Seven Ways 'Til Sunday

Paresh Nath
The National Herald (India)

Men are apt to be much more influenced
by words than by the actual facts
of the surrounding reality
--Ivan Pavlov

Happy is he who could
perceive the causes of things
--Virgil

But it ain't me, babe,
No, no, no, it ain't me, babe,
It ain't me you're lookin' for, babe
--It Ain't Me, Babe, Bob Dylan
______________

Old Army buddy Rob Valentine used to joke that being a proctologist was the best job in the world -- there was always a light at the end of the tunnel. That joke is not feeling so funny now.

The New York Times fronted last Sunday's edition with the horrific story of a "rogue cancer unit" at Philadelphia's Veterans Administration Hospital, where 92 of 116 prostate procedures were "botched" (At V.A. Hospital, a Rogue Cancer Unit). Prostate cancer is a presumptive service-connected condition for Vietnam veterans, so this is of special concern to those exposed to Agent Orange. First we are sprayed, then spayed.

For patients with prostate cancer, it is a common surgical procedure: a doctor implants dozens of radioactive seeds to attack the disease. But when Dr. Gary D. Kao treated one patient at the veterans’ hospital in Philadelphia, his aim was more than a little off.

Most of the seeds, 40 in all, landed in the patient’s healthy bladder, not the prostate.

It was a serious mistake, and under federal rules, regulators investigated. But Dr. Kao, with their consent, made his mistake all but disappear.

He simply rewrote his surgical plan to match the number of seeds in the prostate, investigators said.

The revision may have made Dr. Kao look better, but it did nothing for the patient, who had to undergo a second implant. It failed, too, resulting in an unintended dose to the rectum. Regulators knew nothing of this second mistake because no one reported it.

Two years later, in 2005, Dr. Kao rewrote another surgical plan after putting half the seeds in the wrong organ. Once again, regulators did not object.

Had the government responded more aggressively, it might have uncovered 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.

The team continued implants for a year even though the equipment that measured whether patients received the proper radiation dose was broken. The radiation safety committee at the Veterans Affairs hospital knew of this problem but took no action, records show.

A clerical error revealed the "substandard implants." The investigating Nuclear Regulatory Commission found that, "over all, the implant program lacked a 'safety culture'." This is sounding a familiar note in the V.A. medical culture.

In addition, "seeds were implanted in the wrong places. As more cases were examined, more mistakes were found." Why was lead surgeon Dr. Kao not charged with criminal negligence?

"The V.A. put too much trust in the contractors, said Darrell G. Wiedeman, a senior health physicist for the nuclear commission. 'They claim they hired experts, the best that money could buy from the local university, so therefore they didn’t require a lot of training and oversight,' Mr. Wiedeman said at a recent meeting of the nuclear commission’s advisory board."

The problems at the V.A. are consistent, systemic and often covered-up, hidden like the too-weak radioactive seeds stuck in inappropriate regions (see Scope Alert). For all the talk of shock and reform, here we are seven years into meaningless wars and the infrastructure to care for those returning human assets remains SUSFU.

Not only are the V.A. Clinics and hospitals -- once the poster boys of health care efficiency for Congress because of their limned down expenses -- endangering patients' lives, many can't even get in through those dangerous doors anyway. Almost a million disability claims sit unprocessed at this reading.

"Citing a fast-growing backlog of unresolved disability claims, veterans groups and members of Congress are calling for an overhaul of Department of Veterans Affairs procedures for handling cases.

"The number of unprocessed disability claims has grown by nearly 100,000 since the beginning of the year and totaled 916,625 as of Saturday, a rise driven in part by increasing numbers of veterans from the Iraq and Afghanistan wars.

" Rep. John Hall (D-N.Y.), who last week chaired a House Veterans' Affairs subcommittee meeting titled 'Can VA Manage One Million Claims?,' said the department needs 'a cultural and management sea change'" (Groups Urge VA to Reform Disability Claims Procedure.)

Talk of national health care seems fallow if we can't even get the V.A. system functioning, a sort of "socialized medicine" plan that the U.S. has had decades to tinker with.

The V.A. medical program will not be fixed until the Executive, Legislative and Judicial branches are forced to used DVA facilities as their personal medical provider. Then watch the feathers fly.

The problem is not remedied because they got theirs and we got ours. SRDH, and the veterans inhabit the lowlands.