Jul. 5--Is Gary Kao a renegade physician, or a sacrificial lamb -- or maybe just a doctor who was allowed to get in over his head?

Kao is the only person whom officials have identified in the unfolding scandal over substandard radioactive seed implants at the Philadelphia VA Medical Center.

As the radiation oncologist who did most of the implants, Kao played a central role. But a huge cast of actors supported and directed him -- week after week, for six years -- until the VA suspended the program a year ago.

Those actors included a medical physicist with little experience in developing implant treatment plans, a radiation-safety committee that allowed crucial radiation-dosage calculations to go undone, and Nuclear Regulatory Commission inspectors who let Kao revise two patients' treatment plans to avoid reporting medical errors, according to the Veterans Affairs investigation report.

From top to bottom, that report concluded, there was a lack of concern for safety and accountability.

That's a chilling denunciation, considering that the VA worked with eminent institutions -- the University of Pennsylvania Health System and the NRC -- to create and run the high-tech brachytherapy program. The treatment involves permanently implanting tiny radioactive beads in the prostate gland. The beads emit cancer-killing radiation for about 10 months.

Of 114 prostate-cancer patients who underwent brachytherapy, 92 received suboptimal radiation to the prostate or potentially harmful levels to nearby organs or both.

Kao, who took a leave of absence from Penn on June 24, testified last week before a Senate hearing run by Sen. Arlen Specter (D., Pa.). Kao decried the media's portrayal of him as a "rogue" and complained that he was being scapegoated.

Some observers say he has a point. "I don't condone the mistakes he made, but I also don't blame him for feeling that he is being made a scapegoat," said Peter Crane, an NRC lawyer for 23 years and now a sharp critic of the agency. "This was a systemic failure, not the failure of one individual."

Three people with insight into this systemwide breakdown were listed as witnesses at the Senate hearing: Mary Moore, the Philadelphia VA's radiation-safety officer; Joel Maslow, chair of the VA's radiation-safety committee and a Penn infectious-disease specialist; and Richard Whittington, a Penn radiation oncologist who did a small number of the brachytherapy implants.

They were not questioned by the senators, nor were they allowed to speak to reporters.