Asbestos: Hospitals and the National Emission Standards for Hazardous Air Pollutants (NESHAP)


Although widely used from the 1940s to the 1970s in construction, asbestos has been declared a carcinogen for humans. Indeed, according to medical studies, asbestos exposure can cause lung cancer among other affections. Many buildings still contain them, including hospitals. These fibers become especially hazardous when released in demolitions and renovations. How does the regulation for asbestos abatement affect hospitals in the US?

Read on as we go through the most important aspects you need to know about the NESHAP regulations regarding hospitals.

Asbestos in construction

To begin with, the use of asbestos in construction was because it is a highly efficient material in terms of insulation. It is also very flexible (woven fibers) and resistant to electricity. Helping to keep the warmth in and let the cold out was paramount at the time, thus, wrapping hot water pipes with asbestos was a very common practice. 

Other common places to find asbestos besides piping insulation could be floor and ceiling tiles, wallboards, HVAC insulation, electrical wiring insulation, and cooling towers. All of these were commonly found in most industrial, residential, and commercial buildings at the time. 

Since most of the hospitals built in the US between 1940 and 1973 required such features, it is very common to find asbestos still hidden behind walls and acting as insulating material. Moreover, until a licensed inspector, who has been trained in asbestos, can do proper and thorough research in the facility, workers might not be aware they are being exposed to this dangerous material at all.

When is asbestos dangerous?

Asbestos is not dangerous until fibers are dispersed. This means that they can be a hazard when tampering with them during renovations or demolitions. This is because the material is dispersed (unwoven) and the fibers set loose in the air. Furthermore, asbestos is highly friable when disturbed; aka, cut, demolished, grinding, circular saws, etc.

Once asbestos is set loose in the air, they transform into very tiny particles and continue to float in the environment. For example, buildings that utilize duct systems communicating several rooms within the same facility might suffer from a widespread of asbestos throughout the entire structure. All of this can happen without any kind of warning because most workers who are doing their job are not aware of the hazardous element in an asbestos release.

What are the consequences of asbestos exposure?

These are some of the known consequences of asbestos exposure:

  • Mesothelioma – This is a form of cancer formed on the lung lining (mesothelium) and it´s the most common disease developed by asbestos exposure. It is always fatal and it can rarely have another cause. Between 2003 and 2008, the NIH declared 19,011 cases in the US, which means over 3,000 cases a year. This translates into an annual incidence rate of 1 case per 100,000 inhabitants per year.

  • Asbestosis – Asbestosis can be described as scarring of the lungs as a result of inhaled fibers lodging deep inside of them. It is not as fatal as mesothelioma, and patients can be saved with a lung transplant but make breathing painful and can lead to heart or lung failure.

Asbestos in hospitals

Hospitals built using these materials represent a risk for construction workers but also for professionals and patients. In a report from 2006, the City of New York found asbestos in 10 out of 15 researched municipal hospitals. Although they were not in the areas where patients were treated, they represented a hazard for the health workers ́ community.

For example, British anesthesiologist, Andrew Lawson got his mesothelioma diagnosis in 2007. He is not a construction worker and couldn’t figure out where he got the affection from. After doing some research, he found out that the asbestos he had been exposed to, were highly concentrated in the tunnels at Guy ́s Hospital in London where he had been training for six years. Indeed, he used to walk those tunnels two to three times a day every day. Besides him, three fellow doctors who trained with him got the same affection. All of them are currently deceased. Lawson died in February 2015 at age 55.

The work done in the renovation of hospital buildings could potentially lead to the exposure of workers to a fatal hazard. Furthermore, the deterioration of the material because of the time passing could mean that government officers need to take the initiative to remove and replace any asbestos still present in hospital buildings as a preventive effort.

Let ́s take a look at the NESHAP regulations regarding this sensitive task.

Asbestos abatement and NESHAP regulations

Asbestos is considered a hazardous air pollutant and hence, it is regulated by the NESHAP in the US. This regulation is in place to avoid asbestos to float freely into the air when demolitions and renovations occur. These are the steps proposed by such regulations:

First, thorough research by professionals

Before any kind of demolition or renovation can take place, the area needs to be inspected by a certified inspector. Prior to the renovation, NESHAP rules and regulations require the institution to have an asbestos survey performed, so the professional can determine whether the asbestos in the area meets a certain threshold amount or not. The representative, trained in regulation, identification, and compliance needs to be present on-site and make the decisions about the asbestos-rich waste material. He or she should spend no longer than two years working without refresher training on the matter.

Second, removing asbestos material

The asbestos-rich material found on-site can only be legally inspected and removed from commercial and public buildings by licensed abatement contractors. Those materials are then sealed in a leak-proof container and removed from the area as expediently as possible. This way, the emissions of asbestos in the air are drastically minimized if any. This regulation works to preserve the life of construction workers, hospital personnel, and people living in the surrounding area.

Third, disposing of asbestos materials in a landfill

Landfills that receive asbestos-rich materials need to fulfill special requirements that can help prevent any asbestos waste to reach the air. Moreover, the vehicle transporting the asbestos material from the site to the landfill is required to have proper labeling and recordkeeping.

Old Davis Hospital, an example

The Old Davis Hospital in Statesville is one of the best recent examples of what to do, and what not to do regarding asbestos abatement. The case was given public exposure because of the crossed fire between contractors and authorities.

Created in 1920 by Dr. Davis, this pioneer institution lived through a golden age of innovation and performance. Although it was abandoned in 1987, it wasn ́t until 2014 that the property was sold to build a new health facility. The new Allied center was to be the joined effort of Iredell County, the city of Statesville, and Mitchell Community College.

Demolition work started in July 2015 and was stopped shortly after (four months) because the EPA (the United States Environmental Protection Agency) authorities needed to oversee the sight and confirm there was no asbestos abatement taking place. Contrary to what authorities and contractors expected, the inspectors found asbestos-rich materials and debris on-site. This material was potentially a hazard not only to the workers doing the demolition work but also to the surrounding community.

The NESHAP regulations in terms of asbestos abatement and disposal were not followed properly. According to a recent press release by NESHAP regulations, it wasn ́t until June 2016 (a year after demolishing started) that the site was completely cleared from asbestos. In the same article, the NESHAP authorities claim that such a procedure cost 1.4 million dollars.

After the demolition

According to professionals and neighbors, the massive asbestos exposure the whole community was forced to could have fatal consequences that might begin 20 years after the exposure. Indeed, nearby-neighbor John Staford told the press that every councilman knew about asbestos and that consequences, if any, will be seen in 20 years.

Not following the NESHAP directions regarding asbestos abatement and management could mean a huge hazard for an entire community. Old Davis hospital was proof it can happen.


Asbestos in hospitals represents a hazard to the health community. Many of the largest health facilities in the world were built in the years when asbestos was massively popular as a construction material. As a result, most of the facilities contain some form of it as an insulator.

The NESHAP efforts to regulate asbestos abatement and the handling of this waste could prove to be crucial to prevent the death of workers in the future. 

Information is paramount to do preventive work that could save the lives of up to 3,000 people every year only in the United States. The future remains uncertain, but with proper investment in the right direction, the asbestos-exposure diseases could be something from the past.

Midwest Environmental Consulting Services creates a safer work environment for your organization by providing long-term, cost-effective solutions to a wide range of environmental issues. With over 25 years of professional experience, we have seen it all. We make sure you are compliant and follow all regulations needed to successfully complete your project. Call us today, we will walk with you every step of the way.