Of­fi­cials are tak­ing ac­tion against hos­pi­tals and nurs­ing homes for dis­pos­ing of drugs in sew­ers and land­fills

Reg­u­la­tors tak­ing more in­ter­est in health­care drug-dump­ing

Modern Healthcare - - Front Page -

Bet­ter sci­ence has al­lowed re­searchers to de­tect chem­i­cals in wa­ter at tinier and tinier con­cen­tra­tions, and they’re find­ing scores of phar­ma­ceu­ti­cals in ground­wa­ter, streams and ef­flu­ent from waste­water treat­ment plants.

Scant ev­i­dence in­di­cates these trace amounts of drugs—parts per bil­lion and tril­lion—pose risks to peo­ple or the en­vi­ron­ment, and much of the stuff is be­lieved to come from the se­cre­tions of an­i­mals and peo­ple who di­gest them. But fed­eral and state reg­u­la­tors and law­mak­ers want to pre­vent un­used phar­ma­ceu­ti­cals from get­ting dumped or flushed into sewer sys­tems or sent to land­fills, from which chem­i­cals can leach into ground­wa­ter. Hos­pi­tals, they’re look­ing at you. The op­er­a­tive fed­eral law con­trol­ling the dis­posal of dan­ger­ous chem­i­cals is the Re­source Con­ser­va­tion and Re­cov­ery Act, or RCRA (pro­nounced rick-ra), a 24-year-old statute that pri­mar­ily tar­gets in­dus­trial users. About 5% of phar­ma­ceu­ti­cal prod­ucts are reg­u­lated un­der RCRA as haz­ardous ma­te­ri­als. That leaves thou­sands of prod­ucts on hos­pi­tal for­mu­la­ries out­side the reach of fed­eral reg­u­la­tion, but the govern­ment doesn’t want the rest of it go­ing to land­fills or down the drain ei­ther, even if the na­tional rules haven’t caught up yet.

The U.S. En­vi­ron­men­tal Pro­tec­tion Agency has not been par­tic­u­larly puni­tive in en­forc­ing RCRA against hos­pi­tals. That may be chang­ing as de­tec­tion im­proves and pub­lic scru­tiny in­creases. In 2008, a Se­nate sub­com­mit­tee held a hear­ing on the pres­ence of phar­ma­ceu­ti­cals in drink­ing wa­ter af­ter the As­so­ci­ated Press pub­lished a se­ries of sto­ries on the topic.

The sub­ject also caught the in­ter­est of New York At­tor­ney Gen­eral An­drew Cuomo, who launched an in­ves­ti­ga­tion into the dis­posal prac­tices of hos­pi­tals and nurs­ing homes. The ef­fort in Jan­uary yielded set­tle­ment agree­ments with two crit­i­cal-ac­cess hos­pi­tals and three nurs­ing homes, whose drugs Cuomo al­leged were mak­ing their way into the reser­voirs and lakes that pro­vide wa­ter to 9 mil­lion res­i­dents of New York City and sur­round­ing com­mu­ni­ties (Jan. 18, p. 12).

The agree­ments in­voke RCRA, yet pro­hibit the fa­cil­i­ties from us­ing drains and toi­lets and land­fill-bound garbage to dis­pose of any phar­ma­ceu­ti­cal prod­uct, re­gard­less of whether the feds call it haz­ardous. All of it must go to an in­cin­er­a­tor, and the of­fi­cially haz­ardous stuff must go to an in­cin­er­a­tor per­mit­ted to han­dle it.

“In New York, it ap­pears they used RCRA

PHOTO COUR­TESY OF RIVER­KEEPER Wa­ter from the Ashokan Reser­voir—a wa­ter source for New York City—al­legedly was pol­luted by hos­pi­tals dis­pos­ing of drugs.

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