The Nevada State Medical Board, which suspended Dr. Michael Kaplan's medical license in March because he reused single-use medical devices in prostate biopsy procedures, reinstated his license Tuesday.
And the board stipulated in its reinstatement order that the urologist, who the board had said stopped reusing single-use needle guides only when they became "too bloody," can once again perform invasive procedures at his office as long as a "third party" health professional is on hand to monitor his infection control efforts.
"We determined through our investigation to this point that the imminent risk to the health, safety and welfare of the public has been ameliorated," said Doug Cooper, the board's executive director. "Dr. Kaplan can immediately see patients without doing invasive procedures, but if he does an invasive procedure, he must be monitored throughout."
The Southern Nevada Health District has notified more than 110 of Kaplan's patients that they need to get tested for HIV and hepatitis. So far, there have been no reports of infection.
Two weeks after the board took its suspension action against Kaplan, a second urologist, Dr. Lawrence Newman, reported himself to the board. Cooper said he, too, incorrectly believed he could sterilize single-use plastic endocavity needle guides.
A source close to the state's infection control efforts said Newman, like Kaplan, told authorities that a vendor had said the plastic needle guides could be used more than once. No board action has been taken against Newman.
Kaplan said Tuesday that he was "excited to be going back to work." Never, he said, did he purposely put patients at risk. A vendor for the equipment, he said, had given him bad information.
"I wasn't trying to cut corners," he insisted. "I never have intended to make any excuses for what I did. It shouldn't have been done. But I want people to know why it happened."
Dominic Gentile, Kaplan's attorney, told the Review-Journal that a Providian Medical Equipment vendor, who was distributing needle guides made by CIVCO Medical Solutions, admitted to his law firm that he told Kaplan that the plastic needle guides could be used more than once. A Providian spokesman issued a statement saying the firm was looking into the situation, which Gentile fears is a national problem.
"This isn't an attempt to justify what was done," Gentile said. "This shouldn't have been done. It's an explanation."
Patients of both Kaplan and Newman questioned why the doctors would listen to a salesman rather than follow what they have been taught throughout their medical careers about single-use devices.
The single-use needle guides, plastic sheaths through which needles are directed to obtain biopsy material, regularly come in contact with blood and bodily fluids, which could be passed to another patient if reused.
Lee Hornstein, a former patient of Kaplan's, was stunned by the board's action.
"I'm dumbfounded," said the 69-year-old retired businessman who got tested for hepatitis and HIV even though the prostate biopsy he received from Kaplan wasn't within the December-to-March time frame in which the board said Kaplan's patients were at risk for blood-borne diseases. "Holy mackerel, the board doesn't even know yet whether people are going to come down with infections. Many people have to get tested again in six months. I guess the board knows something we don't."
Cooper said it is not unusual for the board to reinstate a license until a final disciplinary hearing as long as the board determines the public safety is not currently at risk. For instance, he said an orthopedic surgeon who might have had his license suspended because of repeated problems with a procedure might get his license back pending a final hearing as long as he stipulates to not doing the procedure in question.
"In this case, we were concerned about infection control, and we're confident that has been handled," Cooper said, noting that Kaplan could still face stiff penalties at his disciplinary hearing in about 90 days.
In explaining why the board has taken no action against Newman even though he admitted reusing single-use medical devices on 150 patients over a three-year period, Cooper noted that Newman reported himself to the board, stopped the practice and began notifying his patients.
"These are two different cases," Cooper said.
The monitor who will go to Kaplan's office will be a health care professional "trained in infection control," Cooper said. The monitor must be approved by the board, and Kaplan is responsible for the cost.
The board listed 13 procedures during which a monitor must be present, including prostate biopsies, cystoscopies, catheter placements, vasectomies and removal of scrotal and penile lesions.
Kaplan, who told the R-J that he and his attorney had suggested the idea of a third party monitor to the board, said he wanted the board "to be comfortable that our practices are safe."
A board hearing that was scheduled for today to determine whether Kaplan's summary suspension would stay in effect was canceled after Kaplan agreed to the stipulations of the board.
Gentile said he was impressed that the board acted in a manner that protects both the public and the physician. He said too often public agencies don't act in the interest of fairness but to impress a public that might be clamoring for action that is unfair.
Kaplan said he wanted to make it "crystal clear" that he always thinks about his patients' safety and that he would never do anything to deliberately put them at risk.
Former patient Hornstein said he wonders how many people would want to become patients of Kaplan's because of "his lapse" of professionalism.
"I know he's going to be exceedingly careful, but still," he said, letting his thoughts trail off. "Well, I wish him nothing but the best. After all, he helped start our prostate cancer support group, so he is a good man."
Contact reporter Paul Harasim at pharasim@review journal.com or 702-387-2908.