-----Original Message-----
From: Morken, Tim <tim9@cdc.gov>
To: histonet@pathology.swmed.edu <histonet@pathology.swmed.edu>
Date: Monday, September 11, 2000 2:12 PM
Subject: RE: Renal biopsies -Reply


>Richard,
>
>My understanding of the legalities of assessing renal biopsies (in the US
at
>least) is that the pathologist designated as the Technical Manager of a lab
>can delegate this procedure to whomever he/she feels is best suited to do
>it. Of course, the person needes to be well trained. I did this for 15
years
>and had the trust of all the nephrologists and pathologists I worked with.
>Indeed, they often would defer to my decision since I was the one who
>actually had the most experience looking at needle core biopsies. Since I
>was usually at the side of the radiologist, nephrologist and patient as the
>biopsy was performed I was very aware of the ramifications of what I was
>doing and requesting.
>
>Also, very few anatomic path labs have Ph.D.-level people, or even PA's,
and
>the pathologist will rarely attend a biopsy procedure. The nephrologist is
>certainly not going to look at it because they are gowned and gloved to get
>the biopsy. That leaves the technical staff.
>
>So, I don't agree that the person needs to be a certain educational level,
>either legally or professionally, only well trained, highly experienced,
and
>very aware and concerned about the outcome of their decision (perhaps the
>latter is the most important quality of the person doing this sort of
>thing).
>
>Tim Morken, BA, EMT(MSA), HTL(ASCP)
>Infectious Disease Pathology Activity
>Centers for Disease Control and Prevention
>Ms-G32
>1600 Clifton Road
>Atlanta, GA 30333
>USA
>
>PH: 404-639-3964
>FAX: 404-639-3043
>
>email: tim9@cdc.gov
>
>
>
>-----Original Message-----
>From: Richard Cartun [mailto:Rcartun@harthosp.org]
>Sent: Monday, September 11, 2000 10:21 AM
>To: TABrecken@aol.com; histonet@pathology.swmed.edu
>Subject: Renal biopsies -Reply
>
>
>This function should be considered an "intra-operative consultation" and
>should be carried out by a pathologist or someone (PhD/PA) with specialized
>training under the supervision of a pathologist.  Yes, in the past we have
>used technologists with advanced training perform this evaluation under a
>pathologist's supervision, but clearly there are enormous ramifications of
>making a decision that requires that the radiologist or nephrologist
perform
>another needle core biopsy or stating that the biopsy is "adequate" when,
>after reviewing the permanent sections, it is not.  Currently, our Director
>of Electron Microscopy (a PhD) or myself (also a PhD) perform this function
>at our hospital under the supervision of a pathologist.  We issue an
>intra-operative consultation that appears on the surgical pathology report
>and we bill for it.  We keep a microscope in Radiology and, after placing
>the fresh tissue in tissue culture media on a glass slide, can usually tell
>if the biopsy is adequate by looking at it under low power magnification
>(for example 4x or 10x).  Please remember that it may be difficult to
>visualize glomeruli using this method when the kidney has advanced disease
>since there are few RBCs in the damaged capillary loops.
>
>Richard W. Cartun, Ph.D.
>Director, Immunopathology
>Co-Director, Histology
>