Re : Safety Culture

[presley.j@atomcon.gc.ca]

Radsafers,

I would like to comment on the following statement :

Rozental Wrote :

4 - The Radiological Accident in Goiania, the most serious radiological
accident to have occurred to date, could never be happened in the  way that
it occurred, since the management of the facility was composed  of
radiotherapists, working with radioactive materials for about 20 years,
who  knew  the  legislation, and included also in the organization, by
norms, a physicist in radiation protection. It  is difficult to understand,
considering their  background, how could they leave,  totally insecure,  
the
head  unit of  the Cs-137 source  in  a demolished hospital.

Comment :
     
     I am not totally versed in how the source at Goianna was abandoned
     but I would speculate that it was not ultimately due to an oversight
     by a radiotherapist, physicist or some such similar person.
     I would expect that the professional staff either left or were
     let go before the facility was actually closed/abandoned.
      Who knows, perhaps they stated to management as they were leaving 
     "don't forget about the source". At this point it became a management
     responsibility with the ultimate responsibility for public safety 
     falling on the regulatory body.
     As a regulator, it is my view that an appropriate regulatory framework 
     was not in place to ensure that such sources were not abandoned.
     
     If I missed the mark on this one please let me know.
     
     
     Jim Presley
     presley.j@atomcon.gc.ca