At age 69, Portland neurosurgeon Dr. Darrell Brett is in the home stretch of a successful medical career. At his peak, he performed 750 surgeries a year, many at Adventist Health, a Southeast Portland hospital, where he still keeps a clinic. His medical practice has made him wealthy: a lakefront home, a flotilla of boats, a silver Bentley.

But for the past year, Brett hasn’t charged a dime for his services.

It’s not because he has decided to give back to the community. Instead, it’s because the state’s licensing board issued a remarkable sanction against him.

A sprawling investigation by the Oregon Medical Board, begun in 2017 and recently unearthed by WW, alleges that Brett over the past decade engaged in a number of questionable practices. And in 2022, the board, whose members are appointed by the governor, agreed to let Brett continue his medical practice, but only if he did so as a volunteer and did not charge patients.

The very rare agreement came about because Brett “engaged in conduct contrary to recognized standards of ethics of the medical profession,” the Oregon Medical Board said Jan. 18, 2022, in its 30-page complaint. In sum, the board concluded, Brett’s conduct amounted to “gross negligence in the practice of medicine.”

Specifically, the board called out Brett for doing three things:

• Brett prescribed painkillers so liberally in some cases that it crossed into negligence, the medical board determined. In two instances documented by the board, patients died shortly thereafter due to complications arising from use of the powerful drugs, although the board does not explicitly blame Brett for the deaths.
• The board also found that he had marked up the cost of surgery by more than 1,000% beyond what others charge for similar services.
• In 2015, Brett referred his patients to a diagnostic company he owned and then marked up prices, according to the board.

Brett’s story is not just a tale of a single doctor who the board claims is guilty of gross negligence. It also illustrates how Oregon lawmakers, at the behest of health care trade groups, have allowed the state’s regulations to fall out of step with the rest of the country’s.

WW made many attempts to contact Brett for this story. A reporter stopped by his office. (A receptionist said he wasn’t there.) We visited his home. (No one answered the door.) And we contacted lawyers who had previously represented him in malpractice suits. (None responded.)

Nor has a spokesperson responded for Adventist Health, where he continues to keep a clinic.

Ask around medical circles about Dr. Darrell Brett, and you’ll get testimonials about his skill with a scalpel. He operates on the spine, with a specialty in disk replacement. His bread and butter is treating chronic back pain from car accidents or workplace injuries.

Jordi Kellogg, a former colleague, says Brett’s a family man and a good surgeon. “There’s bad apples in everything,” Kellogg says. “He’s not a bad apple.”

You’ll also hear plenty of stories about the stocky, 5-foot-8 neurosurgeon’s wealth—and the lifestyle that came with it.

He collects classic cars and is a regular at Lake Oswego’s toniest parties—once hosting a lavish dinner (price: $1,500 per couple) for what a 2014 charity auction catalog called “an evening F. Scott Fitzgerald might have written himself.”

In 1999, he bought a house on the shores of Oswego Lake and, despite concerns from preservationists hoping to save a historic landmark, bulldozed it to the ground to build one twice as big: five bedrooms, five bathrooms, 10,500 square feet.

Related: Dr. Darrell Brett was once famous for his altercation with an airport parking attendant.

He’s well regarded among his close circle of friends in Lake Oswego. Kent Studebaker, the town’s former mayor, says the neurosurgeon’s a “good man” and a devout Christian. The two men share a private Bible study group. Patients say he’s prone to pray over their bedside prior to lifting the knife.

But as far back as 2017, the Oregon Medical Board opened an investigation after receiving a series of complaints about Brett’s practice.

Each year, the board receives around 700 to 800 complaints. That means it scrutinizes a sizable portion of the state’s 23,000 active medical practitioners. The board fully investigates around half of those complaints, and issues sanctions in 10%, usually after doctors come to a settlement agreement with the board.

Complaints to the board, as well as materials collected during the course of its subsequent investigations, are shielded by law from public view. But the board does sometimes file its own formal complaints against doctors, which outline its allegations and are a matter of public record. In Brett’s case, such a document was filed in 2018 by board investigators and outlines the focus of their inquiry: Brett’s alleged practice of prescribing large doses of painkillers before and after surgery.

Investigators identified 10 cases that they determined violated the Medical Practice Act when the board wrote up its initial complaint, filed that July.

In that complaint, the board said its review of patient files uncovered “a pattern of practice in which [Brett] prescribed excessive amounts of opioids for multiple patients in a manner that constituted unprofessional or dishonorable conduct.”

Brett’s prescribing of “high dosages of opioids” in conjunction with benzodiazepines or muscle relaxers “subjected his patients to the risk of harm,” like heart attacks, the board wrote. And, the board wrote, Brett hadn’t checked the state prescriber database prior to initially prescribing opioids and then “rarely checked” during the course of continued treatment. (That database is a crucial tool for identifying patients who ask for a lot of opioids, and the doctors who say yes. See “Pain Free,” right.)

The prescribing errors were so common, the board concluded, that they constituted “gross and repeated negligence” as defined by the Medical Practice Act.

Critics of the board’s crackdown point out that attitudes regarding pain management have changed dramatically in recent years, catching doctors off guard.

Brett was not unique among neurosurgeons in doling out lots of opioids, Kellogg says: “We deal with people in pain.”

One of the cases the board looked at was that of Glenn Jones, a 58-year-old man who arrived in Brett’s office in 2017 after falling on a TriMet bus and hurting his back.

Jones was already taking a powerful cocktail of painkillers prescribed by his primary care physician: Valium, Neurontin, Lamictal, methadone and oxycodone. He also had a history of drug abuse.

According to the board’s findings, Brett then prescribed more: 10 mg pills of oxycodone HCL, an opioid painkiller, to be taken eight times a day.

Three days after surgery, Jones was found dead at his home. He had overdosed on methadone and oxycodone, the medical examiner later determined.

When the medical board’s investigators reviewed the case, they found that Brett hadn’t determined, either through a urine test, contacting his primary physician or consulting the state database, how many opioids Jones was already taking. This “subjected [the patient] to risk of harm” and “breached the standard of care,” the board wrote in 2018.

What defense, if any, Brett offered to the board is not contained in public records.

In 2018, Brett signed an “interim stipulated order” with the board putting limits on his prescription of painkillers. The board would continue investigating Brett for much of the next five years, amending the complaint twice with new violations as its investigators uncovered them.

One of the new violations concerned Precision Laboratories, a medical limited liability company incorporated in Oregon in 2015 and owned by Brett through a convoluted series of shell companies.

The Oregon Medical Board determined in 2020 that Brett was referring his patients to his own lab for urine drug screens, a test that doctors often order for patients before prescribing them pain medications. What’s more, the lab wasn’t even performing the tests. It was sending the urine samples to Nepenthe Laboratory Services, a Eugene laboratory, according to the board’s complaint.

In other words, the board alleged Brett was funneling his patients to a company he owned that was doing little more than marking up prices and sending patients bills—and not disclosing any details of the arrangement.

“[Brett] failed to inform [the patient] of [Brett’s] financial interest in Precision Laboratories, or to notify [the patient] that her diagnostic services could be referred to a different facility of her choice,” the board wrote.

Federal laws limit physician “self-referral,” the practice of doctors inflating profits by referring patients to businesses they own for additional medical services, such as laboratory diagnostic tests, effectively earning a kickback. Oregon has its own set of restrictions, requiring doctors to disclose such arrangements.

But that hasn’t stopped intrepid doctors from doing it anyway.

Here’s one example of how Brett operated, according to the Oregon Medical Board:

In June 2016, a 64-year-old woman came in to see Brett complaining of back pain following an auto accident. Prior to surgery, he “informed [the patient] that she must undergo a mandatory urinalysis/drug screens (UA) before he could legally prescribe pain medications for her,” the board wrote.

(Brett appears to have been stretching the truth. “There is no law specifically requiring urine drug screens, but the standard of care may include urinalysis under certain conditions,” says a medical board spokeswoman.)

The woman provided two urine samples at Brett’s clinic. Seven months later, the woman received a $9,400 bill from Precision Laboratories, $4,700 for each test.

It was quite the markup. “A comprehensive UA to screen for opioids typically costs no more than a maximum of approximately $400,” the board later wrote.

This arrangement was “conduct contrary to recognized standards of ethics of the medical profession,” the board concluded, listing an array of reasons. Among them: referring patients to a health care facility in which he had a financial interest, and “charging marked-up or excessive fees.”

Any defense Brett offered to the board is not contained in public records.

In 2020, the board published an amended complaint against Brett that included descriptions of two patients whom Brett had referred to Precision Laboratories. That same year, the 4-year-old company dissolved after it failed to renew its annual registration with the state.

Dr. John Santa was medical director of Blue Cross Blue Shield in the 1990s and now tells WW, “Brett’s reputation for making a lot of money and pushing the limits in terms of a variety of issues is pretty well known in the medical community.”

While the creation of Precision Laboratories was the board’s most remarkable finding, it also concluded Brett grossly overcharged patients on at least one other occasion identified by investigators and described in a 2022 amendment to the complaint.

The surgery was on a woman from Astoria named Jentry Wright.

Wright also told her story to WW. She was in a 2018 car wreck and suffered a ruptured disk in her back, which Brett operated on the week before Christmas that year. She later received a $53,000 bill.

The medical board found that bill to be “grossly inflated,” even after Brett offered her a 40% discount. Typical surgeon fees for this procedure, the board said, ranged from $722 to $3,608, meaning Brett’s original fee amounted to a more than 1,000% markup.

“He scams people,” Wright says. She thinks Brett did a good job with the surgery, but, she says, “I think I should get a refund.”

The Oregon Medical Board investigation was closed after five years when Brett agreed to a settlement in July 2022.

In order to keep his medical license, Brett made a remarkable deal with the state oversight board. He was ordered by the board to switch his license’s status to “emeritus.” Brett’s license is currently limited to “unpaid volunteer practice,” according to a description of limits on his license posted on the board’s website.

A board spokeswoman could list only two other instances of such a limit being imposed on a doctor as part of disciplinary action by the board, one in 2005 and another in 2022.

Brett “neither admits nor denies” the allegations, according to the order. He still owns his clinic at Adventist Health, according to state business filings, and by all appearances is still practicing medicine.

But Brett hadn’t gotten out of hot water with the board. In September, the board said he had violated prescribing limits again, by concurrently prescribing sleeping pills and opioids to an unnamed female patient in August 2021.

On Jan. 4, Brett and the board settled, again. Brett agreed to pay a $4,000 fine.

And he accepted the ultimate punishment. As of June 1, the board has ordered, “he may no longer practice medicine in the state of Oregon.”

Pain Free

Oregon tracks opioid prescriptions—but limits regulators’ ability to look at the data.

Prescription painkillers flooded the United States in the early part of the 21st century thanks to the aggressive marketing of new opioid painkillers like OxyContin, which its manufacturer Purdue Pharma marketed as less addictive than rivals.

Purdue’s claims were misleading, and company executives knew it. The consequence was a nationwide epidemic of addiction. Oregon was one of the states hit the hardest. By 2014, it had the second-highest rate in the nation of prescription opioid abuse.

“We thought we were doing the right thing at the time, but we weren’t,” says Dr. David Farris, who took over as medical director of the Oregon Medical Board in 2020.

The state sued Purdue Pharma—twice. But its ability to go after doctors who overprescribe opioids is limited by state legislators.

Oregon, following on the heels of other states, built a database in 2009 to keep track of every time an opioid is prescribed. Pharmacists are required to submit information to the database when they dispense controlled substances like opioids. The result is a list that records the pill, the patient and the prescriber.

The idea is that doctors can check the database prior to prescribing opioids to ensure they’re not fueling a patient’s addiction. But unlike most other states in the country, Oregon doesn’t require doctors to check the database before writing an opioid prescription, a limitation called out in a 2018 audit by the Oregon Secretary of State’s Office. (As of 2021, federal law requires it of all Medicaid providers.)

An effort last year to introduce such a mandate in the Oregon Legislature died after the state’s powerful physician trade group, the Oregon Medical Association, called the bill “extremely overburdensome.” Other health care trade groups also weighed in against it. “It’s hard to pinpoint the exact reason it died,” says one of the the bill’s sponsors, state Rep. Bobby Levy (R-Echo).

More troubling, the medical board is prohibited by law from hunting through the database to identify doctors who might be prescribing too much.

Thirty-five other states send unsolicited reports to their licensing boards, according to the Institute for Intergovernmental Research.

In 2022, since-ousted Secretary of State Shemia Fagan publicly bashed legislators for not heeding her recommendation to broaden the state’s use of the prescription drug monitoring program, reportedly calling state efforts “not good enough.”

The result is that the medical board must still wait for someone to complain before it launches an investigation into how freely a doctor whips out a prescription pad.

Once one comes in, the board’s 16-member investigative division, which Farris says includes former detectives, gets to work, pulling medical records and searching through the database for instances of questionable prescribing.