In Depth

Bitter medicine at Bascom Palmer: Rift between star doctors metastasizes into federal probe

A banner atop the Bascom Palmer Eye Institute reads “Ranked No. 1 in the USA,” based on U.S. News and World Report’s ranking of its ophthalmology services.
A banner atop the Bascom Palmer Eye Institute reads “Ranked No. 1 in the USA,” based on U.S. News and World Report’s ranking of its ophthalmology services. MIAMI HERALD STAFF

The stellar résumés of two physicians at the University of Miami’s Bascom Palmer Eye Institute wouldn’t suggest material for a prime-time medical drama.

Retinal specialist Philip Rosenfeld pioneered the use of a cancer drug to treat a disease that causes blindness. Timothy Murray, a gifted surgeon, draws cancer patients from afar hoping to save their eyesight and lives.

But behind the scenes at UM’s most-prestigious medical facility — a banner atop the building boasts its No. 1 national ranking — an increasingly bitter feud has divided two of its biggest stars. There have been repeated clashes over Murray’s bigger $1 million-plus paycheck, over patient care, medical procedures — even which brand of equipment to buy.

At one point, their relationship turned so strained that Bascom Palmer hired a “personality coach” — a psychologist specializing in academic intervention — in an attempt to ease tensions.

“Every day, it seemed like there was some fire being lit between these two doctors,” said the eye institute’s chairman, Dr. Eduardo Alfonso, who worried that their hostility would undermine the morale of the faculty of 50 physicians and 30 researchers.

“The animosity is still there,” he said.

Federal probe

The rift, well known among staff and administrators but never previously made public, has only grown more serious since Murray left Bascom two years ago to set up a private practice in Coral Gables. After his departure, Rosenfeld reviewed the files and examined dozens of Murray’s former patients, then went to federal authorities with claims that his rival — along with Bascom Palmer, his longtime employer — had bilked the federal government’s popular Medicare program.

Since last year, federal authorities have been investigating allegations that Murray performed unneeded eye treatments and surgeries intended to rack up expensive billings to the taxpayer-funded Medicare program.

A federal search warrant has been issued to collect files for dozens of elderly patients treated by Murray, as well as related computer records from the highly rated teaching hospital, which is also under investigation for its oversight of Murray and Medicare compliance laws. Federal grand jury subpoenas have been issued to turn over additional records and to compel Bascom Palmer doctors to testify. Several Bascom physicians have testified as witnesses, most recently in September and October.

The investigation by the U.S. attorney’s Miami office could — at least potentially — carry Medicare fraud charges, according to multiple sources familiar with the probe, which began last year.

But lawyers for Bascom Palmer and Murray argue that the allegations amount to no more than a “high-end medicine dispute” inflamed by friction between two forceful personalities. Rosenfeld repeatedly raised questions about Murray’s procedures and a range of other matters, the lawyers said.

Their defense against the allegations is extremely unusual. Private hospitals rarely, if ever, publicly discuss internal disputes, and the chief accuser remains a Bascom Palmer employee. But after the Miami Herald obtained the federal search warrant, Bascom’s chairman and attorneys for UM and Murray agreed to discuss the rivalry between the eminent physicians, recognizing the valuable reputations at stake.

Murray’s defense attorney, Jeff Marcus, a former federal prosecutor who handled Medicare fraud cases, contends that Rosenfeld instigated the criminal complaint to discredit Murray. Marcus called the allegations false and defended his client as a pioneering physician who ranks among the world’s most-respected eye surgeons, especially for treatment of a rare cancer, retinoblastoma, that afflicts children.

“Sadly, Dr. Murray now finds himself in the position of having to defend his integrity and clinical acumen because of a petty smear campaign orchestrated by an obsessive and jealous former colleague, Dr. Phil Rosenfeld, who himself was trained by Dr. Murray,” Marcus said in a statement.

Marcus said Rosenfeld “created such a toxic work atmosphere” that Murray, who declined to comment for this story, had no choice but to leave.

There were no physical confrontations. But there was steady sniping behind the scenes, colleagues say, and so much friction that the two doctors refused to attend the same faculty meetings.

Bad to worse

Marcus said their relationship went from bad to worse in 2008, citing emails that Rosenfeld wrote to higher-ups.

“Tim is not a team player,” Rosenfeld wrote that August to a senior Bascom doctor, as he offered his opinion on the selection of the hospital’s next chairman. Rosenfeld voiced his opposition to Murray for the post and went on to complain about how he tried to force the purchase of new imaging equipment on the faculty. “This episode exemplified his totalitarian style,” Rosenfeld wrote.

University of Miami lawyer Dan Gelber defended Bascom Palmer’s oversight of Murray, saying the hospital had conducted reviews of Rosenfeld’s concerns. Gelber said the internal reviews, which involved both Bascom faculty and outside experts, did not support his allegations.

“At times it was difficult to separate Dr. Rosenfeld’s concerns from his personal dislike of Dr. Murray,” Gelber said.

The university treated Rosenfeld’s concerns “seriously, even if they were sometimes trivial” and “is cooperating fully with the government’s review,” Gelber said.

Dr. Alfonso, the Bascom chairman, agreed: “We investigated all of them. Never did we turn our back to any allegations that were made.”

Both Gelber and Marcus argued that Rosenfeld potentially stood to gain financially from the federal probe through a possible “whistle-blower” lawsuit against Bascom Palmer — and at the same time stain the reputation of his rival.

Two Miami attorneys representing Rosenfeld, Ryan Stumphauzer and Kevin Jacobs, declined requests to comment over several weeks. Rosenfeld also declined to comment.

The U.S. attorney’s office also declined to comment, or even confirm or deny the existence of the investigation. Neither the FBI nor Health and Human Services’ Office of Inspector General wanted to comment, as well.

Still, the allegations are significant enough to have cleared a key legal hurdle: A Miami magistrate judge, reviewing an affidavit filed by federal agents in June of last year, found enough probable cause to issue a search warrant for Bascom Palmer’s faculty offices containing files of some of Murray’s former patients, along with related hospital computer records.

South Florida is notoriously known as the nation’s capital of Medicare fraud, but the vast majority of cases have involved crooked clinic operators, home healthcare agencies and medical equipment distributors.

The targets of this investigation have long been considered paragons of the medical profession — and not just in South Florida. Bascom Palmer, a branch of UM’s Miller School of Medicine, has been ranked No. 1 nationally for ophthalmology services by U.S. News and World Report for 11 straight years — an achievement advertised atop its building at 900 NW 17th St., in Miami.

Top doctors

Before his departure after a 21-year career, Murray was undeniably one of Bascom Palmer’s brightest stars.

A 1985 graduate of the Johns Hopkins University School of Medicine, he joined Bascom Palmer in 1991 and became a tenured professor who published about 300 peer-reviewed articles. A colleague who has known Murray for 25 years said he has an uncommon range of expertise and surgical skills, particularly in dealing with rare eye cancers in both adults and children.

“He gets the toughest of the toughest cases,” said Dr. Culver Boldt, a University of Iowa professor and vitreoretinal surgeon, who did a fellowship with Murray in 1990-91. “There are many children and many adults who owe their lives to Dr. Murray.”

At Bascom Palmer, Murray was known as a prolific surgeon who generated a huge stream of Medicare payments for the eye institute. As a result, he ranked among UM’s most highly paid employees, earning $1.1 million in 2011, according to a university tax return. That total did not include other sources of potential outside income.

Murray’s income was almost as much as the private university paid its longtime president, Donna Shalala, the return shows. Only a few other top UM doctors, including medical school dean Pascal Goldschmidt, were paid more by the university that year.

Rosenfeld, in a 2011 email to a senior Bascom physician, complained about Murray’s pay of $1.2 million in 2008 and 2009, citing UM’s tax returns for those years. Rosenfeld wrote that “my total compensation package is not 75 percent of Tim’s package,” according to the email. “I thought we had resolved these differences with the new system.”

Like Murray, Rosenfeld is also a graduate of Johns Hopkins School of Medicine. He came to Bascom Palmer after landing a coveted fellowship in 1995. A highly regarded authority in the retinal field, Rosenfeld joined the faculty the following year.

A decade later, Rosenfeld pioneered the use of a low-cost cancer drug, Avastin, to treat wet macular degeneration, a retinal disease that causes blindness. He has testified before Congress about the drug’s potential savings to Medicare and has been quoted in numerous articles, including a Miami Herald profile.

Clash of egos, style

Alfonso, Bascom’s chairman, and Gelber, UM’s attorney, acknowledged that the clash of egos and styles between the two physicians was widely known within the teaching hospital. Murray’s varied skills — retinal, cancer and surgical specialties — also sometimes intruded into the fields of fellow Bascom doctors.

The result was a faculty divided to varying degrees, with some in the Murray camp and others aligned with Rosenfeld.

In November 2011, when Murray was on the verge of leaving the teaching hospital, more than 20 of his former fellows sent a letter of support to Goldschmidt, the dean of UM’s medical school, calling him one of Bascom’s “consummate mentors.”

“Dr. Murray has provided a level of patient care that we all strive to espouse,” they wrote. “Therefore, to be made aware of his unwilling departure from Bascom Palmer is disappointing.”

Despite the former fellows saying his departure was “unwilling,” Murray’s attorney, Marcus, said he was not pushed out by the hospital administration or university when he left his lucrative tenured post in early 2012.

Marcus and UM’s attorney, Gelber, would not provide details of Murray’s confidential resignation agreement. But Marcus insisted that he left on his own accord and was given a retirement package with “favorable terms.”

UM’s vice provost of faculty affairs, Dr. David Birnbach, who negotiated the tenured professor’s agreement to leave Bascom, declined to comment.

Some Bascom colleagues said Murray recognized he could no longer work in the same place as Rosenfeld. Alfonso, the chairman, said that after Murray left, “we hoped to find peace in the department.”

Murray’s departure, however, did not end Rosenfeld’s probing.

Last year, after examining 36 of Murray’s former patients who remained at Bascom Palmer, Rosenfeld questioned whether Murray may have performed costly, and potentially harmful, procedures patients did not benefit from or need. Because all of the patients were elderly, the procedures were billed through Bascom to Medicare.

The dollar amount in question isn’t clear, but typically, oncologists and ophthalmologists generate some of the highest Medicare bills because they use expensive drugs for chemotherapy, injections and other procedures.

Rosenfeld brought his concerns to federal authorities, multiple sources with knowledge of the investigation said. And his evaluations of those patients became the foundation of the federal search warrant, which was obtained by the Miami Herald.

Search warrant

The search was carried out on June 25, 2013, two weeks after Miami federal magistrate judge Alicia Otazo-Reyes found probable cause of a crime based on an affidavit.

Agents with the FBI and Health and Human Services’ Office of Inspector General seized the medical files of the 36 former Murray patients examined by Rosenfeld. They also demanded Medicare claims, payments and other records, such as operating notes. The patient records, identified by name, date of birth and volume on the search warrant, were broken down into two categories: injections and surgeries.

With the assistance of medical experts, who are helping evaluate whether any of Murray’s patients were subjected to improper or excessive procedures, federal prosecutors and agents are painstakingly working through the complex medical records and presenting evidence to the grand jury in Miami.

According to sources familiar with the investigation, some of Rosenfeld’s fellow doctors at Bascom Palmer have sided with him in their grand jury testimony. Prosecutors, however, have not called Murray supporters as witnesses, those sources said.

There is no suggestion of a pattern of overbilling among doctors at Bascom, but the hospital is also facing allegations of failing to comply with the strict provisions of the Medicare program — including claims it recklessly disregarded patient care while monitoring Murray between 2008 and 2012. According to Bascom, the hospital’s administrative staff submitted Murray’s Medicare charges and collected the payments for the eye institute.

It’s the second Medicare billing probe UM has dealt with in the last few years. In 2013, the University of Miami Hospital was told it would have to refund $3.7 million to Medicare after a federal audit of the hospital’s billing practices found it overbilled in 2009 and 2010, according to a report by the U.S. Department of Health and Human Services’ Office of Inspector General.

Beyond bureaucratic dispute

The current case, however, and its specter of a potential criminal charge, could be more significant than settling a bureaucratic dispute over billing inaccuracies.

Throughout his medical career in South Florida, Murray has been sued only once for medical “negligence,” according to public records — and that came after he left Bascom Palmer.

In a lawsuit filed in June, a longtime Bascom patient accused the ophthalmologist of causing blindness in her left eye after performing “unnecessary” laser removal of a tiny tumor along with cataract surgery.

Murray started seeing the patient, Joyce Sisca, at Bascom in 2003, according to the lawsuit, filed in Miami-Dade Circuit Court. Murray monitored the potentially cancerous nevus tumor for a decade, according to the suit. But in August 2012, after he had left Bascom, he changed his diagnosis when Sisca visited him at his new office — despite “acceptable” and “adequate” vision in her left eye, the suit stated.

Murray then removed the nevus and did cataract surgery on the patient’s left eye at Larkin Community Hospital. But according to the suit, he lasered the “wrong location,” which caused damage that was later determined to be a retinal detachment, according to Sisca’s attorneyss, Robert Kelley and Bonnie Navin.

They said Murray’s total charges came to more than $11,500, which were billed to Medicare. He “recommended and performed unnecessary surgery for the sole purpose to place financial gain over patient safety,” according to the suit.

Murray’s attorney, Marcus, said the civil case represents one patient among thousands treated by his client over a 25-year career. Marcus said his legal team retained outside medical experts to review Sisca’s records, and they found her treatment “was at all times appropriate, medically indicated and within the standard of care.”

Miami Herald staff writer Daniel Chang contributed to this article.

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