Back in February, the enormous magnetic pull of an MRI machine — one of the most powerful magnets on Earth — at Kaiser Permanente’s Redwood City Medical Center in California pulled a medical bed into its field of attraction, pinning a Bay-area nurse against the machine. OSHA reported that the nurse, Ainah Cervantes, suffered crushing injuries from being pinned between the MRI and the hospital bed — including a severe laceration that required surgery.
It all began when an MRI technologist heard screaming, local news outlet KTVU reported. Regulators said systemic problems began when Cervantes and a patient care tech were left unsupervised, as MRI personnel were not in the room. The door to the magnetic room was open, the safety alarm was never sounded and no one was properly screened to be in the room.
“I was getting pushed by the bed,” Cervantes told investigators, as reported by KTVU. “Basically, I was running backwards, If I didn’t run, the bed would smash me underneath.”
It’s an incident not entirely uncommon at medical centers with MRIs, according to MRI expert Tobias Gilk.
“Personally, I find it very frustrating,” Gilk told KTVU. “We know MRI accidents can happen when best practices aren’t followed.”
Dr. Emanuel Kanal, a radiologist at the University of Pittsburgh, has studied hundreds of similar incidents and stressed that MRI safety training is paramount.
“Coming at it from an aviation safety point of view – standardization, certification, recertification, ensuring you’re on top of your game – to me, these are critical aspects of what we need in magnetic resonance to make sure we decrease these incidents as much as possible,” Kanal told KTVU.
Kaiser Permanente has since issued a statement concerning the incident.
“Our teams responded quickly and those involved immediately received the care and support they needed,” Sheila Gilson, senior vice president for Kaiser Permanente San Mateo area, said. “This was a rare occurrence, but we are not satisfied until we understand why an accident occurs and implement changes to prevent it from occurring again.”
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