The Case Of The Dangerous Dermatologist

ddGerri Poe(*) will never forget the visit she made to her new dermatologist 11 years ago. She had an appointment to have some unsightly moles removed, and while she was waiting, she noticed a boldly headlined poster on the wall: CAN YOU SPOT A KILLER WHEN YOU SEE ONE? It listed the ABCs of the warning signs for
moles that can turn into cancerous melanoma: A for asymmetry, B for irregular borders, and C for varied colors. Poe became worried that some of her moles fit the description. Poe, a petite, fair-skinned woman who was then in her mid-20s, had found the doctor’s listing in the phone book. The ad featured a drawing of the pretty physician, with a promise: “Allyn Beth Landau, M.D., helps her patients to achieve and maintain healthy, natural good looks.” Landau, the ad said, was not only a doctor, but also a “scientific beauty expert.” Poe liked the sound of all that, plus the fact that Landau was on her insurance plan.

But that day in the San Francisco waiting room, Poe began to feel uneasy. The doctor’s office “had a
flamboyantly feminine feel,” she recalls — decorated in vibrant florals, with a bright red couch shaped
like a pair of lips. When Landau, an attractive ash-blond woman, then in her mid-30s, introduced herself to
Poe, she apologized for her appearance, explaining that she’d had a disastrous date the night before with a
guy who turned out to be a jerk. Poe was taken aback. “Doctors just don’t talk that way.” At another point,
Poe saw Landau walking through the officer carrying a little fluffy white dog in her arms.
Landau examined Poe and later made a note on the office chart that her medical assistant (someone who is not
legally allowed to perform surgical procedures without a doctor in the room) should see Poe on subsequent
visits. Poe made three more appointments, but that first day was the only time Landau attended to her.
Then ten moles, scattered on Poe’s left arm, neck, and torso, were removed by the assistant, without event
— until she came to one on Poe’s arm. Unlike the others, this one wasn’t raised, but embedded in the skin.
The assistant injected the mole with anesthesia to make it swell so she could shave it off and send a tissue
sample to a lab. The procedure didn’t go well: “She kept sawing at my arm,” says Poe. “There was a lot of
bleeding, and I began to question what she was doing.” The assistant tried to reassure her, but Poe remained
nervous.

After that experience, Poe decided not to return to Landau’s office. She received a bill from the
pathologist, but never heard from Landau’s office, so she assumed the model had not been cancerous. After
the scab went away, the mole was still there, and it soon returned to its original appearance. (It would
later be revealed that not all the tissue below the surface had been excised.) Poe decided to have the mole
checked again by a different doctor. This time she got a call when the lab report came back: It was a
stage-three melanoma — already quite advanced.

st“I was very frightened and angry,” says Poe, whose great-aunt died of melanoma. “I though I’d done everything I could to prevent skin cancer. But a whole year had gone by, and I had done nothing.” She had to have surgery to remove the cancerous tissue, along with some of her lymph nodes. “I had a big chunk taken out of my arm,” she says. It took a long time for the wound to heal, and she still feels embarrassed when wearing short-sleeve shirts, but Poe survived. Ten years later, she is cancer-free. Stephen Bemis wasn’t so lucky. The shy San Francisco bachelor, whose face was slightly pitted from adolescent acne, saw Landau for collagen injections that can temporarily plump up and improve the appearance of uneven skin. During one of his visits, in February 1986, Landau removed a mole on Bemis’s face and sent out a tissue to be tested. Like Poe, Bemis said he never heard from Landau’s office again, except for a phone call in which an assistant questioned why his check had bounced. He assumed he was fine. When the mole started to grow back, Bemis went to another dermatologist in June, who also failed to diagnose the melanoma. By November, the male was much darker and larger, and Bemis went to a third dermatologist.

This time the diagnosis was clear: stage-four melanoma. Bemis underwent surgery, radiation, and
chemotherapy, by the cancer continued to grow, eating away to his face, and eventually spreading throughout
his body. In June 1987, he filed a malpractice lawsuit against Landau, which was settled in February 1989.
(He also sued and settled with the second dermatologist.) Two months later, Bemis was dead.
No one should ever die from melanoma,” says Michael Franzblau, M.D., a spokesperson for the American Academy
of Dermatology who is a clinical professor of dermatology at the University of California School of Medicine
in San Francisco. “It’s curable disease — if caught early,” he says. Dr. Franzblau and other dermatologists
interviewed say, from their understanding of the case, that Poe was indeed lucky — her melanoma could have
become incurable during the time she went without treatment — and that Bemis’s death was an unnecessary
tragedy.

Physicians, though, are human, and occasionally they fail to make a difficult diagnosis, or don’t follow up
on an ambiguous pathology report. But Landau’s practice had all the warning signs of trouble, according to
the California Medical Board, medical ethicists, and other physicians in the community who knew her. To wit,
Landau was a solo practitioner who had no partners or hospital privileges. She specialized in high-priced
cosmetic procedures and advertised heavily, a practice some physicians say is a hallmark of a doctor more
interested in money than medicine. She practiced dermatology, but was not board-certified. (Doctors are not
required to be board-certified for these procedures, but many consider that an important qualification.) She
had an informal, overly personal office manner, as one former patient put it, “It was somewhere between a
beauty salon and a doctor’s office.” Any good doctor might have one of these characteristics, but together,
“they create the profile of a doctor to look out for,” says Alfredo Terrazas, California’s deputy attorney
general.

The San Francisco District Attorney’s office had been investigating Landau since the late-1980’s. A long
list of complaints had been lodged against her: Patients were offered Valium or white wine in the waiting
room; untrained office staff performed medical procedures; and insurance companies were billed for medical
procedures that were actually expensive cosmetic procedures that patients had been told were “free
demonstrations.” By 1988, the California Medical Board was called in as well, and Terrazas joined the effort
in 1990. Terrazas had extensive negotiations with Landau, asking her to “comport and revamp her practice
into conformity.” but he says she continued to deny any wrongdoing at all. All the while, Landau ran slick
ads in local magazines (some featured retouched photos of her), and lived a lifestyle that some called
lavish — with designer clothes, expensive cars, and high-profile society engagements. She became known
around town as the “Collagen Queen”; her ads boasted that she administered “the most collagen in Northern
California.”

By this time, Poe went to a law firm to look into a malpractice suit against Landau; it turned out by
coincidence, to be the same one Bemis had gone to. “There are good doctors who make tragic mistakes,” says
their lawyer, Paul Melodia, who specializes in medical malpractice. “But [Landau] took a cavalier approach
to the practice of medicine.” When both lawsuits were settled — Poe received $137,000, and Bemis received
an undisclosed sum, which was quite a bit larger — the California Medical Board, as required by law, was
notified.

istrocIn 1993, Terrazas, on behalf of the California Medical Board, filed a complaint against Landau, and the prosecution process dragged on until 1995. Landau appealed various court rulings holding that her license be revoked. (She was allowed to continue practicing during these appeals, which spanned almost two years.) Finally, at a hearing in March 1996, a superior court judge ruled that Landau’s handling of Poe’s and Bemis’s cases was grossly negligent, and he upheld the California Medical Board’s decision to revoke her license. He found that she failed to follow up or notify either patient that pathology reports indicated that there was insufficient tissue to rule out cancer, and that another biopsy, in both cases, was called for. He also said that it was “unconscionable” that Landau had allowed an untrained assistant to perform surgical procedures, and he called her testimony to the contrary “contradictory and confused.”
Landau has appealed the board’s decision, asking that her case be reheard; a decision is expected by the end
of the year. If her license remains revoked, she has the right to reapply in three years, but in the
meantime, she can’t practice, and she will have to prove that she’s been rehabilitated. She can do this by
taking continuing-education classes in her specialty or doing charitable work in a non medical area to prove
that she’s trustworthy and dependable.

Throughout the trial, Landau denied the charges and produced supporters. Paul Hirsch, a Beverly Hills dermal
pathologist who testified on her behalf, said that the lab test results in the case of Bemis gave Landau no
reason to make a diagnosis of melanoma, and that the blame should fall on the lab and on the second doctor,
(Steven Bemis’s attorney did sue the lab, which settled out of court.)

Tony Tanke, Landau’s attorney, argues that while his client did make some mistakes, the penalty she received
was far too harsh. “She has been singled out for extremely unfair and discriminatory treatment,” he says.
“Every other doctor who makes mistakes winds up with thirty days’ suspension and then a monitored,
supervised practice.” Tanke says the medical board went after Landau because other physicians didn’t like
her advertising and flamboyant style. “Dr. Landau was regarded by other dermatologist as somebody who
should’ve been a cosmetologist. The fact that she had an M.D. after her name and was making all that money
on collagen treatments made her the subject of some attention and jealously.”

2 thoughts on “The Case Of The Dangerous Dermatologist

  1. I won’t let anyone touch my skin unless the person is a certified skin professional. Before you get into any skin treatment, make sure you check the background of the person who will perform it to you.

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