Salinas urology practice accused
of giving patients unnecessary radiation
Published: November 16, 2012
AN ADVANCED radiation therapy
center in Salinas, in which two Monterey Peninsula urologists
have a financial stake, has been bombarding patients with
radiation treatments they don’t need because there’s so much
money to be made from the procedure, according to an
investigation published last week by Bloomberg News Service.
Salinas Valley Urology Associates — owned by Aytac Apaydin and
Steven Worsham, and used for referrals and treatments by
Monterey urologists Anthony Shaheen and David Flemming — has
treated prostate cancer patients with its $2 million IMRT
accelerator, even though other therapies would have been just as
good or better and cost much less, according to reporter Peter
And the reason the doctors do it is to make money — lots of
money, Waldman reported. Medicare reimburses up to $40,000 for a
course of radiation therapy, and private insurance pays even
more, he said. The doctors who own SVUA and physicians who refer
patients there can earn more than $1 million a year, Waldman
This week, Apaydin and Worsham issued a press release saying
they were “surprised and disappointed” at the accusations in
Waldman’s story, which they said had its “facts wrong.”
“All of our patients are fully informed of their treatment
options,” the doctors said. Furthermore, the decision to treat
someone with SVUA’s radiation equipment is a made by a patient
and his doctor, and “the physicians and staff at Salinas Valley
Urology Associates honor and respect our patients’ decisions,”
the release said.
But Waldman’s research showed that use of radiation therapy at
medical facilities around the country typically goes way up as
soon as doctors acquire their own radiation therapy machines. A
1989 federal statute prohibiting doctors from sending patients
to medical facilities they own has a loophole allowing them to
treat them with equipment in their own offices.
“IMRT is overused, period,” said Matthew Cooperberg, a
University of California San Francisco urologist who has studied
the issue. He estimates that about half the 50,000 men who
receive the radiation treatment in the United States each year
don’t need it, or “don’t gain anything from it that exceeds
cheaper treatment, resulting in about $1 billion of
overspending,” most of it courtesy of U.S. taxpayers via
Medicare, according to Waldman.
The Bloomberg story also cited local statistics to illustrate
the overuse of SVUA’s radiation therapy equipment, which is in
south Salinas, not far from Salinas Valley Memorial Hospital.
In 2006, before the SVUA facility opened, Salinas
Valley Memorial performed 16 surgical prostate removals. In
2011, it did none. At Monterey’s Community Hospital, surgeries
dropped from 21 to 4 during the same period.
And the discrepancy didn’t occur because SVUA’s radiation
machine was new to the county; CHOMP already had one, and
another facility in Salinas did, too, according to local
The difference was that the handful of physicians who own
SVUA and who sent patients there could make a killing from the
use of its machine, according to Waldman’s report.
A Salinas oncologist, Laura Stampleman, said Apaydin tried to
get her involved in the scheme, calling it a “gold mine.” But
she declined to participate, she said.
Waldman managed to uncover the stories of several local
patients who were treated with radiation at SVUA under what they
said were false pretenses.
“He gave me radiation 47 days. No one gave me an examination to
determine the length I should get radiation,” said Max Calderon,
a retired construction worker who appears on a bloomberg.com
video prepared by Waldman. His doctor was Amir Saffarian.
“There’s something fishy going on,” Calderon said.
In 2006, a Salinas resident, Wallace Ahyte, said he was told by
Apaydin he had prostate cancer and advised to have radiation
treatment at the facility Apaydin was building at the time.
“He recommended that I wait until the facility was finished. In
the meantime, he said, ‘I’m going to give you shots,’” Ahyte
said. But then he saw other doctors, who told him he didn’t need
any treatment at all.
Monterey resident Richard Dunsay was told by Shaheen last year
he had prostate cancer. Instead of sending him to CHOMP, Shaheen
offered a limousine to take him to the SVUA facility in Salinas.
“I was concerned that Dr. Shaheen was pushing this Salinas
deal,” Dunsay said. “And I kept saying to myself, ‘CHOMP is
right here, so why would I have to go all the way to Salinas?’”
And when he went to another doctor for a second opinion, he was
told he didn’t need radiation treatment at all.
“What you have is extremely minor, and all we have to do is
watch it every six months,” Dunsay said the doctor told him.
A Georgetown University researcher who’s studied the issue said
that when doctors have a financial stake in an IMRT machine, use
of it “roughly triples within about two years,” Waldman reported
— much of it at a high cost to taxpayers and for little patient
Federal investigators are reportedly going over SVUA’s records
with a fine-toothed comb to determine if self-referral and
anti-racketeering laws have been broken.