In some situations, these individuals mentioned, Epstein himself gave second opinions that agreed with diagnoses made by his spouse. And in a single such case, a person underwent a radical process to take away his bladder, solely to have a post-surgery evaluation point out a unique prognosis, based on the interviews and a report by the Joint Fee, a personal, nonprofit group that accredits hospitals. The report directed the Baltimore hospital to deal with long-standing issues amongst physicians and others “relating to a tradition of bullying and intimidation within the surgical pathology division,” which it mentioned had left sufferers susceptible to improper care.
The hospital put Epstein on go away in Might. The Joint Fee’s report, issued in August, didn’t deal with his involvement in second opinions on his spouse’s work, however those that spoke with The Submit mentioned that side of the scenario performed a job within the issues raised within the report about “intimidation” or “bullying.”
Epstein, the hospital’s director of surgical pathology, mentioned in written feedback to The Submit that he was “profoundly distressed” by the allegations within the report, “as they’re the antithesis of all the things I stand for and have tried to exhibit in my skilled life over these 35 years at Johns Hopkins.” He mentioned that affected person privateness concerns stop him from discussing the bladder removing case however that, generally, medical circumstances “have many complicating components.”
The findings of the confidential report display how even an establishment famend as a chief in affected person security isn’t resistant to important missteps in care which have elevated nationally and greater than tripled amongst Maryland hospitals lately. Holding hospitals accountable for affected person security has lengthy been an advanced process in an business that depends on self-reporting, with scrutiny usually carried out by non-public accreditation our bodies that make few, if any, of their findings public.
Consultants say {that a} rigorous and proactive inside security tradition during which hospital staffers don’t worry retaliation for talking up is crucial to making sure good outcomes. Hopkins docs and researchers have lengthy pushed for safer medical establishments. A Hopkins-led guidelines lowered deaths by 10 % and nearly eradicated bloodstream infections in Michigan hospitals within the early 2010s. Hopkins additionally based in 2017 a Middle for Diagnostic Excellence, which goals to eradicate misdiagnoses and the medical hurt they trigger.
The Joint Fee report, which doesn’t title Epstein, refers to him when it factors to “a division chief” as the topic of the complaints, based on the individuals acquainted with the scenario. The report says reviewers obtained “a number of feedback by pathology physicians and residents stating they didn’t really feel snug talking up relating to ‘intimidation’ or ‘bullying’ conduct by a division chief, indicating that they have been pressured to alter diagnoses, subject addendums and defer to the chief’s needs over a number of years, thereby doubtlessly resulting in hurt to sufferers.”
Physicians mentioned “they feared retaliation or profession repercussions in the event that they spoke up,” based on the report, which was based mostly on interviews with physicians, residents, hospital leaders, chief medical officers and others. The report didn’t present particular particulars concerning the conduct characterised as bullying.
A spokeswoman for the Joint Fee didn’t reply to repeated requests for remark.
Hopkins leaders defended the establishment’s pathology division in response to questions. “Johns Hopkins’ Pathology Division is nationally famend, and we stay assured within the best-in-class providers they supply,” spokeswoman Liz Vandendriessche mentioned in an e-mail. She mentioned the hospital is working intently with the Joint Fee to deal with the problems raised within the report. “In reality, a number of of their citations have already been eliminated on account of info we’ve supplied,” she mentioned.
The hospital declined to offer its personal findings in a root-cause evaluation of the incorrect prognosis famous within the Joint Fee’s report, citing confidentiality legal guidelines.
Epstein, 66, who confirmed that he has been on paid administrative go away since late Might “pending analysis of my responses to allegations,” mentioned he was not interviewed by Joint Fee surveyors or given a chance to offer his viewpoint for the report.
“I’ve all the time complied with skilled tasks, and handled all employees, college students, trainees, sufferers, school and well being care professionals with respect, civility, and equity,” Epstein mentioned in written feedback. “When in a supervisory position, I’ve tried to resolve variations and counsel colleagues and subordinates in a constructive and personal method.”
Acknowledged by urinary pathologists as among the many finest on the earth, Epstein has written quite a few papers on the detection of most cancers and different ailments from biopsies and different specimens. In 2003, it was Epstein who launched a pathology report as then-Sen. John F. Kerry (D-Mass.) vied for the Democratic presidential nomination, saying a microscopic examination of tissues close to the candidate’s prostate confirmed {that a} most cancers there had not unfold.
Epstein joined Hopkins’s school in 1985 and has developed a bustling session follow offering second opinions on pathology experiences on the request of sufferers and different docs.
Epstein instructed The Submit in an e-mail: “Of the 12,000 circumstances despatched to me for my opinion annually from sufferers, urologists, and pathologists in america and abroad, my one purpose has been to offer sufferers probably the most correct prognosis potential.”
Folks with information of the allegations in opposition to Epstein mentioned a few of the diagnoses others round him felt pressured to affirm have been pathology experiences produced by Hillary Epstein, 44, who, based on licensing data, practices at Chesapeake Urology Associates in Beltsville, Md.
She obtained her medical license in 2013 after finishing a genitourinary pathology fellowship at Hopkins the earlier 12 months, based on her résumé. Jonathan Epstein trains these fellows annually, based on his biography on Hopkins’s web site. A social media publish in 2014 exhibits the couple being married within the mountains of Massive Sur, Calif. One other publish concerning the wedding ceremony, by a fellow physician, included what appears to be like like a microscope slide with prostate tissue within the form of a coronary heart, together with the tags #pathology and #love.
In response to the allegations that he pressured different pathologists to alter experiences, Epstein mentioned that pathologists who had experience in different fields, akin to breast pathology, would generally present him troublesome prostate or bladder circumstances.
“It has all the time been my impression that this dialogue was collegial, skilled, and undertaken within the curiosity of affected person care,” Epstein wrote. “I’ve solely requested circumstances to be amended after they have been particularly despatched to me for my opinion by sufferers, clinicians, and pathologists, and initially recognized by another person in my absence. Upon my evaluate, in a minority of circumstances I amended them in order that sufferers would, based mostly on my experience, have probably the most correct prognosis resulting in optimum remedy.”
Two of the individuals acquainted with the probe mentioned that after somebody internally raised issues in March, Hopkins ordered Jonathan Epstein to cease reviewing pathology slides from Chesapeake Urology.
All the individuals with information of the scenario mentioned the bladder removing underneath scrutiny concerned a prognosis by Hillary Epstein that her husband agreed with in a second opinion.
The affected person’s bladder was eliminated on April 28, the Joint Fee report mentioned. However an evaluation of a specimen taken through the process indicated a unique prognosis the subsequent month, based on the report.
Requested whether or not giving second opinions on his spouse’s experiences was a battle of curiosity, Epstein responded that he weighed in on such circumstances “based mostly solely on my goal analysis of the case.” He mentioned such circumstances got here to him on the request of Hopkins physicians, as a result of sufferers had come to Hopkins for care.
“Because the skilled in prostate and bladder pathology, I reviewed circumstances the place there have been disagreements between the [Hopkins] pathologists who didn’t have specialty coaching in prostate and bladder pathology and the [Chesapeake] pathologists (who have been specialists in these fields),” Epstein wrote to The Submit.
Hillary Epstein didn’t reply to telephone calls or a written request for remark {that a} reporter handed to her husband. A spokeswoman for Chesapeake Urology, Severa Lynch, declined to touch upon the case involving the bladder removing, citing affected person privateness, however mentioned Chesapeake is dedicated to the best requirements of medical care. She mentioned Chesapeake has by no means exerted any affect over evaluations of its pathology experiences by Hopkins.
“These circumstances are forwarded for the only objective of acquiring an unbiased evaluate,” Lynch mentioned in an e-mail. “This follow has been integral to our mission of delivering the utmost high quality of care to our sufferers, because it ensures an neutral interpretation of diagnostic slides.”
Whether or not a health care provider ought to give a second opinion on a partner’s work is a grey space, mentioned Arthur Caplan, a professor of bioethics at New York College’s Grossman Faculty of Drugs.
The medical career has lengthy accepted that it’s inappropriate for docs to deal with their very own relations, he mentioned, however there are few pointers on working with a partner who is also a health care provider. The American School of Physicians Ethics Handbook doesn’t explicitly focus on whether or not spouses ought to evaluate one another’s work.
In some circumstances the place one partner might have a really area of interest specialty, having a partner weigh in on a prognosis or therapy could also be the best choice for a affected person, Caplan mentioned. However the physicians’ relationship must be disclosed to the affected person, he added.
Hopkins spokeswoman Vandendriessche wouldn’t say whether or not Epstein’s actions violated the battle of curiosity coverage for Johns Hopkins College staff, which is posted on-line. The coverage, which focuses on monetary conflicts, doesn’t explicitly deal with spouses giving second opinions on one another’s work. No less than one different main hospital system, the Cleveland Clinic, instructed The Submit that it didn’t have a coverage particularly addressing whether or not spouses ought to seek the advice of on one another’s medical circumstances. 5 different main hospitals didn’t reply to inquiries about their conflict-of-interest insurance policies.
Epstein has been on the heart of controversy earlier than. In 2016, a governing council of the Worldwide Society of Urological Pathology censured him over conduct it thought-about unacceptable after acrimony that adopted a dispute over what to call a prostate most cancers grading system on which Epstein had achieved important analysis. The society had rejected a proposal to call the system after Epstein, based on a number of individuals acquainted with the episode who spoke on the situation of anonymity to keep away from getting drawn into latest allegations of which that they had no information. They mentioned the censured conduct included private assaults on the society’s officers.
Epstein instructed The Submit that he was censured for being important of society officers who he and others felt ran its elections undemocratically. He left the society and in 2018 co-founded a competing group referred to as the Genitourinary Pathology Society.
Final week marked a deadline set within the Joint Fee report for Hopkins to submit proof of compliance with fee requirements, together with a requirement that hospital leaders “create and implement a course of for managing behaviors that undermine a tradition of security.”
That proof, just like the report itself, isn’t topic to public disclosure.
Katie Shepherd reported this story whereas taking part within the College of Southern California Annenberg Middle for Well being Journalism’s 2023 Nationwide Fellowship.
