EVANSVILLE, Ind. — Dr. Chris Haughn was in hisbedroom changing clothes to go to his children’sChristmas play when his first seizure hit.

Milly Haughn, Chris’ wife, remembers she was fix-ing the hair for one of their daughters when theiryoungest son came to her screaming and crying that“daddy was hurt really bad.”

“I thought it seemed weird. I went into the room,and Chris was on the floor, flopping around having aseizure,” she said.

Instead of a school play, Chris was taken to an emer-gency room.

In less than a year the 46-year-old healer was dead.Haughn’s family is now suing St. Vincent Evansville

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EVANSVILLE, Ind. — Local officialsfrom Evansville and Henderson foundreceptive audiences recently in Wash-ington, D.C., where they resumed theirpush for an Interstate 69 Ohio Riverbridge.

Conceptual support doesn’t equalfunding, however, and because of that,there’s still no way to know when anew bridge will be built.

A group which included HendersonCounty Judge-Executive BradSchneider, Evansville Mayor LloydWinnecke, Southwest Indiana Cham-ber CEO Tara Barney and I-69 Bridge-Link Chairman Bob Koch met withsenators and congressmen from Ken-tucky and Indiana, as well as other keyplayers.

“We got great responses,” Win-necke said. “Everybody understandsthat without the bridge, it (Interstate69) becomes a cul-de-sac here. Peopleare largely supportive of it.”

Schneider said the local groupheard “vocal support from our con-gresspeople.” Senate Majority LeaderMitch McConnell of Kentucky, accord-ing to Schneider, “knew all about theproject without being prompted.”

Rep. James Comer of Western Ken-tucky has called the I-69 bridge his toptransportation priority.

“It’s good to hear because they areall very familiar with what the bridgeproject is,” Schneider said. “They haveheard about it, and they agree (aboutthe need).”

I-69 extends from the Canadian

Officialsresumepush forI-69 bridgefundingLocal leaders met with key players in D.C.

John T. MartinEvansville Courier & PressUSA TODAY NETWORK

Mark WilsonEvansville Courier & PressUSA TODAY NETWORK

See LAWSUITS, Page 8A

Dr. Chris Haughn

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hospital where he worked. As a sur-geon, Haughn made a career doingsurgeries and procedures that oftenused imaging technology called fluo-roscopes. The widely used X-ray de-vice allows doctors to see into pa-tients’ bodies in real-time, as ifwatching a continuous video, assist-ing doctors in saving countless lives.

But a Courier & Press examinationof court records, academic studiesand government research has foundthe healthcare providers who usethese modern imaging devices may beputting their own health at risk.

The prolonged stream of radiationrequired to use the devices exposesphysicians to the equivalent of50,000 chest X-rays over the course oftheir career, one study found. Doctorsand medical staff who use the devicesare twice as likely to die of cancercompared to those who don’t usethem.

Yet federal enforceable standardslimiting workplace exposure to thisradiation are decades out of date. Ef-forts to update them have been slow,leaving doctors and hospitals on theirown to do more.

“I think we need to raise awarenessof the exposures that medical staffface in these kinds of procedures, andthat includes interventional fluoros-copy,” said Michael Seymour, a formerOSHA official who now advocates fordoctors.

‘A dangerous place to work’

“They did a CAT scan, an MRI, andthey said, ‘We found a mass,’” recalledMilly Haughn, Chris’ wife.

The doctors there didn’t have to tellthe couple what that meant. Chris, asurgeon, and Milly, a nurse, knew theprognosis wasn’t good.

“We both knew, OK, that’s going tobe glioblastoma, and you’re going tobe dead (with)in a year,” Milly said.

Within six months of the confirm-ing diagnosis, Chris succumbed tobrain cancer.

The couple, both Ohio natives, metin 1999 when they worked at AkronCity Hospital. She was a nurse. Hewas in his surgical residency. Theymarried in 2002 and moved to New-burgh, Indiana, in 2005.

Initially attracted to the Evansvillearea when Chris was offered a surgicalpartnership, they soon fell in love withthe region. The family enjoyed fishingtogether, hiking, trips to Florida andjust being at home together.

Three lawsuits against St. VincentEvansville allege the physicians in-volved developed cancers throughworkplace radiation exposure at thehospital, although Haughn’s was theonly fatal case.

Doctors Roger Shinnerl and BrettWeinzapfel, allege radiation exposure

caused their thyroid cancers.The lawsuits allege the hospital’s

radiation safety practices were inade-quate. The first of the suits is sched-uled to take place early next year.

St. Vincent has denied the law-suits’ allegations and filed a motionfor summary judgment in their favor.The hospital declined a request for in-terviews but issued a statement: “Ourhighest priority is the safety and well-being of our patients and staff. Wehave robust safety policies and proce-dures in place for many scenarios andwe adhere to regulations and guide-lines regarding radiation require-ments for medical equipment. At thistime we cannot comment concerningongoing litigation.”

Terry Noffsinger, an Indianapolisattorney, is one of four lawyers repre-senting the doctors’ lawsuits. He be-lieves the lawsuits, filed in Vander-burgh County Circuit Court, may bethe first of their kind.

“After the suit was filed we’veheard concerns from others,” Noffsin-ger said. “Attention to radiation safetyis becoming more of a priority.”

The lawsuits do not accuse manu-facturers of any of the imaging equip-ment or protective gear of wrongdo-ing. Noffsinger said attorneys consid-ered a product liability suit but therewasn’t evidence for that.

“It was not the equipment that wasdefective; it was how the equipmentwas being used,” he said.

The hospital provided the imagingequipment and personal protectiongear used by doctors during proce-dures there, according to the lawsuits.

“We learned about inadequatetraining, the poor and missing per-sonal protection equipment, no do-

simeter badge readings (to measureradiation exposure) for years — all-in-all a dangerous place to work if you’reinvolved with radiation,” Noffsingersaid.

The lawsuits allege the hospitalwas negligent in maintaining per-sonal protective equipment and ig-nored complaints about it, and notenough of these protections wereavailable, including the leaded skirts,jackets, aprons and thyroid shieldsworn by doctors and staff.

Finally, the lawsuits also allege thehospital did not effectively monitorradiation exposure or communicateto personnel the risks of cumulativeexposure to that radiation.

“The doctors all started workingthere around 2007, working in thesame labs, then (were) diagnosedeight years later within 13 months ofeach other,” Noffsinger said. “It wasalso important that for an almost two-year period at the start, there were norecords on the amount of radiationexposure these men had.”

Medical staff face serious healthissues when overexposed toradiation from imaging tools

The Haughns aren’t alone.Across the country, brain tumors

have been reported in dozens of phy-sicians regularly exposed to radiationin the operating room. An increasingreliance on fluoroscopy to diagnoseand treat patients is being blamed fordozens of brain tumors and other ill-nesses in healthcare providers.

About 8,500 doctors, 13,000nurses and 11,500 technicians workwith these fluoroscopically guidedprocedures, according to some esti-

mates.A growing body of studies and re-

ports is calling attention to the healthissues faced by these medical profes-sionals who are repeatedly exposedover time to low doses of ionizing ra-diation from the equipment.

A cardiologist, the type of physi-cian most associated with fluoro-scope-guided procedures, will haveradiation exposure to the head equiv-alent to about 50,000 chest X-raysduring their careers, according to oneeconomic study of the issue by the Or-ganization for Occupational Radia-tion Safety in Interventional Fluoros-copy (ORSIF). The resulting health ef-fects add up to almost $49 million an-nually.

Doctors, nurses and techniciansexposed to this radiation risk devel-oping health effects including braintumors, premature cataracts and thy-roid disease.

Larger efforts to quantify the ex-tent of this risk have concluded thatmore details and study are needed,but evidence pointing to the problemcontinues to grow.

One such study in 2016 by the Na-tional Institute for Health found thatmedical imaging technologists whoperformed fluoroscopy-guided proce-dures had approximately twice therisk of death from brain cancer com-pared to those who never did the pro-cedures as well as increased risks ofmelanoma and breast cancer.

Brain tumors in healthcare provid-ers doing fluoroscopic procedureswere first reported in 1997. A study in2014 compiled reports of brain or necktumors in 36 physicians exposed tosuch radiation for prolonged periods.Half of those were glioblastoma, thesame type of tumor as Haughn’s. In2016, the number was updated to 43doctors and nurses.

Glioblastoma (GBM) is an aggres-sive form of brain cancer, according tothe American Brain Tumor Associa-tion. Hard to treat and even harder tocure, there is a 50 percent chance pa-tients will live past 11 to 15 monthswith treatment.

It’s also relatively rare. Only 15 per-cent of brain tumors are glioblastoma,according to the association, with thevast majority of them occurring ran-domly and not through inherited ge-netics.

Very little appears to be knownabout GBM’s risk factors, with one ex-ception. According to the associa-tion’s web site: “The only confirmedrisk factor is ionizing radiation to thehead and neck region.”

A general surgeon, Haughn wastrained in laparoscopic, bariatric andminimally invasive surgery — alltechniques involving fluoroscopy use.

What is fluoroscopy? It’s ‘like an

Milly Haughn and her husband, Dr. Chris Haughn, gather with their children for a family portrait. The Newburgh surgeon died of braincancer in 2016 at the age of 46. COURTESY OF THE HAUGHN FAMILY

‘He’s in our life every day’ Continued from Page 1A

Fluoroscopy device. RUSTINCOHLE, GETTY IMAGES/ISTOCKPHOTO

See LAWSUITS, Page 9A

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X-ray movie’

The X-ray technique most peopleare familiar with uses radiation totake still pictures of inside the body.By passing through various parts ofthe body, the X-rays produce imagesof tissues, organs and bones, accord-ing to the federal Centers for DiseaseControl and Prevention (CDC).

But fluoroscopy uses these same X-rays to see these images continuously,in real-time, on a monitor “much likean X-ray movie,” according to the U.S.Food and Drug Administration, whichregulates fluoroscopes and other X-ray systems.

Fluoroscope use has expandedrapidly in recent years in a wide rangeof medical specialties where they areoften used to guide various examina-tions and procedures for diagnosingand treating patients, according tothe National Cancer Institute, whichhas been studying cancer risks ofmedical workers exposed to this radi-ation since the early 1980s.

Higher-than-expected reports ofleft-sided brain tumors in doctorswho do these procedures raised con-cerns about exposure, according tothe cancer institute. Although not ev-ery physician with documented braintumors was reported to be on the leftside, the high number was significantbecause doctors typically stand withthe left side closer to the radiation, ac-cording to the National Cancer Insti-tute.

A subsequent study would later failto find that doctors who used fluoro-scopes did not have a higher risk ofdeath compared to other doctors, in-cluding for brain cancer. However, re-searchers noted no radiation dose in-formation was available to determineif the risks increased with greater ex-posure, and they were unable to lookat specific cancer diagnosis informa-tion.

A nonprofit’s mission is toeducate medical staff aboutradiation hazards

At least one organization believesthe evidence warrants a closer look.

Although it’s not as well known assome larger health and cancer non-profits, the Organization for Occupa-tional Radiation Safety in Interven-tional Fluoroscopy (ORSIF), is laser-focused on its mission.

“Our goal is to raise awarenessamong the medical staff and hospitaladministrators and any other relevantparties about the hazards associatedwith radiation exposure and thesekinds of operations and procedures,and what can be done to reduce thoseexposures,” said Michael Seymour,ORSIF’s director of advocacy pro-grams and a former OSHA official.

“I think we need to raise awarenessof the exposures that medical staffface in these kinds of procedures, andthat includes interventional fluoros-copy.”

Seymour was director of OSHA’sOffice of Physical Hazards in 2005when the agency worked on a rule toupdate the federal standards for ion-izing radiation exposure.

Seymour said ORSIF has gatheredsignificant research on the issue.

Among its findings are that 85 per-

cent of the brain cancers in doctorswho do these procedures were on theleft side of the brain, where they areexposed to higher radiation.

“So that’s very suggestive that thebrain cancers that we’ve seen seem tobe associated with this exposure,”Seymour said. “There is a substantialbody of literature on the effects on thethyroid, including cancer.”

Other studies have linked cataractdevelopment to radiation exposure,as well as muscular-skeletal disordersand back pain attributed to the heavylead aprons and protective gear wornduring procedures.

Radiation oversight is caught ina tangle of regulatory agencies

An alphabet soup of governmentagencies, regulations and research ef-forts oversee and offer guidance forfluoroscopic guided procedures andother radiation uses in the workplace.

The Occupational Safety andHealth Administration (OSHA) en-forces safe use of radioactive equip-ment in the workplace. This includesnot just health care facilities, but alsoresearch institutions, nuclear reac-tors and their support facilities, nu-clear weapon production facilities,and other various manufacturing set-tings.

These radiation sources can pose aconsiderable health risk to affectedworkers if not properly controlled, ac-cording to OSHA.

Although the U.S. EnvironmentalProtection Agency has protectiveguidelines for X-ray procedures, in-cluding fluoroscopes, they are consid-ered non-binding.

Manufacture of radioactive equip-ment such as fluoroscopes and othermedical imaging devices falls underthe U.S. Food and Drug Administra-tion.

OSHA’s inspections, when theyhappen, are made without warning tothe workplace being inspected. How-ever, they mostly occur after com-plaints from employees or a local au-thority such as a health or fire depart-ment.

In the last five years, from federalinspections at healthcare-related fa-cilities such as hospitals and dentalfacilities for violations of the radia-

Dr. Chris Haughn and his wife Milly Haughn on their wedding day in 2002. “Wewere so in love,” she said. The couple met during his residency at a hospital inAkron, Ohio. COURTESY THE HAUGHN FAMILY

Milly Haughn holds her husband, Dr.Chris Haughn, on their last weddinganniversary together in 2016. Lessthan two months later, the surgeondied. COURTESY OF THE HAUGHN FAMILY See LAWSUITS, Page 10A

LawsuitsContinued from Page 8A

10A ❚ SUNDAY, SEPTEMBER 29, 2019 ❚ EVANSVILLE COURIER & PRESS

Established Patients Walk-In Schedule—Infants, Children and AdultsLocation Date 2019 Hours Address Patients AcceptedDowntown Saturday, September 21 8 am – Noon 421 Chestnut St., Evansville, IN Infants/Children/Adults

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Princeton Wednesday, October 23 8:30–11:30 am and 2–4 pm 685 Vail St., Princeton, IN Infants/Children/Adults

Lynch Family Medicine Wednesday, October 2 1–3:30 pm 4949 Healthy Way, Ste A, Evansville, IN Infants/Children/Adults

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West Pediatrics Friday, October 11 9–11 am and 1–4 pm 545 S. Boehne Camp Rd., Evansville, IN Infants/Children

West Pediatrics Thursday, November 7 1–4 pm 545 S. Boehne Camp Rd., Evansville, IN Infants/Children

Open To The Public Walk-In Schedule—Adults OnlyLocation Date 2019 Hours Address Patients AcceptedBoonville Express Saturday, September 14 8 am – 8 pm 3150 Warrick Drive, Boonville, IN Adults Only

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tion standard, 19 resulted in citations for violations,according to OSHA.

In addition to federal agencies, states may alsoregulate use of medical imaging and other radioac-tive devices. This is done through OSHA-approvedstate plans administered by the states. The plans arerequired to be at least as stringent as federal regula-tions. There are 28 states, including Indiana, withtheir own OSHA plans but six of these states’ plansonly cover local and state government workers.

Updating federal and state exposure standards isimportant because it is the cumulative effects of ra-diation exposure over time that creates the risk tohealthcare providers.

OSHA attempted to update federal standards forworkplace exposure to ionizing radiation, beginningin 2005, but Seymour said that effort was sidelinedas other regulatory activities competed for agencyresources.

Hospitals could use these methods to reduce harmful exposure

Given the lengthy amount of time creating federalregulation can take, other approaches may offer bet-ter solutions, such as an increased emphasis on us-ing already available protections.

“What is not being used consistently, as far as Iknow, is that there are lead-lined surgical caps thatcan be used that are not frequently used,” Seymoursaid. “There are thyroid shields that are used some-times, but not as often as they should be. There ispersonal protective equipment that can be effectiveif is maintained properly and its use is monitoredand enforced.”

Other types of shielding, including movableshields, also are available, he said.

Distance from the radiation source is anotherpossible means of reducing exposure.

“Unfortunately, the way these procedures aredone, the physician is right next to the patient’sbody. So the physician is right there next to the (radi-ation) source,” Seymour said.

There are robotic technologies, that would allowthe physician to be in another room controlling itwithout needing protective equipment, he said.These robotic systems are add-ons that could beused with existing fluoroscope technology.

This also would allow nurses and technicians tobe farther away from the source and reduce their ex-posure.

Staff work miracles ‘at the cost of their own health’

“The physicians that do this work, they are ded-

icated to saving lives, and that’s their focus. So it canbe a little challenging to get through to them thatthey need to think about their own safety, in an envi-ronment where they are 100 percent focused on thepatient and the effectiveness of the procedures they

are doing,” Seymour said.“These are dedicated people who work miracles

for a living. They shouldn’t have to work those mir-acles at the cost of their own health.”

Chris loved his work, Milly said, and he felt a dutyto help others.

“He was the kindest, most caring and empatheticperson you would ever meet. It didn’t matter if youwere the president of the hospital or a homeless per-son who was brought in, he was going to treat every-body with the same care and compassion,” she said.

He also worked hard to make every minute countwith his family.

“He wasn’t home very much, but when he was, wemade every effort to make sure that it was the six ofus,” Milly said. “It wasn’t a typical Monday throughFriday, nine-to-five type of family where everybodysits down at 6 o’clock for dinner every single night.We always had family dinner but it may not havebeen until 8:30 or 9 o’clock at night.

“So there were a lot of times that it didn’t matter ifwe were doing anything special. It was just the factthat we got to be with Daddy.”

Milly said she expected living with the long hoursChris spent in the operating room and hospital, ac-cepting it even though it meant time away from fam-ily life with their four children.

Chris’ loss, however, is something the family isstill struggling with.

“The worst part of the day for me is around nine or10 o’clock at night when all the kids are in bed. Every-thing’s quiet, and I’m by myself, you know,” she said.“In the past, even if Chris was on call or was stuck atthe hospital, I could call him. I could text him. Wecould go through the day. If there was somethingfunny that I had to tell him if I just needed to rantabout something, I could.

“I don’t have that now.”Even in his absence, Chris remains ever-present

in his family’s daily routine.“He’s in our life every day,” Milly said. “Every day

there is a conversation about happy memories withChris.”

LawsuitsContinued from Page 9A

Milly Haughn said this family picture was taken in fall 2016, just a few months after her husband Dr. ChrisHaughn died of brain cancer. “I haven’t had pictures done of the kids and I since, I can't stand seeing onlyfive of us,” she said. COURTESY THE HAUGHN FAMILY

St. Vincent Evansville Hospital.CHRISTIANA BOTIC / COURIER & PRESS

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