One woman spent 11 months doing painful exercises that Breshears told her would delay hip surgery by regrowing her cartilage.

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1 Boise chiropractor accused of exploiting, mistreating patients By Audrey Dutton The Idaho Statesman, June 30, 2015 Boise chiropractor Laverle Breshears faces a license suspension for exploiting patients financially, giving them unnecessary or useless treatment, misdiagnosing them, and violating the standards of care and licensing rules for the state. Breshears put patients through years of treatments, multiple times a week, that may have hurt patients instead of helping them, according to documents from the Idaho Board of Chiropractic Physicians and its administrative partner, the Bureau of Occupational Licenses. When an 85 year old woman came to Breshears for back pain, he diagnosed a yeast infection and prescribed nutritional supplements. It turned out she had breast cancer. One 9 year old patient came in with attention deficit disorder and ended up getting five years of spinal adjustments, with no record of improvement in the child's problems. A family of three signed up for a program that cost more than $8,000 over three years, though only one of their "treatment plans" would have lasted that long. After the family decided not to go to Breshears anymore, his office sent them a bill for $3,000. One woman spent 11 months doing painful exercises that Breshears told her would delay hip surgery by regrowing her cartilage. "The idea that he can regrow cartilage? If that was true, he would have a line outside his door from China to here. It would be a revolutionary breakthrough," the woman's husband told the Statesman. "It gives chiropractors a bad (name), and that's unfortunate, because there are good chiropractors out there." Despite what appear to be severe and persistent problems, the state Board of Chiropractic Physicians took years to prosecute Breshears after receiving complaints, and the board is not seeking to revoke his license. At least six years elapsed between the first patient care complaint filed against Breshears, in 2009 at the latest, and the board's first disciplinary action against the chiropractor this year. The Idaho Board of Chiropractic Physicians issued an order to suspend Breshears' license for 60 days, put him on probation for a year, force him to retake examinations, take classes and pay a fine of $2,000 and 35 percent of more than $100,000 in attorney's fees and costs for investigating and prosecuting him. Breshears is contesting the board's decision in court. Breshears did not return messages from the Statesman. His receptionist said she was instructed not to talk with a Statesman reporter.

2 "My client would love to give a statement, however, I have legally advised him not to, as the matter is currently under appeal," Breshears' lawyer, Lawrence E. Kirkendall, said in an . "What I can disclose is that a majority of the charges were dismissed after hearing. The remaining charges are pending appeal, and we remain optimistic that we will obtain justice for Dr. Breshears." Breshears mounted a defense that frustrated the hearing officer and others involved in his case. At one point, the hearing officer wondered how much time and money Breshears had wasted by delivering crucial documents only after the proceedings were already underway. The transcript for Breshears' hearing ended up being 2,900 pages long, the officer noted, and the board ended up dropping most of its 18 counts. In his defense, Breshears denied all of the allegations. He said the board violated his due process rights by not giving him adequate notice and explanation of the charges against him. He argued that the standards he is accused of violating are unconstitutionally vague. He said "portions of the decisions were arbitrary, capricious, or in abuse of the agency's discretion." Breshears is now asking the Fourth District Court to review the board's action, which it issued in March. THE INVESTIGATION Records leading up to the disciplinary action show that professional reviewers, whose names and qualifications were not disclosed, told the investigators in charge of looking into complaints that Breshears committed misconduct in treating at least four patients. One reviewer the bureau consulted in 2012 on the 9 year old A.D.D. patient's case files said it was "one of the most abusive and negligent cases he had reviewed." The unnamed reviewer characterized it as "more of a criminal case." Those reviewers said as early as fall 2009 that it appeared Breshears was not meeting professional standards. The records show the reviewers also flagged problems for which the board eventually did not, or found that it could not, charge Breshears with violations. Mary Jo White, a Post Falls chiropractor, chairs the state board that oversees 635 chiropractors actively licensed in Idaho. White cited the pending litigation in declining to comment on the case, including how the board decided that suspension and probation were the right punishments. The Bureau of Occupational Licenses is the contracted agency that handles complaints and investigations for the chiropractic board and 28 other state licensing boards. Dawn Hall, the bureau's administrative support manager, also cited the litigation in declining to do an interview or answer questions, including why it took the bureau and the board at least four years to bring a

3 formal complaint against Breshears. Hall did answer general questions about the complaint process by . "The bureau generally opens a case within a day or two of receiving the complaint," she wrote. "Each case is different, so there is no set timeline" for moving forward with discipline or deciding to close a case. "The bureau's goal is to have all cases investigated within a year after they are received." The bureau has 11 investigators, Hall said. The Idaho Legislature has added three of those jobs since fiscal 2008 to keep up with backlogs and work loads, she said. Here is what the records say happened in the cases in which officials found Breshears had violated the law: 'RED NIPPLE' V.H. was an 85 year old woman who initially went to see Breshears for back pain between December 2007 and February In January 2008, Breshears diagnosed her with "red nipple" and prescribed eight supplements to treat it. V.H.'s daughter was suspicious about the diagnosis and supplements and accompanied her mother to the next appointment. After that visit, the woman's daughter "made a note of her conversation" with Breshears. According to those notes, Breshears said "the nipple was precancerous but had been caught in time, being a plugged duct from too much yeast, that the supplements were to address or 'fix' the red nipple, and that the nipple could break open and discharge, which would be a sign of healing." The daughter asked Breshears about a second opinion. Breshears suggested thermal imaging instead of a mammogram, to keep V.H. from having to go through a biopsy and surgery. The American Cancer Society recommends against thermal imaging as a substitute for mammograms. Breshears later denied that this conversation happened. Instead, he said "he would not make such statements about red nipple, as red nipple is a sign of cancer," according to the board's records. Breshears said he "assumed it was cancer but did not want to scare V.H. and urged V.H. to seek treatment with a breast surgeon for the nipple." Soon after that visit, V.H. underwent a biopsy, testing positive for malignant breast cancer. Breshears said he found out about the biopsy results, but his notes for V.H.'s many visits following the biopsy say nothing about her nipple, cancer, surgery or breast. A hearing officer reviewed the records and decided Breshears' account of what happened contradicted what he had written in V.H.'s chart.

4 The woman's daughter later called Breshears' office to tell an employee not to contact her parents, "saying that (Breshears) could have killed her mother by treating her cancer with herbal supplements." The patient, V.H., has since died, Breshears said. "If she were alive today, her testimony would completely vindicate me of the allegations made by her daughter," he wrote to the board. A reviewer for the board found no diagnosis in the patient's records that would justify the 26 visits V.H. had with Breshears in a two month period. "In short, it appears clear and convincing that Dr. Breshears, either misdiagnosed the nipple, or even worse, diagnosed it as potentially cancerous and held that information back from the patient," disciplinary documents said. "It is clear and convincing that he tried to dissuade (V.H.) from getting a further evaluation, and that he attempted to treat the 'red nipple' with supplements. It also appears that he may have doctored his chart notes to show a referral for diagnostic testing after the breast had already been diagnosed." 'EXTENSIVE TREATMENT' K.W., N.W. and L.W.... a woman, her husband and their 9 year old son... went to Breshears in the summer of K.W. wanted "a checkup and (had) an interest in supplements." N.W. had blood pressure and cholesterol issues as well as "fuzzy thinking." L.W. had "bowel issues." They signed a financial agreement that September to pay $240 a month for 36 months... $8,640 total... of "extensive treatment programs." The agreement did not say which services would be provided or the charges for those services. The records show Breshears also billed the family's health insurance. Breshears charged them for physical therapy he never did and had the family members come in for treatment three times a week, according to the board's records. After the family quit seeing Breshears in January 2008, after just five months or one seventh of their contract term, his office sent them a bill for $3,000. The office told the family the bill was their after insurance balance. That's when K.W. filed a complaint with the board. "Was it financial exploitation? The board expert opined that it was," according to a hearing examiner's report. "K.W. testified she believed she had been exploited financially as a result of the trust given to (Breshears). She also testified that she did not feel any different after the treatment, except for being 'lighter in the wallet.' (Breshears) explained that the reason no improvement was noted by the family is that they abruptly ended the treatment after five months." GRINDING THE SOCKET A female patient, L.G., had her first appointment with Breshears in October Over the next

5 year, she would have 107 more appointments with him. L.G.'s husband testified at the Breshears disciplinary hearing. He agreed to an interview with the Statesman in mid June but asked that his name not be used to protect his wife's privacy. L.G.'s complaint against Breshears was prompted by what happened after an orthopedic surgeon told her she needed hip surgery. L.G. had been seeing Breshears for unrelated reasons, her husband said, and Breshears told her he could help her avoid hip surgery. "He said, 'I can fix it through my therapy, my supplements and my physical therapy and regrow the cartilage in that area,'" the husband told the Statesman. But he was skeptical. He asked Breshears: Had any other patients successfully regrown cartilage? Yes. Would Breshears provide references? Yes. L.G. started the program right away. A month went by, then two months, and Breshears had provided no referrals after repeated inquiries. "By that time, I'm saying this guy is full of it, he's a con artist," the husband said. L.G.'s treatment "proved to be a failure," according to the disciplinary action. It also cost the couple $12,000. "What's worse is I was enlisted... to do the exercises at home," the husband said. "I'm helping with these exercises, and my wife is writhing in pain, and she's saying, 'Well, this is what the doctor says will work.'" According to the board, Breshears failed to document a number of things about those visits, including the dosage of supplements he told her to use, how she responded to his care and why it was necessary to give her supplements. There also "is clear and convincing evidence that (Breshears) engaged in misconduct by making assurances that his treatment would prevent a hip replacement, engaged in rendering inefficacious care, and financially exploited (the patient)," the disciplinary record says. "The 'treatment' of the hip was an 11 month course of little more than grinding the leg in its socket, causing extreme pain, for no valid reason." 'X RAYS ETC.' Patient K.S. first met Breshears in January 2003, when she went to his office at the request of her husband for according to her chart "1st time, X rays etc." Eleven years later, Breshears was still seeing her as a "spine remodeling" patient. Nothing in her chart showed a plan to remodel her spine, though some other records Breshears produced showed "enough justification to begin a spinal remodel plan," the examiner found.

6 In the nine years of records reviewed, K.S. had purchased 77 different supplements and had 230 adjustments. "One cannot escape the conclusion that the plan would have continued in perpetuity on automatic pilot had it not been for the board reviewing the file," the examiner said. The examiner added that while it was "tempting to also find unnecessary or inefficacious care (on the surface the care seems grossly excessive), that cannot be found..." The board decided Breshears was "below the standard of care" in how he treated K.S. TREATING A.D.D.? I.P., a 9 year old girl, made her first visit to Breshears in April The reason on her intake form was "A.D.D.," and Breshears said in his hearing that he intended "to affect the ADD through improvement of the spine." Breshears "prescribed" supplements, though without any indication as to how the supplements would affect her attention deficit disorder, and someone purchased "several" for her a week later, according to the records. I.P. came in for adjustments "in at least six to eight places" two or three times a week until January She "continually complained about back pain" throughout that period. After the girl was in a car crash in April 2008, Breshears started running a series of X rays on her. Her chart showed 38 X rays from then until 2011, and by 2011 she had visited Breshears' office 306 times. The board alleged that Breshears took six X rays on I.P. in a single day in 2008 and took 11 in a single day in The girl's record doesn't seem to give any reason for the spinal adjustments or taking X rays, the board found. Breshears almost never mentioned her A.D.D. or progress in that area. "What is even more troubling is that I.P.'s spine seemed to be fairly asymptomatic when she first arrived at (Breshears') office. Other than a reference to a sore back... some two months earlier, this child seems to have been no different than any other," a hearing officer wrote after reading the records and hearing Breshears' testimony. "After the X ray, when (Breshears) discovered the 'need' for extensive treatment, the patient continuously began to complain about back pain over the course of the months." The girl's family had agreed in October 2006 to pay $141 a month, on top of insurance, for two years. Breshears "engaged in negligent care creating a risk of harm (and in this case actual harm) to the patient," according to findings approved by the board. A VIOLATION OF TRUST

7 The word "trust" shows up nine times in the disciplinary action against Breshears. The hearing officer said most patients "did not testify about trust issues." But in the end, the board said Breshears in three cases had "engaged in any conduct which constitutes an abuse or exploitation of a patient arising out of the trust and confidence placed in the licensee by the patient." From the time investigators gathered "the first batch of files" in 2008, until five years later when the Bureau of Occupational Licenses filed its complaint against him, Breshears has argued he never heard of "alleged problems with my documentation, or other misconduct, or that the alleged problem with documentation could subject me to discipline." Had someone told Breshears about that in 2009 "and the board provided to me or articulated to me the correct standard I was to follow, I certainly would have implemented that standard immediately," he wrote. The husband of L.G., the female patient who needed a hip replacement, said his wife trusted the chiropractor. "When people are desperate," he said, "they will give people the benefit of the doubt. This story was made possible with funding from the Idaho Media Initiative and may be reprinted with proper attribution and IMI funding credit.