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Second lawsuit charges medical report falsification

Friday, December 19, 2003

By Steve Levin, Pittsburgh Post-Gazette

Two separate lawsuits filed this week allege that doctors and administrators with the UPMC Health System and Magee-Womens Hospital falsified hundreds of thousands of Pap smear reports in order to boost profits and prestige while endangering the lives of thousands of women.

Filed by a former Magee pathologist and two Allegheny County women, the suits claim doctors' electronic signatures were used to mislead patients into thinking that their Pap smears were being reviewed by physicians when the doctors had never seen the tests.

If proven true, the gravity of the charges leveled in the lawsuits could have a profound impact on UPMC, the region's largest health system, and Magee, which throughout its 101-year history has prided itself on its clinical care and physicians' services.

Pap smears, which are recommended annually for women, can help in the early detection of gynecologic cancers and precancerous conditions.

A UPMC official yesterday characterized the lawsuits as "unfounded allegations."

"Our laboratories -- I can assure you -- go through all of the periodic testing by regulatory agencies that all hospitals go through," said Irma Goertzen, president and chief executive officer of Magee for the past 14 years.

"One of my greatest concerns is that these unfounded allegations are going to unduly alarm a number of women in our community."

Although both lawsuits -- filed Wednesday and yesterday in Allegheny County Common Pleas Court -- have similar thrusts, they differ in several respects.

One filed Wednesday by Dr. Susan A. Silver of Pittsburgh, who was fired in August 2002 from her job as a Magee pathologist, implicates 19 UPMC and Magee physicians and administrators, and the health system's medical practice, University of Pittsburgh Physicians.

Silver referred all questions to her attorneys.

In addition to the falsified reports, Silver also charges in the 68-page suit that doctors and administrators allowed systemic errors to occur in Magee's pathology department, that cancer patients were subjected to unnecessary tests by doctors with a financial stake in the laboratories performing the tests and that patient confidentiality was repeatedly breached.

Silver's suit also claims that diagnostic slides and medical records were destroyed and that diagnostic errors resulted in a "significant number of misdiagnoses and/or delayed diagnoses of cancer in a myriad of patients."

The suit alleges that although Silver told Magee administrators about the fraudulent reports, they took no action and retaliated against her. The suit claims that Magee administrators advised against contacting patients or their physicians about any Pap smear errors.

Silver says in the suit that she was fired for reporting the alleged abuses. She is seeking damages under the state's whistleblower law.

The second suit, which is seeking class-action status, was filed by breast cancer survivor Christine Walter, 58, of Sewickley, and Sharon King, 41, of West Deer, on behalf of tens of thousands of women whose Pap smear tests were processed by Magee.

It seeks court-ordered notification of women who had Pap smears reviewed by Magee labs at least between 1995 and 2001. The suit also seeks court-ordered testing by an independent third party.

Both Walter and King were retested after their doctors told them about the fraudulent reviews. Yesterday at a press conference, they urged other women to be retested.

"Women's lives are at stake," Walter said.

In addition to UPMC Health Systems and Magee, Dr. Trevor A. Macpherson, chief of pathology at Magee, and Dr. George K. Michalopoulos, chairman of the pathology department at the University of Pittsburgh School of Medicine, were named as defendants in the suit.

Paulina do Amaral, a New York attorney representing Walter and King, said her greatest concern was that negative, or "clean," reports were issued when some of the tests showed clear signs of cell abnormalities.

The suit was filed for all the women "who trusted Magee-Womens Hospital to reliably review their Pap smears before," she said.

"Magee broke that trust."

About 100,000 Pap smear tests are conducted at Magee annually. Nationally, about 55 million are performed. About 6 percent -- 3.5 million -- are abnormal and require follow up.

At Magee and other hospitals, standard Pap smears are conducted by swabbing and scraping cells from the cervix and vagina and placing them in a preservative. After they are dried and treated with methanol/acetic acid, the cells typically are spread on four or five slides.

Cytotechnologists, who are not physicians, screen the Pap smear slides for any abnormal cells. If none is found, the technician signs the test and no further review is required.

If abnormal cells are found, the test is referred to a pathologist for evaluation.

The suits allege that in order to gain a greater share of the Pap smear testing market, the defendants created the impression that all tests would be reviewed not only by a trained technologist but also a physician. Doctors' electronic signatures were placed on tests, even when they had not reviewed them.

The suits claim this would make it appear as if Magee were exceeding the minimum standard of care and that its reports were more reliable, thus increasing its share of the Pap smear market.

The suits allege that the increase in the number of patients and physicians utilizing Magee's services would lead to an increase in costly follow-up surgical procedures. Additional revenues would come from the hospital's switch from conventional Pap smear tests to a procedure known as Thin Prep Pap, which is reimbursed at a higher rate by Medicare and other insurers.

The newer procedure eliminates the clumping of swabbed cells and breaks them down into smaller groups that can be put on a single slide.

"The allegations are totally untrue," said Michalopoulos. "That's the sad part of it.

"We are benchmarked, inspected and quality controlled systematically by multiple national societies and inspecting groups. We always pass with flying colors."

Joseph R. Podraza Jr., a Philadelphia attorney who also is representing Walters and King, estimated that it could take two years for the class-action suit to reach court.

"There is no greater fiduciary duty owed than between a hospital and its patients," he said. "These patients have the right to ask what happened with their tests.

"Each one of these patients now has a right to know that answer."


Steve Levin can be reached at slevin@post-gazette.com or 412-263-1919.

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