When Jacquelyn Scott checked her mailbox in August, she found a letter from an unexpected sender: the Environmental Protection Agency.
Its message was even more surprising. A facility less than half a mile away from Scott's south Memphis home -- one that she didn't know existed -- emits ethylene oxide.
In its letter, the EPA told Scott and other residents that ethylene oxide is about 60 times more dangerous than it previously thought but assured them that the facility at 2396 Florida St. was following regulations.
Scott said she scanned the letter and put it aside. Soon after, she got an email from Memphis Community Against Pollution about a meeting at the South Branch Library to discuss ethylene oxide's cancer risk. That message got Scott's full attention.
Sterilization Services of Tennessee appeared on the EPA's list of high-risk facilities in August, but the company has refused to comment until after there are new regulations on the books.
About 85% of ethylene oxide releases are fugitive emissions, meaning they escape through vents, doors and windows, but EPA regulations don't account for this type of emission. The EPA is moving to enact tighter restrictions on the chemical's emissions, but a pending lawsuit claims the agency has already missed two deadlines for new standards.
The dangers of ethylene oxide
Sterilization Services uses ethylene oxide to disinfect medical and dental equipment. It's one of about 100 commercial sterilizers in the country. Some of the chemical properties that make ethylene oxide an effective sterilizing agent are also the same reasons it's carcinogenic to humans.
If someone near the facility is exposed to ethylene oxide all day, every day, from birth until age 70, their cancer risk is 2,000 in a million -- 20 times higher than EPA's acceptable risk level.
The risk in the outermost parts of Memphis' area impacted by Sterilization Services is about 100 in a million, which meets EPA's benchmark for unacceptable risk. That's in addition to residents' risk of developing cancer for reasons other than chemical exposure.
Scott has unknowingly lived on the residential street closest to the facility -- less than half a mile away -- since 1986, so she attended Memphis Community Against Pollution's meeting about the cancer risks to learn more.
Prior to that meeting, the EPA also hosted two community meetings in October at Monumental Baptist Church on South Parkway, where EPA representatives shared a detailed overview of ethylene oxide and assured residents that the agency is working on more protective regulations.
But Scott, and many other residents, said they missed the memo; either they don't remember getting a letter from the EPA in the mail, they didn't see the invitation to the meeting in that letter or they didn't understand the risk.
After learning more, Scott wondered: "Why all of a sudden? What happened that brought this to (EPA's) attention?"
Lawsuit hopes to give EPA a deadline
In 2016, the EPA learned that ethylene oxide is 60 times more toxic than it previously estimated. In 2019, it announced plans to draft new regulations for the chemical. In 2021, the EPA's Office of Inspector General urged the agency to draft a new rule. Otherwise, the office said it can't guarantee that its regulations protect public health.
The EPA set a deadline for spring 2022, but after the agency pushed its own deadline back multiple times, an environmental law group took action in the hopes of getting the EPA on a court-mandated schedule.
In a new lawsuit, Earthjustice -- on behalf of California Communities Against Toxics, Clean Power Lake County, the Rio Grande International Study Center, the Sierra Club and the Union of Concerned Scientists -- claims that the EPA has missed multiple regulatory deadlines.
The agency did not respond in time for publication.
The Clean Air Act requires the EPA to review its emission standards at least every eight years. The lawsuit's lead attorney, Marvin Brown, acknowledged that rulemaking is a delicate process that requires a lot of information but said more than 16 years have passed since the EPA reviewed its ethylene oxide regulations.
"By failing to timely revise its sterilizer rule, EPA has left communities to fend for themselves against a deadly, cancer-causing chemical," Brown said. "No one should get cancer from the facilities that make sure that medical equipment is safe."
It wasn't until August that Memphis residents learned of their exposure. That's when the EPA published a list of the 23 highest-risk facilities.
"Our regulations are not protective enough. The rules are not good enough," Madeline Beal, EPA's senior risk communications adviser, told Memphians in October.
Too close to home
The ethylene oxide-emitting facilities are most often in low-income neighborhoods and communities of color, which are already grappling with health risks from heavy industrial activity, Brown said.
From Scott's front yard, she can see plumes of smoke from Valero over her neighbor's houses to the right. Sterilization Services of Tennessee is to the left, just around the corner.
"Everybody under the Clean Air Act is entitled to clean air, and right now, we're creating sacrifice zones," Brown said.
Vera Holmes is the president of the Mallory Heights Center for Community Development. It's one of a few neighborhoods in the facility's vicinity. She's been walking door-to-door, telling people about their risk from ethylene oxide, along with the other industrial facilities in the area.
"It's so bad within this community that people are truly walking dead," Holmes said. "So many people are so sick."
Other communities in different parts of the country learned about their cancer risk from ethylene oxide years ago.
Urszula Tanouye lives in Willowbrook, Illinois, about 20 miles southwest of Chicago -- and at the time, about a mile away from Sterigenics, a facility that emitted ethylene oxide.
In mid-2018, Tanouye learned about the neighborhood's risk after EPA employees requested an emissions study. Bill Wehrum, assistant administrator of EPA's air and radiation division at the time, directed local EPA officials to not release the data yet.
They published the report regardless, but later took it down.
It was too late, though. The mayor had a copy of the report and posted it to Willowbrook's website. The results revealed a higher-than-expected cancer risk from Sterigenics' ethylene oxide emissions.
Within days, the community packed a town hall with wide-ranging attendees: the mayor, state politicians, EPA officials, the county health department and representatives from Sterigenics.
A federal report a few months later confirmed the risk. Air monitoring continued for about six months, and in early 2019, Illinois strengthened its state ethylene oxide regulations. The Illinois EPA issued a seal order, effectively shutting Sterigenics down until it complied with new state regulations.
By September 2019, Sterigenics closed its doors. Once a facility closes, the risk ends, because ethylene oxide doesn't linger in the air for long.
Brown said Willowbrook is an outlier in many ways: It's wealthy (the second-wealthiest county in Illinois), majority-white (about 80%) and it's the only place he knows of a commercial sterilizer closing its plant. The community also benefited from the presence of a local EPA warehouse, which Tanouye said kickstarted their case with air monitoring data -- something that other communities have to fight for.
"We worked hard for it, but we also got lucky," Tanouye said.
By now, the conversation about ethylene oxide is over for most of Willowbrook. Some residents are already settling lawsuits, including one individual who received $363 million in damages.
But some advocates such as Tanouye have kept reaching out to communities that are just learning about their risk, like Memphis.
Local government looks to what it can do
"This is pretty much history in Black America," said Angela Johnson of Memphis Community Against Pollution.
At Memphis City Councilman Edmund Ford's request, EPA's Caroline Freeman delivered a virtual presentation to the body Jan. 10. She's the director of the air and radiation division.
"EPA is concerned about this risk," Freeman told the council.
Some of the other high-risk facilities that the EPA identified have voluntarily reduced emissions until the agency's new rules are in place; Sterilization Services of Tennessee has not, but its sister companies in Georgia and Virginia have, Freeman said.
If the local facility doesn't voluntarily take action, Ford said he'd like to see it closed. The council unanimously approved a resolution Jan. 24 urging Sterilization Services of Tennessee to voluntarily reduce its ethylene oxide emissions ahead of more protective EPA regulations.
"It seems like we're moving ahead, but it almost seems like it's at a snail's pace," Councilman Jeff Warren said.
The EPA expects to release a draft of new ethylene oxide regulations early this year. Once that happens, the public will have a chance to provide feedback. Any new facilities will have to comply with the guidelines immediately, but existing facilities will have up to three years to make changes, unless the agency expedites that timeline.