By Olivia Solon and Mike Hixenbaugh

Kim Johnson was nervous as she sat down at her dining room table in January 2015, clutching an unopened letter from the radiology department at Fleming County Hospital in Flemingsburg, Kentucky.

Breast cancer had killed Johnson’s mother years earlier, a painfully slow death that took a toll on her entire family. The prospect of that happening to her was all Johnson had been able to think about since she’d discovered a tender lump in her right breast weeks before, prompting her doctor to send her for a mammogram.

If she got sick, who would keep up with feeding the horses and chickens at the 101-acre family farm that she and her husband ran in northeastern Kentucky? Who would care for the three young children they’d recently adopted after raising five kids of their own?

Kim Johnson on her farm in Ewing, Ky., where she and her husband are raising their three youngest children. Luke Sharrett / for NBC News

Johnson, 53 at the time, says she ripped open the envelope, unfolded the letter and began to read. She says her eyes fixated on four words in the first sentence: “no evidence of cancer.”

“Oh my gosh,” Johnson remembers thinking. “I dodged a bullet.”

Her husband, Delbert, choked up when she called him with the news. That night, they loaded the kids into the car and headed to Tumbleweed Tex Mex Grill to celebrate.

Only, as medical experts who reviewed her records later told her, there’d been a terrible mistake.

The letter Johnson says she received from Fleming County Hospital stated that her mammogram “revealed no evidence of cancer.” NBC News

By the time Johnson discovered the discrepancy 10 months later — thanks only to her own insistence on seeking a second opinion after the pain in her breast worsened — her new doctors feared it might be too late to save her.

Johnson didn’t know it then, but this was the start of a yearslong battle not only with a deadly disease, but with a health system and medical workers who, Johnson’s lawyers say, went to extraordinary lengths to cover up their error.

Johnson — who describes herself as “not a suing person” — ultimately filed a lawsuit because she wanted to know why her cancer wasn’t caught earlier. It took three years of litigation before Johnson, her lawyers and a digital forensics expert who reviewed her electronic patient records were able to piece together what they believe happened: In the days and weeks after Johnson filed a medical malpractice lawsuit in 2016, two hospital employees opened her electronic records and edited them, deleting evidence of the erroneous letter claiming that she was cancer-free, Johnson’s lawyers say.

The hospital then created fake letters and produced them as part of the court case purporting to have directed Johnson to seek additional tests, Johnson alleges in court filings. When questioned under oath, the doctor who’d been overseeing Johnson’s medical care pointed to the newly generated letters as evidence that Johnson was to blame for her own delay in treatment, court records show.

Image:; Kim Johnson and her family at the high school graduation of her son Sam in May 2017 (Courtesy Kim Johnson)

Andrew Garrett, the forensics expert who reviewed Johnson’s medical records on her behalf, has worked on hundreds of malpractice cases, for both patients and hospitals, to find evidence buried deep in electronic records. He described cases like Johnson’s as having a “smoking gun” hidden in the records.

The cover-up alleged in Johnson’s lawsuit highlights a growing threat facing patients in the age of electronic medical records: the potential manipulation of their records by health care providers to hide mistakes and minimize liability.

In September 2016, Johnson sued the hospital that sent her the cancer-free letter and other medical workers involved in her care. Fleming County Hospital responded with a legal filing claiming that it had actually sent Johnson two other letters telling her the results of her mammogram were indeterminate and that she needed to come back for a follow-up screening within four months.

Kim Johnson’s attorneys, Dale Golden and Laraclay Parker. (Jacob Ward / NBC News)

Johnson was baffled. She insisted she’d never seen the letters. Despite the disagreement, Johnson and Fleming County Hospital reached a $1.25 million settlement in April 2018 — enough to at least defray the significant cost of her ongoing cancer treatments. The hospital’s new owner, LifePoint Health, was not part of the settlement, and Johnson’s case continued against the for-profit hospital chain and other medical providers.

Johnson and her attorneys, Dale Golden and Laraclay Parker, said they would never have settled for that amount had they known what they would discover a year later: that the two follow-up letters appeared to have been created only after Johnson filed her lawsuit. That was the conclusion of Andrew Garrett, the digital forensics expert hired by Golden and Parker as part of the ongoing lawsuit against LifePoint Health.

Kim Johnson while she was receiving treatment for cancer. (Courtesy Kim Johnson)

Garrett, who was paid tens of thousands of dollars for his work on the case, trawled back-ups of the hospital’s electronic medical record system during a court-ordered site visit to check Johnson’s record at five points in time before and after the lawsuit was filed, as well as the audit trail of who accessed and altered the record.

Johnson thinks often about her mother’s nearly decadelong cancer fight. She fears becoming a burden to the people she loves — a thought that’s all the more upsetting when she considers that all of this might have been preventable.

“What I worry about the most is the kids,” Johnson said. “If they just would have sent me for a biopsy, maybe I would have more time to spend with them.”

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