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For their own good
Fifty years ago, they were screwed-up kids sent to the Florida School for Boys to be straightened out. But now they are screwed-up men, scarred by the whippings they endured. Read the story and see a video and portrait gallery.
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And he's still practicing
FEDERAL ACCUSATIONS: 25 counts of health care fraud. 25 counts of making false statements. Performed "medically unnecessary" surgeries. Operated on one patient 122 times
By SUSAN TAYLOR MARTIN
Published June 12, 2005
Dr. Michael A. Rosin, Sarasota Occupation: Dermatologist
Specialty: Skin cancer
Action by Florida Board of Medicine: None
Action by Florida Department of Health: None
Action by medicare program: None
Status of license to practice medicine: "Clear/active"
SARASOTA - William Kapfer, an 88-year-old retiree, thought he was in good hands with Dr. Michael A. Rosin.
A physician since 1978, Rosin was among the most respected dermatologists in Sarasota. And he was one of just two with intensive training in Mohs microscopic surgery, a state-of-the-art procedure effective in curing the most common types of skin cancer.
Over a span of four or five years, Kapfer often found himself in Rosin's office undergoing Mohs surgery. So often that he began to wonder if he really had as many skin cancers as the doctor diagnosed.
"I'm a lay patient and you have to go by what somebody tells you - if he takes a sample and says it's cancer and you need to be treated, you accept that," Kapfer said. "However, the number of times he did that became rather large, and I began to get suspicious."
In April, Kapfer's doubts were confirmed: He was among dozens of elderly patients listed in a federal indictment that accuses Rosin of falsely diagnosing skin cancer and performing unnecessary surgery.
From 1996 through last June, the indictment says, Rosin schemed to "deceive his patients" into thinking they needed cancer operations so he could bill the Medicare program for their treatment. He is accused of illegally collecting at least $3.2-million in Medicare payments.
In one case, FBI agents found, Rosin based his diagnosis on a slide that contained chewing gum, not human tissue.
In another case, the FBI said, a lab technician decided to test Rosin by substituting a sliver of Styrofoam for a tissue sample. After examining the slide, Rosin told the patient that her cancer was "very aggressive" and that she needed surgery the next day.
Rosin, 54, would not comment for this story. At a hearing in April, he pleaded not guilty to criminal charges - 25 counts of health care fraud and 25 of making false statements - that could put him in prison for life. One of his lawyers, Greg Kehoe of Tampa, said the allegations are "absolutely not true."
"The work he did was proper in all respects," Kehoe said. If the government was so concerned about Rosin's practice, Kehoe added, why didn't it do something a year ago when it started investigating him?
Rosin is still performing surgery and is still in the Medicare program. Neither the Florida Board of Medicine nor the state Health Department has taken any action against him; prospective patients checking him out on the department's Web site would find that his license remains "clear/active."
"I think that's outrageous," said Kapfer's 80-year-old wife, Rosalie, who also underwent surgery by Rosin. "I don't understand why they don't close him down - it seems terrible having people cut up perhaps unnecessarily. He whacked us up good, we both have scars all over."
Rosin's credentials are impeccable.
A graduate of the University of Florida, he did residencies at George Washington University, the University of Miami and Vanderbilt. Patients generally found him professional and friendly, devoted to his seven children.
His office, across from Sarasota's main hospital, has two signs in the window: "Lionel Trains Wanted" and "Official Boy Scout Gear." Inside, among framed medical certificates, are several examples of his needlework.
One patient recalls Rosin excitedly announcing that he had won a blue ribbon for needlepoint at the Sarasota County fair. He told another patient that he took up the hobby to keep his hands limber for surgery.
"At first I was kind of surprised, but when he explained it I could understand it," said Jean Schnurle, 90, a former secretary.
Rosin is among just 744 fellows of the American College of Mohs Micrographic Surgery and Cutaneous Oncology. Members are required to complete months of training in the delicate surgery Dr. Frederic Mohs developed in the 1930s.
Mohs surgery is primarily used to treat basal and squamous cell carcinomas, the most common and curable types of skin cancer. After the obvious tumor is removed, the surgeon takes an additional layer of tissue and examines it under a microscope for evidence of any remaining cancer cells. If it contains cancer, the doctor removes another layer of tissue from the site. The process continues layer by layer until the cancer is gone.
"I don't think you can go wrong with Mohs because it is the most meticulous way to make sure you remove all the cancer," said Dr. David Brodland of the Mohs College board of directors. "That said, is it necessary to treat everybody with Mohs? Not at all."
Doctors in Sarasota, Manatee and Charlotte counties often referred patients to Rosin. Among them were the Kapfers of Englewood, whose dermatologist was concerned about what seemed to be a growing basal cell tumor near Rosalie Kapfer's eye.
"While we were up there, I had him (Rosin) look at me, too, and he found something," recalled Kapfer, a retired chemical engineer. "We stayed with him for several years because I liked the idea of Mohs surgery, where you didn't have to wait a week before they knew what was going on - they could get it all done in the same day."
Rosin did a "couple of dozen surgeries" on him, Kapfer said, and several on his wife, including one so painful she still shudders to think about it.
Disenchanted with Rosin, the Kapfers quit seeing him two years ago. "Since then we started going to a dermatologist down here who doesn't find something every time," Mrs. Kapfer says. "In fact, he hasn't found anything."
Rosin's own staff was growing suspicious, as well. The FBI began investigating early last year, acting on a complaint from his longtime business manager Carolyn Ferrera.
According to an FBI warrant, Rosin told Ferrera he had a quota for the number of surgeries he needed to perform to support his large family. He said he had to make $10,000 daily; employees noticed that he performed five surgeries a day, reimbursed at the rate of about $2,000 per surgery.
Employees said they also questioned Rosin as to why 100 percent of the biopsies he reviewed were diagnosed as cancerous. His response: The results were positive because he only biopsied areas he thought were malignant. Moreover, he said, most of his patients previously had skin cancer and it was not uncommon for the cancer to recur.
In one case, though, Rosin reportedly examined a slide that contained chewing gum. A lab technician told the FBI she put the gum there because a patient's skin specimen was too small to process.
In two other cases, a technician overheard Rosin telling patients they had cancer and required surgery - before he had even looked at their slides.
On April 14, 2004, police at Tampa International Airport arrested Rosin when he tried to pass through security with a loaded .22-caliber revolver. Rosin, who had a concealed firearm permit, said he forgot the weapon was in his duffel bag.
"He further stated that the firearm was for his protection because he often traveled with a large sum of money," the police report said.
The case was dropped. Six weeks after Rosin's arrest, though, agents from the U.S. Department of Health and Human Services, which administers Medicare, raided his office and carted off dozens of patient files.
Of those, 75 were turned over to Dr. Pearon Gordon Lang, president of the Mohs College, for review. He found that only six slides were of "satisfactory quality" and contained cancerous tissue.
Many of the other slides, Lang said, were of such poor quality that no diagnosis could be made. Six of the Medicare claims did not have any biopsy slide at all.
Rosin's records showed he diagnosed most cases as basal cell carcinoma. "After reviewing the log books, Dr. Lang remarked that it would be nearly impossible for any dermatology practice to have such a high rate of basal cell carcinomas," the FBI warrant says. "He felt there should be a much wider range of diagnoses, including negative diagnoses."
According to another government court filing, Rosin performed so many skin cancer surgeries "that the sheer quantity . . . suggests many of them were medically unnecessary."
At least 13 patients underwent surgery 20 or more times. One patient was operated on 104 times; another, 122 times.
Typically, Rosin removed four layers of tissue during surgery; each layer was reimbursable by Medicare, meaning the more layers he removed the more money he got.
"Four stages is not unusual for difficult cases," said Brodland, the Mohs expert. "But if you do four stages on everybody, that's pretty unusual."
Concerned by all the "cutting and stitching" Rosin did on her, Barbara Sweeney already had switched doctors by the time he was charged. She is among the patients listed in the indictment.
The FBI said "one of the procedures was not necessary, but which one it was I have no idea," said Sweeney, 73, who worked in sales. "As soon as I heard about the problems I pulled all my records out, such as they were. They were just a couple of lines for each procedure, handwritten and hard to read."
Peter Hillenbrand feels betrayed by a man he not only held in professional regard, but considered a friend. Rosin once brought his children to the Hillenbrands' Sarasota home.
"I didn't know all this time he was so deceiving," said Hillenbrand, 84, a former builder and postal employee. "It made me feel like I can't trust any doctors anymore."
Other patients remain fiercely devoted to Rosin.
"He's 100 percent the finest doctor I've had in 87 years," says Stuart Magowan, a retired marketing executive. "I think the charges are probably the work of some idiot in the FBI, and we know what they've proven to be with this Deep Throat mess."
Magowan was among those, the FBI said, whom Rosin diagnosed with cancer and operated on even though his skin specimen was "normal."
At the April hearing, prosecutor Katherine Ho said she was concerned that Rosin continued to see patients. His trial should be held as soon as possible, she said, because of the risk to patients, many of them old and in fragile health.
But Rosin's lawyer said the doctor is presumed innocent and should be allowed to practice while awaiting trial.
"The U.S. has had this information for over a year and did nothing about precluding him from practicing," Kehoe said. "If they were so concerned about the patients, why didn't they do something about it a year ago? Why all of a sudden should he be stopped now?"
The publicity has had a "devastating effect" on Rosin's business, Kehoe said, but he still has many loyal patients who are among those expected to testify at his trial.
"Our client is not guilty and there are plenty of people who will come forward as well as expert testimony to prove that."
Due to scheduling conflicts, the trial is not expected to be held for several months.
The state Department of Health can take emergency action against a doctor who represents "an immediate and imminent danger to the health and safety" of the public. Action can include suspending a doctor's license or restricting practice, such as a ban on performing surgery.
As of Friday, no action had been taken, and department spokesperson Lindsay Hodges said, "I can't confirm or deny" an investigation is under way.
Physicians also can be disciplined by the Florida Board of Medicine, a process that typically takes months. Again, Hodges would not comment.
Rosin remains in the Medicare program and eligible for reimbursement. If convicted, he would be automatically expelled for five years.
Though he can still collect Medicare funds, the government has started forfeiture proceedings against property "derived" from the $3.2-million Rosin is accused of fraudulently receiving thus far. That could include his 3,500-square-foot home on Sarasota Bay, conservatively valued at $1.43-million; a "Michael A. Rosin" is listed as owner of an $800,000 house in the Miami area, where the doctor has told patients he spends time.
Rosin also faces potential malpractice suits from seven former patients who have asked that the statute of limitations be extended.
Among those considering legal action are Loyal Behling, 78, and his wife, Patricia, 80. Rosin did numerous surgeries on both; their daughter, Norvia, said each has a disfiguring scar on the nose, where Rosin cut off the tip.
"My father and mother finally just stopped going to him - they weren't going to have a face left."
Times researcher John Martin contributed to this report. Susan Taylor Martin can be contacted at firstname.lastname@example.org