A Philadelphia radiation oncologist was banned this week from performing most therapies that use radioactive materials.
The federal Nuclear Regulatory Commission found that Dr. Gary Kao performed the vast majority of his prostate brachytherapy procedures incorrectly while he was working at the Philadelphia VA Medical Center between 2002 and 2003.
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.
VA spokesman Dale Warman said he hopes the sanction brings closure one step closer.
“This happened almost three years ago, a lot of corrective measures have been taken,” Warman said. “Our focus is on the quality of care for our veterans.”
The problems at the hospital led to a federal investigation and a change in standards at VA hospitals nationwide, according to Warman.
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.