Re: release of patient based on NRCREG 35.75

[csmarcus <csmarcus@ucla.edu>]

At 04:10 PM 11/24/98 -0600, you wrote:
>>Thanks for providing me with a good laugh.
>>
>>Let me assure you that third party payors will insist that ALL I-131 therapies
>>be done on an outpatient basis if they can get away with it, simply to reduce
>>the reimbursement, regardless of the consequences.  After all, the third party
>>payor will certainly not be climbing into the dumpster with you to locate the
>>contaminated diaper.  If the hospital down the road is doing I-131 therapy on
>>an outpatient basis, why aren't YOU, the third party payor will ask.
>>
>>For those of you who have yet to climb into a dumpster full of three-day old
>>trash, this is your opportunity to have some "fun".  Yes, I know it's LEGAL to
>>send that 200 mCi I-131 thyroid carcinoma patient home in a taxi after they
>>have assured you they won't be going out anywhere.  Be warned that the state
>>DEP will likely decide you are at fault for not giving sufficient instructions
>>to the patient when the radioactive trash is discovered at the mall.
>>Explaining that you followed the rules may not help.  Ask your management
>>representatives at the next Radiation Safety Committee meeting how they will
>>feel when the local paper prints a story with headline: "Local Hospital
>>Questioned About Radioactive Trash".   Just because it's legal doesn't mean
>>it's wise.
>>
>>Just my opinion...
>>
>>Stu Korchin
>Chris Alston
>alstonc@odrge.odr.georgetown.edu
>I am not here a representative of my employer.
>
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>Dear Radsafers:

Please provide me with hard data showing that a third party payor refuses to
pay for ANY I-131 inpatient therapies.  If you have any real data that this
is happening, relay it to me.  It will be dealt with by professionals in the
reimbursement game with clout from regulators.  As long as there is a good
reason to keep the patient in the hospital, a third party payor will be made
to pay.  If the reason to keep a patient in the hospital is that the
physician doesn't know how to do the calculations, and the RSO doesn't
either and just wishes this rule would go away, then I wouldn't blame the
third party payor from refusing reimbursement.  Send the patients to docs
who know what they're doing.

As far as the garbage dump fantasy is concerned, I am searching for hard
data showing that contamination in a sanitary landfill is due to body fluid
contaminated articles of patients given over 30 mCi of I-131.  It is
interesting that I have not been able to document a single instance of this
happening.  I don't mean alarms sounding and I don't mean just I-131.  I
mean I-131 from patients given over 30 mCi as outpatients.  I have my
patients save body fluid contaminated articles that cannot go into the
sewer, and bring them to me in a double plastic supermarket bag at the end
of the week.  While contamination is present, none has been high enough to
trigger landfill alarms in Los Angeles County. I think that this is a fake
fear, and an excuse used by those who don't understand the math, physics,
and radiopharmacokinetics.  In any case, show me hard data.  We are
scientists, are we not?

Ciao, Carol

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