On October 16, 2012, the NRC issued a Notice of Violation to St. John Macomb-Oakland Hospital for a Severity Level III violation involving the failure to have written procedures in place that would provide high confidence that each high dose-rate remote afterloader (HDR) brachytherapy administration was in accordance with the written directive as required by 10 CFR Part 35.41(a). Specifically, on July 9, 2012, the licensee's written procedures failed to ensure that the patient's endobronchial catheters were directly connected to the HDR unit such that the brachytherapy administration would occur in accordance with the written directive.