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Burien cosmetic surgeon practicing after patient death, operating facility without a license

Cosmetic surgeon Dr. Kristine Brecht’s license was restricted after a state commission said her failures led to a patient's severe harm or death.

BURIEN, Wash. — Dr. Kristine Brecht’s resume boasts a host of accolades and media appearances, but the KING 5 investigators found the Burien-based cosmetic surgeon is at the center of at least 17 official complaints into the Washington State Medical Commission (WMC) since 2017.

The WMC monitors and enforces qualifications for licensure and standards of practice for physicians and physician assistants in the state of Washington.

The WMC investigated nine of the complaints received in 2018 and 2019, which resulted in a statement of charges against the doctor, including inappropriate use of anesthesia, prescribing high doses of opioids, benzodiazepines and muscle relaxers without justification and failing to properly monitor patients after surgeries.

KING 5 found that the WMC has “several (other) complaints” against Brecht "in process" at the commission.

“That (number of complaints) is above and beyond what you would expect," said Dr. Sam Lien, president of the Washington State Society of Plastic Surgeons. "That’s a red flag. I have never heard of any plastic surgeon getting that number of complaints."

Three years after WMC began investigating the first complaint, the state and Brecht entered into an Agreed Order in 2021 that restricted her license and placed her on a three-year probation. The order cites several acts of “unprofessional conduct” and that her failures in one case led to “severe harm or death to a human patient.”

Brecht did not agree to be interviewed by KING 5, but she submitted documents to the state in her defense.

“At no time do I believe that I put any patients at risk,” Brecht wrote. “None of the patients in (the state’s case) suffered injuries as a result of my care and treatment.”

Brecht is a board-certified family medicine physician, who, according to her website, specializes in cosmetic surgeries such as breast augmentations, liposuction, fat transfers and tummy tucks. Her resume lists several leadership roles in the industry, including being a board trustee for the American Academy of Cosmetic Surgery, chairwoman of the World Congress of Liposuction and president of the American Society of Liposuction Surgery.

The doctor has also made several appearances on the KING 5 talk show New Day Northwest as a cosmetic surgery expert and paid advertiser. New Day Northwest is produced by KING 5’s programming department, which operates independently from the news department. 

There was no public information about the formal complaints until 2020. KING 5 became aware in May, 2020 when the WMC published the statement of charges on its website, according to KING’s Director of Local Programming Lindsay Sieverkropp. After that, Dr. Brecht never appeared on the show again.

Patient death

One of the complaints centered on the surgery of 54-year-old Shannon Etter of West Seattle. On Oct. 25, 2019, Brecht performed a liposuction and tummy tuck on her. 

State regulators found the doctor shouldn’t have operated on Etter in the first place. She was in poor health and a “poor risk” for the surgery, according to state findings.

“Six months before, her primary doctor said she wasn’t healthy enough to have this procedure,” said Etter’s mother, Mary Frances Duggan. “She shouldn’t have done the surgery on Shannon.”

Credit: Courtesy photo
Shannon Etter.

Three days after the surgery, state documents show Etter collapsed at home and was rushed by ambulance to Highline Hospital in Burien. She was suffering from multi-system organ failure and septic shock. Two days later, she was taken off life support with her family by her side.

“It was just unbelievable. It truly was,” Duggan said. “How could this have gone so wrong?”

State investigators found Brecht didn’t properly assess Etter’s health prior to the procedure. And that three days after the surgery at a follow-up appointment, the doctor didn’t properly respond to the patient’s “dangerously low” oxygen levels. Records show she didn’t give Etter supplemental oxygen or call 911.

“(The doctor’s) failure to perform an adequate physical examination, conduct a thorough medical history, and get timely lab results caused her to perform a procedure for which (Etter) was a poor candidate, ultimately leading to her death,” WMC regulators wrote. “(The doctor) also failed to treat (Etter) in an appropriate manner when her oxygen saturation level was dangerously low at a follow-up appointment, also contributing to her death.”

Brecht defended her care and treatment of Etter in responses submitted to the state. She said the patient and her husband “purposefully withheld” Etter’s chronic health issues from her.

“An honest history is expected from the patient,” Brecht wrote. “At no time did (Etter) inform me that she had chronic, end stage liver disease, chronic lung damage with multiple pneumonias requiring a ventilator annually…Had she provided this information before surgery, I would not have agreed to proceed with the surgery.”

The state charged Brecht with violations involving nine different patients. Five of the complaints centered on inappropriate prescribing of controlled substances, and four were surgical cases.

Sedation concerns

Using “inappropriate anesthesia” was a pattern in the surgeries, according to state investigators. Instead of using general anesthesia or intravenous (IV) sedation under the direction of a board-certified anesthesiologist or a certified registered nurse anesthesiologist, Brecht acted as her own anesthesiologist. Records show she relied on oral medications for surgeries including oxycodone, lorazepam and zolpidem (Ambien), even during high-risk procedures.  

The state found “oversedation is a concern with the amount of (oral) medications” the doctor used in surgeries, and that without an IV, there was no access to the patients’ bloodstream for emergencies that may come about during the surgeries.

In 2017, Brecht performed a breast augmentation on a patient in her mid-30s. The patient complained of memory loss that lasted for days due to the amount of oral sedation used. The state found the patient experienced blood pressure and pulse spikes during the procedure, indicating the “patient was in pain and may not have been properly anesthetized.”

In 2018, a patient in her late 60s had liposuction performed by Brecht. In this case, state investigators found the patient couldn’t walk seven hours after being discharged from Brecht’s surgery center, “suggesting the patient was inappropriately discharged,” and that she was ultimately admitted overnight to a hospital, “further demonstrating that she was over sedated.”

Brecht denies oversedating any patients. In documents submitted to the state, she blamed less that ideal outcomes on patients not following post-op instructions. She also said her protocols with oral sedation are safer than traditional methods.

“I purposefully used oral sedation in the appropriate amounts via a treatment plan that I have carefully developed,” Brecht wrote. “It is my opinion that oral sedation and local tumescence is safer and has less risk to the patient than IV sedation or general anesthesia. There is also less risks for bleeding, and more post procedure comfort. I developed this method because it actually reduces the risk of over sedation.”

“I’m sure that she was a risk to the public,” said Dr. Hakim Said, a board-certified plastic surgeon and clinical associate professor at the University of Washington. “I have to tell you I was shocked and saddened as well …that that series of judgement and series of errors could occur.”

Dr. Said and other board-certified plastic surgeons who consulted with KING 5 said the use of oral sedation in Brecht’s surgeries is outside of best practices.

“The risks are potentially fatal on the table,” Dr. Said said. “It’s a little like boxing with one arm behind your back. If you can only give oral medications, you literally cannot respond to any of the acute things that could happen.”

Licensing deficiencies

Instead of an anesthesiologist or registered nurse in the room, the state found in at least one surgical procedure Brecht was assisted by a nursing aide licensed in South Carolina and a medical assistant with an expired license.

Those weren’t the only licensing problems. On Oct. 22, 2021, the Washington State Department of Health entered into a Cease Desist Agreed Order with Brecht for operating an ambulatory (same-day) surgery center without a license to do so,  which is a violation of state law.

Brecht told KING 5 on the phone that she didn’t realize she needed her facility to be licensed and that she has applied for the appropriate credentials. The Agreed Order prevents Brecht from “engaging in any and all conduct constituting the operation of an Ambulatory Surgical Facility in the state of Washington, unless (the doctor) has first obtained the requisite health care credential.”

“I wanted her to lose her license. I made no bones about that. I felt like she should never, ever deal with patients again,” said Duggan, the mother of the patient who died.

Brecht still has a license to practice medicine but the Agreed Order she signed with the WMC prevents her from ever performing surgeries again that require sedation without an anesthesiologist or credentialed nurse anesthesiologist in the room. 

She lost some privileges on a temporary basis. Currently, she can’t prescribe opioids or perform surgeries that require sedation. But after rigorous retraining, she can petition to get those privileges back.

“Then she can go back to living her life,” Duggan said. “The other people who have been affected by this, that’s not going to happen to them. Shannon’s not living her life.”

Brecht must also pay a fine of $25,000 to the WMC for the violations associated with “unprofessional conduct.” The Department of Health assessed an additional $20,000 fine for running an unlicensed surgical center.

For Etter’s family, the sanctions don’t go far enough. They are also critical of the time it took the state to sanction Brecht. In 2018, the state accepted the first complaint to investigate. The Agreed Order limiting her practice was signed in 2021, two years after Etter’s death.

“If this had been caught early, if that had happened and they put all of this together, they would have stopped before (my daughter’s surgery),” Duggan said. “They would have said, ‘Listen, there’s a definite problem here.’”

The WMC said given the complexity of Brecht’s case, coming to a resolution in three years was reasonable.

“The WMC was investigating and taking legal action on nine people," wrote WMC Legislative Liaison and Public Information Officer Stephanie Mason. “We (completed the cases) in a total of three years. We fully understand that to victims and grieving families this seems like a long time. However in terms of legal action, and the number of cases involved that required thorough investigation all at once, it is swift. Another thing to keep in mind is that the WMC had to contract with two different outside experts (including a board-certified plastic surgeon) to confirm the medical/legal sufficiency of the Findings of Fact in the (Statement of Charges) and (Agreed Order).”

The WMC also said revoking the license of a physician is a high bar in the state of Washington. By statute, the commission must show that a doctor cannot be rehabilitated in order to practice safely again.

On the phone, Brecht told KING 5 she has completed her retraining and has petitioned to get her privileges back from the WMC. She also said she’s an “excellent surgeon,” but is even better now and has a more robust understanding of the laws and regulations applicable to her practice.

In Etter’s parents’ backyard, they’ve planted a tree in their daughter’s honor. It features an inscribed plaque: “Generous. Kind. Thoughtful.” They say that’s how they’re remembering their child, who was also a devoted sister and aunt.

“Every holiday is horrible. We get through it and we try to the best we can,” Duggan said. “And the grandkids’ graduations, (her) nieces and nephews, all the things she missed. Every time we have one of those it’s just really, really hard. She…loved those kids. She was so good with them. To think that she’s not here because of this.”

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