VA Cancer Treatment Problems Identified Among More Patients

Investigators have found at least six more cases of cancer patients given incorrect doses of radiation for prostate cancer at the Veterans Affairs Medical Center in Philadelphia, bringing the total number of patients affected by the clinics cancer treatment problems to 98.

The new cases were reported to the U.S. Nuclear Regulatory Commission (NRC), which oversees use of radioactive materials in medicine. The cases were part of a larger investigation into what some have called a “rogue” cancer treatment unit at the VA hospital, which botched many attempts to perform a common prostate cancer treatment procedure known as brachytherapy.

The six new cases were under doses, meaning patients received too little radiation. Of the 114 patients who have received the treatment at the Philadelphia VA clinic, it now appears that the cancer unit, headed by Dr. Gary D. Kao, may have only got the procedure right 16 times.

Brachytherapy involves radioactive metal “seeds” which are placed in a pattern inside the prostate with needles. The metal seeds create a cloud of radiation that conforms to the prostate and is tailored to attack and contain the cancerous cells.

At the Philadelphia VA cancer unit, investigators have uncovered a number of incidents where patients received radiation doses that were too weak, or where the metal seeds were inserted into the wrong locations, such as the bladder or rectum. The unit continued to do the surgeries for a year even after a device that measured the radiation in patients broke down, giving them no way to check their work.

Some of the errors were not found for years, and many veterans have had to undergo repeat implants or surgeries to mitigate damage caused by the VA cancer treatment problems in Philadelphia.

The NRC has found that there was no peer review, and that there were times when the staff in the cancer unit altered medical records to make it appear as though seed placement errors were actually part of the original medical plan. The unit, run by doctors from University of Philadelphia working for the VA under contract, was shut down in 2008 as part of the investigation.

The new complaints are just the latest in a string of VA medical treatment problems that have shaken the agency over the last year. As a result of the brachytherapy problems in Philadelphia, the VA has suspended brachytherapy implants at hospitals in Jackson, MS and Cincinnati, OH.

The VA has also had to test more than 10,000 patients for HIV, Hepatitis C and other blood borne infections after discovering that several facilities incorrectly cleaned or used endoscopic equipment used in colonoscopy procedures. In some cases, the equipment was not cleaned after every use, and in other cases an incorrectly used valve meant that blood from a previous operation could be trapped and then exposed to the following patients. At least five of the veterans have tested positive for HIV and more than 40 for hepatitis after being treated with equipment that may not have been properly sterilized.