Over 200 hurt or killed by botched radiation in U.K. public hospitals

And secrecy is the first response, of course

More than 200 cancer sufferers have been seriously injured or killed by overdoses of radiation from botched treatment, confidential government figures have shown. Among those harmed are a 15-year-old schoolgirl left with life-threatening injuries, a young father with testicular cancer who suffered nerve damage and a 69-year-old lung cancer victim who died within weeks of his radiotherapy. The errors over the past six years have been blamed on shortages of trained radiographers and substandard equipment combined with spiralling demand because of rising cancer rates.

Senior cancer specialists have expressed alarm at the scale of the problem, which has been exposed under freedom of information laws. Karol Sikora, one of Britain’s leading professors of cancer medicine and a former government adviser, said: “It shocks me that this has been kept quiet and that lessons which could have been learnt from these errors have not been disseminated throughout the service.” According to senior radiologists, the Department of Health (DoH) has also failed to act on an internal National Health Service inquiry that recommended improvements a year ago after a breast cancer patient received a potentially fatal overdose.

Radiotherapy is the use of precisely targeted x-rays that kill cancer cells. About 40% of cancer patients have tumours considered suitable for such treatment. Even when correctly administered, the radiation also kills some healthy cells and generally causes severe nausea. The figures show there were 211 incidents where patients suffered radiation exposure 20% or more higher than the intended dose in the six years between April 2000 and this month — equivalent to one incident every fortnight. It is not known how many of these incidents were fatal. The information has come to light as a result of the campaigning of two former cancer patients: Katharine Tylko, a piano teacher from Bath, and Mitzi Blennerhassett, a health service activist from York.

Radiation remains in the body and, if too much is given, can have a devastating effect, burning through healthy tissue and destroying the body’s efforts to recover. A victim can look outwardly healthy while internal tissue is effectively melting away. In the case of 15-year-old Lisa Norris, who was being treated for a brain tumour, a mistake was made in calculating the dose to be administered by the specialist linear accelerator machine. The error was repeated 17 times because the dose was never rechecked. Lisa’s chances of long-term survival are considered limited.

Two months ago the family had been celebrating what they believed was Lisa’s recovery when specialists called to tell them of the error. Her father, speaking from their home in Girvan, on the Ayrshire coast, said: “She is gradually getting thinner . . . Some days she eats and some days she doesn’t. She is having ups and downs. The problem is, the radiation will never leave her body.” Lisa’s case was thought to be exceptional but the new data show that overdoses are occurring on a regular basis.

Lawrence McCabe, 69, a retired civil engineer, received 70 times the radiation exposure intended to cure a lung tumour at Charing Cross hospital, London, in 2002. He had been expected to survive for five to seven years after treatment but he was dead within weeks. His family received a 35,000 pound out-of-court settlement. “We were told it was the highest accidental overdose of radiation ever recorded,” said Lorraine Buckmaster, his daughter. “He died in agony. Great chunks of his digestive system and his blood vessels just melted away.”

Lack of staff and untrained operators were blamed for the disaster in 2002, but last week the hospital said training and quality managers had been employed and only six of the 52 radiotherapists’ posts were vacant compared with 44% when the accident happened. Details of the case were never circulated among cancer centres nationally.

Last week Irwin Mitchell, a firm of solicitors in Sheffield, said it had recently been contacted by a man in his thirties who suffered damage to his leg nerves in 2003 after an overdose of radiotherapy during treatment for testicular cancer. The man, who did not want to be interviewed, runs his own business and is married with children. He fears that he could lose the use of his legs.

Doctors and technicians in the field blame the disasters on chronic undermanning, obsolete equipment and spiralling demand. There are 1,758 radiographers in 51 centres across the country who deliver 2.5m treatments a year. At least 260 more qualified specialists are needed, according to the Society of Radiographers.

Cookridge, the Leeds hospital where a breast cancer patient received a radiation overdose, has refused to say if the middle-aged mother survived or not. It confirmed, however, that recommendations in a report commissioned from Professor Brian Toft, a national expert on risk analysis, were forwarded to the DoH and to Sir Liam Donaldson, the chief medical officer.

The Royal College of Radiologists (RCR) last week held preliminary discussions with representatives of the Society of Radiographers, the technicians who deliver the treatment, and officials from the Health Protection Agency, to find ways of improving systems for reporting accidents and passing on information so lessons can be learnt. A formal meeting is to be held next month. The DoH insisted last week that new guidelines had been circulated but Robin Hunter, dean of clinical oncology at the RCR, said nobody delivering NHS radiotherapy treatment had seen them. “It is a bad situation,” he said. “Because of the secrecy surrounding these accidents, there is plenty of time before information filters out to us for the same thing to happen to someone else.”

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Update:

A reader writes:

"Radiation leaves the body almost instantly, particularly x-rays and gamma rays. Both of those modalities are photons -- light -- which either deposits energy in cells or passes through on its way to infinity. Once the radiation source is turned off, there's no radiation left in the body. What remains behind is the damage done to cells, which may take time to manifest."






Public hospital antibiotic ignorance in Australia



Patients are being placed at greater risk of acquiring harmful infections because doctors are giving them the wrong antibiotic before surgery, according to infectious disease experts. An analysis of almost 18,000 surgical procedures in 27 Victorian hospitals, by the body that collects information for the State Government about hospital infections, shows the proportion in which the choice of antibiotic is described as "inadequate" ranges from 2.3 per cent for cardiac surgery to 56.7 per cent for hysterectomies. The timing of antibiotic administration is also crucial. A patient should be given a shot of antibiotics ideally in the hour before the surgeon makes the first incision, and no more than two hours before. But too much antibiotic use can build resistance.

The data was collected by VICNISS for surgery between 2002 and 2005. It shows the proportion of operations where a patient was given antibiotics at the wrong time was as high as 42.5 per cent for gall bladder removals. VICNISS director Mike Richards said using antibiotics as a prophylaxis - as a means of preventing infections - was one of the most effective strategies, but not all surgery required antibiotics. He said it was not known how many patients who were inappropriately given antibiotics developed an infection. And patients given the right antibiotics might still develop an infection because of other factors.

Dr Richards said the choice of antibiotic was crucial, because surgery on different parts of the body left patients exposed to different types of bugs. "The rate of infection should be lower if people are given optimum prophylaxis," he said. "What's being observed overseas is if you get all the processes right at times you get very dramatic reductions in infection rates."

Associate Professor Paul Johnson, deputy director of the Austin Health infectious diseases department, said that whether or not antibiotics were used most patients would not get an infection after surgery. Not all doctors knew they were supposed to use prophylaxis before some operations, he said. "So one problem would be failure to be aware of the current guidelines. The second would be being aware of the guidelines, but there's a system failure," he said.

Executive member of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Roy Watson, said the higher rate of inadequate prophylaxis in hysterectomies could be because of a perception that infection in such cases was less serious. "In gynaecological surgery if you get a wound infection, yes it's bad, but it's relatively easily dealt with, whereas clearly with cardiac surgery or orthopedic surgery the consequences are much more dire."

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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