BEFORE THE MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA In the Matter of the Accusation Against: Phillip De Evans Bretz, M.D. Case No. 800-2015-017972 Physician's and Surgeon's Certi?cate No. A 32596 Respondent DECISION The attached Stipulated Settlement and Disciplinary Order is hereby adopted as the Decision and Order of the Medical Board of California, Department of Consumer Affairs, State of California. This Decision shall becomeeffective at 5:00 p.m. on October 25, 2019. IT IS SO ORDERED: September 26, 2019. MEDICAL BOARD OF CALIFORNIA Ronald H. Lewis, M.D., Chair Panel A DCU32 Elia: (31-2039} ?n 10 11 Attorney General of California MATTE-113W 1V1. DAVIS Supervising Deputy Attorney General LEANNA E. Deputy Attorney General State Bar No. 239872 600 West Broadway, Suite 1800 San Diego, CA 92101 PO. Box 85266 San Diego, CA 92186-5266 Telephone: (619) 738-9401 Facsimile: (619) 645-2061 A Itorneys?w Complainant BEFORE THE MEDICAL BOARD CALIFORNIA OF CONSUMER AFFAIRS STATE OF CALIFORNIA In the Matter ofthe Accusation Against: Case No. 800-2015-017972 PHILLIP DE EVANS M.D. No. 2019010387 78-034 Calle Barcelona, Suite . La Qumtas CA 92233 STIPULATED SETTLEMENT AND . . DI RDER Physician?s and Surgeon?s Certificate No. A 32596, Respo ndent. IT ES HEREBY AND AGREED by and between the parties to the above- entitled proceedings that the following matters are true: i 1. Kimberly Kirchmeyer (Complainant) is the Executive Director ofthe Medical Board oi?California (Board). 8116' brought this action solely in her of?cial capacity and is represented in this matter by Xavier Becerra, Attorney General of the State of California, by LeAnna E. Shields, Deputy Attorney General. STIPULATED AND DISC ORDER (800-2015017972) UI 2. Respondent Phillip De Evans Bretz, M.D. (Respondent), is represented in this proceeding by attorney Constance A. Endelicato, Esq, whose address is: 10960 Wilshire Blvd, 18th Floor, Los Angeles, CA 90024-3804 3. On or about July 5, l978. the Board issued Physician?s and Surgeon?s Certificate'No. A 32596 to Respondent. The Physician?s and Surgeon?s Certi?cate was in full force and effect at all times relevant to the charges brought in Accusation No. 800-2015-017972, and will expire on October 31, 2019, unless renewed. JURISDICTION 4. On October 3 l, 20] 8, Accusation No. 800-27015-017972 was ?led before the Board, and is currently pending against Respondent. A true and correct copy of Accusation No. 800- 2015-017972 and all other statutorily required documents were properly served on Respondent on October 31, 2018. Respondent timely filed his Notice of Defense contesting the Accusation. A true and correct copy ofAccusation No. 800-20 5-017972 is attached as Exhibit A and incorporated herein by reference as if fully set forth herein. ADVISEMENT AND WAIVERS 5. Respondent has carefully read, fully discussed with counsel, and fully understands the charges and allegations in Accusation No. 800-2015-01'7972. Respondent has also carefully read, fully discussed with counsel; and fully understands the effects ofthis Stipulated Settlement and Disciplinary Order. 6. Respondent is fully aware ofhis legal rights in this matter, including the right to a hearing on the charges and allegations in the Accusation; the right to confront and cross-examine the witnesses against him; the right to present evidence and to testify on his own behalf; the right to the issuance of subpoenas to compel the attendance of?witnesses and the production of documents; the right to reconsideration and court review of an adverse decision; and all other rights accorded by the California Administrative Procedure Act and other applicable laws. 7. Having the benefit of counsel, Respondent voluntarily, knowingly, and intelligently waives and gives up each and every right set forth above. ff/ 2 STIPULATED SETTLEMENT AND ORDER (800-2015-017972) 20 PA BI LITY 8. Reapondent does not contest that, at an administrative hearing, Complainant could establish a prima?tcie case with respect to the charges and allegations contained in Accusation No. 800-20 [5?017972 apd that he has thereby subjected his license to disciplinary action. 9. Respondent agrees that if he ever petitions for early termination or modi?cation of probation, or ifthe Board ever petitions for revocation ofprobation, all ofthe charges and allegations contained in Accusation No. 800-2015~017972 shall be deemed true. correct and fully admitted by Respondent for purposes of that proceeding or any other licensing proceeding involving Respondent in the State of California. it). Respondent agrees that his Physician's and Surgeon?s Certi?cate No. A 32596 is subject to discipline and he agrees to be boimd by the Board?s probationary terms as set forth in the Disciplinary Order below. CONTINGENCY I. This Stipulated Settlement and Disciplinary Order shall be subject to approval of't?he Board. The parties agree that this Stipulat?ed Settlement and Disciplinary Order shall be submitted to the Board for its consideration in the above?ntitled matter and, further, that the Board shall have a reasonable period oftime in which to consider and act on this Stipulated Settlement and Disciplinary Order after receiving it. By signing this stipulation, Respondent fully understands and agrees that he may not withdraw his agreement or seek to rescind this stipulation- prior to the time the Board considers and acts upon it. 12. The parties agree that this Stipulated Settlement and Disciplinary Order shall be null and void and not binding upon the parties unless approved and adopted by the Board, except for this paragraph, which shall remain in Full three and effect. Respondent fully understands and agrees that in deciding whether or not to approve and adopt this Stipulated Settlement and Disciplinary Order, the Board may receive oral and written commbnications from its staff andfor the Attorney General?s Of?ce. Communications pursuant to this paragraph shall not disqualify the Board, any member thereof, iandlor any other person from future participation in this or any other matter affecting or involving respondent. In the event that the Board does not, in its 4 .3 SETTLEMENT AND DISCIPLINARY ORDER (800-20l5?017972) discretion, approve and adopt this Stipulated Settlement and Disciplinary Order, with the exception of this paragraph, it shall not become effective, shall be of no evidentiary value whatsoever, and shall not be relied upon or introduced in any disciplinary action by either party hereto. Respondent further agrees that should this Stipulated Settlement and Disciplinary Order be rejected for any reason by the Board, Respondent will assert no claim that the Board, or any member thereof, was prejudiced by. its/his/her review, discussion and/or consideration of this St?ipulated Settlement and Disciplinary Order or of any matter or matters related hereto. ADDITION AL PROVISIONS 13. This Stipulated Settlement and Disciplinary Order is intended by the patties herein to be an integrated writing representing the complete, ?nal and exclusive embodiment of the agreements of the parties in the above-entitled matter. 14. The parties agree that copies of this Stipulated Settlement and Disciplinary Order, including copies ofthe signatures ofthe parties, may be used in lieu oforiginal documents and signatures and. further, that such copies shall have the same force and effect as originals. IS. in consideration ofthe foregoing admissions and stipulations, the parties agree the Board may, without further notice to or opportunity to be heard by Respondent, issue and enter the following Disciplinary Order: DISCIPLINARY ORDER IT IS ORDERED that Physician?s and Surgeon?s Certificate No. A, 32596 issued to Respondent PHILLIP DE EVANS BRETZ, M.D., is hereby revoked. However, the revocation is stayed and Respondent is placed on probation for three (3) years on the following terms and conditions. 1. EDUCATION COURSES. Within 60 calendar days of the effective date of this Decision, and on an annual basis thereafter, Respondent shall submit to the Board or its designee for its prior approval educational program(s) or course(s) which shall not be less than 40 hours per year, for each year ofprobation. The educational program(s) or course(s) shall be aimed at correcting any areas of deficient practice or knowledge and shall be Category I certi?ed. The educational programs) or course(s) shall be at Respondent?s expense and shall be in addition to 4 AND DISCIPLINARY (mom (800-2015-017972) . 28' the Continuing Medical Education (CME) requirements for renewal of licensure. Following the completion ofeach course, the Board or its designee may administer an examination to test Respondent?s knowledge of the course. Respondent shall provide proof ofattendance for 65 hours of which 40 hours were in satisfaction ofthis condition. 2. PROFESSIONALISM PROGRAM (ETHICS COURSE). Within 60 calendar days of the effective date ofthis Decision, Respondent shall enroll in a pro-lbssionalism program, that meets the requirements of?Tit?le l6, California Code ofRegulations (CCR) section l358.1. Respondent shall participate in and successfully complete that program. Respondent shall provide any information and documents that the program may deem pertinent. Respondent shall successfully complete the classroom component of the program not later than six (6) months after Respondent?s initial enrollment, and the longitudinal component of the program not later than the time specified by the program, but no later than one year after attending the classroom component. The professionalism program shallhe at Respondent?s expense and shall be in addition to the Continuing Medical Education (CME) requirements for renewal oflicensure. A professionalism program taken after the acts that gave rise to the charges in the Accusation, but prior to the effective date of the Decision may, in the sole discretion ofthe Board or its designee, be accepted towards the fulfillment of this condition if the program would have been approved by the Board or its designee had the program been taken after the effective date of this Decision. Respondent shall submit a certification of successful completion to the Board or its designee not later thanlS calendar days after successfully completing the program or not later . than IS calendar days after the effective date of the Decision, whichever is later. 3. MONITORING Within 30 calendar days ofthe effective date ofthis Decision, Respondent shall submit to the Board or its designec for prior approval as a practice monitor, the name and qualifications of one or more licensed physicians and surgeons whose licenses are valid and in good standing, and who are preferably American Board of Medical Specialties certified. A monitor shall have no prior or current business or personal relationship with Respondent, or other relationship that could reasonably be expected to 5 SEWLEMENT AND DISCIPLJNARY ORDER (800-2015-017972) 26 28 compromise the ability of the monitor to render fair and unbiased reports to the Board, including but not limited to any form ot?bartering. shall be in Respondent?s field of practice, and must agree to serve as Respondent?s monitor. Respondent shall pay all monitoring costs. The Board or its designee shall provide the approved monitor with copies of the Decision and Accusation, and a proposed monitoring plan. Within 15 calendar days of receipt of the Decision, Accusation, and proposed monitoring plan, the monitor shall submit a signed statement that the monitor has read the Decision and Accusation, fully understands the role of a monitor, and agrees or disagrees with the proposed monitoring plan. it? the monitor disagrees with the proposed monitoring plan. the monitor shall submit a revised monitoring plan with the signed statement for approval by the Board or its designee. Within 60 calendar days of the effective date ofthis Decision, and continuing throughout probation, Respondent?s practice shall be monitored by the approved monitor. Respondent shall make all records available for immediate inspection and copying on the premises by the monitor at all times during business hours and shall retain the records for the entire term onrobation. ll? Respondent fails to obtain approval of a monitor within 60 calendar days of the effective date ofthis Decision, Respondent shall receive a notification from the Board or its designee to cease the practice of medicine within three (3) calendar days after being so notified. Respondent shall cease the practice of medicine until a monitor is approved to provide monitoring responsibility. The monitor shall submit a quarterly written report to the Board or its designee which includes an evaluation of Respondent?s performance, indicating whether Respondent?s practices are within the standards of practice of medicine, and whether Respondent is practicing medicine safely, billing appropriately or both. It shall be the?sole responsibility of Respondent to ensure that the monitor submits the quarterly written reports to the Board or its dcsignee within 10 calendar days after the end of the preceding quarter. monitor resigns or is no longer available, Respondent shall, within 5 calendar days oi" such resignation or unavailability, submit to the Board or its designce, for prior approval. the name and qualifications ot?a replacement monitor who will be assuming that responsibility within 6 AND DISCIPLINARY ORDER (800-2015-017972) mp U: \l IS calendar days. If Respondent fails to obtain approval ofa replacement monitor within 60 calendar days of the resignation or unavailability ot?the monitor, Respondent shall receive a noti?cation from the Board or its designer: to cease the practice ofmedicine within three (3) calendar days after being so notified. Respondent shall cease the practice of medicine until a replacement monitor is approved and assumes monitoring responsibility. In lieu of a monitor, Respondent may participate in a professional enhancement program approved in advance by the Board or its designee that includes, at minimum, quarterly chart review, semi-annual practice assessment, and semi-annual review of professional growth and education. Respondent shall participate in the professional enhancement program at Respondent?s- expense during the term of?probation. 4. PROHIBITED PRACTICE. During probation, Respondent is prohibited from performing cryoablation procedures unless performed as part of? an approved Institutional Review Board (IRB) clinical study and protocol. After the effective date of?this Decision-all patients being treated by the Respondent shall be notified that the Respondent is prohibited from I performing cryoablation procedures unless performed as part of an approved Institutional Review Board (I RB) clinical study and protocol. Any new patients must be provided this notification at the time ol?thcir initial appointment. I Respondent shall maintain a log oi?all patients to whom the required oral notification was made. The log shall contain the: l) patient's name, address and phone number; 2) patient's medical record number, il'available; 3) the full name ofthe person making the notification; 4) the date the notification was made; and 5) a description of the notification given. Respondent shall keep this log in a separate file or ledger, in chronological order, shall make the log available for immediate inspection and copying on the premises at all times during business hours by the Board or its designee, and shall retain the log for the entire term of probation. 5. NOTIFICATION. Within seven (7) days of the .e'l?fective date of this Decision, the Respondent shall provide a true copy ot?this Decision and Accusation to the ChiefofStafl?or the Chief Executive Officer at every hospital where privileges or membership are extended to Respondent, at any other facility where Respondent engages in the practice of medicine, 7 AND DISC LDJIQ 6 including all physician and locum tenens registries or other similar agencies. and to the Chief Executive Of?cer at every insurance carrier which extends malpractice insurance coverage to. Respondent. Respondent shall submit proot?of compliance to the Board or its designee within l5 calendar days. This condition shall apply to any change(s) in hospitals, other facilities or insurance carrier. . 6. SUPERVISION OF PHYSICIAN ASSISTANTS AND ADVANCED NURSES. During probation, Respondent is prohibited from supervising physician assistants and advanced practice nurses. 7. OBEY ALL LAWS. Respondent shall obey all federal, state and local laws, all rules governing the practice of medicine in California and remain in full compliance with any court ordered criminal probation, payn-ients, and other orders. 8. QUARTERLY DECLARATIONS. Respondent shall submit quarterly declarations under penalty of perjury on forms provided by the Board, stating whether there has been compliance with all the conditions ofprol'iation. Respondent shall submit quarterly declarations no later than l0 calendar days alter the end ol?the preceding quarter. 9. EN ERAL PR OBAT ON R130 Ul REM EN TS. Compliance with Probation Unit a Respondent shall comply with the Board?s probation unit. Address Changes Respondent shall, at all times, keep the Board informed of Respondent?s business and residence addresses, email address (ifavaiiable), and telephone number. Changes of such addresses shall be immediately communicated in writing to the Board or its designee. Under no circumstances shall a post of?ce box serve as an address 0 l" record, except as allowed by Business and Professions Code section 202 if! 8 SETTLEMENT DISCIPLINARY ORDER (800-2015-0l7972) Place of Practice Respondent shall not engage in the practice of medicine in Respondent?s or patient?s place of residence, unless the patient resides in a skilled nursing Facility or other similar licensed facility. License Renewal Respondent shall maintain a current and renewed California physician?s and surgeon?s license. Travel or Residence Outside California Respondent shall immediately inform the Board or its designee, in writing, ot?travel to any areas outside the jurisdiction ot? California which lasts, or is contemplated to last, more than thirty (30) calendar days. i In the event Respondent should leave the State of California to reside or to practice, Respondent shall notify the Board or its designee in writing 30 caiendar days prior to the dates of departure and return. i 10. INTERVIEW WtTl-l THE BOARD OR ITS DESIGNEE. Respondent shall be available in person upon request for interviews either at Respondent?s place of" business or at the probation unit of?ce, with or without prior notice throughout the term ot?probation. l. ICE WHILE ON PROBATION. Respondent shall notify the Board or its designee in writing within 15 calendar days of any periods of non-practice lasting more than 30 calendar days and within IS calendar days of Respondent?s return to practice. Non?practice is de?ned as any period of time Respondent. is not practicing medicine as defined in Business and Professions Code sections 2051 and 2052 For at least 40 hours in a calendar month in direct patient care, clinical activity or teaching, or other activity as approved by the Board. If Respondent resides in California and is considered to be in non?practice, Respondent shall comply with all terms and conditions of probation. Ali time spent in an intensive training program which has been approved by the Board or its designee shall not be considered new practice and does not relieve Respondent From complying with all the terms and conditions of probation. Practicing medicine in another state ot?the United States or Federal jurisdiction while 9 AND DISCIPLINARY ORDER (800~2015?017972) on probation with the medical licensing authority ol?that state or jurisdiction shall not be considered non-practice. A Board?ordered suspension ofpractice shall not be considered as a period of non?practice. In the event Respondent?s period ol?non-practice while on probation exceeds 18 calendar months, Respondent shall successfully complete the Federation of State Medical Boards?s Special Purpose Examination, or, at the Board?s discretion, a clinical competence assessment program that meets the criteria of Condition 8 of the current version ofthe Board?s ?Manual of Model Disciplinary Orders and Disciplinary Guidelines? prior to resuming the practice ot?medicine. Respondent?s period ofnon?practice while on probation shall not exceed two (2) years. Periods ot?non-practice will not apply to the reduction of the probationary term. Periods of non-practice fora Respondent residing outside of Califbrnia will relieve Respondent ofthe responsibility to comply with the probationary terms and conditions with the exception of?this condition and the following terms and conditions of probation: Obey All laws; General Probation Requirements; Quarterly Declarations; Abstain from the Use ofAlcohol and/or Controlled Substances; and Biological Fluid Testing. l2. COMPLETION OF PROBATION. Respondent shall comply with all financial obligations restitution, probation costs) no later than 120 calendar days prior to the completion ot?probation. Upon successful completion ot?probation, Respondent?s certi?cate sliall be fully restored. l3. VIOLATION OF PROBATION. Failure to fully comply with any term or condition ot'probation is a violation of probation. lf? Respondent violates probation in any respect, the Board, after giving Respondent notice and the opportunity to be heard, may revoke probation and carry out the disciplinary order that was stayed. If an Accusation, or Petition to Revoke Probation, or an Interim Suspension Order is filed against Respondent during probation, the Board shall have continuing jurisdiction until the matter is final, and the period ol?probation shall be extended until the matter is ?nal. I4. LICENSE SURRENDER. Following the effective date ot?this Decision, if Respondent ceases practicing due to retirement or health reasons or is otherwise unable to satisfy 10 SETTLEMENT AND ORDER (800-2015017972) \DOO-qaxuunwu.? the terms and conditions of probation, Respondent may request to surrender his or her license. The Board reserves the right to evaluate Respondent?s request and to exercise its discretion in determining whether or not to grant the request, or to take any other action deemed appropriate and reasonable under the circumstances. Upon formal acceptance of the surrender, Respondent shall within 15 calendar days deliver wallet and wall certi?cate to the Board or its designee and Respondent shall no longer practice medicine. Respondent will no longer be subject to the terms and conditions of probation. If Respondent re-applies for a medical license, the, application shall be treated as a petition for reinstatement of a revoked certi?cate. 15. PROBATION MONITORING COSTS. Reapondent shall pay the costs associated with probation mouitoring each and every year of probation, as designated by the Board, which may be adjusted on an annual basis. Such costs shall be payable to the Medical Board of California and delivered to the Board or its designee no later than January 31 of each calendar year. ACCEPTANCE I have carefully read the above Stipulated Settlement and Disciplinary Order and have ?illy discussed it with my attorney, Constance A. Endelicato, Esq. I understand the stipulation and the effect it will have on my Physician?s and Surgeon?s Certi?cate No. A 32596. I enter into this Stipulated Settlement and Disciplinary order voluntarily, knowingly, and intelligently, and agree to be bound by the Decision and Order of the Medical Board of California. DATED: 30?I?i PHILLIP DE MD. Respondent I have read and ?illy discussed with Respondent Phillip De Evans Bretz, MD. the terms I and conditions and other matters contained in the above Stipulated Settlement and Disciplinary Order. I approve its form and content. DATED: CONSTANCE A. ENDELICATO, ESQ. Attorney for Respondent STIPULATED SETTLEMENT AND DISCIPLDIARY ORDER (800-20l5-Ol7972) Ixthe terms and conditions of probation, Respondent may request to surrender his or her license. The Board reserves the right to evaluate Respondent?s request and to exercise its discretion in determining whether or not to grant the request, or to take any other action deemed appropriate and reasonable under the circumstances. Upon formal acceptance of the surrender, Respondent shall within 15 calendar days deliver Respondent?s wallet and wall certi?cate to the Board or its designee and Respondent shall no longer practice medicine. Respondent will no longer be subject to the terms and conditions of probation. If Respondent re-applies for a medical license, the application shall be treated as a petition for reinstatement of a revoked certi?cate. 15. PROBATION MONITORING COSTS. Respondent shall pay the costs associated with probation monitoring each and every year of probation, as designated by the Board, which may be adjusted on an annual basis. Such costs shall be payable to the Medical Board of California and delivered to the .Board or its designee no later than January 3] of each calendar yeah ACCEPTANCE have carefully read the above Stipulated Settlement and Disciplinary Order and have fully discussed it with my attorney, Constance A. Endelicato, Esq. I understand the stipulation and the effect it will have on my Physician?s and Surgeon?s Certificate No. A 32596. I enter into this Stipulated Settlement and Disciplinary Order voluntarily, knowingly, and intelligently, and agree to be bound by the Decision and Order ofthc Medical Board ofCalifomia. DATED: PHILLIP DE EVANS BRETZ, MD. Respondent I have read and fully discussed with Respondent Philiip De Evans Bretz, MD. the terms and conditions and other matters contained in the above Stipulated Settlement and Disciplinary Order. 1 approve its form and content. Moe: DATED: CONSTANCE A. ENDELICATO, ESQ. Attorney for ReSpondent STIPULATED SETTLEMENT AND DISCIPLINARY ORDER (800?20l5-017972) The farcgoing Siipulatcd Settlement and Disciplinary Order is hereby respectfully submitted for consideration by the Medical Board DATED: 8' 30 7 Respectfully submitted, SD20 8702055 7 929296.d0cx XAVIER BECERRA Attorney Genefal of California MAWHEW M. DAVIS Supervi Deputy A tomey General ANN: E. HIELDS eputy Attorney General Attm-neyxfor Complainant 12 STIPULATED SETTLEMENT AND DISCIPLINARY ORDER (8004013017972) Exhibit A Accusation N0. 800-2015017972 Xavn-tn BECERRA Attorney General of California MATTHEW M. DAVIS Supervising Deputy Attorney General E. FILED airstrirra?aam? STATE or 0111101111 600 West Broadway, Suite 1800 ME ICAL BgAw San Diego; CA 92101 SA. P. O. Box 85266 ANALYST San Diego, CA 92186? 5266 Telephone: (619) 738- 9401 Facsimile: (619) 645-2061 Attorneys for Complainant BEFORE THE MEDICAL CALIFORNIA OF CONSUMER AFFAIRS STATE OF CALIFORNIA In the Matter of the Accusation Against: MBC Case No. 800?2015-017972 PHILLIP DI1 EVANS BRETZ_78- 034 Calie Btu cclona, Suite . La Quinta, CA 92253 Physician? and Suzgeon? 5 Certificate No. A 32596 Respondent. Complainant alleges: . PARTIES Kimberly- Kirchmeyer (Con?tplainant)brings this Accusation solely in her of?cial capacity as the Executive Director of the Medical Board of Caiifornia, Department of consumer Affairs (Board). 2. On or about July 1978, the Board issued Physician?s and Surgeon?s Certi?cate No. A 32596 to Phillip De Evans Bretz, MD. (Respondent). The Physician?s and Snrgeon?s ACCUSATION (800-2015-017972) 19 Certi?cate No. A 32596 was in full force and effect at all times relevant to the charges brought herein and will expire on October 31, 2019, unless reneyyed. JURISDICTION 3. This Accusation is brought before the Board, under the authority of the follciwing laws. All section referencesare to the Business and Professions Code (Code) unless otherwise indicated. 2 4. Section 2227 of the Code states: A licensee Whose matter has been, heard by an administrativelaw judge of the Medical Quality I'learing Panel as designated in Section 1 1371 01" the Government Code, or whose default has been entered, and who is found guilty, or who has entered into a stipulation for disciplinary action with the board, may, in accordance with the provisions of this chapter: 1) Have his or her license revoked Upon order of the board. - Have his or her right to practice suspended for a period not to?exceed one year upon order of the board. Be placed on probation and be required to pay the costs of probation monitoring upon order of the board. I I Be publicly reprimanded by the board. The public reprimandmay include a requirement that the licensee complete relevant educational courses approved by the board. Have any other action taken in relation to discipline as part of an order oi" probation, as the board or an administrative law judge may deem proper. Any matter heard pursuant to subdivision except for warning letters, medical review or advisory conferences, professional competency examinations, continuing education activities, and cost reimbursement as?ociated therewith that are agreed to with the board and successfuily completed by the licensee, or otl er matters made con?dential or privileged by existing law, is deemed public, and shall be made available to the public by the board pursuant to Section 803.1.? 2 (300-2015-017972) Section 2234 oi? the Code, states, in pertinent part: ?The board shall take action against any licensee who is charged with unprofessional conduct. In addition toother provisions of this article, unprofessional conduct includes, butlis not limited to, the following: Violating or attempting to tiiolate, directly or indirectly, assisting in or abetting the violation of, or conspiring to violate any provision of this chapter. Gross negligence. Repeated negligent acts. To be repeated, there must be two or. more negligent acts or omissions. An initial negligent actor omission followed by a separate and distinct departure from the applicable standard of care shall constitute repeated negligent acts. An initial negligent diagnosis followed by' an act or omission medically appropriate for that negligent diagnosis of the patient shall constitute a single negligent act. When the standard of care requires a change in the diagnosis, act, or omission that constitutes the negligent act described in paragraph (1), including, but not limited to, a reevaluation of the diagnosis or a change in treatment, and the licensee?s conduct departs from the applicable standard of care, each departure constitutes a sepai'ateaand distinct breach ol? the standard of care. . FIRST CAUSE FOR DISCIPLINE (Gross Negligence) . 6. Respondent has subjected his Physician?s and Surgeon?s Cettii?icate?No. A 32596 to disciplinary action under section 2227 and 2234, as defined by section 2234, subdivision in that he committed gross negligence in his care and treatment of Patients A, B, and (3,1 as more particularly alleged hereinafter: For patient privacy purposes, patient identities have been withheld. 3 ACCUSATION (soc-2025.017972) 26 _27 28 Patient'A 7. On or about November 3, 2015, Patient A presented to Respondent for the ?rst time seeking a second opinion regarding treatment of a mass located in her right breast which had been previously diagnosed as-grade two mixed duct and lobular Carcinoma for which Patient A?s oncologic surgeon had recommended mastectomy and reconstruction. 8. During the visit, Respondent discussed multiple treatment options and referred Patient A to a website regarding surgical options and dictionary segments. Respondent also discussed the potential For Patient A to undergo hisLavender Procedure, which involves eryoablation of breast cancer.2 Respondent determined Patient A was a candidate for his Lavender Procedure. 9. On or about November 3, 2015, Patient A signed an informed consent form for cryoablation of breast cancer. However, the informed consent form failed to adequately disclose all the risks and Complications of the procedure, including but-not limited to,__the chances ot'arni swelling from a sentinel biopsy, the chance of theiremoval of more than one node, the chance of?injury to the intercostal brachial nerve which may result in numbness to the inner aspect of the arm. 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. - 10. On or about November 20, 2015, Patient A returned to Respondent for the Lavender Procedure; I 1. At no'time did Respondent perform or offer to perform a sentinel node biOpsy. 12. At no time did Respondent perform or offer to perform a partial mastectomy and sentinel node excision or mastectomy and sentinel node excision. .i/x 2 ?Lavender Procedure? 15 a c: yoablat1on procedure 111 which Dr. Bretz uses extreme cold temperatures to destroy breast cancer tissue. Czyoablation of breast carcinoma is experimental and 15 not part ol?an approved Institutional Review Board (1R8) clinical study. 4 (800-20l5?Oi7972) '13. Respondent committed gross negligencelin his care and. treatment or? Patient A, which included, but was not limited to, the Following: A. Respondent failed to provide suf?cient information regarding the Lavender Procedure in order to obtain preper informed consent; and '13. Respondent failed to perform or offer to perform a sentinel node biopsy. Patient i 14. On or about December 2, 2015, Patient 13 presented to Respondent for the ?rst time seekinga second opinion regarding treatment of a mass located in her left breast which had been previously diagnosed as grade two infiltrating ductai carcinoma for which Patient 13 had completed neoadjuvant chemotherapy with apparent complete clinical response. 15. During the visit, Respondent discussed multiple treatment optionsand discussed the potential for Patient to undergo his Lavender Procedure. 16. On or about December 5, 2015, Patient 13 returned to discuss treatment ?options with Respondent, including mastectomy, lumpectomy, and Lavender Procedure. During this visit, Respondent discussed the option of" having a repeat sentinel node biopsy and Lavender Procedure. ?17. On or about December 9, 2015, Patient returned for a re-evaluation. During this - visit, Respondent again discussed the possibility with the Lavender Procedure and started Patient on 'l?alnoitil.?en.3 . 18. On or about December 31,2015, Patient returned for a ?nal evaluation and discussion regarding the option of the Lavender Procedure. According to?progress notes for this visit, Patient decided to proceed with the Lavender Procedure. 19. On or about March 25, 2016, Patient presented to review her current situation. A During this visit, progress notes indicate Respondent advised Patient to consider surgical treatment rather than the Lavender Procedure due'to the original sizeol? the tumor being four (4) centimeters. positive nodes. and not having a de?nitive target. 17! 3 Tamoxifen is a dangerous drug pursuant to Business and Professions Code section 4022 used to block the effects of estrogen. .it is commonly used to treat and prevent breast cancer. 5 AOCUSATION (800-2015-017972) 26 27 28' 20. on or about May ll, 2016, Patient presented to her oncologist, who discovered a palpable mass in Patient B?s breast. A subsequent biopsy revealed Patient B?s tumor had recurred. 2i. Respondent committed gross negligence in his care and treatment of Patient which included. but was not limited to, Respondent 8 failure to tecognize the Lavender was conuaindicated during his initial visits wr th Patient l3 resulting 111 a delay 1n appr'opliate treatment, surgical procedure, to Patient B. Patient I . 22.. On or about March 20, 2015, Patient presentedto Resnondent for the first time seeking'consultation regarding treatment of recurring cancer in herlet?t breast. Progress notes for this visit indicate Patient reported having a history of left breast cance1 with treatment including a lumpectomy and chemotherapy. Patient was refusing any further surgery, chemotherapy or radiation therapy and was requesting cryoablation. During the visit, Respondent prescribed Tamoxifen and indicated there was not much to be done since Patient was refusing any further treatment. - 23. On or about March 25, 2015, Patient was seen by her oncologist and agreed to reexcision of the biopsy cavity. 24. On or about March 2015, Patient returned to Respondent stating she had a reaction to 'I?amoigifen. Progress notes for this visit indicate Respondent prescribed Patient ,Arimidexd and informed Patient that further surgical operation seemed inappropriate since she now had positive margins and likely metastatic disease. 25. On 01 about April 7, 2015. Patient rettnned to Respondent for a ?reevaluation of hot medications. 26. On or about June 26, 2015, Patient returned to Respondent to discuss a-recent visit 'with a radiation oncologist who suggested proton therapy. Progress notes for this visit indicate Respondent encouraged Patient to continue taking Tamoxifen. 4 A1 imidex 1s a dangerous ding pursuant to Business and Ptolessions Code section 4022 used to lowe1 estrogen levels it 13 commonly used to stop or pievent tumot g1 owth by blocking est1ogen ploduction. 6 U) \16about November 4, 20i5, Patient returned to Respondent regarding a recent MRI study. Progress notes for this visit indicate Respondent suspected possible recurrent carcinoma of the left breast, and recommended Patient obtain a core biopsy with her oncologist and return with her results. I 28. On or about January 6, 2016, Patient returned to discuss treatment options of the recurreni carcinoma as determined by a recent core biopsy. Progress notes for this visit indicate Respondent discussed the possibility of performing the Lavender Procedure "due to Patient C?s refusal to have traditional therapy. Informed consent was given at this visit. 29. A On or about January 16, 2016, Respondent performed the Lavender Procedure on Patient C. 30. On or about March 16, 2016, Patient underwent an ultrasound biopsy of the eiyoablation site which demonstrated int1lt1at1ng lobula1 ca1cinoma. 31. Respondent committed gross negligence inhis care and treatment-of Patient C, which included, but was not limited to, Respondent?s failure to recognize the Lavender Procedure was not an appropriate treatment for Patient C, as cryoablation is not an appropriate treatment alternative for recurrent breast cancer. - SECOND CAUSE FOR DISCIPLINE (Repeated Negligent Acts) 32. Respondent has further subjected his Physician?s and Surgeon-?3 Certi?cate No. A 22596 to discipiinary action under sections 2227 and 2234, as defined by 22341, subdivisicntc), in that he Committed repeated negligent acts in his care and treatment of Patients A, B, and C, as more particularly alleged in paragraphs 6 through 31, which are hereby incorporated by reference and reallegcd as if fully set forth herein. I THIRD CAUSE FOR DISCIPLINE ,(Violations of the Medical Practice Act) 33. Respondent has further subjected his Physician?s and Surgeon?s Certi?cate No. A 32596 to disciplinary action under sections 2227 and 2234, as defined 12512234, subdivision in that he committed violations of the Medical Practice Act in his care and treatment of Patients A, 7 ACCUSATION (sensors-017972) 1-0 11 12 13 14 15 1-28- DAIED: B, and C, as more particularly alleged in paragraphs 6 through 32, which are hereby incorporated by reference and realleged as if fully set forth herein. PRAYER Complainant requests that a hearing beheld on the matters herein alleged, and that following the hearing, the Medical Board of California issue a decision: I I l. Revoking or suspending Physician?s and Surgeon?s Certi?cate No, A 32596, issued to Respondent Phillip De liuans Bretz, I 2. ?Revoking, suspending or denying approval of Respondent-Phillip De Evans 'Bretz, authority to supervise physician assistants and advanced practice nurses; 3: Ordering Phillip De Evans Bretz, M11, if placed on probation, to pay the Board the costs of probation monitoring; and 4. Taking such other and further action as deemed necessary and proper. October 31. 2018 . . - Executive Director Medical Board of California Department of Consumer Affairs State of California Complainant 3132016700980 71624762.docx (soc?20150179722)