THE INFORMED PATIENT

By LAURA LANDRO

The Wall Street Journal

Hospitals Go 'Green'

To Cut Toxins, Improve

Patient Environment

October 4, 2006; Page D1

Hospitals play a pivotal role in protecting America's health. But they may also have a surprising unhealthy side -- inadvertently contributing to illness and pollution by exposing patients and staff to a witch's brew of toxins from building materials, medical waste, hospital supplies and cleaning products.

Environmental health experts warn that materials that cover floors, walls and ceilings release hundreds of chemicals into hospital air, and chemicals used to clean and maintain hospitals add more. Volatile organic compounds such as formaldehyde, acetaldehyde, naphthalene and toluene are released into the air from particle board, carpets and other finish materials and are inhaled by patients and staff. Polyvinyl chloride (PVC), which releases the carcinogen dioxin during its manufacture, is widely used in the production of IV and blood bags, plastic tubing and other hospital products, as well as carpets.

In addition, inadequate ventilation and generally high energy consumption have contributed to poor air quality and pollution, studies show, with effects ranging from longer patient recovery times to more sick days for staff.

Now, as the industry embarks on a $200 billion construction program over the next decade to replace or rebuild decaying facilities and meet growing demand from aging baby boomers, that is starting to change. Under pressure from local and state governments, as well as health-care architects and designers and their own environmentally conscious donors, hospitals are building more efficient, eco-friendly facilities with "sustainable" design features that conserve energy, use natural light and materials and reduce potentially dangerous emissions.

Rooftop solar panels on Kaiser's Modesto Medical Center.

About a dozen pioneering groups, including Kaiser Permanente and Dartmouth-Hitchcock Medical Center in Lebanon, N.H., began the move to "green" hospital construction several years ago, and others are now following suit. According to the nonprofit Center for Health Design, which co-sponsored a conference in New Jersey last week to promote green design, more than 180 health-care facilities have been built or are being designed and constructed to standards such as those set by the Green Guide for Health Care (GGHC.org <http://www.gghc.org/> 1), modeled on a certification system developed by the U.S. Green Building Council, a coalition of builders, architects, government agencies and nonprofit groups.

When Kaiser Permanente's new medical center in Modesto, Calif., is completed in 2008, solar panels will cut energy costs, permeable pavement material will filter chemicals from rainwater runoff, floors will be covered with natural rubber, carpets will be backed with recycled safety glass -- even toilets will be fitted with special fixtures to conserve water. The new center is part of a $20 billion-plus facilities program at the Oakland, Calif.-based health-care giant that includes building or replacing 27 hospitals over the next nine years.

To be sure, there is conflicting evidence about the harm caused by chemicals in hospitals, and some manufacturers say there is no direct evidence that PVC, for example, is harmful to humans. But the nonprofit advocacy group Healthcare Without Harm says hospitals have a responsibility to choose the safest course when evidence suggests harmful effects. The group cites studies that show hazardous additives in PVC are toxic to both the reproductive and neurological systems -- a particular concern for neonatal-intensive-care patients. The American Hospital Association signed a memorandum of understanding with the Environmental Protection Agency several years ago to phase out the use of mercury, which can affect the human nervous system, in things like thermometers and blood-pressure cuffs.

At the same time, studies show that environmental improvements associated with sustainable buildings, such as bringing in more natural daylight, meditation areas and "healing gardens," can shorten patients' length of stay, reduce reliance on medication, and lessen mental and physical stress.

As hospitals move to make such changes, the challenge now is not only to build hospitals to rigid environmental standards, but also to operate them with the same principles in mind. "You can't build a green hospital and still have Styrofoam cups in the cafeteria," says health-care architect Robin Guenther, a co-coordinator of the Green Guide for Healthcare.

Stiffer federal regulations governing emissions of chemicals and heavy metals like dioxin and mercury have driven some changes, in particular regarding incinerators used to dispose of medical waste. Since the mid 1990s, when regulators found that hospital incinerators were a major contributor to mercury and dioxin emissions, more than 5,000 medical-waste incinerators have closed, and hospitals have adopted safer waste-disposal and treatment technologies.

"Hospitals didn't think of themselves as polluters, with spewing smokestacks and waste going out the back door," says Laura Brannen, executive director of the nonprofit Hospitals for a Healthy Environment (h2e-online.org <http://www.h2e-online.org/> 2), which helps hospitals devise improved environmental programs that also shave costs. Among them: separating hazardous waste, infectious waste and solid waste, which must be treated and disposed of differently, and recycling or reclaiming chemicals for medical use.

But Ms. Brannen cautions that many hospitals still send their waste to municipal incinerators that contribute to health threats. Wastewater from hospitals, she adds, still contains toxic lab and cleaning chemicals and pharmaceutical compounds, many of which aren't broken down in sewage-treatment plants.

Hospitals are also scrambling to find substitutes for building and interior finish materials. And companies that supply the industry are under growing pressure to come up with green products, including latex-free examination gloves, greener cleaners without harsh chemicals and recyclable solvents.

"In an era of rising construction costs, you don't have to pay extra money and use precious health-care dollars just to be green," says Christine Malcolm, Kaiser senior vice president of national facilities and hospitals. With the industry's purchasing power, "we can force suppliers to generate environmentally sensitive products."

Kaiser, for example, pressured carpet manufacturers to come up with a PVC-free product, which it will use in all its new facilities. Kaiser is also installing "dual-flush" toilets, which use more water for flushing solid waste and less for liquid, saving half a gallon of water for the latter. In the past five years the company says it has eliminated the purchase and disposal of 40 tons of hazardous chemicals, chosen "ecologically sustainable" materials for 30 million square feet in new construction, and saved more than $10 million a year through energy-conservation strategies.

While many of the innovations cost more up front, they can actually reduce operating costs over time, says Gary Cohen, executive director of the Environmental Health Fund, a nonprofit group that works on chemical-safety issues. Rubber flooring is more expensive to install than PVC, for example, "but the hospital will save much more during the lifetime of the flooring due to the fact that you don't need to constantly strip the floor with toxic chemicals and rewax it," Mr. Cohen says.

Still, going green can be challenging for hospitals that have to rebuild or retrofit older facilities. To build the new Lacks Cancer Center, St. Mary's Health in Grand Rapids, Mich., had to tear down old buildings, remove asbestos from pipes, tear out linoleum tiles, and separate metals like steel and copper. But it recycled more than 90% of the materials, recrushing brick and cement for the new facility, and installed energy-saving devices like windows with self-cleaning coatings.

"It may have cost us a few dollars more, but in the long run it will pay dividends," says St. Mary's President and Chief Executive Philip H. McCorkle Jr. Another incentive: A local benefactor made a major gift to the hospital contingent on sustainable design. The hospital also prepares food to order, which Mr. McCorkle says uses less energy, wastes less food, and makes patients happier than the traditional cafeteria model.

The University of Pittsburgh Medical Center, which is building a new children's hospital due for completion in 2009, is paying special attention to issues such as materials used to cover and clean floors, since its small patients "are closer to the floors and the source of chemicals," says President and CEO Roger Oxendale. But the hospital is also teaching medical interns about environmental health and reaching out to underserved populations to educate them about issues such as how second-hand smoke can harm their children.