1. Preparing for a Multi-Media Inspection at your Medical Facility John Gorman EPA Region 2 212-637-4083gorman.john@epa.gov What to expect when an EPA Inspector comes to your door

2. Outline What is a multi-media inspection? What is a multi-media inspection? What are the common environmental problems at medical facilities? What are the common environmental problems at medical facilities? How can medical facilities improve their environmental performance? How can medical facilities improve their environmental performance?

3. What is a Multi-Media Inspection? MMI is an inspection by two or more environmental programs (e.g., air, water, hazardous waste) conducted at the same time or within 6 weeks of each other. MMI is an inspection by two or more environmental programs (e.g., air, water, hazardous waste) conducted at the same time or within 6 weeks of each other.

4. Targeting Multi-Media Inspections Facilities are targeted for MMIs based on a number of factors such as past compliance history, complaints, regional/national priorities, significant environmental impacts, and high non-compliance rate in sector. Facilities are targeted for MMIs based on a number of factors such as past compliance history, complaints, regional/national priorities, significant environmental impacts, and high non-compliance rate in sector. Healthcare facilities are a R2 priority. Healthcare facilities are a R2 priority.

5. Standard Operating Procedures for Multi-Media Inspections Opening Meeting Opening Meeting Conduct Site Visit Conduct Site Visit End of the day Review Meetings (optional) End of the day Review Meetings (optional) Closing Meeting Closing Meeting Follow-up Letter Follow-up Letter Enforcement if necessary Enforcement if necessary

6. 6 Ways To Convince An Inspector to Look More Closely Bad housekeeping Bad housekeeping Keep us waiting Keep us waiting Knowledge personnel not available Knowledge personnel not available Records not readily accessible or organized Records not readily accessible or organized No escorts No escorts Denial of Entry Denial of Entry

11. 6 Ways To Convince An Inspector to Look More Closely Bad housekeeping Bad housekeeping Keep us waiting Keep us waiting Knowledgeable personnel not available Knowledgeable personnel not available Records not readily accessible or organized Records not readily accessible or organized No escorts No escorts Denial of Entry Denial of Entry

12. Results: Compliance Monitoring & Incentives Programs Hospitals Universe480 Inspections44 Enforcement Actions 22 Formal Enforcement Actions 9 ($911,018) Settlements 6 ($404,000) Audit Agreements 37 Voluntary Disclosures 81 ($8,956,016 for 49 resolved) Violations Corrected 1100

13. Results: Environmental Protection from Audits Hospitals Number of Beds 22,071 Number of Inpatients 808,729 Number of Outpatients 12,428,100 Number of Staff 103,734

14. Results: Environmental Benefits Program Environmental Benefits from FY04 Disclosures RCRA More than 3,960 lbs/year of hazardous waste is now being managed properly because hospitals have self- disclosed violations and corrected mismanagement. SPCC At least 30,200 gallons of oil is now being managed properly. TSCA At least 226 residential units now in compliance with lead-based paint rules. CAA At least 650 pounds of chlorofluorocarbons now being appropriately managed. At least 10 buildings now managing asbestos properly. At least 10 buildings now managing asbestos properly.

15. Air (40 CFR 50-99) ( http://www.epa.gov/region02/ff/ca.htm) Air Conditioning/Refrigeration Air Conditioning/Refrigerationhttp://www.epa.gov/region02/cfc 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)

16. 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.

17. Hazardous Waste (40 CFR Parts 260-282) ( http://www.epa.gov/region02/ff/ca.htm) Laboratories Laboratories Dental Clinics Dental Clinics X-rays Units X-rays Units Nuclear Medicine Areas Nuclear Medicine Areas Pharmacy Pharmacy Maintenance Areas Maintenance Areas Physical therapy Physical therapy Underground Storage Tanks Underground Storage Tanks Laundry Laundry Morgue Morgue Operating Rooms Operating Rooms Nursing Units Nursing Units Hazardous Waste Storage Areas Hazardous Waste Storage Areas Medical Technology Unit Medical Technology Unit Construction Areas Construction Areas

18. Hazardous Waste Questions Did the facility identify all their hazardous waste? Did the facility identify all their hazardous waste? How much hazardous waste does the facility generate on a monthly basis? How much hazardous waste does the facility generate on a monthly basis? Is the facility properly managing and disposing of its hazardous waste? Is the facility properly managing and disposing of its hazardous waste? Is the facility storing hazardous materials safely? Is the facility storing hazardous materials safely?

19. Hazardous Waste Questions Are hospital staff adequately trained in hazardous waste management? Are hospital staff adequately trained in hazardous waste management? Is the hospital prepared for emergencies? Is the hospital prepared for emergencies? Does the hospital have required records? Does the hospital have required records? Do the hospital’s underground storage tanks have the required corrosion, spill and overfill protection or were closed properly? Do the hospital’s underground storage tanks have the required corrosion, spill and overfill protection or were closed properly?

20. Hazardous Waste (HW) Issues No/infrequent weekly inspections of HW storage/satellite accumulation areas No/infrequent weekly inspections of HW storage/satellite accumulation areas No/improper labeling of HW containers No/improper labeling of HW containers Open containers of HW Open containers of HW No/Incorrect HW manifests No/Incorrect HW manifests Improper disposal of HW (e.g., throw fluorescent light bulbs and paints in trash, lab chemicals down drain) Improper disposal of HW (e.g., throw fluorescent light bulbs and paints in trash, lab chemicals down drain)

21. 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

22. 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

23. 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

24. Hazardous Waste Environmental Assistance Resources 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

25. Water Regulations (40 CFR Parts 100-136, 460) ( http://www.epa.gov/region02/ff/ca.htm) Wastewater Discharges NPDES: http://www.epa.gov/npdes UIC : http://www.epa.gov/ogwdw/uic.html Wastewater Discharges NPDES: http://www.epa.gov/npdes 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)

26. 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

27. Other Requirements (http://www.epa.gov/region02/ff/ca.htm) Emergency Planning and Community Right to Know (40 CFR 302, 355, 370, 372) http://www.epa.gov/swercepp/crtk.html Emergency Planning and Community Right to Know (40 CFR 302, 355, 370, 372) http://www.epa.gov/swercepp/crtk.html 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

28. Violations from Audits

29. CAA Violations

30. CWA Violations

31. EPCRA Violations

32. RCRA Violations

33. TSCA Violations

34. Environmental Management Systems EMS is a set of management processes and procedures that allows an organization to integrate environmental considerations into day-to-day decisions and practices. It provides a framework for managing environmental responsibilities in a more systematic way. EMS is a set of management processes and procedures that allows an organization to integrate environmental considerations into day-to-day decisions and practices. It provides a framework for managing environmental responsibilities in a more systematic way. EPA Region 2’s EMS Website http://www.epa.gov/region02/ems EPA Region 2’s EMS Website http://www.epa.gov/region02/ems

35. Environmental Auditing EPA’s Voluntary Audit Policy EPA’s Voluntary Audit Policy Audit Agreements Audit Agreements EPA Region 2’s Auditing Website http://www.epa.gov/region02/capp/cip EPA Region 2’s Auditing Website http://www.epa.gov/region02/capp/cip

36. Pollution Prevention Healthcare for a Healthy Environment http://www.h2e-online.org Healthcare for a Healthy Environment http://www.h2e-online.org Environmentally Preferable Purchasing http://www.epa.gov/opptintr/epp Environmentally Preferable Purchasing http://www.epa.gov/opptintr/epp EPA Region 2’s P2 Healthcare Website http://www.epa.gov/region02/p2/health.htm EPA Region 2’s P2 Healthcare Website http://www.epa.gov/region02/p2/health.htm Environmental Self-Assessment for Health Care Facilities – NY Dept of Environmental Protection http://www.dec.state.ny.us/website/ppu/esahcf.pdf Environmental Self-Assessment for Health Care Facilities – NY Dept of Environmental Protection http://www.dec.state.ny.us/website/ppu/esahcf.pdf