Florida suspends Miami psychiatrist in boy’s overdose death

Miami Herald
Florida suspends Miami psychiatrist in boy’s overdose death
State health administrators have suspended the license of a Miami psychiatrist who treated a disabled preteen boy who died of overmedication.
BY CAROL MARBIN MILLER
May 13, 2010
State regulators have suspended the license of a South Florida psychiatrist who has treated hundreds of poor and disabled children, saying Dr. Steven L. Kaplan poses “an immediate, serious danger to the health, safely, or welfare of the public.”

In an emergency order, Florida Surgeon General Ana M. Viamonte Ros issued an emergency suspension of Kaplan’s license, saying Kaplan committed “medical malpractice” in his treatment of 12-year-old Denis Maltez, a boy with autism who medical examiners ruled died of an overdose of mental health drugs.

Viamonte Ros’ order comes three weeks after another state department, the Agency for Health Care Administration, booted Kaplan from the state Medicaid program, the insurer for needy and disabled children that had paid many of Kaplan’s bills. Kaplan’s termination from the Medicaid program is effective May 17.

Kaplan, who has yet to file a response to the suspension, did not return three calls Wednesday from a Herald reporter seeking comment. It’s unclear how long the suspension would span.

The suspension of Kaplan’s license takes effect immediately. Kaplan has 30 days to appeal the order, said Eulinda Smith, a Department of Health spokeswoman, and the department has 20 days to initiate disciplinary proceedings by filing a complaint with a Board of Medicine probable-cause panel — which must make a recommendation for discipline to be imposed.

“Dr. Kaplan’s actions in treating Patient DM demonstrate his inability and/or unwillingness to practice medicine in such a way that adequately protects patients who may not be able to protect themselves,” the suspension order states.

The order adds: “Dr. Kaplan’s actions demonstrate such general lack of medical judgment and understanding of his role as a physician that the safety of the public cannot be ensured by any means other than the suspension of Dr. Kaplan’s license.”

Kaplan was the subject of a front-page story in The Miami Herald on April 19 that focused on the May 23, 2007, death of Denis, who weighed 70 pounds but had been prescribed the maximum adult doses of two powerful anti-psychotic drugs.

The Herald reported that the psychiatrist had for years ignored warnings — both in writing and during office visits from state regulators — that his excessive prescribing of psychiatric drugs to children was potentially dangerous.

Kaplan “said he did not find the time to deal with non-important things such as paperwork,” an expert from the University of South Florida sent to Kaplan’s office on May 15, 2009, wrote in a report. “He said he had been practicing long enough to know how to treat his patients and was tired of being told what to do.”

Viamonte Ros’ May 7 order deals primarily with Kaplan’s treatment of Denis, whose autism sometimes resulted in disruptive outbursts. Acting on the advice of state disability administrators, Denis’ mother, Martha Quesada, placed him in a Miami group home called Rainbow Ranch — which regulators shut down in 2007.

According to the order, executed by the state Department of Health:

• Kaplan failed to perform a physical examination of the boy, failed to develop a treatment plan, failed to document the boy’s mental health history and did not conduct a psychiatric assessment.

• Kaplan “made no attempt” to verify information given to him by Rainbow Ranch’s owner that Denis had been abandoned by his mother, and never sought her consent to treat the boy. “Dr. Kaplan unreasonably relied solely on the reports of a virtually unknown non-health care provider for information regarding [Denis'] complex condition and care.”

• Kaplan did not perform blood tests to ensure that Denis was not being harmed by the mental health drugs he prescribed — assuming, instead, that the tests were being done by Denis’ pediatrician. The pediatrician saw Denis only twice a year, and the necessary blood work was never done.

• Though reviewers with the University of South Florida warned Kaplan on July 24, 2006, that his prescribing of mental-health drugs to four children, including Denis, was problematic, “Kaplan did not respond to the notice, nor did he follow-up with [Denis] through laboratory testing, communication with [Denis'] former psychiatrists, or further assessment.”

• Kaplan insisted that he saw Denis in his office on a couple of occasions, but he had no records to document the office visits.

“Dr. Kaplan fell below the standard of care when when he documented only two visits of this patient over a year’s course of treatment,” the order says, noting that Kaplan had, on one occasion in January 2007, written 11 refills for mental-health drugs for Denis.

The Department of Health began an investigation of Kaplan in November 2009, when the agency received a complaint that his treatment of Denis fell “below the standard of care.” Details of the investigation were forwarded to an unnamed department medical expert for review, the order says.

The expert, the order says, agreed that Kaplan’s treatment fell below accepted practices in a host of areas, including record-keeping, conducting a physical exam, medication prescribing, diagnosis and patient care.

“A review of [Denis'] Rainbow Ranch records demonstrates that DM was being mismanaged physically at the ranch, and if Dr. Kaplan had engaged in appropriate and close follow up, it would be reasonable to infer that Dr. Kaplan would have noticed and reported it,” the order states.

Quoting from the agency’s expert, the report added: “A patient that is as medically and psychiatrically complicated as this patient needed to be followed.”

“Dr. Kaplan has demonstrated a disregard for the duties and responsibilities imposed upon a physician practicing in the state of Florida and for the health and welfare of Patient DM,” the order says.

“Dr. Kaplan’s conduct constitutes a breach of the trust and confidence that the state of Florida placed in him by issuing him a license to practice medicine.”

“This breach is particularly compelling in Dr. Kaplan’s case because his failure to meet the standard of care and failureto adequately document justification for his treatment occurred while practicing medicine and treating a vulnerable patient who did not have the ability to ensure his own well-being.”

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