Event Notification Report for August 05, 2002
U.S. Nuclear Regulatory Commission
Operations Center
EVENT REPORTS FOR
08/04/2002 - 08/05/2002
Hospital
Event Number: 39110
Rep Org: BENEFIS HEALTH CARE
Licensee: BENEFIS HEALTH CARE
Region: 4
City: GREAT FALLS State: MT
County:
License #: 25-12710-01
Agreement: N
Docket:
NRC Notified By: KARI CANN
HQ OPS Officer: FANGIE JONES
Licensee: BENEFIS HEALTH CARE
Region: 4
City: GREAT FALLS State: MT
County:
License #: 25-12710-01
Agreement: N
Docket:
NRC Notified By: KARI CANN
HQ OPS Officer: FANGIE JONES
Notification Date: 08/05/2002
Notification Time: 17:36 [ET]
Event Date: 08/05/2002
Event Time: 00:00 [MDT]
Last Update Date: 08/05/2002
Notification Time: 17:36 [ET]
Event Date: 08/05/2002
Event Time: 00:00 [MDT]
Last Update Date: 08/05/2002
Emergency Class: NON EMERGENCY
10 CFR Section:
35.33 - MED MISADMINISTRATION
10 CFR Section:
35.33 - MED MISADMINISTRATION
Person (Organization):
CHUCK CAIN (R4)
E. WILLIAM BRACH (NMSS)
CHUCK CAIN (R4)
E. WILLIAM BRACH (NMSS)
MEDICAL MISADMINISTRATION - DOSE GIVEN APPROXIMATELY 22% LESS THAN PRESCRIBED
This report is made due to failure to provide test per NRC Notification Notice 2002-19. A review of the administration records indicate that 6 patients received palliative doses of samarium since 12/99 that were about 22% low. Benifis Health Care does not use unit dose vials, they receive multidose vials and withdraw a dose out into a plastic syringe. After receipt of a calibration source, the RSO determined that radiation readings for a dose in a plastic syringe was 21.6% higher than in a glass syringe. A correction factor has been put in place for plastic syringes to insure proper dosages in the future. The patients have been determined to have no adverse affects, they all had relief of pain even with the lower dose. The patients and attending physicians have not been informed at this time.
This report is made due to failure to provide test per NRC Notification Notice 2002-19. A review of the administration records indicate that 6 patients received palliative doses of samarium since 12/99 that were about 22% low. Benifis Health Care does not use unit dose vials, they receive multidose vials and withdraw a dose out into a plastic syringe. After receipt of a calibration source, the RSO determined that radiation readings for a dose in a plastic syringe was 21.6% higher than in a glass syringe. A correction factor has been put in place for plastic syringes to insure proper dosages in the future. The patients have been determined to have no adverse affects, they all had relief of pain even with the lower dose. The patients and attending physicians have not been informed at this time.
Power Reactor
Event Number: 39111
Facility: DUANE ARNOLD
Region: 3 State: IA
Unit: [1] [] []
RX Type: [1] GE-4
NRC Notified By: BRIAN HUPKE
HQ OPS Officer: JOHN MacKINNON
Region: 3 State: IA
Unit: [1] [] []
RX Type: [1] GE-4
NRC Notified By: BRIAN HUPKE
HQ OPS Officer: JOHN MacKINNON
Notification Date: 08/06/2002
Notification Time: 04:34 [ET]
Event Date: 08/05/2002
Event Time: 23:33 [CDT]
Last Update Date: 08/06/2002
Notification Time: 04:34 [ET]
Event Date: 08/05/2002
Event Time: 23:33 [CDT]
Last Update Date: 08/06/2002
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(v)(B) - POT RHR INOP
10 CFR Section:
50.72(b)(3)(v)(B) - POT RHR INOP
Person (Organization):
BRENT CLAYTON (R3)
BRENT CLAYTON (R3)
| Unit | SCRAM Code | RX Crit | Initial PWR | Initial RX Mode | Current PWR | Current RX Mode |
|---|---|---|---|---|---|---|
| 1 | N | Y | 94 | Power Operation | 94 | Power Operation |
LOSS OF RESIDUAL HEAT REMOVAL (RHR) HEAT REMOVAL CAPABILITY.
"At 23:33 on 8/5/02 both loops of RHRSW (Residual Heat Removal Service Water) were declared inoperable due to experiencing high differential pressure greater than 12 psid across the 'A' loop RHRSW strainer and the 'B' loop RHRSW strainer.
"On 8/4/02 while running a surveillance for the 'B' RHRSW pump a high strainer differential pressure annunciator was received, which comes in a 6 psid. 'B' pump flow at the time was 2400 GPM. The in plant operator was sent locally to investigate the local differential pressure indication and discovered the instrument was pegged high at > (greater than ) 15 psid. The pump was secured and the corresponding Limiting Condition of Operation of 7 days was entered for the 'B' RHRSW loop. Maintenance was immediately planned and begun to clean the 'B' RHRSW strainer. At the time plans were also made to inspect the 'B' RHRSW/ESW (Emergency Service Water) pit and Stilling Basin.
"On 8/5/02 after inspections of the Stilling basin found algae growth, plans were made to run the 'A' side RHRSW pumps to determine operability of the 'A' loop of RHRSW. At that time the Stilling basin cleaning also began. After the completion of stilling basin cleaning on 8/5/02, the 'A' RHRSW pump was started and strainer differential was between 2.5 - 4.5 psid at a pump flow of 2400 GPM which was held for 15 minutes. At this time the 'C' RHRSW pump was started and flow raised to 4100 GPM at which time strainer differential pressure was steady at 5.5 - 6.0 psid. As flow was raised to 5000 GPM Strainer differential pressure pegged high at > (greater than) 15 psid within 3 minutes. The 'A' RHRSW pump was then secured and flow lowered to 2100 GPM where strainer differential pressure remained at 10 - 12 psid and then pegged high at greater than 15 psid. The 'C' RHRSW pump was then secured and the 'A' RHRSW loop was declared inoperable at 23:33 on 8/5/02. The LCO for both loops of RHRSW inoperable was then entered at 23:33 on 8/5/02.
"This report is being made under 50.72(b)(3)(v)(B) 'Any event or condition that at the time of discovery could have prevented the fulfillment of the safety function of structures or systems that are needed to remove residual heat.' "
All other Emergency Core Cooling Systems are fully operable if needed.
The NRC Resident Inspector was notified of this event by the licensee.
"At 23:33 on 8/5/02 both loops of RHRSW (Residual Heat Removal Service Water) were declared inoperable due to experiencing high differential pressure greater than 12 psid across the 'A' loop RHRSW strainer and the 'B' loop RHRSW strainer.
"On 8/4/02 while running a surveillance for the 'B' RHRSW pump a high strainer differential pressure annunciator was received, which comes in a 6 psid. 'B' pump flow at the time was 2400 GPM. The in plant operator was sent locally to investigate the local differential pressure indication and discovered the instrument was pegged high at > (greater than ) 15 psid. The pump was secured and the corresponding Limiting Condition of Operation of 7 days was entered for the 'B' RHRSW loop. Maintenance was immediately planned and begun to clean the 'B' RHRSW strainer. At the time plans were also made to inspect the 'B' RHRSW/ESW (Emergency Service Water) pit and Stilling Basin.
"On 8/5/02 after inspections of the Stilling basin found algae growth, plans were made to run the 'A' side RHRSW pumps to determine operability of the 'A' loop of RHRSW. At that time the Stilling basin cleaning also began. After the completion of stilling basin cleaning on 8/5/02, the 'A' RHRSW pump was started and strainer differential was between 2.5 - 4.5 psid at a pump flow of 2400 GPM which was held for 15 minutes. At this time the 'C' RHRSW pump was started and flow raised to 4100 GPM at which time strainer differential pressure was steady at 5.5 - 6.0 psid. As flow was raised to 5000 GPM Strainer differential pressure pegged high at > (greater than) 15 psid within 3 minutes. The 'A' RHRSW pump was then secured and flow lowered to 2100 GPM where strainer differential pressure remained at 10 - 12 psid and then pegged high at greater than 15 psid. The 'C' RHRSW pump was then secured and the 'A' RHRSW loop was declared inoperable at 23:33 on 8/5/02. The LCO for both loops of RHRSW inoperable was then entered at 23:33 on 8/5/02.
"This report is being made under 50.72(b)(3)(v)(B) 'Any event or condition that at the time of discovery could have prevented the fulfillment of the safety function of structures or systems that are needed to remove residual heat.' "
All other Emergency Core Cooling Systems are fully operable if needed.
The NRC Resident Inspector was notified of this event by the licensee.