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A Plant That Sterilizes Medical Equipment Spews Cancer-Causing Pollution on Tens of Thousands of Schoolchildren

27 Dec 2021

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Jennifer Jinot didn’t expect to retire early from her role as an environmental health scientist for the federal government. She’d spent 26 years assessing the dangers of toxic chemicals for the U.S. Environmental Protection Agency. The job could be frustrating but, more than that, rewarding.

Early in her career, Jinot evaluated the health impacts of secondhand smoke exposure. It took four years — a pace she remembers thinking was “crazy slow” — to develop a final risk assessment, published in 1993, that determined secondhand smoke causes lung cancer in adults and impairs the respiratory systems of children. The tobacco industry sued the agency. But, in the end, her work spurred changes to the law. The victory was invigorating for Jinot, who had long dreamed of doing what she calls “socially useful” science.

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In 2002, Jinot joined an EPA team that was evaluating new research to determine whether ethylene oxide, one of the world’s most widely used chemicals, caused cancer. A key building block for an endless array of consumer goods and a common product used for sterilizing medical equipment, the colorless, low-odor gas wafts out of at least 160 facilities across America. Jinot’s colleagues had already spent four years reading studies, scrutinizing data and consulting with experts. She was hopeful it wouldn’t take much longer. The team published a draft assessment in 2006 that found the chemical was significantly more carcinogenic than the agency had previously concluded and especially damaging to children.

Jinot believed the science begged for urgent action to strengthen existing environmental regulations. But industry lobbyists and company executives attacked the draft. Audry E. Eldridge, then-president of the Missouri-based Midwest Sterilization Corporation, argued in a 2006 letter that an “extensive database of toxicological and epidemiological studies” showed the EPA’s findings were flawed. Eldridge, who helped found the Ethylene Oxide Sterilization Association, a trade group that lobbies on behalf of sterilizer companies, didn’t name any specific studies, but said in the letter that the cancer risk posed by the chemical was “thousands of times less than portrayed in EPA’s risk estimates.”

Amid pressure from industry groups, the agency agreed to another round of scrutiny from independent scientists and the public before finalizing its findings. “They don’t want to put out anything that gets attacked,” Jinot said of the EPA in a recent interview. The EPA defended its process for evaluating harmful environmental chemicals as “strong” in a statement to ProPublica and The Texas Tribune.

A process that, according to a director for the U.S. Government Accountability Office, should last no more than four years ended up taking another decade. In 2016, the EPA published the final version of its assessment. It concluded that ethylene oxide was 30 times more carcinogenic to people who continuously inhale it as adults and 50 times more carcinogenic to those who are exposed since birth than the agency previously thought. The chemical, which alters DNA in the human body and increases the risk of certain types of cancer such as leukemia, is particularly harmful to children because their developing bodies can’t mend the genetic damage as effectively as adult bodies.

In the decade it took for the federal agency to finalize what its frustrated scientists already knew, Eldridge’s sterilization company dramatically expanded its new facility in the border city of Laredo, Texas. The facility, a ProPublica analysis determined, emitted far more ethylene oxide than any other sterilizer plant in the country that reports emissions to the EPA.

Simultaneously, families along its fence line were raising a generation of children who would grow up in the plant’s shadow.

JJ Nevares wrote down his birthday wish, attaching it to a balloon and releasing it outside his aunt’s home in San Antonio, where he was staying while undergoing treatment for cancer. His wish was that all people without housing would find a home.

Karla and Cesar Ortiz had a baby girl they named Yaneli, after a Spanish-language television character who embodied kindness and humility, traits they hoped their daughter would share. Through the years, their smiley, curly-haired little girl grew to love arts and crafts, became a fan of ’80s music and K-pop and watched over her two little brothers in their home, located less than 5 miles from Midwest.

Around the same time, Nidia and Rafael Nevares were raising their two boys, Rafael Jr. and Juan Jose, or JJ, about 2 miles from the plant. The younger of the two, JJ was more outgoing and quick to make friends. Among his favorite things to do was pulling his older brother away from the computer to play hide-and-seek in the front yard.

The EPA’s 2016 ethylene oxide report would not be legally enforceable until the agency incorporated it into new regulations. Even so, it inspired many states to crack down on industrial facilities that emitted the chemical — through lawsuits, stricter state regulations, air monitoring and cancer cluster studies. But Texas went in the other direction, becoming the only state to officially reject the agency’s conclusions. In August 2017, the Texas Commission on Environmental Quality, the state’s environmental regulatory agency, announced it would launch a review of EPA’s science; it eventually ruled that the chemical was significantly less toxic than the federal agency had found. That resulted in Texas enacting a new standard that could allow plants to emit more of the chemical.

In 2018, two years after the EPA published its final report, JJ was diagnosed with acute lymphocytic leukemia, a cancer that has been linked to ethylene oxide exposure. He turned 6 years old a month later.

“Have you seen a novela mexicana?” his mother, Nidia Nevares, said. “That’s what it was like, like a soap opera. Crying and crying, shock, shock, totally.”

Yaneli’s diagnosis came soon after. Doctors found that she had the same type of cancer as JJ in June 2019, three months before her 13th birthday.

Left: JJ Nevares sits in his father Rafael’s lap during JJ’s ninth birthday party at a family friend’s home in San Antonio in September. Right: A photo collage of Yaneli Ortiz hangs on the wall of the apartment where she lives with her family in Laredo, Texas. Yaneli Ortiz pauses and takes a breath as she prepares to sit down to get her makeup done in Laredo before her quinceañera.

By then, Jinot was no longer at the EPA. She had grown frustrated with industry’s increased influence over the agency and with a bureaucracy that stalled critical scientific research. So when the Trump administration sought to shrink the agency’s staffing in 2017 by offering employees buyouts, Jinot accepted.

“I couldn’t stand the process anymore,” she said. “There’s no reason it should take so long.”

In the Dark

Communities such as Laredo, where the vast majority of the residents are Latino and more than a quarter live in poverty, have been left in the dark for years by regulators who had evidence of the dangers posed by ethylene oxide but never told the public about them.

Out of all the pollutants that the EPA regulates, ethylene oxide is the most toxic, contributing to the majority of the excess cancer risk created by industrial air pollutants in the United States, according to an unprecedented analysis of the agency’s most recent modeling data by ProPublica, in collaboration with The Texas Tribune. That risk is in addition to those Americans already face from other factors like genetics or lifestyle.

The EPA says it strives to minimize the number of people exposed to emissions that create excess cancer risk worse than 1 in 1 million — meaning that if a million people were exposed to the toxic air pollutants over a lifetime of 70 years, there would likely be at least one additional case of cancer. But the agency is far more permissive about the cancer risk it considers unacceptable: greater than one additional cancer death per 10,000 people.

ProPublica’s analysis of ethylene oxide assessed the impact of the chemical for an intermediate risk level, 1 in 100,000, which experts say is not sufficiently protective of public health. Using that threshold, the analysis, which examined data from 2014 to 2018, shows that more than 60% of the 6.9 million Americans who face heightened excess cancer risk from industrial air pollution are imperiled solely based on their exposure to ethylene oxide. (Though the analysis identifies elevated risk for geographical areas, it can’t be used to determine the specific causes of individual cancer cases.)

The risk is particularly acute in Texas, the nation’s top ethylene oxide polluter and home to 26 facilities that emit the chemical. The state stands out not just for the outsize risk its residents face but because it has emerged as a key ally for companies that emit or use ethylene oxide. Texas has fought stricter federal emissions regulations, even as many other states, including several led by Republicans, have enacted tighter controls on the chemical.

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The Texas Gulf Coast is home to some of the biggest and most toxic hot spots in ProPublica’s analysis, with most of the cities of Houston, Port Arthur and Beaumont exposed at a risk of often well above 1 in 100,000.

But if you look at the risk from all chemicals except ethylene oxide, these hot spots shrink dramatically, showing the outsize impact of the chemical.

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