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Departments Ohio Ohio State's medical industrial complex under fire for unnecessary surgeries Well-respected gynecological pathologist Dr. Gerard Nuovo has provided public records showing that the decision to give women unnecessary surgery on their cervix or endometrium depends upon the diagnosis of an inexperienced pathologist. It has been suggested by the National Organization for Women (NOW) Education and Legal Fund that this is done to maximize profit. Nuovo has been a tenured professor in the College of Medicine at the Department of Pathology in the OSUMC since 1999. Dr. Nuovo has written a textbook on gynecologic pathology and co-wrote a textbook entitled "Human Papillomavirus and the Relationship to Genital Tract Neoplasms." He has published over 260 peer-reviewed articles and has written 37 chapters in various medical books. According to Nuovo and the medical literature, it is common for inexperienced pathologists to misdiagnose or misinterpret Pap smear results or misinterpret the results of cervical and endometrial biopsies. The pathologist becomes the gatekeeper to surgery because of the subjective nature of the Pap smear and cervical biopsy tests. At the crux of the controversy is a condition called dysplasia, also known as precancer, CIN, and SIL, caused by the Human Papillomavirus virus (HPV). Fortunately, a simple and inexpensive objective test, covered by insurance, exists to disclose whether a woman has HPV. Unfortunately for 30% of the patients at the OSUMC, as uncovered by Dr. Nuovo, the medical center failed to administer the objective HPV test resulting in their misdiagnosis. Dr. Nuovo provided a list of real patients, identified only as Jane Does, who were given unnecessary surgeries after misdiagnoses. On July 27, 2008, Nuovo wrote a letter to President Gee stating: "Women are being given the diagnosis of venereal disease when, in point of fact, they do not have one." Nuovo noted the tragic consequences OF these misdiagnoses. Women incorrectly believe that they have a sexually-transmitted disease (STD). Women in relationships falsely accuse their partners of infidelity and marriages suffer. Patients endure the emotional trauma of believing they have a precancerous condition that requires surgery. Amputation of the cervix also increases the risk of miscarriage. Gee Letter [pdf] These preventable misdiagnoses generated a letter to Ohio State President Gordon Gee from the Ohio NOW Education and Legal Fund. "The apparent misdiagnosis results in unnecessary trauma to the woman and her partner, as well as unnecessary surgery, physical pain and trauma," the letter stated. "Although it is clear that unnecessary surgeries provide OSUMC financial rewards, particularly useful in its current expansion campaign, it is unconscionable to make those financial gains on the backs of women through diagnosis, cervical biopsy and amputation," the NOW letter said. The NOW letter to Gee appeared in the December 30, 2010 issue of Columbus' The Other Paper as an ad. NOW Letter [pdf] The letter from the legal division of the NOW Education and Legal Fund pointed out that the OSU Medical Center makes huge profits from the misdiagnoses. A public record document from Sanford Barsky, former Chair of Pathology at OSUMC, indicates that about $1.5 million of the OSU pathology profits end up donated to the Dean's office. Nuovo projects that if the situation at Ohio State was extrapolated to health care nationally, this current practice is a $10-20 billion waste of health care resources. Perhaps this is why the OSUMC is trying to silence Dr. Nuovo. In 2006, Dr. Nuovo challenged the medical center's practices that resulted in the high number of misdiagnoses and surgical mutilations. In an email obtained by the Free Press, Barsky told Dr. Carl Morrison, an attending pathologist at OSUMC at that time, "He [Barsky] described to me how he was going to ruin your career in explicit detail." Morrison put this in a letter dated November 15, 2007. Barsky accused Nuovo of "misconduct" after Nuovo disclosed his findings on the misdiagnoses to the department. Nuovo was then replaced by someone much younger who lacked experience in gynecological surgical pathology. Despite Barsky's accusations, Nuovo remains working on 10 funded medical grants at the university as the academic bureaucracy presses to remove his tenure. Colleagues such as Dr. Deborah Bartholomew, Associate Professor in the Department of Obstetrics and Gynecology, rushed to Dr. Nuovo's defense. "I know quality. I can say without hesitation that Dr. Nuovo is a world class cytopathologist and gynecologic pathologist," she wrote in a letter to Barsky. According to the National Cancer Institute, about 55 million Pap smears are done in the U.S. each year. Approximately 3.5 million are reported to be "abnormal" leading to colposcopy and biopsy. Roughly 2 million women are given the diagnosis of low grade SIL, high grade SIL or ASCUS-H (Atypical Squamous Cells of Undetermined Significance with possible HPV). This is being done without the definitive FDA-approved HPV test. The obvious solution is to administer the HPV test with an estimated $30 out of pocket expense to the patient and $50 cost to the insurance company. The use of lasers and surgeries costs thousands of dollars. The other obvious solution, as indicated in the NOW letter to Dr. Gee, is to have an expert in gynecologic pathology, such as Dr. Gerard Nuovo, review the cervical biopsy/Pap smears before surgery is done. In a written response to a Free Press inquiry in to this situation, David Crawford, Medical Center Public Affairs and Media Relations, called NOW's allegations about OSUMC's financial rewards gained from unnecessary surgeries "wildly inflammatory." Crawford asserted that "within our medical center there are multiple processes and tests utilized to that ensure patients only receive the treatments they medically require. We are very proud of the care provided to OSU Medical Center patients by our highly skilled and dedicated staff of health care professionals." Phyllis Carlson-Riehm, Director of the Ohio NOW Education and Legal Fund, told the Free Press in reference to OSUMC's alleged financial gain from unnecessary surgeries, "Based on information from Nuovo and a current physician working within the system, that's the only conclusion we can come to." Only after the Free Press asked OSUMC for comment did Ohio NOW Education and Legal Fund receive a response from their CEO Steven Gabbe dated December 29, although NOW's letter had been sent November 18, 2010. Gabbe wrote: "As you may or may not be aware, Dr. Nuovo has sued the University, the Medical Center and a number of our most highly respected administrators and physicians, raising a variety of claims including a claim that he had been unlawfully retaliated against for raising concerns referenced in your letter." "Because of the pendency of this litigation, and University rules regarding confidentiality, I regret that I am not at liberty to discuss the issues in that litigation with you in greater detail, but I am sure you can appreciate that allegations by a disgruntled employee may not always be the most reliable source of information. Because it is a matter of public record, however, I can share with you the fact that the vast majority of Dr. Nuovo's claims, including, notably, his ‘whistleblower' claim, have already been dismissed by the Court, and we are confident of prevailing on the remaining claims," Gabbe told Ohio NOW. In September 2009, Nuovo filed a formal complaint with the Ohio State Medical Board saying there have been "hundreds of women in the past several years who have been told they have this disease called human papillomavirus, when in fact they do not have the disease." Dr. Nuovo provided this by using the objective HPV test. A woman cannot have cervical dysplasia if the virus is not present. Filed Third Amended Complaint [pdf] Filed Motion to Amend Complaint [pdf] OSU said at the time it stood by its diagnoses. It has not issued a formal response to Nuovo's lawsuit. But after Nuovo's original charges, it demoted him, revoked his laboratory privileges, cut his pay by 60% and took away his credentials, which have since been restored, though he is still not allowed to review the biopsies of female patients at OSUMC. Nuovo says an official 2008 investigation exonerated him of all charges. Nuovo wants compensation for back pay and other economic losses, as well as restoration of his laboratory privileges. Most importantly, he also wants something done about the unnecessary surgeries. "He's concerned about all these women who were misdiagnosed," says his attorney, William Patmon. -- Originally published by http://freepress.org. |
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