Originally Published 2011-12-16 00:00:00 Published on Dec 16, 2011
The recent hospital fire in Kolkata has raised several concerns on the issue of regulation of radiological units. After a review recently, the hospital's accreditation was kept in abeyance following non conformity with respect to its radiotherapy division.
Kolkata hospital fire raises radiological concerns
The recent hospital fire in Kolkata has raised several concerns on the issue of regulation of radiological units. Even as the tragedy was unfolding, media reports talked of the possibility of a radiation leak from the radiotherapy unit of the hospital. An alert was triggered and consequently a National Disaster Response Force (NDRF) team equipped with radiation detecting equipment checked and confirmed that there was no radiation threat. The Atomic Energy Regulatory Board (AERB) was relatively quick to react and assured that there was no concern on the radiological safety status of the hospital due to the fire incident.

The possible source of radioactivity was the High Dose Rate Brachytherapy unit containing Iridium 192, which is a strong beta emitter and is used for cancer therapy. The AERB press release mentioned that the unit was in a safely retracted condition in the tungsten alloy container inside the brachytherapy housing.

There are, however, several causes of concern on this front. The unit was housed in the lower basement which is where the fire reportedly originated. Second, the National Accreditation Board for Hospitals & Healthcare Providers (NABH), the voluntary accreditation body under the Quality Council of India, had kept in abeyance AMRI’s accreditation following its review recently in November this year.

Statements from NABH secretary Dr Gyani suggested that one among the main non conformities was with respect to the radiotherapy division. Speaking to a leading daily, Dr Gyani said: "We inspected the hospital a month back, and to our shock, we found they were operating an entire radiology department with advanced diagnostic and interventional (treatment) radiology services for several departments - including gynaecology, neurology and nephrology - for a whole year without even applying for AERB clearances."

Third, despite the NABH accreditation being kept in abeyance, AMRI continued to be on the list of AERB licensees which were granted this year, raising serious questions on the efficacy of AERB review procedure with respect to licensing.

Most importantly, the fragmented nature of licensing , different departmental regulations for fire safety, building construction, hospital standards and radiation regulations with an apparent incongruence among many of these seems to be a classic case of the right hand not knowing what the left hand is doing

Accreditation bodies base their reviews on conformities, and depending on the degree and seriousness of non-conformity on any of the established standards, they may suspend the granted accreditation. The process is purely voluntary.

However, with respect to the radiological material/equipment, the AERB offers no such concessions, with good reason. For instance, the material concerned in this case, Iridium 192, is a high security risk exposure material which can increase the risk of cancer because of High Gamma radiation. External exposure could cause burns, acute radiation sickness and even death. It is less penetrating than Cobalt-60 which was found in a scrap dump in Delhi, which on exposure had caused one death and seven injuries, nevertheless is dangerous.

AERB’s mandate extends overarchingly to almost all uses of radiological material/equipment in India, including India’s civilian nuclear reactors and medical use facilities. AERB’s website hosts Safety code on radiological sources, equipment and installation (CODE NO. AERB/RF-MED/SC-1 (Rev. 2)) which outlines in detail provisions regarding layout, operation, use and transportation of Brachymetry equipment. In fact, the radiological safety officer that the release talks about is also a provision in the safety code. That AMRI’s conformity with respect to the provisions of the safety code was dubious is obvious from the NABH statement.

A recent related development involved withdrawal and consequent reinstatement of AERB license to the Lok Nayak Hospital, New Delhi due to non compliance and consequent corrective measures. Ideally, this should have triggered a nationwide review of all licensees akin to the kind that happened to nuclear power plants post Fukushima. This clearly suggests that the threat perception seen at the medial facilities angle is seen to be largely limited to overexposure during therapy rather than leak/loss /theft or exposure from radioactive waste.

A problem with the guidelines is that it only deals with the radiation aspects and not with fire like incidents which could have an indirect impact on radiation safety. Accreditation and other clearances do not seem to be a mandatory prerequisite for an AERB license which would be an ideal case .This is further reinforced by recent media reports that many super specialty hospitals currently among AERB licensees do not have the requisite fire safety provisions.

The Nuclear Safety Regulatory Authority bill which proposes the creation of a regulatory authority superseding the AERB is supposed to, under Clause 45(2) b -ensure high quality of safety management at all places where nuclear and radiation related activities are carried out. , this clause could effectively mean that with the passage of the bill the new regulatory body would be responsible for the comprehensive safety, which would necessarily include fire safety etc. Also the clause of security is not addressed here, and it is not clear who will address security

The question is that with a proposed manifold expansion of civilian nuclear facilities which are the focus area for AERB, and the concurrent spurting of medical facilities housing cancer treatment facilities, AERB or any new regulatory body could find its resources stretched thin. In this case separate bodies to look at nuclear power plant safety and radiotherapy facilities could be considered.

Another aspect regarding the response was that the NDRF team, which is the only unit outside the armed forces equipped for dealing with radiological responses, reportedly responded twelve hours after the incident despite a battalion being stationed in Kolkota. In all probability the Radiation safety Officer (RSO) reported to the AERB which then contacted the Ministry of Home Affairs (MHA). The MHA circumscribes the National Disaster Management Authority (NDMA) under which the NDRF functions. This chain could have extended the response time. Such incidents necessarily mandate a real time response mechanism which seems to be lacking at the moment.

Even if it is assumed that the radioactive substance in the unit was quantitatively too less to prove a threat, any reports of leakage would have caused panic, worsening an already tragic situation .There is a strong case for the AERB or any body replacing it to take such possibly low magnitude, high probability events seriously.

(Akhilesh Variar is a Research Assistant with Observer Research Foundation)

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