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This article was published 2/6/2017 (1211 days ago), so information in it may no longer be current.

In February 2015, a radioactive thyroid cancer patient in Winnipeg went rogue, leaving the hospital after undergoing radionuclide therapy — against medical advice and posing a public health hazard.

"There was someone with really radioactive body fluid out there, somewhere in the city," said Jeff Dovyak, radiation safety co-ordinator for the Winnipeg Regional Health Authority. "Anything they touch, spit on or urinate on is radioactive."

He tracked down the out-of-town patient, who had joined their partner at a downtown hotel, contaminating the room and putting hotel staff, other guests and anyone the patient came into contact with at risk.

The "hot" room was more than just a public health hazard, with several people coming and going from it. It was potentially deadly, Dovyak learned, after finding weapons including a modified hacksaw and a sawed-off shotgun swaddled in highly radioactive towels in a gym bag under one of the two beds.

Neither the public nor the media heard about the incident until Thursday, when Dovyak, one of the experts tasked with controlling and cleaning up after it discussed it at the Manitoba Disaster Management Conference at Canad Inns Polo Park. Although a situation involving a radioactive patient refusing to stay in hospital or to self-isolate at home is rare, it could happen again, said Dovyak.

BORIS MINKEVICH / WINNIPEG FREE PRESS Jeff Dovyak says a patient who left after being treated with radioactive material put anyone they came into contact with at risk.

"We don’t have a legal basis to detain the patient," the longtime radiation safety co-ordinator said. "Currently, there’s nothing that allows them to be confined."

There are no control measures under the Public Health Act for radioactive patients that pose exposure or contamination hazards, Dovyak said.

A spokeswoman for the province said Thursday that under the Public Health Act, "a medical officer of health can issue an order if they reasonably believe a person has been exposed to a ‘contaminant’ (radiation, radioactive material, biological matter that causes disease, etc.), presents a serious and immediate threat to public health and refuses to take necessary action to deal with the threat." They could be detained in isolation in a health facility, and law enforcement officers could apprehend them and take them there, she said.

That’s not the answer Dovyak got when he asked health officials about what to do to prevent a similar situation.

He said they suggested he try to "incentivize appropriate behaviour."

Dovyak said he has no idea how they could have "incentivized" the 20-year-old runaway patient to stay.

Patients previously hospitalized

Until about 15 years ago, Iodine-131 radionuclide therapy patients were hospitalized, even though most don’t need nursing care and many don’t feel sick, he said. They were kept in hospital to protect other people because "I-131," as it’s known, emits gamma rays similar to X-rays but with much higher energy.

After getting I-131 treatment, patients excrete radioactive I-131 through their urine and body fluids for up to 72 hours. After lobbying regulators, patients won the right to isolate themselves at home, Dovyak said.

Now, most receive the treatment as outpatients, except for those who live far away and have to rely on public transportation to get there, and patients residing with young children or a pregnant women. There were fewer than 40 patients in Manitoba receiving the treatment last year, Dovyak said.

“The patient just pushed me out of the way, went out the door, got in a taxi and left.” –Safety officer

The radioactive patient who took off in 2015 lived too far away to be treated as an outpatient, said Dovyak, who didn’t identify their community, name or gender for privacy reasons. The hospital’s radiation safety officer and nuclear medicine physician counselled the patient and their partner about the hazards of radioactivity and why it was important for the patient to be isolated in the hospital for a few days, he said.

Both indicated they understood and agreed but, a couple of hours after the patient drank the radionuclide therapy, Dovyak said he got a call from the hospital’s radiation safety officer saying, "I’m worried. I think this person’s just going to leave."

While Dovyak was trying to contact someone at the Canadian Nuclear Safety Commission for advice after-hours, the safety officer called back, saying, "The patient just pushed me out of the way, went out the door, got in a taxi and left."

They were able to find the person at the hotel room because Health Canada officials had arranged for the patient’s travelling companion to stay there. Before going to the hotel, Dovyak enlisted the help of Manitoba Conservation environmental officers ("they have pretty broad jurisdiction," he said), a CancerCare Manitoba radiation protection officer and two WRHA radiation safety officers.

He and his radiation safety assistant, Daniel Lapkoff, took contamination meters, dose-rate survey meters, extra protective equipment and documentation supplies to the hotel, where they met the manager as well as several unexpected and unregistered "guests."

'Just about everything we checked was radioactive'

"When we got to the hotel lobby, we were met by someone trying to get into the room," said Dovyak. It wasn’t the patient or their travelling companion, he said. "She wanted to get her purse. She was really agitated," Dovyak said.

The door to the room was opened from inside by someone who wasn’t the patient or their companion, he said. The radiation experts went in and checked the woman’s purse for contamination. It was one of very few things in the room that was uncontaminated, so they gave it to her.

"Just about everything we checked was radioactive," said Dovyak.

The two armchairs in the room were 20 times the level of background radiation — anything twice the level of background radiation is considered contaminated, he said.

The trash bag in the closet was 100 times that, the sink and toilet were 80, the washroom floor was 70, the telephone handset was 50 times and the bed was 18 times background radiation.

"Everything we measured was contaminated," Dovyak said. "I’m used to some contamination, but this was a lot. What we could, we bagged and tagged" with radiation warning signs.

He said "hotter" bags were taken back to the hospital for secure storage. "Warm" radioactive waste was left in the room, and it was sealed off with radioactive warning tape, all keycards to access the room were cancelled, and staff members were ordered to stay out.

Patient fled a second time

The patient was found and returned to isolation at the hospital but fled again. The hotel called to say the patient’s partner returned there and asked to retrieve their items and left when they couldn’t. Dovyak said he discovered the patient was staying with a relative where no young children or pregnant women resided.

On Louis Riel Day, the patient contacted Dovyak to find out how to get their contaminated possessions back. He said to contact the hospital in May, when they’d be safely decontaminated.

“A patient taking off on us ‐ it had never happened here before... Maybe it’s never happened before in Canada.” –Jeff Dovyak

On Feb. 23, Dovyak and Lapkoff returned to the hotel room to decontaminate it. The bathroom door was removed so the entire area could be cleaned.

"There was a lot of elbow grease — scrubbing and rubbing," he said. They checked the carpets and found a radioactive hot spot and cleaned it. When they tried to move a bed to get at the rest of the carpet, something was jammed underneath.

"It was a gym bag, and it seemed really radioactive." When they opened it, they found "super-radioactive" towels wrapped around a sawed-off shotgun, Dovyak said. The gun wasn’t contaminated, and they contacted Winnipeg police, who took it away. The situation was "pretty unique," said Dovyak.

"A patient taking off on us — it had never happened here before," Dovyak said. "Maybe it’s never happened before in Canada."

Finding the weapons was alarming, but the high levels of radioactivity in a hotel room where guests and staff were unaware of it was a bigger worry.

"It’s a real hazard.

"If you got some radioactive contamination on your skin, if you had a cut or got it on your hands and didn’t wash them then ate an apple, it could kill the thyroid."

They decided handling the public health situation quietly was best. Instead of putting warning tape up outside the entrance to the room, they put it just inside the door of the hotel room, which staff were ordered not to enter, Dovyak said.

"We didn’t want to cause panic to people in the hotel," Dovyak said. There was a concern that news of the radioactive room would spread. "We didn’t want to spin up the media."

carol.sanders@freepress.mb.ca