Health director apologizes, but doesn't explain failure to notify women about Pap smears
Since officials disclosed last month that Mecklenburg County’s medical clinics failed to notify nearly 200 women about abnormal Pap smears, Health Director Marcus Plescia has assured the public that the tests found only mild to moderate problems.
But newly released information to the Observer shows results for at least 20 of the women revealed high-grade abnormalities that suggest the possibility of cervical cancer.
More seriously, follow-up procedures performed recently for two women showed CIN 3 abnormalities, which are commonly considered pre-cancer and often require surgery to prevent invasive cancer.
The county would not make Plescia and County Manager Dena Diorio available for interviews.
In written responses, however, the county said that none of the women affected had Pap smear results at a stage requiring urgent follow up and none had cervical cancer, which typically takes years to develop.
But they acknowledged that it remains unclear what, if any, adverse affects the months-long delays in notifications will have on treatments needed for the women.
Nearly three months after Health Department workers discovered the issue, 13 women with results indicating they need follow-up care have not been located.
County Commissioner Pat Cotham said the disclosures add to suspicions that county administrators haven’t revealed the full extent of the problems at public clinics at Beatties Ford Road in west Charlotte or Billingsley Road in southeast Charlotte
Cotham said that’s one reason some commissioners want to interview four workers who recently left the Health Department after the failures were discovered.
“I didn’t accept what I heard” when Plescia denied that Pap smears showed no severe abnormalities for any of the women, Cotham said. “I was like, ‘How can he know that?’ It didn’t make any sense.”
‘Mild to moderate’ problems
Secrecy has surrounded the issue from the beginning.
Workers first discovered on Dec. 12 that a nurse had failed to notify 185 patients of abnormal Pap smear results since May. Plescia and Diorio didn’t learn about the problem until Jan. 4.
They briefed top elected officials in January, but the lapse wasn’t made public until Feb. 21 after inquiries from the Observer.
The next day, Plescia answered questions from reporters at a news conference. He said that he had personally reviewed paperwork and found the patients had only “mild to moderate” abnormalities.
“I hope that may allay some anxiety,” he said.
But 75 of the women needed colposcopy exams or other follow-up to determine if abnormalities found by the Pap smears indicated signs of cancer or pre-cancer.
The county said it has received pathology results from follow-up procedures for 30 women so far.
The vast majority of the women had normal results or CIN 1 abnormalities that may progress without treatment but usually go away on their own.
But two patients had CIN 3 abnormalities, often called pre-cancer because it is considered the same as carcinoma in situ. That means cancer has not yet spread to deeper tissues. Without removal, however, there is an elevated risk of invasive cancer, experts say.
Early detection has helped reduce rates of cervical cancer in the U.S., but more than 4,000 women die from the disease each year.
Dr. Otis Brawley, chief medical officer for the American Cancer Society, said in some cases the body’s immune system takes away CIN 3 abnormalities.
But such abnormalities should be monitored closely, especially in younger women, Brawley said.
Women with even CIN I results should have Pap smears performed every six months for at least two years, Brawley said.
County Commissioner Bill James, chair of the board’s Audit Review Committee, which is investigating the matter, said he has heard conflicting information about Pap smear results from the affected patients.
James said commissioners are trying to determine ways to get first-hand information about what happened instead of relying solely on county staff. That may include seeking the views of medical experts and speaking with former staff, he said.
“It’s not that I don’t believe (administrators), but everyone agrees that something was screwed up,” James said. “There is debate about who is responsible. My plan is to get to the bottom of these issues.”
James and Cotham, who heads the board’s Health and Human Services Committee, said commissioners will also look to see if problems at the health department extend beyond Pap smear notification.
They both said they want to know if there were problems involving other health screenings.
In response to questions from the Observer, the county acknowledged clinicians questioned the results of syphilis tests in three patients. They later learned a laboratory employee failed to follow proper procedures in a case.
In December, a patient received incorrect results from a pregnancy test.
The county said pregnancy tests should be reviewed immediately and staff received training to prevent future mistakes.