Two nurses and Rush SurgiCenter have been fined by a state agency for violating radiation protection regulations after an investigation found that the nurses operated X-ray equipment they were not supposed to use.
By Illinois law, radiologic equipment must be operated by health professionals licensed under the state Medical Practice Act, including chiropractors, dentists, podiatrists and veterinarians, or by a certified radiologic technologist, also called a radiographer.
The civil penalty from the Illinois Emergency Management Agency comes amid growing national concern about overexposure to medical radiation, including highly publicized cases in which patients were injured or died after undergoing CT scans and other radiologic procedures. Some patients were overdosed as a result of human error.
Donald Agnew, chief of the agency's electronic products section, which regulates equipment that uses radiation, characterized the violation at Rush SurgiCenter as "fairly serious" and said the facility was fined $2,000 and the two registered nurses $500 each. The penalties, levied in January, were paid by the outpatient facility, which is affiliated with Rush University Medical Center and located in the medical center complex.
"I don't think there's any impact to the patients, but we do take it seriously because we believe these machines ought to be operated by people who are trained and credentialed to do so," Agnew said. "Radiation is potentially dangerous. People who are using these machines ought to know what they are doing."
Rush SurgiCenter administrator Barbara Ramsey said the facility has made changes in scheduling, staffing and training to make sure the violation doesn't happen again.
Even before the fines, Ramsey said, staff were required to wear a radiation reader, called a dosimeter, that records radiation levels in the room. She said it is monitored quarterly to ensure that overexposure is not occurring.
"Patient safety and the safety of the staff is paramount," Ramsey said, "and anytime anything is reported to us it is thoroughly dissected down to the bottom line. This is something we do not take lightly here."
The violations involved a fluoroscope, a type of X-ray device. During a fluoroscopy procedure, patients are positioned on a table and a physician or radiographer presses either a button or a foot pedal to release an X-ray beam that passes through the body while a continuous image is transmitted to a monitor. Radiation doses vary depending on the size of the patient as well as the length of the exposure.
At Rush, Ramsey said, the procedure is done with a piece of equipment called a C-arm, which has an X-ray tube that can be positioned above or below the patient to take images from different angles. She said the machine is used for hip procedures and for procedures involving pain management.
The two major risks of fluoroscopy are radiation-induced burns to the skin and underlying tissues, and the small possibility of a radiation-induced cancer, said Myke Kudlas, chief academic officer for the American Society of Radiologic Technologists. He said improper settings on the equipment also can result in images of poor quality, possibly missing vital information.
The Illinois Emergency Management Agency inspected the facility in December after receiving a complaint from an operating room nurse who said he witnessed a nurse running a fluoroscope on two separate occasions.
Registered nurse Jeff Pecoraro, who worked in one of Rush SurgiCenter's four operating rooms, said he saw a nurse operate a fluoroscope in August and immediately reported the incident to facility administrators but was not satisfied that appropriate action was being taken. He said he saw a second nurse operate the machine in October and filed a complaint with the state Emergency Management Agency in November.
"These people have licenses and a responsibility to be advocates for patients, and they are doing the opposite of what they are trained to do," said Pecoraro, who was fired from Rush in December and now works in the Seattle area. "It's sad that this was allowed to happen."
Ramsey disputed that problems occurred in August and October. She said that, more than three years ago, a physician on two occasions had directed a nurse to push a button to activate one of the facility's two fluoroscopes. In both cases, she said, a doctor adjusted the settings and was present and no patient was harmed.
"Two separate nurses pushed the button when told to do so even though it was against policy," Ramsey said, adding that she was unaware of the incidents until after the state agency's investigation was concluded.
Agnew said Ramsey had acknowledged to an investigator that violations occurred but said the agency did not determine when the incidents took place.
The agency investigates "a few" cases each year that involve personnel with lapsed credentials using radiologic equipment, but cases involving unqualified personnel operating the equipment are rare, Agnew said.
Kudlas said it can be tempting for some health facilities to use nurses to operate radiologic equipment because it is more convenient for them.
"People are being asked to do more with less," he said, "and this is one place where people feel they can cut corners, and they really shouldn't be."