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
Hospitals
Universe 480
Inspections 44
Enforcement Actions 24
Formal Enforcement Actions 10 (1,289, 913)
Settlements 8 (557,612)
Audit Agreements 37
Voluntary Disclosures 128 covering 478 facilities (10,417,113 for 59 resolved)
Violations Corrected 1100
6
Healthcare Violations679 Violations from 128
Facilities
7
Top 15 Healthcare ViolationsFrom 59 Resolved
Voluntary Disclosures
Rank Violation Statute Frequency
1 ID of HW RCRA 92
2 Universal Waste RCRA 66
3 Chemical Inventory EPCRA 48
4 SIP Requirements CAA 48
5 SPCC CWA 44
8
Top 15 Healthcare ViolationsFrom 59 Resolved
Voluntary Disclosures
Rank Violation Statute Frequency
6 Labeling RCRA 35
7 CFC Leak Detection Records CAA 32
8 MSDS Records EPCRA 30
9 Manifests RCRA 30
10 CESQG Requirements RCRA 25
9
Top 15 Healthcare ViolationsFrom 59 Resolved
Voluntary Disclosures
Rank Violation Statute Frequency
11 Personnel Training RCRA 25
12 Empty Containers RCRA 23
13 CFCs Use Certified Technicians CAA 23
14 Lead Paint Disclosure TSCA 23
15 Container Management RCRA 21
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

14
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
22
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

26
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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