The Department of Veterans Affairs is back on the hot seat for the failures of prostate cancer programs in a dozen of its hospitals – including the Philadelphia VA Medical Center.

The U.S. Nuclear Regulatory Commission, which oversees the medical use of radioactive materials, issued a preliminary finding that the VA violated three federal regulations in prostate brachytherapy programs in hospitals in Brooklyn, N.Y., Jackson, Miss., Seattle, Wash. and Los Angeles, Ca.  The NRC has scheduled a conference with the VA for June 30 after which it will issue its final findings and any fines or other enforcement actions.

In March, the NRC levied a $227,500 fine against the VA for a series of failures at the Philadelphia VA's prostate brachytherapy program that resulted in 97 veterans getting incorrect doses of radiation from dozens of radioactive seeds implanted in the acorn-sized glands.

Prostate brachytherapy involves implanting dozens of tiny radioactive seeds into the prostate gland to kill cancerous cells over several months. It is an effective treatment when done correctly. Records show that the Philadelphia VA's program was deeply flawed from its earliest patients, and that doctors and officials repeatedly missed chances to fix it.

Those treatment failures at the Philadelphia VA _ which occurred from February, 2002 until the program was shut down in June, 2008 _  prompted the NRC to take a deeper look at other brachytherapy programs in the VA system and at the VA's national radiation safety committee and at its national health physics program both of which were supposed to oversee the safe use of radiation across the Veterans Health Administration.

On Monday, the NRC sent a letter to the VA's Under Secretary for Health Robert A. Petzel identifying the three apparent violations and three additional potential violations that that were "not being considered fro escalated enforcement action."

The apparent violations that could result in a fine or even the loss of the VA's authority to oversee the use of radioactive materials at it's hospitals and other facilities involved the failure of 11 of the VA's 12 prostate brachytherapy programs to develop procedures that would ensure "high confidence" that implants of radioactive seeds would be performed as planned prior to the procedure; failure to verify the procedure went according to plan in at least four medical centers; and not reporting a incident of mis-dosing within 24 hours as required.

The NRC said that the VA's national health physics program failed to identify the problems during routine inspections of its medical center.

In its letter to the VA's Petzel the NRC said that in light of the large fine that resulted from the problems at the Philadelphia VA and the apparent violations found in its broader probe of the VA's system-wide oversight of radiation uses that the agency should be ready to present specifics corrections it has made as well as other actions taken to assure the NRC that all the use of radiation by the VA will be "in compliance with the commission's requirements and that the health and safety of the public will be protected."

A phone call and email for a response to the NRC's 51-page report were not immediately returned by a VA spokeswoman.

Check out earlier stories on the program at the Philadelphia VA:

Sunday, June 21, 2009
Feds see wider woes in VA's cancer errors

Sunday, July 19, 2009 
VA radiation errors laid to offline computer

Thursday, July 23, 2009
Federal official quantifies Phila. VA problems

Sunday, August 9, 2009
VA's prostate treatment woes began at Penn;
Prior to the VA program, leading brachytherapists said the Penn doctors performing the radioactive seed implants lacked the proper skills and safeguards.

Sunday, November 15, 2009
VA clinic troubles bring few penalties;
Despite poor care in the Phila. prostate program, the agency has only slapped a few hands

Wednesday, November 18, 2009
NRC cites VA clinic for radioactive-treatment violations

Wednesday, November 25, 2009
Claims against Phila. VA up to $58 million

Friday, December 18, 2009
VA apologizes but denies radiation violations

Saturday, January 16, 2010 
VA clinic now concedes violations

Thursday, Mar. 18, 2010
NRC fines Phila. VA $227,500 over prostate care

Tuesday, May 4, 2010

Mistakes, little oversight cited for Phila. VA prostate cancer treatment