The Philadelphia VA Medical Center was hit with a $227,500 fine by the Nuclear Regulatory Commission yesterday for poor care in a prostate cancer program that resulted in 97 veterans getting incorrect doses of radiation.

The fine levied against the Department of Veterans Affairs was the second largest ever by the NRC against a medical facility. The VA has 30 days to contest the fine.

"The VA Philadelphia had a total breakdown in management oversight, a total breakdown in the program, and a total breakdown in safety culture that resulted in these egregious failures," said Steve Reynolds, director of the division of nuclear material safety for NRC Region III, which oversees the Veterans Health Administration.

The largest NRC fine was $280,000 in 1996 against the owners of hospitals in Indiana, Pa., and Marlton. That case involved the death of a patient.

"Fortunately nobody died here," Reynolds said.

At least not yet.

Between February 2002 and June 2006 - when the prostate brachytherapy program at the Philadelphia VA was shut down - 114 veterans were implanted with dozens of radioactive seeds to kill their cancerous cells.

So far, 11 of those veterans have had recurrences of their cancer, and eight more show signs of a possible return. In addition, nine men sustained radiation injuries to their rectums, according to the VA.

The treatment mistakes led to internal investigations, congressional scrutiny, the NRC probe, a continuing review by the VA's inspector general, and a flood of legal claims.

The VA inspector general is expected to issue its report next month.

"There were clearly missed opportunities in oversight from 2002 to 2008," said Richard S. Citron, the Philadelphia VA director.

"But issues with the brachytherapy program do not reflect the high level of health care offered in Philadelphia or throughout the VA system."

Brachytherapy involves implanting dozens of radioactive seeds inside the prostate gland to destroy cancerous cells over several months. The treatment is highly effective when done correctly.

Records show that the Philadelphia program - which was run by University of Pennsylvania doctors - was deeply flawed from the start, and that doctors and officials repeatedly missed chances to fix it.

On Feb. 3, 2003, for example, the brachytherapy team implanted its ninth patient with 74 radioactive seeds aimed at his prostate. A routine check after the implant showed that 40 of the seeds landed in the bladder.

Legal claims, suits

In a case in 2005, 45 of the 90 seeds implanted in an 86-year-old veteran were put in his bladder and had to be extracted.

Some seeds ended up near the rectum, and the patient reported significant pain in urination, records showed. He was one of eight Philadelphia patients whom the VA sent to Seattle last year for reimplantation.

At least 31 veterans or wives have filed claims seeking a total of $58 million against the VA. Two men have filed federal lawsuits.