For the past year, Portland neurosurgeon Darrell Brett hasn’t been charging his patients for his services, but only as a result of disciplinary action. In an in-depth investigation conducted by the Oregon Medical Board that began in 2017, Brett was found to have grossly overcharged his patients for surgical procedures, overprescribed painkillers and referred his patients to a specimen testing company he owned. Lucas Manfield is a reporter for Willamette Week. He joins us to share more about this specific case and how it reflects failures in the system of oversight and regulation by the state medical board and other agencies.
This transcript was created by a computer and edited by a volunteer.
Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. For the past year, Portland neurosurgeon Derrell Brett has not been charging his patients for his services, but not out of the kindness of his heart. It’s because of disciplinary actions against him by the Oregon Medical Board. The regulatory body began a series of investigations in 2017. It found that Brett had overprescribed painkillers, grossly overcharged patients for procedures, and referred patients to a medical testing company that he owned. According to Willamette Week reporter Lucas Manfield, the story is about more than one surgeon. It reflects systemic oversight failures. Lucas joins us now. Welcome back.
Lucas Manfield: Thank you.
Miller: I want to start with the basics here. Who is Derrell Brett?
Manfield: He’s a really well known neurosurgeon in the Portland area. Very wealthy, does a lot of surgeries. He founded an outpatient surgery center down in Wilsonville, runs an office out of the Adventist Hospital. Really well known, very long career.
Miller: Long time Portlanders or readers of Willamette Week may remember his name not just from surgeries but from another incident which goes back to 1995. What did you find when you went into the archives?
Manfield: A very well known incident. Basically, he was accused by essentially a parking attendant at Portland Airport that he left his car in the drop off lane. But then she was writing him up a ticket, and he rammed her so hard that she ended up on the hood of his car, kind of being dragged along. And this kind of horrific incident ended up in court, there’s a civil lawsuit, and the jury ended up handing out a $1 million verdict, which was really eye-popping. We wrote about it at Willamette Week, and national news outlets ended up writing about it as well. Everyone kind of knew about this incident at the time.
Miller: Your recent article is as much about this one surgeon as it is about the Oregon Medical Board. What is this board?
Manfield: The Oregon Medical Board basically enforces this series of statutes and rules that define what is acceptable behavior by various medical professionals, in this case physicians. They have many roles, they kind of hand out licenses and do administrative tasks like that. But they also take in complaints and then they do investigations of these complaints, and they discipline doctors if they find the findings are sustained.
Miller: How much power do they have if they decide to actually wield it?
Manfield: I mean, they can pull some of the licenses. So they have a lot of power, when they choose to wield it. Generally, in almost all cases, they come to agreements where the idea is to help doctors fix the problems and get back on track.
Miller: So let’s turn to some of the actions that led the medical board to investigate Dr. Brett. They fall into two broad categories. One about money that we’ll get to in a bit, and one about opioid prescribing. Can you tell us what happened to one of his patients, Glenn Jones?
Manfield: What happened was, [Glenn Jones] had an injury on a bus, fell over, hurt his back. He was operated on by Derrell Brett. He’d been taking a lot of painkillers that were being prescribed by his other physicians, and Brett kind of piled on more. He ended up overdosing and dying subsequently after the surgery. And when the board looked at it, they basically said Dr. Brett really needed to have reviewed his past prescriptions, and needed to have made smarter decisions about what to have prescribed him, and been more careful.
Miller: How much of a pattern or practice did the board find, in terms of either overprescribing opioids or not paying enough attention to the totality of what patients were taking?
Manfield: It was really a pattern. Lots of patients, I think the final number in the investigation was around 10. And basically the pattern was that he wasn’t reviewing documentation or doing tests to find out how many opioids that person was already taking, was he following up and making sure that they were taking the appropriate amounts? And the board found that it was negligent prescribing behavior.
Miller: You did note that you heard from one of Brett’s defenders, a former colleague named Jordi Kellogg, that Brett was not unique among neurosurgeons in terms of doling out lots of opioids. He told you “we deal with people in pain.” Is there a way to know if that’s true, a way to compare the prescribing habits of different doctors?
Manfield: The state keeps a database, This has been a national problem, the issue of opioids being misused resulting in countless deaths around the country. So one of the ways that states are responding to this problem is that they’re trying to keep track of who’s getting prescribed opioids, who’s prescribing opioids, how much opioids. And so they keep these databases. Oregon set up its database in 2009. And I think one of the major things the board faulted Dr. Brett for is that there wasn’t any record they were able to find that he was actually checking this database.
Miller: So let’s turn to another big issue that the board looked into, which is financial issues. One of the issues had to do with sending patients to get urine tests. What did they find?
Manfield: Basically, that he was charging a lot of money for a test that shouldn’t have cost that much. He started this company that basically was charging up to $5,000 for these urine tests, and then was farming it out to another company to actually do the work of doing the test. And as the board said, these tests should have cost like $400 bucks. So it was a massive markup, and it wasn’t even really clear what Dr. Brett’s company was even really doing besides just handing out these giant bills.
Miller: So seemingly a kind of shell company that was purely created for markup, as opposed to even doing the tests themselves?
Manfield: It would certainly appear that way.
Miller: And that is separate from simply charging more than seems to be standard for procedures themselves. What did you find about that?
Manfield: The board also found evidence that he was charging, in one case, upwards of $50,000 for surgery that the board said should have cost between $1,000 and $3,000. From their perspective, in that case it was just a massive upcharging.
He kind of was able to do it a couple of ways. One, he coded for procedures that he wasn’t actually performing. And then he wasn’t billing typical health insurance, it was an auto accident, so it was being paid for through other ways. And so the insurance company wasn’t really pushing back against this massive bill as it would have if it was a normal health insurer.
Miller: I should say that the board in total found that his actions constituted gross negligence in the practice of medicine.
So let’s turn to the repercussions for this doctor. What did the board actually do?
Manfield: Pretty quickly after they started investigating, they put limits on what he could prescribe. That was back in like 2018. And then as the investigation continued, they started getting more complaints, finding more patients, uncovering the financial improprieties. And then in 2022, they basically came to this agreement with Dr. Brett saying “you can continue practicing, but you’re gonna have to be a volunteer, you’re gonna have to switch your medical status to something known as emeritus,” which essentially says you can continue practicing, but you can’t take any money from patients to do it.
Miller: How common is an arrangement like that?
Manfield: As a disciplinary tool, it does not appear to be very common at all. When I was talking with a board spokesperson, they were only able to come up with two examples of having come to that agreement in the past.
Miller: What did you learn from that spokesman or other people you talked to about why and how the board came up with this deal: yes, you can keep practicing, no, you can’t charge money for it?
Manfield: It’s a good question because the board is extremely secretive about these investigations. I can get certain documents with the findings of the investigations. But I can’t actually see anything of the materials of how they conducted the investigation, or even the complaints themselves. So it’s a difficult question for me to answer about why they came up with this agreement.
I would assume the board was pretty shocked by the findings of the financial problems. And they tend to come to these sort of settlement agreements with doctors where they negotiate essentially down to something that both sides can live with. Dr. Brett planned to retire soon, he’s approaching the end of his career. It probably wasn’t the worst outcome for him.
Miller: You do note near the end of the article that that agreement is no longer going to be the status quo pretty soon, right? He’s now going to simply be prevented from practicing medicine pretty soon. So what changed?
Manfield: Back in 2018, when the board started this investigation, they came to an agreement with Brett saying “you need to stop these prescribing patterns that seem very problematic.” The board came up with another case where after that agreement, he continued to essentially prescribe two medications that are particularly dangerous when prescribed together. And so basically after they came to this first agreement, they said “hey, you broke it, we’re going to look at additional sanctions.” I had heard previously that he was planning on retiring this summer. And so basically the board said “we’re going to make that permanent, you’re going to lose your license beginning this summer.”
Miller: So 5, 6, 8, ten strikes, and you’re out, essentially?
Manfield: Yeah, that’s certainly one way to look at it.
Miller: Let’s get back to the bigger issue here. After your story came out, the Secretary of State’s office released an audit looking into the oversight of health care practitioners in Oregon. What did you find to be the most important findings from the audit?
Manfield: Looking at this most recent audit, I think it was an effort to understand these patterns of how the board was sanctioning doctors, and was it always consistent. Because as I was explaining before, it’s really a black box in terms of how the sanctions and agreements that they come to with doctors. So I think the Secretary of State was curious if this was actually fair. And reading the report, I think they reviewed a couple of dozen cases, and I don’t think they found any glaring examples of things that were unfair. But they really faulted the board in terms of record keeping, and making it more transparent how they’re coming to these decisions. And I believe the board ultimately agreed, and said “we’re gonna make some changes to our process to try to make it more transparent.”
Miller: Well, back to Dr. Brett’s example that you really focused on, what do you think his story says about the larger context of medical practitioner oversight in Oregon?
Manfield: I’ve kind of written a series of stories about doctors being sanctioned by the medical board. And one thing that really strikes me is that the board, by law and by role, essentially only responds to complaints. It doesn’t go out and try to find problematic doctors. And I think that they’re actually prohibited by law from essentially using this database to go find doctors that have problematic prescribing patterns, unless the complaint comes in. And this is something that other states do. Many other states across the country are more proactive in using these databases. And it’s something that the Secretary of State and other audits several times over the past recent years has faulted the board on, and that legislators have never really acted on.
Miller: Lucas, thanks very much.
Manfield: Thank you.
Miller: Lucas Manfield covers criminal justice for Willamette Week.
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