The Government Response
As hospitals work to improve their environmental condition, there is always the backdrop of governmental oversight, especially from the U.S. Environmental Protection Agency and the Occupational Safety and Health Administration. Until now, the government has not left much of a shadow in enforcement of environmental infractions for healthcare facilities.
As hospital officials tell it, government enforcement is haphazard, often depending on the region in which the hospital is placed. EPA officials declined to discuss overall enforcement strategy or actions. However, in a sampling of 863 medical centers inspected by the EPA over the past five years, only 26 facilities were cited for Resource Conservation and Recovery Act violations, according to federal records reviewed by HealthLeaders Media. Of the 26 facilities cited, only five were fined more than $50,000, and some were penalized as little as $450, the records show.
The 1976 law gives the EPA the authority to control hazardous waste generation, transportation, and disposal.
Environmental activists say the EPA’s actions involving hospitals over the past five years reflect the uneven enforcement by the agency. But hospital officials say that they expect federal officials to step up their inquiries and possible enforcement actions. Janet Brown, director of sustainability operations for Practice Greenhealth, a not-for-profit organization of 1,000 hospital and business members committed to eco-friendly practices, says there appears to be a “resurgence” at the EPA in its oversight in environmental matters. “There are different pressures in different regions,” she says.
Van Rees of Metro Health Hospital says hospital officials are becoming increasingly aware of compliance issues raised by the federal government, as well as accrediting agencies, such as The Joint Commission. “Accrediting bodies are starting to ask questions, and more and more the EPA is jumping on this,” he says. Within the past year, “there are some hefty fines, and with healthcare being a big industry and manufacturing being down, the government is directing attention to healthcare,” Van Rees says.
The EPA is proposing changes in federal regulatory oversight, particularly in its plans to restrict disposal of pharmaceutical waste. Although RCRA was enacted more than 30 years ago, the government just in 2008 issued proposed regulations that would specifically ban healthcare facilities from dumping pharmaceutical waste into waste water treatment plants and municipal solid waste facilities.
The EPA extended its comment period for the proposed regulations last year, and is expected to promulgate the regulations sometime this year. The addition of pharmaceutical waste to the so-called Universal Waste Rule will facilitate the collection of personal medications from the public at various facilities so that they can be more properly managed, the EPA said.
In a statement, the EPA said it understands that many healthcare facilities may be unaware of the applicability of RCRA regulations to their hazardous pharmaceutical wastes.
Recent studies have documented the presence of various pharmaceutical chemicals and metabolic byproducts in surface waters and groundwater in the United States, and the issue of pharmaceutical use and management has become increasingly important, according to the EPA.
In May, the Metro Health Hospital system began its pharmaceutical waste removal program, in part because of proposed actions by the EPA. Before construction of the pharmaceutical waste system, “some of this stuff was going down the drain; it was like everything else thrown in the trash,” Van Rees says.
“It was costly; it added to my waste management budget by $60,000 a year—it had a total cost of $100,000, but it had to be done,” Van Rees says of the new pharmaceutical waste disposal program, which was developed with the help of pharmacy director Peter Haverkamp. “We’re monitoring the compliance level—we’ve seen some stuff that was put in the trash that shouldn’t be.”
The pharmaceutical waste program will be “required by law, but this also keeps those harmful drugs out of the watershed because they will be disposed of properly and not end up in the landfill,” he adds. Many hospitals have not yet started a pharmaceutical waste disposal program, he says.
As an example of the “hefty” violations that Van Rees mentioned, the EPA in August 2009 ordered the Department of Veterans Affairs Eastern Kansas Health Care System to pay more than $50,000 in civil penalties and nearly $500,000 in improvements stemming from improper hazardous waste discharges. The government told the healthcare system to develop and implement programs to identify, segregate, and manage its pharmaceutical and chemical waste at the Leavenworth and Topeka hospitals.
The agreement resolved a series of violations found during inspections of the Dwight D. Eisenhower Veterans Medical Center in Leavenworth, KS, in January 2006. The EPA cited the hospitals for violations of the RCRA.
“I can tell you that when it comes to healthcare facilities, the enforcement section [of the EPA] has been taking a harder look for some time,” says Chris Whitley, spokesman for the EPA regional office in Kansas City, KS. “One reason for enforcement is the potential detrimental effect on others,” he says.
“We have gotten a lot of interest and attention, and we know it’s on the radar screen,” Whitley says of the Kansas case. “It certainly gets the attention of the industry. We’re hopeful that people will take this as a learning opportunity. There’s nothing like a peer or competitor facing charges to open one’s eyes.”
States also act; for example, an investigation by New York State Attorney General Andrew M. Cuomo determined in January that five healthcare facilities had been improperly flushing painkillers, antibiotics, antidepressants, and other pharmaceuticals into sinks and toilets that drained into the New York City watershed, the drinking water supply for half the state’s residents.
In a settlement with the state, the healthcare facilities, which included hospitals and nursing homes, were to take “specific steps” to ensure no waste went into the water supply, and were ordered to pay civil penalties.
A spark for a CEO
What does it take for a hospital to initiate major environmental changes? Many CEOs have initiated changes over time, often prompted by advocates within the organization. Sometimes the spark comes from outside the hospital.
In 2007, the Cleveland Clinic sponsored an Ideas for Tomorrow program, in which Bill McDonough—a leader in the development of green architecture and a designer of sustainability products—talked about a vision for comprehensive sustainability and the potential for making environmental improvements for businesses.