A surgeon's trials: 'This is getting scary'

His anxiety was heightened by the refusal of some patients to see any other doctor. Several patients hired a Washington lawyer to pressure the university into letting the surgeon practice again. Many had advanced cancer and were grasping desperately for time.

One is Vernon Campbell, a 42-year-old prison guard from Hagerstown who had been fighting a yearlong battle against melanoma.

Several operations had slowed the cancer's progress, but new tumors kept appearing. With little chance for a cure through conventional methods, Dr. Elias included Mr. Campbell in a federally approved trial involving experimental vaccines made from a patient's own tumor cells. The strategy was to coax the immune system into mounting its own killer assault against the cancer.

"Another doctor could not finish up what he had started," Mr. Campbell said.

The patients considered suing the university, but it never came to that. Two months ago, Mr. Campbell called his doctor in distress. He had found a new lump on his side.

Dr. Elias said he knew immediately that the lump was malignant, and he was determined to remove it himself. He decided on the spot to resume his full practice no matter what university officials said.

The university has not protested.

Chaperons

Dr. Elias' appointment book is again stacked with patients, but he says the atmosphere around the office will never be the same. Now, an employee witnesses nearly every exam. The university insisted on that, and Dr. Elias recognizes the value of a chaperon in case there is a copy-cat accuser.

"It's a no-trust situation, and I'm personally damaged. I'm telling you, there is something new: fear. You're concentrating on protecting yourself rather than on medical practice," he said.

In an exam, he said, his mind will be operating like a computer, running down a checklist of everything that must be done to reach the right diagnosis or treatment plan. Then, he said, an inner voice will say: "Now, how about George? What can we do to protect him?"

Earlier this year, Dr. Elias moved to counter the possibility that he could lose his license to practice. With a criminal conviction on his record, it was a foregone conclusion that the state licensing board would consider some form of discipline.

So he made a pre-emptive strike, inviting the state Board of Physician Quality Assurance to send investigators. They could tour his office and gather any evidence they wanted.

"I said, 'Do me a favor: Take the case to the board now and decide it. If you want to take my license, take it now.' "

He has heard nothing from the board, but he said he was satisfied that investigators viewed the case as a misunderstanding. Dr. Weiner, the board chairman, said he could only speak for himself -- the board has not acted on the case -- but that he doesn't believe the surgeon did anything wrong.

"My first reaction was that the judge's decision is a lot like the Antioch College policy on sex -- for every escalation of the physical exam, the judge wants you to ask for permission to touch this or touch that," said Dr. Weiner, a neurosurgeon.

"You can look back and say he should have explained. But it's unreasonable to ask a doctor to explain every aspect of an examination."

Some doctors have begun to question whether they, too, should deploy their staff to chaperon virtually all exams -- a practice that is now commonplace only during rectal and vaginal examinations involving patients of the opposite sex.

"This can happen to anybody," said Dr. Ira Fine, a Baltimore internist. "When I have a female patient who has a cough and I have to listen to her chest, should I have a chaperon with me?"

"I never had a chaperon in the office in my life until George was convicted," said Dr. Bolling, the St. Agnes surgeon. "Now, I have to bring my secretary away from her type writer. I can just tell you, the surgeons in this community are as angry as they can be."

After the second conviction, Dr. Elias turned to Anton Keating, a flamboyant but meticulous lawyer who began assembling a case that the surgeon deserved yet another trial.

When Mr. Keating finished preparing the case for a retrial, his arguments filled eight volumes.

He said prosecutor Videtta Brown had violated rules of evidence expressing her own opinions. He said Judge Gordy had been rude and impatient and had intimidated Mr. Mann. But mainly, he went after the lawyer.

He said his predecessor had failed to build an unassailable case around the surgeon's reputation, which would make an abuse charge seem ludicrous. He offered the judge a list of 211 patients and colleagues who were eager to praise Dr. Elias' character in a new trial.

He said Mr. Mann should have cemented the point that palpating the lymph nodes was essential to ruling out any possibility of a spreading cancer. To help the judge grasp how doctors track melanoma, he said, other surgeons should have testified about how they handle similar cases.

A surgeon testifies