The nuclear option: Bogdanich drops a bomb on VA hospital

Walt Bogdanich, three-time Pulitzer-winning New York Times reporter, has written a phenomenal story about cancer care at the Veterans Affairs hospital in Philadelphia and tapped into a rich source of material for medical writers: the Nuclear Regulatory Commission.

On Sunday, the Times published Bogdanich's detailed account of "a rogue cancer unit at the hospital, one that operated with virtually no outside scrutiny and botched 92 of 116 cancer treatments over a span of more than six years - and then kept quiet about it, according to interviews with investigators, government officials and public records."

He also spreads the blame around.

"Peer review, a staple of every good hospital, in which colleagues examine one another's work, did not exist in the unit," Bogdanich writes. "The V.A.'s radiation safety program; the Nuclear Regulatory Commission, which regulates the use of all nuclear materials; and the Joint Commission, a group that accredited the hospital, all failed to intervene; either their inspections had been limited or they had not acted decisively upon finding problems."

Bogdanich posted six pages of medical records for one of the patients, detailing how one he had been wounded by improper placement of radioactive seeds that should have targeted cancer cells in his prostate but instead ended up damaging his lower bowels. With the help of some physicians at Thomas Jefferson University, the Times created a wonderful animated graphic showing how the seeding procedure should work and what went wrong in two cases at the VA hospital.

If you go to the NRC's site, it won't be obvious that there is medical information to be found there. But play around with the agency's ADAMS search engine. My first attempt, using the terms veterans affairs medical center, without quotation marks, yielded 1,000 documents. At the top was a document that gave Bogdanich one of the best quotes in his story, a transcript of a May 2009 meeting in which the problems at the Philadelphia VA were discussed.

If you do an advanced search and click on "boolean," you can try brachytherapy, which was the type of surgery that went awry, and Philadelphia and VA. You should get 92 results. If you set the sorting function to "Document Date" and "ascending," you will get the oldest records first. Now you can see the story start to emerge. (Might some eagle-eyed reporter in Pennsylvania have caught it before Bogdanich?)

Here's one example of the misplaced radioactive seeds being discussed in a May 2007 NRC report. There appears to be a potentially huge untold story here about the use of radioactive seeds. At the same time the Philadelphia VA was having problems, the Guthrie Clinic in Sayre, Pa., was reporting a series of mistakes in its seed treatment, according to these advisory committee records:

"Since June 16, 2003, Guthrie Healthcare System has reported a total of 21 misadministrations/medical events that occurred at its facility in Sayre, Pennsylvania between January 2001 and January 2002 during the implant of iodine-125 seeds for treatment of prostate cancer. On July 28, 2003, after licensee identification and reporting to NRC of four such medical events, Region I issued a Confirmatory Action Letter (CAL No. 1-03-003). The CAL outlined the actions to be taken by the licensee. Included, in order to identify any additional such events, was performing an audit of all prostate seed implants performed at the licensee's facility from 2001 to the date of the letter and any others performed at its facility prior to 2001 by the Radiation Oncology staff members who were involved in the four reported misadministrations/medical events."

You can find reports to Congress about abnormal occurrences, enforcement reports and even lists of FOIA requests. To understand the big picture, here is just one example of a document that could provide great fodder for reporters. I found it doing the same search I described above. In it, the NRC decries a "systemic management failure" in Veterans Affairs oversight of hospitals in Chicago, Indianapolis, St. Louis and, of course, Philadelphia. It says "the poor management attitude will destroy the radiation safety culture in the VA...and continuing safety failures will occur."

If you've read Bogdanich's story, you will remember that phrase, "safety culture."

"Over all, the implant program lacked a 'safety culture,' the nuclear commission found," Bogdanich writes. Maybe that's because, until now, so few stories about the NRC's role in medical oversight have seen the light of day.