1. Adapted from Region 2 May 2005 presentation 1 Regulatory and Enforcement Update Janet Bowen, EPA Region I 617-918-1795, Bowen.Janet@epa.gov Bowen.Janet@epa.gov www.epa.gov/region1/healthcare July 27, 2005

2. 2 Region I Approach Mercury Challenge Program (1999-2001) Mercury Challenge Program (1999-2001) National Award:Making Medicine Mercury Free National Award:Making Medicine Mercury Freehttp://www.h2e-online.org/programs/award/appls/mmmfChallenge.htm Regional Hospital email group Regional Hospital email group Promote H2E (2001 – present) Promote H2E (2001 – present) National: 1,038 partners representing 4,366 facilities (as of July 13, 2005) facilities (as of July 13, 2005) Region I: 127 partners in New England

3. 3 Region 1 Approach (Cont.) Increased Compliance Assistance - Compliance workshop 2001 - Compliance workshop 2001 - SPPC Conference 2002 - SPPC Conference 2002 - Compliance workshop: May 20, 2004 - Compliance workshop: May 20, 2004 - RCRA half day trainings - RCRA half day trainings * One in each state * One in each state * June 2004- December 2004 * June 2004- December 2004

4. 4 Region 1 Approach (Cont.) Increase Enforcement Presence in Healthcare EPA sent letter to hospital CEOs (April 2004) EPA sent letter to hospital CEOs (April 2004) - Increase enforcement presence - Increase enforcement presence - Information about EPA Audit policy - Information about EPA Audit policy - Information about Region II - Information about Region II enforcement cases enforcement cases

5. Adapted from Region 2 July 20055 Results: Compliance Monitoring & Incentives Programs Hospitals Universe 480 Inspections 44 Enforcement Actions24 Formal Enforcement Actions10 ($1,289, 913) Settlements8 ($557,612) Audit Agreements37 Voluntary Disclosures 128 covering 478 facilities ($10,417,113 for 59 resolved) Violations Corrected1100+

6. Adapted from Region 2, July 20056 Healthcare Violations 679 Violations from 128 Facilities

7. Adapted from Region 2, July 20057 Top 15 Healthcare Violations From 59 Resolved Voluntary Disclosures RankViolationStatuteFrequency 1 ID of HW RCRA92 2 Universal Waste RCRA66 3 Chemical Inventory EPCRA48 4 SIP Requirements CAA48 5SPCCCWA44

8. Adapted from Region 2, July 20058 Top 15 Healthcare Violations From 59 Resolved Voluntary Disclosures RankViolationStatuteFrequency 6LabelingRCRA35 7 CFC Leak Detection Records CAA32 8 MSDS Records EPCRA30 9ManifestsRCRA30 10 CESQG Requirements RCRA25

9. Adapted from Region 2, July 20059 Top 15 Healthcare Violations From 59 Resolved Voluntary Disclosures RankViolationStatuteFrequency 11 Personnel Training RCRA25 12 Empty Containers RCRA23 13 CFCs – Use Certified Technicians CAA23 14 Lead Paint Disclosure TSCA23 15 Container Management RCRA21

10. Adapted from Region, July 200510 Healthcare RCRA Violations 409 Violations

11. Adapted from Region 2 May 2005 presentation11 Hazardous Waste (HW) Issues Lack of HW management training of employees Lack of HW management training of employees Treating HW without a permit Treating HW without a permit Lack of RCRA contingency plan Lack of RCRA contingency plan Spill control equipment not readily accessible Spill control equipment not readily accessible Failure to make HW determinations Failure to make HW determinations

12. Adapted from Region 2 May 2005 presentation12 Hazardous Waste (HW) Issues Failure to ensure that HW meets Land Disposal Restrictions Failure to ensure that HW meets Land Disposal Restrictions Failure to upgrade/close underground storage tanks (USTs) by 12/22/98 Failure to upgrade/close underground storage tanks (USTs) by 12/22/98 Malfunctioning leak detection systems on USTs Malfunctioning leak detection systems on USTs

13. Adapted from Region 2 May 2005 presentation13 Hazardous Waste Environmental Compliance Audit Protocols Hazardous Waste Generators Hazardous Waste Generators Used Oil and Universal Waste Generators Used Oil and Universal Waste Generators Underground Storage Tanks Underground Storage Tanks Hazardous Waste Treatment, Storage, and Disposal Facilities Hazardous Waste Treatment, Storage, and Disposal Facilities Facilities Regulated under Subtitle D of RCRA Facilities Regulated under Subtitle D of RCRAwww.epa.gov/compliance/incentives/auditing/protocol.html

14. Adapted from Region 2 May 2005 presentation14 Hazardous Waste Environmental Assistance Resources Hazardous Waste General Resources Hazardous Waste General Resources http://www.hercenter.org/regsandstandards/RCRA.html http://www.hercenter.org/regsandstandards/RCRA.html Understanding the Hazardous Waste Rules: A Handbook for Small Businesses http://www.epa.gov/region02/waste/public/sqg_pdf.pdf Understanding the Hazardous Waste Rules: A Handbook for Small Businesses http://www.epa.gov/region02/waste/public/sqg_pdf.pdf Hazardous Waste Requirements for Large Quantity Generators http://www.epa.gov/region02/waste/public/lqgpdf.pdf Hazardous Waste Requirements for Large Quantity Generators http://www.epa.gov/region02/waste/public/lqgpdf.pdf EPA’s Office of Underground Storage Tanks http://www.epa.gov/swerust1/index.htm EPA’s Office of Underground Storage Tanks http://www.epa.gov/swerust1/index.htm

15. Adapted from Region 2, July 200515 Healthcare CWA Violations 49 Violations

16. Adapted from Region 2 May 2005 presentation16 Water Compliance Issues No permit for wastewater discharges No permit for wastewater discharges Not complying with permit conditions Not complying with permit conditions No/inadequate secondary containment of storage tanks/containers No/inadequate secondary containment of storage tanks/containers No SPCC plan No SPCC plan Floor drains Floor drains

17. Adapted from Region 2 May 2005 presentation17 Water Regulations (40 CFR Parts 100-136, 403, 460) ( http://www.epa.gov/region02/ff/ca.htm) Wastewater Discharges NPDES: http://www.epa.gov/npdes Pretreatment: http://cfpub.epa.gov/npdes/home.cfm?program_id=3 Wastewater Discharges NPDES: http://www.epa.gov/npdes Pretreatment: http://cfpub.epa.gov/npdes/home.cfm?program_id=3 UIC : http://www.epa.gov/ogwdw/uic.html Stormwater Discharges http://cfpub.epa.gov/npdes/home.cfm?program_id=6 Stormwater Discharges http://cfpub.epa.gov/npdes/home.cfm?program_id=6 Oil above ground and underground tanks Oil above ground and underground tankshttp://www.epa.gov/oilspill/index.htm Other (e.g. filtration plants) Other (e.g. filtration plants)

18. Adapted from Region 2, July 200518 Healthcare CAA Violations 113 Reported Violations

19. Adapted from Region 2 May 2005 presentation19 Air Compliance Issues Failure to use properly trained and accredited asbestos personnel. Failure to use properly trained and accredited asbestos personnel. Failure to notify EPA of asbestos removal projects and keep required documentation/recordkeeping. Failure to notify EPA of asbestos removal projects and keep required documentation/recordkeeping. Failure to properly dispose of asbestos debris. Failure to properly dispose of asbestos debris. Failure to close lids on parts washers when not in use. Failure to close lids on parts washers when not in use. Failure to properly handle CFCs and records. Failure to properly handle CFCs and records. Failure to include ETO sterilizer, spray paint booth, and parts degreaser in air permit. Failure to include ETO sterilizer, spray paint booth, and parts degreaser in air permit.

20. Adapted from Region 2 May 2005 presentation20 Air (40 CFR 50-99) Clean Air Act General Resources Clean Air Act General Resources http://www.hercenter.org/regsandstandards/CAA.html http://www.hercenter.org/regsandstandards/CAA.htmlhttp://www.hercenter.org/regsandstandards/CAA.html Air Conditioning/Refrigeration Air Conditioning/Refrigeration Asbestos Asbestoshttp://www.epa.gov/asbestos Boilers/Emergency Generators Boilers/Emergency Generators Medical Waste Incinerators Medical Waste Incineratorshttp://www.epa.gov/ttn/atw/129/hmiwi/rihmiwi.html Other (e.g., degreasers, ETO sterilizers, spray booths) Other (e.g., degreasers, ETO sterilizers, spray booths)

21. Adapted from Region 2, July 200521 Healthcare EPCRA Violations 79 Violations

22. Adapted from Region 2 May 2005 presentation22 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.gov/oswer/CeppoWeb.nsf/content/epcraOverview.htm Emergency Planning and Community Right to Know (40 CFR 302, 355, 370, 372) http://yosemite.epa.gov/oswer/CeppoWeb.nsf/content/epcraOverview.htm Pesticides (40 CFR 150-189) http://www.epa.gov/pesticides/ Pesticides (40 CFR 150-189) http://www.epa.gov/pesticides/ PCBs (40 CFR Part 761) http://www.epa.gov/opptintr/pcb/ PCBs (40 CFR Part 761) http://www.epa.gov/opptintr/pcb/www.epa.gov/compliance/incentives/auditing/protocol.html

23. Adapted from Region 2, July 200523 Healthcare TSCA Violations 24 Violations

24. 24 EPA’s Audit Policy National Audit policy www.epa.gov/compliance/incentives/auditing/auditpolicy.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.html

25. 25 National Tools Profile of the Healthcare Industry (2/05) Document Number: 310R05002 - plain language environmental profile - plain language environmental profile http://www.hercenter.org/links/http://www.hercenter.org/links/ Or call 1-800-490-9198 http://www.hercenter.org/links/ Compliance Assistance Center – Healthcare still under construction - on-line compliance assistance - on-line compliance assistance - Formal launch mid-April 2005 - Formal launch mid-April 2005 - Website www.hercenter.org - Website www.hercenter.org

26. 26

27. 27 National Tools – Cont. Environmental Compliance and Improvement Guide – To improve compliance with JCAHO Environmental of Care Standard Environmental Compliance and Improvement Guide – To improve compliance with JCAHO Environmental of Care Standard Available www.hercenter.org/regsandstandards/jcah ointro.html Available www.hercenter.org/regsandstandards/jcah ointro.html

28. 28

29. 29 Choose a Standard.

30. 30 “Clip Board” Versions

31. 31 National Tools – Cont. H2E Waste Management System Excel spreadsheet to assist hospitals track waste data – solid, hazardous, recyclable, regulated medical Excel spreadsheet to assist hospitals track waste data – solid, hazardous, recyclable, regulated medical Currently being piloted with hospitals Currently being piloted with hospitals Register for this FREE tool at Register for this FREE tool at http://www.hercenter.org/wms.html

32. 32 H2E Waste Management Tool

33. 33 National Tools – Cont. Mercury Assessment Tool Based on CA Excel speadsheet (2002) Based on CA Excel speadsheet (2002) Use to help inventory mercury items Use to help inventory mercury items Use to calculate the amount of mercury Use to calculate the amount of mercuryhttp://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 Scroll down and click Mercury Assessment Worksheet. To access the manual open the spreadsheet and click on INSTRUCTIONS at the bottom

34. 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” www.kppc.org

35. 35 Regional Projects OECA Hospital Assessment Project OECA Hospital Assessment Project - UNH interns collected data from 25 - UNH interns collected data from 25 hospitals in RI, CT and NH hospitals in RI, CT and NH - Summer 2003 - Summer 2003 - Federal Template online - Federal Template online - Project data available online - Project data available onlinehttp://www.epa.gov/region1/healthcare/compliance.html

36. 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. 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 Mercury, Waste Reduction, Green Buildings, Green Purchasing, Energy Efficiency, Chemical /Pollution Prevention, Water Conservation, Universal Waste  Monthly Teleconferences for Partners  Technical Resources

38. 38 How to Become a H2E Partner Partner Registration Form online http://www.h2e- online.org/programs/partner/p_reg.htm

39. 39 Toll Free Hotline: 800-727-4179 E-mail: h2e@h2e-online.org www.h2e-online.org h2e@h2e-online.org Kelly Heekin, Communications Kelly.Heekin@H2E-online.org Kelly Heekin, Communications Kelly.Heekin@H2E-online.org Kelly.Heekin@H2E-online.org Liza Nanni, Program Assoc. Liza.Nanni@H2E-online.org Liza Nanni, Program Assoc. Liza.Nanni@H2E-online.org Liza.Nanni@H2E-online.org – 603-795-9966 Jolie Patterson-Rosst, Awards Coordinator Jolie.Rosst@H2E-online.org Jolie Patterson-Rosst, Awards Coordinator Jolie.Rosst@H2E-online.org Jolie.Rosst@H2E-online.org – 703-243-0056 Cecilia DeLoach, State Partnership Programs Coordinator Cecilia.DeLoach@H2E-online.org Cecilia DeLoach, State Partnership Programs Coordinator Cecilia.DeLoach@H2E-online.org Cecilia.DeLoach@H2E-online.org –800-727-4179 Laura Brannen, Director Laura.Brannen@H2E-online.org Laura Brannen, Director Laura.Brannen@H2E-online.org Laura.Brannen@H2E-online.org –603-795-9966 Chen Wen, Director Chen.Wen@H2E-online.org Chen Wen, Director Chen.Wen@H2E-online.org Chen.Wen@H2E-online.org –202-564-8849 Janet Brown, Partner Coordinator Janet.Brown@H2E-online.org Janet Brown, Partner Coordinator Janet.Brown@H2E-online.org Janet.Brown@H2E-online.org –cell 347-393-3809 Sarah O’Brien, Champion Coor. Sarah.obrien@h2e-online.org Sarah O’Brien, Champion Coor. Sarah.obrien@h2e-online.org Sarah.obrien@h2e-online.org –(802) 479-0317 H2E Program Contacts

40. 40 General Resources Sustainable Hospital Project http://www.sustainablehospitals.org/cgi- bin/DB_Index.cgi Healthcare Without Harm http://www.noharm.org/ RCRA Online http://www.epa.gov/rcraonline/

41. 41 A voluntary partnership with EPA ENERGY STAR is… A strategic approach to energy management Recognized by 60% of U.S. Households

42. 42 EnergyStar Resources Healthcare Benchmarking - Evaluate your hospital’s energy perf - Evaluate your hospital’s energy perf - Healthcare benchmarking starter kit - Healthcare benchmarking starter kitwww.energystar.gov/healthcare Portfolio Manager to benchmark energy performance available for: - Acute care and children hospitals - Acute care and children hospitals - Medical offices (new in 2004) - Medical offices (new in 2004)

43. 43 EnergyStar Resources – Cont. Building Upgrade Manual Building Upgrade Manual http://www.energystar.gov/index.cfm?c=business.bus_upgrade_manua l New Building Guidance New Building Guidance http://www.energystar.gov/index.cfm?c=new_bldg_design.new_bldg_d esign Free EnergyStar Internet training Free EnergyStar Internet traininghttp://es.netspoke.com/attendee/default.asp Toll Free EnergyStar Hotline: Toll Free EnergyStar Hotline: 1-888-STAR-YES (1-888-782-7937) 1-888-STAR-YES (1-888-782-7937)

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