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Crisis at the Instituto Oncologico

by Willy Carrera

Six patients suffering from pelvic tumors who were receiving treatment at the Instituto Oncologico Nacional (Panama's main public cancer treatment center, now located in the former Gorgas Hospital complex) have died, apparently from the treatment they received there rather than as the direct result of the cancers from which they were suffering. Officially, however, there have been no causes of death determined in the cases.

Initial reports from sources in the Health Ministry and at the Institute had it that the six patients were among 28 who were exposed to overdoses of radiation from a cobalt machine at the hospital, of whom 11 subsequently died. Because many of these patients were gravely ill from cancer, attributing the causes of death to cancer or to radiation sickness becomes a tricky question about which experts may honestly disagree.

The hospital's medical director, Dr. Juan Pablo Barés, explained that the majority of patients treated on the cobalt machine in question had advanced cancers and poor prospects of survival, which meant that "their treatment generally has to be radical and toxic." Thus he said that the Institute's work normally includes treatments to diminish the effects of high doses of radiation to which such patients are normally exposed. He added that due to the problems that have been discovered, changes have been made so that patients won't be unduly harmed by their therapy.

"The responsibility here is ours," Barés said. "We are in charge of everything that's done or not done, and we're in direct communication with the Ministry of Health and the Institute's foundation."

Of the 28 patients affected by radiation overdoses, 16 were outpatients and six were hospitalized in critical condition. Of the latter six, five died, but Barés said it's not possible to tell whether it was due to the high radiation.

The medical director said that until an inquest is concluded "we can't definitively say that losses were the result of their treatment." He added that the inquest is not for the purpose of assigning blame among institutions or individuals, but to gather all the facts about what happened.

The sixth patient to die of an apparent radiation overdose, Walter Chandler, passed away on May 20 at the Paitilla Hospital. Chandler, who was 64 years old, was a professor at the University of Panama and worked for many years as the head of the Health Ministry's Department of International Affairs. After his demise members of his family met with Barés to ask for a complete inquiry to determine the facts and to take whatever measures are needed to prevent a recurrence of the problem.

Dr. Eusebio Morales, the Health Ministry's general director of public health, said that the investigation is now into its second phase, which is exclusively technical. At this point, he added, it is being handled entirely by the ministry, which is the ultimate authority on radiological risks to human health. The national investigating team is headed by Eloy Gibbs, a physicist, which will work in coordination with a team of experts that is being sent here by the International Atomic Energy Organization, a United Nations agency.

"We want to be serious and responsible, informing the community at the moment when we have the information about exactly what has occurred," Morales said.

One theory that stands out at first glance was that the overdoses happened due to a malfunction in the functioning or use of the cobalt machine's computerized controls, so the Instituto Oncologico, after suspending treatments for several days, has resumed radiation treatments with the cobalt machine in question, using manual controls only. The country does not have a replacement machine immediately available, and a number of patients with colo-rectal, uterine or other pelvic tumors can not wait for the radiation therapy that they need.

The technical investigation is expected to take about one month, during which other experts will review all of the medical records of the affected patients. The possibilities of machine failures and of human errors are all being looked into. "The result will be what it will be, and any charges will be based on it. If any personal responsibility is found, those who are responsible will receive the sanctions due to them," Morales said.

In addition to the Health Ministry's probe, at least one private lawsuit has been filed and presumably the attorneys involved are conducting their private investigation. The nation's Ombudsman, Juan Antonio Tejada, is also looking into the matter, and has spoken with Barés to gather information and to express his concern for the health of other patients with pelvic tumors. After his meeting with Barés, Tejada assured the public that a genuine investigation is underway. "At this point we shouldn't rush to judgment," Tejada said. "Let's wait for the results of the investigation."