The bungled radiation treatment of close to a hundred veterans with prostate cancer over a six-year period at Philadelphia's Veterans Affairs Medical Center falls far short of the government's promise to veterans. Ninety-two of the 116 veterans who received a kind of radiation treatment for prostate cancer there got inadequate or misdirected doses, which may have damaged adjacent tissues and organs, such as the bladder, peritoneum, and rectum. In many cases, the victims did not know they had received substandard treatment until months or even years later.
If this had been a consumer product, we would be talking about a breakdown in quality control. That is essentially what happened here.
All of the safeguards of quality care were missing. There was no peer review, no government or agency oversight, and not even a definition of what constituted a reportable "medical event" - which might have alerted authorities to the problems sooner. The bottom line is that problems with the procedure, known as permanent implant prostate brachytherapy, went undetected for more than six years.
By the time they were detected, it was too late to undo the tissue damage sustained by the Rev. Ricardo Flippin, a 21-year Air Force veteran who served in Vietnam. Flippin suffered incontinence and radiation burns to his rectum.
"I spent six months in bed, unable to walk or stand," he testified before a Senate Veterans' Affairs Committee hearing I chaired in Philadelphia last week. The House Veterans' Affairs Committee is to continue investigating questions surrounding the breakdown in Washington this week.
In brachytherapy, small radioactive seeds are surgically implanted in the prostate to destroy cancerous cells. Of the 92 mishandled cases at the Philadelphia VA, 35 suffered unintended doses of radiation to an organ or tissue other than the prostate, and 57 suffered underdoses of radiation to the prostate, mainly because the seeds were implanted incorrectly or had migrated to other organs.
The Department of Veterans Affairs, like other health systems, relies on a number of oversight systems to maintain the quality of health care in its medical centers. These include patient surveys; peer reviews; the VA radiation-safety program; the Nuclear Regulatory Commission, which monitors the use of nuclear materials; and the Joint Commission, a group tasked with accrediting the hospital. These systems all failed to detect the aberrant care at the Philadelphia VA.
Flippin learned he had prostate cancer in September 2004, and he underwent brachytherapy in May 2005. It was not until July 2008 - more than three years later - that the Philadelphia VA finally informed him: "Our review of your treatment program has indicated that there is a possibility that you received a radiation dose to your prostate gland that was less than your physician intended." He was asked to report for a CT scan, after which he received a second letter stating: "The results of the CT scan indicate that the treatment you received did not meet the VA's high standard of care."
No patient should have to endure what Flippin did. Timely peer review and oversight by responsible government agencies and the VA could have uncovered problems with the brachytherapy program, and corrective steps could have been taken to avoid later tissue and organ damage.
If there was a saving grace in the grim recitation of Flippin's travails at last week's hearings, it was when his doctor, Gary D. Kao, a radiation oncologist from the University of Pennsylvania, said he wished he had done better, and the two men embraced. It was a gesture of reconciliation between patient and doctor that, however brief, concluded the hearing on a positive note.