Re: [Fwd: RE: Nuclear Medicine Patients and Homeland Security]

[John Jacobus <crispy_bird@YAHOO.COM>]

And what makes you think the medical community is not

accountable?  If a licensee violates the condition of

its license or NRC regulations, it is cited.  I am not

sure what you expect the medical community to do?  In

general, for all medical treatment, the physician is

required to determine if the the patient is going to

follow directions whether it involves radiation or

not.  However, a medical facility cannot restrain a

patient who decides to leave.  A patient cannot be

restrained against their will without a court order. 

It a patient wants to leave after recieving a

significant dose of I-131 for therapy, the facility

cannot prevent it.  (If I am wrong on this issue, I am

sure one of the physicians who read this list will

correct me.)



With regarding to compliance of instructions when a

patient is released, consider the following from NUREG

1556, Vol 9, Appendix U, "Model Procedure for Release

of Patients or Human Research Subjects

Administered Radioactive Materials" at

http://www.nrc.gov/reading-rm/doc-collections/nuregs/staff/sr1556/v9/



"U.2.1 Activities and Dose Rates Requiring

Instructions



Based on 10 CFR 35.75(b), for some administrations the

released patients must be given instructions,

including written instructions, on how to maintain

doses to other individuals ALARA after the patients

are released.(Footnote 1) . . ."



"(Footnote 1)NRC does not intend to enforce patient

compliance with the instructions nor is it the

licensee’s responsibility to do so."



So, if either the NRC nor the licensee can enforce

compliance, what is you argument about?  What makes

you think that medical licensees are not making a good

effort?





--- William V Lipton <liptonw@dteenergy.com> wrote:

> Accountability seems to be a new concept for the

> medical community.

> 

> Yes, I do follow my doctor's instructions.  Let's

> get that out of the way.

> 

> Having the patient sign a statement of compliance

> would probably be a good idea.

> 

> The other issue is that, in releasing the patient

> with a significant radiation field, the

> licensee is making a judgment that the patient will

> comply with the applicable instructions.

> If there is doubt regarding this, the patient should

> not be released.

> 

> I don't see the regulators as demanding 100%

> compliance; only a reasonable effort.

> 

> The opinions expressed are strictly mine.

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

> Curies forever.

> 

> Bill Lipton

> liptonw@dteenergy.com

> 

> 

> John Jacobus wrote:

> 

> > And what would you suggest?  Having the patient

> sign a

> > statement that they would comply with directions? 

> How

> > would you ensure compliance once the patient has

> left

> > the hospital or "licensee's control?"

> >

> > Have you always followed your physician's

> > recommendations to finish all of your medications?

>  If

> > you did not, then what should we do with you?

> >

> > --- William V Lipton <liptonw@DTEENERGY.COM>

> wrote:

> > > IN 2003-22 implies that the licensee is

> accountable,

> > > to some degree, for

> > > the patient's compliance with the applicable

> > > instructions.  Quoting:

> > > "...When licensees are required to provide

> written

> > > instructions to

> > > patients released in accordance with 10 CFR

> 35.75,

> > > the licensees are

> > > expected to, among other things, review with

> > > authorized users the

> > > expectation that written instructions provided

> to

> > > patients will be

> > > followed...."  Although this is currently an

> > > "expectation" rather than a

> > > requirement, my advice to medical licensees is

> to

> > > make every effort to

> > > comply.





=====

+++++++++++++++++++

"There's no trick to being a humorist when you have the whole government working for you."

Will Rogers



-- John

John Jacobus, MS

Certified Health Physicist

e-mail:  crispy_bird@yahoo.com



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