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NYT Report Charges “Rogue” Cancer Unit In Philadelphia with Botching Prostate Cancer Treatments

Posted Aug 27 2009 11:37pm

An article in The New York Times today charges that that a “rogue cancer unit” at the veterans hospital in Philadelphia seriously botched 92 out of 116 procedures to treat prostate cancer.  Dr. Gary D. Kao performed almost all of the botched procedures, which took place between 2002 and mid-2008, when the “problems” began to surface and the prostate treatment unit was closed.

The procedure was brachytherapy, in which tiny radioactive seeds are placed in the prostate to kill cancerous cells.  According to the Times, the Nuclear Regulatory Commission ultimately found that “Dr. Kao and other members of his team … were not properly supervised or trained in what constitutes a substandard implant or the need to report it.”  Medical procedures using radiation are supposed to be closely monitored.  Neither the hospital nor any of the agencies that oversee the use of medical radiation or hospital safety in general noticed the pattern of botched procedures until a clerical error led to a systematic review of the unit’s performance.

Apparently Dr. Kao routinely missed the prostate, putting the powerful radioactive seeds into surrounding tissues instead — the bladder, the rectum, and the perineum.  Many of the patients not only received too little radiation in their cancerous prostates, but  also experienced tissue damage in other areas.  One patient, Reverend Ricardo Flippin, experienced months of bowel pain that did not respond to any treatment.  Flippin finally got a diagnosis of “radiation injury to the anal canal” after months of agony and many rounds of painkillers, circumstances that eventually forced him to quit his job.

This awful report highlights several critical things for patients to remember:

1) Know exactly who is going to be treating you.  Rev. Flippin, for example, was apparently counseled about brachytherapy by another doctor — Dr. Richard Whittington, then chief of radiation oncology at the Philadelphia V.A. Flippin says Whittington told him: “he had done over 600 seed implants, that there was nothing to worry about.” However, it was Dr. Koa who performed the procedure on Flippin, seriously botching it.

2)  Doctors and hospitals police themselves, and are usually loath to interfere with any physician’s “right” to continue to practice.  It’s true that this is an unusually serious case, but it unquestionably pays to thoroughly research your physician, particularly if you are having a risky procedure.  A doctor’s experience with a procedure does make a difference, and the quality of care varies significantly depending on who your physician is and what hospital you stay at.  Use online rating tools like HealthGrades and Angie’s List to find out more about your doctor. Ask them directly how often they have done the procedure and how many of their patients have side effects and how serious those side effects where.  Call around and find out the records of several physicians.  A good doctor should not be defensive about his or her performance, and should be honest and open about potential side effects.  Go to sites like The HealthCareScoop.com to find out if anyone has good or bad experiences to share about your doctor.

3) Understand the risks and side effects of any procedure before you have it done.  Certainly, it’s no good to obsess about side effects to the point where you convince yourself you are having them.  But it is good to know what the side effects are, how you’ll know when you are really experiencing them, and what can be done to guard against them.

Arming yourself with information before you have a procedure is just good sense.  Sure, it’s easier to put your head in the sand, cross your fingers, and expect the best, but by chosing your physician wisely and understanding the risks fully you are giving yourself an even greater chance of a good outcome.

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