A sad case of VERY bad medicine

Reports yesterday in the Philadelphia Inquirer and in the New York Times detail what appear to be a series of truly miserable cases of mistreatment of nearly 100 prostate cancer patients at the Veterans Administration Medical Center in Philadelphia between February 2002 and May 2008.

Apparently some 92 patients were treated with brachytherapy for localized prostate cancer during that time by a Dr. Gary Kao: the vast majority of these patients were supposedly undertreated and many of them had a range of other problems, from severe adverse events resulting from their treatment to simple mistreatment as a consequence of bad technique in implantation of the radioactive seeds.

Dr. Eric Horowitz, the recently appointed president of the American Brachytherapy Society, and the acting chairman of the radiation oncology department at the Fox Chase Cancer Center in Philadelphia is said to be “troubled” by the findings to date and is quoted as saying that, “It is still surprising that some of these things happened.” The “New” Prostate Cancer InfoLink thinks that Dr. Horowitz should be more than “troubled.” He should be appalled!

The list of evils is well documented by the articles in the Philadelphia Inquirer and the New York Times. What The “New” Prostate Cancer InfoLink would like to focus on is that this should be a wake up call for the Veterans Administration as a whole.

For years there have been numerous and widely reported cases of poor medical care being provided at VA medical facilities across the nation. Yet politicians continue to claim that the American health care system is “the best in the world.” That may be true for those who have the insurance coverage and the capabilities to get to centers of excellence — but it certainly is not true for many veterans and their families who are dependent on the VA for their health care.

In another case that The “New” Prostate Cancer InfoLink is intimately familiar with, the VA failed to appropriately manage the care of a relatively young patient left with chronic and severe incontinence after radical prostatectomy. The patient suffered for 3 years with his problems while the VA provided minimal support and pretty much told him that there was nothing they could do. He was using in excess of 20 incontinence pads a day throughout much of that time  — except when he was catheterized. Happily we were able to assist this patient to gain a referral to a respected expert in post-surgical incontinence, with a referral relationship for VA patients, and the patient in question was provided with appropriate expert care within a matter of a few months. But why couldn’t the VA have done this themselves?

The VA’s health care system needs a complete, top-to-bottom overhaul as part of the health care reform process. We are well aware that there are parts of the VA system that provide excellent and very high quality care. There are others that apparently would not recognize such quality of care even if it was held under their noses. It is our position that the VA health system should be a leader, not a follower, in the provision of well-documented quality of care across it’s entire system. It provides health care services for millions of men and women who have given service to America — some for a few years but others for decades. It should set an example for others to follow.

The Philadelphia VA Medical Center is one with a long history of less than exemplary service to patients in the area it serves. We suggest that the overhaul of the VA system starts with a complete review of quality and care services in place the Philadelphia VA Medical Center, leading to the development and implementation of quality of care protocols that can then be used as a model for VA hospitals across the nation — and a built-in process of continuous monitoring and quality improvement. Secretary Sebelius, President Obama, are you listening?

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