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

The accident happened not long after Brian West left the parking lot of Beverages and More. He missed his exit, and his car hit another on Interstate 80, just north of Sacramento. It was July 30, 2000, a warm Saturday. A CHP officer took notes. Blood was drawn; West's blood-alcohol level registered at 0.19 percent, more than double the legal limit. He told the CHP officer he was on his way to his office. It was later discovered that West, a charming, Stanford- and UC Irvine-educated plastic surgeon, had also planned to do his rounds at a nearby hospital that day. He was due to see Becky Anderson, a patient of his who was suffering from an abdominal infection. This was West's second DUI arrest.

If things had gone according to the standards set by the Medical Board of California, Dr. West's fingerprints would have made it to the board's enforcement department soon after his arrest. Because this was his second DUI, the board would have launched an investigation to assess whether or not his behavior was a threat to his patients or to the public and whether it was cause for discipline. The investigation would have landed on the desk of the state attorney general, who represents the board, and the decision would have been made whether to file a formal accusation against West.

Last year, the board filed just such an accusation against Beverly Hills plastic surgeon Jan Adams, who operated on hip-hop superstar Kanye West's mother the day before her death, following an investigation into his second DUI arrest in 2006. The accusation was listed under Adams' physician profile on the board's website.

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.

According to the board, West's fingerprints never showed up, and they're not sure why. They did not become aware of the DUI arrest until a full year later, when West was convicted.

For the next few years after that incident, both West's drinking and his plastic-surgery practice continued. Former patients say that during this time, they were injured at the hands of a doctor they had no idea was battling an addiction. The surgeon shut down his practice, filed for bankruptcy, joined the U.S. Air Force for a few years and disappeared from Sacramento.

The Medical Board of California allowed him to evade disciplinary action through his enrollment in the board's secretive and problematic substance-abuse-diversion program. West was later found by the board to have falsified records and lied about his stated sobriety during his time in the program-while he was still seeing patients. He was put on probation, but the board never revoked his license.

Last year, West began practicing in Southern California, first at the Beverly Hills Plastic Surgery Institute, with offices in Beverly Hills and Long Beach, and now at the Plastic Surgery Institute of Beverly Hills in Huntington Beach and in LA. Early last year, the medical board complaints filed by five of his former patients were taken up by the attorney general's office and are now part of one formal accusation filed last February by the Medical Board of California, alleging multiple acts of gross negligence by West. These former patients (and one ex-patient's husband) allege that West left a disturbing trail of deformed and injured patients behind him in Sacramento, and they do not believe he should still be practicing medicine. At issue is the state medical board's handling of doctors like West, who, these former patients say, should not be practicing while battling their addictions. These ex-patients say they won't rest until the board revokes his license.

West could not be reached for comment for this story. His attorney, Dominique Pollara, emphasizes alcohol has not been a patient-care issue for West and cited an appellate court and medical-board decision where this was determined. "There has been absolutely no evidence where I've represented Dr. West where he has treated patients under the influence," she says. "Does that mean he doesn't have a drinking problem? No. But it means there was no alcohol involved during patient care."

*   *   *

The day of West's DUI accident in 2000, Becky Anderson, a feisty grandmother who had been diagnosed with breast cancer the year before, was in the emergency room at Mercy San Juan Hospital near Sacramento. She had gone in with a severe infection in her abdomen and later wrote in a statement that she had repeatedly tried to reach West that day, but couldn't.

Anderson had already been through two surgeries with West. In 1999, she met with him to talk about a breast reconstruction after her mastectomy. Anderson wasn't shy about disclosing her medical and drug history, says her sister Sherry Bural, who accompanied Anderson on the visit. (Anderson is currently in hospice care and could not be interviewed for this story.) She told West that she was a heavy smoker and that she had Hepatitis C, Bural claims. The surgery West urged for Anderson, known as a Tram Flap, was contraindicated for smokers.

"I was furious after that meeting," Bural says. "I felt that was the surgery he wanted to do, the harder one."

The procedure involves cutting out the skin, muscle and fat from the area below the belly button and using it to "rebuild" a breast. It is one option for post-mastectomy cancer patients who would like to reconstruct one or both breasts. Studies have found that current or former smokers have a much higher risk of complications with this particular surgery because of the loss of stomach muscle. The draw for some patients is that the breast is made from real tissue—and the removal of the tissue from the abdomen becomes the added bonus of a "tummy tuck."

"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.

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.

*   *   *

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."

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.

*   *   *

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."

After he closed down his practice and filed for bankruptcy, West sent a letter to the diversion program requesting that he be released for staying sober. He had plans, he said, to join the Air Force. The diversion committee did not approve his request to leave the program. In November 2003, West sent a letter to the committee informing them that he was "now a major in the United States Air Force Medical Corps." He asked that his urine-testing and diversion-meeting requirements be reduced.

According to medical-board records, on Dec. 26, 2003, West stopped off at a gas station and purchased two 48-ounce cans of Heineken and drank them in a McDonald's parking lot. He was asked for a urine test hours later and tested positive for alcohol. It was his first documented relapse. He tested positive three more times during the next few months, according to board records.

*   *   *

By April 2004, West had had four documented relapses, and his license was still active. The diversion-program committee told West he would need to check into a 90-day inpatient rehab facility or be terminated from the program. Because he was on active duty with the Air Force, West couldn't get the time off and was subsequently terminated from the diversion program. Soon after, the Medical Board of California filed a formal accusation against West for violating the program's terms.

"They had a policy that after three relapses, the program should terminate him," says Fellmeth. "It took them four months to file an accusation against him, then eight months for a hearing. The system is just stalling and stopping; meanwhile, this guy is practicing medicine."

"When a person tests positive, what we want is to pull them from practice," says Kimberley Kirchmeyer, deputy director of the Medical Board of California. But Kirchmeyer could not explain why West was not pulled from practice or put into an inpatient treatment program after he tested positive four times. The slow reaction on the part of the program when a physician has relapsed is "part of the flawed program," she says.

In 2005, Minasian filed a malpractice lawsuit against West in Placer County Superior Court. Later that year, before her case had gone to trial, her attorney informed her that West was under investigation by the state medical board. She went to two of the hearings and learned about West's failure to stay sober while he was in diversion—and while she was a patient of his. "That's how I found out he was an alcoholic," she says.

In September 2005, an administrative-law judge ruled in the board's case that West's behavior warranted grounds for the revocation of his license. But the order was stayed, and West was given five years' probation and required to attend AA meetings and submit to random urine testing, among other requirements.

During the hearings, Minasian learned that patients could file complaints against their doctors to have their licenses revoked through the state medical board, independent of any lawsuit. A deputy attorney general told Minasian that she was not called as a witness in his case because she had not filed a complaint against West with the medical board, she says.

Frustrated, Minasian tracked down the files of other patients who had filed lawsuits and contacted some of them to find out if any of them had filed complaints with the state medical board. "None of them knew. I thought—we all thought—that our lawsuits went to the medical board, that they knew about them and were investigating doctors," says Minasian. But she discovered that the board only investigates cases in which there has been an award or settlement above $29,999.

In November 2005, Fellmeth issued the scathing results of her two-year internal audit, which found that the board's enforcement program was essentially failing to protect the public. She made recommendations for how the board could improve its enforcement program.

"Prior to November 2004, you could find out if someone had been ordered [into diversion] only through a public-records-act request for that disciplinary order," says Fellmeth. "All they would post on the website was 'license on probation,' and they wouldn't say that they were required to participate in the diversion program." Information about doctors who were referred or who voluntarily joined the program could never be obtained. As a result of Fellmeth's report, patients can now obtain documents for doctors who have been disciplined by the board on the board's website; information about diversion is included only if doctors were mandated into the program.

In December 2005, Minasian lost her malpractice suit against West. By then, she had filed five medical complaints against him with the medical board. Although a complaint with the medical board has to go through a series of reviews before it is green-lighted for investigation by the state attorney general, Minasian felt that she and other patients who had suffered similar infections and complications after their surgeries by West could build a case to have his license revoked. Pollara, West's attorney, says Minasian's pursuit of West is motivated by the loss of her lawsuit. "Dr. West often agreed to try and help patients that no one else would touch because he felt patients should be entitled to feel better about themselves. There are many people that probably would not have agreed to operate on Becky Anderson or Tina Minasian."

Of the dozens of former patients whom Minasian says filed medical complaints against West, five have made it through the board's stringent tiered elimination process and to the investigation-and-accusation level at the attorney general's office. The board receives an average of 7,000 to 8,000 complaints per year. Of those, 1,200 were investigated last year, only 416 of which were referred to the attorney general's office for formal investigation.

*   *   *

In 2006, Minasian started a blog with patients' stories about their experiences with West. She has been contacted by about 100 women, she says, who say they have had bad experiences with him. Minasian encourages them to file complaints with the medical board, "but not all have filed complaints because they don't think it will do any good," she says.

Minasian, Anderson and McDonald are among the five women listed in the accusation against West filed in February, two years after the complaints were first submitted. The other patients listed at the time the accusation was filed are Sharon Mikulecky and another known only as M.H.

A sixth patient, Ruby Young, was added to the complaint in November 2007. West performed a Tram Flap procedure on Young in August 2000. Young's breast and abdomen became infected after her sutures ruptured, according to the complaint. "The sutures were coming undone, so [West] used his bare hands and took every stitch out, one by one, without any gloves on," she claims. West's bare-handed procedure is part of Young's allegation of gross negligence. Her wounds did not close for five months.

Ken Mikulecky, whose wife Sharon also had a Tram Flap procedure performed by West in August 1999, is alleging repeated acts of negligence by Dr. West. According to the complaint, her breast and abdomen became infected and did not heal for a full year following her surgery. "From one hip to another hip, her wound was wide open," Mikulecky says. The Mikuleckys tried to sue but could not afford the costs, he says. They eventually went to another doctor to close up her wounds in 2001.

Sharon Mikulecky died in August 2003 following an unrelated recurrence of her cancer. "I can't blame [West] for killing my wife because she had cancer before," says Mikulecky. "But I can blame him for weakening her to the point where she damn well died. If it hadn't been for his botched job, she wouldn't have spent a full year at two hospitals and at home healing up."

Minasian says about half a dozen of the women who have complained to her about West are from Southern California. To date, no lawsuits have been filed against West in Orange or Los Angeles counties. If there have been medical-board complaints filed, information cannot be known about them unless they are green-lighted for investigation and submitted as formal accusations by the attorney general.

West worked for the now-defunct Beverly Hills Plastic Surgery Institute for about one year beginning in the fall of 2006, according to Daniel Shin, the center's former medical director. Shin, an anesthesiologist, says West told him he was in the diversion program and asked if Shin would be his sponsor, which Shin agreed to. "He just needed to be watched, charts checked, to see if he was showing up to work late, because of the diversion thing," Shin says. "But none of those things ever occurred.

"He was in the diversion program, but he was very compliant. There were never any complaints that he was drunk or smelled of liquor," says Shin. "He was very productive. He was able to do four or five surgeries a day." Shin says West left the institute because of the company's financial issues, not because there were any problems with West's practices. Complaints Shin may have received regarding West's surgeries "are normal for any plastic surgeon," he says.

West now works for the Plastic Surgery Institute of California, which is also listed as the Advanced Surgical Institute and the Advanced Medical Institute at its Huntington Beach offices. The company has locations in Beverly Hills, Pasadena and Newport Beach. West splits his time between the Huntington Beach and Beverly Hills offices. Located on a large lot on Beach Boulevard between Utica and Yorktown, the Huntington Beach offices are spread out over the third floor of a wide, four-story realty building. The patient visitor's office is hidden down a long corridor. Huge Italian Riviera paintings and plush gold-and-dark-mustard-colored 17th-century-style chairs fill the snug, neat room.

An assistant to Dr. Mazin Alhakeem, president of the Plastic Surgery Institute of California, confirmed that West practices there. Alhakeem had no further comment by press time.

*   *   *

This past June, in an audit meant to reveal whether the rest of a long list of recommendations made by Fellmeth in 2005 had been implemented, the state auditor's office found that the diversion program was still not working. "Inconsistent monitoring of participants and inadequate oversight of its service providers continue to hamper its ability to protect the public," the report read.

In July 2007, the Medical Board of California voted to abolish the diversion program altogether by June. The decision set off a firestorm among physicians who support the program and believe eliminating it will only make matters worse for doctors and patients. In October, the California Medical Association, California Psychiatric Association and California Society of Addiction Medicine issued a joint proposal for a "Public Protection and Physician Health Program," in lieu of the termination of the diversion program. Their proposed program, not unlike the one being abolished, would monitor doctors with substance abuse and other problems and allow them to participate in the program confidentially.

The board's Kimberley Kirchmeyer says the abolishment of the program may work in patients' favor, since physicians will now be promptly and temporarily pulled from practice, she says, while the board reviews incidents if they test positive for drug use or if they are caught violating the law where it affects their work.

A hearing date has been set for April for the accusation against West; Minasian hopes that by encouraging patients to go public with their complaints and to pressure the board to post as much information about doctors as possible, patients will be safer in the long run. "When you file a complaint, your hope is that [the doctor] will be disciplined," says Minasian. "And all disciplines are public record."

daltan@ocweekly.com

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