Prostate Cancer Treatment Problems at Philadelphia VA Medical Center

A VA Hospital Cancer Unit in Philadelphia is under investigation after it allegedly botched 92 out of 116 attempts at a prostate cancer treatment known as brachytherapy, where patients were exposed to radiation.

A New York Times article reports that doctors and administration at the Veterans Affairs Medical Center in Philadelphia covered up failed prostate cancer treatment surgeries over a six-year period. Most of the surgeries were performed by Dr. Gary D. Kao, who appears to have routinely implanted radioactive metal seeds meant to treat prostate cancer into the wrong organs of veterans seeking treatment, the newspaper reported.

The Nuclear Regulatory Commission (NRC), which oversees radioactive medical procedures, is investigating the hospital’s cancer unit and has reportedly found a number of problems. There was no peer review of the cancer unit, and no oversight by the hospital, investigators have found. The prostate unit has been closed since mid-2008 as a result of the ongoing investigation.

The majority of problems surround a procedure called brachytherapy, where radioactive metal “seeds” 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.

NRC officials say their own regulators let Dr. Kao rewrite surgical plans on two occasions where he had implanted the seeds in the wrong location. In one instance, the majority of 40 radioactive seeds bound for a patient’s prostate ended up in his bladder instead.

VA hospital officials in Philadelphia have admitted that they failed to supervise Kao’s unit, and said Kao no longer works at the hospital and would not be allowed to return. Several other staff members have also been removed from their positions at the hospital. Nationally, the VA has suspended brachytherapy implants at hospitals in Jackson, MS and Cincinnati, OH, in addition to Philadelphia.

The investigation and report about these VA health care problems come on the heels of congressional hearing last week that was highly critical of the quality of VA health centers across the country. The hearing was held in response to contamination issues at VA clinics in Tennessee, Georgia and Florida that exposed thousands of veterans to unsanitary endoscopic equipment and may have cause several to develop HIV or hepatitis.

“Exposing our veterans to that type of risk is unacceptable … and frankly, I’m outraged that any of our nation’s heroes were potentially infected or that they even have to worry about that possibility,” said Rep. Harry E. Mitchell (D-AZ), who chairs an oversight and investigation subcommittee for the House Committee on Veterans’ Affairs, at the hearing last week.

Months after the VA endoscopy problems were discovered, follow-up inspections revealed that more than half of Veteran Affairs facilities continued to have inadequate health safety procedures.