The independent investigation
into the over radiation of cancer patients between January 9 and June, 2010, at
the Brian Lara Cancer Treatment Center (BLCTC) can take months. In the meantime,
patients are calling me, e-mailing me, saying: “What is the over radiation doing
to our bodies? What are the interim arrangements for us? Apart from one free
appointment we were told we have to pay for all our tests ‘as usual.’” For
weeks, now I have been calling the BLCTC to interview the senior radiation
oncologist for answers but have been blocked by their platitudinous PRO. This
week, a patient sent me a letter she received from the BLTCT.
“Dear (Patient X)–
As you may be aware, the Centre
has been very much in the news in the past week following the release of a
report by the Pan American Health Organisation (Paho) on summary findings of its
2010 investigation into our operating procedures and administration of radiation
to people in our care for the period June 2009 to June 2010. “The BLCTC deeply
regrets this most unfortunate series of events which has resulted in a general
misunderstanding of the administration of radiation in the care of cancer
patients and the resulting emotional distress caused to all concerned.
“We assure you that our records
and the results of continuous monitoring over the past 13-25 months show that at
no time did patients receive any radiation therapy that was above tolerable
dosages or significant enough to cause a misadministration or overdose of
radiation that would be harmful to the patient; nor do any of our patients to
date show any symptoms or side effects of radiation overdose. “Even at the
highest recorded level of variance at 13.9 per cent, the levels received were
still within internationally established guidelines for safe or tolerable
dosages of radiation. Those guidelines state that doses above 20 per cent of the
prescribed dose would be considered a misadministration of dosage.
“The news stories may have
caused you some alarm and distress, as it did our administrative staff. Please
be assured that the Centre has not acted inappropriately nor has it put patients
at risk. We are confident that our own internal enquiry, our consultation with
five independent specialists and extensive research into a number of
international institutions, support our view that no misadministration of
radiation has occurred at the Centre. “We wish to assure you that our records
reflect that you, and indeed all 218 patients treated by us during that period
have not presented with any symptoms or side effects of over radiation and that
we continue to monitor and evaluate your condition as part of your ongoing care.
“We have sourced a new clinical
director and a radiation oncologist of international repute, and recruited the
only board-qualified radiation physicist in the country to be part of our new
team going forward. “In the meantime, we are doing everything possible to bring
the highest levels of transparency to the circumstances leading up to the
discrepancies in administered dosages and have made comprehensive administrative
and operational changes to ensure that this never occurs again. “We thank you
for choosing the BLCTC. We affirm our commitment to providing world-class,
state-of-the-art technology in your treatment, and to safeguard your right to
privacy and proper care. If there be ever any question or concern that you may
wish addressed, please call in and schedule an appointment to see one of our
oncologists who will address your questions or concerns at no additional costs.
Patients need answers
Patient X felt this letter from
the Centre needed to be publicised. She responded in an open letter (below) to
Dr Bovell on behalf of many patients who are too ill or too fearful to speak
“Dear Dr Bovell,
I am in receipt of your letter
dated July 20, 2011, from the Brian Lara Cancer Treatment Center–the first such
communication from you. I assume that these letters are being sent to all the
patients involved in over radiation, and I decided to publish my response as an
open letter, to share it with others who might be lulled into a false sense of
security by your letter. “I am baffled when you refer to ‘a general
misunderstanding of the administration of radiation’. What misunderstanding?
The Paho report (September, 2010) clearly stated that there was a miscalibration
of a linear accelerator at BLCTC. And several medical experts have concurred
that we, the patients who were administered an overdose of radiation during the
period June, 2009–June, 2010, could be exposed to potential late side effects of
“You assure me that I was one of
the patients being monitored over the past 13–25 months. This is false, grossly
arrogant and unethical. How could the BLCTC be monitoring me when I was totally
unaware that I was being monitored? My understanding of being monitored is that:
1 Patient would be called
immediately after the clinic became aware of the problem, to be informed of
possible side effects, and;
2 That the Centre would then set
up a system for regular check-ups at no expense to the patient. This was not
“You state that your patients to
date show no symptoms or side effects of radiation overdose, but how can you
come to that conclusion without the monitoring suggested above? “In fact,
several fellow patients have complained to me of severe scarring, blistering,
difficulty in swallowing and swelling of limbs. “The point is, we were
administered an overdose of radiation above the dosage prescribed by your
oncologist which could have resulted in side effects which may not have
occurred, had we been administered the recommended dose.
“When you say the BLCTC will
continue to ‘monitor and evaluate’ my condition, what exactly do you mean? What
special considerations are you giving to us, the overdosed patients who are
concerned about our future? The effects of radiation overdose can be manifested
as late as five years after radiation–who will bear the financial burden then?
“As far as I can see from the press coverage, the Centre was more concerned with
covering up the problem and suggesting that the publicity was an attempt to
undermine the BLCTC. The Centre never came out publicly to accept
responsibility. The alarm and distress suffered by us the patients was more than
justified given the attitude of the Centre.
“I believe this letter is part
of an attempt to silence critics. “Clearly, there is nothing in the Centre’s
behaviour to inspire confidence. For those who have no option, the Government
should insist on the BLCTC establishing a fund to cover the cost of patients
wishing to have second opinions from other labs in Trinidad & Tobago and abroad.
“Your letter, written ten months after the initial exposure at BLCTC, has done
nothing to reassure me or to ease the trauma, alarm and distress I have endured
due to the total lack of communication, when this report of miscalibration was
first made public.
One overdosed cancer patient.”
I forwarded this letter to the
BLCTC, hoping finally for some answers as the questions had come directly from a
Cancer Centre responds
Their response to me:
“Thank you for your offer to
respond to the letter which you forwarded to us on August 3. We would welcome an
opportunity to address all of the concerns and answer all of the questions of
the patient who forwarded you his/her open letter to Dr Bovell. We are committed
to continuing a dialogue with patients who have further questions and concerns.
Given issues of patient confidentiality and the need to consider each patient’s
case on an individual basis, we do not consider the press an appropriate forum
to adequately respond to patients.
“We have issued an invitation to
all of our patients treated during the material time to consult with our
oncologists and to attend the Centre for regular follow-up visits at no charge.
The patient in contact with you is likely already aware that such an invitation
has also been extended to him/her. Nevertheless, as the patient in contact with
you remains anonymous in your letter and we are unable to identify him/her to
make further contact, we would appreciate it if you would convey to him/her that
he/she is welcome to make an appointment with the Centre to discuss all of
Open answers to open questions
Dr Bovell’s response is unacceptable and deliberately obtuse because the matter
is now in the public domain. The patient was openly asking for general
accountability on behalf of fellow patients, not discussing her specific
‘confidential’ case and wanted an open answer. She, and I firmly had the door
shut on our faces. Over the weeks, I understood from the Centre’s PRO (who seems
to have moved on to another “project”) that the matter was in legal hands, that
everything that needed to be said was said, that finally they would “call” me
back for the interview with regards to the oncologist I promoted in last week’s
column. In other words, please, allow the issue to die a natural death.
The fact, if there are 218 (or
223) patients out there who were wronged and need answers. We as a people also
need answers because although individual patient’s records are confidential,
accountability in the medical profession, because it is a matter of life and
death for us all, cannot remain “confidential” since this could set a dangerous
precedent. Paho and the Ministry of Health didn’t consider revealing the over
radiation confidential. With great power and knowledge held by medical
professionals (and the institutions they work for) comes great responsibility.
The odds are heaped against patients, often poor, backed against a wall, held
hostage by the spectre of death, anxiety and illness.
As one reader put it: “We, the
cancer patients, are just a number (among 223?) over radiated from a
miscalibrated machine between 3 per cent–19 per cent ...depending on whose story
That’s why, Dr Bovell, it’s everybody’s business. This nation wants open answers
to your patients’ open questions.