Doctor Punished For Nearly 100 Prostate Surgeries Performed Incorrectly on Veterans

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pipedream
Regular Member


Date Joined Aug 2010
Total Posts : 64
   Posted 2/25/2011 9:44 PM (GMT -6)   
I saw a short story about this in our local newspaper today and have to say I am stunned to read that this Doc may be allowed to perform seeding again if he gets more training and that no mention was made of what happened to the almost 100 men whose treatment he botched. Presumably Dr. Kao had training prior to all these procedures, no? What makes the Nuclear Regulatory Commission think that more training will make the man competent?


Doctor Punished For Nearly 100 Prostate Surgeries Performed Incorrectly on Veterans

Dr. Gary Kao, of the Philadephia VA Medical Center, has been sanctioned after botching 91 prostate surgeries.

The doctor has been barred from doing any Veteran's Administration activities without first obtaining more education. The affected patients were found to have doses of radiation that were well below therapeutic because Dr. Kao inserted the radioactive seeds in the wrong place.

Instead of inserting the radioactive seeds in the prostate gland, where the radiation would have worked as a treatment for prostate cancer, he was found to have inserted them in surrounding tissue and organs. Not only would this not be effective for treating prostate cancer, but the seeds could cause significant damage to the organs and tissues where they were inserted.


surgery.about.com/b/2011/02/24/doctor-punished-for-nearly-100-prostate-surgeries-performed-incorrectly-on-veterans-dr-gary-kao.htm

Excerpts from another article:

....The errors in the common cancer treatment involved misplacing iodine tablets meant to be inserted into the prostate.

This is the latest sanction from the NRC, which oversees all civilian use of nuclear materials, in what it called a "widespread programmatic breakdown" at the hospital.

Between 2002 and 2008, the commission found 97 of the 116 brachytherapy procedures performed on prostate cancer patients were done incorrectly. Of those, 91 were performed by Kao.

“That percentage of mistakes, and having gone for six years without recognizing or reporting (them), is unprecedented,” NRC spokeswoman Viktoria Mitlyng said.

In 2008, the VA hospital suspended its brachytherapy program. Last year, it was fined more than $200,000 for failing to catch and report the errors.....

Kao is now a researcher at the University of Pennsylvania. In a statement, he said he accepts the ruling and is glad the investigation is over. A University of Pennsylvania representative said the doctor does not have any clinical responsibilities and the NRC order does not affect his job.

The NRC said Kao could be allowed to perform radiation therapies again if he receives further training. In a separate order, the NRC also required a medical physicist involved in many of the cases, Gregory Desobry, to notify the agency if he engages in any activities it regulates.


www.newsworks.org/index.php/local/item/13833-doc
Husband DX @ 64; 7.5 year survivor colon cancer; father had PCa @ age 65
04/09 - PSA 3.06
10/09 - PSA 1.55
04/10 - PSA 4.26

Biopsy 7/10 Gleason 7; 3+4 & 4+3 - 6 of 10 cores

RRP - 10/1/10; Gleason 3+4; 20%; pT2c; contained, clear margins

Post surgery PSA - 11/10 = <0.06

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 2/25/2011 10:12 PM (GMT -6)   
As a fellow Vet, a story likes this just boils my skin. Yeah, that fine is really going to teach the doctor in question. Geez.
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

H555
New Member


Date Joined Mar 2010
Total Posts : 15
   Posted 2/26/2011 11:01 AM (GMT -6)   
ditto. I'm 100% SCD and just signed up for VA health care as I get ready to retire in 4 months. We'll still have my wife's health insurance till she retires and I hope I never need health care from the VA.

geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 2/26/2011 2:37 PM (GMT -6)   
This story actually broke nearly two years ago. It was at the Philadelphia VA hospital but the radiation program was managed by the Hospital of the University of Pennsylvania. Nobody is going to nominate Dr. Kao for any awards, but there is a lot of other blame to go around. It reads to me like a management meltdown with lots of different people letting their responsibilities slide.

It may be that requiring more training is the strongest penalty that the NRC can impose on a doctor

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 2/26/2011 5:04 PM (GMT -6)   
geezer, i spent time back in 1971 at the Philly VA hospital as a patient when I first got out of the Navy, and it was a living shi*t hole back then, I wasn't surprised when I first read of this story and event when it happened. There's not a VA hospital I would be a patient of in my entire state of SC. Fortunately, I can go to the one in Asheville, NC, which surprisingly, has a good overall reputation.

david
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4229
   Posted 2/27/2011 12:59 PM (GMT -6)   
The VA is the last place I would go for a serious condidtion. It was a lot more than just the doctor's fault.
A Brachytherapy procedure should always have a urologist present who scopes the bladder after the procedure to look for stray seeds and a CT scan is given two weeks after the procedure to confirm the seed placement. If these two quality control fuctions were taken these probems could have been spotted.
To me it looks like a total breakdown in basic quality, not just an incompetent doctor.
JT
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

NEIrish
Regular Member


Date Joined Aug 2010
Total Posts : 245
   Posted 2/27/2011 6:56 PM (GMT -6)   
I hate to add fuel to this fire, but we learned from a VA nurse friend our ours many years ago that so many of the hospitals or treatment centers the vets used were horrifyingly substandard. Then the media finally broke the news after the desert wars of how bad the VA hospitals were in many places. I'm sure many remember the coverage of the peeling ceilings, leaky pipes etc. At the time she let us know pre-media, they'd just had a bad series of colonoscopies - major infections resulted from insufficiently sterilized instruments. We found out after she was let go from her job of many years, soley to save money by cutting back on staff. Really horrifying to learn what some vets would come home to for treatment...
Husband 60yrs., no symptms: PSA 10/04 2.73, 12/06 3.64, 5/09 3.9, 10/09 4.6, 1/10 5.0w/ free PSA 24
6 core biop 4/1/10 path rept: rt mid: adnocarc. G=3+3, 5% of core; R apx v. susp. minute ca, R base bnign w/ mod. atrophy, L side atrphy only; 2nd opnion JH confrmd
MRI - 15mm nodule
BiLatRP surg 7/6/10, path: T2c, nodes, sem.ves, extra caps. neg., adenoc both sides G=3+3 cntinent, Viagr-8/27 ED

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 2/27/2011 7:38 PM (GMT -6)   
So, will there be legal action against Dr Gary Kao, a.k.a. GD Kao?

This link gives more details. Was he paid for this work? At the very least all charges and penalties should be taken out of his hide salary.

'...a patient that he had improperly implanted seeds into his rectum instead of his prostate. Almost all the 92 veterans who had received incorrect radiation doses had the seeds implanted in the wrong places.'

Jeff

Link corrected

Post Edited (Worried Guy) : 2/28/2011 6:00:45 AM (GMT-7)


pipedream
Regular Member


Date Joined Aug 2010
Total Posts : 64
   Posted 2/27/2011 8:18 PM (GMT -6)   
American Board of Radiology, Radiation Oncology, 1994

Does this mean he is "Board Certified"? Not very confidence producing.

Nor does his continued employment at UPenn inspire faith in the ivys.
Husband DX @ 64; 7.5 year survivor colon cancer; father had PCa @ age 65
04/09 - PSA 3.06
10/09 - PSA 1.55
04/10 - PSA 4.26

Biopsy 7/10 Gleason 7; 3+4 & 4+3 - 6 of 10 cores

RRP - 10/1/10; Gleason 3+4; 20%; pT2c; contained, clear margins

Post surgery PSA - 11/10 = <0.06
02/11 = <0.06

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3748
   Posted 2/27/2011 8:32 PM (GMT -6)   
Punished? How was Dr. Kao punished?? He probably got a pay raise when he moved from the VA to the University of Pennsylvania..

I wonder how the 92 men who had their treatment botched are doing....That's the real story and it's being swept under the rug..Do the 92 Veterans even KNOW what happened to them?? Do they even know the name of the doctor who performed the brachythrerapy procedure on them? Did someone inform them t might be a problem?

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6949
   Posted 2/27/2011 8:47 PM (GMT -6)   
Fairwind,
 
Besides choice of boat, we seem to disagree now and then, but here we are 100% in line.
 
I would expect that the hours of pain, days/weeks/years living or lost with bad treatment, money spent to fix the errors, all should be quantified and taken either in prison time at 50 cents a day or assets seized from all those who participated in this maltreatment.
 
Being "remanded" to research work does not seem like punishment. Maybe they can get into a training program and learn a trade in prison. License plates, anyone?
 
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