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<div class=Section1>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>I’ll take a stab at quantification:<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>1: we have ER visit data on child hood
poisoning form national poison control center.<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>2 anecdotal but tabulated data from a
county sheriff’s department on breaking into houses for drugs, need
better data<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>3.<st1:place w:st="on"><st1:PlaceType
w:st="on">Institute</st1:PlaceType> of <st1:PlaceName w:st="on">Medicine</st1:PlaceName></st1:place>
data on adverse events cost and not quite the same as costing out the cost of
confusion in over-accumulation.<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>4 This is your world<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>5 1.3 million Euros… the cost of a
new incinerator the World Bank is being asked to finance.<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>Not great but an attempt to start the
quantification ball rolling.<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>Stevan Gressitt, M.D.<o:p></o:p></span></font></p>
<div>
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face="Times New Roman"><span style='font-size:12.0pt'>
<hr size=2 width="100%" align=center tabindex=-1>
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<p class=MsoNormal><b><font size=2 face=Tahoma><span style='font-size:10.0pt;
font-family:Tahoma;font-weight:bold'>From:</span></font></b><font size=2
face=Tahoma><span style='font-size:10.0pt;font-family:Tahoma'> Gilliam, Allen
[mailto:GILLIAM@adeq.state.ar.us] <br>
<b><span style='font-weight:bold'>Sent:</span></b> Tuesday, January 24, 2006
8:37 AM<br>
<b><span style='font-weight:bold'>To:</span></b> H2E - Hospitals for a Healthy
Environment - Info Exchange Listserv<br>
<b><span style='font-weight:bold'>Cc:</span></b>
pharmwaste@lists.dep.state.fl.us<br>
<b><span style='font-weight:bold'>Subject:</span></b> [h2e] RE: any
legislation/ordinances banning disposal of pharmaceuticals to sanitary sewer?</span></font><o:p></o:p></p>
</div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>H2E -- Hospitals for A Healthy Environment Info Exchange Listserve<br>
(h2e@email.sparklist.com)<o:p></o:p></span></font></p>
<div>
<p><font size=3 color=blue face="Times New Roman"><span style='font-size:12.0pt;
color:blue'>Ms. Otteni?</span></font><o:p></o:p></p>
<p><font size=3 color=blue face="Times New Roman"><span style='font-size:12.0pt;
color:blue'>was the brief (below) on the CWA's national pretreatment program's
objectives what you were looking for back in December?</span></font><o:p></o:p></p>
<p><font size=3 color=blue face="Times New Roman"><span style='font-size:12.0pt;
color:blue'>thanx again to Dr. Gressitt for pointing out other costs that are
real but, hard (impossible at this time?) to tabulate.</span></font><o:p></o:p></p>
<p><font size=3 color=blue face="Times New Roman"><span style='font-size:12.0pt;
color:blue'>this has probably already been posted but, see interesting
article: </span></font><b><font color=blue face=AGaramond-Bold><span
style='font-family:AGaramond-Bold;color:blue;font-weight:bold'>Emerging
Liabilities from Pharmaceuticals and Personal Care Products @</span></font></b><b><font
size=5 color=blue face=AGaramond-Bold><span style='font-size:18.0pt;font-family:
AGaramond-Bold;color:blue;font-weight:bold'><o:p></o:p></span></font></b></p>
<p><font size=3 color=blue face="Times New Roman"><span style='font-size:12.0pt;
color:blue'><a
href="http://www.howrey.com/docs/liabilitiespharmaceuticals20020401.pdf">http://www.howrey.com/docs/liabilitiespharmaceuticals20020401.pdf</a></span></font><font
size=2 color=blue face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:blue'> </span></font><o:p></o:p></p>
<p><font size=3 color=blue face="Times New Roman"><span style='font-size:12.0pt;
color:blue'>allen g</span></font><o:p></o:p></p>
</div>
<blockquote style='margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt'>
<p class=MsoNormal style='margin-bottom:12.0pt'><font size=2 face=Tahoma><span
style='font-size:10.0pt;font-family:Tahoma'>-----Original Message-----<br>
<b><span style='font-weight:bold'>From:</span></b> Stevan Gressitt
[mailto:gressitt@uninets.net] <br>
<b><span style='font-weight:bold'>Sent:</span></b> Monday, January 23, 2006
9:39 PM<br>
<b><span style='font-weight:bold'>To:</span></b> Gilliam, Allen; 'H2E -
Hospitals for a Healthy Environment - Info Exchange Listserv'<br>
<b><span style='font-weight:bold'>Cc:</span></b>
pharmwaste@lists.dep.state.fl.us<br>
<b><span style='font-weight:bold'>Subject:</span></b> RE: [h2e] RE: any
legislation/ordinances banning disposal of pharmaceuticals to sanitary sewer?</span></font><o:p></o:p></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>Apologies for being late in replying but I
had been saving this for when I had a few minutes to go over the regs.
I’ll defer on those for now. <o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>At the bottom where you comment on the
economics. Could I suggest that the paradigm for costing out the value is
missing variables that actually make this a very simple sell.<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<ol style='margin-top:0in' start=1 type=1>
<li class=MsoNormal style='color:navy;mso-list:l0 level1 lfo1'><font size=2
color=navy face=Arial><span style='font-size:10.0pt;font-family:Arial'>Cost
of childhood accidental poisonings.</span></font> <font size=2 face=Arial><span
style='font-size:10.0pt;font-family:Arial'><o:p></o:p></span></font></li>
<li class=MsoNormal style='color:navy;mso-list:l0 level1 lfo1'><font size=2
color=navy face=Arial><span style='font-size:10.0pt;font-family:Arial'>Cost
of burglary for drugs, and teenage pharming</span></font> <font size=2
face=Arial><span style='font-size:10.0pt;font-family:Arial'><o:p></o:p></span></font></li>
<li class=MsoNormal style='color:navy;mso-list:l0 level1 lfo1'><font size=2
color=navy face=Arial><span style='font-size:10.0pt;font-family:Arial'>Cost
of patient medication errors from having accumulated a confusing pile</span></font>
<font size=2 face=Arial><span style='font-size:10.0pt;font-family:Arial'><o:p></o:p></span></font></li>
<li class=MsoNormal style='color:navy;mso-list:l0 level1 lfo1'><font size=2
color=navy face=Arial><span style='font-size:10.0pt;font-family:Arial'>Cost
of environmental injury goes here…someday</span></font> <font
size=2 face=Arial><span style='font-size:10.0pt;font-family:Arial'><o:p></o:p></span></font></li>
</ol>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>But there is now a 5<sup>th</sup>: The
cost of disposal in third world countries of badly donated drugs that
don’t meet the 1999 WHO Guidelines and that now for example have a price
tag of over 1 million Euros in Banda Aceh alone for the 340 tons of unusable
“donations.” <o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>Maybe I’m overstating a bit, but
those seem compelling arguments and I simply added the word cost to each for
the sake of this email.<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>Seems actually to make it more starkly
important.<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>Stevan Gressitt, M.D.<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>207-441-0291 <o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<div>
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face="Times New Roman"><span style='font-size:12.0pt'>
<hr size=2 width="100%" align=center tabIndex=-1>
</span></font></div>
<p class=MsoNormal><b><font size=2 face=Tahoma><span style='font-size:10.0pt;
font-family:Tahoma;font-weight:bold'>From:</span></font></b><font size=2
face=Tahoma><span style='font-size:10.0pt;font-family:Tahoma'> Gilliam, Allen
[mailto:GILLIAM@adeq.state.ar.us] <br>
<b><span style='font-weight:bold'>Sent:</span></b> Tuesday, November 22, 2005
2:25 PM<br>
<b><span style='font-weight:bold'>To:</span></b> H2E - Hospitals for a Healthy
Environment - Info Exchange Listserv<br>
<b><span style='font-weight:bold'>Cc:</span></b>
pharmwaste@lists.dep.state.fl.us<br>
<b><span style='font-weight:bold'>Subject:</span></b> [h2e] RE: any
legislation/ordinances banning disposal of pharmaceuticals to sanitary sewer?</span></font><o:p></o:p></p>
</div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>H2E -- Hospitals for A Healthy Environment Info Exchange Listserve<br>
(h2e@email.sparklist.com)<o:p></o:p></span></font></p>
<div>
<p class=MsoNormal><font size=2 color=blue face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:blue'>tough questions Dan!</span></font><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'> <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=2 color=blue face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:blue'>easy, but time and resource
intensive anwer? City Pretreatment programs and their inspectors
(doubt the epa will come up with the regs). 40 cfr 403 (the national
pretreatment regs which are self-implementing) apply to all "non-domestic
dischargers": </span></font><b><font size=1 face=Arial><span
style='font-size:7.5pt;font-family:Arial;font-weight:bold'><o:p></o:p></span></font></b></p>
</div>
<p><b><font size=2 color=blue face="Times New Roman"><span style='font-size:
10.0pt;color:blue;font-weight:bold'>§ </span></font></b><b><font size=2
color=blue face=NewCenturySchlbk-Bold><span style='font-size:10.0pt;font-family:
NewCenturySchlbk-Bold;color:blue;font-weight:bold'>403.2 Objectives of general
pretreatment regulations.</span></font></b><b><font size=1
face=NewCenturySchlbk-Bold><span style='font-size:7.5pt;font-family:NewCenturySchlbk-Bold;
font-weight:bold'><o:p></o:p></span></font></b></p>
<p><font size=2 color=blue face="Times New Roman"><span style='font-size:10.0pt;
color:blue'>By establishing the responsibilities of government and industry to
implement National Pretreatment Standards this regulation fulfills three
objectives:</span></font><o:p></o:p></p>
<p><font size=2 color=blue face="Times New Roman"><span style='font-size:10.0pt;
color:blue'>(a) To prevent the introduction of pollutants into
POTWs [publicly owned treatment works] which will interfere with the
operation of a POTW, including interference with its use or disposal of
municipal sludge; </span></font><o:p></o:p></p>
<p><font size=2 color=blue face="Times New Roman"><span style='font-size:10.0pt;
color:blue'>(b) To prevent the introduction of pollutants into POTWs which will
pass through [cause toxicity] the treatment works or otherwise be
incompatible with such works; and</span></font><o:p></o:p></p>
<p><font size=2 color=blue face="Times New Roman"><span style='font-size:10.0pt;
color:blue'>(c) To improve opportunities to recycle and reclaim municipal and
industrial wastewaters and sludges.</span></font><o:p></o:p></p>
<div>
<p class=MsoNormal><font size=2 color=blue face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:blue'>best management practices or general
permits can and might be required, paperwork (daily procedure logs,
manifests and/or bills of laden) will have to be available for review upon
request by the city's inspectors that all meds/lab chems were disposed of
off-site. these cities have the authority for implementing the same
type enforcement options that epa and the states do including civil and/or
criminal penalties, administrative orders, severing your sewer
service, imprisonment, publishing your facility's name in the local
newspaper for being non-compliant, etc. </span></font><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'> <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=2 color=blue face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:blue'>that's why the clean water act
created the program. let the cities decide at their own discretion, what's
allowed into their sewage collection systems. who better to make the
judgement than the folks protecting its publicly own assets and have a chance
to interact with their next door neighbors, business leaders, civic clubs,
council members, etc on a daily basis?</span></font><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'> <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=2 color=blue face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:blue'>it's in this office's lowly opinion
that a federal or state decision would side with the city. if
you get down to the Act's Pretreatment reg. bare bones, a city
with a publicly owned sewer systerm is not obligated to take ANY non-domestic
wastewater.</span></font><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'> <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=2 color=blue face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:blue'>inducements/incentives?
environmental stewardhip and doing the right thing is a hard sell when
there's no immediate monetary gains mentioned in the same sentence (and,
as previously mentioned, no absolute proof of toxicity after it passes
thru a city's w.w. treatment plant). avoiding fines would be my reward
and a plaque in the window an article in your
newletters/ads that your facility is a recognized environmental friendly
facility with a certified <st1:place w:st="on">EMS</st1:place> (go
H2E!) should help your bottom line in the long run. </span></font><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'> <o:p></o:p></span></font></p>
</div>
<div>
<div>
<p class=MsoNormal><font size=2 color=blue face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:blue'>[sorry, but i've taken the liberty of
cc'ing the pharmawaste listserve at the risk of violating any unknown cross
talking policies as i know many of you are on both anyway. somebody chew
me out if i did bad....got my leather on today....].</span></font><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'> <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=2 color=blue face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:blue'>alot of eyes still need to be opened and
more information gained nationwide.</span></font><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'> <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=2 color=blue face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:blue'>have a great holiday,</span></font><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'> <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=2 color=blue face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:blue'>allen gilliam</span></font><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal><font size=2 color=blue face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:blue'>adeq state pretreatment coordinator</span></font><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal><font size=2 color=blue face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:blue'>501.682.0625 </span></font><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'> <o:p></o:p></span></font></p>
</div>
</div>
</blockquote>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
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