The sluggish pace of medical regulation

By Marshall Allen

Sunday, July 26, 2009 | 2 a.m.

Three weeks ago, state medical authorities ordered Dr. Sean Su of Las Vegas to stop performing surgeries in his clinic after investigators — called in because he allegedly harmed a patient — discovered gross violations of safety standards.

Su is still practicing medicine, however. He still has a medical license, despite the ban on surgeries at his clinic.

The reason for the apparent contradiction is found in the way health care is regulated.

The order to stop performing surgeries at his clinic came from the Nevada State Health Division, which licenses medical facilities.

But Su’s medical license is overseen by a separate entity, the Nevada State Medical Examiners Board, which has been widely criticized for failing to move quickly and decisively against bad doctors.

In Su’s case, the board has yet to take action even though the doctor has not cooperated with its investigation. He ran away from medical board investigators during one visit, according to a source familiar with the case.

Su did not return the Sun’s calls to comment for this story.

The medical board has the authority to summarily suspend a doctor’s license if he’s putting the public at risk. But the board’s investigation is not complete, three weeks after the Health Division’s Health Care Quality and Compliance Bureau ordered him to stop performing plastic surgery in his clinic. Health Division investigators found liposuction waste left in an exam room for days and expired medications, scalpels and sutures.

The Las Vegas Sun asked Louis Ling, executive director of the medical board and its spokesman, why a doctor would be allowed to continue practicing if he has injured a patient, maintains an unsanitary practice and ran away from representatives of the board.

Ling replied that a major reason is the big difference in the remedies. The Health Division’s action can be immediately reversed once unsafe operations are stopped. Revoking a medical license is more serious because it prevents a doctor from earning a living.

Running away from investigators may be a violation of Nevada’s Medical Practice Act, but it isn’t necessarily enough to suspend someone’s license, Ling said.

“When you start talking about taking away somebody’s ability to make a living ... you are crossing into constitutionally protected behavior,” Ling said. “As a state agency you had better be right and you better be able to prove it.”

Barred from commenting specifically about Su’s case, Ling emphasized that his silence does not mean the medical board is not moving ahead as swiftly as possible. He noted that the board’s actions are slowed by antiquated regulatory laws, some of which haven’t been updated since the 1980s. That will soon change, he said. The state Legislature enacted reforms that will go into effect in October to give the medical board the ability to develop procedures to act more quickly when necessary, Ling said.

So for now, Su continues to practice, despite the Health Division’s findings during a July 2 visit to his practice, Skin & Body Institute, at 2451 Professional Court in Las Vegas. Investigators found the doctor and his staff misleading, and the conditions unsanitary, according to the health division report.

Investigators were summoned because of a botched breast augmentation performed April 16 at the clinic. The patient had returned June 3 to have an implant reinserted, and then was hospitalized June 15 with an infection in her breast. That led to a complaint to the medical board and the notification of the Health Division.

Su is not a plastic surgeon. He is a 1996 graduate of Loma Linda University School of Medicine and completed two years of internal medicine and two years of family medicine postgraduate training at University of Nevada School of Medicine. He claims in his advertising to be board certified, but he is not certified with the American Board of Medical Specialties, the organization that is considered the professional standard.

His Web site says that he and his wife, Suzie Nguyen-Su, a dentist, are a team that runs the clinic “to pamper guests from out of town and all over the world who come to fabulous Las Vegas.” They offer an array of cosmetic procedures, including Botox injections, a “5-minute nose job,” breast augmentation, skin treatments and weight loss services. Suzie Nguyen-Su is also under investigation by the Nevada State Dental Examiners Board in connection with the case, a source told the Sun.

Su’s answers to investigators on July 2 revealed apparent evidence of substandard care, according to the report. He told investigators he performed breast augmentation surgeries at the clinic under local anesthesia only, and that the operations took up to eight hours.

Dr. Alan Matarasso, a board certified plastic surgeon from New York, said doctors sometimes will use local anesthesia for breast augmentation surgery, but only when it is in the best interest of patients.

Breast augmentation surgery is usually conducted under general anesthesia — with the patient unconscious — or intravenous sedation, where the patient is semiconscious, according to the American Society of Plastic Surgery. Matarasso said he expects an anesthesiologist to be involved in such procedures.

As for the length of Su’s operations, experts said the procedure should take one-fourth as long — about two hours. Matarasso said a four-hour breast augmentation surgery is “much longer than average.”

Investigators also found other safety breaches. They discovered a canister of liposuction waste in one examination room. Su told them it had been there for days. Sterile instruments were packaged and stored tightly in a drawer, which could compromise sterility, and one package had a hole in it.

A box of scalpels had expiration dates from 2005, and all the suture kits had expiration dates from 2008, 2005, 1999 and 1998. Investigators asked Su to bring the exact sutures he would use for a procedure, and he brought sutures with a January 2005 expiration date, the report said.

Eight of the medications in the clinic were expired — including Lidocaine, which Su said he used for the local anesthesia. Su said he sometimes used medications brought by the patients themselves, the report said.

Matarasso said he has never heard of a doctor using medications that are brought in by patients. The drugs are all prescription-only, so it probably wouldn’t be legal, he said.

The inspectors noted in their report that some of the expired medicine containers showed that Su was the one who filled the prescriptions.

The July 2 inspection found other ways that Su and his staff were misleading, the Health Division report said. Su could not tell investigators the proper sterilization process for instruments, the report said. He said that one of his wife’s employees, Ryan Ramos, did the sterilization. Ramos was present during the inspection, and one of the investigators asked if he was the “Ryan” in question. Ramos denied it and left, the report said.

Later, investigators called Ramos, with Su present, and the doctor prompted him to agree that he sterilized his equipment. Ramos was then unable to tell investigators anything about the sterilization process, at which time he said he sterilized only the dental equipment.

Su’s apparent deception extends to the resume he has posted on his Web site. He is listed as the medical director of Bombshell Tattoo Removal, which his Web site says is based in the Hard Rock Hotel. But the business is not at the Hard Rock; it’s near Valley View and Tropicana.

Su also says on his Web site that he has been licensed by the Medical Board of California since 2003. But that license was canceled in 2006. Su failed to report a 1989 misdemeanor conviction for petty theft when he applied for his California license in 2003. He didn’t abide by the terms of his probation and his license was canceled, California records show. The Nevada medical board publicly reprimanded Su in 2006 for the California violation.

Su also claims on his Web site that he is an adjunct faculty member and clinical supervisor at Touro University Nevada, College of Osteopathic Medicine, in Henderson. But Touro officials say he has never held any position at the school.

The Nevada medical board has drawn criticism for being too gentle and slow in dealing with bad doctors.

After the hepatitis C outbreak was announced in February 2008, the board said it couldn’t summarily suspend the licenses of doctors involved because the clinic had stopped the unsafe injection practices, so the public was not at risk. The public outrage over the board’s lack of action was visceral — 50,000 people had been told to get tested for infectious disease.

Two months passed before the board got an injunction from the attorney general’s office against the licenses of three of the doctors involved in the outbreak.

The board drew heat again recently for negotiating an agreement with Dr. Eladio Carrera, one of the partners at the clinic whose practice was barred by the injunction, essentially letting him off the hook in exchange for his testimony against the other two partners.

Ling took over in September as the medical board’s executive director and has been working to streamline and update the board’s procedures. Before issuing a summary suspension of a doctor’s license, board investigators must finish their probe, present their findings to a board committee and then to the entire board, a process that can take many weeks, Ling said.

An injunction through the attorney general’s office also requires extensive investigating, Ling said. In either case, the medical board needs hard evidence to support any drastic action, Ling said.

The standard has always been whether the action in question is putting patients at imminent risk of harm, Ling said.

Ling said he understands the public’s criticism of the board, and that it’s a recurring critique that its disciplinary process takes too long. But he said the board has always been reined in by state law.

In December, the board proposed a bill later passed by the Legislature. When it takes effect in October, it will allow the medical board to streamline its process so it can react within hours, if necessary, Ling said.

“They are frustrated when they can’t move as quickly as they would like,” Ling said of the board members.

Ling knows that the public probably cares little about the intricacies of the laws that guide the board’s decisions.

“What they want is results and they deserve results,” he said. “What they can’t understand is that we are working as fast as we can within the current process that we have.”