Despite imaging and pathology reports to the contrary, a surgeon insisted he had removed a patient's ear tumor. He was accused of doctoring the pathology report with Wite-Out to confirm his argument. Another surgeon later removed the ear tumor, but the delay allegedly caused the patient to go deaf. The patient sued the first surgeon for malpractice and fraud, and he won.

George Ralli had a benign tumor in a very hard-to-reach area of his ear canal, but it needed to come out because it was pushing against auditory nerves and would eventually make him go deaf. David Eisenman, MD, a surgeon near Mr. Ralli in Maryland, recommended conventional middle fossa surgery, but warned it was a tricky operation and there was a 30% to 40% chance of failure.

Researching on the internet, Mr. Ralli identified an alternative endoscopic procedure called retrosigmoid surgery, performed by Hrayr K. Shahinian, MD, in California. Dr. Shahinian claimed a 98% success rate, and Mr. Ralli opted to go with him instead.

Dr. Shahinian believed the operation was a success and he had removed the tumor. But his attorney, Richard D. Carroll, says ear tumors are so tiny that it was hard to know for sure. "He took out this little brown thing and, on the theory of exclusion, he thinks this is the tumor," says Mr. Carroll. A radiologist viewing the post-op MRI scan reported the tumor was still there, but Mr. Carroll said Dr. Shahinian believed the radiologist mistook normal post-surgical scarring for the tumor, and he told Mr. Ralli this.

Mr. Ralli was mailed 2 nearly identical pathology reports, allegedly from Dr. Shahinian's office, describing what objects had been removed in the surgery. One report read, "No tumor seen," but in the other, the "No" was covered with Wite-Out to read, "tumor seen." Dr. Shahinian denied he altered the report. "This is such an obvious deception," says Mr. Carroll, adding he would not rule out the possibility that Mr. Ralli had done it to cast aspersions on his client.

Mr. Ralli then asked Dr. Eisenman to order a new MRI, which conclusively found that the tumor was still there. Dr. Eisenman removed it, but it caused Mr. Ralli to go deaf. At trial, Mr. Ralli's expert witness maintained that if Dr. Eisenman had done the surgery earlier, Mr. Ralli would likely have retained his hearing, but Dr. Shahinian disputes that, says Mr. Carroll.

The lawsuit against Dr. Shahinian alleged medical malpractice, fraud and intentional infliction of emotional distress. The judge ruled in favor of Mr. Ralli on all charges, finding that Dr. Shahinian had used the wrong kind of surgery, failed to find the tumor, misled the patient into thinking the operation had succeeded, misinterpreted the post-operative MRI and misreported the pathology finding.

Dr. Shahinian was ordered to pay $950,600 and his appeal of the case was denied last month. Mr. Carroll said the finding of fraud could prompt an investigation by the medical board and possible disciplinary action against Dr. Shahinian. Richard T. Lobl, an attorney for Mr. Ralli, could not be reached for comment.

Leigh Page