Contraindications: Dr. James Stirbl
Robin Lowe went to the Sano Medical Clinic in Costa Mesa one June with what appeared to be an obvious and urgent problem. She had felt a lump in her left breast.
At 29, she was young to develop breast cancer. Making matters worse, she was pregnant.
Dr. James Stirbl, the doctor who ran the clinic, examined Lowe but did not recommend she undergo a mammogram or a biopsy, according to the Medical Board of California.
By July, her breast had started to feel sore around the lump, and the surrounding tissue was thickening. She saw Dr. Long-Dei Liu, an obstetrician who had been hired by Stirbl. He examined her breast but did not order a mammogram or biopsy.
By August, the lump was impossible to ignore. It had grown to nearly 2 inches wide and was warm to the touch. Stirbl ordered a mammogram.
But Lowe was now more than six months pregnant. When she went to Santa Ana Hospital for the test, the radiologist on duty refused to perform the mammogram.
When Lowe visited Stirbl again in September, the lump was larger still and "now felt like there was a second lump under the original lump," according to the medical board. Stirbl told her "not to worry," the board wrote, "that the lump was most likely a cyst." He recommended an ice pack.
On Christmas Eve, Lowe gave birth to a son at Santa Ana Hospital. Stirbl walked into her room after the birth and congratulated her, the board wrote, asking if she intended to breast feed her baby.
"She's got a lump in her breast," Lowe's mother told Stirbl, according to the board. "You were supposed to take care of it."
Lowe was given a mammogram the same day. Unfortunately for her, she was not told the results.
She went to Stirbl in January to say that her breast was very painful and that it had grown to a D-cup size while her right breast had remained an A-cup. His diagnosis, according to the medical board: "milk trapped in your breast." As for the mammogram results, he told her he had not had a chance to review them. He put her on penicillin and changed his home remedy from ice packs to warm towels.
By the end of January, she couldn't lift up her left arm because of the swelling and pain. When, after repeated attempts to get Stirbl on the phone, she threatened to go to Santa Ana Hospital instead of his office, he consented to have her admitted.
The biopsy was conclusive: Lowe had breast cancer. An oncologist told her she would have to have her breast and most of the surrounding lymph nodes removed the next day.
It had to have been scary news. But at least she was being taken seriously. Nine months after she first noticed the lump, Lowe was finally going to be treated.
Until Stirbl heard about it.
He cancelled the surgery, according to the medical board, and asked another doctor to examine Lowe. That doctor agreed with the first doctor and scheduled a mastectomy.
The diagnosis after the surgery was grim. The cancer - a ductal carcinoma - had spread to her ribs and nine out of the nine lymph nodes removed. By June, even after chemotherapy, it had spread to her skull, hips and spine.
On Sept. 24, 1986, she died. She was 30. Her son was not yet one.
Stirbl continued to practice until nearly 10 years later. After he was sued by Lowe's family and forced to pay Lowe's family $768,000 in a jury trial, the board filed charges. In 1996, the medical board placed him on five years of probation, including 120 days of having his license suspended.
It wasn't just Lowe's case that got him in trouble. He also was accused of hiring two unlicensed physician's assistants and allowing them to practice medicine as if they were doctors. One of them allegedly got so flustered while trying to give an EKG to a patient having a heart attack that he asked the office secretary to do it for him.
By December 1999, the medical board cut Stirbl's probation short, saying he had learned from his errors. In the intervening years, his business had not suffered. He employed 14 people at two clinics that saw about 50 patients a day, according to the medical board. He caters to Latinos, many of them low-income. And it's no surprise.
Stirbl now has a nice foothold in the immigrant community, courtesy of the federal government.
He has been designated a civil surgeon, a designation I have talked about in an earlier post. His story is one more reason this group of doctors warrants an investigation.