Medical Association Exhibits an Unhealthy Self-Interest

Here’s something you probably won’t read in the California Medical Assn.’s newsletter, unless it has a “Shame on Us” section.

If you wanted to be unduly charitable about it, you could say it’s a story about an association that protects its clients’ interests. If you didn’t want to be charitable, which I don’t, it’s a story about an association so concerned with self-protection that it has lost all sense of propriety.

The case involves a lawsuit filed by Connie and Mike Hull, a couple who should be enjoying the good life with their two young children at their home in the hills above San Clemente. Instead, a specter hangs over the house that probably won’t be leaving anytime soon.

After the birth of her second child in May, 1988, Connie Hull went to her doctor for a routine Pap smear, a procedure for early cancer detection. Hull says now that she wasn’t all that knowledgeable about the test and put it out of her mind after the doctor sent the results off to a laboratory for testing but then never said a word about any negative findings.

Fourteen months later, Hull developed abdominal problems and went in for another examination. The slides were sent to a different lab, which confirmed the presence of cervical cancer. Hull says her doctor told her that the cancer couldn’t be very advanced, based on the “clean” test of 14 months earlier.

Not to worry, indeed.

It turned out that the first sample had been sent to the Central Pathology laboratory in Tarzana. In the months between the two Pap smears done on Hull, the lab had been cited by the federal government for misreading a high percentage of Pap smears. Eventually, the state of California shut down the lab, citing an error rate of 20% in its Pap tests. The state fined the lab $558,000 and ordered it to notify all doctors who had sent slides to it within the past five years so that they, in turn, could notify their patients. The state also barred Central Pathology’s two top officers from ever operating a similar laboratory in California again.

A state Department of Health Services spokesman told me Friday that it was the strongest sanction the state could impose on the lab. The spokesman said health department lawyers are confident that Central Pathology has complied with the requirement to notify physicians who used the lab.

Back to the Hulls’ story. After the news hit the press about Central Pathology, Hull casually asked her doctor if she had ever sent Hull’s results there. The doctor, according to Hull, never told her she had used Central Pathology.

By the time Connie Hull finally got her cancer diagnosis in September, 1989--again, 14 months after the original Pap smear test--a radical hysterectomy was required. She currently has no sign of cancer, but doctors have told her that it will be at least five years before they can say with any certainty that she has beaten it.

The Hulls sued both the lab and the doctor for negligence and later added claims for punitive damages. Targeted specifically at the offending parties, punitive damages aren’t covered by insurance and can often result in large judgments against those being sued.

Although the California Medical Assn. wasn’t a party to the Hulls’ lawsuit, its lawyers wrote a letter to California Chief Justice Malcolm Lucas and the other justices urging the court to overturn two lower-court rulings that had let the Hulls ask for punitive damages. Nine days ago, the state high court did just that, leaving the Hulls unable to ask a jury for punitive damages.

“I’m sure the California Medical Assn. would agree there’s a time and place for punitive damages,” Hull said, “and if there’s a case crying out for it, it’s this lab who put so many women at risk. As you and I sit here, there are women walking around with ticking time bombs in their abdomens, and they don’t have a clue.”

I tried to reach the medical association and a lawyer for Central Pathology, but neither returned my calls.

Meanwhile, the Hulls await trial--probably next year--on their negligence claims, and Connie Hull says she’s trying to turn the nightmare into something constructive. She wants to warn all women to make sure they know where their Pap smears are being tested and especially any whose doctor may not have told them the slides were sent to Central Pathology in recent years. The American Cancer Society has estimated that 60,000 women a year get cervical cancer and that nearly 7,000 die.

“No woman should suffer from this,” Connie Hull said last week at her home. “It should never get to the point of invasive cancer, let alone die from it, and yet (it’s been) reported that 7,000 women a year die from it, and it’s totally preventable.”

The Hulls have two children, a daughter, 6, and a son, 4. “Part of this is that I’m fighting this battle because of them,” Connie said. “If, God forbid, something should happen to me, I want them protected and provided for. But beyond that, as a matter of principle, I want to be able to tell my daughter (when she’s older), ‘This is what happened to me: They were bad people and caused this to happen to Mommy, and Mommy got cancer because of what they did. But here’s what I did to fight back.’ ”

Maybe all this sounds like legal mumbo jumbo to you. Or the Hulls’ problem.

I would expect the lab to defend itself. I would expect the doctor to defend herself.

But the medical association?

That’s what professional associations do, you say--they protect their members.

But if protecting your members means galloping to the rescue of a discredited, shut-down laboratory and of a doctor charged with failing to disclose potentially life-threatening information to a patient, then maybe the California Medical Assn. needs that “Shame on Us” section after all.