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Enforcement of the U.S. Department of Veterans Affairs’ Brachytherapy Program Safety Standards

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Enforcement of the U.S. Department of Veterans Affairs’ Brachytherapy Program Safety Standards ENFORCEMENT OF THE U.S. DEPARTMENT OF VETERANS AFFAIRS’ BRACHYTHERAPY PROGRAM SAFETY STANDARDS HEARING BEFORE THE SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS OF THE COMMITTEE ON VETERANS’ AFFAIRS U.S. HOUSE OF REPRESENTATIVES ONE HUNDRED ELEVENTH CONGRESS FIRST SESSION JULY 22, 2009 Serial No. 111–36 Printed for the use of the Committee on Veterans’ Affairs ( U.S. GOVERNMENT PRINTING OFFICE 51–875 WASHINGTON : 2009 For sale by the Superintendent of Documents, U.S. Government Printing Office Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800 Fax: (202) 512–2104 Mail: Stop IDCC, Washington, DC 20402–0001 VerDate Nov 24 2008 00:56 Jan 06, 2010 Jkt 051875 PO 00000 Frm 00001 Fmt 5011 Sfmt 5011 E:\HR\OC\51875.XXX GPO1 PsN: 51875 anorris on DSK5R6SHH1 with HEARING COMMITTEE ON VETERANS’ AFFAIRS BOB FILNER, California, Chairman CORRINE BROWN, Florida STEVE BUYER, Indiana, Ranking VIC SNYDER, Arkansas CLIFF STEARNS, Florida MICHAEL H. MICHAUD, Maine JERRY MORAN, Kansas STEPHANIE HERSETH SANDLIN, South HENRY E. BROWN, JR., South Carolina Dakota JEFF MILLER, Florida HARRY E. MITCHELL, Arizona JOHN BOOZMAN, Arkansas JOHN J. HALL, New York BRIAN P. BILBRAY, California DEBORAH L. HALVORSON, Illinois DOUG LAMBORN, Colorado THOMAS S.P. PERRIELLO, Virginia GUS M. BILIRAKIS, Florida HARRY TEAGUE, New Mexico VERN BUCHANAN, Florida CIRO D. RODRIGUEZ, Texas DAVID P. ROE, Tennessee JOE DONNELLY, Indiana JERRY MCNERNEY, California ZACHARY T. SPACE, Ohio TIMOTHY J. WALZ, Minnesota JOHN H. ADLER, New Jersey ANN KIRKPATRICK, Arizona GLENN C. NYE, Virginia Malcom A. Shorter, Staff Director SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS HARRY E. MITCHELL, Arizona, Chairman ZACHARY T. SPACE, Ohio DAVID P. ROE, Tennessee, Ranking TIMOTHY J. WALZ, Minnesota CLIFF STEARNS, Florida JOHN H. ADLER, New Jersey BRIAN P. BILBRAY, California JOHN J. HALL, New York Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public hearing records of the Committee on Veterans’ Affairs are also published in electronic form. The printed hearing record remains the official version. Because electronic submissions are used to prepare both printed and electronic versions of the hearing record, the process of converting between various electronic formats may introduce unintentional errors or omissions. Such occur- rences are inherent in the current publication process and should diminish as the process is further refined. ii VerDate Nov 24 2008 00:56 Jan 06, 2010 Jkt 051875 PO 00000 Frm 00002 Fmt 0486 Sfmt 0486 E:\HR\OC\51875.XXX GPO1 PsN: 51875 anorris on DSK5R6SHH1 with HEARING C O N T E N T S July 22, 2009 Page Enforcement of the U.S. Department of Veterans Affairs’ Brachytherapy Pro- gram Safety Standards ........................................................................................ 1 OPENING STATEMENTS Chairman Harry E. Mitchell ................................................................................... 1 Prepared statement of Chairman Mitchell ..................................................... 47 Hon. David P. Roe, Ranking Republican Member ................................................ 3 Prepared statement of Congressman Roe ....................................................... 48 Hon. John H. Adler .................................................................................................. 4 Hon. John J. Hall ..................................................................................................... 5 Hon. Chaka Fattah .................................................................................................. 5 WITNESSES United States Nuclear Regulatory Commission, Steven A. Reynolds, Director, Division of Nuclear Materials Safety Region III ............................................... 25 Prepared statement of Mr. Reynolds .............................................................. 55 U.S. Department of Veterans Affairs, Joseph A. Williams, Jr., RN, BSN, MPM, Assistant Deputy Under Secretary for Health for Operations and Management, Veterans Health Administration ................................................ 37 Prepared statement of Mr. Williams .............................................................. 65 Bieda, Michael R., M.S., Clinical Chief, Division of Medical Physics, Depart- ment of Radiation Oncology, University of Pennsylvania, School of Medi- cine, Philadelphia, PA .......................................................................................... 10 Prepared statement of Mr. Bieda .................................................................... 53 Hahn, Stephen M., M.D., Henry K. Pancoast Professor and Chair, Depart- ment of Radiation Oncology, University of Pennsylvania, School of Medi- cine, Philadelphia, PA .......................................................................................... 9 Prepared statement of Dr. Hahn ..................................................................... 51 Kao, Gary D., M.D., Ph.D., Associate Professor of Radiation Oncology, Depart- ment of Radiation Oncology, University of Pennsylvania, School of Medi- cine, Philadelphia, PA .......................................................................................... 6 Prepared statement of Dr. Kao ....................................................................... 48 American Society for Radiation Oncology, W. Robert Lee, M.D., M.S., M.Ed., Professor, Department of Radiation Oncology, Duke University, School of Medicine, Durham, NC ........................................................................................ 26 Prepared statement of Dr. Lee ........................................................................ 58 The Joint Commission, Paul M. Schyve, M.D., Senior Vice President ................ 23 Prepared statement of Dr. Schyve .................................................................. 53 SUBMISSIONS FOR THE RECORD Desobry, Gregory E., Ph.D., Medical Physicist, Division of Medical Physics, Department of Radiation Oncology, University of Pennsylvania, School of Medicine, Philadelphia, PA, statement .............................................................. 67 Lazarescu, George, Ph.D., Medical Physicist, Division of Medical Physics, Department of Radiation Oncology, University of Pennsylvania, School of Medicine, Philadelphia, PA, statement .............................................................. 68 Stearns, Hon. Cliff, a Representative in Congress from the State of Florida, statement .............................................................................................................. 68 iii VerDate Nov 24 2008 00:56 Jan 06, 2010 Jkt 051875 PO 00000 Frm 00003 Fmt 0486 Sfmt 0486 E:\HR\OC\51875.XXX GPO1 PsN: 51875 anorris on DSK5R6SHH1 with HEARING VerDate Nov 24 2008 00:56 Jan 06, 2010 Jkt 051875 PO 00000 Frm 00004 Fmt 0486 Sfmt 0486 E:\HR\OC\51875.XXX GPO1 PsN: 51875 anorris on DSK5R6SHH1 with HEARING ENFORCEMENT OF THE U.S. DEPARTMENT OF VETERANS AFFAIRS’ BRACHYTHERAPY PROGRAM SAFETY STANDARDS WEDNESDAY, JULY 22, 2009 U.S. HOUSE OF REPRESENTATIVES, COMMITTEE ON VETERANS’ AFFAIRS, SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS, Washington, DC. The Subcommittee met, pursuant to notice, at 10:00 a.m., in Room 334, Cannon House Office Building, Hon. Harry E. Mitchell [Chairman of the Subcommittee] presiding. Present: Representatives Mitchell, Walz, Adler, Hall, and Roe. Also Present: Representative Fattah. OPENING STATEMENT OF CHAIRMAN MITCHELL Mr. MITCHELL. Good morning, and welcome to the Subcommittee on Oversight Investigations Hearing on Enforcement of U.S. De- partment of Veterans Affairs’ (VA’s) Brachytherapy Program Safety Standards. This is July 22, 2009, and this hearing will come to order. I ask unanimous consent that Mr. Fattah of Pennsylvania be in- vited to sit at the dais for the Subcommittee hearing today. Hear- ing no objection so ordered. Mr. Fattah, you are invited when you do come in, to come up to the dais. I would like to thank everyone for attending today’s Oversight and Investigations Subcommittee Hearing entitled, Enforcement of U.S. Department of Veterans Affairs’ Brachytherapy Safety Stand- ards. Thank you especially to our witnesses for testifying today. All Members of this Subcommittee take particular interest in this issue, as well as the care of our Nation’s veterans; however, I would like to especially thank Congressman John Adler of New Jersey for being such a passionate advocate for this issue. Reports of botched prostate cancer procedures, a lack of quality and standard controls in the VA health care system, and egregious errors in the brachytherapy treatment at the Philadelphia VA Med- ical Center are unacceptable and wrong. Brachytherapy is a form of radiotherapy often used to treat pros- tate cancer in which radioactive seeds are placed inside or next to a patient’s malignancy. Failure to accurately place the radioactive seeds can cause serious damage. To say that it is disturbing to learn that veterans received bungled procedures and that safety protocols failed to safeguard against such mistreatment would be (1) VerDate Nov 24 2008 00:56 Jan 06, 2010 Jkt 051875 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 E:\HR\OC\51875.XXX GPO1 PsN: 51875 anorris on DSK5R6SHH1 with HEARING 2 an understatement. As a result, we are here today to examine the system-wide safety standards for these procedures to ensure that our veterans are receiving the best and safest care possible. In 2003 and 2005, the Nuclear Regulatory Commission (NRC) re- ceived reports of botched placement of radioactive
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