California, US – 1st November, 2019: A La Quinta doctor was placed on three years’ probation last week after the executive director of the state medical board accused him of committing gross negligence in three instances.
Dr. Phillip De Evans Bretz, a breast cancer surgeon, is prohibited from performing cryoablation procedures — in which extreme cold is used to destroy tissue, in this case breast cancer tissue — while on probation unless the procedure is performed as part of an approved clinical study, according to the state medical board.
He's also prohibited from supervising physician assistants and advanced practice nurses. While he is able to keep his license, Bretz is required to complete education and ethics courses as well, according to the state medical board.
The state said Bretz made no admissions and his acceptance of a settlement with the board "is not an admission of guilt."
Attempts to reach Bretz by phone over several days were unsuccessful.
'Failed to provide sufficient information'
Kimberly Kirchmeyer, executive director of the state medical board, filed the accusation against Bretz in October 2018. In the eight-page document, Bretz is accused of gross negligence, repeated negligent acts and violating the Medical Practice Act.
The accusation involves three cases involving patients with breast-related issues.
The first accusation alleged Bretz committed gross negligence by failing to "provide sufficient information regarding the Lavender Procedure in order to obtain proper informed consent" or "perform or offer to perform a sentinel node biopsy."
The first woman, identified only as "Patient A" in the document, came to see Bretz in November 2015 for a second opinion on treating a mass in her right breast, the accusation stated.
While talking with the woman about treatment options, Bretz discussed the potential for her to undergo his "Lavender Procedure," which involved Bretz using extreme cold to destroy cancer tissue.
According to the medical board, cryoablation of breast carcinoma is "experimental" and not part of an approved Institutional Review Board clinical study.
In that case, the woman then signed an informed consent form. However, the form failed to "adequately disclose all the risks and complications of the procedure," according to the accusation.
Risks and complications associated with the procedure included chances of arm swelling, removal of more than one lymph node and injury to a nerve that could result in numbness to part of the arm, the accusation stated.
"Additionally, the informed consent form was misleading in that it failed to properly disclose the details of the experimental trial results and implied successful treatment of breast cancer with cryoablation only, without any other modalities, such as radiation, chemotherapy, or surgery," the accusation stated.
The woman returned to see Bretz a few weeks later for the procedure. But Bretz never performed or offered to perform a partial mastectomy or sentinel node biopsy, according to the accusation.
'Delay in appropriate treatment'
Bretz also was accused of committing gross negligence by failing to "recognize the Lavender Procedure was contraindicated during his initial visits with Patient B, resulting in a delay in appropriate treatment, surgical procedure, to Patient B."
In December 2015, a woman identified only as "Patient B" sought out Bretz for a second opinion regarding treatment of a mass in her left breast.
During the visit, Bretz discussed several treatment options, including the Lavender Procedure, according to the accusation. The woman returned a few more times in December before taking Tamoxifen, a drug commonly used to treat and prevent breast cancer, and deciding to move forward with the Lavender Procedure.
A few months later, the woman returned and Bretz advised her to consider surgery instead of the Lavender Procedure. In May, the woman found out her tumor had recurred, the accusation stated.
'Not an appropriate treatment alternative'
Bretz again was accused of committing gross negligence by failing to recognize the Lavender Procedure was not a valid treatment for a patient, according to the accusation.
A woman identified only as "Patient C" visited Bretz in March 2015 regarding treating recurring cancer in her left breast. The patient was refusing further surgeries and requested a cryoablation procedure, according to the accusation.
Bretz prescribed Tamoxifen and indicated there wasn't much more he could do since the patient refused further treatment. A few weeks later, she returned and indicated she had a reaction to the drug, the accusation stated.
Bretz prescribed her another drug instead and indicated that further operations seemed inappropriate since the cancer had likely metastasized, or spread, according to the accusation. After several more visits, the woman returned in January 2016. Bretz discussed the possibility of performing the Lavender Procedure due to the patient's unwillingness to have traditional therapy.
The woman went through with the procedure. Two months later, a biospy revealed she had a carcinoma.
"Cryoablation is not an appropriate treatment alternative for recurrent breast cancer," the accusation stated. His probation is expected to end in October 2022.
Source: https://www.desertsun.com/story/news/health/2019/11/01/la-quinta-doctor-put-three-years-probation-after-being-accused-negligence/2500457001/