A leading pathologist at major US hospital has been placed on leave after an alleged misdiagnosis led to a patient’s bladder being removed — as well as claims he bullied staff, according to a report.
Dr Jonathan Epstein, 66, was accused of pressuring other doctors at Johns Hopkins Hospital, in Baltimore, to give second opinions that matched diagnoses made by his wife, Dr Hillary Epstein, a fellow pathologist, the Washington Post reported.
The news outlet cited a hospital accreditation report by the non-profit Joint Commission and four people with knowledge of the situation who spoke on condition of anonymity
Dr Epstein, the hospital’s director of surgical pathology, gave second opinions that agreed with those made by his wife, who works at Chesapeake Urology Associates in Beltsville, Maryland, according to the paper.
In one instance, a patient underwent the removal of his bladder — only to have a post-op analysis show a different diagnosis, according to the Washington Post, which cited the sources and the accreditation report.
The Joint Commission ordered Johns Hopkins to address concerns among staff “regarding a culture of bullying and intimidation in the surgical pathology department,” which it said exposed patients to improper care, reported the New York Post.
Dr Epstein was placed on administrative leave in May, according to the newspaper.
The commission’s report — which was released in August — did not address Dr Epstein’s involvement in second opinions on his wife’s work, but sources told the Washington Post that it played a role in the allegations of “intimidation” or “bullying”.
Dr Epstein wrote the paper that he was “profoundly distressed” by the allegations, “as they are the antithesis of everything I stand for and have tried to exhibit in my professional life over these 35 years at Johns Hopkins”.
He declined to address the bladder removal case due to patient privacy considerations but said that, in general, medical cases “have many complicating factors”.
Dr Epstein also denied that there was any conflict of interest by giving second opinions on reports made by his wife, saying he weighed in on such cases “based solely on my objective evaluation of the case”.
“As the expert in prostate and bladder pathology, I reviewed cases where there were disagreements between the [Hopkins] pathologists who did not have specialty training in prostate and bladder pathology and the [Chesapeake] pathologists (who were experts in the field),” he told the outlet in a written statement.
Hillary Epstein did not respond to requests for comment by the Washington Post.
Severe Lynch, a spokeswoman for Chesapeake Urology, declined to comment on the bladder removal case, also citing patient privacy, but said the practice is committed to the highest standards of care.
The spokeswoman added that Chesapeake had never exerted any influence over reviews of its pathology reports by the hospital.
“These cases are forwarded for the sole purpose of obtaining an independent review,” Ms Lynch told the paper in an email.
“This practice has been integral to our mission of delivering the utmost quality of care to our patients, as it ensures an impartial interpretation of diagnostic slides.”
A Hopkins spokeswoman defended the hospital.
“Johns Hopkins’ pathology department is nationally renowned, and we remain confident in the best-in-class services they provide,” Liz Vandendriessche told the outlet in an email, adding that the hospital is working closely with the Joint Commission to address the issues cited in the report.
“In fact, several of their citations have already been removed as a result of information we’ve provided,” she added.
A spokesman for the Joint Commission did not respond to the paper’s requests for comment.
Though it did not refer to Dr Epstein by name, the Joint Commission report said several complaints had been made by other doctors against the “department leader,” according to the Washington Post.
Investigators received “multiple comments by pathology physicians and residents stating they did not feel comfortable speaking up regarding ‘intimidation’ or ‘bullying’ behaviour by a department leader, indicating that they were forced to change diagnoses, issue addendums and defer to the leader’s wishes over several years, thereby potentially leading to harm to patients”.
Doctors said “they feared retaliation or career repercussions if they spoke up,” according to the report, which did not provide specific details about the behaviour described as bullying.
Dr Epstein claimed that when he worked with other pathologists, they would show him difficult cases.
“It has always been my impression that this discussion was collegial, professional and undertaken in the interest of patient care,” he told the paper.
“I have only requested cases to be amended when they were specifically sent to me for my opinion by patients, clinicians, and pathologists, and initially diagnosed by someone else in my absence. Upon my review, in a minority of cases I amended them so that patients would, based on my expertise, have the most accurate diagnosis leading to optimal therapy,” he added.
In response to allegations that he pressured other pathologists to change reports, Dr Epstein said those with expertise in other fields, such as breast pathology, would sometimes show him difficult prostate or bladder cases.
Dr Epstein confirmed that he has been on paid administrative leave “pending evaluation of my responses to allegations,” but said he was not interviewed by the Joint Commission or given an opportunity to comment for its report.
“I have always complied with professional responsibilities, and treated all staff, students, trainees, patients, faculty, and health care professionals with respect, civility, and fairness,” Dr Epstein wrote the paper.
“When in a supervisory role, I have tried to resolve differences and counsel colleagues and subordinates in a constructive and private manner.”
Dr Epstein, who joined Johns Hopkins in 1985, has written multiple papers on the detection of cancer and other diseases.
In 2003, he was the pathologist who released a report on then Senator John Kerry, who was vying for the Democratic presidential nomination, according to the outlet.
He said a microscopic examination of tissues near Mr Kerry’s prostate showed that a cancer there had not spread.
Johns Hopkins has ranked in the top five of the best hospitals in the US for the last 33 years, according to rankings by media group US News & World Report.
This story appeared in the New York Post and is reproduced with permission.