The new administration has announced that EPA is freezing the last-minute regulations of its Bush predecessors, but the below-the-radar stuff apparently hasn’t caught their attention yet. It will.
The “Memorandum of Understanding” with the American Dental Association is a good example of the dark side of sub-regulatory decisions. The MOU is, in effect, a by-product of EPA’s consideration of health care facilities as potential sources of toxic pollutants which might require categorical effluent guidelines under the Clean Water Act. EPA’s consideration of potential new industries is a required process under sec. 304(m) of the Clean Water Act. The Bush adminstration went through the motions of the 304(m) process, but managed to conclude that no new effluent guidelines at all are called for.
On the surface, the dental MOU appears to be OK — a way of getting a lot of mercury-reducing technology in place with little or no expenditure of government resources. EPA is doing at the federal level what lot of states have already done — “working with” an industry to promote voluntary good practices without regulatory enforcement. “Good practices” includes buying technology to separate mercury-containing amalgam particles from wastewater destined for discharge. These “separators” have supposedly been verified as effective products by means of a test method established by the International Standards Organization — the “ISO” test.
This concept has obvious advantages and disadvantages, and then some not-so-obvious disadvantages, and then some down-sides that are truly outrageous. Obviously, it saves a lot of government resources. Obviously, it invites free-riders: if 80% of dentists spend the money to do the right thing, 20% save their money, while they get to go along without any risk of oversight or enforcement. Why is this a good deal for the 80%? Or is the number of those who will choose to save their money — the obvious beneficiaries of a choice for a voluntary program — a much larger number?
The free riders are by no means necessarily harmless, even to themselves. In Massachusetts, during the time of its voluntary program, one dentist decided he had better ideas than the government and the dental association, and began discharging from his chairs to an underground tank. This was, for one thing, illegal, but more importantly, it was really unwise: the wastewater leaked into the surrounding groundwater, leading ultimately to a massive cleanup bill, which the dentist had to a pay under an enforcement order from the state.
Less obviously, the whole scheme is vulnerable to another problem: the weaknesses of the testing scheme. The ISO test is limited in ways that don’t result from anyone being a bad guy: the test only tells us the effectiveness of the technology when it is brand new and operated under ideal conditions, at a specified volume of flow. The test doesn’t tell us how long a unit will operate effectively — it is up to the manufacturer to figure out when components should be replaced, and up to the operator to follow the vendor’s instruction, and pay attention to any apparent deterioration. Generic testing won’t assure that these things get done, although inspections by a regulatory authority would. Similarly, dental facilities come in different sizes and configurations – the ISO test does not establish that a device is a one-size-fits-all device. A device that is too small for a large flow of wastewater is may not deliver the desired results — but who knows how often this happens? It may that at some size, facilities are too big for any of the technology tested with the ISO test, and should be using something completely different. We don’t know — and we aren’t likely to find out with the approach being taken under the new EPA-ADA MOU.
The ISO test also does not address the soluble portion of the mercury in dental wastewater. Research has shown that the use of acidic solutions to clean vacuum lines can disolve mercury out of accumulated amalgam particles. The use of such cleaners in combination with a separator that collects amalgam particles could result in a larger portion of dissolved mercury being disharged — a result that can be prevented by avoiding such cleaners. A program that simply encourages, or even requires that dentists purchase ISO certified separators is not sufficient to control dissolved mercury releases caused by line cleaners.
As a further dilemma, we have no oversight over the testing laboratories themselves. The United States, unlike the member states of the European Union, has done nothing — strictly speaking, that should be ABSOLUTELY NOTHING — to assure that the tests are being performed by credible, independent laboratories. You, me and my baby sister could do an ISO test under the current regime. This means that legitimate vendors have no protection against scam artists competing for market share with phony test results.
Many of the state and local efforts to promote amalgam separators rely on a list of tested units published by the ADA in their journal “JADA” in 2002. But those test results specifically disclaimed applicability to individual facilities, because they were not published with flow data. As a result, individual dentists cannot be sure from that list whether a product is right for their facilities or not.
Finally, the dentists will have to find ways to dispose of the solids from their units, and here again, neither the dentists nor the regulators will escape the burden of dealing with the bad actors. In Massachusetts, in 2007, after only a couple of years of the program (it switched from voluntary to mandatory in 2006), the state discovered an individual marketing a “disposal” service to dentists which involved picking up filter cartridges full of amalgam solids and washing the solids down a drain into the sewer system. The state has now indicted this character and is struggling to get the landlord to get the mercury out of the drains in the building where he operate
In short, the”voluntary” approach espoused by EPA in the closing weeks of the Bush administration simply cannot protect the public and the environment. Experience with this approach in the states has shown that things will go wrong — people will make them go wrong — in every way you can think of. A large core of decent practitioners trying to do the right thing can’t possibly substitute for a government agency charged with detering the misconduct that will otherwise gather around the margins, ready to undo the work of the core whenever there is a buck to made. What do we gain from letting these elements flourish, at the expense of both the public and the profession?
Ostensibly, EPA’s MOU is intended to give the feds time to develop a better understanding of dental wastewater and the technology of controlling it, in the anticipation of re-visiting the question of federal regulation two or three years from now. One might wonder why EPA chose to give itself this time, instead of availing itself of the fruits of 15 years of effort by the states and POTWs. But it is probably a better idea to take EPA at its word, and begin pressing the agency to make a serious effort to address the problems posed by the current system. EPA should use the time to develop a truly robust national testing system — that is, a process for credibly certifying laboratories to carry out the ISO test, to certify their results, and to address issues that the ISO test does not address.
EPA should also address the national problem of dental mercury solids disposal — the last, most truly outrageous piece of this picture. In the past, state and local programs could not direct the generators of such wastes to retire them and get them out of the environment — recycling facilities were a legal solution. This has never been an environmentally acceptable solution; it is no longer economically feasible. Nor is it possible any longer to argue that amalgam particles are non-soluble and should not be hazardous waste. There has always been some data to show that amalgam solids sometimes fail the TCLP test — showing that there is potential solubility and release of bioavailable mercury. But the TCLP test, like the ISO test, is fairly easy to game: if you choose the right samples, you can assure that most of them won’t be soluble.
EPA should establish that at least after-placement amalgam solids — that is particles from the dental chair — are a listed hazardous waste, to be handled under RCRA without further recourse to TCLP testing. In reality, based on the mercury and toxic metals content, all amalgam waste should listed, and appropriate disposal requirements identified for these specific wastes — i.e., no incineration, and no recycling.
If EPA takes these issues seriously, dental wastewater should be back on the 304(m) calendar. These wastewaters and the technology for treating them are a national problem, and can be addressed with uniform national minimum standards. The standards do not have to be concentration-based effluent limits, as other standards have been. They could rely on the ISO test, or something like it, and on certification by the user, as Massachusetts and many other states are doing. But the Agency has to take this program seriously. There should be no place in national environmental policy for shams — which is the legacy of the Bush administration.