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“A prominent cancer-detecting doctor at Johns Hopkins Hospital is on administrative leave after a misdiagnosis led to a patient’s bladder removal, and as allegations have surfaced that he bullied or intimidated others in his department, according to interviews and an accreditation report obtained by The Washington Post.
The internationally regarded pathologist Jonathan I. Epstein has been accused by other doctors of pressuring them to give second opinions that agree with diagnoses made by his wife, who also is a pathologist, said four people who have knowledge of the situation and spoke on the condition of anonymity to discuss an ongoing probe.”
In some instances, those people said, Epstein himself gave second opinions that agreed with diagnoses made by his wife. And in one such case, a man underwent a radical procedure to remove his bladder, only to have a post-surgery analysis indicate a different diagnosis, according to the interviews and a report by the Joint Commission, a private, nonprofit organization that accredits hospitals. The report directed the Baltimore hospital to address long-standing concerns among physicians and others “regarding a culture of bullying and intimidation in the surgical pathology department,” which it said had left patients vulnerable to improper care.
The hospital put Epstein on leave in May. The Joint Commission’s report, issued in August, did not address his involvement in second opinions on his wife’s work, but those who spoke with The Post said that aspect of the situation played a role in the concerns raised in the report about “intimidation” or “bullying.”
Epstein, the hospital’s director of surgical pathology, said in written comments to The Post that he was “profoundly distressed” by the allegations in the report, “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 said that patient privacy considerations prevent him from discussing the bladder removal case but that, in general, medical cases “have many complicating factors.”
The findings of the confidential report demonstrate how even an institution renowned as a leader in patient safety is not immune to critical missteps in care that have increased nationally and more than tripled among Maryland hospitals in recent years. Holding hospitals accountable for patient safety has long been a complicated task in an industry that relies on self-reporting, with scrutiny often conducted by private accreditation bodies that make few, if any, of their findings public.
Experts say that a rigorous and proactive internal safety culture in which hospital staffers do not fear retaliation for speaking up is essential to ensuring good outcomes. Hopkins doctors and researchers have long pushed for safer medical institutions. A Hopkins-led checklist reduced deaths by 10 percent and virtually eliminated bloodstream infections in Michigan hospitals in the early 2010s. Hopkins also founded in 2017 a Center for Diagnostic Excellence, which aims to eradicate misdiagnoses and the medical harm they cause.
The Joint Commission report, which does not name Epstein, refers to him when it points to “a department leader” as the subject of the complaints, according to the people familiar with the situation. The report says reviewers received “multiple comments by pathology physicians and residents stating they did not feel comfortable speaking up regarding ‘intimidation’ or ‘bullying’ behavior 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.”
Physicians said “they feared retaliation or career repercussions if they spoke up,” according to the report, which was based on interviews with physicians, residents, hospital leaders, chief medical officers and others. The report did not provide specific details about the behavior characterized as bullying.
A spokeswoman for the Joint Commission did not respond to repeated requests for comment.
Hopkins leaders defended the institution’s pathology department in response to questions. “Johns Hopkins’ Pathology Department is nationally renowned, and we remain confident in the best-in-class services they provide,” spokeswoman Liz Vandendriessche said in an email. She said the hospital is working closely with the Joint Commission to address the issues raised in the report. “In fact, several of their citations have already been removed as a result of information we’ve provided,” she said.
The hospital declined to provide its own findings in a root-cause analysis of the incorrect diagnosis noted in the Joint Commission’s report, citing confidentiality laws.
Epstein, 66, who confirmed that he has been on paid administrative leave since late May “pending evaluation of my responses to allegations,” said he was not interviewed by Joint Commission surveyors or given an opportunity to provide his viewpoint for the 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,” Epstein said in written comments. “When in a supervisory role, I have tried to resolve differences and counsel colleagues and subordinates in a constructive and private manner.”
Recognized by urinary pathologists as among the best in the world, Epstein has written numerous papers on the detection of cancer and other diseases from biopsies and other specimens. In 2003, it was Epstein who released a pathology report as then-Sen. John F. Kerry (D-Mass.) vied for the Democratic presidential nomination, saying a microscopic examination of tissues near the candidate’s prostate showed that a cancer there had not spread.
Epstein joined Hopkins’s faculty in 1985 and has developed a bustling consultation practice providing second opinions on pathology reports at the request of patients and other doctors.
Epstein told The Post in an email: “Of the 12,000 cases sent to me for my opinion each year from patients, urologists, and pathologists in the United States and overseas, my one goal has been to give patients the most accurate diagnosis possible.”
People with knowledge of the allegations against Epstein said some of the diagnoses others around him felt pressured to affirm werepathology reports produced by Hillary Epstein, 44, who, according to licensing records, practices at Chesapeake Urology Associates in Beltsville, Md.
She received her medical license in 2013 after completing a genitourinary pathology fellowship at Hopkins the previous year, according to her résumé. Jonathan Epstein trains these fellows each year, according to his biography on Hopkins’s website. A social media post in 2014 shows the couple being married in the mountains of Big Sur, Calif. Another post about the wedding, by a fellow doctor, included what looks like a microscope slide with prostate tissue in the shape of a heart, along with the tags #pathology and #love.
In response to the allegations that he pressured other pathologists to change reports, Epstein said that pathologists who had expertise in other fields, such as breast pathology, would sometimes show him difficult prostate or bladder cases.
“It has always been my impression that this discussion was collegial, professional, and undertaken in the interest of patient care,” Epstein wrote. “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.”
Two of the people familiar with the probe said that after someone internally raised concerns in March, Hopkins ordered Jonathan Epstein to stop reviewing pathology slides from Chesapeake Urology.
All of the people with knowledge of the situation said the bladder removal under scrutiny involved a diagnosis by Hillary Epstein that her husband agreed with in a second opinion.
The patient’s bladder was removed on April 28, the Joint Commission report said. But an analysis of a specimen taken during the procedure indicated a different diagnosis the next month, according to the report.
Asked whether giving second opinions on his wife’s reports was a conflict of interest, Epstein responded that he weighed in on such cases “based solely on my objective evaluation of the case.” He said such cases came to him at the request of Hopkins physicians, because patients had come to Hopkins for care.
“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 specialists in these fields),” Epstein wrote to The Post.
Hillary Epstein did not respond to phone calls or a written request for comment that a reporter handed to her husband. A spokeswoman for Chesapeake Urology, Severa Lynch, declined to comment on the case involving the bladder removal, citing patient privacy, but said Chesapeake is committed to the highest standards of medical care. She said Chesapeake has never exerted any influence over reviews of its pathology reports by Hopkins.
“These cases are forwarded for the sole purpose of obtaining an independent review,” Lynch said 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.”
Whether a doctor should give a second opinion on a spouse’s work is a gray area, said Arthur Caplan, a professor of bioethics at New York University’s Grossman School of Medicine.
The medical profession has long accepted that it is inappropriate for doctors to treat their own family members, he said, but there are few guidelines on working with a spouse who also is a doctor. The American College of Physicians Ethics Manual does not explicitly discuss whether spouses should review each other’s work.
In some cases where one spouse may have a very niche specialty, having a spouse weigh in on a diagnosis or treatment may be the best option for a patient, Caplan said. But the physicians’ relationship should be disclosed to the patient, he added.
Hopkins spokeswoman Vandendriessche would not say whether Epstein’s actions violated the conflict of interest policy for Johns Hopkins University employees, which is posted online. The policy, which focuses on financial conflicts, does not explicitly address spouses giving second opinions on each other’s work. At least one other major hospital system, the Cleveland Clinic, told The Post that it did not have a policy specifically addressing whether spouses should consult on each other’s medical cases. Five other major hospitals did not respond to inquiries about their conflict-of-interest policies.
Epstein has been at the center of controversy before. In 2016, a governing council of the International Society of Urological Pathology censured him over conduct it considered unacceptable after acrimony that followed a dispute over what to name a prostate cancer grading system on which Epstein had done significant research. The society had rejected a proposal to name the system after Epstein, according to several people familiar with the episode who spoke on the condition of anonymity to avoid getting drawn into recent allegations of which they had no knowledge. They said the censured behavior included personal attacks on the society’s officers.
Epstein told The Post that he was censured for being critical of society officers who he and others felt ran its elections undemocratically. He left the society and in 2018 co-founded a competing organization called the Genitourinary Pathology Society.
Last week marked a deadline set in the Joint Commission report for Hopkins to submit evidence of compliance with commission standards, including a requirement that hospital leaders “create and implement a process for managing behaviors that undermine a culture of safety.”
That evidence, like the report itself, is not subject to public disclosure.
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pinched by male docs.
