Environmental Stewardship at Kaiser Permanente

1
Environmental Stewardship at Kaiser Permanente
American Public Health Association Annual
MeetingWashington, D.C. November 9, 2004

• Prepared by Kathy Gerwig, Kaiser Permanente, VP
  Workplace Safety
• Presented by Liz Taghavi, Kaiser Permanente,
  National Environmental Health and Safety

2
Overview

• Kaiser Permanente is the nations largest
  nonprofit health plan

• 25 billion annual revenue
• 136,500 employees
• 12,300 physicians
• 9 states and Washington, DC

30 medical centers
8.2 million members
431 medical office buildings
3
Environmental Paradox for Healthcare
Hazardous chemicals and materials used to treat
patients
Harmful effects on environmental and human health
4
Environmental Paradox for Healthcare

• Incineration of vinyl creates dioxins
• Heavy metals in manometer, fixatives, and other
  products
• Wide range of chemicals used, some toxic
• Trash
• Poor environmental quality responsible for 25
  preventable ill-health in the world
• Environmentally attributable diseases in American
  children cost 55 billion

Eliminating or reducing these hazards will
eliminate environmental health impacts.
5
KPs Vision for Environmental Stewardship

• We aspire to provide health care services in a
  manner that protects and enhances the environment
  and the health of communities now and for future
  generations.

6
Values

• Come from people and events that date back
  decades in the history of Kaiser Permanente.
• Concern for the health of communities extends to
  the air we breathe and the water we drink.
• Business activities are aligned with protecting
  public health and the environment. Environmental
  Stewardship supports worker and patient safety,
  and is undertaken in full alignment with quality
  and cost imperatives.
• Precautionary Principle where there is credible
  evidence that a material were using may result
  in environmental/public health harm, we should
  strive to replace it with safer alternatives.

7
Environmental Stewardship Focus Areas

• Environmentally Responsible Purchasing
• Reduce toxicity and waste through product
  selection
• Increase post-consumer recycled content
• Select reusable and durable products
• Eliminate mercury
• Select products free from PVC and DEHP

8
Environmental Stewardship Focus Areas

• Green Buildings
• Efficient water and energy systems
• Least toxic building materials
• Recycle demolition debris
• Make use of daylight
• Manage storm water to enhance surrounding
  habitats
• Reduce site development area to limit disturbances

9
Environmental Stewardship Focus Areas

• Sustainable Operations
• Energy conservation
• Waste minimization
• Safe electronic equipment disposition
• Optimal reuse of single-use products
• Capital equipment redistribution
• Greening janitorial cleaning products
• Recycling and reuse of solvents

10
Environmental Stewardship Focus Areas

• Transportation Systems Management
• Spare the Air
• Bike to Work
• KaiseRider program
• Commuter Choice

11
Evolution of Stewardship Effort at KP
Clinical products and materials (Existing
protocols)
Non-clinical products (Invent protocols)
Consultants hired for initial work on building
materials
Conduct most activities internally
12
Framework for Assessing Materials
Sourcing No PVC, PBTs, or carcinogens
post-consumer material security of supply
Sustainable Manufacturing Waste energy water
TRI
Use CHPS 1350 Green Seal our own air sampling
performance aesthetics
Post Use Recyclable reuse take back
13
KPs Role in Initiating Change
14
Barriers to Environmental Stewardship

• Infection Control, staining/discoloration issues,
  wet environments
• Quality and Cost environmental considerations
  will never trump quality and cost requirements
• Although we have an assessment process, its in
  its infancy, and can be improved
• Trade secrets claimed by manufacturers
• We insist on objective, independent, transparent
  verification of vendor claims and test results.

15
Barriers to Environmental Stewardship

• Chemicals and materials targeted and removed are
  often replaced by other unhealthy components.
• Once weve made a stand, a product is chosen,
  many other products come out of the woodwork.
  We deal with ongoing improvements by periodic
  review (typically one year).

16
Accomplishments
Waste Minimization and Pollution Prevention

• In 2003, diverted 8,000 tons of solid waste from
  landfills
• In 2003, reused or redeployed 40,000 pieces of
  electronic equipment, weighing 410 tons
• Eliminated 27,000 grams of mercury from KP health
  care operations
• Phase out of mercury-containing blood pressure
  devices, thermometers, and GI equipment.
• 100 tons of single use devices reprocessed

17
Accomplishments
We pioneer and test products and publicize our
findings so that others can benefit from our
expenditure of resources, time, and expertise

• Carpet (vinyl free, recycled content, recyclable)
• Resilient flooring (vinyl free, recyclable,
  non-toxic cleaners and finishers)
• Casework and furniture (no added formaldehyde,
  renewable materials)

18
Goals

• 2004 Purchasing Goals
• Implement scaleable criteria during the SST
  process
• Review existing contracts for environmentally
  friendly products
• Accelerate the existing work to free NICUs of
  materials containing DEHP/PVC
• Develop strategy to comply with Prop 65 (CA)
  which requires notification of exposure to DEHP

19
Goals

• Immediate Future and Beyond
• New Chemical Policy
• Avoid the use of carcinogens, mutagens, and
  reproductive toxins, and persistent
  bioaccumulative toxic chemicals
• New Food Policy
• Support healthy food systems in health care
• Ecologically sound, economically viable, and
  socially responsible
• KP currently has farmers markets in operation at
  five medical centers in CA and HI, with expansion
  plans.

20
Imagine
Imagine how many cancers could be prevented by
eliminating the use of carcinogens in health
care. Imagine how much infertility could be
prevented if there were no endocrine disrupting
phthalates like DEHP in neonatal units or
elsewhere. Imagine how many communities could
have access to nutritious, locally grown organic
food if every hospital made it part of their
procurement policy.