People from all over the world can log on to the Internet and get information about Silver Spring physician Giulio I. Scarzella Sr. The Web site of the 62-year-old urologist attracts patients from as far away as the Middle East, where he travels several times annually to operate in hospitals in Saudi Arabia and Egypt. Recently, Scarzella said, a neighbor in Bethesda newly diagnosed with prostate cancer was doing research "and found my Web site," which contains his resume, information about impotence, cancer and bladder problems, and testimonials from satisfied patients.

But consumers who troll the Web searching for information about doctors would have a much harder time unearthing the less laudatory details of Scarzella's practice.

Scarzella has medical licenses in Maryland and the District, privileges at four Washington area hospitals and an appointment at a local medical school. But since 1986 he has been a defendant in six medical malpractice cases filed in state or federal courts in Maryland. In 1990 the Maryland Board of Physician Quality Assurance disciplined him for "failing to meet appropriate standards of care" and placed him on supervised probation that would eventually total six years. The D.C. Board of Medicine followed suit. In 1992 Scarzella surrendered his West Virginia medical license to end an investigation by officials in that state.

A patient who checks Scarzella's physician profile on the Web site of the Maryland medical board might have trouble learning some of this. Scarzella's profile says only that he has been "sanctioned"; it doesn't say why. Consumers with an Internet connection and the proper up-to-date software could download two disciplinary orders and learn that Scarzella had been placed on supervised probation twice. But a consumer would discover nothing about any malpractice cases. Finding out about them would require trips to the Montgomery County Circuit Court in Rockville and U.S. District Court in Baltimore.

Health plans and hospitals whose officials want to check Scarzella's record would have a much easier time than a consumer, whose search could take days. Those officials can simply query the federal government's National Practitioner Data Bank, a massive computerized repository containing files on more than 133,000 doctors and dentists. Its purpose is to protect patients by creating a permanent paper trail of disciplinary actions and malpractice payments, which presumably would make it harder for physicians to move undetected and with impunity from one state to another.

The four hospitals that have granted privileges to Scarzella--Holy Cross and Washington Adventist in Montgomery County; George Washington University Hospital in downtown Washington, where he is also an assistant clinical professor of urology; and Doctors Community Hospital in Lanham--are required by law to check the data bank before granting a doctor admitting privileges and every two years thereafter.

But patients have no access to the data bank, which contains malpractice payments and disciplinary actions since 1990.

Since its inception, the data bank has been closed to the consumers it is supposed to protect at the insistence of the American Medical Association. AMA officials have repeatedly stated that malpractice payments are not a valid measure of a doctor's abilities, because even good doctors get sued and pay to settle cases. Releasing malpractice and disciplinary information, AMA officials contend, would confuse the public and unfairly taint good doctors.

But critics disagree, saying that secrecy protects bad doctors, not good ones. They say that the current system unfairly requires consumers to become virtual detectives, ferreting out crucial information about doctors, one of the most important choices a consumer makes.

"If we're supposed to be savvy consumers and make good decisions and take responsibility for our health care, then why is the data being kept away from us?" asked Charles Inlander, director of the People's Medical Society, a patient advocacy group based in Allentown, Pa. "If we don't get the information, how can we take the responsibility?"

"We continue to think the public has a right to know what's in the federally funded data bank," said Sidney M. Wolfe, director of the Washington-based Public Citizen Health Research Group.

Several years ago, partly in response to the secrecy of the data bank, Public Citizen began publishing its multivolume directory, Questionable Doctors, which contains disciplinary actions culled from the public files of state medical boards, Medicare and several other sources.

"You Can Get More Information on Your Car"

Questions about consumer access to important information about physicians loom larger as managed care plans proliferate and patients' choices are limited to a fixed panel of doctors, health experts say. They note that these days many patients are handed a list and told to make what could turn out literally to be a life-and-death decision armed with little more information than name, address and specialty.

"You can get more information on your car than about your doctor," said Warren W. Koontz, a urologist who directs the Virginia Board of Medicine. "I think the more information people have, that's good. We get a lot of calls from people saying, 'If only I'd known.' "

"The public is expected to make more and more decisions about health care," agreed Dale M. Austin, an executive vice president of the Federation of State Medical Boards. "There's a lot of data out there, but we haven't put it together in a very usable form."

"If you go onto the Internet," Austin added, "there are over 10,000 Web sites where you can get information on physicians." But much of the information, he noted, is not reputable.

The inability of the public to see what's in the data bank has required state medical boards to "reinvent the wheel," said Barbara Neuman, chief of Administrators in Medicine, the association of state medical board executive directors.

Officials of state boards, said Neuman, who heads the Vermont medical board, have spent months trying to make information about doctors accessible to the public in the form of physician profiles available on the Internet.

"There is a huge public interest in profiles," she added. "The public has been extremely uncomfortable asking their doctors about things like malpractice suits or disciplinary actions."

Scarzella said he thinks profiles of doctors are a good idea, as are profiles of "lawyers and pharmacists and senators."

A consumer checking the Maryland board's Web site would discover that Scarzella's first encounter with the board occurred in 1990, after he had been in practice for more than 20 years. The Maryland board, acting on a complaint by another urologist, reviewed the records of 13 of Scarzella's patients and charged the doctor with incompetence.

In its final order Scarzella was cleared of incompetence; instead the board found that he failed to meet "appropriate standards as determined by appropriate peer review." In one case the board found that Scarzella had failed to obtain a pathology report before operating on a patient he suspected of having bladder cancer.

The board allowed Scarzella to keep practicing but placed him on supervised probation for three years. While he was on probation in 1992, officials investigated a new complaint and found that Scarzella had violated the condition of probation that he practice "in a fully competent and adequate manner" by leaving a surgical device in a patient's urinary tract, where it was discovered nine months later by another doctor. The board then extended Scarzella's probation. His Maryland license was fully restored in 1996.

Scarzella said his problems "are all in the past. I went through all the requirements, and I passed with flying colors."

Lawsuits, Scarzella said, are an occupational hazard for doctors who work with medical devices. In his case, those devices are penile implants, a controversial surgical technique for treating impotence that he has performed 900 times. Last year a Montgomery County jury ordered him to pay $197,700 to a Northern Virginia man who claimed Scarzella botched penile implant surgery and left him with permanent nerve damage. Scarzella said four other malpractice suits against him involved penile implants. Most were settled with a payment, although Scarzella said he doesn't recall the amount of any of the settlements.

"I will challenge you to get 100 patients who get artificial hips and not to find somebody who is unhappy," Scarzella said.

Discipline Remains a Rarity

Consumers should consider disciplinary action by a state board against a doctor to be a red flag. While disciplinary actions taken by state medical boards are public information, they are rare. Last year, according to the Federation of State Medical Boards, there were 3,767 serious actions, such as license revocation, surrender, suspension or probation, taken by states against the nation's total of approximately 700,000 doctors.

Most physicians who are eventually disciplined continue practicing for years while their cases are pending or underway. Some are found to be alcoholics, drug addicts or incompetent; others are sanctioned after being found guilty in court of sexual assault, fraud or other offenses.

The legal system is not much better at identifying problem doctors or compensating their victims. One of the most influential studies of medical malpractice, conducted by Harvard researchers a decade ago, found that acts of negligence are eight to 10 times more common than lawsuits. Of the cases that do result in lawsuits, about half end with a payment to the patient or family.

For consumers, finding out whether a doctor has been sued can be a frustrating and laborious process--or an impossibility.

Although malpractice payments must be reported to the federal data bank, and in most states to the medical board, only a few jurisdictions tell consumers if a doctor has made malpractice payments. And no state tells the public about cases in which a doctor was sued but did not make a payment.

To find out about malpractice cases, consumers must go to the courthouse in every jurisdiction where a physician practiced to see if he or she has been sued. In some places, lawsuits are filed by the name of the person bringing the suit, not by the name of the doctor being sued.

Consumers who manage to ferret out lawsuits will quickly discover that secret settlements--payments made to avoid the exposure and expense of a trial--are commonplace. Sometimes entire case files are sealed. Increasingly, secret settlements include gag orders barring both sides from discussing the case.

Another indicator for consumers is a doctor's standing in the hospital in which he or she practices. But information about disciplinary action taken by hospitals is nearly always secret, although a hospital is required to inform the data bank if it suspends a doctor's privileges for 30 days or longer.

Later this year the federal government will launch another mammoth data bank, the Healthcare Integrity and Protection Data Bank, which Congress created in 1996. The Healthcare data bank is supposed to make it easier for law enforcement officials to track fraud and abuse, which is estimated to cost taxpayers $100 billion annually.

The new data bank will list criminal convictions and civil judgments primarily related to health care fraud and will contain disciplinary actions taken against all health care providers, including health maintenance organizations and other health plans, not just doctors and dentists. It will also be open to a much broader array of groups than the National Practitioner Data Bank, including local police and a plethora of government agencies.

Once again Congress has ordered that this data bank be closed to the public, largely to protect the privacy of physicians.

Opening either data bank would require congressional approval, noted Claude Earl Fox, director of the federal Health Resources and Services Administration, the agency that oversees both data banks. Such a move would certainly face the implacable opposition of the AMA, whose officials repeatedly have condemned both data banks as intrusive and unnecessary.

Fox, a physician, noted that most doctors never wind up in the National Practitioner Data Bank and he expects the same to be true of the new fraud data bank.

What's Online and How to Get It

Although the federal data banks are closed, consumers are turning to other sources for information about their doctors.

"I think ultimately a lot of what's in the data banks will become available," said Dale Austin of the Federation of State Medical Boards. "It's an accountability issue. The public expects it and people will find ways to make it available."

In 1996 Massachusetts became the first state in the country to provide profiles of its 27,000 licensed doctors. [See "Even the Best Source of Information Has Flaws", Page 15] Since then 16 other states, including Maryland, have put information about doctors on the Web. Virginia is expected to launch profiles later this year modeled on the Massachusetts program. The District has no immediate plans to provide them.

"We've been absolutely amazed at how popular profiles are," said Barbara Neuman of the Administrators in Medicine, which launched and maintains the centralized Web site (www.docboard.org). There have been more than 2 million hits on the Web site of the California medical board and more than 250,000 hits have been recorded in Maryland, which went online last year.

While the Web sites are undeniably popular, they vary considerably in ease of access and the extent of information they provide.

The Massachusetts site is the most comprehensive and user-friendly and is one of the few that contains information about malpractice payments. But in most cases, Massachusetts profiles list disciplinary actions with little more than a file number and no indication of why a doctor has been sanctioned.

Consumers who want to know why a doctor was disciplined must leave a message on the voice mail of a board employee who will mail copies of the disciplinary order at a cost of 20 cents per page. Those who want to know the size of a malpractice payment or whether other malpractice suits are pending or closed must search the files at the relevant courthouse.

Maryland profiles are much more abbreviated and deliberately exclude any malpractice information, at the behest of the state medical society.

"Our board is concerned that malpractice data is not helpful for consumers," said Suresh C. Gupta, a physician who is chairman of the Maryland Board of Physician Quality Assurance.

California provides information about disciplinary actions and about malpractice judgments--cases that go to trial and result in a payment. But settlements, which represent the majority of dispositions in cases where a payment is made, are not public information.

Consumers in Florida seeking information about doctors must consult the confusing Web sites of three separate agencies, all of which are responsible for tracking and disciplining doctors.

A consumer who checks the disciplinary history of James Stuart Pollack, a surgeon in St. Petersburg, Fla., will find nothing in the files of the Florida Board of Medicine. That's because the board has never taken any action against him.

But a check of the records maintained by the state's Department of Insurance shows that Pollack settled nine malpractice cases--one for $1 million, another for $1.5 million--for a total of about $4 million for surgeries performed between 1989 and 1991. State records classified seven of those cases as resulting in "permanent, significant injury" to patients.

Pollack said in an interview that all the claims were paid before trial and over his objections by his former insurance company. All the cases, he said, involved a complicated abdominal procedure performed on patients who have had their intestine removed because of serious bowel disease.

Pollack said that some of his patients have seen the Florida Web site data and have asked him about his malpractice history. "I just tell them the truth," he said. Pollack said he still performs the procedure and has not been sued for surgeries performed since 1991.

Moving From State to State

Sometimes the disciplinary process takes so long that by the time a medical board takes final action, a doctor has moved to another state. And unless a patient knows which state the doctor came from, it may be nearly impossible to check his or her history.

In 1994 the Florida Board of Medicine alleged that Palm Beach neurosurgeon Henry A. Saiontz was guilty of "failure to practice medicine with the level of care, skill and treatment" required by law. Records compiled by the Florida Department of Insurance show that between 1982 and 1992 Saiontz paid a total of $2.8 million to settle 14 malpractice cases for amounts ranging from $9,500 to $750,000.

In February 1998, four years after Florida initiated proceedings against him, Saiontz agreed to pay a $10,000 fine and to permanently surrender his license. In a letter to the medical board, his attorney Joseph Harrison cited his 3 1/2-year absence from Florida and "the major expense, logistical difficulties and personal toll upon his family of continued, expensive and protracted litigation in Florida."

In 1995 Saiontz, whose brother Donald is a prominent personal injury attorney, moved back to his native Baltimore and began operating at Maryland General Hospital.

In December 1998, 10 months after he gave up his Florida license, the Maryland Board of Physician Quality Assurance disciplined Saiontz.

In a consent order the board cited Florida's action and placed him on probation for three years. The board also imposed several unusual conditions. It ordered that Saiontz "permanently cease performing surgery and/or providing surgical opinions" and that he agree not to seek membership on any medical staff or privileges in any hospital in Maryland for the remainder of his career.

But there was little chance that a Maryland patient would discover Saiontz's history in Florida since there is no information about disciplinary actions taken by other states on the Maryland board's Web site.

In the past four years, Saiontz has been sued twice for malpractice in Maryland. The first case was resolved after Saiontz was dropped from the lawsuit without making a payment, according to his attorney Catherine Hanrahan.

The second case was filed last February against the hospital, Saiontz and a medical group that employed him. A 39-year-old Glen Burnie woman alleges that she suffered severe, permanent neurological damage as a result of a 1997 disc operation he performed.

The lawsuit also accuses the hospital of negligence in granting privileges to Saiontz. And it alleges that Maryland General "knew or in the exercise of reasonable care should have known of . . . Saiontz's extensive claims history and continued negligent conduct."

Neither Saiontz nor his attorney in the case could be reached for comment. The hospital has denied that it was negligent in granting Saiontz privileges or that Saiontz was unfit or incompetent.

Where to Go for Data on Doctors

You want to check out your doctor, but where's the best place to start?

Many states offer information over the Internet and by telephone and fax. Medical boards in every state will tell consumers whether a doctor has been formally disciplined. But in most states it's not possible to learn whether a doctor has been the subject of complaints or is under investigation. Malpractice information is rarely available from medical boards: For that you must go to the relevant courthouse.

For Maryland physicians the first place to check is the Web site of the Maryland Board of Physician Quality Assurance, www.docboard.org. Sixteen other states provide information about doctors on this site, which is run by the Administrators in Medicine. More states, including Virginia, will be added in the next few months. Information from the Maryland board is also available by calling 410-764-4777 or 1-800-492-6836.

Malpractice claims in Maryland state courts are filed with the Maryland Health Claims Arbitration Office (410-767-8200), but little information is available by phone. Consumers who want to learn about malpractice cases must visit the office in Baltimore or check the files of the appropriate state or federal court. The office does not track cases filed in federal court.

The District does not offer physician profiles. The D.C. medical board maintains a Web site that lists disciplinary actions taken in the past year (www.dchealth.com). The board's phone number is 202-442-9200.

Virginia medical board officials expect to start offering Internet profiles later this year. The board's Web site is www.dhp.state.va.us. It contains consumer information but it is not yet possible to look up an individual physician. Information is also available by calling 804-662-9388.

One of the most comprehensive sources of disciplinary information is Questionable Doctors, the multivolume compendium published by Public Citizen Health Research Group. The volume covering the Washington area costs $20. Many libraries also own the directories that can be obtained by calling 202-588-1000 or 1-800-289-3787.

The Web site of the American Board of Medical Specialties, www.certifieddoctor.org, will tell you whether a doctor is board certified and in which specialty. The same information appears in the Official ABMS Directory of Board Certified Medical Specialists, available in many public libraries.

Even the Best Source of Information Has Flaws

Consumer advocates regard the Massachusetts physician profiles Web site, the nation's first, as the best. The profiles are easy to navigate, require no special software or skill and contain a wealth of information. Although they don't list the dollar amounts of malpractice payments or tell consumers how many times a doctor has been sued, they do characterize payments made in the past 10 years as average, below average or above average depending on the specialty.

There's no doubt that the Massachusetts profiles are widely used. The Web site has recorded more than 1.2 million hits since its inception 18 months ago; nearly 126,000 profiles have been faxed or mailed to consumers since 1996 when the program began. Users naturally assume that the profiles, produced by a state agency, are accurate and up-to-date.

But sometimes they are not.

In early May a consumer checking on Jerry M. Blaine, an internist in the Boston suburb of Burlington, would have found that his profile resembled those of most of the state's 27,000 other physicians. It said that Blaine had not been disciplined and had made no malpractice payments in the previous 10 years.

But on Sept. 18, 1998, a Massachusetts jury returned a verdict totaling nearly $11 million against the doctor in connection with the death of a 45-year-old patient whose breast cancer the jury found he had repeatedly failed to diagnose. Both Andrew C. Meyer, the lawyer who represented the woman's family, and Blaine's attorney David Gould, confirm that the payment was made last year.

So why wasn't the judgment, which was paid more than six months earlier, listed on Blaine's profile? "We wait for insurance companies to send us that information, and it has not been reported yet," spokeswoman Kim Hindin of the Massachusetts Board of Registration in Medicine said May 11.

Not so, according to an official at Blaine's malpractice carrier. He said the payment was reported to the medical board and the National Practitioner Data Bank last January. Two days after a reporter asked about it, Blaine's profile was taken off-line to be "updated." It now says that an "above average" payment was made on Blaine's behalf on Nov. 4, 1998.

A month ago a consumer who checked the profile of Dennis P. Lund, a pediatric surgeon at Boston's Children's Hospital, would find he made an "average" malpractice payment in January 1998. But the next business day the same payment was listed as "above average." According to Meyer, who represented the plaintiffs, Lund's insurance company paid about $8 million to settle a case in which a jury returned a $24 million judgment.

What changed overnight?

Hindin, the board spokeswoman, said that payment classifications are based on state averages and are recalculated daily "so a particular payment may change" categories.

Or take the profile of Marcos U. Ramos, a rehabilitation specialist and former professor at Boston University. Consumers who checked his profile in early February would have found it was clean.

On Feb. 12, Ramos was indicted in Boston on charges that he raped one patient and molested three others. Two weeks later the medical board suspended his license, alleging that he was "a serious threat to the public health, safety and welfare" and asking victimized patients to contact the board.

Ramos, who has pleaded not guilty to criminal charges, was already well-known to the medical board. He had been the subject of 15 complaints by a dozen patients dating back to 1981, board officials said later. The board closed 13 of these complaints without taking action against the physician; two remaining complaints were pending when Ramos was indicted, officials said.

"We missed this one," said Daniel Grabauskas, director of the Massachusetts Department of Consumer Affairs, which oversees the medical board. Grabauskas said that as a result of the Ramos case--and two others in the past two months in which doctors with numerous complaints were not disciplined until after they had been indicted on criminal charges--the medical board has made procedural changes. The board's veteran director resigned in March and the agency has announced it will expedite its investigation of 472 doctors who have been the subject of three or more complaints. The board is also providing more information to consumers about closed complaints such as those against Ramos, which in the past had been kept secret.

Grabauskas said inaccuracies in the profiles, which are compiled from information provided by physicians, insurance companies, state courts, hospitals and the board itself, are rare. Consumers, he said, should regard the profiles, which are put together on an annual budget of $250,000, as a "snapshot" of a physician rather than a comprehensive portrait. He cautioned that consumers should not use them as the sole basis for picking a doctor.

But to critics who monitor the profiles, inaccuracies are commonplace and consumers have no way to knowing this.

"They're worthless," said Meyer, the Boston malpractice lawyer. "I settle 10 cases a week, and I check them all the time and I find that the information is only accurate about 50 percent of the time. The concept is a good one, but the board is understaffed and there's a lack of political will" to discipline doctors or to make sure that profiles are accurate.

Massachusetts consistently ranks near the bottom of states in the number of doctors it disciplines, according to both the Federation of State Medical Boards and the advocacy group Public Citizen Health Research Group. Last year Public Citizen ranked Massachusetts as 47th out of 50 states. Grabauskas said the board disciplined 41 of the state's 27,000 doctors last year, down from 51 in 1996.

The medical board, he said, takes seriously its dual mission of policing doctors and educating the public.

"The profiles are a very good tool that could be made better," Grabauskas said. "I'm not going to sit here and tell you they are 100 percent helpful. Is it better than not having them? You bet."

Surgeon Is Easy to Find, but His Record Is Not

Consumers will find lots of links to the Web sites of Alexandria cosmetic surgeon Stephen X. Giunta. Click on "facial plastic surgery" or "cosmetic surgery" or "rhinoplasty" or "liposuction" or "penis" and a consumer can find Giunta's Web pages. The doctor even has a special site for laser phalloplasty, an operation he pioneered that is supposed to increase penis size.

One Web site features before-and-after photos of a young woman whose nose has been shortened. "The surgical artistry is so complex and instinctive that talent for obtaining the best results borders on the gift of genius," the text states. Another site notes that after "extensive experience in the private practice of face, head and neck plastic and reconstructive surgery, Dr. Giunta has naturally gravitated to the exclusive practice of Aesthetic Surgery. . . . His natural inclination and artistic expression find fulfillment and expression in this creative field."

"People come from all over the world to see me," said Giunta, who added that he is the only doctor in the United States to perform laser phalloplasty, a procedure that involves releasing with a laser the internal ligaments that hold the penis and injecting abdominal fat into the organ. Giunta estimates that he performs 10 such operations each week in his office at a cost of $4,000 to $8,000 each. Like all cosmetic surgery, the procedure is not covered by insurance.

But a patient who wanted to check out other aspects of Giunta's practice would have a considerably harder time finding that information. Much of it is buried in thousands of pages of court records in Alexandria Circuit Court and U.S. Bankruptcy Court in Alexandria, and in the files of the Virginia Board of Medicine in Richmond. Those documents paint a different picture of the 60-year-old Georgetown University medical graduate than the one he advertises on the Internet.

Those documents show that in the past decade Giunta has been named as a defendant in nine malpractice suits, declared personal bankruptcy after a $750,000 jury award, and was placed on probation by the Virginia Board of Medicine after a patient died in his office following a routine nose job.

Giunta declined to discuss most of these matters. "It's taken me 10 years to get past it, and I'm not interested in bringing it up," he said. In his view, "It's usually the good doctors that have the worst problems."

Although he practices plastic surgery--Giunta's clinic is called Aesthetic Plastic Surgery International--he has not completed a residency in that specialty. He is board certified in otolaryngology and was formally trained as an ear, nose and throat doctor. Although there is no legal requirement that doctors limit their practices to the area in which they are board certified, most hospitals and managed care companies do not permit doctors to practice outside their designated specialty, because there is no way to formally evaluate their training or performance. Doctors who perform surgery in their offices are not bound by these restrictions and are largely exempt from regulation or oversight.

Giunta said he performs a wide variety of procedures outside his certified specialty because "I'm a highly skilled individual." He has privileges at Northern Virginia Community Hospital in Arlington and Sibley Hospital in Washington but says he rarely goes to either institution, preferring to operate in his office because it's cheaper and because in his view, "Statistics show that patients do better in a doctor's office."

The late Spyridon Xanthos is one who did not. The 44-year-old Arlington stonemason died in Giunta's office in 1989 of an anesthesia complication an hour after undergoing a routine operation to straighten his nose. On the first day of a civil trial in Alexandria Circuit Court in October 1991, Giunta and his nurse agreed to pay what he called "a nominal amount" to settle a malpractice case brought by Xanthos's estate. Court records show the case was settled for $675,000; Virginia law caps damages in malpractice cases at $1 million.

The Virginia Board of Medicine, which investigated the death, criticized Giunta for failing to use a pulse oximeter, a device regarded as essential in monitoring anesthetized patients. No anesthesiologist or nurse anesthetist was present during the procedure. In its 1994 order the Virginia board also found that Giunta had left the office shortly after performing the operation and that Xanthos died while "in the care of an employee [a nurse] whom [Giunta] failed to appropriately supervise."

In August 1994 the medical board placed Giunta on probation for 15 months, but allowed him to continue practicing. His license was fully restored in October 1995.

In 1993 Giunta's financially troubled malpractice insurer agreed to pay $705,000 to settle a case brought by Helen Jean Secondari, a District woman who was left brain damaged and legally blind after undergoing extensive facial surgery and neck liposuction by Giunta at the now-defunct Jefferson Hospital in Alexandria.

Secondari, who spent 14 days in a coma and an additional six months in a hospital, had an extensively documented history of alcoholism and hepatitis. Before the operation her internist had warned Giunta in a letter that she was a high-risk patient who bore "the stigmata of chronic liver disease and cirrhosis." In court papers Giunta denied all allegations of negligence and said he believed that the internist had cleared Secondari for surgery.

A year after the Secondari settlement, in November 1994, an Alexandria jury awarded $875,000 to Elaine K. Reeder of Arlington after she suffered irreversible damage to facial nerves and other injuries as a result of a "touch-up" of a face lift Giunta performed in his office. That award was subsequently reduced by a judge to $750,000, the amount Reeder's lawyer had requested. In court papers Giunta denied that he was "negligent in any manner" in treating Reeder.

Four months after that verdict, Giunta filed for personal bankruptcy. Several weeks earlier, his insurance carrier had gone bankrupt.

In court papers filed in March 1995 in U.S. Bankruptcy Court in Alexandria, Giunta cited personal assets of $1.2 million, much of it in real estate jointly owned with his wife, and liabilities of more than $6 million.

Giunta's personal bankruptcy, which he declined to discuss, effectively ended three pending malpractice cases against him and jeopardized Reeder's $750,000 award, according to court records and lawyers familiar with the cases.

A personal bankruptcy postpones a malpractice case, often indefinitely. Usually only judgments or settlements reached before the bankruptcy have any chance of recovery, often at greatly reduced amounts, bankruptcy lawyers say.

"Basically we got screwed," said Washington lawyer Sanford Freidman, an attorney for a District woman who sued Giunta claiming he botched her face lift. The case never went to trial. "The bankruptcy basically cut us off at the pass. My client just became one of a number of people standing in line."

After nearly three years of complicated and costly litigation in bankruptcy court, Reeder agreed to settle her case for $260,000, court records show. Jeffrey L. Tarkenton, one of Reeder's bankruptcy attorneys, declined to discuss the case because it was settled with a gag order. But Tarkenton noted that money a doctor earns after declaring bankruptcy is typically beyond the reach of previous creditors. "All your earnings after the date of bankruptcy are yours," he said.

Bankruptcy has not affected Giunta's ability to keep property owned jointly with his wife. Fairfax County tax records show that the couple still own a waterfront house on exclusive Lake Barcroft in Falls Church. The house is assessed at $490,500.

Giunta said he has malpractice insurance, although in Virginia doctors are allowed to practice without it. But he said his policy excludes phalloplasty, which constitutes 50 percent of his practice, "because there is too little information on it" and only about a dozen physicians in the United States perform it. Giunta said he tells phalloplasty patients he is not covered by malpractice insurance, but most decide to have the surgery anyway.

So far, he said, none of his nearly 3,000 phalloplasty patients has had any problems with their operations.

California Profile Reveals Little of Doctor's Past

Stephen Owen Dell once held unrestricted medical licenses in seven states. Now he can only practice in California.

Consumers who want to check on him will never learn this by logging on to the Web site of the Medical Board of California--or that of any other state. Dell's California profile says that he has an active, unrestricted license, that he practices in Oakland, and that he completed probation last year. Consumers who want to learn why Dell was placed on probation must call or write the board in Sacramento.

But what prospective patients won't learn from the California board is that after years of litigation the 54-year-old neurosurgeon no longer has medical licenses in Massachusetts, New Hampshire, New York, New Jersey, Maine or Vermont. Consumers can't find out that his privileges had been restricted or revoked by two hospitals and that in New Hampshire, where he practiced between 1982 and 1989, Dell paid to settle more than eight malpractice cases before trial. Three cases involved the deaths of patients on whom he operated.

In January 1994, when he applied to reactivate the California medical license he had obtained 21 years earlier, the California board notified Dell that it planned to take disciplinary action. The California board's decision was based on a 1992 ruling by the Vermont medical board, which had denied Dell's request to activate his license. Vermont officials refused to allow Dell to practice until his New Hampshire license was fully restored. New Hampshire officials had suspended Dell's license on charges that he had lied about his academic credentials and lied to patients about surgeries he supposedly had performed. After years of court battles, including Dell's unsuccessful appeal to the state Supreme Court, New Hampshire revoked his license in 1995.

But in April 1994, the California board reached a settlement with Dell. He was placed on three years' probation during which he was allowed to practice, as long as he passed an oral exam in neurosurgery.

In a brief interview Dell said he was not currently performing surgery. He declined to discuss his practice or his past. "I don't think I was treated very fairly," he said. "All of this has been gone over 100 times. The more I say about it, the less useful it would be to me." For several years he has been one of three doctors associated with Neuromuscular Consultants of Oakland.

Dell's lengthy disciplinary history and any malpractice payments he has made since 1990 are contained in his file in the National Practitioner Data Bank. But the nation's sole repository of disciplinary and malpractice information is off-limits to the public. Consumers instead would have to find and then plow through tens of thousands of pages of court records and medical board proceedings in half a dozen Northeastern states to glean some of the information in Dell's data bank file.

One of the malpractice cases Dell settled before trial involved Heather Bennett, the 3 1/2-year-old daughter of Mark and Avis Bennett of Dover, N.H. The little girl died in 1984, less than 24 hours after Dell operated on her to replace a shunt that drained fluid from a cyst in her brain. Her mother testified that Dell, who was recommended by the hospital where the surgery was performed, told her he had performed dozens of similar procedures.

Shortly after surgery, Heather began vomiting and complaining of headaches. Dell dismissed the problem as an anesthesia reaction and said she would be fine. At midnight, her condition much worse, the little girl suffered respiratory arrest and inhaled vomit into her lungs, causing aspiration pneumonia. The next day, after suffering numerous seizures, she had a fatal heart attack.

An autopsy determined that the cause of death was a blocked shunt, a correctable complication if detected in time. Avis Bennett said that when she met with Dell after Heather's death, he told her that nurses had never informed him of Heather's problems, which were documented repeatedly in the medical record. A nurse later testified at a deposition that when she suggested to Dell that the shunt might be blocked, he brusquely dismissed her observation, reminding her that he was the doctor.

After the Bennetts sued the hospital and Dell in 1988, they were horrified at what they discovered. They learned that Dell had not replaced a pediatric shunt in years. They found out that Dell had also falsely claimed degrees from Oxford and Princeton universities and membership in Phi Beta Kappa. They discovered that in 1982, before he moved to New Hampshire, Dell had been forced to leave Tufts New England Medical Center in Boston after colleagues questioned his abilities.

The Bennetts, who settled their malpractice case before trial for a sum they agreed not to disclose, launched a crusade. They sent thick packets of information about Dell to Texas and to other states where he was applying for new licenses and to places where he was facing disciplinary action. Several years ago they testified before Congress in support of a change in the law that would open the federal data bank to the public.

Mark Bennett said he sent a packet to the California medical board when he learned from another physician that Dell had moved there in the mid-1990s and was seeking to reactivate his old license.

"We have done everything we can to make sure people know," Mark Bennett said. "I'm very disappointed that the National Practitioner Data Bank is still closed and that people can't check on doctors themselves. My wife and I sort of got very burned out. We decided there's nothing more we can do and we've just tried to get on with our lives."

CAPTION: Stephen Owen Dell in a 1984 photo.

CAPTION: Information about Giulio Scarzella's practice is readily available on the Internet; data about sanctions against him are harder to find.

CAPTION: A screen shot from Stephen X. Giunta's Web site.