LITTLE ROCK, Ark. (AP) — A federal appeals court on Wednesday upheld the 20-year prison sentence for a former pathologist at an Arkansas veterans hospital who pleaded guilty to involuntary manslaughter in the death of a patient he misdiagnosed.

The three-judge panel of the 8th U.S. Circuit Court of Appeals rejected arguments by Robert Levy’s attorneys that the sentence was unreasonable.

Levy pleaded guilty to misdiagnosing a patient with small cell carcinoma who died after being treated for a type of cancer he didn’t have. Levy falsified the patient’s medical record to state that a second pathologist agreed with his diagnosis, according to a plea agreement.

Levy was fired from the Veterans Health Care System of the Ozarks in Fayetteville in April 2018.

VA officials said in 2019 that outside pathologists reviewed nearly 34,000 cases handled by Levy and found more than 3,000 errors or missed diagnoses dating back to 2005. Levy has acknowledged that he once showed up to work at the Veterans Health Care System of the Ozarks drunk in 2016, but he denied that he had worked while impaired. He entered an in-patient treatment program following that incident and returned to work in October 2016 after agreeing to remain sober and submitting to random drug testing.