EPA Launches New Hospital and Healthcare Environmental Enforcement Initiative

In-Sites
(Susanne Peticolas, Arthur J. Clarke)
January 14, 2002

EPA's Enforcement Initiative

The United States Environmental Protection Agency ("EPA") has launched a new enforcement initiative aimed at hospitals and healthcare facilities in the northeast. EPA Regions I, II and III, covering states from Virginia to Maine, announced that they will focus environmental compliance audits and subsequent enforcement measures on hospitals and healthcare facilities in its latest enforcement initiative. Hospitals can expect increased scrutiny from the federal EPA, as well as State and local environmental agencies that enforce both state and federal laws.

The EPA has rolled-out its new enforcement initiative in the form of an "invitation" to the healthcare field to employ the voluntary audit and disclosure procedures EPA currently offers other regulated industries. This "invitation" allows such facilities to audit themselves to find non-compliance issues and correct them without direct EPA intervention. As an incentive to self-auditing and self-disclosure of such violations, the Hospitals may employ EPA's Audit Policy that reduces certain penalties for environmental violations by as much as 75 percent when such violations are voluntarily disclosed to EPA and corrected by the violator. The EPA has held information seminars on which regulatory program areas it intends to focus on as part of this new enforcement effort.

Healthcare Environmental Issues

Mercury

One of the main concerns of EPA is the disposal of mercury in hospital waste. Mercury is highly toxic and is widely used in hospitals not only in thermometers, but in a number of different test kits and laboratory operations. Hospital incinerators are the fourth largest known releasers of mercury into the environment. EPA and the American Hospital Association have entered into a Memoranda of Understanding (MOU) entitled Hospitals for a Healthy Environment (H2E). The goal of H2E is to eliminate the use of mercury by hospitals by the year 2005.

Solid Waste

Hospitals produce one percent of the nation's solid waste. H2E sets a goal for the reduction of solid wastes by hospitals by 33 percent by 2005 and 50 percent by 2010. These goals will be extremely hard to achieve and are unprecedented by any other industry group since the advent of mandatory recycling. H2E is developing a guidance document entitled How to Reduce Hospital Waste Guide. The guide should help healthcare facilities meet their waste reduction goals.

Environmental Justice

The new EPA enforcement initiative is just one of the many environmental issues faced by the healthcare industry. Environmental compliance in the healthcare industry has become a critical business issue for healthcare providers. Compliance with Federal, State and local environmental regulations assure that hospital operations are safe and environmentally sound. In what is termed "environmental justice" or "environmental equity," more and more communities, especially those in urban areas, are actively opposing new projects that pose environmental health risks to the local community. Additionally, community groups have an unprecedented voice in the environmental permitting process. These permits are critical to the construction of new healthcare facilities, the expansion of older facilities, and the continued operation of both.

JCAHO Accreditation

In addition to the impacts on the local community, environmental regulatory compliance and compliance with the Occupational Health and Safety Act ("OSHA") are critical elements in healthcare facility accreditation. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the independent healthcare standards and auditing agency, has new standards that impact environmental incident response and command systems. In addition, JCAHO surveyors check other environmental management systems such as the management and control of hazardous substances and hazardous/biological waste.

Health care organizations are responsible for adhering to local, State and Federal environmental regulations for proper handling and disposal of hazardous materials and wastes. JCAHO surveyors routinely determine whether an organization is complying with all environmental codes, standards and regulations even when they differ from one location or state to another. Federal EPA regulations apply to most organizations, and it is with these regulations that JCAHO surveyors are most familiar. State and local regulations are generally even more restrictive. Thus, the JCAHO surveyor usually determines what additional requirements the state or local regulations have imposed.

The healthcare organization's hazardous material and waste management program must be designed and operated in accordance with all applicable laws and regulations. This written program must contain the policies and procedures that are necessary for the healthcare organization to be in compliance with all applicable laws. Through a thorough review of the hazardous materials and waste program, JCAHO surveyors determine the extent to which the State and local regulations have been included within the scope of the program. JCAHO encourages each organization to maintain a reference library of all applicable Federal, State and local laws and regulations. JCAHO considers maintenance of this library as evidence that all of the various regulatory requirements have been taken into consideration during program design. Although there is no written policy that coordinates EPA and JCAHO audits, both play a critical role in the maintenance of a record of good standing for the healthcare facility.

Other Voluntary Programs

In addition to the EPA's Audit Policy, there are a number of other voluntary environmental compliance programs that EPA is emphasizing to the healthcare industry. Pollution prevention (P2) is an ongoing program that promotes the economic benefits that can be realized from the reduction of wastes. Hospitals are being encouraged to re-evaluate their waste streams to see if pollution prevention can reduce costs and benefit the environment. The EPA is also promoting its environmental leadership programs to the healthcare industry. The National Environmental Performance Track is designed to motivate and reward top environmental performers through national recognition, the use of state-of-the-art technology and access to top EPA officials to solve environmental issues. Project XL promotes innovative performance-based standards developed by the healthcare facility as an alternative to traditional "command and control" regulatory programs. Other voluntary EPA programs being promoted to the healthcare industry include Environmentally Preferable Purchasing (EPP) which encourages the procurement of environmentally preferable products, the Water Alliances for Voluntary Efficiency (WAVE) which promotes water conservation, and WasteWise which targets the reduction of solid waste.