Midwest Sterilization Corporation employees look on as the Clean Air Coalition protest from outside the facility's perimeter in March of 2022.

On behalf of citizen group Laredo Children for a Better Tomorrow, the U.S. Environmental Protection Agency was served with a 60-day notice of intent for a Clean Air Act citizen suit.

A legal document stated that by delaying community meetings, and the installation of a surveillance program for Ethylene Oxide, or EtO, the EPA is failing to properly protect the residents of Laredo, which goes against the mandate of the agency and the Clean Air Act.

Victor D. Trevino is representing the citizen suit and outlined the different factors in forming the suit, including ProPublica and the Texas Tribune’s five-year analysis of industry data regarding Midwest Sterilization Corporation’s proximity to elementary schools. Ultimately, per the clean air act, Trevino wrote that the EPA is required to act by implementing air quality monitors, biological surveillance programs and community engagement on the true risks associated with the emissions on current and future generations.

The EPA explained that EtO is a colorless gas and is used to sterilize devices that cannot be sterilized using steam or radiation, such as some medical and dental equipment. Furthermore, it is used to treat approximately 50% of sterile medical devices, about 20 billion medical devices annually.

Trevino’s letter referenced a town hall meeting by the Clean Air Coalition and writes that a Dec. 8, 2021 meeting saw several residents living in the impacted area described losing family members to cancer due to unknown or environmental factors.

Regardless, the EPA states that EtO is the only safe and effective sterilization method currently available for some devices but is working to reduce EtO emissions and FDA is looking to identify alternatives to EtO.

During this meeting, the notice states that the then-Laredo Health Authority of Laredo, Victor Trevino Sr., proposed the creation of an EtO surveillance program that either involved biological surveillance in coordination with the Centers for Disease Control and Prevention and/or installing air quality monitors around the sterilizing plant.

"The installation of EtO emission monitors is long overdue in the Laredo area. In light of the known scientific evidence, the lack of independent EtO emissions monitoring is a gross failure by the EPA to protect this medically underserved community. As mentioned, the agency inaction goes against the basic mandate of the EPA and is a violation of the of the 'CAA,'" the legal document states.

The document cites the EPA’s research, and Trevino writes that the EPA has known and concluded that ethylene oxide was 30 times more carcinogenic than previously thought for people who continuously inhale it as adults and 50 times more carcinogenic for those who are exposed since birth.

He continues to write that since 2018, the EPA has known that some of the communities that it identified are at risk from ethylene oxide pollution. 

Meanwhile, Laredo continues to be a medically underserved community, and Trevino writes that the inaction by the EPA and lack of EtO monitoring significantly impacts Laredo due to its limited medical resources. He cited the EPA's report this month about Midwest being identified by the EPA as creating a higher cancer rate for locals. Midwest has previously responded to those claims, stating it "takes its regulatory compliance seriously and expects to remain in compliance, including when the new rulemaking is adopted."

"This position is further reinforced by the EPA’s August 3, 2022, announcement that the Laredo sterilizing plant is among 23 identified sterilizers across the country that created an excess cancer risk for nearby residents of at least 1 in 10,000," Trevino wrote. "What this represents is that that out of 10,000 people exposed to that amount of ethylene oxide over their lifetimes, at least one would likely develop cancer."

Trevino highlighted that the medically underserved nature of Laredo and a Laredo Cancer Study by the Texas Department of State Health Services found that rates of one type of cancer associated with ethylene oxide exposure, extranodal non-Hodgkin lymphoma, were "significantly greater than expected" given the population. 

Exacerbating the situation, the Laredo community has been reported to likely be low-income, underinsured, uninsured or a combination. LMT previously reported that based on the former health authority, there are multiple factors for the city to be medically underserved.

He noted that based on the U.S. Census population figures, 23.9% of these individuals are living in poverty and 28% are underinsured. Laredo has been medically underserved for decades, with only 1/3 of the primary care physicians and health care professionals needed for a population of its size.

The EPA issued a release on Aug. 3, announcing a plan to engage and inform communities, states, tribes, territories and stakeholders about up-to-date information on the risks posed by air emissions of EtO from commercial sterilizers, as well as EPA’s efforts to address these risks.

As of July 2022, the EPA reported that Midwest is at an elevated risk at or above 100/million to city. According to the report, EtO is limited by the Texas Commission on Environmental Quality to a maximum daily rate of 7,007 pounds a day and a maximum annual rate of 2,557,555 pounds per year.

The legal document also cites the two agencies and notes of their disagreements regarding the exposure concentration that EtO may cause cancer and the predicted ambient concentration near plants.

"Even though the U.S. Environmental Protection Agency has superseding jurisdiction over emissions in the United States, neither position can be known without a proper EtO Monitoring Program," Trevino wrote.

The EPA will host a meeting on Sept. 15 to discuss more about its plan to address the risks from commercial sterilizers. It will be held at the Barbara Fasken Center on 15201 Cerralvo Drive between 6:30-8 p.m.

The agency added that later this year, it is expected to propose an air pollution regulation to protect public health by addressing EtO emissions from commercial sterilizers.

Christian Alejandro Ocampo reports on education for the Laredo Morning Times. He originally joined LMT as a photographer.