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[Fwd: Re: medical misadministrations]







-------- Original Message --------

Subject: Re: medical misadministrations

Date: Wed, 05 Sep 2001 09:00:09 -0400

From: "Thomas J Savin " <tjsav@lycos.com>

Reply-To: tjsav@lycos.com

Organization: Lycos Mail  (http://mail.lycos.com:80)

To: "William V Lipton" <liptonw@dteenergy.com>



Sure, -  I really do not know what is being done about this - I saw this

morning that the pharmicist who diluted the chemo therapy drugs may have

done it with two other drugs - so much for establishing public

confidence.



Tom  





On Wed, 05 Sep 2001 08:50:25  

 William V Lipton wrote:

>Many thanx for your response.  May I post this to RADSAFE?

>Bill

>

>

>Thomas J Savin wrote:

>

>> HI Bill,

>>

>> This is an excellent question, but I would like to know if there is an estimate of how many incidences go unreported?

>> ---

>> Tom Savin

>>

>> On Wed, 05 Sep 2001 07:31:46

>>  William V Lipton wrote:

>> >I'll dare to use the "e" word, again.  There seems to be an epidemic of

>> >medical misadminstrations, that seem mostly due to human error:

>> >

>> >8/7/96 - 10/18/00 - Providence Hospital, Washington, DC - 14

>> >misadministrations where approximately 3000 rads was delivered with

>> >1200-1500 rads prescribed with a Sr-90 eye applicator.

>> >

>> >8/31/01 - St. Mary's Hospital, Rochester, MN - delivered dose from Co-60

>> >gamma knife 39% greater than prescribed due to timer entry error.

>> >

>> >8/31/01 - University of Kansas Hospital, Kansas City, KS - Technician

>> >administered wrong radionuclide to patient.

>> >

>> >(I'm not counting the 8/21/01 misadministration at Wyoming Medical

>> >Center, where the misadministration resulted from highly technical

>> >issues.)

>> >

>> >I'd be interested to know whether the medical hp's are doing anything to

>> >improve human performance in this area.

>> >

>> >BTW:  I don't buy the previous excuses, when I raised this issue, that,

>> >"It's not my job."  According to the HPS Prospectus, "The Society is a

>> >professional organization whose mission is to promote the practice of

>> >radiation safety..."  This seems to be one area where "the practice of

>> >radiation safety" seems to need improvement.

>> >

>> >The opinions expressed are strictly mine.

>> >It's not about dose, it's about trust.

>> >

>> >Bill Lipton

>> >liptonw@dteenergy.com

>> >

>> >

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>> >

>> >

>>

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>

>





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