1. Top Ten Environmental Compliance Pitfalls December 7, 2006 Adapted from Region 2 August 2006 presentation

2. Healthcare Compliance? • In the business to promote health • Hospitals already fall under several regulatory standards • Environmental compliance refers to: • Hazardous waste or RCRA • Air quality or air permits requirements • Waste water discharges Adapted from Region 2 May 2005 presentation

3. Healthcare compliance • Kansas H2E and regional H2E program helps with compliance and pollution prevention (workshop with KHEA) • East coast EPA compliance initiative • Compliance pitfalls identified on east coast, probably mirror the compliance gaps we have in Midwest Adapted from Region 2 May 2005 presentation

4. Healthcare compliance • Janet Bowen will present on east coast findings • Our region, Region 7, has begun inspecting hospitals • State tables in vendor area • Learn from our east coast finding Adapted from Region 2 May 2005 presentation

5. Top Ten Compliance Pitfalls based on Region II Audit Disclosure Data Janet Bowen, EPA Region I 617-918-1795, Bowen.Janet@epa.gov www.epa.gov/region1/healthcare December 7, 2006 Adapted from Region 2 August 2006 presentation

6. EPA - Regions Adapted from Region 2 May 2005 presentation

7. EPA Region I Approach • Mercury Challenge Program(1999-2001) • Increased Compliance Assistance(2001-2004) • Letter to hospital CEOs (2004) - Increase enforcement presence - Promote audit disclosure policy • Audit Disclosures to date - 6 agreements representing 14 large hospitals - over 30 disclosures received to date

8. Approach – EPA Region II • Region 2 combined the following strategies to address compliance issues in these sectors: • Compliance assistance • Compliance incentives (voluntary audit/disclosure) • Compliance monitoring • Enforcement • Pollution prevention • Environmental management systems (EMS) Adapted from Region 2 May 2005 presentation

9. Results EPA Region II:Compliance Monitoring & Incentives Programs Adapted from Region 2 August 2006

10. Healthcare Violations – All R2 Adapted from Region 2 August 2006 presentation

11. Top 10 Violations (From 146 Voluntary Disclosures) Adapted from Region 2 August 2006 presentation

12. Top 10 Violations –Cont. Adapted from Region 2 August 2006 presentation

13. Maximum Number Of Violations (From 156 Voluntary Disclosures) Adapted from Region 2 August 2006 presentation

14. Number Of Facilities With ViolationsFrom 156 Voluntary Disclosures Adapted from Region 2 August 2006 presentation

15. Root Causes Of Noncompliance Systemic violations appear to stem from: • Inadequate resources for people, equipment and training to carry out environmental activities; • Limited or no environmental compliance accountability for individual departments, laboratories, and staff; • Limited authority vested in environmental compliance officials; Adapted from Region 2 January 2006 presentation

16. Root Causes Of Noncompliance • No clear environmental compliance chain-of-command; • Scattered, incomplete, and missing environmental compliance documentation; • Incomplete institutional knowledge regarding environmental regulatory requirements; and • Broad use of hazardous materials when effective substitutes exist Adapted from Region 2 January 2006 presentation

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46. Healthcare RCRA Violations – All R2 Adapted from Region 2 August 2006 presentation

47. 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 Adapted from Region 2 May 2005 presentation

48. 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 Adapted from Region 2 May 2005 presentation

49. Laboratories Dental clinics X-rays units Nuclear medicine areas Pharmacy Maintenance areas Physical therapy Underground storage tanks Laundry Morgue Operating rooms Nursing units Hazardous waste storage areas Medical technology unit Construction areas Satellite accumulation points Common Hazardous Waste Violations Adapted from Region 2 May 2005 presentation

50. 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/protocol.html Adapted from Region 2 May 2005 presentation