Event Notification Report for March 25, 2003
U.S. Nuclear Regulatory Commission
Operations Center
EVENT REPORTS FOR
03/24/2003 - 03/25/2003
EVENT NUMBERS
397033969739698396993970039701
Hospital
Event Number: 39703
Rep Org: DOYLESTOWN HOSPITAL
Licensee: DOYLESTOWN HOSPITAL
Region: 1
City: DOYLESTOWN State: PA
County:
License #: 37-13234-01
Agreement: N
Docket:
NRC Notified By: NUNNO
HQ OPS Officer: CHAUNCEY GOULD
Licensee: DOYLESTOWN HOSPITAL
Region: 1
City: DOYLESTOWN State: PA
County:
License #: 37-13234-01
Agreement: N
Docket:
NRC Notified By: NUNNO
HQ OPS Officer: CHAUNCEY GOULD
Notification Date: 03/26/2003
Notification Time: 11:10 [ET]
Event Date: 03/25/2003
Event Time: 09:00 [EST]
Last Update Date: 03/26/2003
Notification Time: 11:10 [ET]
Event Date: 03/25/2003
Event Time: 09:00 [EST]
Last Update Date: 03/26/2003
Emergency Class: NON EMERGENCY
10 CFR Section:
35.3045(a)(1) - DOSE <> PRESCRIBED DOSAGE
10 CFR Section:
35.3045(a)(1) - DOSE <> PRESCRIBED DOSAGE
Person (Organization):
PAMELA HENDERSON (R1)
TOM ESSIG (NMSS)
PAMELA HENDERSON (R1)
TOM ESSIG (NMSS)
MEDICAL EVENT WHICH INVOLVED EXCEEDING THE PRESCRIBED DOSE TO A PATIENT
During a procedure using a Galileo 3 IVB made by Guidant, the company trainer was demonstrating how to conduct the procedure. A "hot" (wire containing approximately 100 millicuries of P-32) wire was to be inserted into the patient's coronary vessel, but prior to this a dummy wire was to be inserted. The dummy wire was inserted but not all the way. It was removed and then the "hot" wire was inserted to the same position and then removed. It was then realized that it was not fully inserted, so they reinserted it to the full position realizing that the patient would get more that the prescribed dose of 2,000 rads (actual dose received was 2,833 rads or 41% more than the prescribed dose), but the treatment was needed by the patient. There would be no adverse affects to the patient and both the patient and prescribing physician were notified.
During a procedure using a Galileo 3 IVB made by Guidant, the company trainer was demonstrating how to conduct the procedure. A "hot" (wire containing approximately 100 millicuries of P-32) wire was to be inserted into the patient's coronary vessel, but prior to this a dummy wire was to be inserted. The dummy wire was inserted but not all the way. It was removed and then the "hot" wire was inserted to the same position and then removed. It was then realized that it was not fully inserted, so they reinserted it to the full position realizing that the patient would get more that the prescribed dose of 2,000 rads (actual dose received was 2,833 rads or 41% more than the prescribed dose), but the treatment was needed by the patient. There would be no adverse affects to the patient and both the patient and prescribing physician were notified.
Power Reactor
Event Number: 39697
Facility: MCGUIRE
Region: 2 State: NC
Unit: [1] [2] []
RX Type: [1] W-4-LP,[2] W-4-LP
NRC Notified By: WADSWORTH
HQ OPS Officer: CHAUNCEY GOULD
Region: 2 State: NC
Unit: [1] [2] []
RX Type: [1] W-4-LP,[2] W-4-LP
NRC Notified By: WADSWORTH
HQ OPS Officer: CHAUNCEY GOULD
Notification Date: 03/25/2003
Notification Time: 12:41 [ET]
Event Date: 03/25/2003
Event Time: 00:00 [EST]
Last Update Date: 03/25/2003
Notification Time: 12:41 [ET]
Event Date: 03/25/2003
Event Time: 00:00 [EST]
Last Update Date: 03/25/2003
Emergency Class: NON EMERGENCY
10 CFR Section:
73.71(b)(1) - SAFEGUARDS REPORTS
10 CFR Section:
73.71(b)(1) - SAFEGUARDS REPORTS
Person (Organization):
RUDOLPH BERNHARD (R2)
RUDOLPH BERNHARD (R2)
| Unit | SCRAM Code | RX Crit | Initial PWR | Initial RX Mode | Current PWR | Current RX Mode |
|---|---|---|---|---|---|---|
| 1 | N | Y | 100 | Power Operation | 100 | Power Operation |
| 2 | N | Y | 100 | Power Operation | 100 | Power Operation |
DISCOVERY OF CRIMANAL ACT INVOLVING FALSIFICATION OF INFORMATION PERTAINING TO ACCESS SCREENING
Compensatory measures taken by Licensee upon discovery. The NRC Resident Inspector was notified.
Contact HOO for additional information.
SEE EVENTS # 39698 AND 39700
Compensatory measures taken by Licensee upon discovery. The NRC Resident Inspector was notified.
Contact HOO for additional information.
SEE EVENTS # 39698 AND 39700
Power Reactor
Event Number: 39698
Facility: CATAWBA
Region: 2 State: SC
Unit: [1] [2] []
RX Type: [1] W-4-LP,[2] W-4-LP
NRC Notified By: BRADLEY
HQ OPS Officer: CHAUNCEY GOULD
Region: 2 State: SC
Unit: [1] [2] []
RX Type: [1] W-4-LP,[2] W-4-LP
NRC Notified By: BRADLEY
HQ OPS Officer: CHAUNCEY GOULD
Notification Date: 03/25/2003
Notification Time: 12:57 [ET]
Event Date: 03/25/2003
Event Time: 12:00 [EST]
Last Update Date: 03/25/2003
Notification Time: 12:57 [ET]
Event Date: 03/25/2003
Event Time: 12:00 [EST]
Last Update Date: 03/25/2003
Emergency Class: NON EMERGENCY
10 CFR Section:
73.71(b)(1) - SAFEGUARDS REPORTS
10 CFR Section:
73.71(b)(1) - SAFEGUARDS REPORTS
Person (Organization):
RUDOLPH BERNHARD (R2)
RUDOLPH BERNHARD (R2)
| Unit | SCRAM Code | RX Crit | Initial PWR | Initial RX Mode | Current PWR | Current RX Mode |
|---|---|---|---|---|---|---|
| 1 | N | Y | 100 | Power Operation | 100 | Power Operation |
| 2 | N | N | 0 | Hot Standby | 0 | Hot Standby |
DISCOVERY OF CRIMANAL ACT INVOLVING FALSIFICATION OF INFORMATION PERTAINING TO ACCESS SCREENING
Compensatory measures taken by Licensee upon discovery. The NRC Resident Inspector will be notified.
Contact HOO for additional information.
SEE EVENTS # 39697 AND 39700
Compensatory measures taken by Licensee upon discovery. The NRC Resident Inspector will be notified.
Contact HOO for additional information.
SEE EVENTS # 39697 AND 39700
Power Reactor
Event Number: 39699
Facility: PALISADES
Region: 3 State: MI
Unit: [1] [] []
RX Type: [1] CE
NRC Notified By: KEN JOHNSON
HQ OPS Officer: ERIC THOMAS
Region: 3 State: MI
Unit: [1] [] []
RX Type: [1] CE
NRC Notified By: KEN JOHNSON
HQ OPS Officer: ERIC THOMAS
Notification Date: 03/25/2003
Notification Time: 11:42 [ET]
Event Date: 03/25/2003
Event Time: 11:21 [EST]
Last Update Date: 03/27/2003
Notification Time: 11:42 [ET]
Event Date: 03/25/2003
Event Time: 11:21 [EST]
Last Update Date: 03/27/2003
Emergency Class: ALERT
10 CFR Section:
50.72(a) (1) (i) - EMERGENCY DECLARED 50.72(b)(3)(iv)(A) - VALID SPECIF SYS ACTUATION 50.72(b)(3)(v)(B) - POT RHR INOP 50.72(b)(2)(xi) - OFFSITE NOTIFICATION
10 CFR Section:
50.72(a) (1) (i) - EMERGENCY DECLARED 50.72(b)(3)(iv)(A) - VALID SPECIF SYS ACTUATION 50.72(b)(3)(v)(B) - POT RHR INOP 50.72(b)(2)(xi) - OFFSITE NOTIFICATION
Person (Organization):
MICHAEL PARKER (R3)
BILL BATEMAN (NRR)
JOHN JOLICOEUR (IRO)
DAVE BARDEN (FEMA)
BLAIR SPITZBERG (R4)
MICHAEL PARKER (R3)
BILL BATEMAN (NRR)
JOHN JOLICOEUR (IRO)
DAVE BARDEN (FEMA)
BLAIR SPITZBERG (R4)
| Unit | SCRAM Code | RX Crit | Initial PWR | Initial RX Mode | Current PWR | Current RX Mode |
|---|---|---|---|---|---|---|
| 1 | N | N | 0 | Refueling | 0 | Refueling |
ALERT DECLARED DUE TO LOSS OF SHUTDOWN COOLING
The reactor is shutdown for a refueling outage since 3/17/03. An alert declaration was made on 3/25/03 at 1121 EST due to loss of shutdown cooling. Time to boil is estimated to be less than fifty five (55) minutes. Plant status is degrading. There are no radioactivity releases in progress. The current wind direction is from 270 to 90 degrees. The wind speed is eight (8) miles per hour, class B stability with no precipitation. Mitigating responses by the Licensee are in progress.
The U.S. NRC entered the Monitoring Phase of Normal Mode at 1159 at EST.
*** UPDATE ON 3/25/03 AT 1233 EST FROM JONATHAN SEGUNDO TO HQ OPERATIONS CENTER***
The Alert condition was terminated and the Station entered an Unusual Event at 12:31 EST due to loss of offsite power. Shutdown cooling was restored at 11:41 EST. Plant systems are being powered by the Emergency Diesel Generators. Reactor Coolant System temperature is at 104 degrees Fahrenheit. There are no radioactivity releases in progress.
*** UPDATE ON 3/25/03 AT 1824 EST FROM AMY HAZELHOFF TO ARLON COSTA***
"Nuclear Management Company is providing additional information related to event notification 39699, which was reported at 1121 [1142] EST on March 25, 2003. This information is provided for completeness of reportability requirements. The event reported earlier is also reportable under the following criteria:
10CFR50.72(b)(3)(iv)(A), due to actuation of the emergency diesel generators and
10CFR50.72(b)(3)(v)(B), due to loss of shutdown cooling.
"Additionally, a press release has been issued. Therefore, a report is required per 10CFR50.72(b)(2)(xi) for notification to offsite agencies. Palisades remains in an Unusual Event until a qualified offsite circuit is supplying a vital bus. The plant is currently stable. The root cause [of this incident] is not yet known."
Notifications of this update were made by the Licensee to the NRC Resident Inspector, the state, local and other government agencies, and a press release was issued on this incident.
* * * UPDATE ON 3/27/03 AT 1742 EST FROM PAUL ZWISSLER TO HOWIE CROUCH * * *
Palisades Nuclear Power Plant has terminated the Unusual Event declared on 3/25/03. Plant vital busses are being powered by offsite power source and the emergency diesel generators have been secured and returned to standby status. There were no security implications associated with this event.
The licensee has notified the NRC Resident Inspector.
The reactor is shutdown for a refueling outage since 3/17/03. An alert declaration was made on 3/25/03 at 1121 EST due to loss of shutdown cooling. Time to boil is estimated to be less than fifty five (55) minutes. Plant status is degrading. There are no radioactivity releases in progress. The current wind direction is from 270 to 90 degrees. The wind speed is eight (8) miles per hour, class B stability with no precipitation. Mitigating responses by the Licensee are in progress.
The U.S. NRC entered the Monitoring Phase of Normal Mode at 1159 at EST.
*** UPDATE ON 3/25/03 AT 1233 EST FROM JONATHAN SEGUNDO TO HQ OPERATIONS CENTER***
The Alert condition was terminated and the Station entered an Unusual Event at 12:31 EST due to loss of offsite power. Shutdown cooling was restored at 11:41 EST. Plant systems are being powered by the Emergency Diesel Generators. Reactor Coolant System temperature is at 104 degrees Fahrenheit. There are no radioactivity releases in progress.
*** UPDATE ON 3/25/03 AT 1824 EST FROM AMY HAZELHOFF TO ARLON COSTA***
"Nuclear Management Company is providing additional information related to event notification 39699, which was reported at 1121 [1142] EST on March 25, 2003. This information is provided for completeness of reportability requirements. The event reported earlier is also reportable under the following criteria:
10CFR50.72(b)(3)(iv)(A), due to actuation of the emergency diesel generators and
10CFR50.72(b)(3)(v)(B), due to loss of shutdown cooling.
"Additionally, a press release has been issued. Therefore, a report is required per 10CFR50.72(b)(2)(xi) for notification to offsite agencies. Palisades remains in an Unusual Event until a qualified offsite circuit is supplying a vital bus. The plant is currently stable. The root cause [of this incident] is not yet known."
Notifications of this update were made by the Licensee to the NRC Resident Inspector, the state, local and other government agencies, and a press release was issued on this incident.
* * * UPDATE ON 3/27/03 AT 1742 EST FROM PAUL ZWISSLER TO HOWIE CROUCH * * *
Palisades Nuclear Power Plant has terminated the Unusual Event declared on 3/25/03. Plant vital busses are being powered by offsite power source and the emergency diesel generators have been secured and returned to standby status. There were no security implications associated with this event.
The licensee has notified the NRC Resident Inspector.
Power Reactor
Event Number: 39700
Facility: OCONEE
Region: 2 State: SC
Unit: [1] [2] [3]
RX Type: [1] B&W-L-LP,[2] B&W-L-LP,[3] B&W-L-LP
NRC Notified By: Daniel Durham
HQ OPS Officer: CHAUNCEY GOULD
Region: 2 State: SC
Unit: [1] [2] [3]
RX Type: [1] B&W-L-LP,[2] B&W-L-LP,[3] B&W-L-LP
NRC Notified By: Daniel Durham
HQ OPS Officer: CHAUNCEY GOULD
Notification Date: 03/25/2003
Notification Time: 12:42 [ET]
Event Date: 03/25/2003
Event Time: 12:00 [EST]
Last Update Date: 03/25/2003
Notification Time: 12:42 [ET]
Event Date: 03/25/2003
Event Time: 12:00 [EST]
Last Update Date: 03/25/2003
Emergency Class: NON EMERGENCY
10 CFR Section:
73.71(b)(1) - SAFEGUARDS REPORTS
10 CFR Section:
73.71(b)(1) - SAFEGUARDS REPORTS
Person (Organization):
RUDOLPH BERNHARD (R2)
RUDOLPH BERNHARD (R2)
| Unit | SCRAM Code | RX Crit | Initial PWR | Initial RX Mode | Current PWR | Current RX Mode |
|---|---|---|---|---|---|---|
| 1 | N | Y | 100 | Power Operation | 100 | Power Operation |
| 2 | N | Y | 100 | Power Operation | 100 | Power Operation |
| 3 | N | Y | 99 | Power Operation | 99 | Power Operation |
DISCOVERY OF CRIMINAL ACT INVOLVING FALSIFICATION OF INFORMATION PERTAINING TO ACCESS SCREENING
Compensatory measures taken by Licensee upon discovery. The NRC Resident Inspector will be notified.
Contact HOO for additional information.
SEE EVENTS #39697 AND 39698.
Compensatory measures taken by Licensee upon discovery. The NRC Resident Inspector will be notified.
Contact HOO for additional information.
SEE EVENTS #39697 AND 39698.
Power Reactor
Event Number: 39701
Facility: SUSQUEHANNA
Region: 1 State: PA
Unit: [1] [2] []
RX Type: [1] GE-4,[2] GE-4
NRC Notified By: ROBERT BOESCH
HQ OPS Officer: MIKE RIPLEY
Region: 1 State: PA
Unit: [1] [2] []
RX Type: [1] GE-4,[2] GE-4
NRC Notified By: ROBERT BOESCH
HQ OPS Officer: MIKE RIPLEY
Notification Date: 03/26/2003
Notification Time: 00:30 [ET]
Event Date: 03/25/2003
Event Time: 23:58 [EST]
Last Update Date: 03/26/2003
Notification Time: 00:30 [ET]
Event Date: 03/25/2003
Event Time: 23:58 [EST]
Last Update Date: 03/26/2003
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(2)(xi) - OFFSITE NOTIFICATION
10 CFR Section:
50.72(b)(2)(xi) - OFFSITE NOTIFICATION
Person (Organization):
PAMELA HENDERSON (R1)
PAMELA HENDERSON (R1)
| Unit | SCRAM Code | RX Crit | Initial PWR | Initial RX Mode | Current PWR | Current RX Mode |
|---|---|---|---|---|---|---|
| 1 | N | Y | 100 | Power Operation | 100 | Power Operation |
| 2 | N | N | 0 | Refueling | 0 | Refueling |
OFFSITE NOTIFICATION OF MEDICAL CONDITION
"On 3/25/03 at 23:45 [EST] the Main Control Room was notified that an individual with a medical condition (believed to be a kidney stone) needed to be transported to the hospital by ambulance. An ambulance was dispatched to the site. The individual was not contaminated. The individual was transported to a local hospital for treatment.
"The Pennsylvania Emergency Management Agency was notified at 23:58 [EST]. Due to notification to another government agency, this event is reportable under 10CFR50.72(b)(2)(xi)."
The licensee notified the NRC Resident Inspector.
"On 3/25/03 at 23:45 [EST] the Main Control Room was notified that an individual with a medical condition (believed to be a kidney stone) needed to be transported to the hospital by ambulance. An ambulance was dispatched to the site. The individual was not contaminated. The individual was transported to a local hospital for treatment.
"The Pennsylvania Emergency Management Agency was notified at 23:58 [EST]. Due to notification to another government agency, this event is reportable under 10CFR50.72(b)(2)(xi)."
The licensee notified the NRC Resident Inspector.