The U.S. Department of Veterans Affairs (VA) is being fined for botching 97 of 116 procedures to treat prostate cancer among men seeking care at the agency's medical center in Philadelphia. Although the punishment, which adds up to a mere $227,500, might not sound like more than a slap on the wrist, it is coming from the Nuclear Regulatory Commission (NRC) and is one of the largest the commission has ever given out for medical mistakes.
Whereas the NRC might be more in the habit of checking up on nuclear power plants or old weapons facilities, it is also charged with monitoring medical treatments that involve radiation. So after the Philadelphia VA facility was found to have botched 83 percent of prostate cancer radiation therapy procedures, the NRC announced this week that the department has a month to pay up or contest the charges.
No deaths have yet been linked to the mistakes, but 11 patients have seen their cancer return, and dozens of treatments were administered to the wrong organs entirely in the men.
An NRC investigation, prompted in part by internal VA reports of recurring errors, found that contract doctors working at the hospital had placed the brachytherapy iodine-125 pellets incorrectly or in incorrect amounts in nearly 100 prostate cancer procedures between 2002 and 2008. In the operation, dozens of quarter-inch-long radioactive "seeds" are implanted by a needle or catheter into the prostate, and imaging equipment is usually used to ensure proper placement. If the dose to the cancerous area is too low, not all of the cancer cells will be killed, and if the pellets are placed in incorrect locations, the radiation can also damage healthy tissue. If done correctly, the treatment has a high success rate.
"The potential consequences to the veterans who came to this facility and the sheer number of medical events show the gravity of these violations," Mark Satorius, that region's administrator of the NRC, said in a prepared statement.
The finding is one of many recent discoveries of radiation therapy gone wrong. In October 2009, a Los Angeles hospital was found to be overdosing patients undergoing CT (computed tomography) brain scans. And in February 76 patients at a Missouri hospital, most of whom had brain cancer, received about 50 percent more radiation than they should have, The New York Times reported at the time. There have also been numerous reports by The Washington Post and others of sub-standard medical care provided at VA facilities to veterans, including many returning from the Iraq War.
Most of the NRC's fine to the VA ($208,000) was aimed at punishing a lack of written procedure instructions at the Philadelphia facility and the remainder ($19,500) was for a specific incident in May 2008 in which a patient received the wrong dosage. This particular procedure—along with 56 others—resulted in less than 80 percent the recommended amount, according to a 2009 NRC inspection report. Some 35 of the flawed procedures resulted in doses of the iodine seeds "to an organ or tissue, other than the treatment site (prostate)," the same report concluded. The New York Times found that one patient had received multiple treatments at the hospital in which large quantities of the iodine seeds had been deposited in his bladder and rectum. Many of the errors might have gone unnoticed because the procedure was not subject to peer review at the hospital, a step that is common in most medical settings, experts told the Times.
The VA medical facility in Philadelphia had begun performing the procedure in 2002 and stopped when the errors began to become apparent in 2008.
The long-term medical implications of the faulty implants are still largely unknown. "Fortunately nobody died here," Steve Reynolds, the region's NRC director of nuclear material safety, told The Philadelphia Inquirer. Nevertheless, The New York Times spoke with one patient who suffered from severe rectal disorders after having erroneous seed placements at the Philadelphia VA hospital. And the Inquirer found that that veteran was just one of nine who had had this particular maltreatment.
Image of seeds used to treat prostate cancer courtesy of Wikimedia Commons