Case Study 4: When Radiation Therapy Kills (pages 187-189)

Question 1: What concepts in the chapter are illustrated in this case? What ethical issues are raised by radiation technology?

Question 2: What management, organization and technology factors that was responsible for the problems detailed in this case?

Question 3: Do you feel any of the groups involved with this issues (hospital administrators, technicians, medical equipment and software manufactures) should accept the majority of the blame for these incidents?

Question 4: How would a central reporting agency that gathered data on radiation-related accidents help reduce the number of radiation therapy errors in the future?


Question 1:

The basic concepts covered: responsibility, accountability and liability. The ethical issues: Management failed to regulate the hospitals' overworked staff and for not having safety procedures in place to check their work and enough time to do so. The organization neglected to budget their tie and resources properly for training doctors and medical technicians. Absence of appropriate updates in software by equipment manufacturers is also one of the issues.


Question 2:

The factors that was responsible for the problems detailed in this case are:
In management it is the lack of training of staff (doctors, technicians and machine operators) and inadequate staffing. While in technology it is the software glitches.

Question 3:

There are 3 categories of errors this are errors caused by machinery complexity, errors caused by medical personnel that operate such machinery and hospital administration errors. The Medical machinery and software manufacturers claim that hospitals that provide with radiation treatment should be responsible for training their staff to correctly operate radiological equipment while the technicians claim that they are understaffed and overworked and that there are no procedures in place that would check accuracy of their work and the hospitals on the other hand, claim that manufacturers should be doing better job providing radiation equipment with fail-safe mechanisms. Therefore, I feel that the blame should go to State Government because they are the regulator and controller of groups involved in radiation therapy and they are the one who is majorly responsible for medical errors associated with radiological mistreatment.

Question 4:

The emerging issues are radiation, misadministration and deaths/near deaths. The data can be use to help standardize, monitor, train and instill a safety culture. Managers within the MIS utilize raw data, report techniques, consultation services and aid to change policy and procedures. Complying with federal & state reporting mandates R&D of unique techniques that reduces personnel time and related costs in processing data, personnel, including mid-level management, senior junior programmer analysts, provides 24-hour, 7-day support for communications network that will reap the benefits of technological change by building an economical, efficient, and salable and integrated computer system.