A Salinas urologist under federal investigation is also facing possible sanctions by the California Medical Board over a separate issue.
Dr. Aytac Apaydin, co-owner of Salinas Valley Urology Associates, is accused of failing to realize he left a wire in a patient's bladder despite a radiologist's CT scan report identifying the problem. The man complained of severe pain and urinary bleeding for eight months before a doctor in Arizona discovered the error and removed the wire, according to the state complaint.
The man sued Apaydin in Monterey County Superior Court, reaching an undisclosed settlement a year ago. He also reported the incident to the California Medical Board, which investigated and filed a formal accusation seeking suspension or revocation of Apaydin's license in August 2011.
In seeking serious discipline, the medical board noted that Apaydin was publicly reprimanded in May 2008 for allegedly altering a patient's records and failing to inform him of the effects of Lupron, a hormone drug often used to treat prostate cancer that can cause severe hot flashes.
The latest action has not gone to trial. Deputy Attorney General Lynne Dombrowski, who is prosecuting the case for the medical board, said she is expecting a "decision" fairly soon. Such cases often are resolved without a trial.
Apaydin and other doctors who practice at Salinas Valley Urology are simultaneously being federally investigated over some of their business practices. A spokeswoman
for the Office of the Inspector General at the U.S. Department of Health and Human Services confirmed the investigation but declined to discuss its nature or status.The Inspector General's Office is responsible for eliminating fraud and abuse in Medicare, Medicaid and other programs.
A Nov. 6 report by Bloomberg News said the inspector general is examining whether the doctors at the Salinas clinic, which includes a surgery center, radiation facility and pathology lab, are violating laws that prohibit physicians from referring patients for treatments chiefly for profit. Particularly at issue, the article said, is intensity-modulated radiation therapy, or IMRT, a treatment for prostate cancer.
In addition to Apaydin, co-owner Dr. Stephen Worsham and the clinic's radiation oncologist, Dr. David Gallardo, nine other urologists pay to see patients at the center at 1115 Los Palos Drive a few hours a week ? providing an apparent loophole in the "self-referral" laws. None has been accused of wrongdoing.
Salinas Valley Urology issued a statement following the Bloomberg article, saying some of its facts were wrong and that the center's doctors provide "state-of-the-art ... thorough and compassionate diagnostic and treatment services to our patients."
Apaydin did not respond to requests for comment for this article. A Sacramento attorney representing him, Robert Sullivan, said the allegations pending before the medical board and in a separate medical-malpractice lawsuit have nothing to do with radiation therapy for prostate cancer.
The medical board's action targets only Apaydin. It details the years-long medical saga of a patient referred to as "J.P.," who had been Apaydin's patient since 1995.
J.P. was 72 when Apaydin removed his cancerous prostate in December 2004. In July 2007, he went to see Apaydin with complaints of frequent nighttime urination, bloody urine and abdominal pain.
The state accusation says Apaydin "apparently" diagnosed a constriction in the bladder neck. He treated the problem by running a wire through the blockage to guide a laser used to ease the stricture. He did not realize the laser also cut through the wire, leaving a piece in the patient's bladder. The accusation says Apaydin's medical records did not contain an operative report, nor documentation of an antibiotic he had prescribed.
Eleven days later, a radiologist in Apaydin's office conducted an abdominal CT scan. In his written "finding" and "impression," the radiologist twice stated, "There is a coiled metallic wire seen within the urinary bladder."
Apaydin initialed the report to indicate he had received it and reviewed it. Two weeks later, J.P. again complained of pain and urination five times a night. A urinalysis again showed red blood cells.
Apaydin recommended he return in three months.
Another five weeks passed and J.P. called Apaydin from Yuma, Ariz., where he was working. He was passing blood and experiencing pain with urination and incontinence. Apaydin prescribed an antibiotic and urinary analgesic, but detailed neither prescription in his records, the accusation states.
When J.P. returned from Yuma two months later, he was still experiencing the symptoms. Apaydin continued his antibiotic and recommended Kegel exercises for the incontinence.
By March 2008, J.P. had added impotence and blood clots to his list of maladies, according to the accusation. Apaydin's records do not indicate if he continued the man's antibiotic and do not document any other treatment.
In May 2008, after returning to Yuma, J.P. turned to a new doctor, who found and removed the wire.
In a written summary of J.P.'s care, Apaydin said he read and signed off on the patient's original CT scan, but failed to notice the finding of the wire in the bladder.
The accusation states Apaydin is subject to discipline for "repeated negligent acts," including failing to recognize he had cut the guide wire during the cystoscopy, failing to adequately review the CT report on four separate occasions and failing to maintain adequate and accurate records.
It seeks revocation or suspension of his license and his authority to supervise physician's assistants, and, if he is placed on probation, an order for him to pay the costs of the board's probation monitoring.
Monterey County court records show Apaydin also was sued for malpractice in 2010 and 2011. One of those lawsuits was settled, the other is pending trial.
Sullivan said it is not unusual for a surgeon to face two lawsuits over an 18-year practice.
Virginia Hennessey can be reached at 753-6751 or vhennessey@montereyherald.com.
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