Regulatory and Enforcement Update

1
Regulatory and Enforcement Update

• Janet Bowen, EPA Region I
• 617-918-1795, Bowen.Janet_at_epa.gov
• www.epa.gov/region1/healthcare
• July 27, 2005

2
Region I Approach

• Mercury Challenge Program (1999-2001)
• National AwardMaking Medicine Mercury Free
• http//www.h2e-online.org/programs/award/appls/mmm
  fChallenge.htm
• Regional Hospital email group
• Promote H2E (2001 present)
• National 1,038 partners representing 4,366
• facilities (as of July 13,
  2005)
• Region I 127 partners in New England

3
Region 1 Approach (Cont.)

• Increased Compliance Assistance
• - Compliance workshop 2001
• - SPPC Conference 2002
• - Compliance workshop May 20, 2004
• - RCRA half day trainings
• One in each state
• June 2004- December 2004

4
Region 1 Approach (Cont.) Increase Enforcement
Presence in Healthcare

• EPA sent letter to hospital CEOs (April 2004)
• - Increase enforcement presence
• - Information about EPA Audit policy
• - Information about Region II
• enforcement cases

5
ResultsCompliance Monitoring Incentives
Programs
6
Healthcare Violations679 Violations from 128
Facilities
7
Top 15 Healthcare ViolationsFrom 59 Resolved
Voluntary Disclosures
8
Top 15 Healthcare ViolationsFrom 59 Resolved
Voluntary Disclosures
9
Top 15 Healthcare ViolationsFrom 59 Resolved
Voluntary Disclosures
10
Healthcare RCRA Violations409 Violations
11
Hazardous Waste (HW) Issues

• Lack of HW management training of employees
• Treating HW without a permit
• Lack of RCRA contingency plan
• Spill control equipment not readily accessible
• Failure to make HW determinations

12
Hazardous Waste (HW) Issues

• Failure to ensure that HW meets Land Disposal
  Restrictions
• Failure to upgrade/close underground storage
  tanks (USTs) by 12/22/98
• Malfunctioning leak detection systems on USTs

13
Hazardous Waste Environmental Compliance Audit
Protocols

• Hazardous Waste Generators
• Used Oil and Universal Waste Generators
• Underground Storage Tanks
• Hazardous Waste Treatment, Storage, and Disposal
  Facilities
• Facilities Regulated under Subtitle D of RCRA
• www.epa.gov/compliance/incentives/auditing/protoco
  l.html

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Hazardous Waste Environmental Assistance Resources

• Hazardous Waste General Resources
• http//www.hercenter.org/regsandstandards/RCRA
  .html
• Understanding the Hazardous Waste Rules A
  Handbook for Small Businesseshttp//www.epa.gov/r
  egion02/waste/public/sqg_pdf.pdf
• Hazardous Waste Requirements for Large Quantity
  Generatorshttp//www.epa.gov/region02/waste/publi
  c/lqgpdf.pdf
• EPAs Office of Underground Storage
  Tankshttp//www.epa.gov/swerust1/index.htm

15
Healthcare CWA Violations49 Violations
16
Water Compliance Issues

• No permit for wastewater discharges
• Not complying with permit conditions
• No/inadequate secondary containment of storage
  tanks/containers
• No SPCC plan
• Floor drains

17
Water Regulations (40 CFR Parts 100-136, 403,
460) (http//www.epa.gov/region02/ff/ca.htm)

• Wastewater DischargesNPDES http//www.epa.gov/np
  desPretreatment http//cfpub.epa.gov/npdes/home.
  cfm?program_id3
• UIC http//www.epa.gov/ogwdw/uic.html
• Stormwater Dischargeshttp//cfpub.epa.gov/npdes/h
  ome.cfm?program_id6
• Oil above ground and underground tanks
• http//www.epa.gov/oilspill/index.htm
• Other (e.g. filtration plants)

18
Healthcare CAA Violations113 Reported Violations
19
Air Compliance Issues

• Failure to use properly trained and accredited
  asbestos personnel.
• Failure to notify EPA of asbestos removal
  projects and keep required documentation/recordkee
  ping.
• Failure to properly dispose of asbestos debris.
• Failure to close lids on parts washers when not
  in use.
• Failure to properly handle CFCs and records.
• Failure to include ETO sterilizer, spray paint
  booth, and parts degreaser in air permit.

20
Air (40 CFR 50-99)

• Clean Air Act General Resources
• http//www.hercenter.org/regsandstandards/CAA.
  html
• Air Conditioning/Refrigeration
• Asbestos
• http//www.epa.gov/asbestos
• Boilers/Emergency Generators
• Medical Waste Incinerators
• http//www.epa.gov/ttn/atw/129/hmiwi/rihmiwi.html
  
• Other (e.g., degreasers, ETO sterilizers, spray
  booths)

21
Healthcare EPCRA Violations79 Violations
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Other Requirements(http//www.epa.gov/region02/ff
/ca.htm)

• Emergency Planning and Community Right to Know
  (40 CFR 302, 355, 370, 372) http//yosemite.epa.g
  ov/oswer/CeppoWeb.nsf/content/epcraOverview.htm
• Pesticides (40 CFR 150-189)http//www.epa.gov/pes
  ticides/
• PCBs (40 CFR Part 761)http//www.epa.gov/opptintr
  /pcb/
• www.epa.gov/compliance/incentives/auditing/protoco
  l.html

23
Healthcare TSCA Violations24 Violations
24
EPAs Audit Policy

• National Audit policy
• www.epa.gov/compliance/incentives/auditing/auditpo
  licy.html
• Press releases New England
• May 25, 2005 Caritas Christi Health Care
• http//www.epa.gov/region1/pr/2005/may/sraw050501.
  html
• February 14, 2005 Portsmouth Regional Hospital
• http//www.epa.gov/region1/pr/2005/feb/sr050203.ht
  ml

25
National Tools

• Profile of the Healthcare Industry (2/05)
  Document Number 310R05002
• - plain language environmental profile
• http//www.hercenter.org/links/ Or call
  1-800-490-9198
• Compliance Assistance Center Healthcare still
  under construction
• - on-line compliance assistance
• - Formal launch mid-April 2005
• - Website www.hercenter.org

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National Tools Cont.

• Environmental Compliance and Improvement Guide
  To improve compliance with JCAHO Environmental of
  Care Standard
• Available www.hercenter.org/regsandstandards/jcaho
  intro.html

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(No Transcript)
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Choose a Standard.
30
Clip Board Versions
31
National Tools Cont.

• H2E Waste Management System
• Excel spreadsheet to assist hospitals track waste
  data solid, hazardous, recyclable, regulated
  medical
• Currently being piloted with hospitals
• Register for this FREE tool at
• http//www.hercenter.org/wms.html

32
H2E Waste Management Tool
33
National Tools Cont.

• Mercury Assessment Tool
• Based on CA Excel speadsheet (2002)
• Use to help inventory mercury items
• Use to calculate the amount of mercury
• http//www.h2e-online.org/tools/merc-man.htm
• Scroll down and click Mercury Assessment
  Worksheet. To access the manual open the
  spreadsheet and click on INSTRUCTIONS at the
  bottom

34
National Tools Cont.

• Healthcare Guide to Pollution Prevention
  Implementation through Environmental Management
  Systems, second edition
• Revised draft second edition May 2005
• Available
• Kentucky Pollution Prevention Center
• URL www.kppc.org, under Now Available

35
Regional Projects

• OECA Hospital Assessment Project
• - UNH interns collected data from 25
• hospitals in RI, CT and NH
• - Summer 2003
• - Federal Template online
• - Project data available online
• http//www.epa.gov/region1/healthcare/compliance.h
  tml

36
Hospital for Healthy Environment Goals

• Virtually eliminate mercury waste by year 2005
• Reduce total waste volume by 33 by year 2005, by
  50 by 2010
• Identify and reduce PBT chemicals and other
  hazardous substances in hospitals through
  pollution prevention and waste reduction
• Our key to success is your involvement!

37
H2E Tools

• H2E Listserve
• H2E Self Assessment Guide and other Guides
• Comprehensive Website
• Mercury, Waste Reduction, Green Buildings,
  Green Purchasing, Energy Efficiency, Chemical
  /Pollution Prevention, Water Conservation,
  Universal Waste
• Monthly Teleconferences for Partners
• Technical Resources

38
How to Become a H2E Partner

• Partner Registration Form online
• http//www.h2e-online.org/programs/partner/p_reg.h
  tm

39
Toll Free Hotline [phone]E-mail
h2e_at_h2e-online.orgwww.h2e-online.org
H2E Program Contacts

• Laura Brannen, DirectorLaura.Brannen_at_H2E-online.o
  rg
• 603-795-9966
• Chen Wen, DirectorChen.Wen_at_H2E-online.org
• 202-564-8849
• Janet Brown, Partner CoordinatorJanet.Brown_at_H2E-o
  nline.org
• cell 347-393-3809
• Sarah OBrien, Champion Coor. Sarah.obrien_at_h2e-onl
  ine.org
• [phone]

• Kelly Heekin, Communications Kelly.Heekin_at_H2E-onli
  ne.org
• Liza Nanni, Program Assoc.Liza.Nanni_at_H2E-online.o
  rg
• 603-795-9966
• Jolie Patterson-Rosst, Awards CoordinatorJolie.Ro
  sst_at_H2E-online.org
• 703-243-0056
• Cecilia DeLoach, State Partnership Programs
  CoordinatorCecilia.DeLoach_at_H2E-online.org
• 800-727-4179

40
General Resources

• Sustainable Hospital Project
• http//www.sustainablehospitals.org/cgi-bin/DB_Ind
  ex.cgi
• Healthcare Without Harm
• http//www.noharm.org/
• RCRA Online
• http//www.epa.gov/rcraonline/

41
ENERGY STAR is

• A voluntary partnership
• with EPA

A strategic approach to energy management

• Recognized by 60 of U.S. Households

42
EnergyStar Resources

• Healthcare Benchmarking
• - Evaluate your hospitals energy perf
• - Healthcare benchmarking starter kit
• www.energystar.gov/healthcare
• Portfolio Manager to benchmark energy performance
  available for
• - Acute care and children hospitals
• - Medical offices (new in 2004)

43
EnergyStar Resources Cont.

• Building Upgrade Manual
• http//www.energystar.gov/index.cfm?cbusiness.bus
  _upgrade_manual
• New Building Guidance
• http//www.energystar.gov/index.cfm?cnew_bldg_des
  ign.new_bldg_design
• Free EnergyStar Internet training
• http//es.netspoke.com/attendee/default.asp
• Toll Free EnergyStar Hotline
• 1-888-STAR-YES (1-888-782-7937)

44
Contact Us
Bill White EPA Region 1, ENERGY STAR Boston,
MA 617-918-1333 white.william_at_epa.gov Clark
Reed National Healthcare Manager, ENERGY
STAR Washington, D.C. reed.clark_at_epa.gov
www.energystar.gov/healthcare