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Uropathologist Jonathan Epstein renders 'second opinion' on allegations: He'll be cleared
Colleagues protest 'smear campaign' and 'hatchet job'
By Howard Wolinsky
Renowned genitourinary (GU) pathologist Jonathan Epstein, MD, has come back swinging against charges published by the Washington Post one week ago of missing a diagnosis and of fostering a “culture” of bullying and intimidation in his practice at Johns Hopkins.
The Post reported on an investigation of Epstein by the Joint Commission, the body that accredits medical facilities, claiming Epstein was linked with a diagnostic mistake that led to the removal of a healthy bladder and also having pressured his staff to match second-opinion diagnoses made by Epstein’s wife Hillary Epstein, a GU pathologist at Chesapeake Urology, Beltsville, Maryland.
In an email to his trainees obtained by TheActiveSurveillor.com, Epstein, who has been on administrative leave as reported here in May, denies all charges brought against him and predicts he, in the end, will be cleared.
Epstein noted: “First and foremost, Johns Hopkins Hospital and the University are engaged in a thorough review of the situation and neither has made a final evaluation.”
He said: “For obvious reasons, this situation is of great concern to me and my family, and I look forward to its successful conclusion. In the meantime, I have been heartened by the outpouring of support from my pathologist friends and colleagues from all over the world in response to what they have termed a ‘hatchet job’ or a ‘smear campaign.’”
Epstein stated: “What is currently under review is allegations made by a colleague(s) who claim that I coerced them into modifying diagnoses. This could not be further from the truth.”
He said the “actual events” resulted from two types of situations where he asked for diagnoses to be modified:
—”The first situation stems from cases that were specifically sent to me for my opinion by patients, clinicians, and pathologists. When I was out of the office, these cases were initially diagnosed by another JHU GU pathologist (all former GU fellows trained by me), who I was grateful for covering my service.”
“When I returned to the office, there were a handful of cases that I was asked to re-review at the specific request of the patient or contributing physician. Upon my re-review, I asked for isolated cases to be amended so that patients would, based on my expertise, have my best accurate diagnosis.
—”The second scenario was when a JHU pathologist without subspecialty training in GU Pathology showed me difficult, confirming GU cases coming to JHU for treatment, where they disagreed with the diagnosis rendered by an outside GU pathologist. In some of these cases, I agreed with the outside GU pathologist and asked that the JHU generalist pathologist render their diagnosis accordingly.”
He stressed that “claims that my diagnoses would be influenced by the referring or the outside GU pathologist contradict the high work ethics of my practice.”
The referring and outside genitourinary pathologist apparently was, according to the Post, Dr. Hillary Ross Epstein, his wife and former trainee.
Dr. Epstein is famous for sharing uropathology results with patients. I can tell you—as author of a book on the future of the field for the College of American Pathologists—that direct patient contact isn’t common among pathologists. Often, they consider themselves “doctors’ doctors” rather than “patients’ doctors.”
Epstein broke the mold on that score.
I’d like to invite Dr. Epstein to write an open letter to his patients for TheActiveSurveillor.com. I know his patients would appreciate an explanation and reassurance aimed at them. He has played a major role in determining our fate with prostate cancer—whether to be treated or whether to safely go on Active Surveillance.
[Note: I had a second opinion from Dr. Epstein when I was diagnosed in 2010. He has been generous in giving back to the prostate cancer community and sharing his knowledge in patient-oriented webinars and Q&As.]
Still, his note to his trainees takes us patients into account.
Epstein wrote: “Suffice it to say, the care of patients is paramount to what we as pathologists do, and providing patients with the correct diagnosis cannot be overstated. Therefore, when asked for a second opinion of a colleague's assessment, I was, and am always, solely focused on providing the correct diagnosis, as opposed to agreeing with a colleague simply to preserve their personal feelings.”
I was pleased to hear that some Hopkins urologists are offering to order re-reviews of Epstein’s pathology reports should patients want them. It’s the right thing to do. The hospital should do this even if patients decide to go elsewhere for second opinions.
One Hopkins urologist told me: “I feel the sting of this situation almost as much as my patients do. I had so much trust in Dr Epstein’s reads. But I agree with your commentators [He was referring to an earlier column]- the team [Epstein] had ‘left behind’ here in pathology is actually outstanding.”
Here’s hoping investigators are honest and transparent. Dr. Epstein’s legion of patients have a right to know.
The Hopkins surgeon was referring to this column where I list other credible sources for second opinions on prostate biopsies.
Tick-tock, vote …
By Howard Wolinsky
Can you weigh in on my survey on what otherwise healthy men should do about Active Surveillance once they reach their mid-70s?
I have had 120+ responses, but I’m greedy and would like more by the time I close voting next week.
There’s still time to answer a couple of questions on AS and related topics: https://forms.gle/oFvfH3rPdgJmEbiQ7
Can we can get a dialogue going with the urologists and develop guidelines to help us decide what to do about AS in older men?
By Howard Wolinsky I mentioned in this space the other day that my prostate signs point to stability and most likely I’ll die from something else. In a way, I am lucky. I have learned to co-exist with my “cancer” on Active Surveillance (AS) without overwhelming emotional distress. Mine has not been an Anxious Surveillance.
You’ve got questions? They’ve got answers.
By Howard Wolinsky
Starting in November, a panel of experts will answer your questions about Active Surveillance and lower-risk prostate cancer right here at TheActiveSurveillor.com.
These top docs will respond to your questions about pathology, urology, radiology, and sex and surveillance.
Please send questions via email to mailto:email@example.com
Keep the questions short and sweet. They should be of general interest. Sign with your real name, or just initials, tell me where you live, how long you‘ve been on AS, how it’s going for for you.