Catching phony physicians: Those masquerading in medicine sometimes injure patients

The great pretender went by many names. Gerald C. Barnes. "Doc" Barnes. Jerald Charles Barnes. Jerry Donald Barnes. Jerald Barnbaum. Gerald Birnbaum.

For more than 20 years, the man posed as a doctor, even though he didn't have a medical degree. He used copies of school records and medical credentials of a real physician, California surgeon Gerald C. Barnes, MD, to land jobs at clinics in Southern California. At a Los Angeles clinic, he conducted physicals on FBI agents who had no idea he was an imposter.

In 1981, he pleaded guilty to involuntary manslaughter after a misdiagnosed patient died from diabetes complications. Each time he was convicted of impersonating a physician and served prison time, he somehow wiggled his way back to practicing medicine.

Barnes, 71, no longer poses as a physician. U.S. marshals caught him, and he is now in a federal prison, serving his fifth conviction for impersonating a doctor.

There are scores of other pretenders like Barnes who practice medicine without a license. Law enforcement officials are not sure how many they number, but there are enough to pose a serious threat to the public.

These phony doctors set up shop in offices -- occasionally working with real physicians who know the imposters do not have legitimate medical licenses -- or trick clinics into believing they are the real thing when they present fake credentials for employment. Others see patients in makeshift home offices in communities where visiting a doctor at home is culturally accepted.

They are not easy to sniff out. They typically surface after a patient complains to state authorities after receiving poor medical care. Or a real physician contacts authorities after treating a patient who was hurt by the work of a fake practitioner.

The potential harm is high: improper care can leave patients debilitated, or at its most extreme, dead. And imposters have stolen identities of actual physicians.

Law enforcement agencies, state medical boards and other groups are trying to crack down on people who pose as doctors, beefing up efforts to find and stop the phonies.

In 1998, Florida opened its first unlicensed activity office to investigate and refer for prosecution all unlicensed health care complaints and allegations. The American Society for Dermatologic Surgery is trying to create greater awareness about the problem. In the wake of the Barnes fiasco, the Medical Board of California instituted tougher procedures for issuing duplicate certificates and created an unlicensed activity unit, which was slashed last year due to budget cuts but whose efforts have been absorbed by field offices.

Even with these and other efforts, law enforcement officials don't expect the problem to vanish anytime soon.

"[The Medical Board of California] informs me they are busier than ever with these types of cases. I will expect more of these cases to be coming to me," said Cheri Pham, deputy district attorney for the consumer and environmental protection unit of the Orange County District Attorney Office.

Fake dermatologist fled country

Stories about doctor imposters often make the news. A sampling:

• In February, Luis Sanchez was sentenced to five years in prison for posing as a doctor in Texas and possibly injecting hundreds of patients with industrial-grade silicone.
• Larry Lammers was arrested this winter in Michigan and charged with unauthorized practice after he presented himself as a physician and treated patients at his father's clinic.
• Douglas Lenhart pleaded guilty in July to aggravated assault and practicing medicine without a license in Pennsylvania after he tried to perform a castration on a transgender woman in her dining room.

Perhaps the highest profile case in recent years has been that of Dean Faiello.

Faiello pretended to be a dermatologist in Manhattan, operating what he called a skin and laser center, law enforcement officials said. Faiello advertised that he did laser hair removal, collagen treatments, removal of skin lesions and other procedures. Tips to law enforcement agencies and the media led to scrutiny and news reports questioning Faiello's activity.

In October 2002, Faiello, then 43, was arrested on charges of unlicensed practice of medicine. He posted $5,000 bail. Faiello pleaded guilty and was awaiting sentencing. But apparently he wasn't through with medicine.

Investigators since have charged Faiello with second-degree murder in the death of investment banker Maria Cruz, who was last seen on April 13, 2003. Investigators believe Cruz may have died in a botched operation performed by Faiello. Her body was found this February in Faiello's former Newark, N.J., home, stuffed in a suitcase and buried under concrete.

Faiello, who had fled the country, was found in Costa Rica by police detectives and investigators from the New York State Attorney General's Office.

"Our guys found him in a beach resort. We received a tip that he was in Central America," said Paul Larrabee, spokesman for the New York Attorney General's Office.

Roy G. Geronemus, MD, is familiar with Faiello. About four or five years ago, he started seeing patients with complications from Faiello's work. The dermatologist has treated about 10 to 15 of Faiello's former patients.

"We realized he was not a physician, and these patients were under the belief that he was," said Dr. Geronemus, director of the Laser & Skin Surgery Center of New York.

Dr. Geronemus reported Faiello to authorities. "There was little if any response whatsoever," he said.

At least not until the media brought attention to Faiello and he was first arrested in 2002.

"The authorities tell me they have limited resources. They're only going after the most egregious examples, and everyone else is flying under the radar," Dr. Geronemus said.

Creating greater awareness

A few years ago, the American Society for Dermatologic Surgery launched a campaign to warn patients about cosmetic treatments by nonphysicians.

The society said the Faiello case underscored the need for tighter regulations on nonphysician practice of medicine. Dr. Geronemus, past president of the society, said authorities should develop a federal clearinghouse on fake doctors.

"They're out there. I think there's a lot," Dr. Geronemus said. "People are getting hurt. People are getting misdiagnosed."

The Federation of State Medical Boards keeps a list of phony doctors named in media reports, and it shares the list with member boards. The organization said many medical boards have limited authority over fake doctors because boards deal with licensed physicians. Most boards can do little but refer complaints to law enforcement agencies.

"You do have to rely on pharmacists, patients and employees to alert you to these situations," said Roland Summers, MD, president of Georgia's Composite State Board of Medical Examiners.

In 2001, the Medical Board of California started Operation Safe Medicine to crack down on unlicensed activity. John Hirai supervised the unit and had four investigators. "The board felt that unlicensed practice was a very serious issue," Hirai said.

Hirai said cases typically fell into two categories: Fakers working in a medical clinic doing procedures they were not licensed to do; or people practicing medicine without a license in their home or in back of a business. In some cases, pretenders worked alongside physicians.

"Some doctors don't even care. They know the person is unlicensed but they still allow it," Hirai said.

Budget cuts ended the unit in 2003. Today, cases are filtered to board investigators. Meanwhile, the board receives numerous complaints each year alleging that a physician is allowing an unlicensed person to do medical procedures. The board can take action against such physicians' licenses for aiding and abetting unlicensed practice.

Despite states' efforts, phonies such as Barnes manage to work around the system. The real Dr. Barnes, who is semi-retired now in Stockton, Calif., said states need to do a better job of checking credentials of fakes such as the Gerald Barnes who stole his identity. He said California's medical board should have flagged his file when trouble started.

He hopes he has heard the last of the fake Barnes.

"Unless he escapes from prison," Dr. Barnes said. "I suppose he's crazy enough to try [practicing medicine] again."

Undercover work pays off

Florida takes an aggressive approach. The Florida Dept. of Health started its first unlicensed activity office in 1998 in South Florida. It began with three employees and now has more than a dozen.

The program fielded 765 complaints on unlicensed activity from July 1, 2003, to June 30, 2004. Of those, 101 cases led to criminal convictions.

Besides protecting patients, "It protects the integrity of the profession," said Amy Jones, director of the Florida Dept. of Health's Division of Medical Quality Assurance.

Medical experts and law enforcement officials agree that cooperation among agencies is key to catching phony doctors, along with good undercover work.

Take the case of Maria Genoveva Torres, 58, of Santa Ana, Calif. An anonymous tipster told authorities Torres was representing herself as a physician and seeing patients in her home. The Santa Ana Police Dept. and the Medical Board of California worked on the case. Investigators drove past her house last winter on several occasions and saw adults and children waiting on the front porch.

"There were people lining up outside her door constantly," said Pham, the deputy district attorney for the Orange County District Attorney's Office.

In March, two undercover officers went to Torres' house. One male officer said he had a stomach ailment. Torres told him to remove his shirt and lie down on the floor, officials said.

Torres told the officer he had colitis. She then treated him by placing a penny on his stomach, putting a lighted candle on the penny and covering both with a glass. She rubbed the glass in a circular motion, then offered the officer a substance she claimed would release the blockage in his stomach.

A few days later, police arrested her.

"She admitted to everything," Pham said.