On nights and weekends, Judy Packevicz shed the tedium of her job as an accounts clerk for the city of Saratoga Springs, NY, and her spirit soared.

She was a naturally gifted singer. Her soothing, angelic voice so notable that she was a national award-winning soloist. She sang with the Sweet Adelines and other quartets.

In her mid-50s, her life was active and fulfilling.

Then her stamina waned. Sharp pain seared her midsection.

Following a battery of tests, doctors discovered Packevicz had metastatic cancer of the liver. Only a transplant would save her life.

Packevicz had ample medical benefits through the city plan and turned to her HMO -- MVP Health Plan of Schenectady -- to fund the procedure.

But they refused, citing expert medical opinions that the $350,000 operation would do more harm than good.

Suddenly Judy Packevicz was in a desperate fight for her life.

The first television journalists to take note of her struggle were WRGB-TV reporter Darcy Wells and videographer Bruce Forget, who began telling Albany region viewers of the woman's plight.

But there was a behind-the-scenes complexity to the story that would have an immediate impact on the station.

News Director Joe Coscia recognized that by reporting the story there could be potential business ramifications affecting WRGB because MVP Health Plan was a major advertiser spending hundreds of thousands of dollars a year. Soon, representatives from the HMO were in his office to complain.

"Our reporting had been honest and fair. MVP had reviewed 109 transplant requests and 108 were approved. Judy Packevicz was that 109th and we wanted to know why she had been denied," Coscia said. "This was a human drama unfolding."

Then a New York City law firm took on the woman's fight and filed suit against MVP.

As the story wove on, tension at the station mounted. WRGB sales reps were getting word from MVP that there would be repercussions.

"We were doing the right thing," said WRGB General Manager Doreen Wade. "This was about being denied surgery that might save your life. Don 't people deserve that chance? Isn 't that what we 're paying for, for HMOs to do everything possible to save our lives? That was really the issue."

Eventually, MVP reviewed the grandmother 's case and approved the transplant. However, she died on the operating table.

Late in 1998, MVP made good on its threat and retaliated. Thus far, WRGB has lost $125,000 that MVP normally would have spent on advertising. There is no sign of letup.

"It 's been devastating. But if we don 't have integrity, then we 're out of business," Wade said. "Who would watch a newscast if they thought the coverage was biased and we didn 't do stories because we were afraid of losing money in the process?"

Sometimes, integrity dictates that deciding not to go with a story is more important than being the first to publish. On Florida 's Treasure Coast, such decisions take courage and wisdom because the competition for readers and viewers is intense. In Fort Pierce, The Tribune is surrounded by Scripps Howard newspapers in Vero Beach and Stuart, and a television station in West Palm Beach.

"We have to be on top of our game every day; you can 't fall down ever or you get beat," said Tribune Editor Larry Croom.

It also means that time is not a luxury; decisions about stories have to be made quickly. However, at The Tribune, getting it right means more than printing it first.

Two stories run by The Tribune 's competition -- a series on cancer in children and allegations about a school board candidate -- put The Tribune 's integrity to the test.

The Tribune came under fire by readers after its competition ran a series of stories claiming there was an unexplained increased cancer rate in children in Port St. Lucie.

"There was a Love Canal mentality among residents," explained Managing Editor Anthony Westbury. "After their series ran, there was panic and we saw it spill over to real estate where property values plummeted."

The Tribune took on the story.

"Our tack was to look at the statistics and do our homework," Westbury said.

The Tribune reported the reality was that the area 's cancer rate among children was no higher than any other comparable area. And state tests of water, soil, air and other possible causes came up negative. There was no smoking gun.

The Tribune 's series took first place in the Florida Society of Newspaper Editors Awards. The competition placed second.

The other incident involved a school board candidate -- a former school principal who was dogged by rumors of past sexual misconduct and inappropriate relationships.

"School employees were putting immense pressure on us to print these allegations," said Croom. "We looked at it and found they were without any foundation. Our decision making is based on the fact that we affect people 's lives every day. About 70,000 people read our paper and we have to print a newspaper with integrity."