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Radiation Patients Endanger Public, Congressman Says

 |  By cclark@healthleadersmedia.com  
   October 21, 2010

The public is being unwittingly exposed to potentially dangerous levels of radiation from patients released from the hospital after undergoing therapy with radioactive isotopes, according to Rep. Edward J. Markey, (D-MA).

In a letter Wednesday to the U.S. Nuclear Regulatory Commission, he said this has occurred "because of weak NRC regulations, ineffective oversight of those who administer these medical treatments, and the absence of clear guidance to patients and to physicians that provide procedures to ensure that such exposures do not occur."

The rules were weakened in 1997, when standards required hospitalization of patients emitting high levels of radiation in order to protect children and other members of the public.  Today, those radiation treatments are permitted on a less expensive outpatient basis, he wrote.

Many patients responded to a federal survey that they were never told that their treatment could expose vulnerable patients to potentially harmful radiation.

Markey says the NRC should immediately revise its 1997 rule making hospitalization mandatory for patients treated with levels of the isotope I-131 at doses above internationally accepted thresholds. It should also aggressively enhance its oversight of both its medical licensees and the agreements states to better identify, track and respond to regulatory violations.

Among the problems outlined in Markey's letter:

• Two states, Maryland and Massachusetts, say they have a compounded problem of radioactive contamination of waste management facilities such as landfills disposed by households of patients treated with I-131.

• In Illinois, a patient was released to a hotel in 2007 and contaminated the bed, linens and other items in both her room and throughout the hotel, radiation that was "only discovered because two nuclear power plant workers who were equipped with radiation monitors subsequently stayed in the same hotel and set off alarms when reporting to work."

• State inspections in 10 states, Arizona, California, Illinois, Maryland, New Jersey, New Mexico, Ohio and Pennsylvania, revealed that licensees were not performing required dose calculations to ensure they would not contaminate those they came into proximity with after their treatments.  The destinations for those patients after treatment were never recorded.

• Patients in many states said they went directly after radiation treatment to buildings where they used bathrooms or bedrooms they shared with pregnant women or children, and "may have exposed these vulnerable populations through their use of taxis or public transportation."

Markey's letter details a Subcommittee on Energy and Environment survey of 1,080 thyroid cancer survivors, 781 of whom were treated as outpatients since 1997, in order to determine how they were educated and cared for post treatment. The survey revealed:

• Only 27% of those responding were treated as inpatients and therefore were allowed to stay overnight in a hospital or other medical facility. Insurance companies denied requests for inpatient stays for 10.4% of treatments after 1997.

• More than 93% of patients treated with I-131 were given a choice on whether to have their treatment on an outpatient or inpatient basis.

• More than 89% of those responding said they were treated with I-131 doses higher than 33 millicuries, which would have required inpatient stays before the 1997 regulation change for most of these patients.

• 52 patients who received 67 treatments with I-131 in 1997 in 28 states left the hospital to go directly to a hotel, motel, inn or similar facility.

The letter, addressed to NRC chairman Greg Jaczko, says that exposures are likely occurring "because NRC has failed to address these practices through the provision of clear guidance" to states with NRC agreements to use these materials.

"As a result, physicians fail to properly instruct patients, and these patients are then left with the impossible choice of exposing their family members or exposing strangers since inpatient stays are simply no longer viable options for most."

Exacerbating the issue, he wrote, is that the NRC has voted in 2000 and 2002 "not to even be informed when its licensees learn tha ta member of the public has received or is estimated to have received a dose exceeding 5 rem —a dose that is 10 times as high as NRC's own safe dose limits for released patients—from a patient who has been discharged from treatment with radioisotopes.

See Also:
CA Governor Signs Radiation Overdose Bill into Law
Severe Radiation Oncologist Shortage Forecast
CT, MRI Use in Emergency Departments Soaring

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