VA Cancer Probe ContinuesJun 30, 2009 | Parker Waichman LLP
Dr. Gary D. Kao, the doctor linked to scores of potentially shoddy medical procedures conducted at the Veterans Administration (VA) Medical Center in Philadelphia admitted to making mistakes when administering radiation seed implantation—brachytherapy—to prostate cancer patients. It seems 92 veterans allegedly received incorrect radiation doses.
But, Kao, who admitted to “missing his target” when performing brachytherapy, claimed this type of error is not unusual and something for which he refused to be singled out, reported the Associated Press (AP). “Contrary to the allegations that I was a ’rogue’ physician, ... I always acted in the best interest of the patients in delivering this important treatment,” said Kao, quoted the AP. Kao, a radiation oncologist, was quoted when testifying at a Senate field hearing at the hospital, said the AP, noting that Kao worked at the VA center from 2002 to 2008.
KYW1060 reported that Kao testified that it is understood that radioactive seeds can move outside of the prostate to tissue and other organs, "The chance of seeds in the bladder, or outside the prostate, is a recognized risk of the procedure," said Kao. Senator Arlen Specter asked Kao at this point, "It's a recognized risk, but did you notify patients?" quoted KYW1060, to which Kao responded, "No sir.” Kao claimed such errors did not constitute a lower level of care that required reporting to the Nuclear Regulatory Commission (NRC) and other agencies, said the AP. “Brachytherapy was and still is an evolving field,” claimed Kao, quoted the AP.
The prostate is the size of a walnut and is located near the bladder and rectum, said the AP. Brachytherapy involves implantation of radioactive seeds to kill cancer cells, explained the AP previously, 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.
According to an earlier AP report, the team performing the brachytherapy “botched” dosing on most cases, but continued to conduct treatment despite that “monitoring equipment was broken,” citing The New York Times. The AP reported that the NRC found incorrect dosing occurred because, generally, seeds landed outside of the prostate in tissue or nearby organs. Kao performed most procedures, said Philly.com, noting that Kao stopped seeing patients a year ago.
In one case, a patient testified to losing his job because he was forced on five months bed rest after Kao allegedly implanted radiation seeds into his rectum, not his prostate, said the AP. Although the VA said the problem likely came from hemorrhoids or constipation, an Ohio State University physician diagnosed the problem as radiation burn, surgically correcting the problem, the AP reported.
In another case, a patient underwent a seed removal from his bladder, alleged that three seeds were expelled in blood clots, and suffered radiation irritation to his rectum and bladder. The patient claims he never received the VA letter allegedly sent to all its brachytherapy patients. The cancer remains and the patient’s options are significantly limited and include surgery to remove the prostate, bladder, and colon, forcing use of urine and feces collection bags, said Philly.com.
The VA center’s brachytherapy program has been suspended, said the AP, noting that a review of 12 other VA hospitals in which brachytherapy is conducted revealed some problems, as well; none allegedly as severe or frequent as at the center in Philadelphia. According to the AP, Kao took a leave from the University of Pennsylvania last week.