How Hospitals Systematically Harm People

The minute you're admitted into the hospital, you confront a disturbing paradox: Most hospitals aren't particularly healthy places. As a patient, you're likely to encounter toxic chemicals, eat lousy food, breathe unhealthy air and suffer stress triggered by an often-dismal and alienating environment. Even worse, you may find yourself at the mercy of drug-resistant "super bugs" or overworked staff members who make mistakes -- all in a place that's supposed to help you heal. It's enough to make you sick. And sometimes it does.

In the U.S. alone, an estimated 2 million people a year contract infections in hospitals, and nearly 100,000 are expected to die from them this year, according to the U.S. Centers for Disease Control and Prevention. Although such statistics are deeply troubling, hospitals around the world also contribute to a subtler but equally insidious threat: They expose patients and staff to a host of substances and practises that can harm their health.

For example, hospitals use cleaners and disinfectants containing chemicals that can trigger asthma and other problems. A major study by Spanish researchers published in The Lancet last July hints at the extent of the problem. The study found nurses twice as likely as workers in other fields to develop asthma on the job, due to chemical exposure.

Needless to say, patients breathe the same air as the nurses. Fumes from disinfectants and other cleaners as well as pesticides contribute to indoor air pollution, a particular threat to patients with weakened immune and respiratory systems. These chemicals can also irritate the eyes, nose and throat, and trigger symptoms ranging from headaches to nausea to loss of coordination.

Another problem, perhaps the most obvious, is hospital food. Not only unappetizing, it was probably produced with pesticides, artificial preservatives, hormones and unnecessary antibiotics. To make matters worse, the usual alternative to a bland hospital meal comes from the fast-food joints encouraged to operate in many hospital lobbies. These sorts of things send people like Gary Cohen through the roof.

"About 30 hospitals have McDonald's restaurants in their lobbies," says Cohen, co-founder of Health Care Without Harm, an international organization that pushes hospitals to make changes that support the health of their patients, workers and communities. "Here we are with 60 million Americans who are obese and 120 million who are overweight and we're feeding people in hospitals food that contributes to obesity. Stuff like that just amazes me."

Many hospitals fail to recognize how their everyday choices, involving everything from food to chemicals to their physical and emotional environments, affect the health of their patients. Until recently, that is. Change is afoot in some of the most unlikely places.

Little more than a decade ago, most hospital administrators thought burning medical waste was the safest way to protect patients and communities from infectious disease. In 1995, the U.S. Environmental Protection Agency (EPA) issued a wake-up call: Medical waste incineration had been found to be a leading source of dioxins, arguably the deadliest carcinogen.

"It was incredible that the very institutions devoted to healing people were actually poisoning them," says Gary Cohen. In the years since the report was published, more than 5,000 medical-waste incinerators have been closed in the U.S., as have scores more in Europe and elsewhere. Although the problem hasn't gone away (dioxins are found in everyone, including newborns), closing medical-waste incinerators was the first step for many hospitals toward beginning to examine healthier ways of caring for their patients and communities.

When Kathy Gerwig, vice-president for workplace safety at the Kaiser Permanente health-care network in the U.S., learned that burning the vast amounts of polyvinyl chloride (PVC) used in hospitals produces dioxins, she and her colleagues promptly started looking for alternatives. They first reduced hospital waste and switched from vinyl to nitrile exam gloves. "That was a success because we learned something very important," Gerwig says. "Changes we initiated for environmental reasons often had other advantages."

It turns out that PVC intravenous bags and tubing also contain the phthalate DEHP, which can leach out of the devices and directly into the bodies of patients receiving medications and blood transfusions. Animal studies have linked this industrial chemical to birth defects, cancer and reproductive disorders, and the European Union has banned it from children's toys, cosmetics and personal-care products.

"We've known for more than 30 years that DEHP leaks out of the PVC devices in hospitals," says Gavin ten Tusscher, consulting pediatrician at the Westfriesgasthuis in the Netherlands and a researcher who has done groundbreaking work on dioxins in children. "We know that DEHP goes directly into newborn babies who have IV lines and receive blood transfusions -- and we can also measure exposure."

Until a few years ago, no alternatives existed, but that's no longer the case. Several manufacturers including Baxter and Hospira make PVC-free intravenous supplies, which are becoming more available.

The Westfriesgasthuis and Kaiser Permanente -- the largest non-profit health-maintenance organization (HMO) in the U.S. -- are among scores of hospitals that are replacing supplies made with PVC with safer alternatives.

"There is a steady stream of safer products becoming available for almost everything in the hospital setting," says Ten Tusscher. "Now, it's a matter of mindset. It's up to hospitals to make the choices."

So why don't they? Besides the oft-cited element of cost, hospitals frequently lack current information or the facts may simply not be available.

"One of the most difficult tasks is to identify toxic components of products and materials," says Kathy Gerwig of Kaiser Permanente. "Without labelling or complete disclosure about product content, it's hard to determine the potential for exposure."

In April 2007, the European Parliament approved new regulations that require manufacturers to label medical devices containing phthalates and other materials suspected of being carcinogenic, mutagenic or harmful to reproduction. No restrictions like this exist in the U.S.

The lack of effective laws, education and awareness may help explain why many hospitals still use a troubling number of toxic chemicals even though alternatives are widely available. In a national survey of 22 U.S. hospitals published in 2003, Health Care Without Harm found that every hospital used chemical pesticides and 36 percent used products no longer registered for use by the EPA. Pesticides can worsen allergies, chemical sensitivities and asthma, affect the nervous, reproductive and immune systems and cause cancer. In hospitals, a majority of the patient population is at particular risk from the possible health effects of pesticides: the elderly, chronically ill and chemically sensitive, along with children and pregnant women.

Perhaps the most outrageous missed opportunity for healing in the typical hospital turns up on patients' food trays. It has long been known that good nutrition speeds healing, yet many hospitals serve industrially grown processed foods -- typically lower in nutrients and higher in chemicals than sustainably produced meats, fruits and vegetables.

Numerous studies suggest industrial agriculture's reliance on artificial fertilizer is dramatically depleting soil minerals, and the results are showing up in our produce. Researchers have found, for example, that since 1985, mineral and vitamin levels in potatoes have plummeted 70 percent, beans 60 percent and apples 80 percent, according to studies cited in the UK newsletter What Doctors Don't Tell You.

How hospital food is handled can further reduce its nutritional value. According to a study published in the Journal of Food Service in October 2006, the common practise of overheating hospital food served to patients can reduce levels of Vitamin C, an important marker of nutritional content, by up to 86 percent.

So what does a healing hospital look and feel like? Hospitals in the U.S., Europe and elsewhere are pursuing answers, sometimes from the ground up. Among them is Clinique Champeau, a 116-bed private hospital in Béziers, France. One of the first things Director Olivier Toma noticed when he joined the hospital after a career as an hotelier was the condition of his employees' hands. "I was scandalized to see the hands of some of the nurses and people who clean in such a pitiful state," Toma says.

Toma replaced toxic cleaners with safer alternatives, a move that also reduced patients' exposure to chemicals. That was an easy step: Options are plentiful, such as the less-toxic cleaning products listed in the EU eco-label catalog or certified by the non-profit Green Seal program in the U.S.

But he didn't stop there. Toma has gone on to create an internationally recognized hospital that uses natural non-toxic materials. The paint on the walls is free of harmful volatile organic compounds. Thanks to a pioneering purchasing policy, everything the staff buys is screened for toxins.

Besides that, the hospital serves patients meals mostly prepared from scratch, while generous windows let in abundant daylight, which has been shown to help reduce patients' use of painkillers and shorten the time some people spend in the hospital.

On a larger scale, Kaiser Permanente is wielding its $6 billion annual purchasing budget to push for safer products and materials for patients at its 32 medical centres in the U.S. -- and to make these products more affordable and available for smaller health-care facilities. The HMO has also developed a new policy that calls for avoiding carcinogens, mutagens and reproductive toxins as well as persistent chemicals that accumulate in our bodies in everything it purchases, from cleaning supplies to medical devices.

"We're targeting riskier products and doing everything we can to encourage suppliers to switch to environmentally preferable products," says Dean Edwards, vice-president and chief procurement officer.

The inroads being made at Clinique Champeau, Kaiser Permanente and other hospitals suggest administrators can no longer avoid making changes to clean up environmental problems. Signs indicating how this can be done are everywhere.

Looking back on the last decade, Gary Cohen of Health Care Without Harm says elimination of mercury is a prime example. Thousands of hospitals around the world have replaced mercury thermometers with safer alternatives and are working to eradicate mercury from health-care settings.

"We've shown that you can phase out toxic materials on a global scale," Cohen says. "If we can do that with mercury, we can do it with a whole set of chemicals and technologies that are destroying our planet and weakening our health."

Scores of hospital managers around the world have recently signed resolutions committing to implementing healthy changes on many fronts, from serving safe and sustainably raised food to reducing waste and ditching PVC. Still, signing a resolution or passing a law is one thing, and implementing it consistently is another.

And that, says Dutch pediatrician Gavin ten Tusscher, is where everyone comes in. "Consumers need to know that they're the ones who have the power," he says. "They're the ones who can influence change in their choices in health care. They can say, 'I don't want my child to receive an intravenous line with PVC,' and demand other healthy changes. The more people who do, the more governments and hospitals will listen."