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Health Care reform thyself

Posted by on Aug. 12, 2009 at 12:50 PM
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Health Care reform thyself
Urbanite #52 October 08

By: Sharon Tregaskis


The hauls of medicine: Tim Pickering, vice president of Biomedical Waste Services, says his company collects 1 to 2 million pounds of medical waste each year.
(photo by Bill Dennison)


Every day, a fleet of nine trucks emblazoned with the moniker "Biomedical Waste Services" rumbles through the streets of Baltimore, patrolling from loading dock to loading dock, collecting everything from used needles to leftover chemotherapy drugs from three local hospitals and roughly five hundred doctors' and dentists' offices. Much of the refuse packs a toxic wallop: expired medications from pharmacies, mercury fixative used in pathology labs, and radioactive waste from the VA Hospital downtown. The 45,000 to 50,000 pickups made statewide by BWS trucks each year add up. The company collects more than 12,000 gallons of hazardous waste packed in Department of Transportation-approved drums, 1 to 2 million pounds of medical waste in telltale red plastic bags, and 100,000 pounds of computers and other "e-waste."

Decades back, steel was king in Baltimore. Today, the city runs on health care, which comprises the fastest-growing sector of the economy and serves as a linchpin of the Baltimore Development Corp.'s efforts to catalyze growth in the region. But behind the gleaming laboratories and white-coated doctors, the health care system has a dark side: Nationwide, hospitals produce nearly 4 billion pounds of trash each year. This river of refuse that flows out the back doors and into landfills, rivers, and the air we breathe has come to symbolize the excesses of a bloated, wasteful industry.

And it's an industry that keeps growing. Today, the $2.3 trillion sector represents more than 16 percent of the gross domestic product. By 2016, it's expected to blossom to 20 percent. And in anticipation of a tsunami of demand from aging baby boomers, the industry is in the midst of a $200-billion building campaign. In Baltimore, that translates to more than $2 billion in construction at Mercy Medical Center and Johns Hopkins, Franklin Square, and St. Agnes hospitals.



Green machine: Nurse Barbara Sattler, director of the University of Maryland School of Nursing's Environmental Health Education Center, started the state chapter of Hospitals for a Healthy Environment.
(photo by Bill Dennison)


For health care providers focused on the Hippocratic precept, "First, do no harm," toxic trash is a sign of an increasingly alarming truth. Our health care system is making people and the environment sick. Nurses suffer one of the highest occupational rates of asthma in the nation. Medical labs juggle an extensive chemical arsenal, complemented by the caustic cleaning supplies and neurotoxic pesticides used throughout health care facilities. Pharmaceuticals work their way through our bodies and wastewater treatment plants and into our waterways. Dioxin, a compound released into the atmosphere by medical waste incinerators, poisons breast milk, which has become the most chemically contaminated of all foods.

Efforts to clean up the industry first made headlines in the late 1980s, when needles and other medical refuse washed up on East Coast beaches. In 1998, the American Hospital Association, the American Nurses Association, and the Environmental Protection Agency (EPA) made a joint pledge to cut medical waste in half by 2010, forming the advocacy organization Hospitals for a Healthy Environment (H2E)-now called Practice Greenhealth-to promote environmental sustainability in health care. Health Care Without Harm, founded in 1996, helped shutter several thousand medical waste incinerators nationwide and create tougher emissions standards for those that remain. Today, the group boasts nearly five hundred member organizations in fifty countries. Meanwhile, the nonprofit Teleosis Institute has launched a green pharmaceuticals program, and Healthcare Design magazine highlights the latest in green building. 

"Given that our mission is both to keep people healthy and help them heal when they're unhealthy, it would be a complete contradiction for us to contribute to poor health-whether of employees, patients, or the community," says nurse Barbara Sattler, professor and director of the University of Maryland School of Nursing's Environmental Health Education Center and head of the nation's only graduate program in environmental nursing. "We're focused on making our mission consistent; we want our health care institutions to be healing places."

To move Maryland's hospitals closer to that goal, Sattler authored a grant application in 2005 to establish a Maryland chapter of Hospitals for a Healthy Environment. She called on many of the same philanthropic heavyweights that have supported the construction of hospitals throughout the region: the Jacob and Hilda Blaustein Foundation, the Zanvyl and Isabelle Krieger Family Foundation, the Aaron and Lillie Straus Foundation, the Clayton Baker Trust, and the Abell Foundation. The Maryland chapter of H2E now boasts a membership comprising more than half of the hospitals in the state. These facilities have implemented innovative recycling and composting efforts, developed local food programs, reduced reliance on toxic chemicals, and established environmentally preferable purchasing policies. "We're now seeing the hospitals begin to adopt an environmental ethic," Sattler says, "so it's part of the fabric of the decisions they're making."

That doesn't make it easy. Greening the industry requires confronting a set of unique realities. Hospitals run twenty-four hours a day, 365 days a year. A staggering array of state, federal, and accreditation agencies regulates the sector. Then there are the people-patients, employees, and a highly decentralized management system to keep it all together. "An institution with six thousand employees and eight hundred patients on any given day, it's a huge operation," says Denise Choiniere, a cardiac care nurse and environmental health coordinator at the University of Maryland Medical Center, who piloted a program that now recycles 97,000 batteries each year that were previously incinerated. "You can't just stick out some recycling bins and expect it's going to work. Who's going to pick it up and where will we store it until the recycling people come?"

 

by on Aug. 12, 2009 at 12:50 PM
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