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U.S. Department of Health and Human Services

File photo
Picture Stony Brook University Hospital. It’s over a million square feet of facilities provide a wide range of medical services. The people who run the operations in this complex have created policies and procedures that make the entire hospital much greener than the distinctive two-tone building that’s visible from a distance along Nicolls Road.

For the hospital’s plethora of policies that protect the planet, the U.S. Department of Health and Human Services recently recognized Stony Brook, among others, for a commitment to decarbonize its operations and improve its resilience amid climate change.

Barbara Boyle is the director of Healthcare Safety at Stony Brook University Hospital. Photo from Stony Brook Medicine/ Jeanne Neville

During the recent United Nations Climate Change Conference, called COP28 in Dubai, HHS recognized Stony Brook as one of more than 130 organizations that joined the White House-HHS Health Sector climate pledge, which committed to reduce emissions by 50 percent by 2030 and have net zero emissions by 2050.

The recognition is “validating” and “wonderful” and provides the kind of excitement that “pushes you along a little further,” said Barbara Boyle, Director of Healthcare Safety at Stony Brook University Hospital.

Carol Gomes, chief executive officer and chief operating officer at Stony Brook University Hospital, added that green practices were not only good for the university, but were also supportive of the bottom line.

“When you reduce bio hazardous waste from the waste stream, it reduces expenses related to carting away” the more dangerous refuse, Gomes said. Such actions are part of the school’s fiscal responsibility.

Numerous measures

Stony Brook University Hospital has taken a wide range of steps to reduce its carbon footprint, to minimize toxins, and to reuse and recycle materials to encourage sustainability.

One of the first initiatives was to install motion and LED lighting. While the cost of a bulb might be higher initially, the lights last much longer.

“You have to think longer term, not shorter term in terms of savings,” said Gomes. “I was so proud of that project” which included retrofitting every light in the hospital, parking garage and on the roadway on the campus.

Carol Gomes is the chief executive officer and chief operating officer at Stony Brook University Hospital. File photo

Hospital efforts include using cleaning materials that are better for the environment. In 2022, 76% of the housekeeping chemicals were green, well up from 18% in 2021.

Additionally, electricity use at the hospital declined by 13 percent from 2020 to 2022.

In the operating room, anesthesiologists use considerably less desflurane, which is damaging to the atmosphere, with an extended lifetime in the atmosphere that has 20 times the environmental impact of other gases. The use of desflurane declined by 80 percent from 2017 to 2022.

The hospital also recycled 1,635 tons of paper. Each ton of recycled paper can save 17 trees, 380 gallons of oil, 3 cubic yards of landfill space, 4,000 kilowatts of energy and 7,000 gallons of water. That means, among other benefits, the hospital saved about 28,000 trees and 11.5 million gallons of water. That is 10,000 more trees than are in all of Central Park.

Coordinating emergency care

Stony Brook has also worked on a climate resilience plan to ensure that it can remain operational in case of a major climate event, such as a hurricane, an extended heat wave, or a nor’easter, among others.

“We need to make sure the hospital can continue to remain operational,” said Boyle, which includes anticipating the needs of communities that are at a disproportionate risk of climate harm.

The hospital also has extensive plans in case Stony Brook needs to provide shelter for staff who can’t return home and return to work.

Hospital staff recently joined a discussion with community members, the Suffolk County Department of Health, emergency services such as the Red Cross, and volunteer organizations to discuss how to ensure efficient and effective communication pathways and resource allocation.

Boyle explained that she learned the specifics of Red Cross shelters and cooling centers in Municipal Buildings.

Changes in personal habits

Such professional efforts are consistent with the lessons Gomes learned from her grandmother, who herself grew up during the Great Depression. Gomes recalled how her grandmother encouraged her to turn off lights when she left a room and to shut off the faucet in the kitchen sink in between cleaning dishes.

Boyle explained that her mother-in-law Beryl Ellwood Smith, who grew up in England during World War II and had lived with Boyle’s family for the last two years, didn’t believe in throwing things out. She believed everything had a second or third use, repairing and mending items to keep them longer.

“In my family, we’ve really taken this to heart, recycling and eliminating waste,” Boyle said.

The hospital encourages staff to take similar approaches to saving and recycling in their own lives.

Staff recently received a note about ways to think about sustainable holiday decorations.

People who work in the hospital can offer their friends and family experiences rather than adding to the collection of material goods often packaged in styrofoam or plastic for holiday gifts.

The hospital is encouraging its staff to “make the connection between the workplace and the home and the importance of protecting the Earth in general,” Gomes said.

Stony Brook University hosts opioid forum featuring health care community

Medical professionals participate in an opioid ethics symposium at Stony Brook University Aug. 3. Photo by Kyle Barr

The opioid crisis has reached its tendrils out to touch every person in the U.S., and the doctors who prescribe those opioids for pain relief see the ethical dilemma; whether they should treat their patients’ pain or not out of concerns of misuse.

At an opioid ethics symposium hosted at Stony Brook University Aug. 3, Dr. Kevin Zacharoff, an expert in pain medicine and a sitting member of the Anesthetic and Analgesic Drug Products Advisory Committee of the U.S. Food and Drug Administration, said a number of doctors no longer prescribe opioids for pain management because of how quickly the repercussions of misuse will come down on them. 

“All the regulatory agencies are coming down and tightening the screws of people in primary care, and people in primary care are saying ‘I wash my hands of it,’” Zacharoff said. “This is all falling on the shoulders of health care providers — when people dying from heroin and fentanyl has overtaken pain medication.”

Dr. Kevin Zacharoff delivered the keynote speech and discussed the effects of regulatory agencies on addiction. Photo by Kyle Barr

The U.S. Department of Health and Human Services reports that nationally 116 people a day died from opioid-related drug overdoses in 2016. A U.S. Centers for Disease Control and Prevention report released in 2016 said that the rate of death from drug overdoses has increased 137 percent and a 200 percent increase in the rate of opioid overdose deaths from 2000 to 2014. 

CDC data shows that regulations on prescription opioids restrained the rise of overdose deaths involving legal drugs, but since 2011 there has been a spike in the number of deaths caused by illicit drugs such as heroin and other painkillers including fentanyl. Zacharoff said he fears that these regulations on opioid prescribing pushes stable patients who could have been using opioids to treat long-term pain into using illicit drugs.

“Prescription drug monitoring programs have made a positive impact, but they have also had a negative impact on health care providers, because it takes a lot of time and energy,” Zacharoff said. “Should we sacrifice our care for patients for the sake of people using the substances illicitly?”

For the past several years federal agencies, as well as state governments, have started to restrict the number of opioids available for pharmacies as well as scrutinizing how doctors prescribe that medication. A large number of federal agencies, such as the CDC, the FDA, the Drug Enforcement Administration, just to name a few, are involved in opioid research and regulations. This is on top of state prescription drug monitoring programs, which make doctors fill out forms on patients, saying whether they informed them of the dangers of the drugs and whether they asked if there was a person in the house with a history of addiction.

In April, Attorney General Jeff Sessions announced that the DEA would propose setting more limits on the numbers of opioids that a drug manufacturer could produce. Prescribing doctors said they have seen multiple problems with a shortage of opioids due to these limits on manufacturing and distribution.

“We are seeing an inability to get our prescriptions filled on Long Island,” said Laureen Diot, a nurse practitioner from East Patchogue.

Though that is not to say there have not been bad actors. In May, Merrick doctor Michael Belfiore was convicted of prescribing hundreds of opioids for profit and for causing the deaths of two men via overdoses. He wrote 5,000 prescriptions for 600,000 pain pills between January 2010 and March 2013, but Belfiore is asking a federal judge to dismiss the case, saying it was the pharmaceutical companies who promoted the drugs while downplaying their risks.

The issue, Zacharoff said, stems from doctors’ lack of education when it comes to pain medicine. A 2011 study in the National Academies Press showed that out of 117 U.S and Canadian medical schools only four U.S schools offer a required course on pain.

“That’s despite the fact that pain is the most common reason people seek medical attention,” Zacharoff said. “Doctors will often say to me, ‘I have to think about hypertension, diabetes, heart disease,’ but pain is more prevalent than diabetes, cancer and heart disease combined.” 

Suffolk County officials are hoping to see a decline in the number of opioid-related deaths this year. In a report presented at the May 31 Suffolk County Legislature’s health committee meeting Chief Medical Examiner Michael Caplan said that if numbers stay low, approximately 260 opioid-related deaths are expected this year — a near 100-person decrease compared to 2017. However, the county will not know the total opioid-related deaths until the year’s end.

There are options for nonopioid pain relief, such as rehabilitative and psychological therapies. Doctors at the symposium said they expect as opioid prescribing ebbs, then other practices or drugs will become more prevalent. While some medical professionals said medical marijuana might one day work as effective pain relief, it not being legal in New York and without the necessary number of tests, the drug is not viable at this moment.

“It’s too early to write the book on marijuana for chronic pain,” said Marco Palmieri, the director of the Center for Pain Management at Stony Brook University. “Some physicians have gotten around this by opting not to test for marijuana [when doing prescriptions]. Whether that’s right, I don’t know. There certainly needs to be more data available.”