RE: NRC PROPOSES $6,000 FINE AGAINST ST. JOSEPH MERCY HOSPITAL IN

Cray,

Thanks for the information. Obviously, this patient was in end-stage renal failure and close to death. It total escapes me why the physician would have proceeded with this treatment. I suspect that taking the patient off of the Synthyroid may have even hastened her death.

Cary Renquist <crenquis@med.umich.edu> wrote:

>>> John Jacobus 05/15/2003 16:07:38 >>>
>It should be noted that people being treated for thyriod cancer with I-131 are not in imminent death. I am not sure why the daughter had to
>be in the room with the mother, but the hospital certainty did not meet it license obligations to reduce exposure to those other than the patient.
>There were action that they should have taken and did not. At our facility, we have the same requirements to reduce exposures, and have no
>problems meeting them.

It seems that her condition took a turn for the worse due to other complications:

An inpatient received a 300 mCi dose of 1131 in the Nuclear Medicine department at St. Joseph Mercy Hospital.
She remained in the hospital under radiation precautions until she expired several days later due to multiple medical
comp! lications. Due to poor renal function, the patient was unable to excrete the radioactive materials, which resulted
in readings at higher than anticipated level throughout the admission. A restricted area was designated outside the
patient room, radiation precautions were posted on the door to the patient's room, and family members and visitors were
instructed by the nursing staff and Radiation Safety Officer about the precautions and risks to radiation exposure. The
Radiation Safety Officer performed bedside readings during the patient's admission post-administration. As the patient's
condition significantly deteriorated, the family requested to be closer to the patient. The Radiation Safety Officer and
authorized user were contacted regarding this request. The authorized user granted permission for the family to be closer
to the patient for brief periods of time due to the extenuating circumstances surrounding the patient's condition. This
info! rmation was relayed to the Radiation Safety Officer. The family was again instructed to limit their time and distance
to the patient and the shields were removed from the patient bedside for approximately 1 hour. At one point, the patient's
condition improved slightly and the shields were returned to the bedside. However, even after numerous reminders from
nursing staff as to the precautions and risks family members and visitors disregarded the radiation precautions and repeatedly
entered the restricted area and went around.

RE dose calcs:

The dose calculations used to examine exposure to family and visitors are based on recorded bedside readings and dose
exposure at 1 meter. In reconstructing the dose given the bedside readings of approximately 200 millirem per hour, a visitor
at or near bedside for greater than 30 minutes would potentially exceed the 100 millirem limit. Visitors at 1 meter from the
patient for approximately six hours! could exceed the 100 millirem when using the recorded reading of 17 millirem/hour at 1
meter.

It seems that there is some discrepancy between what the daughter told the Hospital and what she told the NRC which resulted
in different dose estimates -- the hospital estimates ~3-5 rem, the NRC 3-15 rem.

I guess the good news is that the patient did not receive the 600 mCi dose that was originally considered....

Y'all can find most of the documents pertaining to this violation by searching the ADAMS system using:
"St. Joseph Mercy Hospital"
http://www.nrc.gov/reading-rm/adams/web-based.html

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