Gloria Galloway
The Hamilton Spectator
April 7, 1998

Atomic agency reacts to Hamilton concerns

Canada’s atomic energy regulator will determine if a high incidence of thyroid disease among nurses at the former Hamilton Civic Hospitals can be attributed to a radioactive drug they dispensed in the 1970s and ’80s.

A recent Spectator investigation found at least seven of an estimated 14 nurses on the intravenous team at Hamilton General Hospital, who injected patients with fibrinogen 125 between 1975 and 1985, have experienced serious thyroid problems.

One has had thyroid cancer. Others have had their thyroid glands medically or surgically removed.

And after the article was published last month, two additional nurses who dispensed the drug at Henderson Hospital called the paper to say they too have had pre-cancerous growths removed from their thyroids.

Together they represent a jarring cluster, given that only about five per cent of the general population suffers severe thyroid disease.

The Atomic Energy Control Board took interest in the situation after The Spectator article was published, Richard Cawthorn of the AECB said yesterday. Cawthorn is responsible for reviewing the Hamilton Health Sciences Corporation’s licence to dispense nuclear medicine.

The alleged mishandling of fibrinogen 125 predates the amalgamation that created Rating twoSC, “but we assume that when they amalgamated, they took the problems too.”

So the AECB asked the hospital corporation for a report outlining the “historical basis” of the allegations and the Rating twoSC complied.

Then, last week, the board was contacted by one of the nurses involved and it decided to proceed with the study.

The nurses have been unwilling to have their names printed because some are still employed by the hospital. Others fear reprisals for speaking out. But Cawthorn said they have agreed to assist the AECB with its investigation.

“What we want to do is determine if there is a health effect here before we look at any cause,” he said. “On a preliminary basis, one of our medical advisers who is a physician, is going to contact these nurses and collect as much information as she can about their thyroid problems.”

“The type of problems that are attributed to iodine exposure are very specific and she wants to screen for those and say, ‘does there appear to be an increased incidence of thyroid problems in this group of nurses?'”

If the medical adviser determines there is a statistically high incidence of thyroid disease among the nurses, “we will likely move to a more elaborate study that usually has a fairly large price tag associated with it,” said Cawthorn.

The preliminary study shouldn’t take more than a couple of months, depending on the level of co-operation from the hospital, he said.

Barb Wahl, president of the Ontario Nurses Association, said she was “really excited” by the AECB probe.

“It may confirm some of the things that the nurses have felt,” she said, adding she hoped it would draw other nurses with the same problems to report their experiences.

The fact two more nurses from Henderson who handled fibrinogen 125 have come forth in the past month poses questions about how widespread the situation really is, said Wahl.

“I would doubt very much that it’s just Hamilton.”

Norm Rubin of Energy Probe, a Toronto-based group that has been a regular critic of Canada’s atomic energy industry, said the chance that seven of 14 nurses in one unit could get a disease that occurs in five per cent of the population is about one in 300,000.

Still, the Rating twoSC has dismissed the possibility of any relationship between fibrinogen 125 — a naturally occurring blood protein combined with low-level radioactive iodine — and the nurses’ thyroid problems.

When one of the nurses pressed the hospital for compensation, the hospital argued her condition could not be job-related. But the new study may reopen that door.

CASUAL LINK

“If the AECB established a causal link between occupational exposure and health effects, I would imagine it would provide the basis for compensation,” said Cawthorn.

An internal Rating twoSC study completed in January found that, in the suspect material, the radioactive iodine is so tightly bound to the fibrinogen that only an injected dose 100 times greater than that given to patients could be harmful.

And 15 years of tests on workers at McMaster University Medical Centre’s nuclear pharmacy, where the isotope was made — and which recently had its licence to produce radioactive medicine yanked by the AECB — found no similar thyroid problems.

The nurses who now have the disease say they were never consulted by those conducting the Rating twoSC study.

They have periodically complained to the hospital about the handling of fibrinogen since three of them developed thyroid problems in the late ’70s.

Fibrinogen 125, which is still on Health Canada’s list of approved drugs, was never widely used and had been replaced by less intrusive and more accurate technologies.

The nurses were required to dispense the material without gloves and defrost it under running water at nursing stations. Sometimes the vials would leak or break. By the early 1980s, they were told to wear gloves and a gown and the material began arriving in lead containers, they say.