A doctor accused of botching dozens of prostate cancer surgeries at a Veterans Administration hospital admitted Monday that he sometimes missed his target when implanting radioactive seeds, leaving patients with incorrect dosages.
But Dr. Gary D. Kao called the mistakes commonplace in aiming seeds at the walnut-sized prostate, which sits near the bladder and rectum, and he steadfastly refused to become a scapegoat for the scandal at the VA Medical Center in Philadelphia.
"Contrary to the allegations that I was a 'rogue' physician, ... I always acted in the best interest of the patients in delivering this important treatment," Kao, a radiation oncologist, testified at a Senate field hearing at the hospital, where he worked from 2002 to 2008.
The Nuclear Regulatory Commission has found that 92 of 116 men treated in the hospital's brachytherapy program received incorrect doses of the radiation seeds, often because they landed in nearby organs or surrounding tissue rather than the prostate. Kao performed the majority of the procedures under a VA contract with the University of Pennsylvania, where he was on staff.
Under questioning from Sen. Arlen Specter, Kao acknowledged that he never informed patients when he missed the prostate or delivered insufficient doses.
Kao, however, said the mistakes did not necessarily amount to substandard care that had to be reported to the NRC or other agencies.
"Brachytherapy was and still is an evolving field," he said.
Kao, 45, testified at the hearing voluntarily, albeit with a lawyer at his side. In a lengthy written statement, he said he earned his medical degree from Johns Hopkins University, did his radiation oncology residency at the University of Pennsylvania and has never been sued for malpractice.
Rep. John Adler, D-N.J., harshly questioned why he still had a medical license.
Rep. Chaka Fattah, D-Pa., seemingly defended Kao while questioning the long-term safety of the procedure, which thousands of men across the country have undergone in recent years.
Specter sought the middle ground, eliciting an apology and an awkward embrace from Kao to one of his alleged victims, the Rev. Ricardo Flippin.
Flippin, 68, of Charleston, W.Va., testified that he lost his job during five months he spent in bed, incapacitated, after Kao implanted seeds into his rectum instead of his prostate in 2005. The VA suggested he was suffering from hemorrhoids or constipation afterward, but an Ohio State University physician finally diagnosed the problem as radiation burn and surgically corrected it, Flippin said.
"Rev. Flippin, we should have, we can do better," Kao said. "I hope we have a chance to do better for you and your colleagues in the future."
Flippin said he would have chosen another treatment option, such as having his prostate removed, had he known the risks involved with the radiation seeds.
The brachytherapy program at the VA Medical Center in Philadelphia has been suspended. A review of 12 other VA hospitals where the procedure is performed showed a handful of problems, but none on the same magnitude. The NRC also said, based on reporting by doctors and the agency's own reviews, the problems at the Philadelphia hospital were far more frequent than U.S. hospitals overall.
Kao has stopped performing the surgeries and last week took a leave from the University of Pennsylvania.