Doctors’ bitter fight heading for court

Published Wednesday, April 1, 2009 | 2 a.m.

Updated Wednesday, April 1, 2009 | 5:32 p.m.

Two Las Vegas cancer doctors accuse each other of letting greed get in the way of good medical care in a pitched legal battle that’s lasted more than four years and cost one of them more than $200,000 in legal fees.

And, if one side of the story is to be believed, the dispute highlights how far an established specialist will go to protect his turf and hinder competition for patients.

More than four years ago Dr. Navneet Sharda filed a defamation lawsuit against Dr. Dhan Kaushal, accusing him of telling colleagues — including primary care doctors who provide referral business — that Sharda is driven by profit and harms patients by subjecting them to too much radiation. Kaushal, who works for one of the city’s large cancer groups, is also accused of telling doctors that he would refuse to accept the patients of any physician who continues sending patients to Sharda.

Furthermore, Sharda accuses Kaushal of filing bogus complaints against him with the Nevada State Medical Examiners Board, insurance companies and local hospitals, saying he commits malpractice and bills patients for unnecessary procedures.

Sharda can now measure his life in stacks of legal filings in the case. He said he’s spent more than $200,000 trying to clear his name.

“I have no other option,” Sharda said. “I’m here to get vindicated.”

Kaushal, in turn, countersued Sharda for defamation, claiming that Sharda was incompetent and overtreated patients to turn a profit. The lawsuit filed by Kaushal, who would not comment for this story, was dismissed in June 2007 in District Court in Clark County.

There were not problems when the doctors first met. Both physicians are Indian, and they run in the same social circles with Indian primary care doctors who may naturally refer them patients. Sharda specializes in radiation treatments, and Kaushal in chemotherapy, but both perform initial consultations for cancer patients.

Sharda started a solo practice in 2001. Kaushal, who works for Cancer & Blood Specialists of Nevada, was licensed to practice in Nevada in 1995. Initially they referred patients who needed both forms of therapy to each other.

Sharda says the relationship soured when primary care doctors started sending patients for initial consultations to him instead of Kaushal. The tension erupted when they disagreed about treatment methods for patients, he said.

Sharda recalls a case in 2003 of a 24-year-old woman with a rare form of cancer coming to him after visiting Kaushal, who allegedly told her she needed intense chemotherapy treatment. Sharda was not familiar with the form of cancer, and doubted anyone else in Las Vegas was either. He told the woman she probably should not get chemotherapy treatment, and that she should get a second opinion before proceeding. The patient canceled her appointment with Kaushal.

Sharda recalls Kaushal calling him with a warning not to contradict his recommendations. “ ‘I told her she needs chemotherapy — you keep your mouth shut,’ ” he recalls the chemo specialist saying. “ ‘If I tell a patient they need chemotherapy, you don’t say anything. I’ll make my money. And when I’m done with them and they need radiation, you can make your money.’ ”

The woman went to Mayo Clinic, Sharda said, and was told she needed radiation, not chemotherapy.

In a different case, both doctors were referred by a primary care doctor to consult a patient at Sunrise Hospital & Medical Center who was suffering from lung cancer that had spread to his brain. Kaushal saw the man and recommended an immediate regimen of chemotherapy, Sharda said, but the standard treatment in such a case is to start with radiation. Sharda took the extreme measure of confronting Kaushal and canceling his orders, only to have the chemo specialist override his decision and start chemotherapy.

Sharda said the dispute led to an angry phone call from Kaushal, who said: “I’m going to teach you a lesson and drive you out of town.”

Since then, Sharda says, his referrals from primary care doctors have dropped.

Sharda says that in the past five years, Kaushal filed a half-dozen complaints with the medical board involving about two dozen patients. He thinks Kaushal filed all the complaints because he also treated the same patients.

An Aug. 8, 2005, letter from the medical board to Sharda describes the allegedly substandard care that he provided to eight patients. The complainant alleged that Sharda had “uncontrollable ways of doing radiation therapy” and that he radiated patients without concern for their needs. “It is alleged that your unethical treatments are done purposely for your financial benefits,” the letter said. That complaint was dismissed, according to later correspondence by the medical board to Sharda.

The medical board filed a formal complaint against Sharda in October, accusing him of substandard care for three patients.

In the case of a 74-year-old woman, he is accused of not fully investigating her pacemaker before starting radiation therapy, and of poor record keeping.

In the case of a 76-year-old man, Sharda is accused by the medical board of failing to record treatments and document information about diagnostic studies. Sharda claims the medical board has since removed this patient from the complaint because the case was investigated in 2002 and dismissed. Medical board officials said a case can be reintroduced for discipline and that the complaint involves three patients.

In the case of a 63-year-old woman, Sharda is accused of poor record keeping and failing to refer the patient for other possible therapies before starting radiation treatment. He also allegedly used an excessive dose of radiation, the medical board claims.

Sharda said that the three patient files in the medical board's complaint have been reviewed by his own expert and that there is no evidence of wrongdoing.

The medical board is scheduled to conduct a hearing in August to determine whether Sharda should be disciplined.

A past complaint also resulted in the medical board seeking to discipline Sharda. The board filed a case against him on April 6, 2006, according to state documents, “for substandard medical care.” An expert hired by Sharda to review found no evidence of wrongdoing, and the medical board dismissed the case.

Complaints about Sharda’s care have also been made to insurance companies. Documents from TriWest Healthcare Alliance, which administers health insurance for the military, show that a 2004 review of seven cases found no evidence of wrongdoing.

Anthem Blue Cross and Blue Shield’s Nevada credentialing committee — which includes associates of Kaushal, according to Sharda, and which gives authorization to see Anthem patients — initially terminated Sharda’s credentials, but a letter from the company in 2006 shows that the decision was overturned by the national quality management committee.

Sharda said his strongest evidence of Kaushal’s defamation will be presented if the case goes to trial.

Sharda says it’s time for his nemesis to give up.

The protracted legal battle has involved subpoenas to other physicians — who have no interest in getting bogged down in the allegations. “You know the only people who are going to make money on this?” said one doctor familiar with the battle. “The lawyers.”

Sharda said the legal fight illustrates the danger of standing up to the Las Vegas medical establishment.

“The existing powers will do whatever they have to do to keep new thought and more appropriate medical care from changing the status quo,” Sharda said. “You’re just pushing uphill all the way.”

Sharda said he’s offered a settlement to Kaushal: Stop the harassment, apologize and pay all legal fees and the case will be over.

The trial is set for June 30.

Update: A jury ruled in Sharda's favor in August 2009

Editor’s note: This story has been updated to include details of the current medical board complaint against Sharda.