A doctor who has spent the last seven years trying to clear his name after settling a medical malpractice lawsuit says a revised autopsy report by Dr. Cyril H. Wecht forced him to capitulate, even though he continues to claim he did nothing wrong.

Dr. Wecht, who is facing a possible retrial on federal felony charges, changed the cause of death in his original autopsy report during the course of the civil case and was ultimately paid by the defense, the plaintiffs and Fayette County.

The case shows some of the workings of the complex legal-medical stage on which the renowned pathologist and former Allegheny County coroner operates.

In 2001, Dr. Tusharsindhu Chauhan, a gastroenterologist, agreed to a $350,000 payout to settle a wrongful death claim over his treatment of Stephanie Santello, a 16-year-old girl who died under his care.

Dr. Wecht performed the autopsy and wrote the report listing cause of death as "complications of an acute, overwhelming viral infection."

Dr. Chauhan and Uniontown Hospital, which was also named as a defendant, hired Dr. Wecht to be their expert witness when the girl's family filed a wrongful death claim alleging they failed to diagnose Reye's syndrome.

But as the case progressed through Fayette County's court system -- and after Dr. Wecht had been paid by the defendants -- he wrote a new autopsy report that changed the cause of death to Reye's syndrome.

Dr. Wecht did not include any explanations for the change, or note that it was an addendum. The report was dated the same as the original autopsy.

Jerry McDevitt, Dr. Wecht's defense attorney in his federal case, said that his client was simply following his own procedure in making the changes. He did so after reviewing a number of newly available reports, such as Ms. Santello's medical records and depositions from the civil case.

Though Dr. Wecht was ultimately precluded from testifying for the plaintiffs, he was paid by them after the case settled. Often doctors who are subpoenaed are compensated for their time, even if they are never called.

While it's not unusual for a doctor who performs autopsies to be called as both a fact witness (a person directly involved in the incident in question) and an expert (someone hired to render a professional opinion) it is unusual for a witness to offer conflicting opinions in a case and to collect fees from both sides.

Experts say that it is perfectly acceptable for a forensic pathologist to change his mind on a cause of death based on newly discovered evidence or information, but a number interviewed for this story say it goes against accepted practice to re-issue an autopsy report without creating an addendum explaining the change.

The Post-Gazette reviewed a number of documents associated with this case. Many of those related to the Santello lawsuit were admitted as exhibits in Dr. Wecht's criminal trial, and Dr. Chauhan, who has been labeled "a victim," by the U.S. attorney's office, was subpoenaed.

However, the prosecution chose not to introduce any of the Santello evidence and did not call Dr. Chauhan to testify in Dr. Wecht's trial, which ended with a hung jury in April.

Last week, a three-judge panel of the 3rd U.S. Circuit Court of Appeals heard oral argument on why the charges should be dismissed, based on a defense claim that the trial judge, Arthur J. Schwab, failed to follow proper procedure in declaring a mistrial.

There is no indication when the court might rule.

In the Santello case, Dr. Wecht was hired by Fayette County Coroner Dr. Phillip Reilly for $550 to perform a post-mortem examination on the girl. The defense paid him $3,500 as an expert. The plaintiffs later paid him $1,000.

In his original autopsy report, dated March 22, 1996 -- the day after the girl died -- Dr. Wecht found she had sepsis and concluded she died from "complications of an acute, overwhelming viral infection."

When Ms. Santello's family filed a medical malpractice lawsuit against Uniontown Hospital and the doctors who treated her in the spring of 1998, they alleged that she died from undiagnosed Reye's syndrome.

Because Dr. Wecht had concluded the girl had sepsis, he was hired by Dr. Chauhan to support his claim that there was no Reye's syndrome.

Reye's syndrome commonly occurs during recovery from a viral illness; it results in swelling of the brain and massive accumulation of fat in the liver.

Dr. Chauhan's insurance carrier and the hospital paid Dr. Wecht $3,500 in September 1998.

When attorney William D. Phillips first contacted Dr. Wecht about hiring him, he spoke to his assistant.

"Dr. Wecht's assistant told me that she discussed this matter with Dr. Wecht and he was quite surprised that there was an allegation concerning Reye's syndrome and that he is apparently ready to stand by his autopsy report," Mr. Phillips wrote in a June 10, 1998, letter to his client's insurance representative.

But at some point between then and February 1999 -- Mr. McDevitt said it was around December 1998 -- Dr. Wecht wrote a different autopsy report, finding that the girl died "due to acute fatty change of the liver, most probably a manifestation of Reye's syndrome."

The new report was dated the same as the original, March 22, 1996, and did not include any addendum explaining the reason for the change, or chronicle any newly discovered evidence.

After Mr. Phillips received a copy of Dr. Wecht's altered autopsy report, he and James Hartline, who represented Uniontown Hospital, went to meet with him on April 1, 1999.

"Initially, Dr. Wecht seemed to go to great pains to reassure us that since we had retained him as an expert he would never voluntarily go to the aid of the plaintiffs, but of course if he were to be subpoenaed he would have to go and testify as to his opinion," Mr. Phillips wrote to Dr. Chauhan on April 9, 1999.

Dr. Wecht's explanation to the men was that when he did the initial autopsy, he did not have any of the girl's clinical information.

"Dr. Wecht claims that whenever we contacted him about this case, to include providing him with a copy of the hospital chart and the plaintiffs' expert witness reports, he took it upon himself to re-review the case, to include researching the literature, examining the slides and also showing the slides to other pathologists, particularly at Children's Hospital of Pittsburgh," Mr. Phillips continued.

Mr. McDevitt, Dr. Wecht's attorney, said that after he was retained as an expert, he received new clinical information that required a revision to his findings.

"Although the change was ultimately disadvantageous to the defense, science required the change to be made," Mr. McDevitt said.

After the new report surfaced, it still took more than two years for the Santello case to wend its way through the court system. It was scheduled for trial in April 2001.

Because of the new autopsy report, the defense had decided it would not call Dr. Wecht as an expert witness.

The plaintiffs did not list him as an expert for their side, either, though plaintiff's attorney J. Michael Benninger sent a letter on March 23, 2001, to Fayette County Coroner Dr. Reilly, requesting permission to speak with Dr. Wecht about Ms. Santello's autopsy.

Dr. Reilly responded 10 days later, that that was acceptable.

Later, Mr. Benninger indicated that he would subpoena Dr. Wecht for the trial.

In a hand-written note to himself dated April 11, 2001, Dr. Wecht wrote:

"1) CHW to call defense attorney and tell them that Benninger came to CHW on Dr. Reilly's permission.

"2) Attorney Benninger has second autopsy report regarding Reye's syndrome

"3) CHW has been subpoenaed by Benninger.

"4) CHW will not bill now (will do so later.)"

Mr. Phillips, upon learning of the planned subpoena, went to Judge Gerald R. Solomon in Fayette County and asked that Dr. Wecht's testimony be precluded.

The judge ruled that Dr. Wecht could not testify at the trial, which ended after three days when the parties reached a $350,000 settlement.

When Dr. Wecht learned that he couldn't testify, he sent Mr. Benninger a letter.

"I was quite surprised and disappointed by the judge's ruling that prohibited you from calling me to testify in this case," Dr. Wecht wrote in the April 20, 2001, letter. "After all, I was a fact witness; and inasmuch as this is a death case with the cause of death as the principle issue, I would think that the pathologist who performed the autopsy would be the most important witness.

"I hope that you obtain a plaintiff's verdict. If not, I assume you probably will appeal based on the judge's ruling pertaining to me, as well as any other likely points of trial error."

Along with the letter, Dr. Wecht sent Mr. Benninger an invoice for $1,000.

He was paid on May 30, 2001, for what Mr. Benninger called "medical legal consultation."

Mr. Benninger refused to answer any questions on the matter.

Mr. McDevitt said the likely reason Dr. Wecht wasn't permitted to testify in the Santello case is that the rules prohibit plaintiffs from calling a defense expert.

But, he continued, that does not suggest a conflict of interest for Dr. Wecht.

Mr. McDevitt also challenges Dr. Chauhan's allegation that it was the revised autopsy report that forced him to settle, since Dr. Wecht was never even permitted to testify.

Dr. Reilly, the Fayette County coroner who requested Dr. Wecht perform the autopsy on Stephanie Santello, refused to accept his changed report and did not reissue the girl's death certificate with the new finding.

That refusal wasn't because he was opposed to Dr. Wecht's procedures in changing his findings, but simply because Dr. Reilly didn't agree with his conclusion of Reye's syndrome.

"I did not think in my 40 years of medicine that that's what it was," Dr. Reilly said, noting that no request was ever made to change the death certificate.

Dr. Chauhan said the ramifications of the new Santello autopsy report have been maddening.

He said he felt forced to settle the case by his own attorney. But Dr. Chauhan also weighed the benefits: He did not have to pay any of the $350,000 out of his own pocket; his malpractice insurance premiums did not go up; and he said he was told that the settlement would not be reported to the National Practitioner Databank, which catalogs, among other things, medical malpractice payouts.

However, a few months after the agreement was reached, Dr. Chauhan received a letter saying that the case had been reported.

His attorney, Mr. Phillips, would not comment for this story.

Since that discovery, Dr. Chauhan has engaged in an intensive letter-writing campaign to professional organizations and law enforcement agencies trying to have Dr. Wecht's actions investigated. The doctor, who now practices in New Jersey, even filed a civil lawsuit against the Santello family, believing that that might prompt officials to reopen the case.

Dr. Chauhan said one of the reasons he filed the lawsuit was to try to convince Ms. Santello's family that she did not die from Reye's syndrome, but instead from a metabolic disorder that he believes her sister may have as well. His lawsuit was quickly dismissed by the Fayette County court, and no agencies undertook the investigation he sought.

"Justice has to be based on the truth," Dr. Chauhan said. "If someone repeatedly convolutes the truth ... and that's what they did -- they sold the wrong medicine to buy justice."

As they were preparing for Dr. Wecht's federal trial, the FBI and the U.S. attorney's office spoke with Dr. Chauhan. But they chose not to call him as a witness.

Mr. McDevitt, Dr. Wecht's attorney, called that a wise decision, saying that Dr. Chauhan's letter-writing and lawsuit-filing amount to nothing more than harassment.

"Dr, Chauhan's inability to come to grips with the consequences of his treatment [of Ms. Santello] and his subsequent attempts to lash out at all involved, including the parents, is a regrettable repetition of the same lack of judgment reflected in the expert reports roundly criticizing his care in the first place."