Montana Cancer Physician Surrenders Medical License Following Board’s Findings

The Board of Medical Examiners of State of Montana issued a Final Order on December 19, 2025 that stated: “The Board accepts the surrender of licensure and HEREBY REVOKES THOMAS WEINER’S MONTANA PHYSICIAN LICENSE. Weiner is permanently prohibited from practicing medicine in Montana and cannot seek licensure as a physician in Montana in the future.”

The Stipulation entered into by the parties stated, in part:

Patient Care

Patient 1

3. In February 2009, Weiner diagnosed Patient 1 with metastatic non-small cell lung cancer and began treating Patient 1 with chemotherapy.
4. Prior to Weiner’s cancer diagnosis, Patient 1 underwent a biopsy of neck tissue ordered and performed by other providers.
5. The pathology report for Patient 1’s biopsy did not diagnose Patient 1 with cancer. Weiner disagrees with this finding and does not admit to it.
6. Weiner did not recommend or order additional biopsies of Patient 1’s neck or a biopsy of Patient 1’s lungs to confirm the presence of cancer before initiating treatment.
7. At the time of diagnosis, Patient 1 was 39 years old.
8. Lung cancer is uncommon in patients in their 30s. Weiner does not admit to this finding. Weiner admits he did not know the statistics for patients in their 30s developing lung cancer when he treated Patient 1.
9. Weiner used carcinoembryonic antigen (CEA) blood testing to assess tumor response, and CEA and C-reactive protein (CRP) testing for surveillance of tumor response, in addition to other lab work and imaging.
10. CEA and CRP testing was not appropriate for monitoring tumor response and surveillance for non-small cell lung cancer when Weiner treated Patient 1. Weiner disagrees with this finding and does not admit to it.
11. From 2009 into 2014, Patient 1 continued to receive cancer treatment and Weiner did not recommend or order tissue biopsies to determine the progression of Patient 1’s cancer. Weiner disagrees with this finding and does not admit to it.
12. Weiner prescribed chemotherapy drugs that were not standard for treating non-small cell lung cancer and prescribed nonstandard combinations of chemotherapy drugs for non-small cell lung cancer. Weiner disagrees with this finding and does not admit to it.
13. At the time Weiner treated Patient 1, less than 1 percent of patients with metastatic non-small cell lung cancer survived 5 years after diagnosis without receiving immunotherapy. Weiner initiated immunotherapy for Patient 1 for the first time in May 2014, more than 5 years after Patient 1’s metastatic non-small cell lung cancer diagnosis. Statistically, Patient 1’s 5-year survival expectation without having received immunotherapy for metastatic non-small cell lung cancer was less than 1 percent of patients. Weiner disagrees with this finding and does not admit to it.
14. In June 2014, Weiner ordered a bronchoscopy after Patient 1 requested it. The resulting pathology report indicated the collected lung tissue showed no evidence of malignancy.
15. Weiner treated Patient 1 with chemotherapy and immunotherapy from 2014 until September 2020.
16. In April 2020, Weiner ordered a biopsy for molecular testing of Patient 1’s left lung, which revealed fibrosis and a granulomatous disease. No malignancy was detected.
17. Weiner treated Patient 1 with three cycles of gemcitabine, a chemotherapy drug, from May 2020 until September 2020.
18. Patient 1 died of respiratory failure in September 2020, due to gemcitabine-associated pulmonary toxicity.
19. An autopsy of Patient 1’s lungs and the spaces between them, the mediastinum, was performed at the Huntsman Cancer Center in Salt Lake City, Utah. No malignancy was identified by the autopsy.

Patient 2

20. Patient 2 had a lesion in the right middle lobe of their lung and a small nodule on the left adrenal gland. Weiner ordered imaging to monitor the lesion and nodule, which occurred every 3 to 6 months.
21. On October 3, 2019, Weiner reviewed a scan and charted “Patient with right middle lob pulmonary nodule. I reviewed [their] CAT scan. I do not have the official report, but it looks stable to me. I told [them] at this point I would probably just repeat it again in a year.”
22. The radiology report for the October 3, 2019 scan indicated a “Mild interval increase in size of right middle lobe nodule” and the radiologist charted “consider biopsy.”
23. Weiner did not document in Patient 2’s records that he ever reviewed the radiology report for the October 3, 2019 scan, nor did he document any response to the radiology report. Weiner did not order a biopsy. Weiner disagrees with this finding and does not admit to it.
24. Patient 2 returned one year later as Weiner recommended. At that time, Patient 2 was diagnosed with stage IV lung cancer after further testing and diagnostic imaging. Weiner disagrees with this finding and does not admit to it.

Patient 3

25. Patient 3 was referred to Weiner after receiving a diagnosis of breast cancer – stage II T1cN1M0 ER+/HER2 – in July 2015. Patient 3 was 43 years old and premenopausal when Weiner initiated care.
26. Patient 3 underwent a bilateral mastectomy and Weiner treated Patient 3 with chemotherapy for a total of 24 weeks.
27. In January 2016, Weiner began prescribing Anastrozole to Patient 3. Anastrozole, an aromatase inhibitor, is a hormone therapy medication that can block or lower a patient’s hormones like estrogen and progesterone.
28. Anastrozole is not effective as a stand-alone medication for treating premenopausal women because estrogen produced by the ovaries can reduce the efficacy of Anastrozole. When Weiner prescribed Anastrozole to Patient 3, he did not prescribe an ovarian suppression treatment. Weiner disagrees with this finding and does not admit to it.
29. In February 2016, Patient 3 underwent a hysterectomy, to remove the uterus, and a bilateral salpingo-oophorectomy to remove both fallopian tubes and ovaries.
30. Weiner prescribed Patient 3 Anastrozole from January 2016 until July 2020, which was less than the standard duration of 5 continuous years. Weiner disagrees with this finding and does not admit to it.
31. Weiner assessed Patient 3’s early-stage breast cancer tumor recurrence with cancer antigen 27-29 (CA 27-29), a tumor marker.
32. When Weiner provided care to Patient 3, CA 27-29 was specifically recommended against for assessment of early-stage breast cancer recurrence because it is ineffective. Weiner disagrees with this finding and does not admit to it, while
    admitting CA 27-29 is currently recommended against for assessment of early-stage breast cancer recurrence.

Patient 4

33. Patient 4 was diagnosed with metastatic lung adenocarcinoma, with a PDL1 expression level of 40%, and no actionable genetic variants identified on limited molecular testing.
34. Proper treatment at the time for lung cancer of the specific type diagnosed in Patient 4 – adenocarcinoma with a PD-L1 expression level of 40% and no actionable genetic variant – required immune checkpoint inhibitor treatment and chemotherapy. Weiner disagrees with this finding and does not admit to it.
35. Weiner recommended and initially prescribed an immune checkpoint inhibitor, nivolumab, only. There is no documentation in Patient 4’s medical records that the patient declined the standard treatment of immune checkpoint inhibitor treatment and chemotherapy. Weiner disagrees with this finding and does not admit to it.
36. On January 28, 2019, Weiner documented that Patient 4’s “CEA is up to 230” and the cancer was “progressing.” While Patient 4 underwent diagnostic imaging earlier in January which did not show cancer progression, Weiner did not order further diagnostic imaging to verify the progression of Patient 4’s cancer after making that determination on January 28, 2019.
37. A rising CEA cannot be used to determine the progression of a patient’s lung cancer without confirmation from diagnostic imaging, especially if a patient is treated with immune checkpoint inhibitors such as nivolumab. Weiner disagrees with this finding and does not admit to it.

Patient 5

38. Patient 5 was diagnosed with metastatic colon cancer.
39. Weiner ordered KRAS gene testing for Patient 5.
40. When Weiner treated Patient 5, it was standard to order molecular testing for gene mutations for patients with metastatic colorectal cancer, and specifically to test the KRAS, NRAS, and BRAF genes. Weiner acknowledges some medical guidelines recommend testing all 3 genes, and he does not admit to this finding.
41. CT scans are standard for accurate assessment of a treatment response to colorectal cancer. Patient 5’s medical records confirm Weiner used only PET scans to assess Patient 5’s treatment response. Weiner does not agree with this finding and does not admit to it.

Patient 6

42. Patient 6 was diagnosed with stage III triple-negative inflammatory breast cancer.
43. Weiner treated Patient 6 with a combination of nab-paclitaxel, a chemotherapy drug, and atezolizumab, an immunotherapy drug.
44. A test for an immune checkpoint protein, PD-L1, was ordered but no results were received or in Patient 6’s medical records. Therefore, Weiner did not review PD-L1 test results either prior to prescribing atezolizumab with nab-paclitaxel, or after Patient 6 started the medications.
45. Atezolizumab is approved for breast cancer treatment only when PD-L1 testing is positive.
46. PD-L1 levels must be tested prior to initiating immunotherapy for patients diagnosed with stage III triple-negative inflammatory breast cancer. Weiner does not agree with this finding and does not admit to it.

Patient 7

47. Patient 7 was under Weiner’s care for 7 years in a primary care capacity. Patient 7 did not have cancer, was not diagnosed as having cancer by Weiner, and was not treated for having cancer by Weiner, at any time while Patient 7 was under his care.
48. Patient 7’s medical history included COPD, hypertension, diabetes, osteoporosis and obesity.
49. Weiner prescribed chronic, high doses of prednisone for Patient 7’s COPD. In February 2018, Patient 7 was taking prednisone 20 mg daily. In March 2018, Weiner decreased prednisone to 10 mg daily. Clinic visit notes in May and June 2018 do not include documentation of whether Patient 7 was still taking prednisone.
50. The next clinic note from November 29, 2018, includes continuing Bactrim for Pneumocystis carinii pneumonia prophylaxis. Weiner’s record provided no rationale for the use of prophylaxis, or preventative measures taken to reduce the risk of Pneumocytis pneumonia (PCP) or Pneumocystis jirovecii pneumonia (PJP).
51. Weiner’s clinic visit notes do not document an assessment or plan for Patient 7’s pain management.
52. Weiner prescribed opioid pain medications and medical marijuana for Patient 7 for long term use without appropriate documentation and routine assessments. There is no documentation in Patient 7’s records whether the opioids
    Weiner prescribed were effective, were causing side effects, or whether Patient 7 was receiving opioids. Weiner does not agree with this finding and does not admit to it.
53. Weiner’s inadequate documentation for Patient 7 persisted throughout 2016, 2017, 2019 and 2020. Weiner does not agree with the finding his documentation was inadequate and therefore does not admit to it.

. . . .

3. Weiner violated rules of unprofessional conduct for a physician when he involuntarily lost his privileges to practice at St. Peter’s Hospital for a period exceeding 30 days. Admin. R. Mont. 24.156.405(2)(n).
4. Weiner violated statutes of unprofessional conduct for physicians in the care and treatment of Patients 1-7 for whom he did not meet the generally accepted standards of practice applicable at the time of treatment. Mont. Code Ann. § 37-1-316(1)(r).1
5. The Board will issue an order imposing sanctions following a decision a licensee has committed unprofessional conduct. Mont. Code Ann. § 37-1-312.

Source

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