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U.S. Department of Health and Human Services

Inspections, Compliance, Enforcement, and Criminal Investigations

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Eureka Springs Hospital


Food and Drug Administration
Southwest Regional Office
4040 North Central Expressway
Suite 900
Dallas, Texas 75204




May 6, 2009

Via Federal Express - Next Day


Re: MQSA Inspection ID # 201939
FEI# 1000517245

David Wheeler
Eureka Springs Hospital
24 Norris Street
Eureka Springs, AR 72632

Dear Mr. Wheeler,

On April 30, 2009, a representative of the State of Arkansas, acting on behalf of the Food and Drug Administration (FDA) performed an inspection at your facility which revealed a serious problem involving the conduct of mammography. Under the Mammography Quality Standards Act of 1992 ("MQSA") which is codified in Section 263b of Title 42 of the United States Code (USC), you must meet specific requirements to practice mammography. These requirements serve to protect the health of women by assuring that a facility can perform quality mammography.

The problems identified during this inspection constitute a violation of the MQSA as identified below.

Processor QC records in the month of 6/2008 were missing for at least 30% of operating days, for processor Kodak, Min-R. [See 21 CFR 900.12(e)(1)].

Processor QC records were missing at least 2 but less than 5 consecutive days for processor Kodak, Min-R. [See 21 CFR 900.12(e)(1)].

Because these violations may be indicative of serious underlying problems that could compromise the quality of mammography at your facility, FDA may take additional actions, including, but not limited to, the following:


•    requiring your facility to undergo an Additional Mammography Review

•    placing your facility under a Directed Plan of Correction
•    charging your facility for the cost of on-site monitoring
•    requiring your facility to notify patients who received mammograms at your facility, and their referring physicians, of the deficiencies, the potential harm resulting from such deficiencies, appropriate remedial measures, and other relevant information
•    seeking civil money penalties up to $11,000 for each failure to substantially comply with, or each day of failure to substantially comply with, MQSA standards
•    seeking to suspend or revoke your facility's FDA certificate
•    seeking a court injunction against your facility

See 42 USC 263b(h)(j) and 21 CFR 900.12(j).

FDA may need to perform a Compliance Follow-up Inspection to determine that each problem at your facility has been corrected.

You should respond in writing to FDA within (15) working days from the date you received this letter. Your response should address the findings listed above and include:

1. the specific steps you have taken, or will take, to correct all of the violations noted in this letter, including projected timeframes for implementing those steps;
2. the specific steps you have taken, or will take, to prevent the recurrence of similar violations, including projected timeframes for implementing those steps;
3. sample records that demonstrate proper record keeping procedures.

Please submit your response to this letter to:

Deborah M. McGee
Southwest Regional Compliance Officer
U. S. Food and Drug Administration
4040 N. Central Expressway, Suite 900
Dallas, TX 75204

Please send a copy of your response to:

Melinda Davis
Mammography Program
Arkansas Department of Health
4815 West Markham, Slot 30
Little Rock, AR 72205

Finally, you should understand that there are many requirements pertaining to mammography. This letter pertains only to violations related to the recent inspection of your facility and does not necessarily address other obligations you have under the law.

You may obtain general information about all of FDA's requirements for mammography facilities by contacting the Mammography Quality Assurance Program, Food and Drug Administration, P.O. Box 6057, Columbia, MD 21045-6057 (1-800-838-7715) or through the Internet at http://www.fda.gov/cdrh/mammography/index.html.

If you have additional or more specific questions about mammography facility requirements, or about the content of this letter, please feel free to contact Deborah M. McGee, M.S., Southwest Regional Compliance Officer, by telephoning (214) 253-4935.

Sincerely yours,


Dennis E. Baker
Regional Food and Drug Director
Southwest Regional Office


Melinda Davis
Mammography Program
Arkansas Department of Health
4815 West Markham, Slot 30
Little Rock, AR 72205