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Lost records sink case

Florida Board of Medicine members said Friday they wanted to impose serious restrictions on Miami psychiatrist Steven Leslie Kaplan, but said they cannot for legal reasons.

The medical records connected to the highly publicized case, which involved the death of a 12-year-old autistic boy, are missing, said Department of Health attorney Carol Gregg. Without the records, DOH cannot bring charges against Kaplan to a legal hearing, she said.

Gregg said the owner of the group home where the boy lived, Rainbow Ranch, never relinquished the medical records. Rainbow Ranch closed soon after the 2007 death of the child, Denis Maltez.

The case flared into a statewide issue after The Miami Herald published an article about it in 2010. It led to executive and legislative scrutiny of alleged over-medication of children in foster care.

At the time of his death, Denis was taking adult-level doses of two anti-psychotic drugs, a tranquilizer and mood stabilizer. By all accounts, his case was extremely difficult; he had been hospitalized numerous times for trying to kill himself or his family members, and his mother had asked the state to take over his care because she couldn’t control him.

State records show that she received a $1 million settlement from Dr. Kaplan after suing him for malpractice.

Board of Medicine members said Friday at Kaplan’s hearing in Jacksonville that they considered his treatment of Denis seriously deficient. However, disciplinary action against a license requires a higher level of proof than civil court cases do, under state law, and if the board imposed a penalty that he chose to contest, DOH would have to come up with evidence.

The First District Court of Appeals already threw out an emergency suspension of Kaplan’s license that then-Secretary of DOH Ana Viamonte Ros issued a few weeks after publication of the Herald article. The court said DOH couldn’t seriously argue that the public was in immediate danger from a three-year-old case.

So on Friday, the medical board abandoned efforts to impose several harsher penalties that board members suggested: a reprimand, an outside evaluation of his practice, or passage of board-certification exams in psychiatry.

A majority accepted a negotiated settlement, which called for a “letter of concern,” some short courses and a $4,000 fine, with one additional restriction: That Kaplan not treat children.

Legally Kaplan has seven days to decide whether to accept that restriction or to demand an evidentiary hearing. His attorney, Monica Rodriguez, said they’d have to discuss the options and get back to DOH.

(Update Friday afternoon: Rodriguez told the medical board that Medicare officials might exclude Kaplan from the program if there were any restriction on his license, even one against pediatric practice. Since Kaplan now practices mainly in nursing homes and assisted living facilities, she said, that would be a problem.

(So the settlement agreement was rewording to include a clause in which Kaplan stipulated that pediatric practice was beyond his scope of training and experience. The board then voted to lift the restriction and accept the settlement.)

Board member Dr. Onelia Lage said she regretted the constraints and wished the board could go further.

“Medically, I disagree” with the outcome, she said, but she said she’d go along “for legal purposes.”

Carol Gentry, founder and special correspondent of Health News Florida, has four decades of experience covering health finance and policy, with an emphasis on consumer education and protection.