Under Wraps

Many of Dr. Brian West's patients didn't know he was in the state medical board's substance-abuse-diversion program. At least six of them claim they're paying the price

"When I tried to talk about the smoking, Becky said Dr. West didn't think it was that big of a deal," asserts Bural, who tried to talk her sister out of the Tram Flap surgery. "He was a good salesman." The handsome West was charming to the point of being slightly flirtatious with Anderson, she alleges. Anderson went through with the procedure in March 1999, and soon after, she was back in the hospital. The large incision on her belly would not close and had become infected. Because of the infection, she was unable to begin chemotherapy treatments for her breast cancer.

In late 2000, a month or so after West's DUI arrest, West performed a different surgery to address the still-open wound in Anderson's stomach. The plan was to close the hole, now about the size of a quarter, with a small piece of skin grafted from her leg. When Anderson awoke from the surgery, she found that West had severed a large muscle above her knee and placed it on her abdomen to close up her wound-a procedure to which she had not consented, she claimed. "It looked like she'd been filleted," Bural says. "She was mutilated."

The wall of muscle tissue on Anderson's stomach eventually died and could no longer hold her intestines in. A second doctor eventually covered the intestines with a skin graft from her leg, but a pouch-like mound containing her intestines emerged from her body. Today, Anderson keeps the intestinal bulge in by wearing tight jeans all the time, even to bed, her sister says. Anderson's part of the complaint filed by the medical board alleges gross negligence and dishonesty on the part of West.

Dr. West performed Tina Minasian's surgery while he was enrolled in the state medical board's secretive program  for doctors with substance-abuse problems.
Jeremy Sykes
Dr. West performed Tina Minasian's surgery while he was enrolled in the state medical board's secretive program for doctors with substance-abuse problems.

Judy McDonald, a soft-spoken 62-year-old homemaker from Auburn, north of Sacramento, had been referred to West by the surgeon who performed her mastectomy. After West performed a Tram Flap breast reconstruction in the summer of 1999, McDonald says, her wounds became gravely infected. "My belly and my breast came unsewed after the infection," she claims. Within a few weeks, McDonald says, her opening was so big she could see inside her gut. "My house smelled like gunk," she says. "Every time I saw [West], he said it was normal with infections. He said it took a couple of months to cure and said I had to be patient-and then he just gave me prescriptions."

West tried to vacuum-pump the pus draining from McDonald's wounds, but that made her anemic, she alleges. In late September 1999, McDonald went into the hospital to have her abdominal and breast wounds closed by West. During the surgery, a ball of infection burst in her abdomen, she says. "I'm sure there was panic in that surgery room," McDonald says.

She then had to be treated by an infectious-disease doctor at the hospital and received in-home nursing for several months following the surgery. She says she continued with West as her surgeon "because I just thought it was my body. I thought it was my fault that I just got infections." In May 2000, West performed his third and final surgery on McDonald to "lift" her right breast so that it would match her much larger, reconstructed left breast. Instead, McDonald claims, she received a breast reduction and nipple surgery, which she says she did not consent to. She is now part of the formal complaint, alleging gross negligence by West.

According to state medical-board records now available to the public, in June 2001, West was convicted of a misdemeanor for the previous year's DUI arrest. The Medical Board of California launched an investigation soon after. Becky Anderson sued West for medical malpractice in August 2001. After its investigation, the board recommended West join the diversion program in lieu of potential disciplinary action. In December 2001, West committed to the secretive program, which would allow him to continue practicing, as long as he agreed to attend AA meetings, remain sober and take random urine tests, among other requirements.

Anderson settled with West in May 2002 for $250,000, the maximum allowed for malpractice suits in California. According to West's attorney, the doctor admitted no fault in the settlement.

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The Medical Board of California's diversion program is as confidential as they come. Created in 1980, it was designed to monitor doctors with substance-abuse problems who agreed to take steps toward sobriety, instead of taking action against them for their drug abuse. "They wouldn't be disciplined [by the board]. Their lives and careers wouldn't be destroyed," says Julie D'Angelo Fellmeth, administrative director of the Center for Public Interest Law in San Diego. "For some physicians, that probably was the case, but for others, they were gaming the system. Doctors who are smart, who want to preserve both their career and their addiction, they'll figure it out," says Fellmeth, who has scrutinized the board's enforcement procedures for nearly two decades.

In 2003, Fellmeth was charged by the state to do an aggressive audit of the board's enforcement practices, including that of the diversion program. It would be the fourth audit in the program's history. After nearly two years as the only person with unlimited access to the diversion program's highly confidential files (not even members of the enforcement division could peer into them), Fellmeth found that "the whole program was a mess."

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