Cancer, Lawsuits Are Legacy Left by Pap Test Uncertainty : Medicine: State shut down lab after inspectors said they found inaccurate readings. The pain still lingers for women battling the disease and a system that will not allow them to sue for punitive damages.

It is every woman’s nightmare. Connie Chatwood Hull received a Pap smear test that showed no cancer only to learn 15 months later that the lab apparently had made a mistake.

By then, the malignancy had sent its tendrils through her abdomen, forcing Hull to undergo extensive surgery, which left her unable to lift her two young children for three months. By then, the Tarzana laboratory that she believes overlooked the abnormal cells had been closed by state inspectors, who found widespread test inaccuracies.

Hull and her husband filed suit against the lab, Central Pathology Medical Services Group, and her doctor, Dr. Elizabeth Irwin of Torrance. Earlier this month their case suffered a setback when the state Supreme Court ruled that they could not seek punitive damages because they had not shown that they were likely to be awarded extra money as a result of those damages.

Although Hull’s attorneys have vowed to find a way around the ruling and continue seeking $4 million in damages, it was a blow to her and to other women who have sued the lab for such alleged errors.

“It was terrible, terrible, terrible, terrible what happened to her and what happened to me and she should be allowed to punish them,” said Julita Cardenas, a 52-year-old lab assistant from El Monte who underwent extensive cancer surgery three years after Central Pathology told her she was tumor-free.

Cardenas’ family asked her not to divulge details of her traumatic ordeal. But court records show that she did not learn that the 1984 Pap showed a precancerous condition until after her hysterectomy, after radiation treatments had damaged her bowels and bladder, and after news reports about the lab prompted her doctor to have the tests re-examined.

Pap smears are a routine scraping of cervical cells that women are advised to undergo annually. Viewed through a microscope, the scrapings can reveal cancer and other diseases in their early stages, when less extreme measures--such as laser surgery--often can be employed.

Attorneys representing Central Pathology did not return telephone calls last week. But Superior Court files show that in Southern California, at least five lawsuits alleging that the lab bungled Pap smear tests have been pursued since 1988.

A search of court records in other states indicate there could be dozens of similar suits across the country against the lab, which evaluated nearly 700,000 Pap smears annually, making it one of the nation’s largest so-called “Pap mills.” The state, which inspected the lab in spring, 1989, found that 21% of a random sampling of tests had been misread, well above the 5% margin of error generally expected in the industry.

The five Southern California lawsuits reflect the human fallout from the lab’s practices, which state investigators said included encouraging technicians to read too many slides a day, issuing results even when specimens were damaged, and mixing up patients’ slides. The women who sued claim that they learned of the lab’s errors through coincidence or persistence, that hundreds of other women may not know that their cancer could have been detected earlier or that such a mistake merits legal action.

The suits are filled with similarities even though the women are different, ranging in age from 24 to 56 and in occupations from attorney to nurse. All of the suits document the grief that followed the cancer diagnoses, then the disbelief that followed news that the disease might have been halted in an earlier stage if the first Pap readings had been accurate.

The women all have said, through interviews and in their court depositions, that the experience radically changed their lives. Surgery and worry interrupted education and careers. Scars and pain linger and some women have become cancer phobic, calling the doctor with any ache or pain.

“I was driving to the doctor the other day and I heard that Don Henley song, ‘The End of the Innocence,’ and I thought: ‘That about sums it up. This was the end to my innocence,’ ” said Hull, 38.

Of the five suits, only Hull’s and one filed by Karen McIntosh are pending in the courts. In three other cases, including Cardenas’, the women settled out of court for $300,000 or less.

Because of the $250,000 limit for pain and suffering in medical malpractice cases, except for the rare award of punitive damages, the women’s lawyers said they had nothing to gain by rejecting the settlement.

Nancy M. Royer, 56, of San Diego had to promise not to discuss her case or the amount of her settlement in order to receive the money, said her attorney, Samuel Hornreich of El Cajon.

Royer had a slightly abnormal Pap smear in 1988 and her doctor advised her to wait a few months and have another test, Hornreich said. That test came back negative from Central Pathology, but almost a year later she was found to have cancer, which by then had spread to her lymph nodes.

“An oncologist later told her it was impossible to have a normal Pap smear in the middle” of the two abnormal ones, Hornreich said. The doctor had the Central Pathology smear re-evaluated by a pathologist who said it clearly showed abnormal cells, the beginning signs of cancer.

“She’s doing very well, luckily for her,” Hornreich said.

Only one case, that of student Lori Sarpatjian, involved a false positive result. In 1987, Sarpatjian--then 18--was told she had cancer of the cervix based on test results provided by Central Pathology. Her doctor ordered a cervical biopsy, a painful procedure.

When the biopsy turned up no evidence of malignancy, the doctor had the Pap slides re-evaluated and found that they showed no cancer cells. Her slide had been mixed up with someone else’s, the doctor said.

Sarpatjian’s case was also the only one in which Central Pathology came close to publicly admitting guilt. In a 1987 letter sent to her before she filed suit, the lab’s client relations director, Leonard Hill, wrote: “It is our desire to extend to you our sincere apologies for the inconveniences and personal concern caused you.”

The letter offered Sarpatjian $340 to pay her medical bills.

Sarpatjian settled her lawsuit against the lab in 1991 for an undisclosed amount. Neither she nor her lawyer could be reached for comment.

In the other four lawsuits, the lab’s attorneys defended their clients on technicalities unrelated to the test result problems documented by the state.

They blamed Cardenas for not going in for annual Pap smears between 1984 and 1987, which they said would have detected the cancer.

They repeatedly argued that the three-year statute of limitations for filing malpractice claims had passed in the cases because the alleged injury--the misread test--had often occurred years before the suit was filed.

Judges sided with the women, saying the statute also calls for a one-year grace period after discovery, which the judges held began when the slides were reread, after the cancer diagnosis and, in some cases, after news reports of Central Pathology’s demise.

In fighting the suit filed by McIntosh, who moved to New Mexico with her husband and two children before discovering her cancer, Central Pathology’s lawyers maintained that the wrong party had been sued because she originally filed against the company’s sister firm, Central Diagnostics.

Charles D. Sneathern, McIntosh’s lawyer, described that argument as “a sham” in a response filed with the court. He pointed out that the California secretary of state’s records listed the same corporate officers--owner Allen N. Levy and Harry Sagh--and the same Tarzana address for the two firms.

McIntosh, 39, said last week that she was afraid to discuss the pending suit without the consent of Sneathern, who was on vacation.

Court files indicate that McIntosh worked as a nurse for a Torrance gynecologist who sent his Pap smears to Central Pathology. Because of a history of cervical cancer, which had been treated with a freezing technique, McIntosh was careful to receive an exam every six months.

Four tests sent to Central Pathology in 1987 and 1988 came back negative for malignancy.

McIntosh moved to Santa Fe in March, 1989, and by fall she had received the most troubling of Pap results from her new gynecologist. She underwent a hysterectomy in September and soon after saw a television report about Central Pathology, causing her to ask that her previous tests be retrieved.

When slides from two of her Paps were reread, both showed abnormal cells.

Like McIntosh, Hull learned of Central Pathology’s demise through the media, but in her case those newspaper reports appeared months before her cancer diagnosis.

Hull, an attorney who decided to stay home with her children after her 1989 cancer surgery, said her doctor denied using Central Pathology and that she finally learned the truth from another patient, just before her hysterectomy. When her tests from spring, 1988, were later reviewed, they also showed abnormalities.

Exposing the lab and others like it has become a crusade for Hull. She peppers interviews with information drawn from the state investigation, especially the fact that Central Pathology was paying its technicians $1 for every slide past 100 they read daily, even though at that time the industry’s recommended limit was 75.

“One dollar, is that what a woman’s life is worth?” she asked.

Editorial librarian Peter Johnson contributed to this story.

A Troubled Past

Here is a chronology of the Central Pathology Services Medical Group in Tarzana.

January, 1989: As part of a new national testing program, a federal inspection of Central Pathology finds errors in 12% of a sample group of Pap smear results.

February, 1989: Federal health authorities decertify Central Pathology, preventing the company from receiving Medicare or Medi-Cal payments for Pap smears. The lab vows to appeal the ruling.

March, 1989: Twenty state health inspectors go to Central Pathology to investigate allegations that the lab is misreading a high percentage of smears. “We are a high-quality laboratory. We are not second to anyone,” says lab medical director Dr. Cyrus Milani.

April, 1989: The state orders Central Pathology to halt operations because the inspection found errors in reading 21% of a randomly selected group of tests. The lab, which was handling about 700,000 Pap smears a year, is ordered to notify all of its clients for the previous five years of the problems and to offer retesting.

May, 1989: The state sues Central Pathology and its sister firm, Central Diagnostic Laboratories, for $3 million in damages and seeks revocation of its license. The lawsuit is meant to enforce the state’s demand for client notification. Six days after the suit is filed, Central Pathology announces it has mailed notices to 15,000 physicians.

June, 1989: State health officials, saying they think the lab’s efforts to notify clients were inadequate, say they will issue a nationwide health advisory.

July, 1989: A Newport Beach medical firm, MetWest Inc., agrees to buy Central Diagnostic Laboratories’ operations for $65 million, one of the highest prices ever paid for a private medical lab. The sale does not include Central Pathology, because that operation has closed. Court records show the owner of the two firms, Dr. Allen Levy, had made millions through their operations and owned a fleet of classic automobiles and a $30-million house in Malibu.

November, 1989: Central Pathology agrees to give up its operating license and to pay a $558,000 state fine to settle the suit. The settlement prohibits the lab’s top officials from ever owning or operating a Pap smear laboratory in California. A lab spokesman says Levy believes the charges against him were excessive because, although the company’s own rescreening of tests had uncovered some problems, none of the cases were found to be cancerous.