Health Care Facilities Cope with New Environmental Risks
Ayers, Kenneth W., Risk Management
The well-publicized washing ashore of medical wastes along the beaches of New York, New Jersey and Delaware in the late 1980s marked the end of the age of environmental innocence for hospitals and other health care facilities. Since that time, health care facilities have increasingly come under the scrutiny of the federal Environmental Protection Agency (EPA), plus local and state regulators. Hospital boards, administrators and risk managers, already under stress from rising costs and malpractice concerns, must now weigh the costs and consequences of reducing the pollution they contribute to the air, land and waterways of their communities.
Health care is a service industry that most communities traditionally have welcomed as clean and desirable, but with respect to pollutant discharges to the environment, it has many traits in common with manufacturing and industrial operations. As such, hospitals, clinics and nursing homes are subject to greater scrutiny from environmental interest groups. They are being forced to deal with recent environmental legislation that not only mandates compliance and cleanup, but also includes administrative, civil and even criminal penalties for noncompliance. Many of the newer environmental laws also allow citizen or third-party lawsuits designed to bring about compliance.
While many of these regulations have resulted in significant improvements to the general well-being of the American public, the cost of compliance, in many instances, has been enormous. Few institutions in the health care industry have been left untouched. In order to manage environmental risk, health care facilities should take a proactive approach to complying with these regulations. The facility will have more control over the process by acting first, rather than waiting for regulators to respond. Early identification of exposures allows a hospital, clinic or long-term care facility to develop compliance and remediation plans without the restrictive schedules often mandated by government regulators. In many cases, proactive compliance will allow regulatory involvement to be avoided completely.
In 1987, large quantities of medical waste washed ashore in New York and New Jersey, resulting in the closing of local beaches and an environmental and public relations nightmare for local health care facilities. Similar incidents made national headlines in 1989. The fallout from these events included the passage of the Medical Waste Tracking Act of 1988, which charged the EPA with developing rules for managing medical wastes. Beginning in 1989, the EPA started what was to be a two-year test program in Connecticut, New York, New Jersey, Rhode Island and Puerto Rico. The evaluation of that pilot program is still ongoing, with formal rules to follow.
It is a certainty that medical wastes will be regulated by the EPA in the near future, even though the exact terms are not yet known. Most health care institutions have taken the initiative by tightening their own internal procedures. At issue here is not only the environmental liability posed by these procedures, but also the risk of spreading infection among patients, staff and visitors.
Virtually all health care facilities already employ "red bags" to collect medical wastes, and have strict procedures for segregating and properly disposing of these wastes. Another common technique is the use of clear plastic bags for the collection of non-medical debris, so that the custodial staff can check for proper segregation of these wastes prior to disposal.
Concerned about their own liability problems, most solid waste collection and disposal firms now closely monitor solid wastes collected from hospitals, clinics and long-term care facilities. Any indication of medical wastes being improperly disposed of normally results in the waste-management firm refusing to accept the shipment. In some instances where these rules have been violated, the institution guilty of mixing medical and non-medical wastes has been required to remove all wastes associated with that shipment from the disposal site and has been barred from further disposal for several months. …