This white-frocked cube of a man really can yak, often engagingly. But Birenbaum's skill at monopolizing a conversation isn't what earned him his reputation. Neither are some of the startlingly egocentric things he tends to say, such as: "I am one of the most ethical people you will ever meet."
Or better yet: "I wonder how many lives have been lost because I've lost patients to other oncologists. I'm not the only one who's hurt by this."
Oh, yes. This. The events that put the 51-year-old cancer doctor on the map. The investigation. The lawsuits. The acres of bad publicity. This has been Birenbaum's life for the past five years, ever since Aetna Life & Casualty blew the whistle on him for allegedly overcharging his patients.
He was accused of billing one man $1,000 a day, billing a dead man for a day in the hospital, billing for consultations with himself--in short, cheating desperate people fighting for their lives.
In the end, though, none of it stuck. An unprecedented, headline-making vote by the Texas medical board to revoke Birenbaum's license in 1993 for "persistent and flagrant overcharging" was overturned in Austin courts. The following year, he sued Aetna, and in June 1996, the company quietly paid him $3 million to settle the case. The doctor, struggling to regain his reputation, hired a publicist this fall to try to convince the Dallas-Fort Worth media that he is a good doctor after all.
Actually, Birenbaum's competence as a physician has never been questioned. There is no shortage of patients and colleagues who praise his medical skills. But his campaign to regain his reputation has been a far more complex quest.
Some reporters have bought into the simple, alternate story line of Birenbaum as a man wrongly accused. The truth turns out to be grayer and more illustrative of the tug-of-war between doctors and health-care insurers. In reality, it is difficult to find anyone wearing a white hat in Birenbaum's long-running tale.
There's a doctor who bellyaches about his practice being ruined while he trades up to a $1.7 million Highland Park mansion, a health-insurance company accused of putting a price tag on life, and a medical board so ineffective that it can't make a case stick. Birenbaum, says one peer in the Dallas medical community, is a prime example of an old-guard doctor who can't come to grips with giving up power, prestige, and income in the era of managed care. "Those guys used to have it great," says the thirtysomething doctor, who asked not to be identified. "You can still have a great practice, but those days are gone."
There is also the important side issue of how a bad rap, once it is cemented into electronic databases, can live on indefinitely.
Over much of the past two years, state authorities have been incorrectly reporting that a cloud still hangs over Birenbaum's medical license--much of the time without Birenbaum's knowledge. To top that off, last month Fort Worth TV station KTVT-Channel 11 incorrectly included Birenbaum's name on a list of Texas doctors who have been disciplined by the medical board. The report claimed to have used the board's information as its source.
Birenbaum, who never lost his license for even a day, had a new adversary, and last month filed suit against the medical board, the TV station, and its network, CBS.
"People say I'm bombastic and loud, and I probably am," he says, talking about his latest foray into the courts. "I'm also probably the most principled individual you will ever meet."
Born in Dallas and educated at Southern Methodist University, Birenbaum received his medical degree in 1972 from the Universidad Autonoma Guadalajara in Mexico. He completed his education with a residency fellowship at the prestigious University of Texas M.D. Anderson Cancer Center in Houston. "All of us who studied there learned a very aggressive, very proactive approach to cancer treatment," he says, talking with the kind of force and enthusiasm that tends to endear him to his patients, who typically need a dose of fighting spirit.
"If you're giving a patient chemotherapy and their hair doesn't fall out, you're not giving enough drug," he says. "If you don't get cell counts dropping, you're not getting maximum cell kill. If you're not being aggressive, you're wasting everyone's time."
In 1982, Birenbaum co-founded the Arlington Cancer Treatment Center, a group practice that broke up five years later as a result of personality conflicts. He moved his primary office to RHD Memorial Medical Center in Farmers Branch and began seeing patients from across the North Dallas area. "The market seemed bigger over here," he says. And he was right. By the early 1990s, Birenbaum's practice was booming. "He had a whole floor of patients in RHD, 30 or so in there at a time," says Dr. John Anderson, a Dallas cancer surgeon and friend and colleague of Birenbaum.