ML20216E534

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Amend 8 to License SNM-1375 for St Mary Hosp.Control:257821
ML20216E534
Person / Time
Site: 07001397
Issue date: 03/30/1998
From: Dan Collins
NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION II)
To:
References
257821, NUDOCS 9804160236
Download: ML20216E534 (12)
v • d • e


Text

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NRC FORM 374A U.S. NUCLEAR REGULATORY CoMMISslON PAGE 1 of 1 PAGES 1

License Number i

! SNM-1375 MATERIALS LICENSE Docket or Reference Number SUPPLEMENTARYpHEET 070-01397 s

k NS 'd!fO djfl Amendment No. 8 St. Mary's Hospital 5801 Bremo Road i Richmond, Virginia 23226 1

l In accorda with letters and attachments dated February 9 and March 16,1998 License Number SNM-1375 is hereby terminated.

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f FOR THE U.S. NUCLEAR REGULATORY COMMISSION , '

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pAVID J. COLLINS ,.

l1 Date .,

MAR 3 01998 By v[g' ,

[Ev.2 l 1 Region 11, Nucl Materials Licensing Section Alan GA 3 3d3 i />  ;

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l March 30, 1998 St. Mary's Hospital ATTN: Marcelle D. Anthony Nuclear Medicine Department 5801 Bremo Road >

Richmond, VA 23226 l I

SUBJECT:

TERMINATION OF MATERIALS LICENSE (REFERENCE CONTROL NO. 257821)

I Gentlemen:

Enclosed is Amendment No. 08 to License No. SNM-1375 issued in response to your letter with attachments dated March 16, 1998. Based upon the information  !

contained in these documents, we have determined your facility to be suitable 1 for release for unrestricted use and have issued the enclosed amendment which l terminates your license.

If you have questions about this letter or your license, please call me at (404) 562-4735 or Ms Diane Heim at (404) 562-4723.

Sincerely, David J. Collins, Materials License Reviewer Materials Licensing / Inspection Branch j Division of Nuclear Materials Safety )

Docket No.: 070-01397 License No.: SNM-1375 l

Enclosure:

Amendment No. 08 1

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G ST. MARY'S HOSPITAL Bon Secours Health System Marcelle D. Anthony, Chief Technologist Department of Nuclear Medicine Bon Secours Richinond IIealth System St. Mary's llospital 5801 Bremo Rd.

Richmond, Va. 23226 l March 16,1998 U.S. Nuclear Regulatory Commission, Region 11 Nuclear Materials Licensing / Inspection Branch Division of Nuclear Materials Safety Attn: Diane lleim 61 Forsyth Street, Suite 23T85 Atlanta, Georgia 30303-3415

SUBJECT:

Request for Tennination of NRC License SNM-1375 l

Dear Ms. Ileim,

St. Mary's llospital is providing the requested information for disposition of materials authorized by Materials License SNM-1375.

The last isotopic pacemaker in possession under this license was recovered from the patient in which it was l implanted on July 27,1997, at St. Mary's liospital. The pacemaker was shipped to Medtronics Return l Products division on August 7,1997. The address to which it was shipped is 7000 Central Avenue, NE Minneapolis, Mn. 55432. [See attached paperwork].

I made a call to Medtronics within seven days of shipment to confirm that they had received the pacemaker, and FedEx has subsequently provided proof of delivery of the package containing the pacemaker for documentation.

Sincerely, 77}2u.gA ,b . OA9 Marcelle D. Anthony 5801 Bremo Road. Richmond Wginia 23226 804/285-2011 Good he'p to those in need since 1824

( , LSc/Xnsp Fax:404-562-49$5 Mar 3 '98 10:59 P.01 p Woq'o UNITED STATES NUCLEAR REGULATORY COMMISSION

[ REGION 11 I

61 FOR TH TC 23T85 AnANTA. GEORGIA 30303 3415 u-1  : k/Wx'3 $ i/ icense No. c/tMf /d?f' CompanyM ///aps/ //ard / Title Fax No. " ( 178949fff]/ff _

FROM: dM6 Id5 Nuclear Materials Licensing / Inspection Branch ,

Division of Nuclear Materials Safety No 04) 562-4955 Voice (404) 562-4723

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SUBJECT:

YOUR REQUEST FOR TRANSFER OR TERMINATION OF NRC LICENSE Please provide the following information, in addition to the NRC Form 314 (Certificate of Disposition of Materials):

All records considered important to the safe and effecdve decommissioning of the facility, in accordance with 10 CFR 30.35(g), 40.36(f), )70.25(g) and $72.30(d);

and all records concerning public dose and waste disposal, have been transferred to:

50 1.Name Med h oni cs (Successor)

License No. stdry -//57o Address 7000 C.e n+ral Avenga . A/ E City Minneanoiis ' State m o'nnesofit $5 h'3A Phone (800 13a 9 c95/ 9 __ Fax No. (100 ) 2 a4 - 4362 OR x

0 2. US NRC Region II, Nuclear Materials Licensing / Inspection Branch, Division of Nuclea- Materials Safety OR O 3. There is no residual contamination of the facility or environs from licensed materials.

Signature Printed Name and Title G:\DNMS\ FORMS \ Term. fax Date

, Usty it i LiC/InSp Fax:404-562-4955 Mar 3 '98 10:59 P.02 NRC FORM 314

(.m , U.S. NUCLEAR RLGULATORY COMMISSION APPROVED BY OMO: No. 3S60 0028 EXPmES: 06/30/ta 1

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INSTRUCTIONS: ALL ITEMS MU$7 et COMPLETED - PRWT OR TYPE P,1"'."OFMCI Q11100:31 RF WakAGEMENT Aho ccuouci a spon:on, aan A PEM04 as NOT Af0Wto TO AfsPoNO ft. A C8LitcTl8N af SEND THE COMPI.ETED CERTIFICATE TO THE NRC OPPICE SPECIFIED wowAmm msslimars ON TN4 aREVERSE cenAus mana am ma. - m.u A-u .e s- -

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A. Mh3ERIALs DATA (Check one and complete as necessary)

THE LICENSEE OR (Check ANYand/or INDMOUAL EXECUTING THIS L.ERTIFICATE ON BEHALF OF complete the oppropriare item (sI below.)

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CR NO MATERIALS HAVE EVER BEEN PROCURED OR POSSESSED BY THE LICE h 3, ALL ACTIVITIES AUTHORIZED BY THE UCENSd HAVE CEASED AND ALL MATERIALS PR LICENSE reverse NUMBER side or CITED ABOVE provide ettschments.) HAVE BEEN DISPOSED OF IN THE FOLLCWING MANNER (//edd/r/onel ,

Describe specific matenal traar,fer actione and, if there were radioactive westes generated in terminating this floI actions including oppilomb!e. the disposition of low-level radioactive waste, mixed weste, Greater-than-Clate C Weete, und seal For transfore.

State epecify name and license the nutricr. date of the transfer. the name of the license reciplent, and the recipient's NRC lice 11 meterials were disposed of directly by the licensee rather then transferred to another licensee, licensed disposal elte or we contractor, describe the specific disposal procedures (e.g., deceyin storspe)

8. OTHER DATA j 1. OUR LICENSE HAS NOT YET EXPIRED; PLEASE TERMINATE IT.
2. A RADIATION SURVEY WAS CONDUCTED BY THE LICENSEE TO CONFlRM THE ABSENCE OF AND TO DETERMINE WHETHER ANY CONTAMINATION REMAINS ON THE PREMISES COV ND Viitach explanation,'

YES, THE RESULTS (Check onel ARE ATTACHED. or

~WERE FORWARDED TO NRC ON /Date)

3. THE PERSON TO BE CONTACTED "'"'

REGARDING THE INFORMATION M*[,' "es'"

PROVIDED ON THIS FORM

4. Mali. ALL FUTURE CORRESPONDENCE REGARDING THIS LICENSE To i

CFRTIFYING OFFICIAL Ffu4&o hAut AND TTiui 1 CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT SIGNATVME , oAft l

WARNtNG: FALSE STATEMENTS IN THl$ CERTlHCATE MAY SE SUBJECT TO civil AND/OR CRIM;NAL PENALTIES. NRC REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLETE AND ACCURATE IN ALL MATERIAL RE SECTION 1001 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY FALSE STATEMENT OR REPRESENTATIO DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WITHIN ITS JURISDICTIONS.

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  • SIGNATURE RELEASE UNAVAILABLE C No,I,lo .

I Two completed and signed copies of this Declaration must be ' Io 9691130234 ease L or _ leases a aaeo 'o 'ne ogerator. WARNING i TR ANSPORT DETAILS Failure to comply in all respects with the applicable Dangerous Goods I "'18%"*,,",'7,"&"* 

              ,,,,                                                       Akpat ot Departa O          a----                                                                                               Reguistions may be in breach of the applicable law, subject to legal l eenaities. Thi. Deciaration must noi, in any circumstances. ee completed                               1 E8['M$$                                                                                      and/or signed by a consolidator, a forwarder or an LATA cargo agent. {

AmcmAFI _ AWport of Dest 6 nation: Shipment type: (delete nor,-applicable) l$MMM RADIOACTIVE l NATURE AND OUANTITY OF DANGEROUS GOODS Dangerous Goods identification Class UN Subs 6- Quantity and Packing Proper Shipping Name or or P ckin0 type of packing Authorization E gi ,y Inst. Division ID No. Risk O Podicache- t%erial s '7 (lhl Pti cp3 8 whi k:t \ Sgdal Gem, ad g ge,;, ; p5 c m O Al . O . E . o? . 5 C o ri es- l

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h conditson for transport by air according to the applicable international and National Governmental Regulations. and Dat P1g*y , g ,g ) ;gf ff"'7}O I Emergency 1-e a N mbee (H . ne . for US Ongin o< astinaisun snipenents; S'0"8'u'* L N .2 k3 . _ i tF t.CCEPTABLE FOR PASSENGER AIRCRAFT, THIS SHIPMENT CONTAINS RADIOACTIVE MATERIAL INTENDED FOR USE IN, OR INCIDE.NT TO, RESEARCH, MEDtCAL L C*AGNOSIS, OR TRE ATMENT. m

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l Peder;a1 E= press Corporanen U G. Mat PG Bos 787 Teeprene tot 053800 Outoner Owpwt Memptus,TN M1944643 ' besbe Trece M16 AerwJys Boulevard Modde H, des Picar Memps, TN Mt14 nwimalPMau l March 11,1998 i MARCELLE D ANTHONY (804) 287-7675

Dear MARCELLE D ANTHONY:

This is in response to your request for proof of delivery for package tracking number 9691130234. You will find the delivery information below. SHIPMENT INFORMATION: Tracking No: 9691130234 Ship Date: August 07,1997 l Shipper: MARCELLE D ANTHONY Recipient: RETURN PRODUCTS ST MARYS HOSPITAL MEDTRONICS INC , 5801 BREMO RD 7000 CENTRAL AVE NE l RICHMOND, VA 23226 MINNEAPOUS, MN 55432 US l DELIVERY INFORMATION: i Signed For By: A.HEINZ Delivered to: 7000 CENTRAL Delivery Date: August 11,1997 Delivery Time: 09:36 AM i Your business is greatly appreciated and we look forward to the opportunity of serving your future express shipping needs. Federal Express Corporation Worldwide Customer Service 1-800-GO-FEDEX l Reference No: R1998031100002245622 i l

C 1 BETWEEN:  : -------------------- License Fee Management Branch. ARM  : Program Code: 22160 and  : Status Code: 0 i Regional Licensing Sections  : Fee Category: EX 7C i Exp. Date: 20030930 PACEMAKER /45-11367-02

Fee Comments: )

i

Decom Fin Assur Reqd: N LICENSE FEE TRAN MITTAL  !

A. REGION 

                                                                                                  ]
1. APPLICATION ATTACHED Applicant / Licensee: ST. MARY'S HOSPITAL Received Date: 980217 Docket No: 7001397  !

Control No.: 257821 License No.: SNM-1375 Action Type: Termination

2. FEE ATTACHED Amount:

Check No.: I

3. COMMENTS  !

1 Signed -diane heim i Date 2/18/98  ! B. LICENSE FEE MANAGEMENT BRANCH (Check when milestone 03 is entered / _/) .

1. Fee Category and Amount: 12 / 9b ((( b l

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2. Correct Fee Paigt Application may be processed for:

Amendment V ps l Renewal  ! License t l 3. OTHER j _~ Signed 'U. - 

                                                                                        /

__ Date M/cFl/HN ' 1 

                                                                             /            8 RECElVfD BY).FMS                                                                  l Date.

Log _ 

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l l ST. MARY'S HOSPITAL Bon Secours Health System February 9,1998 US Nuclear Regulatory Commission, Region 11 Nuclear Materials Safety Section 101 Marietta Street, Suite 2900 Atlanta, Georgia 30323 RE: Termination of License SNM-1375 St. Mary's llospital would like to terminate our Materials License No. SNM-1375, for the possession of the Plutonium-238 Medtronic Laurens-Alcatel Model 9000 isotopic pacemakers. The last isotopic pacemaker in possession under this license was recovered from the patient in which it was implanted on July 27,1997 at St. Mary's llospital. The patient expired on July 27,1997, and his body was transferred to St. M:Jy's fer removal of the pacemaker. The pacemaker was returned to Medtronic, Inc. on August 7,1997. The Radiation Safety Committee at St. Mary's has approved the recommendation to terminate this license, at the request of Dawn W. Burks, MD, Radiation Safety OfHeer. if there are any questions concerning this letter, please contact Marcelle Anthony, at (804) 281-8458. l l l 

                                                                                                                            )

Sincerely, Ann IIoneycutt Executive Vice President, Administrator , 

                                                                                                             , ,21 l

61b l i 5801 Bremo Road, Richrnond. Wgna 23226 804/285-2011 Good heip to those in need since 1824}}

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