Court Removes Absurd Barrier To Missed Pap Smear / Cervical Cancer Case

When it comes to medical malpractice lawsuits, the deck is often stacked against patients. That’s a hard concept for many people to accept after years of advertising and lobbying by insurance companies and health systems to mislead the public, but, truth is, studies even by medical professionals have shown that the malpractice system, if anything, is too protective of doctors, and too often lets them off the hook for deadly mistakes.

A malpractice case decided last week by the Court of Appeals of Georgia shows just how difficult these cases can be, and how it can take years, and numerous court rulings against the patient, just to get a case in front of a jury.

Cathleen Lavelle had a pap smear in April 2006, which was then sent along to the Laboratory Corporation of America (“LabCorp”) for review. Patients aren’t told this, but, when pap smear biopsies are sent off for review, they are often not reviewed by a doctor but by a “cytotechnologist” reviewing pathology slides from over 100 patients a day. The cytotec isn’t supposed to do the work of the medical pathologist, they’re just supposed to see if there’s anything at all abnormal about the cells on the slide, and, if so, then send the slide to a pathologist for a real review.

The slides from Cathleen’s Pap smear showed abnormalities, but the cytotec missed them and so her developing cervical cancer went undiagnosed. The whole point of a pap smear, of course, is to catch these abnormalities early on and to treat the abnormality before it becomes cancerous, as more than 90% of these cases can be successfully treated if caught early on. If not caught early, however, it can be deadly. Cathleen’s opportunity was lost and her cancer spread. The cancer was eventually diagnosed, but by that point it was too late, it metastasized, and it took her life.

Her husband brought a malpractice lawsuit against her gynecologist and against LabCorp, alleging that they had failed to timely diagnose her abnormalities and then treat her, thereby preventing the development and spread of her cervical cancer. His lawyers then did what good lawyers do: they asked a Professor of Pathology, Oncology, and Gynecology and Obstetrics at Johns Hopkins with experience in cytotechnology and interpreting pap smear slides and who has been publishing about these issues in peer-reviewed journals for years to review the case, to see if those original slides showed signs of cellular abnormalities, and to give her opinion about whether or not the doctor and lab court were negligent.

The medical professor said that the case was a “blatant miss,” that the cytotech should have noticed the abnormalities on the cells, and that a pathologist would have agreed the abnormalities warranted specific follow-up by any gynecologist or family medicine doctor. The medical professor then also said that, even beyond her own “focused review” on the slide itself, two “blinded reviews” were done, in which a cytotech or pathologist looked at the same slides without knowing where they came from and found cell abnormalities.

Sounds reasonable enough, doesn’t it? What more could possibly be asked of a plaintiff in a malpractice lawsuit than to hire one of the top experts in the country to explain, in detail, what went wrong, what should have happened, and how her outcome would have been different if the right thing had been done?

LabCorp, however, challenged the sufficiency of the expert’s testimony, and – incredibly – convinced the trial court to throw out the case against it, without even a jury trial. In short, the court held that the professor of pathology oncology couldn’t be trusted to do a focused review at all (due to ‘hindsight bias’), and that the blinded reviews were done improperly. The judge, of course, had no medical training, experience, or education, at all, and then they’re just supposed to apply the law, and not think they know the medicine. Nonetheless, the Court felt its interpretation of guidelines provided by the College of American Pathologists and the American Society of Cytopathology was good enough that it could tell a Johns Hopkins professor that her opinion was “unreliable” and that she isn’t even allowed to testify before a jury.

If this sounds, well, crazy, it’s because it is crazy, and yet it happens all the time. Courts are supposed to be mindful of the potential for “junk science” to make its way into the courtroom (as I’ve written before, most of this junk science comes from big corporations or from malpractice insurers trying to avoid paying legitimate claims), but many courts take that “gatekeeper” function way too far, and presume it’s up to them — rather than the experts and a jury — to decide what the science and medicine really show.

Thankfully, last week, the Court of Appeals of Georgia reversed the trial judge’s ruling and sent the case back down, with the expert’s opinion back in evidence. I would say “all’s well that ends well,” but three points need to be made:

First, it has been several years since this lawsuit was filed, and the surviving spouse has still not been given their chance to present their case to a jury, and, even now, it will be at least several months before they get the opportunity to do so, so there’s more than a little bit of “justice delayed, is justice denied.”
Second, in the Georgia Court of Appeals, four judges agreed to reverse the case, but two judges felt the trial court was right! This shouldn’t be a close question.
Third, following up on that last point, this case is just one of many. Throughout the country, everyday malpractice plaintiffs have parts of their cases dismissed, and sometimes the whole case dismissed, because a judge ruled that they knew the science and medicine better than the expert witness asked by the plaintiff to testify in the case.

I hope this ruling is part of a trend, with courts being a little more respective of the role of experts and the jury in our system, but I fear that this is more likely just a successful battle in the middle of a long and difficult war. Congratulations to Frank Ilardi in Atlanta for his hard-won victory, and I wish him and his client the best on their continued pursuit for justice.