Beth DuPree: The Good Doctor

Meet the woman who wants to revolutionize breast cancer care

By Melinda Henneberger
Dr. Beth DuPree on her last day of work at the breast cancer hospital she is determined to reopen.
Photograph: Photo by Samantha Appleton

If Beth DuPree, MD, FACS, founder of the country’s first stand-alone breast care hospital, worked as a TV anchor, she’d be saddled with the “perky blonde” label. The day we first meet, in October 2008, she downloads the abridged history of Beth Baughman DuPree in the time it takes us to walk from the waiting area to her office, a grown-up version of a princess bedroom, missing only the canopy bed. She’s running late, she says, because she’s been on the phone with her sister (DuPree is the youngest of seven kids of a York, Pennsylvania, cop and a homemaker), and over the weekend they’d had to move their parents (her mom has Alzheimer’s) out of the house they’d lived in for 46 years. So that was hard. Plus her center’s parent company has just gotten a new CEO, one of her employees has been hospitalized with chest pain, and she had to fire another for lying. “But since I’m not one of the people I’m treating, it’s a good day anyway,” she concludes with a smile.

And for those she’s treating today, it’s not as bad as it might have been. DuPree, 48, a surgeon and lecturer with a slew of awards, built this five-star, one-stop, mammo-to-mastectomy-to-reconstruction center in Bensalem, Pennsylvania, because the idea of women running to 10 different places for consultations, tests, surgery and adjuvant therapies was anathema to her. That kind of care is designed “for the convenience of hospitals, not patients,” she tells me as we reach her office. DuPree especially hates hearing from women who, after finding a lump, are forced to wait weeks to get an appointment with a surgeon at a time when a day can feel like a decade. So in April 2007, she opened her 24-bed, bricks-and-mortar alter ego in the outsize hope of redefining care for the one in eight American women who learn they have breast cancer.

It’s 8:15 AM, and DuPree has already worked out for an hour with her “NFL two-time Super Bowl guy” trainer, aka Vaughn Hebron, who may or may not have been trying to kill her with crunches; she has also learned that one of her friends from the gym has just found a breast lump. “She can’t wait around” for an appointment, DuPree tells the scheduler. At the Comprehensive Breast Care Institute, friends always go to the front of the line. But after only five minutes in DuPree’s office I am wondering if it’s possible that all her patients are her friends, because every one of them seems to go to the front of the line. “I think I can miss my workout for a 32-year-old” she tells her assistant, referring to yet another woman she wants to see squeezed in first thing tomorrow. “People need information, and they shouldn’t have to beg for it.”

While most patients are deeply grateful to get into a surgeon’s office on the same day they call about a breast lump, from a purely financial perspective, there is a downside: That kind of flexibility usually means that the doctor is not overbooked. And money, DuPree tells me, is a growing source of friction between her and her partner, Nashville-based Diversified Specialty Institutes. Although she is CEO of her hospital, DuPree says, she does not have control of the business end and she has locked horns with her partners on everything from the medical records system to whether the hospital should contract with large insurance companies. In addition, she says, DSI dragged its feet on such critical purchases as radiation equipment. And now, she tells me, given the current economic climate, her investors are beginning to panic. “This is by no means a stable situation for me yet,” she says. “But if it were easy, somebody else would have done this a long time ago.” Comprehensive Breast Care may be the first of its kind, she says, “But I don’t want it to be the last.”

Nobody is thinking about sustainability, however, as DuPree’s first patient of the day lies facedown on an elevated table with one breast hanging through a hole so the doctor can remove some calcifications that ma  malignant. I had breast cancer myself six years ago, and one patient joke I remember is that once you’ve had a needle the size of your elbow stuck into your nipple, everything else is a cakewalk. At my own biopsy, the “little tight pinch” Beth warns this patient about was anything but. DuPree, however, wields the dreaded needle so skillfully that the woman—and I kind of can’t believe this—is actually laughing from relief. “That wasn’t so bad,” she says after the procedure is over. “Really?” DuPree asks. “Most people say it sucks.”

Next, DuPree examines a woman who has just found a new lump—on the last day of her radiation treatment. “Hop up here on the table, girlfriend,” DuPree says brightly. “Cute shoes! I’ve got a fetish.” The woman is visibly shaking and doesn’t understand, she says, “how anything could possibly grow in there with all the nuking I’ve had. Could there be more of them that I haven’t felt?” DuPree winds up doing an immediate core biopsy while the tech holds the patient’s hand and tries to divert her with gossip about a hunky young radiation guy who works in the hospital. At the end, DuPree tells the woman that the lump is “tiny, and it looks like a cyst, but we’re not going to take a chance with it,” meaning she will send it to the lab to be certain.

“Well, I am having cocktails tonight, that’s for sure,” the patient says, so we go around the room and place make-believe drink orders for our make-believe happy hour. And although no amount of jollying or reassurance is going to ease the couple of days before the new biopsy results come back, the patient clearly appreciates the tender treatment she’s receiving: When DuPree gives her a hug on the way out the door, the patient clings to her with an unabashed vulnerability that not every doctor inspires.

Of course, not every doctor insists that her hospital be a holistic medical practice that offers not just traditional medicine but also preventative and complementary care, or liberally dispenses such extras as heated blankets and deep-tissue massages. Or hands each of her breast cancer patients a heart-shaped rose-quartz crystal to “remind them to make themselves a priority in their life.” For the cancer patients, services such as acupuncture and guided imagery (aka visualization) are provided free of charge by DuPree’s foundation, The Healing Consciousness (More’s publisher sits on the board). The money comes from the sale of DuPree’s book, The Healing Consciousness, and from her fundraiser fashion galas in which all of the models have had breast cancer surgery. The funds also come from the sale of a special line of jewelry, including a “breast cancer education bracelet”; its rose quartz and silver beads, which range in size from four millimeters to two centimeters, represent the sizes a breast mass can reach at varying stages of detection.

Next DuPree makes an appearance in the OR, excising a benign tumor the size of a couple of grapes; then she goes to check on one of her nurses, who is here as a patient today, having just gotten a new nipple, post-reconstruction. In fact, several women who work at the hospital tell me they’ve had breast cancer themselves, which DuPree feels “gives them an edge” on the job. The next woman DuPree checks on has just had reconstructive surgery after a double mastectomy: “Oh, they’re perky,” DuPree says, checking out the new breasts. “I know!” the patient agrees. “He listened to me, and they’re not too big.” DuPree awards the surgeon a gold star in absentia: “He’s a very good boy; he doesn’t oversize.”

Among the other boys on the premises is the founder’s own husband, Joe DuPree, 53, whom she met when she was a medical student at Hahnemann University Hospital in Philadelphia. A medical researcher, who supervised the students’ projects, he was “a really nice guy,” she says, “a male with an intact ego who didn’t need to prove anything. So I found out he wasn’t married, living with his mother or gay, and asked him out on a date.” They eloped eight months later.

When the second of their two sons was born, Joe DuPree quit to stay home with the kids for several years. In 2000, he started managing his wife’s practice at St. Mary Medical Center in Langhorne, Pennsylvania, the hospital where she worked before opening her own place. He later segued into doing the same job at CBCI, where he also runs the coffee shop he created in the lobby, pushing lattes and berry-mango smoothies while acting as a kind of back-door counselor to the men shuffling around the halls waiting for their wives. “He’s like Ted Danson at Cheers,” DuPree tells me. We are now back in her office, and DuPree is back in her brown suit jacket, off to deliver a speech on her lunch hour.

We climb into DuPree’s gray pre-owned BMW and drive to Bucks County Community College, where she will be addressing 100 nursing students. On the way, she tells me about her own cancer scare, finding a lump just seven days after she opened her gleaming new facility. “I felt it in the shower and wanted to puke,” she says. “So I did what every self-respecting surgeon does: I scanned myself.” Then she had a colleague do a quick, quiet biopsy. It came back negative, which was doubly a gift, she says: “Now I know how my patients feel. I tell them, ‘When you get good news, that tumor was God whispering in your ear. And that list of everything you were going to change if it was cancer? Don’t throw it away; make those changes anyway.’ ”

From the moment we arrive at the nurses’ luncheon, DuPree is besieged by hugs. And I don’t mean those anemic taps that accompany air kisses but deep squeezes from women who throw their arms around her and explain that they are her patient so-and-so’s sister or cousin or friend and can’t thank her enough.

DuPree eschews the lectern and moves easily about the room. She begins by asking how many classes in healing the nursing students have taken. “Zero, right?” she says, and almost all nod yes. When she was training to become a surgeon, she tells them, it was the same way: Nothing heals like cold steel, her teachers used to say. To cut is to cure. Only, she’d learned from the losses and near misses in her own life that there’s more to it than that. “When I was 17 years old, I was out with my friends one night, being bad, and we heard on the radio that someone had been killed in a traffic accident,” she tells them. And somehow, before she even pulled up to her house and saw all the police cars, she knew it was her brother. “So when someone I’m treating or their loved one is facing loss, I do know what that feels like,” she says. That was also the first step in the spiritual journey that eventually led her to conclude that “because someone’s disease is not curable does not mean they can’t heal from it. When we pull back, that’s the worst thing we can do. We want to help them get to a safe place before they transition”—die, she means—“and they don’t teach that in med school.”

Now, I’ve been to quite a few lectures and have given some myself, and in both instances, there have always been at least a few audience members dozing in their seats. I look around the room at the students—a mixed bag of age, gender and race, this being a community college—and every single person is rapt with attention.

DuPree admits to the audience that she was not exactly wide open to Eastern notions about healing until a close friend from work was diagnosed with brain cancer while pregnant with her first child. “So I took a course in reiki,” a Japanese healing technique that focuses on energy flow. “Not because I believed in reiki—at that time, I only rakied my leaves!—but because I needed to do something for my girlfriend,” who had been given a very poor prognosis (and is doing fine 12 years later). “I live in a house of skeptics, and my husband thought I was kind of out there with my woo-woo girlfriends.”

But she’d gotten even further out there  by the time another friend, an orthopedic surgeon, was diagnosed with ALS: “She called me, crying, and said, ‘I am so screwed. Will you come over here with the Cliffs Notes to spirituality?’ ” Which is when DuPree decided to write a book—a spiritual memoir, really—that quotes a medium who channels the Archangel Raphael and the Blessed Mother.

Her friend with ALS died three years ago. “I feel her with me every day, and if you don’t believe that, I don’t care,” she tells her audience of future health care workers, not one of whom looks skeptical. “The last thing she blinked to me, her blinks spelled out—everybody’s over 18 in here, right?—her blinks spelled out, ‘Publish the fuck-ing book!’ ” Remember, she tells the students, you can’t be good healers unless you can heal yourselves, so enjoy life already and “stop pissing it away, because we’re all going to die. And I hope I have lit a fire under you, because you guys are going to be taking care of me someday.”

The notion of a one-stop shop devoted to the treatment of a single disease is not new. Such centers have long existed for kidney dialysis, orthopedics and cardiac care, and although cancer takes so many forms that it is not considered a single disease, large centers like New York City’s Memorial Sloan-Kettering offer the full range of treatment. In the 1970s, Melvin J. Silverstein, MD, one of Beth DuPree’s role models, brought many aspects of breast care under one roof, but his Van Nuys, California, facility stopped short of offering mastectomy and reconstruction. Since then, a hospital solely dedicated to the full range of breast care hasn’t been considered a profitable enough endeavor (mainly because breast cancer surgeries are not reimbursed as highly as some other types, DuPree says). Still, she chose to buck the conventional wisdom. She partnered with DSI, an operator of kidney dialysis centers looking to expand into hospitals dedicated to individual diseases and created this oasis, a dream come true for doctors, patients and families. There is just one problem: The Comprehensive Breast Care and Aesthetics Institute at DSI of Bucks County still isn’t turning a profit.

So maybe I shouldn’t be so surprised when, on January 25, I get an e-mail from DuPree saying that “The economy and politics are wreaking havoc” on the hospital, and the parent company has decided to close it in just a few weeks. “But fear not,” she writes, “we will prevail in the end.”

Over a series of phone calls, she fills in the details: In late 2008, she endured several near-death experiences as her parent company informed her that they needed to find a buyer for the troubled facility or the doors would have to close. For many months, she says, she convinced them to push back their deadline. “I was, like, ‘Is that even legal? To shut the doors when patients are in treatment?’ I think it was one of  those bullshit men’s power plays.” (The CEO of DSI, Leif Murphy, did not respond to messages left on his voice mail and with his assistant.)

As her conflicts with DSI increased, DuPree tells me she considered buying the business but was convinced by her lawyer that she would “have to put on her big-girl pants” and let the hospital close for a time—or else her new entity would be responsible for the old facility’s debt. In the midst of all this, DuPree underwent surgery to correct a colon problem. (“No coincidence that my guts are twisting literally while my guts are twisting emotionally,” she writes in an e-mail.) “It’s been hell,” she tells me on the phone February 3, the night before the clinic is due to close. “Utter hell.” Although her private practice still operates out of a space she’s leasing in the building, her 85 hospital employees are being laid off.

“She was ahead of the curve,” says Greg Wozniak, president and CEO of St. Mary’s, where DuPree’s practice used to be based. “And candidly, our whole industry is evolving to that, to trying to change the model so we’re looking at the whole person.”

She is organizing a group of 20 to 40 doctors, some of them her former colleagues, who would take over ownership of the center, in partnership with a local hospital. And while she has a plan B—to relocate the program within another hospital—what she really wants is to develop a partnership that would enable her to remain in the facility and resume her program there.

One chief of a nonprofit Pennsylvania hospital is strongly considering the idea of going into business with DuPree. “We’d do our whole range of women’s services [in the revived facility],” he says, while asking not to be named because of the ongoing negotiations. “[Her model] is much more of a healing setting . . . What we can give her is the infrastructure and support to [allow her to] be an inspirational leader and surgeon. We can put things there that can give her the [patient] volume, and we can go back to the insurers” to negotiate in-network coverage.

“Places like what she created will win,” the hospital chief tells me. “The reality is that Beth has forced all of us to look at what we do in health care. Everybody wanted her to fail, because we don’t want change. But my team said, ‘There’s good stuff here and we need to look at it.’ ”

Just as DuPree is gathering partners—no mean feat in this economy—it turns out that Washington may also have a say in her plans. Concerned about the issues (ethical and financial, among others) raised by doctors referring patients to companies they own, members of Congress proposed legislation banning physician ownership of hospitals. For now, it’s in limbo. “But what if in six months it rears its ugly head?” she says. And so Dr. DuPree goes to Washington, to lobby Pennsylvania Senator Robert Casey Jr.

While waiting for her turn with the big guy, DuPree goes around introducing herself to aides, practicing her pitch—“First, breast care is not a big moneymaker, which is why there aren’t any other places like this, and yet [physician ownership is] getting a bad rap because of a few bad colleagues!”—and asking if the female aides have had their mammograms. She works the room, batting down objections that boutique shops like hers greedily skim off the most lucrative patients. “We’ve always cared for the indi-gent,” she says. (DuPree estimates that she treats three uninsured patients a month.) A half dozen Casey staffers gather around her. By the time the senator joins them, she’s not just warmed up but breathing fire. “Instead of taking the cream off the top, we’d take the crap too,” she assures him animatedly. “But maybe there’s a better word for crap?’’ he asks, laughing. “Nooo, crap is better,” she answers him.

“If you own a home, you take better care of it—that’s why we need a hybrid model” that allows part ownership by physicians, she says. “I’m willing to listen,” he tells her. “What would you argue?”

“That the first model [of CBCI] didn’t work because I was working with guys who were only in it to make money,” she shoots back. Whereas in her new venture, the profit motive married to—and here she points to herself—“Miss Altruism” just might be the charm. “I would be willing to educate you any way I can,” she says, and as we leave he invites her to come back someday soon and do just that.

In the hall outside his office minutes later, Casey passes her and calls out, “You’re a damn good saleswoman!”

“I’m an even better surgeon,” she calls back.

“And health care adviser,” she adds under her breath.

NOTE: At press time, we learned that DuPree was unable to reach a deal to buy the facility; she’s now evaluating offers from three local hospitals to duplicate her breast care model on their premises.

Melinda Henneberger is editor-in-chief of PoliticsDaily.com. She and her mother, Freida Henneberger, have agreed to walk the runway together in DuPree’s 2009 fund-raiser fashion gala, in which all the models have had breast cancer surgery.

For more information about Beth DuPree, visit  thehealingconsciousness.com

Originally published in MORE magazine, May 2009.

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First Published Mon, 2009-04-27 17:00

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http://www.more.com/health/breast-cancer/beth-dupree-good-doctor