Hospital’s Improper Nuclear Use Detailed : San Diego: State records reveal why Sharp’s license for using some radioactive materials was suspended.

Sharp Memorial Hospital was incapable of figuring out how much nuclear material it had, how carefully the material had been used by doctors and how much was sent back to suppliers when the state recently suspended Sharp’s license for using certain radioactive materials, state records obtained Wednesday show.

Although there apparently was no specific danger to the public health, the records kept by the Radiologic Health Branch of the state Department of Health Services portray an institution so lax that the person listed in state records as in charge of monitoring the materials used in the hospital’s radiological program was no longer even working there.

At one point in correspondence contained in the records, a nuclear materials supplier plaintively asked for help in figuring out who was in charge.

“It would be most useful if you would advise us of the full titles of each of these Sharp Memorial Hospital personnel as well as who has the senior authority to issue instructions,” Krishnan Suthanthiran, president of Best Industries of Springfield, Va., wrote the hospital.

Even as this apparently virtually rudderless ship was documented by the state, however, Sharp contends in its written responses that blame for improper disposal of radioactive materials belongs to the physician who used them, Dr. Ronald S. Scott.

Scott performed implants of radioactive iridium-192 into patients to kill cancer cells. It was iridium-192, improperly sent to a Miramar landfill, that led the state to investigate Sharp. Scott acknowledges being the only doctor at Sharp using iridium.

In turn, Scott said Wednesday that he believes it was the hospital’s responsibility to assure that radioactive materials were not thrown in the trash.

The state documents, obtained by The Times, and interviews with state officials and the San Diego inspector who investigated the iridium incidents reveal that:

The first iridium that went astray showed up at the city’s Miramar landfill Sept. 20. It came not from the hospital but from Scott’s office at 8008 Frost St., across the street from Sharp. There were five bird-seed-sized pellets, sealed inside plastic sheeting and detected by an automatic radiation monitor that every trash truck passes.

An investigation of that incident revealed that Scott, a doctor since 1979, was receiving and storing nuclear materials at his office without a state license to do so. He was operating improperly under Sharp’s license, the inquiry showed.

The second batch of iridium pellets sent to Miramar arrived Dec. 6. It took several weeks to determine that the iridium apparently left the hospital inside dirty linen and went to California Linen Supply, where it was found and discarded. There were 10 pellets in that incident.

An inspection report in the Sacramento file by health physicist Frank O. Bold, with whom San Diego County and the state contract to enforce radiation safety laws, showed that Sharp failed to conduct routine radiation monitoring to catch radioactive contamination from hospital procedures.

At Scripps Clinic, for instance, it is routine to check for radioactivity in every piece of paper or linen from a room where a radioactive-implant patient has stayed, said James McIlraith, director of Scripps’ environmental health and safety.

Bold found that the Sharp hospital had no records to show that, when it did use radiation detectors, the machines had been regularly calibrated for accuracy.

In one case, there was no record of a nuclear medicine technologist having been monitored for radiation exposure, he alleged.

The inspector also found the door to the radioactive “hot lab” unlocked and ajar, with no one in attendance.

Bold’s report and the state’s investigation resulted March 2 in the suspension of the hospital’s license for conducting radioactive implant procedures in cancer therapy. The action was merited, Bold wrote to Sharp on Feb. 23, because “obviously the corrective action plan provided . . . after the first incident did not correct the situation.”

The handling of radioactive materials used in hospitals is regulated under state and federal laws because of the potential for health hazards.

However, an independent medical physicist contacted by The Times calculated that radiation doses to anyone inadvertently exposed to the iridium sent to the landfill would be negligible. The radioactivity level of the five pellets in the September incident was so low--4.3 millirems per hour--that a person standing a yard away from them would have to stand there for seven hours before receiving a radiation dose equivalent to that of a single chest X-ray, said Jerry Hilbert, of Medical Physics Associates.

The 10 pellets discarded in the December incident were not as radioactive as the ones discarded in September; a person would have to stand next to them for about 28 hours to get a radiation dose equivalent to a chest X-ray, he said.

(A millirem is one-thousandth of a rem, which is a measure of the biological damage done by radiation. A resident of a low-altitude American city such as San Diego receives 100 to 200 millirems a year from natural sources, such as cosmic rays and radon seeping out of the Earth.)

Although both incidents involved very small amounts of radioactivity and potential radiation doses, they were viewed as serious by the state because of the pattern the incidents revealed, the state records indicate.

Contacted for comment Wednesday, Caty Van Housen, a Sharp spokeswoman, said she was having trouble getting in touch with officials who could speak about the situation. In a statement issued Tuesday, the hospital said it is redesigning its radiation safety program to remedy the problems and win back its license.

Scott acknowledged responsibility Wednesday for a miscount that allowed the 10 iridium pellets to show up in California Linen’s trash on Dec. 6.

A patient had 362 iridium “seeds” implanted in her body in late November, and then removed a few days later. But only 352 were in the shipment of seeds that was returned to the supplier, where they can be reused, he said.

“The only thing that one would look to in this case is to say the counts didn’t match,” Scott said. “I made the counts, so obviously I made a mistake. I counted 352 and got 362. But remember, you’re counting little tiny things that are radioactive, and they’re right in front of your nose.”

The hospital is adopting a new rule that pellets must be counted twice by separate people, he said.

When one is working with that many iridium pellets, it is not unusual for some to get lost, Scott added. In that case, hospital radiation checks of the room and the radiation monitoring at the city landfill are sufficient to assure that misplaced pellets are found, Scott said.

The September seeds from his office were apparently unearthed and discarded during an office remodeling, state records indicate he told Sharp officials.

On Wednesday, Scott said the spacing of those seeds inside a plastic sheet wasn’t one he had used in the last year, so he isn’t sure that those iridium seeds were from his tenure in the medical practice.

Scott took over the radiation oncology practice of Dr. David Seay in February, 1989.