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Because doctors were allowed to participate in the diversion program confidentially, patients never knew if their doctor had a drug or alcohol problem, Fellmeth says. Patients were thus completely dependent on a diversion program that was not doing its job of making sure doctors were taking the necessary rehab classes, passing urine tests, attending group meetings and staying sober. "The board was lulled into this sense of security that if it diverted these doctors, patients would be safe," she says.
But, Fellmeth says, "the program was lax in its monitoring procedures," making it possible for doctors to continue with their addictions while practicing under the medical board's radar.
"The case of Brian West is, to me, a grim illustration of the failings of the diversion program," Fellmeth says. By the time West joined the diversion program in December 2001, several former patients, including Anderson and McDonald, claim they had been injured by the doctor. Other patients would claim they were injured after he joined the program.
West's lawyer, Dominique Pollara, says too much emphasis is being placed on West's case in particular. "You have to look at each patient individually, at their individual circumstances. You can't lump them all together," she says. Of Becky Anderson, Pollara says, "Her outcome was not a good one, and Dr. West agreed and felt it was not an optimal outcome. But it was not because he fell below the standard of care. Becky was treated by many physicians, and they were not able to treat her wounds."
West has been the subject of a series of scathing television reports in Sacramento since 2005; he was recently one of only a few doctors featured in an Associated Press article about the problems with diversion programs nationally. Part of the reason for West's exposure is that his was one of the first cases to go public with his diversion-program record. When West relapsed for the fourth time in 2004, the medical board filed an accusation and held hearings in Sacramento through 2005 on whether or not to revoke his license. Former patient Tina Minasian, who was involved in a malpractice lawsuit against him in 2005, found out about the hearings from her lawyer and thus discovered that West was an alcoholic and had been in the diversion program.
The board found him guilty of violating his diversion commitments, but it did not find that he had been impaired while operating on any patients. West was put on probation and allowed to keep his license. Minasian dug up the malpractice-suit files of other former patients and began contacting them. Although she lost her case against West, both initially and on appeal, Minasian maintains that the issue is one of public safety. Had the medical board made the information about West's—and other doctors'—DUIs and alcoholism or substance-abuse problems available to the public, she says, she and other patients would have never gone to him.
Minasian has not relented since she lost her case against West, Pollara says. "This is an attempt to blackball Dr. West," she says.
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A loan officer from Roseville, near Sacramento, with deep-set eyes and a low, purring voice, Minasian met West through her work in 2002. Like many patients, she found West to be affable and pleasant. She went in to see him about a tummy tuck in the summer of 2002, but had no idea that he was enrolled in the diversion program or that he had any substance-abuse problems. Strangely, the program approved an employee of West's, his office manager, to be his worksite monitor, a move that allowed West to direct her as to how and what she would report to the board.
Minasian had no way of knowing at the time of her surgery in late 2002 that West had two DUI convictions.
"I would have liked to have known if he was an alcoholic," says Minasian. But that information was completely confidential and off-limits to patients. West's profile on the medical-board website, like that of all other doctors, was limited to informing patients whether or not a doctor's license was revoked, but not why.
Not only was Minasian unaware that West was in the diversion program, but she also had no way of knowing that he was cheating the program. Between March 2002 and March 2003, West ordered his office manager, Karen Valdez, to falsify his hours worked in order to meet program requirements. According to sworn testimony by Valdez in a subsequent investigation by the California attorney general's office on behalf of the board, West also required her to falsify Alcoholics Anonymous sign-in logs to reflect his attendance at meetings he had never gone to. Valdez testified that she was aware that West drank after hours and, on occasion, observed signs of his having been drinking the night before.
"The program never detected any of these falsehoods," says Fellmeth. "Here we are, the safety of the public is depending on a non-physician clerk who is hired and fired by West." Valdez also testified that she never observed him to be impaired while treating patients.
Minasian was still dealing with problems from her body-lift when West abruptly closed down his Roseville practice in the spring of 2003. "I still had ruptured sutures coming out of me," she says. "Today, I still have three open holes, which means stitches are trying to make their way out of me."