[Date Prev][Date Next][Thread Prev][Thread Next][Date Index][Thread Index]
RE: Here's what happens when you don't know which end is up!
On that subject:(Therapeutic ,malpractice)
Who takes care of the "over-exposure" (I can't find another word for that
if, for exemple, the WRONG patient is being exposed to, let say, gamma
therapy) issue in the US?
NRC or the State or the Professional Order of ________ (fill the blank with
adequate profession)
Here, we had a patient mix-up (a couple of years ago) and the wrong patient
was exposed to the therapy (Cobalt therapy, Theratron 1000)intended for
another patient. I was surprised to see that AECB (Canadian equivalent of
NRC) could not do anything, it was a medical issue. I understand part of the
problematic but surely "patient identification" should also fall under
radiation safety or Health Physics.
Just my opinion.
Stephane Jean-Francois , P. Eng., CHP
Spécialiste en radioprotection/Radiation Safety Specialist
Gestion des Risques/Risk Management
Merck Frosst Canada & Co.
Tel: (514) 428.8695
Fax: (514) 428.4917
e-mail: stephane_jeanfrancois@merck.com
-----Original Message-----
From: LIPTONW@dteenergy.com [mailto:LIPTONW@dteenergy.com]
Sent: Wednesday, March 31, 1999 10:29 AM
To: Multiple recipients of list
Subject: Here's what happens when you don't know which end is up!
[from NRC events report for March 31, 1999]
A MAN SCHEDULED FOR A THERAPY DOSE TO HIS COLON WAS GIVEN A BRAIN TREATMENT
|
| INSTEAD.
|
|
|
| The text following information is a portion of a facsimile received from
the
|
| Tennessee Department of Environmental and Conversation Division of
|
| Radiological Health:
|
|
|
| "On 03/30/99, the Radiation Safety Officer at Methodist Central Hospital,
|
| Memphis, reported a therapeutic misadministration to the Memphis Field
|
| Office Manager. The event occurred on 03/29/99. A man scheduled for a
|
| therapy dose to his colon was given a brain treatment instead. The dose
to
|
| the brain was 200 rad. The man answered to the wrong name when called for
|
| treatment. A written report will be submitted to the State of Tennessee
|
| Department of Environmental and Conservation Division of Radiological
|
| Health within 15 days."
|
|
|
| The machine used was a linear accelerator.
|
+---------------------------------------------------------------------------
---
+
The opinions expressed are strictly mine.
It's not about dose, it's about trust.
Bill Lipton
liptonw@dteenergy.com
************************************************************************
The RADSAFE Frequently Asked Questions list, archives and subscription
information can be accessed at http://www.ehs.uiuc.edu/~rad/radsafe.html
************************************************************************
The RADSAFE Frequently Asked Questions list, archives and subscription
information can be accessed at http://www.ehs.uiuc.edu/~rad/radsafe.html