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iciarisfox'
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SF
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u~
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V
S
Ernronme~
i1a1Pwiectton
Agency
(
EPA)
to
conflnuéits
diaIo~
u~
WI?]?
the
American
H~
spi1a~
Asso~
1ion(
A~
HA)
about
tI'e
~
ramc~
ers
ofthe
Meniorwtdum
of
Understanding(
MOU)
~
th
E1~
~
ndotlIer
stakehok]&
s
oi
health
ca1~
pofluzioa
prevention
(
As
you
know~
the
ongm~
1MO1.
J
was
~
don
June24,.
1998)

SF
PSR,
repr~
enungo%'
erI~
5OOphyszciaus~
andother
heaJth.
poio~
aLs~
nthc
SF
Bay
Ares,
encouraged
lo
hearthat
the
AHA
agreed
to
i~
on1mne~
tspubhc
comn~
iTment
to
this
~
mpc~
taxit
partnership,
based
on
the
outcomes
oEth~
1'.
4OU'sEnvironmental
Lcades~
hzpCounciIs(
ELC)
mcct~
ngonJuae
~
8.2OOji~
Chi~
go
We
~
jvders~
ndthat
during
that
meeting
there
wasconsensus
among
the
ELC
members
on
the
folluwing
po;
nl~
­

The
~
1OUshould
be
~
wntte~
coDmrnuent
aniong~
1spaz~
eis~

*
The
MOU
sbo~
ldc~
n~
ai~
n
all
the
goals
ofthe
ong~
aa~
MQU.
rneluthngJang~
iageabout
elimrnanng
persistent
bjp~
cci~
uJativetoxit
s(
PBTs)
~
theneverpossille,
ath
*
Thc
revisedMO~
Jdoc
~
jepL.~
Jjou1d
dearly
idenuI~'
all
the
pari­
nex~
to
the
memo
o(
in~
d~
ianthng
We
also
undersrand
that
theMMstated
ZJ~
iatit
would
qu~
ck1ygenerate
a
press
re1~
isewith
thçse
~
n~
portwit
ca~
nfications
SF
PSRis
co~
icemed,
h~
wevcxthat
the
press
release
that
A~
subseq~
ntiy
released
did
rw~
e~
pIicitlymake
the
n~
nitm~
nt~
identified
above
StithezitCh~
pters
~
nWif~!
fl~
rii~
o:
av~
s
~
n~
iWQf.
CaIit0t5
F~
iS~

`
r'~
Ii~~
~
~
Jun.
7
20U2
8:
06AM
Ho­
2239
Ps
3
FROM
Julie
Silas
FRX
NO.
5105947616
Jul.
a9
2~
1113BP~
p3
Wehope
this
t~
lIbe
quickly
remedied
in
future
public
releases
and
in
the
development
ofthe
rtviscd
MOl).

A
commitment
by
both
EPA
and
AJIA
to
develop
a
work
plan
for
implementing
the
goals
of
the
original
MOU,
a
vital
and
influential
agreement
on
health
care
pollution
prevention,
is
impor~
ntto
health
provideis
and
manyinstiwtions
concerned
about
aa
anvimninent
and
the
health
ofour
community.

We
look
forward
to
heaiing
from
you
about
yourcommitment
to
thegoals
agiced
upon
at
theiuag
it
meeting
°
Sincerely,

Robert
M.
Gould,
MD.
PrSdcnt
San
Francisco
Bay
Area
Physicians
for
Social
Responsibility
cc:
AHA:
lvThe
Robinson,
Rick
Pollack,
Neil
Jesuele,
Becky
Maron
EPA:
Christine
ToddWhitman,
WilliamR
Sanden,
TomMunay
Jun
7.
2002
8:
06AM
°
Mo~
2239
P
4
HEALTH
CARE
WITHOUT
HARM
IHE
CAMF~
A~
GNFOR
ENV(
FWNMENTALLY
s~'
oM~
I~
LF~
IFAL1~
CARE~

°
°
June
12,
2001
B.
ebccca
Maron
PMG
Administration
American
Hospital
Association
One
North
Franklin
Chicago,
IL
60606
°

Dear
Ms,,
Maron:

I
am
writing
on
behalfof
Health
Care
Without
I­
1~
rmto
si
±
ongly~
ge
youto
teconsider
your
Associations
action
to
terminate
the
Memorandum
of
U~
tderstanding(
MOU)
between
the
American
HospitalAssociation
(
AHA)
and
the
Ec~
vironmena1Protection
Agency
(
EPA).
While
we
understand
the
American
Hospital
Association
hasexpressed
a
ilhingnes~
to
publicly
state
its
continued
commitment
to
thegoals
enumerated
in­
the
MOU,
we
are.
concerned
that
the
termination
wifi
inevitably
be
perceived
as,
a
retreat
from
astrong
°
commitment
to
environmental
stewardship
by
the
nations
hospitals.

The
MOU
has
launched
and
sewed
as
thc
structure
for
numerous
s~
ite,
rc~
onaland
°
hospital­
based
initiatives
to
reduce
the
environmental
impact
ofthe
health
care
sector.
°
Almost~
J1of
these
effort~
expllcidyrefercnc~
the
MOU.
The
ripple
started
by
the
signiiig.
of
the
agreement
has
becothe
a
cascade
of
activity,
guided
by
the
goals
articulated
in
tl~
original.
agreement.
That
cascade
has
resulted
in
a
significant
increase
in
both
awareness
~
tndactions
that
have
zneas~
ablyitnproved
the
environment.
However,
theMOU's
full
potential
has
not
yet
been
±
~
a1ized.
We
fear
that
the
language
of"
terminating"
the
MOU
scndsthe
wrOng
°
sign~
1about
the
value
~
indimportance
of
this
work,.

The
AHA
has
articulated
several
ieasons
for
the
termination.
Among
them,
the
need
for
the
AFL~
to
focu~
on
core
priorities;
resource
limitations;
and
a
view
that
implementation
activities.
are
outside
of
the
expertise
of
the
Association.
`
While
we
understand
these
&
rnstraints,
they
suggest
the
possibility
to
craft
another
arrangement
more
suitable
to
~
hc.
constraintsof
th~.
AHA,
while
maintaining
a
high­
profile
commitment
to
the
goals
in
the
l'
40U,.

Public
concern
about
environmcntal
issues
shows
no
signs
of
abating,
and
in
fact
that
concern
has
recently
become
a
national
political
issue.
Increasingly,
industry
sectors,
including
Eh~
health
care
sector
as
a
whole,
and
individual
hospitals,
will
be
measuted
not
only
by
their
ddivcry
of
quality
care,
hut
also
by
the
extent
to
which
they
are
responsive
to
the
needs
of
their.
host
communities
and
the
broader
public
In
this
climate,
the
merits
HCWH
Al
ThE
~
J1'~
~
OF~~
AI
1H,
~
NVlRO,~
M~
N1
)
JF.
J~
1icr~

ro
50x
6606
FALLS
CHURCH
VA
22040
T:
7C~
2~
3/
2249­
F~/
0~.
23f~
3°~
LMAIL:
NO~
RM~
JATRORC
~
VWWNORAPM.
ORG
Jun.
7.
20U2
8:
01AM
No.
2239
P.
5
ofa
continued
clear
public
commitment
to
a
common
sense
agreement
with
reasonable
environmental
goals
benefits
the
nation's
hospitals
as
well
as
the
environment
Health
Care
Without
Harm
stands
ready
to
launch
implementation
initiatives
with
the
Al­
IA,
in
keeping
with
the
Association's
strengths,
constraints,
and
mission,
that
could
further
our
shared
goals
We
welcome
the
AHA's
interest
in
collaborating
with
I­
J.
CWH.
Such
initiatives
might
include
using
the
existing
communication
and
education
channels
of
the
Al­
IA
to
spread
the
word
about
available
tools,
co.
bitting
efforts
on
a
mercury­
free
medicine
pledge,
developing
a
joint
list­
serve
or
other
regular
communication
tool,
developing
joint
model
environmentally
preferable
purchasing
initiatives
on
PVC
and
DEHP­
containing
pr6ducts,
supporting
emerging
hospital
green
buildings
initiatives,
and
encoura~
ngactivity
around
all
of
these
goals
at
the
state
and
regional
hospital
association
level,
and
within
hospital
systems
The
actions
of
the
A_
HA
in
the
next
few
weeks
will
he
watched
closely.
AHA
can
signal
support
and
a
continued
commitment
to
the
environment
on
behalf
of
hospitals
across
America,
or
it
can
signal
something
less
than
a
full
commitment.
We
urge
you
to
send
the
strongest
possible
message
that
the
Al­
IA
remains
publicly
committed
in
principle,
in
writing,
and
in
action
to
environmental
stewardship
We
look
forward
to
a
continued
conversation
about
collaboration
in
an
environment
that
is
fully
andclearly
supportive
of
the
articulated
goals
of
the
MOU..

Sincerely,
I
 
'
­­~~)
­

(
7.
­`
I
7j'
~`

I
b~~'
/~./~­..._
Z
`
eharlotte
~
rody,
­

Coordinal/
Dr
Health
Ca~
e'WithoutHarm
cc:
Lindsay
Robinson
Richardj­.
Davidson
Richard3.
Pollack
Neil
J.
Jesuele
USEP.
A
Administrator
Christine
Todd
Whitman
William
FL
Sanders
Thomas
M­­
Murray
Jun.
7.
20U2
8:
UJAM
No.
2239
P.
6
June
7,2001
Richard
J.
Davidson
Chief
Executive
Officer
American
Hospital
Association
One
North
Franklin
Chicago.
IL
60606
Fax~
312
422­
4602
Dear
Mr..
Davidsoir.

I
am
writing
as
President
of
the
NH
Infection
Control
and
epidemiology
Professionals,
Director
of
Infection
Control
at
a
large
hospital
in
Manchester,
NH,
and
a
concerned
citizen..
The
NHTCEP
is
a
group
of
over
100
infection
control
professionals
representing
New
Hampshire
hospitals.
nursing
homes,
physiciaxi
offices
and
public
health..
Our
hospitals
are
active
members
of
the
New
Hampshire
Hospital
Association..

I
am
writing
to
you
to
express
our
concern
and
dismay
that
the
American
Hospital
Association
is
planning
to
withdraw
from
the
Memorandum
ofUnderstanding
(
MOU)
with
U.
S.
EPA
on
healthcare
pollution
prevention.
Since
its
implementation,
the
MOU
has
had
major
impacts
on
local
hospitals
and
their
communities
across
the
country.
Hospitals
for
a
Healthy
Environment
was
created
in
response
to
the
MOO
and
a
significant
numbers
ofhospitals
have
strengthened
or
begun
polLution
prevention
programs.
AHA
has
had
a
si~
ificantinfluence
throughout
the
healthcarc
industry,
especially
with
the
signing
of
the
MOU
that
strongly
influenàed
local
hospitals'
participation
in
pollution
prevention
Because
of
AHAs
leadership
and
involvement
related
to
the
MOU,
goals
like
mercury
elimmation
are
now
perceived
as
worthwhile.
and
achievable
and
manyNew
Hampshire
hospiials
have
pledged
to
eliminate
mercury..

We.
feel
itwouldbe
an
irreparable
mistake
for
AHA
to
withdraw
from
the
MOU.
AHA
will
be
hard
pressed
to
explain
to
hospita's
and
the
American
public
why
they
discontinued
the
opportunity
to
continue
their
leadership
role
on
this
crucial
set
of
issues.
Our
hospitals
are
significant
contributors
to
the
waste
stream,
and
need
AHA
and
the
MOU
as
guiding
forces
to
assist
in
reducing,
recycling
and
reusing
valuable
resources
and
keep
this
within
our
rathr
as
important
initiatives..

We
strongly
urge
you
to
continue
AHA's
commitment
to
the
Hospitals
for
a
Healthy
Environment
initiative
and
the
important
Memorandum
of
Understanding
thatbegan
it.
Thank
you
for
your
consideration,

Sincerely,
 
Lynda
Z.
Caine,
RN,
BSN,
CIC
President,
NH
Infection
Control
and
Epidemiology
Professionals
Director,
infection
Control
Elliot
Hospital
1
Elliot
Way
Manchester,
NH
03106
cc:
AHA;
Mac
Robinson,
Rick
Pollack,
Neil
Jesüele,
Becky
Maron
EPA~
Christine
Todd
Whitman,
William
H..
Sanders,
Tom
Murray
Jun.
1.
2002
8:
08AM
~
Jo.
2239p.
7
..
juii
f~
tjI
`
Fq3rM
SAFETY
ENV
PROGRAMS.
NO.
035
P
2
.
ds.°.
DARTMOUTH­
HITCHCOCKMEDICAL
CENTER
MARY
HITCHCOCK
MEMORIAL
HOSPITAL
OneMedical
Center
Drive
Safety
andEnvIronmental
Programs
Lebanon,
New
Han2pshire
05756­
0001
605­
650­
1535
6O~.
65O­
6616(
Fax)

June
7,2001
Richard
J.
Davidson
CitI
Executive
Offlcer
American
Hospital
Ass
ociaffon
Via
Fax;
312
422­
4602
Dear
Mr..
Davidson:

I
amwriting
to
express
my
disappointment
that
the
American
Hospital
Association
is
considering
a
withdrawal
from
theMemorandum
of
Understanding
(
MQtJ).
with
U.
S.
EPA
onhealthcare
pollution
prevention.
I
sfrongly
encourage
you
to
reconsider
this
and
to
reflect
onits
benefits
to
date.

The
Dar~
outhHitchcock
Medical
Center
was
one
ofthe
earlypioneers
of
polluban
prevention.
Inourfacility,
we
have
already
phased
out
the
use
of
the
sterilant
ethylene
oxide,
and
we
are
almost
completely
eliminated
the
use
of
mercuty.
We
spend
a
tremendous
amount
of
time
counseling
and
teachingother
hospitals
that
this
is
a
good
idea
forour
patients,
our
community,
theenvironment&~
4it
saves
money.
We
teach
all
of
ournew
~
tployees
our
mission
to
provide
excellent
care
for
ourpatients,
while
preventing
bairn
to
the
environment
We
l~
owfrom
our
ten
years
inpollution
prevention
that
protecting
public
healthand
promoting
pollithon
prevention
are
the
same,
and
we
are
couinuitted
to
this
concept
Unfortunately,
not
all
hospitals
have
the
adminisfrthve
support,
enthusiasticemployees
or
technical
skills
as
we,
and
theMOU
had
a
sisnilicant
impacton
getting
the
information
to
those
facilities
that
wanted
to
make
a
change
and
needed
art
additional
boost.
Acollaborative
approachto
solving
this
problem
was
a
perfect
solution,
and
many
hospitals
have
deepcith
or
begun
pollution
prevention
programs
purely
because
the
MOLTwas
aeated,

AHA's
hospital
members
have
the
responsibility
to
pati~
and
the
environment
that
we
all
sbare
to
continue
with
the
MOLT
and
to
get
the
word
out
to
hospithis
to
begin
or
maintain
theirpollution
prevention
efforts.
Given
the
EPA's
recent
regulatory
actions
against
some
~
th]
itiesfor
their
envfronxnentalpractices,
it
is
clear
to
me
that
many,
niaxty
facilities
still
have
a
long
wayto
go.

Thank
you
far
your
consideradon.

I'~
4ãn.
vjctgxja
Jas,
MS.
Manager
of
Biosafety
and
Environmental
Programs
Dartmouth
Hitchcock
Medical
Center
Lebanon,
New
Hampshire
Dannouth
Medical
School
°
Darzmtuth.
Ritchccck
Clinic
.
Mary
Ritcheoak
Memorial
Ho6pital
­
V.
A.
Medical­
Cenff~
V~
1,
iuttvarJwmthn,
yr
No.
2239
P.
8
Jun.
7.
2U02
8:
U8AM
/
S
MENUL
sw
M~
vE.
Fot.
i~
Y,,
MS..
~

AMERICAN
NURSES
/
SUiti~
100
WEST
PRESIDENT
ASSOCIATION
/
WASIIINOT0N.,
DC
20024­
2571
/
202
651­
7000
FAx
202
651­
7001
Lm~
mAJ.
STIERLE.
MSN.
RN,
CNAA
/
http;//
www.
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CHIEF
L'icLrrIvE
OFFICER
June
15,2001
Richard
J.
Davidson
ChiefExecutive
Officer
American
Hospitals
Association
One
North
Franklin
Chicago,
IL
60606
By
Facsimile:
312
422­
4602
Dear
Mr..
Davidson
The
American
Nurses
Association
has
just
recently
learned
about
the
decision
ofthe
AH_
A
not
to
renew
the
Memorandum
of
Understanding
with
the
Environmental
Protection
Agency.
This
cause&'
ANA
geat'concem.
because
calls
into
question
AHA's
commitment
to
prevent
the
production
ofpollution
by
the
health
care
mdustrv
I
am
~
v5itingon
behalf
ofthe
ANAto
express
our
deep
disappointment
that
AEA
woald
consider
this
directidrz
and
to
urge
that
you
reconsider
this
decision.
ABA
leadership
is
essential
to
set
and
achieve
goals
that
will
protect
not
only
the
American
people
but
the
population
of
the
earth
from
toxic
pollution.
AIM's
work
to
assist
it's
member
hospitals
with
product
selection
through
environmentally
responsible
purchasing
and
the
implementation
of
comprehensive
waste
management
sirategies
has
been
not
only
good
forthe
environment
but
good
for
the
relationship
ofit's
member
hospitals
with
their
communities..

Hospitals
are
in
the
business
to
care
for
patients
and
cure
disease;
not
to
contribute
to
illness
as
a
result
ofpoorstewardship
of
the
products
usedto
treat
patients..

The
American
Nurses
Association
strongly
urges
you
to
continue
AHA's
commitment
to
the
Hospitals
for
a
Healthy
Environment
initiative
and
the
MOLT
defining
that
commitment.
LANA
pledges
our
support
to
assist
AMA
and
it's
member
hospitals
in
achieving
these
goals.,
Thank
you
very
much
foryour
reconsideration
ofthis
very
important
issue...

Sincerely,
`
.
,
.
.
.
.
.`

Linda
J.
StieUé,
MS1'~
EN.
CNAA
ChiefExe~
utiw.
effi&
r:
,
,

American
Nurses
Assocjatidn
,
.
.
.
,

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