A former Veterans Affairs pathologist who the agency says botched 3,000 cases, including at least 15 in which patients died, admitted in court Thursday that he schemed to cover up a substance abuse problem and twice misdiagnosed a cancer patient who got the wrong treatment and died.

Robert Morris Levy, 53, pleaded guilty to one count of mail fraud and another of involuntary manslaughter, which together carry a maximum prison term of 28 years, though federal sentencing guidelines might call for something less. He had been charged last year with 31 counts in total, and had been scheduled for a Sept. 8 jury trial in U.S. District Court in Fayetteville, Ark.

Because of public health restrictions stemming from the coronavirus pandemic, the plea hearing took place on Zoom, with Levy appearing in a county jail cell. He wore a gray, striped prison jump suit and a black mask that covered his nose and mouth, answering most of Judge Timothy Brooks’s questions with a simple, “Yes, your honor.”

Levy confirmed that, while he was facing regular drug and alcohol monitoring for being caught drunk on the job, he used a substance that mimicked alcohol’s effects but was untraceable with normal tests.

He also admitted to twice misdiagnosing an Air Force veteran in 2014 with types of cancer the man did not have, and falsifying records to claim that his deputy had concurred with his diagnosis. That prompted doctors to give the veteran, who was not named during the hearing, the wrong treatment before he died five months later.

“I plead guilty, your honor,” Levy said, as the judge asked him about each of the two charges. He is expected to be sentenced in several months.

The plea begins to bring to a close a rare criminal case against a government physician whose misconduct led to more than 3,000 misdiagnoses, at least 15 deaths and medical harm to dozens of veterans, VA officials have acknowledged to members of Congress and investigators.

Levy read almost 34,000 pa­thol­ogy slides from aging veterans during 12 years as chief pathologist at the VA hospital in Fayetteville and in leadership roles on multiple oversight boards and medical committees. He failed to properly diagnose cancers and many other serious illnesses, investigators have said, mistakes that delayed medical care for an unknown number of veterans and led to unnecessary treatment for others.

“Amen,” Eva Chick said on Wednesday when she learned that Levy planned to plead guilty to manslaughter. Her father-in-law, Robert Thomas Chick, died in 2017 at age 70 of lung cancer that Levy had missed two years earlier, investigators determined.

When Chick finally was diagnosed — weak and his breathing labored — the cancer had metastasized. He died five months later.

His daughter-in-law said she wishes that Levy “would have gotten more than what he’s getting.”

“He killed all those people,” she said. “Why did they get him for just one death?”

Within months of Chick’s death, VA gave Levy a bonus for stellar performance after he completed a three-month inpatient alcohol treatment program, one of several missteps in his supervision, records show.

Kelly Copelin, a retired Air Force master sergeant, was prescribed antibiotics for an earache in 2015 after a biopsy Levy read came back negative.

Thirteen months later, Copelin’s neck and throat cancer was discovered at Stage 4 — and the treatment that saved his life was so invasive that today he cannot swallow food. He eats intravenously because of the damage to his throat.

“Does it surprise me? No,” Copelin said of Levy’s plea bargain. “Does it upset me? Yes. Look at everybody he’s hurt. They’re focusing on one case. It’s a slap in the face.”

VA fired Levy from the Fayetteville medical center in 2018 after an arrest for driving under the influence. The arrest prompted an 18-month review of his cases dating back 12 years. It discovered that almost 10 percent of his diagnoses involved clinical errors, more than 10 times the normal misdiagnosis rate of 0.7 percent for pathologists.

Levy’s termination followed a tumultuous tenure during which his colleagues in the pathol­ogy lab complained that they witnessed erratic behavior from him while on the job.

Inspector General Michael Missal began an investigation of Levy’s actions and of agency missteps in overseeing and addressing his behavior. In their indictment last year, prosecutors alleged that the complaints against Levy went unheeded.

Following an earlier incident of erratic behavior, Levy had entered a program for impaired physicians in Mississippi in 2016 and returned to work. But a year later, he appeared at a meeting of fellow pathologists and oncologists and was unable to stand and slurred his words, according to documents and interviews.

His medical privileges were suspended but he continued to perform administrative work until his DUI arrest.

To avoid detection of his severe substance abuse problem, Levy used his knowledge of toxicology and the science of blood testing and urinalysis to devise a dangerous solution, prosecutors alleged.

He routinely took a substance called 2-methyl-2-butanol (known as 2M2B), which he bought online, to mask the alcohol level in his blood, prosecutors said. The substance, which is not approved for individual use, cannot be detected in routine tests for drugs and alcohol. And it can be lethal if too much is taken.

VA officials have called Levy’s misconduct an isolated case. But the case drew attention to what investigators, Congress and veterans groups have called a lax system of oversight of poor-performing physicians, who often are reassigned rather than dismissed.

The agency said it has added oversight of small specialty staffs across the system — as was the case in Fayetteville — to ensure “independent and objective oversight.”

The Fayetteville VA hospital director, Kelvin Parks, said in a statement before Levy’s court appearance: “The Veterans Health Care System of the Ozarks is thankful this now former, fired employee will be brought to justice, and hopes that today brings some closure to Veterans and their families.”

Parks said VA has implemented a systemwide policy that requires hospitals with two or fewer doctors in a given specialty to have outside providers conduct peer reviews of their work to ensure “independent and objective oversight,” among other changes.

The hospital said it has settled tort claims with five veterans or families that were hurt by Levy’s conduct.

Bryan Smith, a Memphis attorney representing about 15 families whose loved ones either died or suffered medical harm, said the agency has offered some settlements. “But the offers have not been much, and we haven’t resolved any of the claims,” said Smith, of counsel to the Whetstone Law Firm in Little Rock.

He said VA has rejected some claims on the premise that even if Levy misread their pathology slides, other physicians outside the VA system soon caught their cancers or other illnesses, so no medical harm was done.

Smith said he rejects that premise. “For many of these veterans, there would have been less radical treatment options if Levy had not misread their slides,” he said.

The inspector general’s office has not yet issued a report on the Levy case. Such investigations are typically deferred until a criminal case is completed.