopsies that are only supposed to be used one time. … If we get any different information in the investigation, those dates will change."

Patients concerned that they could be at risk for diseases that include HIV and hepatitis C were nervous Wednesday.

One patient wasn’t calmed by the time frame issued by authorities.

"My biopsy was done last November," the man, who didn’t wish to be identified, wrote in an e-mail. "I am still very concerned he was already reusing devices then."

A prostate cancer support group, USTOO, will meet at the Nevada Cancer Institute at 7 tonight to discuss the situation, said Tony Crispino, the group’s leader.

"Many of our members are patients of Dr. Kaplan," he said.

Dr. Nicholas Vogelzang, a renowned prostate cancer specialist at Comprehensive Cancer Centers of Nevada who had many patients sent to him by Kaplan, said many men who were battling cancer called Wednesday and asked to get tested for blood-borne diseases immediately.

"It was the same kind of fear brought on by (Dr. Dipak) Desai," Vogelzang said. "This is really sad."

Less than five years ago, more than 40,000 patients at Desai’s endoscopy clinics were notified they had to be tested for hepatitis C and HIV after authorities saw his staffers reusing syringes and single-dose vials of anesthetics.

More than 100 of the clinics’ patients are thought to have contracted hepatitis C, a virus which can be fatal.

Some of Desai’s employees said he reused syringes to save money. The syringes cost only a few cents.

Cooper said the medical board received "dozens of calls" from worried patients of Kaplan on Wednesday. He said he had five staffers poring over patient records "to see who had to be notified."

"We’re doing it as fast as we can so the health district can notify patients," he said.

How the medical board learned of the breach of infection control cannot be disclosed, Cooper said, "because that source will probably be helping us with the investigation down the line."

At this time, no cases of disease transmission have been identified as a result of the infection control breach.

Health district officials will make a formal notification once the process of identifying patients who underwent the procedure is completed and recommendations based on the ongoing investigation are finalized.

Dr. Mitchell Forman, president of the Clark County Medical Society, said it should be simple for medical practitioners to avoid breaches of infection control.

"Single-use only means single-use only," he said.

Contact reporter Paul Harasim at pharasim@reviewjournal.com or 702-387-2908.