Florida Medicaid ousts psychiatrist who prescribed high doses of psychiatric drugs to child who died of toxicity

April 20, 2010

State healthcare regulators have booted from the state Medicaid program a Miami psychiatrist who had prescribed a cocktail of potent mental health drugs to an autistic, 12-year-old boy who later died of complications from over-medication.

The Florida Agency for Health Care Administration, which oversees the state Medicaid program for the needy and disabled, has notified Dr. Steven L. Kaplan that he has been terminated from the insurance program effective May 17, said Tiffany Vause, an agency spokeswoman in Tallahassee.

Vause said Kaplan, like all Medicaid providers, had signed a ``voluntary contract'' with the state. ``The agency elected to terminate the agreement as it was believed to be in the interest of the program to do so.''

``We will be working to ensure a smooth transition of care for his patients,'' Vause added.

Kaplan declined to speak with a Miami Herald reporter Tuesday.

Kaplan, who treats about 800 patients -- most of them disabled or impoverished children -- was the subject of a report in The Herald on Monday. The story said administrators at three state agencies had expressed concerns about Kaplan's prescribing of psychiatric drugs to disabled children before and after the May 23, 2007, death of 12-year-old Denis Maltez.

Denis, who weighed 70 pounds, had been on three different mental health drugs, two of them in the maximum dose, at the time he died, a consultant for the state Agency for Persons with Disabilities wrote.

``In combination, all three of these agents have additive effects as a central nervous system depressant,'' the consultant, psychiatrist Jorge J. Villalba, wrote. The drugs, he added, ``may have been contributing factors in the client's death.''

The Miami-Dade Medical Examiner's Office attributed the boy's death to Serotonin Syndrome, also called Serotonin Toxicity, which can occur when an excess of medications causes the body to produce too much serotonin, a chemical that helps brain and nerve cells to function.

Over the past few years the University of South Florida, acting on behalf of the state healthcare agency, had sent Kaplan several letters suggesting he reconsider his prescribing practices. ``He said he had been practicing long enough to know how to treat his patients and was tired of being told what to do,'' a pharmacist working for USF wrote following a visit to Kaplan's office in May 2009.

Most affected by Kaplan's termination will be clients of Florida's Agency for Persons with Disabilities, many of whom have been treated by him.

Melanie Etters, an APD Tallahassee spokeswoman, said the healthcare agency will be notifying Kaplan's patients that he will no longer be able to receive Medicaid payments.

``APD will also let [disability caseworkers], residential providers, and Family Care Council members know about Dr. Kaplan's termination as a Medicaid provider. We will also let them know of other psychiatrists serving the Miami area,'' Etters wrote in an e-mail to The Herald.

``APD is supportive of this reasonable and responsible action by our sister agency to protect the health and safety of the people we serve,'' Etters added.

Martha Quesada, Denis' mother, declined to speak with a Herald reporter Tuesday. Quesada's lawsuit against the psychiatrist still is pending in Miami-Dade circuit court.

``Unfortunately, Florida has no procedure to protect the patients of physicians who write behavioral health care prescriptions that exceed thresholds and who blatantly ignore the `red flag' letters from the University of South Florida Medicaid Drug Therapy Program,'' said Quesada's attorney, Howard Talendfeld.

``Nor does the state tell the parents or guardians of mentally disabled persons or foster children that these drugs prescriptions may be dangerous or monitor whether or not the physicians obtained informed consent from them.''