No. III-10-033

Contacts: 

Viktoria Mitlyng 630-829-9662

Prema Chandrathil 630-829-9663

 August 23, 2010

 E-Mail: opa3@nrc.gov 

Web site: www.nrc.gov

NRC PROPOSES $39,000 FINE AGAINST DEPARTMENT OF VETERANS AFFAIRS 

FOR VIOLATIONS OF NRC REQUIREMENTS

The Nuclear Regulatory Commission has proposed a civil penalty of $39,000 against the 

Department of Veterans Affairs (DVA) for two violations of NRC regulations. The NRC 

identified that the DVA failed to recognize that problems with prostate brachytherapy programs

existed at other VA facilities after similar problems were previously cited at the Philadelphia VA 

Medical Center’s program.

“These violations should have been identified by the DVA during their own independent 

inspections of the VA facilities,” said NRC Region III Regional Administrator Mark Satorius. 

“We expect the DVA to ensure all facilities with prostate brachytherapy programs not only fully 

understand and follow NRC regulations but also rigorously implement their oversight role to 

ensure medical procedures with nuclear materials are delivered safely to patients.”

The NRC identified the violations after conducting numerous inspections and reviews at 

other VA facilities with prostate brachytherapy programs across the country from Oct. 8, 2008 to 

April 22, 2010. NRC inspections of the other VA facilities began after the VA hospital in 

Philadelphia failed to report 97 medical errors out of 116 prostate cancer treatment procedures 

performed between 2002 and 2008. 

The violations are associated with the DVA’s failure to develop and implement written 

procedures across all VA brachytherapy programs to verify the administrations of nuclear 

material according to the patients’ treatment plan and written directive; as well as a failure to 

notify the NRC no later than the next day after the discovery of a medical event. The DVA has 

taken corrective actions to fix these two violations.

The NRC also determined that the DVA had not taken steps to fix the larger problems 

with the DVA’s regulatory oversight organizations. The NRC concluded the VA National 

Radiation Safety Committee (NRSC) and the VA National Health Physics Program (NHPP) had 

not taken steps internally to aggressively assess their regulatory and oversight functions and 

performance.

NRC NEWS

U.S. NUCLEAR REGULATORY COMMISSION

Office of Public Affairs Region III

2443 Warrenville Road

Lisle IL 60532
The NRC held a regulatory conference in June at which the DVA disagreed with some 

aspects of the NRC’s evaluation. After considering the information provided by the DVA, the 

NRC staff issued its final determination including the two violations and the $39,000 civil 

penalty. 

The NRC plans to hold a public meeting with the DVA to further discuss the actions that 

are necessary to improve the DVA’s regulatory oversight organizations’ performance. A meeting 

notice will be issued when a date has been finalized.

The DVA has 30 days to respond to the notice of violation.

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