Doctor in Phila. VA prostate controversy takes leave

The University of Pennsylvania radiation oncologist at the center of the controversy about the Philadelphia VA Medical Center's prostate cancer program has taken a leave from Penn's medical school.

Gary D. Kao "asked for a leave of absence" and it was granted yesterday, said Susan E. Phillips, senior vice president of the Penn health system, in response to The Inquirer's questions about the doctor's status.

Kao also will voluntarily attend a hearing at the Philadelphia VA hospital on Monday to answer questions about the program, his lawyer, Jack Gruenstein, said. Gruenstein declined to comment about the leave yesterday.

Sen. Arlen Specter (D., Pa.) has scheduled the hearing on the brachytherapy program for 10 a.m. in the Third Floor Multipurpose Room at the hospital, 3900 Woodland Ave.

Although the Department of Veterans Affairs has been in the spotlight over the suspended program and safety violations, the scandal has implications for Penn's reputation.

The VA facility is on the edge of the Penn campus, and the agency contracted with Penn physicians, who performed the brachytherapy procedures on veterans.

The facility is also a teaching hospital for Penn medical residents.

Last year, after questions were raised about the program, Kao voluntarily limited himself to laboratory work. Penn has said he was involved in treating most of the 92 veterans whose radiation care was substandard. The procedures occurred from the program's start in 2002 to its suspension in mid-2008.

In brachytherapy, physicians permanently implant in a prostate from 80 to 120 tiny metal "seeds" that emit radiation over a 10-month period.

If improperly placed, the seeds can damage nearby organs while delivering less-than-optimal doses of radiation to the prostate.

The ongoing investigations by the VA and the U.S. Nuclear Regulatory Commission found that 57 veterans were underdosed. An additional 35 received excessive radiation to tissue or organs near their prostates, including 25 whose rectums were overdosed.

Yesterday, the problems with the program were a focus of a public meeting of the NRC, which regulates treatments using radioactive materials, and its medical advisory committee in Rockville, Md.

All five NRC commissioners expressed concern about the situation that caused dozens of veterans to get incorrect radiation doses.

Commission Chairman Gregory B. Jaczko noted that the NRC's medical consultant in the case concluded that the "seed placement was quite erratic and not in keeping with current medical standards."

"We will continue to pursue this issue," Jaczko said.

The NRC is expected to complete its investigation this summer.

The Rev. Ricardo Flippin, 68, now of Charleston, W. Va., was one of those apparently injured by the treatment.

A 68-year-old minister, teacher and Air Force veteran who served in Vietnam, Flippin underwent the procedure at the Philadelphia VA facility in May 2005. Medical records show that his prostate gland received only 67 percent of the prescribed radiation dose.

After the treatment, he began having rectal pain, bleeding and digestive problems that grew more debilitating.

A doctor outside the VA system finally diagnosed Flippin's problem as radiation injury to the anal canal. Surgery repaired the damage, but he continues to have problems with bowel control.

His lawyer, Robb Graham of Cinnaminson, has filed a claim against the VA.

At yesterday's NRC hearing, advisory committee member James Welsh, a radiation oncologist from the University of Wisconsin, cautioned against a rush to judgment. He also expressed concerns about the "culture of safety" at the Philadelphia VA hospital as well its failure to catch the problems early on.

Welsh noted that nationally in 2008, there were about 100 "medical events" - or substandard care - involving brachytherapy out of 50,000 procedures, suggesting that the Philadelphia VA problems may have been an isolated situation in which a "safety culture may have been lacking."

He told NRC commissioners yesterday that while "some of the reported events may prove to be clinically significant, others may not."

Inquirer staff writer Marie McCullough contributed to this story.