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By Nancy B. Solomon, AIA

This article is also available for Continuing Education credit here.

First, do no harm.” This has been the motto of the medical profession since Hippocrates. Yet, over the past few decades, it began to appear as if the purchasing habits, facility operations, and, ultimately, building design standards of this sector might not always be consistent with its own professed values. While practitioners may be providing state-of-the-art medical treatment to the sick, some of their products, systems, and structures may be compromising the overall health of their patients, staff, and outlying community.

The warning signs came as early as the 1980s, when used syringes washed up on Long Island and New Jersey beaches. Because of fears of infectious-disease transmission, medical waste soon began to be segregated and burned. But in 1996, the U.S. Environmental Protection Agency (EPA) deemed incineration of medical waste to be the largest contributor of dioxin, a potent carcinogen, into the environment. The incinerators also released mercury, another serious threat to public health. In response to the incineration problem, Health Care Without Harm (www.noharm.org), a coalition of health-care, environmental, and community groups, was formed at this time to work toward reducing the industry’s environmental impact. Due to stronger EPA pollution controls, most medical-waste incinerators have since ceased operation. Hospitals also began to look at other ways to minimize toxins and waste. In 1998, for example, EPA, in conjunction with the American Hospital Association (www.aha.org), began a program called “Hospitals for a Healthy Environment” to encourage the phasing out of mercury—from thermometers to fluorescent lamps—in health-care facilities by 2005 and the cutting of health-care waste by 50 percent by 2010.

 

Children’s Hospital of Pittsburgh, designed locally by the architecture firm Astorino, includes a vast garden. It is one of a few health-care facilities in the U.S. seeking a high LEED rating. Image: Courtesy Astorino

Despite—or perhaps because of—these serious operational and purchasing concerns and subsequent large-scale initiatives, “health care is way behind the curve” when it comes to sustainable building design, reports Carol Antle, director of capital planning for Northern California for Kaiser Permanente in Oakland, California. With its own department of environmental stewardship, Kaiser has been trying to push the industry’s sustainable-design envelope.

The reasons for this are many. Health-care architect Robin Guenther, AIA, of Guenther5 Architects in New York, cites, among other causes, the size of the “environmental footprint” facing medical facilities. “Health care was not ready to go after the building until it got those other aspects, such as medical waste and mercury, in order,” she says.