Doctor with drug past suspended

Seemed to fall asleep performing liposuction

The state has temporarily suspended the medical license of a plastic surgeon who allegedly performed two operations at Beth Israel Deaconess Medical Center last month while impaired and appeared to fall asleep during a patient's liposuction.

The hospital fired Dr. Loren J. Borud earlier this month, after he was allowed to practice for six years while struggling with substance abuse problems.

Borud, 44, has been in treatment for alcohol or drug abuse since at least 2002, and last month was the second time he was known to have behaved strangely at work, raising questions about the balance between patient safety and the desire to help physicians recover from addiction.

On June 27, staff members assigned to work in the operating room with Borud noticed that he looked tired and that his eyes were bloodshot, according to a statement of allegations by the Board of Registration in Medicine, which licenses physicians. During his first surgery, a tummy tuck, Borud accidentally cut a stitch while closing the patient's incision, but made no attempt to correct the mistake. A resident eventually repaired the stitch.

During the second surgery, repair of a chest scar and liposuction, staff noticed that Borud had his eyes closed during the liposuction, the board alleged; he closed them again after a resident roused him.

After Borud left the operating room, the hospital's associate chief of surgery told Borud to take a drug test.

Later that day, Borud saw the resident who had assisted him in the surgeries and told him about his conversation with the chief. Borud told the resident that he would fail the drug test because he had "consumed several alcoholic beverages on Tuesday," and asked if the resident would provide him with urine to use for the drug test, according to the board. The resident refused.

The next day, Borud told the associate chief that he had not taken the drug test because the facility was closed for the weekend. The hospital immediately suspended his operating privileges.

On July 1, Borud, who is also a Harvard surgery instructor, entered an inpatient rehabilitation program. The hospital fired him on July 18.

Borud had previously reported to the board that he sought treatment for alcohol and drug abuse in April 2002. He entered a monitoring agreement with Physician Health Services, a rehabilitation program run by the Massachusetts Medical Society, the state's largest physicians organization.

He eventually relapsed and in September or October 2006 "exhibited behavior" at work that caused hospital administrators to cancel his surgeries for the day and refer him again to Physician Health Services.

Dr. Kenneth Sands, senior vice president of healthcare quality at the hospital, said Physician Health Services has a good reputation for helping doctors recover from addiction and closely monitors them after they return to work to make sure they do not drink or take drugs.

"I don't think you can set specific rules as to whether it should be one, two, or three [chances]," he said. "This is approached as an illness. It's a condition that has protections under the Americans with Disabilities Act."

Medical board spokesman Russell Aims said the board did not know about the 2006 incident until recently. But, he said, if the board had known, it would not necessarily have suspended Borud's license.

"It would really depend on the circumstances," he said. "It would clearly be a much more serious matter if there was patient harm or potential for patient harm."

Sands said he could not discuss details of the June 27 cases because of patient confidentiality rules, including whether the patients were harmed.

But he said "the patients both had post operation recovery that is within the bounds of what you can expect to occur."

Liz Kowalczyk can be reached at kowalczyk@globe.com.