Four years ago, after talking to doctors at the Philadelphia VA Medical Center, the Rev. Ricardo Flippin opted for a radiation therapy that would precisely target his prostate cancer and leave nearby organs unharmed.

Instead, his prostate cancer got too little radiation while his rectum received so much that he suffered excruciating, permanent damage.

Flippin, 68 - a minister, teacher, and Air Force veteran - is hardly unique.

The Philadelphia VA has notified 92 prostate cancer patients treated between 2002 and 2008 that their "brachytherapy" radiation doses were too high or too low. The U.S. Department of Veterans Affairs has shut down the brachytherapy program in Philadelphia and three other VA hospitals with less serious problems.

Yesterday, the unfolding scandal prompted Sen. Arlen Specter (D., Pa.) to say he would hold a hearing on the matter in Philadelphia on Monday.

"The news accounts have created a great deal of concern in the veterans' community," Specter said. "They report very serious problems and . . . it is a matter for congressional oversight. We need to find out what happened."

Rep. John Adler (D., N.J.), the region's only member of the House Veterans Affairs Committee, also called for a congressional probe.

The problems represent "more than medical malpractice," said Adler, who represents Burlington, Ocean, and Camden Counties. "It is also supervisory malpractice and regulatory malpractice."

Flippin, meanwhile, has recovered from surgery he had in 2006 to repair the radiation injury to his anal canal. Physicians at Ohio State University diagnosed and repaired the injury after Flippin spent more than a year complaining to doctors at the VA hospital in his hometown of Charleston, W. Va.

'Are you ... listening?'

"They're telling me about hemorrhoids and constipation. They're prescribing me Sitz baths. I said, 'Are you guys listening to me?' One guy did a [colonoscopy] and he saw rawness. He said, 'Oh, that's just a mild infection.' "

Ongoing investigations by the Philadelphia VA and the Nuclear Regulatory Commission have found a number of factors that may have contributed to the substandard care. These included a lack of training in recognizing and reporting medical errors, lack of adequate oversight, and failure of the hospital's radiation safety committee to address deficiencies.

In Washington, VA spokeswoman Katie Roberts said that a new leadership team at the VA was conducting a "top-to-bottom review" of the entire agency and that it would take aggressive action "to make sure the right policies and procedures are in place to protect our veterans and provide them with the quality health care they have earned."

It is not clear whether the lapses have affected the cancer prognoses of any of the 92 affected veterans - almost 80 percent of all brachytherapy patients at the Philadelphia VA. However, the VA arranged for eight of them to receive additional seed implants at the Seattle VA hospital.

In brachytherapy, physicians permanently implant in the prostate about 80 to 120 tiny metal "seeds" that emit radiation over a 10-month period. Ultrasound is used to guide correct placement, and a postsurgical CT scan confirms it.

Brachytherapy is an option only for patients with small, early-stage, nonaggressive prostate tumors - patients like Flippin.

In 2004, he had just moved from Charleston to Philadelphia to care for his elderly mother.

Led to diagnosis

An elevated PSA test led to his cancer diagnosis at Philadelphia's sprawling VA center, which is a teaching hospital for the University of Pennsylvania.

Flippin and his wife opted for brachytherapy because it is quicker - just an overnight hospital stay - than external radiation and less invasive than prostate removal.

"The entire procedure was completed without difficulty or complication," according to the medical reports, electronically signed by radiation oncologist Gary Kao, and two surgeons.

The next day a CT scan requested to check seed placement found "brachytherapy seeds are also noted surrounding the prostate gland," a radiology report says.

Eric Horwitz, head of radiation oncology at Fox Chase Cancer Center, said placing seeds outside the prostate "is not common" because "most or all of the seeds should be in the prostate."

Later - years later - Flippin would learn that VA doctors calculated that his radiation dose to the prostate was only 67 percent of the intended dose.

Flippin returned to Charleston after his surgery because his mother had died. Nine months later, he began having rectal pain and bleeding.

As the symptoms steadily worsened - killing his appetite, causing weight loss, forcing him to quit his church job, and finally leaving him bedridden - he made the connection to the brachytherapy.

The Charleston VA hospital doctors did not. Not exactly. In June 2006, a medical report said Flippin's painful "rectal ulcer" was "probably related to seed implants for cancer of the prostate." Yet doctors continued to prescribe antibiotics, enemas, and addictive painkillers - not the corrective surgery that he finally obtained after he insisted on being referred to another hospital.

After getting the Philadelphia VA's July 2008 letter about possible substandard treatment, Flippin hired Robb Graham, a Cinnaminson attorney who specializes in suing the VA.

Flippin, who retired as a technical sergeant after a 21-year career that included service in Vietnam, now works for a West Virginia church coalition that offers social-service programs to veterans.

He also takes precautions against "accidents."

"I do not have consistent control of my bowels," he said. "I wear protective undergarments."

Contact staff writer Marie McCullough at 215-854-2720 or mmccullough@phillynews.com.
Staff writers Josh Goldstein, Heather Chin, and Karen Knee contributed to this report.