Kaiser Permanente Case Study Alternatives Assessment Meeting December 2, 2004 Lynn Garske Environmental Stewardship Manager

2 Overview Kaiser Permanente is the nation’s largest nonprofit health plan 8.2 million members30 medical centers431 medical office buildings $25 billion annual revenue 136,500 employees 12,300 physicians 9 states and Wash DC

3 Environmental Stewardship at KP  Environmental Stewardship Vision: We aspire to provide health care services in a manner that protects and enhances the environment and health of communities now and for future generations.  Focus areas: Green Buildings, Environmentally Responsible Purchasing, Sustainable Operations

4 Why Sustainability  Alignment with corporate mission: improve the health of the communities we serve.  Industry practices generate waste, pollution and consume natural resources  Recognized link between building design and health outcomes  Impact of building materials on indoor air quality and environmental health  Planned growth : 25 new hospitals, replacements or significant additions 100 new medical office buildings (MOBs)

5 Alternatives Assessments  Medical Products: PVC/DEHP-free products for neonatal units; latex-free and PVC-free exam gloves; mercury-free measurement devices  Safer chemicals: Replacing mercury-based fixatives; selecting greener cleaners; recyclable solvents  Green Buildings: carpet hard surface/resilient flooring casework

6 Evolution of Effort  Clinical (with formal protocols) to non- clinical (we invented protocols)  Initial work on building materials required consultants; today we’re able to conduct most of the activities internally  Key component is objective, independent, transparent verification of vendor claims and test results

7 Framework for Assessing Building Materials Sourcing Mfg Use Post-Use  Sourcing (product content) free of PVC; free of PBTs and carcinogens; post consumer; security of supply  Sustainable manufacturing waste; energy; water; TRI  Use CHPS 1350; Green Seal; our own air sampling performance; aesthetics  Post use recyclability; reuse; take back

8 Overview – Casework Project  Project context  Results  Details – limited LCA – 7 vendors Sourcing Manufacturing Use Post-Use

9 Project Context  Goal: To improve indoor air quality of the built environment by reducing harmful emissions.  Scope: Particleboard (PB) and Medium-Density Fiberboard (MDF) that are the foundations of finishings and furnishings.  Project: To identify alternative materials to traditional PB and MDF bound with urea formaldehyde binders using LCA criteria.

10 Review Team  Environmental Stewardship – Research, vendor contact  Cabinet Shops – Performance testing, expertise  Contracting – Pricing and acquisition  NFS Green Buildings Liaison

11 Early Research Results – PB/MDF  Binders Urea Formaldehyde – traditional Lignin – not yet viable for desired applications Phenol Formaldehyde – not subject to Form. Reg. due to low emissions Polymeric diphenylmethane diisocyanate - pMDI – low exposure limits for raw product, no detectable emissions after curing  Content Recovered/recycled wood Forest Certified Wood – recovered/not Wheat residuals Rice residuals – local plants don’t mfg. product Sugarcane bagasse – not in production Paper – Mfg. out of business

12 Vendors  Did not undergo LCA Enviroboard - rice, wrong product – thick board Weyerhauser – recovered wood, no response Temple-Inland, FSC – formaldehyde binder Acadiaboard Duracane, sugarcane bagasse – out of business CanFibre – AllGreen, recovered wood, unable to contact DuraGreen, sugarcane bagasse, out of business  Underwent LCA Sonoco – paper/lignin, out of business Phenix Bioply – newspaper, pMDI SierraPine Medite – recovered wood, pMDI Collins Companies – FSC wood, urea form. Dow BioProducts Woodstalk – wheat, pMDI Rodman Industries Resincore – recovered wood, phenol formaldehyde Sorm, Inc. – wheat, pMDI

13 Life Cycle Analysis - Sourcing  PBT’s, carcinogens – binders, pesticides  Rapidly renewable – wheat, rec. wood  Security of supply – capacity available  Packaging – minimal, strapping  Transportation – rail, truck  FSC, SCS certified – recovered wood/not  Free of added formaldehyde - binder  Sustainable agricultural practices - wheat

14 LCA – Sustainable Manufacturing  Waste minimization  Water minimization  Non-renewable energy minimization  Reduced emissions during manufacturing  Environmental data: US EPA - Toxics Release Inventory - Scorecard - Environment Canada -  Worker injury data

15 LCA – Use: IAQ and Performance  Indoor Air Quality California High Performance School (CHPS) 1350 emissions – whole unit testing – CHPS Carcinogen standards Green Seal /recommendations.htm Building Green Inc. com/menus/subtopics.cfm ?TopicID=5  Performance Machinability Aesthetics Durability  Strength  Water resistance Maintenance/IAQ Cabinet Shop findings  Wheat PB  Recovered wood MDF Finishes

16 LCA – Post Use  Closed loop recyclable  Readily down-cycled  Supplier facilitates end of life disposition

17 LCA – General Criteria  Environmental Statement, Mission  Facility locations  Dimensions  Quality assurance

18 Resources – Fiberboard, Isocyanates  Green Seal Choose Green Report /CGR_PB&MDF.pdf  ISOCYANATES by Eric LeBreton n/articles/documents/isocy.htm  Isocyanates - Risk Assessment and Preventive measures, Nordic supervisory authorities, - Copenhagen publikasjoner/rapporter/rappor t1eng.html  OSHA info - cyanates/  Preventing Asthma and Death from Diisocyanate Exposure NIOSH ALERT: 1996 DHHS (NIOSH) Publication No hma.html  report on particleboard/mdf ages/fiberlinks.html

19 KP Decision on Casework  Pursuing RFP on 3 most promising products all are free of added formaldehyde 2 wheat-based products 1 post industrial wood product all are less expensive than current product!  For contracted casework, develop specs and pursue through our GPO  Overall effort considered big win by the KP Green Building Committee

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