The two leaders in a conspiracy to defraud Miami's Kendall Regional Medical Center for about $7 million were Jorge de Cespedes, the No. 2 official at Pharmed, and Sylvia Oramas, who worked in the hospital's housekeeping department, a federal judge has decided. U.S. District Judge Patricia Seitz's decision that the two were "organizers and leaders" could mean she might give them stiffer sentences.