PITTSBURGH Signatures on tests prompt suit but are common

Doctors stand by the test as being one of the best cancer screenings.
PITTSBURGH (AP) -- The practice of putting a physician's electronic signature on a Pap smear report even though the doctor may not have reviewed the results is common, the nation's leading lab accrediting body said Friday, a day after two women filed suit alleging fraud by the University of Pittsburgh Medical Center.
"It is very common and it has been for years and years," said Jared Schwartz, secretary-treasurer of the College of American Pathologists. "For years, the electronic signature of the medical director would be at the bottom of the report with a telephone and address."
The practice was intended to give gynecologists and doctors who ordered the tests a person to contact should they have questions about test results, and there are no rules against the practice, Schwartz said.
Two women, Christine Walter and Sharon King, filed suit alleging UPMC's Magee-Womens Hospital misled patients into thinking their tests were examined by doctors by putting doctors' electronic signatures on test results between 1995 and 2001.
Attorneys' contention
Attorneys for the plaintiffs say the hospital tried to get more gynecologists to send samples for testing, generating more revenue, by claiming that Pap smears were checked by physicians, rather than technicians. They are seeking class-action status for the suit.
A second lawsuit, filed Wednesday by former Magee pathologist Susan Silver, made similar claims. The suit questioned whether some slides had even been reviewed by technicians, alleging that a number of cancer patients and others were wrongly declared healthy and that some weren't properly diagnosed for up to four years.
The College of American Pathologists, based in Chicago, which accredits more than 6,000 laboratories across the nation beyond federal standards, requires only that a doctor review and sign tests that come back with abnormal results.
But Schwartz, who is director of pathology at Presbyterian Healthcenter in Charlotte, N.C., said his labs had routinely put director's names on normal tests until the hospital recently switched to a new computer system.
Thomas Cooper, a pathologist at Centinela Hospital in Los Angeles, said his electronic signature is placed on tests that come back normal, or negative, after a technician has reviewed the samples. He says he doesn't look at all the slides under a microscope.
"The pathologist is supposed to be in charge of all this. Whether or not he or she actively looks at those [results] that are not abnormal, some person's name has to go on that," Cooper said.
A successful screening
Doctors say the test is not perfect, but the Pap smear remains one of the most successful cancer screenings.
About 4,100 women die from cervical cancer each year, but since the test was developed in the late 1940s, the mortality rate for women in the U.S. has gone down 70 percent, according to Debbie Saslow, director of breast and gynecological cancer at the American Cancer Society.
"Basically, if women in this country didn't get Pap tests then the death rate would be extremely high," Saslow said. "Instead, about 85 percent of women in this country have had Pap tests in the past three years."
While most Pap tests return normal, an estimated 5 percent come back with abnormal results, Schwartz said. Of those abnormal tests that get reviewed, there's an estimated five percent error rate, he said.
"Of those five, even in the best laboratories, some of those abnormal Pap smears will not be present, not seen or misinterpreted," Schwartz said.
In an effort to check for false negatives, or samples that contain cancerous or precancerous cells and weren't detected, the federal government requires 10 percent of all normal results be checked.
Perhaps as more labs begin allowing patients to order their own testing, labs will need to find a way to format test results so there's no confusion as to who reviewed the test results, Schwartz said.