VA on radiation hot seat

Steven Reynolds, Director, Division of Nuclear Materials Safety, Region III (center), asks questions of the Veterans Administration Medical Center, Philadephia, staff during the US Nuclear Regulatory Commission hearings, Dec. 17, 2009, on the brachytherapy mistakes made at the Philadelphia Veterans Administration.

The failures of a prostate cancer program at the Philadelphia VA Medical Center and similar problems at 12 other VA hospitals has raised questions about whether the Veterans Health Administration can adequately oversee the safe use of radioactive materials in its health system.

Wednesday, top radiation safety officials from the Department of Veteran’s Affairs will testify before a panel of the U.S. Nuclear Regulatory Commission in advance of the agency’s decision on how to address three apparent violations of federal radiation safety regulations.

The NRC could levy a fine against the VA for the problems or, in a more far reaching action, strip the VA of its ability to oversee radiation services at all 153 hospitals nationwide. The commission would then take on those duties or assign them to states, such as Pennsylvania and New Jersey that have that capability.

On May 25, the NRC released a preliminary finding that the VA had violated federal regulations in its 13 prostate brachytherapy programs in hospitals from Brooklyn, N.Y., and Jackson, Miss., to Seattle and Los Angeles. Prostate brachytherapy involves implanting dozens of tiny radioactive seeds into the acorn-sized gland to kill cancerous cells over several months. It is an effective treatment when done correctly.

But the records show that the Philadelphia VA’s program was deeply flawed from its earliest patients and that doctors and officials repeatedly missed chances to fix it. Those failures - which occurred from February 2002 until the program was shut down in June 2008 - prompted the NRC to take a deeper look at other brachytherapy programs in the VA system.

In March, the commission levied a $227,500 fine against the VA for a series of failures at its Philadelphia hospital’s prostate brachytherapy program that resulted in 97 veterans getting incorrect doses of radiation.

The commission also launched an investigation of the VA’s national radiation safety committee and its National Health Physics Program, which oversee the use of radiation across the Veterans Health Administration.

The nuclear agency found the three apparent violations extended beyond Philadelphia to other VA hospitals centers. They involve failing to develop procedures to ensure that care is carefully laid out, verify that the procedure goes according to plan in at least four medical centers; and not reporting one incident of improper dosing within 24 hours, as required.

NRC officials said it was worrisome that those VA safety organizations failed to identify problems such as underdosing of patients, accidentally implanting radioactive seeds in patient's bladders, and delivering excessive radiation doses to patients' rectums and other healthy tissue.

The problems at the Philadelphia VA also promoted the Veterans Health Administration to change its oversight of programs that use radiation to treat cancer at its hospital said Charles Anderson, chair of the VA National Radiation Safety Committee.

“These changes have come about because they realized the weakness that was exposed by Philadelphia,” Anderson said. 

Calling the failures in the brachytherapy program at the Philadelphia VA hospital a “game change,” Anderson added, 
“our level of oversight of our radiation safety programs has profoundly increased from what we had before.”

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Check out other stories on the prostate brachytherapy program at the Philadelphia VA:

Sunday, June 21, 2009
Feds see wider woes in VA's cancer errors

Sunday, July 19, 2009 
VA radiation errors laid to offline computer

Sunday, August 9, 2009
VA's prostate treatment woes began at Penn;
Prior to the VA program, leading brachytherapists said the Penn doctors performing the radioactive seed implants lacked the proper skills and safeguards.

Sunday, November 15, 2009
VA clinic troubles bring few penalties;
Despite poor care in the Phila. prostate program, the agency has only slapped a few hands

Wednesday, November 25, 2009
Claims against Phila. VA up to $58 million

Thursday, Mar. 18, 2010
NRC fines Phila. VA $227,500 over prostate care

Tuesday, May 4, 2010
Mistakes, little oversight cited for Phila. VA prostate cancer treatment

Wednesday, May 26, 2010
NRC finds apparent violations at 13 VA hospitals