RE Monitoring University Health Center OPINION

[VERNIG.PETER@FORUM.VA.GOV]

I tend to concur with Jim Herold.  I think the "insurance" afforded by 
monitoring may well be over rated.  Ten or so years ago I heard a talk
at the Northern Calif Chapeter HPS of Stanfords 5 to 7 year ordeal in
fighting a Workers Comp claim alledging cancer resulting from occupation-
al exposure WITHIN LIMITS.  The claimant paintained that she had violated
policy and worn her badge inside of her lead appron and, I believe, neglec-
ted to wear it on occasion so actually her dose was much higher than
the record showed.
 
Folks, this was a workers compensation claim, so millions were not at
stake, no pain and suffering damages.  But Stanford apparently felt 
that there was a principal at issue.  I'm sure they spent far more in
defending it than if they would have simply paid the claim.  The point is
Stanford had dosimetry and it did not protect them against the claim
being made and the costs of defending it.
 
BTW Stanford eventually won, I believe.  Someone pointed out that it is
hard to defend or make a case based on no dosimetry data.  So we're back
to professional judgement.  Some people have to be badged.  Our policy
says that if you handle non-exempt amounts of radioactive material or spend
substantial amount of time in the vicinity of fluoroscopy you should have
a badge.  JCAHO has succeeded in convincing a host of people that they
should have dosimetry which is why the OR nurses here do  Though I can
use that data and that of the x-ray Techs to counter any claim of others
arguing that the x-ray techs are most exposed and that the nurses exposure
[nil] should approximate the doctors.
 
Finally, any in a University setting might want to investigate U.C.
Berkeley's system.  They started with quarterly extremity, then went to
adding quarterly whole body, and finally to monthly whole body as 
amounts of material went up.  I had understood that they were going to
raise their thresholds based on their 10+ years of experience with the
system.  And yes it was to save money.  Hospital type operations, in
my opinion could well badge mostly the Rad and N.M. Techs and argue that
they are the most exposed.  I lost that battle with respect to the OR
Nurses.
 
Opinions, of course are mine and do not reflect anybody elses opinion
and certainly are not endorsed by my employer.
 
Peter G. Vernig
VA Medical Center, vernig.peter@forum.va.gov