Summer Recap | Penn Med doctor defends actions despite errors at VA hospital

Gary Kao, a radiation oncologist at the School of Medicine, was told his services would no longer be needed at the Philadelphia Veteran Affairs Medical Center after he was accused of poorly administering 92 veterans' prostate cancer treatments.

Kao performed 116 brachytherapy treatments - in which radioactive seeds are implanted in prostates to attack cancerous cells - while on contract with the VA hospital. An investigation revealed that, of those 116, 55 may have received a lower dose of radiation than planned, while 37 may have received a higher dose or had radioactive seeds implanted in organs other than the prostate.

Kao testified in July at both a hearing of the U.S. Senate Veterans' Affairs Committee, held at the Philadelphia VA Medical Center, and a Congressional hearing a couple of weeks later in Washington, D.C. At both hearings, he defended his actions and denied that his misconduct was as severe as news reports have described.

At the first hearing, he asserted that the errors he committed should have been prevented and caught by other members of the brachytherapy team.

While Kao admitted he inserted the radioactive seeds into organs surrounding the prostate and failed to notify his patients of these errors, Kao did not consider these procedures to be botched.

"The chance of seeds being outside the prostate is a recognized risk [of brachytherapy]," Kao said, noting that this risk is explained on the consent form the patient must sign before surgery.

He added, "Even when seeds are outside the prostate, they still contribute to the radiation dose."

At the later hearing, he stressed that many of the 92 procedures considered "reportable medical events" - those a hospital is required to report to the Nuclear Regulatory Commission, which is responsible for issuing the necessary license to use radioactive seeds for the treatment - were not actually misadministered since the NRC's standards focus on radiation dosage.

Additionally, Kao held that the brachytherapy program at the VA hospital is identical to those he participated in at Penn Medicine and one of its satellites.

However, he did admit that for 14 months, a technology problem at the VA Medical Center prevented the results of the procedures from being optimally analyzed, and that he continued administering treatments in spite of this problem.

Duke University Radiation Oncology professor Robert Lee, who testified on behalf of the American Society for Radiation Oncology at the Congressional hearing, found fault with Kao's arguments and actions.

After looking at images of Kao's procedures, Lee, who has no affiliation with the Philadelphia VA Medical Center's program, said he thought Kao performed the treatments poorly enough that they needed to be reported.

He added that he would have stopped treatments when the technology problem occurred.

The brachytherapy program has been shut down and does not plan to start back up until all investigations are completed.

The center has not lost its license to perform the procedure, according to Eliot Brenner, Director of the Office of Public Affairs at the NRC.

The NRC has been conducting its own investigation of the incident since July 2008, when it received initial reports of inaccurate dosages. One of the goals of this investigation is to determine if the VA hospital properly reported the issue at the proper time, according to Brenner. No conclusions have been reached so far.

Senior staff writers Naomi Jagoda and Liz Rubin and Opinion Blog Editor Abby Schwartz contributed reporting to this article.

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