California Revokes Podiatrist's License
Stephen Barrett, M.D.
In 2001, the California Board of Podiatric Medicine, a unit of the state medical board, revoked the license of Garey Lee Weber, DPM [1,2]. Weber formerly owned and worked at the Doctor's Foot & Ankle Centers, a group practice with seven other podiatrists and a large support staff in foot-care centers in Studio City, Irvine, and Victorville, California.
In 1987, the podiatric board and the Attorney General accused Dr. Weber, two associates, and three other podiatrists who used his operative facilities of engaging in substandard treatment and unethical business practices that included diagnosing and treating nonexistent conditions, falsifying medical records, providing sham second opinions, and submitting false billings .
The charge of substandard treatment pertained to the type of bunion operation Weber performed. A bunion is a protuberance of bone or tissue around a joint. The standard treatment for severe cases is surgery in which the enlarged portion of the affected bone is removed and the bone is severed and realigned. In standard practice, a pin, screw, or absorbable rod is inserted to hold the cut ends in place, a slipper or short leg cast may be worn for four to six weeks, and walking may be assisted by crutches. The American College of Foot and Ankle Surgeons' Web has an excellent discussion of bunions and their treatment. Weber's operation (a type of "minimal incision surgery") involves shaving the bony prominence with a burr inserted through a small opening in the skin. Standard ("open") procedures are done through a larger opening large so that the surgeon can view the operative area and, if desired, to immobilize the involved bony segments. The Board charged that Weber did not properly immobilize the foot and told patients they could walk immediately, which can lead to improper alignment of the bones. Weber claims that his method is superior.
The 1987 case was settled in 1990 by a stipulated agreement under which the defendants, without admitting that they had done anything wrong, agreed that:
- They would not engage in any acts that violate the laws and regulations governing the practice of podiatric medicine.in California.
- They would not state, imply, or otherwise represent that the minimum incision bunion removal was superior to open bunion-removal surgery unless they had demonstrated that such statements were truthful. (Although Weber was the only defendant performing this procedure, the agreement was intended to prevent others from doing it under his supervision.)
- They would not engage is a long list of improper billing practices.
- The cost of investigating and prosecuting the case would be $420,000, plus interest . (Weber paid this amount, which appears to be a national record for a medical board case.)
In response to further problems, the Board investigated again and placed Weber on five years' probation in 1999. This decision, which involved the care of four patients, was based mainly on concerns that "[Weber's] chosen method of post-surgical treatment, in which [he] refrains from post-operative casting, is not a recognized or approved alternative form of post-surgical treatment in California."  During the proceedings, Weber argued that his procedures complied with guidelines issued by the Academy of Ambulatory Foot Surgery (AAFS), which did not require internal fixation. However, the Board concluded that these guidelines were (a) vague, (b) not recognized by podiatry's nationally recognized certification body, and (c) "breach the basic tenets of bone healing and place patients at significant risk of severe, long-term disability."  The board ordered Weber to conform to the nationally recognized Preferred Practice Guidelines established by the American College of Foot and Ankle Surgeons and to have his practice closely monitored to be certain that he was in compliance.
In May 2001, after holding hearings, the Board concluded that Weber had violated his probation and revoked his license. The Board's report stated that Weber had "followed a continuing pattern and practice of doing everything he could, either directly or through his attorney, to frustrate compliance with the terms and conditions of probation" by failing to:
- Enroll and complete an assessment program on a timely basis
- Obtain timely approval of a practice plan
- Pay probation monitoring costs in a timely manner
- Respond to a request for medical records
- Attend probation interviews
- Provide the practice monitor with full and complete access to patient records 
The Board's decision stated that "to the extent [Weber] was in compliance as of October 1, 2000, he came into compliance only after months and months of resistance, delay and obfuscation." The Board also ordered Weber to pay $6,761.50 for the cost of investigating and disposing of the case .
The Board's executive officer, Jim Rathlesberger said that the Board has received more complaints about Weber than about any other doctor in the board's history . In his written arguments for revocation, Deputy Attorney General John E. DeCure stated:
- Weber's "multiple probation violations and testimony . . . indicated an indifference toward rehabilitation, an antagonism toward the Board's authority, and an utter lack of personal accountability for compliance with even the simplest terms and conditions of probation."
- Weber's "recalcitrance . . . effectively places him outside the Board's regulatory scope and authority."
- Weber "displayed a most uncooperative and recalcitrant spirit and gave no indication that he was either deserving of a second chance at probation or a likely bet to succeed without further violations."
- Weber's probation officer "testified that of the nearly two-hundred cases he has handled as a probation monitor, this is the most difficult case he has ever had in terms of gaining the probationer's cooperation."
- Weber's "recalcitrance and lack of responsibility for complying with his probation is overwhelmingly evident. . . . This defiance . . . mandates that the Board exercise its discretion to revoke.
Weber appealed to Superior Court and obtained a stay of the revocation until the court ruled. His attorney, Matt Rifat, who also represented several other podiatrists, filed many lawsuits against the Board. Rathlesberger characterized these lawsuits as an attempt to bankrupt the board through litigation costs . Rafat stated that their purpose was to liberalize board regulations . Rifat also hired a lobbyist to seek elimination of the Board by merging it with the state medical board [8,9]. Rifat told me he was confident that the court would overturn the Board's decision to revoke Weber's license. However, in October 2001, a Superior Court Judge upheld the Board's decision  and in October 2002 the last of Weber's 25 lawsuits against the Board was dismissed. Rathlesberger estimated that these suits cost the Board about $375,000, which amounted to an average of $210 for each fee-paying licensee.
In 2005, in response to Weber's petition for reinstatement, the Board placed him on five years' probation with the provision that he follow the American College of Foot and Ankle Surgeons' Preferred Practice Guidelines and employ a practice monitor for three years . The guidelines preclude further use of the bunion operation that got him into trouble.
- News release, Office of the California Attorney General, Sept 24, 1987.
- Board of Podiatric Medicine revokes license of Southern California doctor. State of California Department of Consumer Affairs, May 15, 2001.
- Permanent injunction and final judgment and order, No. C662345, March 9, 1990. People of the State of California, Plaintiff, v. Albert Apkarian, D.P.M., West Valley Podiatric Group, Gary Weber, D.P.M., Gary Lee Weber, A.P.C., Podiatry Group Surgical Center, Inc., Romeo Pettinelli, D.P.M., Michael Hickey, D.P.M., and Frank Garofalo, D.P.M. Superior Court of the State of California for the County of Los Angeles, March 9, 1990.
- Decision after nonadoption. In the matter of accusation against Garey Lee Weber, D.P.M. Case No. 1B-95-46977, OAH No. L-9702033 before the Board of Podiatric Medicine, Dept. of Consumer Affairs, State of California, April, 26, 1999.
- Decision after nonadoption. In the matter of the amended accusation and petition to revoke probation against Garey Lee Weber, D.P.M. Case No. 1B-95-46977, OAH No. L-1999120182 before the Board of Podiatric Medicine, Dept. of Consumer Affairs, State of California, May 14, 2001.
- Bennett WF. Trouble afoot for local podiatrist: Doctor kept performing 'Weber Bunionectomy' surgical procedure after ruling. Victorville Daily Press, May 19, 2001.
- Abrams G. Shin-kicking duel is a good reason to buy best shoes you can afford. Daily Journal Newswire, Losa Angeles, May 28, 2001.
- Rifat M. Personal communication to Dr. Stephen Barrett, May 28, 2001.
- Rifat M. Memorandum to public policy decision maker, April 5, 2001.
- Foot doctor loses major battle with California board of podiatric medicine. Department of Consumer Affairs news release, Oct 22, 2001.
- Order granting reinstatement. In the matter of the petition for penalty/reinstatement of relief/reinstatement of revoked Certificate of Garey Lee Weber. Case No. 1B-2004-159986 before the Board of Podiatric Medicine, Dept. of Consumer Affairs, State of California, March 4, 2005.