Hospital Cited Over Disposal of Medical Wastes : Radioactive: Sharp Memorial suspends certain cancer-fighting surgeries after radioactive wastes from implants are discovered at landfills.

Sharp Memorial Hospital improperly disposed of radioactive medical waste twice this year, and as a result it has been barred from performing surgical implants of radioactive substances into cancer patients.

The state Radiologic Health Branch issued an emergency order against the hospital March 2 after a county investigator found radioactive trash included with medical waste that went to a landfill.

The San Diego County district attorney’s office is considering whether to file criminal charges.

“The order was issued because radioactive sources were accidentally thrown into the trash at the hospital and ended up at a local landfill on two separate occasions,” says a March 26 branch memo to Jack McGurk, chief of environmental health for the state.

“The hospital has abided by the order and did not request a hearing,” the memo says. “They have requested an amendment to their license and will put in place greater controls over the doctors using therapeutic (radioactive) sources.”

Caty Van Housen, spokeswoman for the hospital, said Sharp suspended all radioactive implants Feb. 16, soon after an investigator told the hospital of the problem and three weeks before the state order was issued.

Sharp has modified its safety procedures for using radioactive iridium-192 and other radioactive implant materials and expects a new license to be issued by June, she said.

The iridium-192 that contaminated Sharp trash on two occasions is used by oncologists for surgical implants of bird-seed-sized pellets that irradiate and destroy cancer cells, said Dr. Ronald S. Scott, adding that the pellets are removed after two or three days.

Scott is one of the doctors who is having to take his implant patients to other area hospitals because of the Sharp problems.

Scott said he understood that the improperly disposed-of Sharp waste was detected when an inspector took a Geiger counter to a landfill. A Geiger counter

clicks every time an atom decays and emits gamma radiation, which is the kind that passes most easily through solids.

“It wasn’t really enough to be concerned about,” Scott said. “First of all, the (radioactive) source was largely decayed down, and probably wouldn’t have been picked up if they hadn’t used a Geiger counter at the dump. The public risk for this is near zero.”

Iridium-192 is most commonly used in large gynecological cancers, but also can be used in local, hard-to-treat disease such as in the tongue, he said. Small tubes are first placed surgically into the cancer site, and the iridium pellets are inserted into the tubes later.

Iridium-192 has the advantage of a relatively long 72-day half-life--the amount of time for half of it to decay away radioactively. This means that over two or three days its delivers a relatively constant amount of radiation to tissues that the oncologist wants to irradiate. Iridium-192 would decay to nearly undetectable amounts after about two years.

Other radioactive materials also can be used for implants, but very few such procedures are done at Sharp, he said.

Besides iridium-192, radioactive waste from hospitals comes from a number of cancer therapies and other diagnostic procedures. Under state and federal law, however, all waste from these procedures must be labeled as radioactive waste and sent to a designated dump for such trash.

County and state officials familiar with the case could not be reached for comment Tuesday on how much radioactive material was found.

However, the district attorney’s office has received the county’s investigative report on the case to consider criminal charges against the hospital, said spokeswoman Linda Miller. A decision could take several months.