On the heels of the Veterans Affairs (VA) health facilities scandals involving shoddy colonoscopies and endoscopies, it seems 92 veterans allegedly received incorrect radiation doses. According to the Associated Press (AP), the veterans received shoddy dosing during prostate cancer treatment over a six-year period at the VA Medical Center in Philadelphia, citing newspaper reports. The VA is a teaching hospital for the University of Pennsylvania School of Medicine said Philly.com.

It seems, said the AP, the hospital team performing the brachytherapy “botched” dosing on most—92 of 116—cases, continuing to conduct treatment despite that “monitoring equipment was broken,” citing The New York Times. According to The Philadelphia Inquirer, said the AP, treatment errors took place in 92 of 114 cases. Most implants were performed by Penn radiation oncologist, Gary Kao, said Philly.com, noting that Kao stopped seeing patients a year ago and is doing lab work at Penn, citing a school official.

Brachytherapy involves implantation of radioactive seeds to kill cancer cells, explained the AP, noting that most veterans allegedly received ‘”significantly less” dosing than what was prescribed, while others “received excessive radiation to nearby tissue and organs.” Brachytherapy is an option only used in patients diagnosed with “small, early-stage, non-aggressive prostate cancers,” said Philly.com.

Last week at a hearing before a House VA committee, the VA was roundly criticized for not increasing safeguards and improving procedures at VA health facilities after it was found that shoddy procedures were potentially linked to the spread of hepatitis and HIV. Despite a nationwide scare, media attention, and suspected links to HIV, hepatitis B, and hepatitis C, less than half of all VA facilities were operating under appropriate procedures based on surprise investigations spurred by the scandal, which broke months earlier, noted the AP. According to the VA, six veterans have tested positive for HIV, the virus that causes AIDS; 34 have tested positive for hepatitis C, and 13 have tested positive for hepatitis B, said the AP previously.

Citing federal investigators, Philly.com reported that in 2002, soon after the Philadelphia VA began offering brachytherapy, questions began circling about the quality of the treatment. Despite this, it took until last year for the VA to suspend brachytherapy and look into the over 100 veterans who allegedly received incorrect doses, said Philly.com. The Nuclear Regulatory Commission (NRC)— responsible for such radiation therapy oversight—initiated an investigation, releasing some results in this month’s Federal Register. News reports also said of 92 mismanaged cases, 57 men received significantly less radiation than prescribed, and 35 received too much radiation, including 25 who received excessive radiation to the rectum, reported Philly.com

Philly.com reported that the NRC discovered a number of what it described as system-wide problems at the VA facility, including that clinicians were never trained in how to define or report medical errors; a standard quality assurance (QA) measure did not exist; and problems were not revealed, despite quarterly audits.

“It is mind-boggling to me,” said adviser James M. Welsh, a radiation oncologist from Wisconsin, “that a physician could say that a dose . . . is acceptable, and then look at these implants and not realize that this is gross incompetence,” quoted Philly.com. “Probably the thing that bothers me the most,” said adviser Orhan Suleiman, representing the FDA, is that “the consulting physicist had identified some problems earlier on. . . . If they had a concern, who did they report that to? Were they aware that they had that responsibility?” reported Philly.com.

Physicians permanently insert 80 to 120 radioactive metal “seeds,” about the size of a grain of rice, which, when implanted correctly, kill the prostate tumor with no serious bladder or rectum damage, explained Philly.com.

The effects to the patients remain unknown, but it is believed the shoddy treatment might have contributed to rectal damage in one patient, said Philly.com

This entry was posted on Monday, June 22nd, 2009 at 6:18 am and is filed under Health Concerns.