On April 24, 2018, the NRC issued a Notice of Violation and Proposed Imposition of Civil Penalty in the amount of $11,600 to Providence Alaska Medical Center for three violations: failure to have a written directive dated and signed by an authorized user before administering therapeutic doses of radiation (10 CFR 35.40 (a)), failure to develop, implement, and maintain written procedures to provide high confidence that each administration is in accordance with the written directive (10 CFR 35.41(a)), and failure to follow procedures specified on the license, including training (License Condition 18 of NRC License Number 50-17838-01). These violations are cited as a combined Severity Level II problem. Specifically, from January 1, 2015 to June 27, 2017, the licensee failed to have the written directives dated and signed for approximately 40 therapeutic doses of yttrium-90 microspheres. During the same time period, the licensee also failed to develop its procedure to assure that the written directive was followed: failure to verify that ordered and received doses matched those planned; and failure of the medical physicist to review the written directive, dose calculations, and to provide direction regarding doses ordered. Additionally, from October 28, 2016 to June 27, 2017, the licensee failed to provide training on its yttrium-90 microspheres procedure to its staff, including staff that ordered and prepared doses of the yttrium-90 microspheres. These failures are associated with the medical event (10 CFR 35.2) that occurred when the licensee administered yttrium-90 microspheres to a patient liver in the amount of 54,000 centigray (cGy; rad) instead of the prescribed dose of 11,000 centigray (cGy; rad).