Tags:Depending on whom you ask, Fletcher-based neurosurgeon Michael J. Rosner is either a skull-shaving savior or a shameless opportunist who's needlessly operating on patients desperate for a cure.
For about a decade, Rosner's work has gone in a direction pursued by only a handful of neurosurgeons in the United States: snipping away bits of the spine and the back of the skull to treat neurological conditions found in patients diagnosed with chronic fatigue syndrome or fibromyalgia.
Rosner's work caught the attention of the North Carolina Medical Board, which summarily suspended his medical license in 2002, concluding that he'd performed eight unnecessary surgeries on patients. Brian Blankenship, the board's attorney, said the agency, which is charged with looking after patients' welfare, found that Rosner's surgeries were "deviating from the accepted and prevailing standard of care."
"If you look at the board's actions, they're very case-specific and very fact-specific," said Blankenship. Summary suspensions are rare -- the medical board issued four in 2007 and three in 2006.
Rosner wasn't allowed to reapply for his license for six months, and when he did, his application was denied. Rosner appealed. Following a June 2004 hearing, the medical board did reinstate his license -- but with certain conditions.
As for Rosner's patients, some have reported improvement that's little short of miraculous; others say the treatment made only a minor difference, and still others report worsening conditions. But Rosner has also been sued at least 48 times in the past six years by people alleging unnecessary surgery. Fifteen of those suits have been dismissed, he says, and eight more have been withdrawn. According to Henderson County court records, however, 32 lawsuits against Rosner remain unresolved.
Rosner maintains that over his entire career, only one malpractice claim has been paid on his behalf: a $50,000 settlement in 1987 for operating on the wrong level of a patient's back. Rosner also contends that the medical board's actions may actually have encouraged some suits. Four months after the suspension of his license, he notes, a single law firm filed eight cases.
A confident man with a salt-and-pepper goatee, Rosner seems unbowed by the controversy that continues to dog him. He's still seeing patients, most of whom are referred to him either by other doctors who believe in his work, or by passionate supporters who network via the Internet.
In Rosner's eyes, the real question is how long it will take to change what he believes is faulty science.
"It's a long process to change anything in the world ... and the same is true in medicine, particularly with the egos and intellect involved," he observes. "Because if you believe something and you've got an IQ of 140, that's a difficult process to unlodge, because you've got all your intellect behind maintaining what you believe in."
A minority view
Rosner and other proponents of the surgery believe that many of the patients they see suffer from one of two conditions: a skull that's too small for the brain, or a compressed spinal column. Sometimes they have both.
In medical terminology, "hypoplastic posterior fossa," also known as a "Chiari I malformation," essentially means that the back of the skull and upper spinal column are too small to contain the lower part of the brain and the upper spinal cord. This condition has long been known to cause some neurological difficulties -- such as tremors, sleep apnea, headaches and poor coordination -- in some sufferers.
Rosner wants to be clear: He's not operating to treat fibromyalgia or chronic fatigue. Rather, he's using surgery to correct what he calls a "neurological deficit" in his patients. He also emphasizes some fundamental differences in the way he examines patients and determines a course of treatment.
In his small office next to Park Ridge Hospital in Fletcher, Rosner says he sees two to four new patients a week and generally performs surgery at the hospital one day a week. Patients come to him from across the country, often after wrestling with their medical problems for years.
"I spend a great deal of time with my patients," Rosner explains. "We schedule one-and-a-half to two-and-a-half hours for new-patient evaluations, and I do it myself, so we have very accurate, very detailed examinations."
Most neurosurgeons spend just half an hour with a new patient, he says. "The [insurance] reimbursement is such that using your brain and really delving into a history and taking the time with a patient and listening to what they're saying is not financially feasible for most practices."
Rosner's way of making diagnoses also represents a departure from standard medical practice. The neurosurgeon began his career working on cases involving cerebral vascular disease, head injury and intracranial pressure. Noticing that people with head injuries often also had spinal-cord abnormalities, he says he began to look at patient X-rays and MRIs in a new light. Rosner concluded that patients could be helped by surgery even if the back part of the brain wasn't pushed as far out of the skull as is typically deemed necessary to justify the surgery. He also began looking for signs of compression farther down the spinal column than is typically done.
In a June 2004 hearing before the board, Rosner offered the expert testimony of Dr. Peter Jannetta, a prominent Pennsylvania-based neurosurgeon. Janetta testified: "The prevailing diagnostic criteria for this condition [a too-small skull] are inadequate. The majority view among neurosurgeons regarding the diagnosis of a Chiari I malformation is that a certain portion of the brain, known as the cerebellar tonsils, must descend through the hole in the skull through which the spinal cord passes (known as the foramen magnum) by a measurable amount -- usually 3 to 5 millimeters -- somewhat dependent on the patient's age. The view held by a minority of neurosurgeons is that no descent of cerebellar tonsils is necessary to support an operable diagnosis, so long as radiographic studies demonstrate abnormalities arising from crowding of the structures of the hindbrain. Dr. Rosner subscribes to the minority view."
After the hearing, the board restored Rosner's medical license, noting that neurosurgeons had begun discussing the issue and articles had started appearing in the neurological literature debating the issue. The agency also acknowleged the testimony of Rosner's expert witness and colleagues, who called him "a careful, thoughtful, deliberate, knowledgeable physician [who] exhibits professionalism and has made contributions to his specialty and to his medical community." The board emphasized, however, that it wasn't drawing any conclusions concerning which view is correct.
Some credit Rosner with dramatically improving their lives. Allen Shelton, 35, who lives in Madison County's Laurel Valley, says the neurosurgeon removed sections of bone from his spine and a 2-inch-by-3-inch chunk of his skull after he began suffering from fatigue, chest pains and seizures. "I had no control over my body," says Shelton, adding that he's seen significant improvement. "I'm not 100 percent -- but hey, man, I'm way better than I was." Of Rosner, Shelton says, "God give him a gift, and he's using it."
Rosner's patients often arrive bearing stacks of X-rays and stories of extended suffering along with their diagnoses. Many, but not all, have been diagnosed with fibromyalgia syndrome and chronic fatigue syndrome, conditions marked by pain, depression and muscle failure. And in many cases, the neurosurgeon concludes that the appropriate treatment involves shaving the back of the skull or spinal cord to "decompress" the soft tissue in those passageways.
Gori Anna Lipsey, 35, says she suffered pain for years before seeing Rosner. "I had been told it was all in my head. You could touch me and I felt like I'd been punched; you just can't imagine the pain. I've had a child, and it's worse than labor pains," says Lipsey, an 11th-grade English teacher in Spartanburg, S.C.
Diagnosed with fibromyalgia, Lipsey says she tried acupuncture and other therapies, but nothing helped. Two years ago, she was referred to Rosner. It took her a year to decide to go forward with the surgery, but eventually, " it got so bad that I didn't really have any options."
After Rosner operated on Lipsey's spine and the back of her skull, she says, "I woke up with an extremely bad headache, but I was ready to get up and go walk," adding that she's seen marked improvement.
Helen Hudgins, a 43-year-old automotive-service consultant for Hunter Chevrolet in Hendersonville, also reports dramatic improvement following surgeries by Rosner. After suffering a stroke in 2006, Hudgins says she had headaches, lost her peripheral vision and was taking medication to control her blood pressure.
"I believe in prayer, and I prayed, 'Good Lord, help me. Find me somebody who doesn't treat me like an experiment,'" she recalls.
Post-surgery, Hudgins says she's significantly cut back on her prescription drugs, and her vision and balance have improved.
Asheville-based clinical psychologist Paul Fleischer counsels Rosner's patients before surgery. Many, he says, come to him having run out of medical options. As for the controversy surrounding Rosner, Fleischer says, "The pioneers are the ones that get the arrows in the back."
Dozens of lawsuits
Other former patients tell a radically different tale. Dozens have filed lawsuits against Rosner.
On Aug. 6, 2004, Janice Lasko of Greenville, Tenn., filed a lawsuit in Henderson County Superior Court. According to the suit, Lasko had been referred to Rosner several years earlier with a diagnosis of fibromyalgia. Rosner operated on Lasko on Aug. 8, 2001; she was discharged four days later. In a series of follow-up visits, Lasko complained of continuing pain and difficulties -- some of which she believes were caused by the surgery.
During a December 2001 visit, the court papers state, "Plaintiff reported that her neck pain was somewhat worse and constant, extending down to and through her lower back; she [sic] arms and legs felt weak; and her tinnitus and hyperacusis remained constant. Dr. Rosner noted that Plaintiff had significant weakness in her right triceps, interossei, quadriceps, iliopsoas and hamstring muscles, with transient weakness in the majority of other muscle groups. He noted abnormalities in her gait and that Plaintiff's toes were externally rotated. Despite these findings, Dr. Rosner recorded that Plaintiff's neurological exam was significantly improved."
Lasko maintains that Rosner's surgery was unnecessary and that she was permanently injured by it. Four years later, the suit is still pending.
Wade Byrd, a Fayetteville attorney representing about a dozen people who are suing Rosner, says his experts maintain that Rosner misinterprets X-rays and performs unnecessary surgeries. "These are people that, in my words, he preys upon and gets them to consent to this radical surgery."
Byrd goes on to say that his cases target not just Rosner but also Park Ridge Hospital, where Rosner operates on Tuesdays. Byrd claims the 100-bed hospital "is just after money," noting that Rosner is the only neurosurgeon on staff.
In a written response, Bruce Bergherm, the hospital's vice president for business development, said: "Dr. Rosner has a license to practice, and he is following the guidelines of the state medical board. As long as he follows those guidelines, he is permitted to practice at our hospital."
A lose/lose situation?
When the medical board restored Rosner's license, it stipulated two conditions. The first is that any patient Rosner plans to operate on for hypoplastic posterior fossa must seek a second opinion on the need for surgery from another North Carolina-licensed neurosurgeon whom the board must approve. The second condition is that Rosner's surgery must be included in a formal research project under the oversight of an institutional review board.
The requirement for a second opinion has been difficult to satisfy, says Rosner. He calls it a "lose/lose situation" for the other doctor, who must take time out of a busy schedule to evaluate a patient who'll probably wind up returning to Rosner. Patients, he says, have reported having a hard time securing a second opinion. According to Rosner, there are only about a half-dozen approved neurosurgeons in the state who are willing to provide second opinions for the surgery he performs.
As for the research project, Rosner says he'd been planning one anyway and is happy to comply.
Since his license was reinstated, Rosner says he's performed the surgery on 62 patients. Of those, 18 reported complete or near complete resolution of their chief complaint, he says, while 13 reported "significant improvement" and 31 reported improvement. None reported a worsening of their chief complaint, says Rosner.
Before the surgery, 55 of those patients were taking drugs to treat their symptoms, he says, and 26 of them subsequently reported going off the drugs entirely. Fourteen said they now use prescription drugs occasionally, and 15 said they still use drugs regularly but in lesser amounts.
A huge amount of human suffering
On May 27, however, yet another complaint was filed in connection with an August 2006 operation on a patient complaining of hip, back and neck pain. Rosner diagnosed a too-narrow spinal canal and possible hypoplastic posterior fossa. He's now preparing for a hearing before the medical board next month to answer this complaint.
Meanwhile, Rosner says he's begun videotaping some patients before and after surgery to demonstrate the benefits of the treatment. Because of substantial discrepancies between Rosner's conclusions after examining some patients and the second opinions provided in those cases, Rosner says he wants to document the legitimacy of his findings.
One video, he says, shows a patient going "from drugged-up zombie to productive citizen. We've given the board a number of those -- how they act on it or how it affects their opinion, I don't know."
Rosner also emphasizes that under state law, the medical board "shall not take somebody's license away just because they're different -- and that includes being different at a professional level. That doesn't mean being unprofessional: That means being different at a professional level.
"So if my opinion [is that] this is the best way to handle it, and that's what I do, and the other nine guys out there say, 'No, that's not right,' and I'm getting OK results, then they can't take my license," he asserts.
Blankenship, the medical board's attorney, concurs -- but he also emphasizes that the board is empowered to take action when a physician deviates from the commonly accepted proper treatment.
Another wrinkle is that Rosner is not board-certified in his specialty, having lost that certification when the medical board suspended his license. Although it's not legally required, board certification -- which involves a peer-review process -- is widely regarded as a sign of quality assurance. But Rosner says he can't be recertified until the state board removes the restrictions on his medical license.
Asked why he perseveres despite all this, Rosner pauses a moment. Then he says it's because "there's a huge amount of human suffering here" on the part of people whom he believes he's helping.
In its standard wording of notices of allegations, however, the board had this to say concerning the May complaint:
"By performing in surgery on Patient A as described above, Dr. Rosner engaged in unprofessional conduct, including, but not limited to, departure from, or the failure to conform to, the standards of acceptable and prevailing medical practice, or the ethics of the medical profession" as defined by state law -- which is grounds for the board to take action, such as another license suspension.
To which Rosner has this response: "In medieval times, we burned people at the stake for different ideas. Now we simply strip them of their professional reputation." =