Are hos­pi­tals ter­ror­ism tar­gets?

Some shirk pre­cau­tions against ‘dirty bomb’ threat

Modern Healthcare - - FRONT PAGE - Jaimy Lee

Some hos­pi­tals, wary of main­te­nance costs, aren’t par­tic­i­pat­ing in gov­ern­ment ef­forts to keep high-risk ra­di­o­log­i­cal sources in med­i­cal fa­cil­i­ties se­cure from ter­ror­ists. A Gov­ern­ment Ac­count­abil­ity Of­fice re­port re­leased last week ex­am­ined the providers’ adoption of a vol­un­tary se­cu­ri­tyup­grade pro­gram of­fered to hos­pi­tals and health­care fa­cil­i­ties by the Na­tional Nu­clear Se­cu­rity Ad­min­is­tra­tion.

High-risk ra­di­o­log­i­cal ma­te­ri­als, which are of­ten used to treat can­cer, pu­rify blood or con­duct re­search, can be used to make a “dirty bomb.” The ma­te­ri­als, al­though stored in sealed con­tain­ers, are vul­ner­a­ble to theft or mis­use, in part be­cause of their small size and porta­bil­ity.

“While we un­der­stand that some hos­pi­tals and med­i­cal fa­cil­i­ties may not par­tic­i­pate in the pro­gram due to cost con­cerns, the longer the se­cu­rity up­grades re­main unim­ple­mented, the greater the risk that po­ten­tially dan­ger­ous ra­di­o­log­i­cal ma­te­ri­als from these fa­cil­i­ties could be used as a ter­ror­ist weapon,” the GAO con­cluded.

The Amer­i­can Hospi­tal As­so­ci­a­tion said ex­ist­ing rules set by the Nu­clear Reg­u­la­tory Com­mis­sion and Joint Com­mis­sion re­quire hos­pi­tals to se­cure ra­dioac­tive ma­te­ri­als. “Hos­pi­tals are com­mit­ted to strength­en­ing se­cu­rity and safe­guard­ing their com­mu­ni­ties,” Roslyne Schul­man, the AHA’s di­rec­tor of pol­icy, said in a state­ment.

As of March 2012, the Na­tional Nu­clear Se­cu­rity Ad­min­is­tra­tion has spent $105 mil­lion to up­grade se­cu­rity at 321 high-risk hos­pi­tals and health­care fa­cil­i­ties, and the agency ex­pects to com­plete all 1,503 se­cu­rity up­grades by 2025. Half of the 26 hos­pi­tals and health­care fa­cil­i­ties sur­veyed by the GAO had vol­un­teered for and re­ceived the se­cu­rity up­grades.

Four­teen fa­cil­i­ties have de­clined par­tic­i­pa­tion in the pro­gram, in­clud­ing one un­named hospi­tal with a blood ir­ra­di­a­tor that is lo­cated in an undis­closed ma­jor U.S. city.

Hospi­tal of­fi­cials told the GAO that they were con­cerned about “main­te­nance costs as­so­ci­ated with the se­cu­rity equip­ment af­ter the three- to five-year NNSA-funded war­ranty pe­riod ex­pired.” Main­te­nance costs are es­ti­mated to be about $10,000 per fa­cil­ity per year af­ter the war­ranty pe­riod ends.

A se­cu­rity of­fi­cer at the un­named hospi­tal told the GAO that “the hospi­tal is un­der se­ri­ous bud­get pres­sure that makes it dif­fi­cult to jus­tify spend­ing more money to sus­tain equip­ment for pro­tect­ing their ra­di­o­log­i­cal sources.”

The re­sources re­quired to keep the ma­te­ri­als se­cure is a con­cern even for lower-risk fa­cil­i­ties that are also reg­u­lated by the Nu­clear Reg­u­la­tory Com­mis­sion but do not house the types of high-risk ma­te­ri­als that would make them qual­ify for the up­grade pro­gram.

Gun­der­sen Lutheran Health Sys­tem, which has a 261-bed hospi­tal in La Crosse, Wis., pur­chased three se­cu­rity cam­eras that are mon­i­tored 24 hours a day and in­stalled card-swipe ac­cess locks on stor­age rooms hous­ing ra­di­o­log­i­cal ma­te­ri­als in 2008, ac­cord­ing to Mary Ellen Ja­fari, Gun­der­sen’s ra­di­a­tion safety of­fi­cer and a med­i­cal ra­di­a­tion physi­cist. “Cost is def­i­nitely an is­sue,” Ja­fari said.

The GAO re­port also ques­tioned the ad­e­quacy of the NRC’s risk-based ap­proach to im­prov­ing the se­cu­rity of ra­di­o­log­i­cal sources at health­care fa­cil­i­ties and rec­om­mended that the NRC strengthen its se­cu­rity re­quire­ments. The re­port cited spe­cific ex­am­ples of weak se­cu­rity, in­clud­ing a blood ir­ra­di­a­tor stored on a wheeled pal­let down the hall from a load­ing dock. An ir­ra­di­a­tor at an­other fa­cil­ity had the com­bi­na­tion to the locked door writ­ten on a door frame.

The GAO said the NRC’s se­cu­rity re­quire­ments act more like a frame­work for how to se­cure ra­di­o­log­i­cal ma­te­ri­als rather than set­ting out spe­cific mea­sures de­tail­ing how providers can se­cure equip­ment that con­tains ra­di­o­log­i­cal ma­te­rial. How­ever, NRC of­fi­cials cited the dif­fer­ences in providers’ fi­nan­cial health, as well as the vary­ing fa­cil­ity types, lay­outs and op­er­a­tions, as rea­sons why a “one-size-fits-all” ap­proach to se­cu­rity re­quire­ments wouldn’t work.

One small un­named med­i­cal fa­cil­ity re­ported that im­ple­ment­ing spe­cific se­cu­rity re­quire­ments, in­clud­ing cam­eras and other equip­ment, could “jeop­ar­dize con­tin­ued op­er­a­tions” due to in­stal­la­tion and main­te­nance costs.

Ja­fari, who also con­sults with hos­pi­tals about how they se­cure ra­di­o­log­i­cal ma­te­ri­als, said the cur­rent re­quire­ments are ad­e­quate. “Since 9/11, the state and the NRC are tak­ing a much more rig­or­ous ap­proach,” she said.

If any­thing were to change, she said, the NRC should re­quire that ev­ery fa­cil­ity con­duct an an­nual au­dit of its se­cu­rity for high-risk ra­di­o­log­i­cal ma­te­ri­als. At lower-risk fa­cil­i­ties, an au­dit is con­ducted by NRC or state in­spec­tors ev­ery three years.

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