Thirty-five years into a distinguished career as a cancer surgeon, Dr. George Elias was finishing a delicate operation last March when he heard a policeman was looking for him.

Mystified, the doctor later called the police and left a message that he was available. The next day, an officer entered a waiting room brimming with patients and bluntly told Dr. Elias that a 31-year-old woman had accused him of inappropriately touching her pubic area during an exam.

Charged with two misdemeanors -- battery and fourth-degree sexual assault -- Dr. Elias minimized the danger he faced, figuring the case would crumble once he explained that he had done nothing more than examine her groin for signs of cancer.

"At first, we were just disbelieving of it all," said Mary Ellen Elias, his wife of 31 years. "I know my husband didn't do what she said he did. I thought, 'Well, we'll tell what happened, and it will be over.' "

A year later, the Eliases know how wrong they were.

Dr. Elias, chief of cancer surgery at the University of Maryland Medical Center, stands twice convicted of battery and faces a $4.5 million malpractice suit. Last month, he lost his bid for a retrial after arguing that he had been denied a fair trial by an ineffective lawyer, a biased prosecutor and an intimidating judge.

He spent four months in forced exile from his medical practice, having been told by university authorities not to see a single patient. Desperate for his care, several cancer patients hired a lawyer to negotiate his return.

He faced an investigation by the state licensing board, which has the power to revoke or suspend medical licenses for ethical lapses. Even if the board decides to do nothing, which appears likely, the allegations have cast an ugly shadow over a career that once seemed beyond challenge.

He has spent at least $60,000 and vows to appeal his conviction no matter what the cost. Two weeks ago, his lawyer petitioned the Court of Appeals to hear his case, but the court is under no obligation to do so.

Through it all, Dr. Elias has regarded himself as the victim of an accuser who is seeking a malpractice payday and of a court system bent on dictating how doctors should practice their trade.

'I know my business'

"Since when do the courts tell us how to examine our patients and when?" he said in a recent interview. "They're telling me, professor of surgical oncology, how to do my business. I know my business."

His predicament has sent a chill through the medical community, leading some doctors to view the examining room as a legal minefield.

Like Dr. Elias, many physicians are perplexed by the reasoning of District Judge Askew Gatewood, who told the surgeon that he erred -- criminally -- when he felt the woman's groin for suspicious lumps without asking permission.

"I don't think you have done anything wrong in the case except to be so damn good as to be automatic in your examination," he told Dr. Elias. "I think all you have got to do was to simply say, 'I want to touch this groin area. May I?' And had you done that, we wouldn't have had this difficulty."

Should doctors explain their every move, lest patients read sexual intent into procedures done purely for medical reasons? Should a nurse observe at all times, ready to bear witness?

At a time when the public has become outraged over widely publicized incidents of flagrant sexual misconduct, has abuse become so narrowly defined that every practitioner is in peril?

"Sure, we think doctors should explain to patients what they are doing," said Dr. Israel Weiner, a neurosurgeon who heads the state Board of Physician Quality Assurance.

"But in the Elias case, it sounds like part of a routine examination, nothing out of the ordinary. . . . I think the patient misunderstood," he said.

"People in our community are outraged when a doctor is molesting patients," said Dr. Bruce Bolling, a surgeon at St. Agnes Hospital who trained under Dr. Elias. "We want these guys out of medicine. But you cannot place a guy who is examining groin nodes in that category.

"It looks to me like this is a witch hunt. This could happen to anybody."

'A father figure'

Last month, a 51-year-old breast cancer patient took the stand to support Dr. Elias' request for a new trial. Sexually molested as a child, she said she dismissed four oncologists before she found one who didn't frighten her. That was Dr. Elias, and he has been her doctor for five years.

"From the first moment I was in his presence, I just felt comfortable," she said. "He's like a father figure. He's there for a pat on the back. He's there to raise hell if something's wrong. He's just been a real good doctor."

Contacted by telephone, the patient who filed the charges said testimonials won't change her mind about what happened in the examining room.

"I can't say anything bad about Dr. Elias," said the woman, who refused to comment in detail. (The woman's name is not being used because The Sun does not identify people alleging sexual abuse.) "I can't get into people saying he's a great man or that he's wonderful. I don't know. All I know is what happened to me."

Dr. Elias, 60, is a fiercely proud, bulldog of a man who speaks with an Egyptian accent. The son of a criminal lawyer, he was reared in Cairo and earned a medical degree at Cairo University.

Egyptian custom barred him from training in his chosen specialty, obstetrics and gynecology. The field was considered too sensitive for any male doctor who wasn't a Muslim, and he was a Christian. So he immigrated to the United States in 1959, training first at Harlem Hospital in New York and later at Baltimore's Union Memorial.

When his interests turned to cancer surgery, he spent several years in Buffalo, N.Y., training and later practicing in the specialty.

Since 1977, he has held the top clinical and teaching positions in the University of Maryland's program of surgical oncology. He has written two books and 211 articles on cancer. He advises the federal Food and Drug Administration on medical devices, and he is a retired colonel in the U.S. Medical Corps, which awarded him the meritorious service medal.

Melanoma expert

He specializes in the surgical treatment of solid tumors, including those of the breast, colon and skin. He is widely known for his expertise in melanoma, a form of skin cancer that can spread quickly from a single mole to other parts of the body. It is among the deadliest of cancers.

The morning of Jan. 5, 1993, began like many -- with a 2 1/2 -hour tumor conference, a meeting in which oncologists confer on difficult cases. After that, Dr. Elias walked across the street to see 12 patients in his private office.

The first was a 31-year-old social worker with the hospital's AIDS program. He recognized her as someone who occasionally stopped by his office to chat with a secretary.

Bothered by breast pain, she went to Dr. Elias to determine whether her problem was a malignant tumor. Examining her, Dr. Elias concluded that she had a benign condition that didn't warrant a mammogram.

What happened next is a matter of dispute.

The woman said in court testimony that Dr. Elias noticed a cluster of white spots on her upper thigh. They had been there since childhood. Doctors long ago had diagnosed them as vitiligo, a harmless condition in which skin unaccountably loses pigmentation.

'Out of nowhere'

He asked her to lie down, she said, so that he could finish the breast examination and take a closer look at the spots. Then, she said, he startled her by sliding one hand, and then the other, inside her underpants and touching her vagina.

It happened "out of nowhere" and was over in an instant, she said.

When she asked what he was doing, she said, he explained that he was "checking for melanoma because it had been found in places like that." When she asked why he wasn't wearing gloves, she said, he turned around to wash his hands and made a dismissive remark.

Dr. Elias seethes at the woman's account.

He testified that he completed the breast examination and was leaving the room when "she stood up, and showed me the vitiligo on her thigh and said, 'What do you think of this?' "

Dr. Elias said he examined the spots, then felt the groin to determine whether her lymph nodes were swollen. Melanoma is a killer when it invades other parts of the body, and its first stop would be the closest nodes, which in this case were just inches away.

He explained that the disease is 20 times more common among whites than blacks but is particularly lethal when it does strike blacks. Then it tends to show up in lightly pigmented areas such as the palms, soles of the feet and patches of vitiligo. The woman is black.

All of this, he said in court, was outlined in his book "Handbook of Surgical Oncology." His section on melanoma documented the case of a South Baltimore man whose vitiligo had been casually dismissed until melanoma branched off to invade a large section of his buttocks.

But in this case, his female patient was lucky. The spots and both sides of her groin felt normal.

At no time, he said, did he reach inside her underpants. And there was no need for gloves because the exam didn't include any area that could be a conduit for infection.

The woman waited two months to file a criminal complaint, but in the meantime she discussed the matter with a roommate, a minister and the hospital's risk management office. She testified that she delayed going to the police because she was intimidated by Dr. Elias' high position.

'Against the system'

"I felt like I was going up against the system," she said.

A friend later disputed at least one element of her account -- that she never asked Dr. Elias to examine her thigh.

Thelma Perry, who was a secretary in the surgeon's office, said the woman stopped her in the hospital hallway after Dr. Elias' first trial and casually asked whether it was common for a doctor to examine a woman's vagina during a breast exam.

"She said she went to see Dr. Elias and he did a breast examination on her. However, when he finished she asked him to look at a discoloration on her thigh," Ms. Perry said in an affidavit.

"That's when he touched her," she said later in an interview with The Sun. "I suggested maybe he was feeling her groin lymph nodes. She said, 'What's that?' I said, 'It's in that area, and it's common for him to examine to see if there are any lymph nodes down there.' "

Ms. Perry said she initially kept quiet because she didn't want to violate her friend's confidence. But her boss' second conviction so shocked her that she later told the story to bolster his case for a retrial.

'Miraculous things'

"It took me a long time to decide to talk about it," she said. "Dr. Elias, I've seen him do miraculous things. I've seen this man make house calls; I've seen him pick little old ladies up in their homes and drive them to appointments."

To this day, Dr. Elias puzzles over how the state could prosecute on the strength of one person's allegation. There were only two people in the examining room, a patient who says her doctor improperly touched her and the doctor who swears he didn't.

State's Attorney Stuart O. Simms said his office often prosecutes cases that lack witnesses or corroborating evidence: woman charges a man with mugging her; a Lexington Market vendor accuses someone of stealing produce. Such cases become a test of one person's credibility against another's.

"You could argue interminably about this type of situation," Mr. Simms said. "In many instances, it's incumbent on the state to put the matter before the trier of fact. There's a dispute here, a strong difference of agreement between two individuals. Can it be resolved?"

Dr. Elias and his lawyer, Robert P. Mann, decided to try the case before a judge instead of a jury, confident that would ensure the verdict would turn on points of law rather than emotion.

"The burden was on the state to prove its case beyond a reasonable doubt. If there's a reasonable doubt, the conclusion should be not guilty," Mr. Mann said.

The case went to trial in Baltimore District Court in April 1993. Besides Dr. Elias, three members of his staff testified for the defense, bolstering the doctor's contention that the woman didn't complain or appear upset as she left the office.

The prosecution agreed that the doctor's long record was spotless: State licensing authorities had never disciplined him, and the hospital had received no other complaints.

A stunning verdict

Easing into his verdict, Judge Gatewood said he found Dr. Elias and his alleged victim equally credible. He praised the woman's courage and lauded the doctor's professionalism.

Then, he told the stunned surgeon that he had not committed a sexual offense but was guilty of battery -- "an offensive touching." Even there, he was guilty in the least egregious and most technical sense, the judge said.

"It would be an oversight on your part as opposed to anything that is actually intentional," he told Dr. Elias.

He also offered probation before judgment, the chance to have the criminal conviction erased if there is no future offense. Dr. Elias refused.

"Why didn't I accept it? Because I'm not guilty," Dr. Elias said.

Instead, he accepted the conviction and a $100 fine. Determined to clear his name, he exercised his right to retrial in a higher court.

In Circuit Court in November, the only witnesses were Dr. Elias and his accuser.

Evidence barred

Mr. Mann tried in vain to present records showing the woman was what he called "unusual." Several years ago, she married a convict who was serving a life sentence for rape and murder. The man had killed a Prince George's County woman with a hammer and used it to maim her 9-year-old son when the boy tried to save her.

Judge Clifton J. Gordy ruled that background irrelevant.

Later, in an interview, the woman said she didn't care what anyone said about her husband, who is now on parole in a halfway house. "That doesn't bother me. I believe God is a forgiving God. I'm a born-again Christian. I believe people can change."

After a trial that lasted an hour and five minutes, Dr. Elias was found guilty of battery and fined $5,000.

"After the second trial, I said, 'Hell, this is getting scary,' " Dr. Elias said.

A new lawyer

"You're angry, frightened," Mrs. Elias recalled. "That's when I said to my husband we had to get a new lawyer."

About that time, Dr. Elias was barred from his practice and began referring patients to a colleague at Mercy Medical Center. "I didn't see any patients, old or new. It was hell," he said.

His anxiety was heightened by the refusal of some patients to see any other doctor. Several patients hired a Washington lawyer to pressure the university into letting the surgeon practice again. Many had advanced cancer and were grasping desperately for time.

One is Vernon Campbell, a 42-year-old prison guard from Hagerstown who had been fighting a yearlong battle against melanoma.

Several operations had slowed the cancer's progress, but new tumors kept appearing. With little chance for a cure through conventional methods, Dr. Elias included Mr. Campbell in a federally approved trial involving experimental vaccines made from a patient's own tumor cells. The strategy was to coax the immune system into mounting its own killer assault against the cancer.

"Another doctor could not finish up what he had started," Mr. Campbell said.

The patients considered suing the university, but it never came to that. Two months ago, Mr. Campbell called his doctor in distress. He had found a new lump on his side.

Dr. Elias said he knew immediately that the lump was malignant, and he was determined to remove it himself. He decided on the spot to resume his full practice no matter what university officials said.

The university has not protested.

Chaperons

Dr. Elias' appointment book is again stacked with patients, but he says the atmosphere around the office will never be the same. Now, an employee witnesses nearly every exam. The university insisted on that, and Dr. Elias recognizes the value of a chaperon in case there is a copy-cat accuser.

"It's a no-trust situation, and I'm personally damaged. I'm telling you, there is something new: fear. You're concentrating on protecting yourself rather than on medical practice," he said.

In an exam, he said, his mind will be operating like a computer, running down a checklist of everything that must be done to reach the right diagnosis or treatment plan. Then, he said, an inner voice will say: "Now, how about George? What can we do to protect him?"

Earlier this year, Dr. Elias moved to counter the possibility that he could lose his license to practice. With a criminal conviction on his record, it was a foregone conclusion that the state licensing board would consider some form of discipline.

So he made a pre-emptive strike, inviting the state Board of Physician Quality Assurance to send investigators. They could tour his office and gather any evidence they wanted.

"I said, 'Do me a favor: Take the case to the board now and decide it. If you want to take my license, take it now.' "

He has heard nothing from the board, but he said he was satisfied that investigators viewed the case as a misunderstanding. Dr. Weiner, the board chairman, said he could only speak for himself -- the board has not acted on the case -- but that he doesn't believe the surgeon did anything wrong.

"My first reaction was that the judge's decision is a lot like the Antioch College policy on sex -- for every escalation of the physical exam, the judge wants you to ask for permission to touch this or touch that," said Dr. Weiner, a neurosurgeon.

"You can look back and say he should have explained. But it's unreasonable to ask a doctor to explain every aspect of an examination."

Some doctors have begun to question whether they, too, should deploy their staff to chaperon virtually all exams -- a practice that is now commonplace only during rectal and vaginal examinations involving patients of the opposite sex.

"This can happen to anybody," said Dr. Ira Fine, a Baltimore internist. "When I have a female patient who has a cough and I have to listen to her chest, should I have a chaperon with me?"

"I never had a chaperon in the office in my life until George was convicted," said Dr. Bolling, the St. Agnes surgeon. "Now, I have to bring my secretary away from her type writer. I can just tell you, the surgeons in this community are as angry as they can be."

After the second conviction, Dr. Elias turned to Anton Keating, a flamboyant but meticulous lawyer who began assembling a case that the surgeon deserved yet another trial.

When Mr. Keating finished preparing the case for a retrial, his arguments filled eight volumes.

He said prosecutor Videtta Brown had violated rules of evidence expressing her own opinions. He said Judge Gordy had been rude and impatient and had intimidated Mr. Mann. But mainly, he went after the lawyer.

He said his predecessor had failed to build an unassailable case around the surgeon's reputation, which would make an abuse charge seem ludicrous. He offered the judge a list of 211 patients and colleagues who were eager to praise Dr. Elias' character in a new trial.

He said Mr. Mann should have cemented the point that palpating the lymph nodes was essential to ruling out any possibility of a spreading cancer. To help the judge grasp how doctors track melanoma, he said, other surgeons should have testified about how they handle similar cases.

A surgeon testifies

At a 10-hour hearing on Dr. Elias' bid for a retrial, a Baltimore surgeon testified that patients who are worried about cancer implicitly consent to a thorough exam.

"I don't ask, 'Do I have permission to touch the groin?'" said Dr. Carl Ramsey.

Because of the path that cancer follows, a vigilant doctor examines a man's or a woman's pubic area if metastasis is likely, Dr. Ramsey said.

"I can honestly say I'm guilty of touching patients without specifically having permission to touch that particular area," he said.

Mr. Mann had arranged for three surgeons, including Dr. Ramsey, to attend the second trial as witnesses, but none was called. In an interview, the lawyer said he did not call them because the prosecution did not challenge Dr. Elias' actions from a medical standpoint. And there was no need to defend the doctor's character because it had not been attacked.

"There was nothing in the case to indicate he was a bad man or a bad person," Mr. Mann said. Dr. Elias' curriculum vitae was introduced, and it was about an inch thick.

"The problem wasn't with me," Mr. Mann said. "I'm all for Dr. Elias, and I still am. Of course, the problem was with the judge."

Questioning that legal strategy, three lawyers asked by The Sun to review the case said a doctor charged with a sex offense needs character witnesses and expert testimony to defend his conduct.

"One of the things you do is make sure the judge knows in detail the propriety of the examination as described," said Daniel Goldstein, a Baltimore defense lawyer. "Not just from his mouth but from others."

"Putting just the defendant on the stand to talk his way out of a jam is rarely productive," said trial lawyer L. George Parry of Philadelphia.

Judge Gordy gave no explanation when he convicted Dr. Elias in November. Last month, he was equally terse when he rejected Mr. Keating's motion for a retrial.

"What is this here, Kafka? They make it sound like he was sitting back with his feet up, waiting for some woman to come along," Mr. Keating said a few days later.

"I think my husband was treated in a shabby manner -- like some guy who opened up his raincoat," Mrs. Elias said.

"I think my husband was treated with contempt. It made me angry. At the same time, it made me scared. I mean, they believe it."

Whatever the legal outcome, Dr. Elias doubts he will recover emotionally. "When you cut someone, you leave them with a permanent scar," he said. "The injury happened. You're not as close. Not as cheerful. That's a fact."