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When 53-year-old Beverly Hills resident H. Michael Heuser suffered a stroke on July 4, 2009, he was rushed by ambulance to Cedars-Sinai Medical Center, where he spent two weeks undergoing a variety of procedures designed to save his life.
At the time, he believed he was receiving the best possible care available.
While at Cedars-Sinai, Heuser received three CT brain perfusion scans, a diagnostic procedure to assess the damage caused by the stroke, as well as three other types of CT scans. Following the two-week hospitalization, he was transferred to a rehabilitation facility in Downey, and he began to recover physically. But two days after entering the rehabilitation facility, he began to notice that something was very wrong.
“After the second day, I ran my hands through my hair and clumps of hair materialized. It was between my fingers, on my palms and on the floor,” Heuser said. “In a day or two, I had a four-inch band [of hair missing] around my head from ear to ear. It was apparent to me that it was the same size and shape of the CT scan device.”
Heuser said he wasn’t sure what was happening or why, so he took photographs of the hair loss and contacted doctors at Cedars-Sinai. On Aug. 12, he returned to the hospital for an examination. Heuser said his doctor told him that he had never seen anything like it, and the hospital staff took their own photos. Heuser said he was told by his doctor that they were going to check with the imaging department, but that the hair loss was not cause for alarm, and that it would likely grow back. Heuser said he waited 17 days before officials at Cedars-Sinai Medical Center got back to him on Aug. 29, 2009, a day he said he will never forget. Heuser was at the beach with his family when he received the call from the hospital.
“They said, bad news, you received an overdose of radiation during the CT scans, so that particular physician arranged for me to have a meeting with another physician in the imaging department,” Heuser said. “All along I had been trying to shield my sons from this traumatic experience. I had to sit down. Frankly, I was panicked. I had tears well up in my eyes.”
Heuser said he met in early September 2009 with the doctor from the imaging department, who Heuser claims “trivialized the experience.”
“They said somebody had ‘tinkered’ with the machines, but didn’t know who, when or why, and possibly the machines were defective,” Heuser said. “Cedars-Sinai has never been honest with me on the extent of my exposure, and the other risks I‘ve been exposed to, and that’s infuriating.”
In October, the news broke that more than 200 people who underwent CT brain perfusion scans at Cedars-Sinai Medical Center between February 2008 and August 2009 received eight times the normal amount of radiation. The number of patients who were over-radiated eventually climbed to 269. Heuser said it wasn’t until the story came out in the media that he learned there were other people facing the same situation. He also claims hospital physicians never told him that the amount of radiation he received was eight times the normal level.
In addition, the Federal Drug Administration, which regulates CT scan machines, and the California Department of Public Health, launched investigations into the radiation overdoses. It was at that time that Heuser realized he should contact an attorney. He later became the person who is now referred to as “Patient One” in a collection of lawsuits being filed by separate attorneys against Cedars-Sinai Medical Center and General Electric, the manufacturer of the CT machines.
Officials from Cedars-Sinai Medical Center issued a series of written statements last October admitting that the radiation overdoses occurred, and stating that the hospital suspended CT brain perfusion scans while an internal investigation was conducted. The hospital said letters were sent to all of the patients who were affected — Heuser confirmed he received the letter — alerting them about the overdoses and the possible danger of having a higher risk for developing cataracts as a result. When contacted this week, Simi Singer, a spokesperson for Cedars-Sinai, said the hospital had nothing new to add, and as a general rule, hospital officials do not comment on pending litigation.
Heuser’s attorney, Bruce Brusavich, of the Torrance-based law firm, AgnewBrusavich, said Heuser’s lawsuit is “very early in litigation”, and that they are trying to determine exactly how many people will be suing. Brusavich said it will likely be approximately 90 people. Some of the patients have died since the overdoses occurred, and others may have accepted settlements, the terms of which are confidential.
Brusavich and attorney Bill Newkirk, who represents 46 patients, are members of a steering committee comprised of approximately seven attorneys who are handing lawsuits filed by the patients who received the overdoses. A court hearing is scheduled on Oct. 22 between the lawyers for the plaintiffs and the defendants in the case to work out how the lawsuits will proceed. Originally, a class action lawsuit had been filed, but now the lawsuits are moving forward individually. The lawsuits claim the hospital was negligent, and that G.E. is liable for defects in the machines. Cedars-Sinai has not disclosed specifically how the machines were reset to deliver eight times the normal dose of radiation.
Heuser said the physicians from Cedars-Sinai Medical Center told him that the radiation overdoses would likely not cause any long-term risks. His hair grew back after several weeks, but Heuser claims he now has more grey hair than before. He added that he now lives with the uncertainty of possibly developing cancer or other diseases as a result of the radiation. Some studies have indicated that overdoses of radiation to the degree of the Cedars-Sinai incidents put patients at up to 600 times more at risk for developing cancer.
“The consensus is something will happen,” Heuser said.
Newkirk said there is an urgency for the patients because the statute of limitations on filing a medical malpractice lawsuit in California is one year the mark in this case would be Oct. 31. After that, the patients will have no legal recourse, Newkirk said. He added that the families of patients who have died after they received the radiation overdoses are prevented from filing malpractice lawsuits under California law. Their only recourse would be to file a wrongful death lawsuit, which would be very difficult to prove, given the serious medical conditions, such as strokes, that brought them to the hospital in the first place, Newkirk said.
Both Brusavich and Newkirk said that the specific damages being sought have not yet been determined. Newkirk added that the goal of the lawsuits is not only to provide recourse for the patients who received the overdoses, but also to bring the problem into the spotlight and to enact change in the way CT machines are manufactured and operated so that mistakes do not occur in the future.
“It has begun to make the whole field of medicine look at the problem and begin to tighten down on some of these problems,” Newkirk said. “It is because of these lawsuits that these problems have been the focus of not only lawyers, but the legislature and the whole medical industry in general.”
The overdoses at Cedars-Sinai Medical Center were not isolated incidents, but part of a larger problem that is occurring around the country, and probably worldwide, according to Newkirk. The California Department of Public Health’s investigation determined that similar overdoses occurred with 10 patients at Glendale Adventist Medical Center, 34 patients at Providence St. Joseph Medical Center in Burbank, as well as at Bakersfield Memorial Hospital and another medical center in Arcata. The state department of public health cited Cedars-Sinai Medical Center for “deficiencies” in protocol as a result of its investigation, but did not issue any fines. The hospital put in place measures to correct the problem, which met the state’s requirements, according to Ralph Montano, a spokesman for the California Department of Public Health. A statement from the hospital indicated that the corrective actions include “double checks to our process whenever a protocol is changed”, and a retraining of staff that operates the machines.
The radiation overdoses at Cedars-Sinai also prompted state legislators to get involved. Sen. Alex Padilla (D-Pacoima) authored a bill that will require the dosage of radiation to be indicated on the imaging film the machines produce, as well in the patient’s permanent medical record. The bill also requires hospitals to report any over-radiation to patients, the treating physician and the California Department of Public Health. In addition, hospitals are required to verify the calibration on CT machines on an annual basis, in compliance with federal law. The legislation, SB 1237, was signed into law by Gov. Arnold Schwarzenegger on Sept. 20.
“SB 1237 will protect patients. There is an urgent need for protocols and safeguards to prevent radiation overdoses,” Padilla said. “This bill will provide physicians the information they need to track dosage levels, identify errors and prevent patients from receiving overdoses of radiation.”
The FDA has also issued recommendations that the manufacturers of CT machines update the devices to show technicians the level of radiation a patient is receiving, and to prevent the settings from being changed and not reset. Brusavich said Seimens, a CT scan machine manufacturer, and others have begun selling machines with the safeguards, and are using them as a marketing tool.
“All of the new generation machines are going to document the radiation doses on the film and in the patient report,” Brusavich said. “It has already begun a competition and is a sales factor to offer a machine that will offer a lower dose of radiation.”
For Heuser, however, the changes could not come soon enough. He said he still sometimes gets reddening of the face allegedly caused by the overdoses, and is experiencing some short-term memory loss.
“I go to bed thinking about it and I wake up thinking about it. The level of anxiety is very tangible. It’s the fear of not knowing,” Heuser said. “I want them (Cedars-Sinai) to come clean. It has affected my life in a very serious way.”