Doctors Behaving Badly: Dr. Peter Breen

Anesthesiologists everywhere cringed when they heard the news that Michael Jackson was found dead with a bag of propofol nearby.

The drug is too strong to be used as a sleep aid and deceptively simple to administer. Anesthesia drugs like propofol require constant monitoring, and Jackson, apparently, was
left unattended after receiving the drug.

To understand how anesthesiologists should (or should not) do their jobs, consider the case of Dr. Peter Breen (California License 78104).

While Breen was running the anesthesiology department at the University of California Irvine, he and other anesthesiologists falsified notes about their surgeries, according to federal inspectors and the California Medical Board. Investigators say the notes described how an operation had gone before the operation had begun, sometimes months in advance.

And it wasn't just the doctor's notes that may have been faked. After Dr. Glenn Provost was fired from the department, he sued UCI and claimed that nurses' signatures were forged on pre-operation records.

In a detailed account of the UCI anesthesiology department's troubles, Roy Rivenberg at the Los Angeles Times quoted one of anesthesiologist saying, "It's just a big mess."

Breen has denied doing anything wrong and told the Times that he attempted to end the practice of filling out reports before surgeries after he took over the department.

Rivenburg reported in September 2006 that the Medical Board was investigating Breen. He announced his resignation a few days later, effective June 2007, and continues to practice at UCI.

In August 2008 the U.S. Centers for Medicare and Medicaid Services found so many problems with the department that they threatened to yank all federal funding and turned the hospital temporarily over to the state Department of Public Health. A followup inspection in October found more problems. That same month, the Medical Board filed its case against Breen, and Kimi Yoshino at the Times wrote about it. Maureen Zehntner, appointed that March as the hospital's chief executive, announced her resignation a few weeks after Yoshino's story.

One detail from the Medical Board investigation suggests a lot about how Breen may have viewed the practice of anesthesiology. The board says that Breen assigned a medical resident whose hand was in a cast to surgical duties, knowing that the resident would be unable to handle the tasks at hand, including "intubation or airway management," in other words, insuring that the patients would be able to breath. One can almost hear the elder doctor boasting, "I can do that with one hand tied behind my back. Why can't you?"

Marla Jo Fisher at the Orange County Register wrote a great piece detailing how much money Breen was making while all this was going on. Nearly $500,000 a year in public money.

In defending himself, Breen wrote a letter to the Times that said:

For years, the department was underfunded and in deficit, which resulted in significant pressures from billing and compliance. These system issues resulted in cases in which anesthesiologists pre-documented their section of the chart to maintain case flow in the operating rooms. With rare exceptions, the anesthetic record was accurate. Anesthesiologists supervised the anesthetics. There was no patient injury, no compromise of care, no fraud, no malice and no monetary gain associated with pre-documentation.

Pre-documentation?

Another wonderful medical euphemism. Lest I pre-document Breen's guilt here, let me say that I hope the investigation yields a lot more post-documentation about what Breen actually did and did not do.