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After teacher Janet Rau learned that a carcinogenic gas was being released from an industrial plant near her school in 2019, she started a campaign for more oversight. Five years later, the Environmental Protection Agency issued rules requiring facilities that use the gas to better monitor and cut their emissions of it.

Those rules were set to take effect starting this month. But the Trump administration has granted dozens of temporary exemptions, including to the Atlanta-area facility near Rau.

Now, as part of a sweeping deregulatory push, the EPA wants to ease the new regulations for the gas — ethylene oxide, or EtO — permanently. The push to get tighter rules was maddeningly slow, says Rau, but “this is worse. The things that we’ve done have essentially been erased.”

Back in 2016, the EPA determined that ethylene oxide, which is used to sterilize medical devices, was 30 to 60 times more carcinogenic than previously thought. Two years later, it identified areas near sterilizing facilities with elevated health risks. One was on the northwest edge of Atlanta, around a plant operated by the company Sterigenics, which is just downriver from the private Lovett School where Rau teaches fourth grade.

As Rau and others learned about the pollution and pushed for answers, the EPA embarked on the years-long rulemaking process. In 2024 it finalized regulations requiring commercial sterilizers to cut their ethylene oxide emissions by 90%; carry out continuous monitoring of levels of the gas; and report the results in a way that communities could be confident gas wasn’t leaking into the air. Activists in Cobb County and an hour away in Covington, Georgia, where Becton, Dickinson and Co. operates a sterilization plant, considered it a victory.

Then came the Trump administration.

Last year, it offered waivers to a range of industries from having to comply with Biden-era standards for toxic air pollutants. More than three dozen of the country’s roughly 90 medical sterilizing facilities, including the Cobb County and Covington plants, got two-year exemptions from the new ethylene-oxide rules, according to the White House.

This March, the EPA proposed to loosen the 2024 rules permanently. It will make its decision after a public comment period that ends May 1. If it makes the rollback final, legal challenges are almost sure to follow.

Brigit Hirsch, a spokesperson for the EPA, said the standards are too burdensome to meet for an industry that’s critical for the country. “The 2024 rule posed a real threat to one of America’s only options for a secure domestic supply chain of essential medical equipment,” Hirsch said in a statement. She added that there was “no viable alternative” to ethylene oxide on the market.

Sterigenics, in a letter to the Trump administration requesting waivers, wrote that the complexity of the rules and other factors like supply-chain delays and the limited availability of contractors made it “challenging and expensive” to meet the compliance deadline in April.

When asked for comment, Sterigenics, which is owned by Sotera Health Co., referred Bloomberg News to a page on its website that describes the EPA’s proposal to revise the rule as “an important step.” The company says on its website that it is committed to safety, adding, “Sterigenics has and will continue to invest in state-of-the-art facility enhancements across our EtO facilities.”

Matt Marcus, a spokesman for Becton, Dickinson, said the company has always been committed to “best available technology” and to providing its emissions data to state regulators. Getting a waiver for the Covington plant was necessary, he said, to “complete the specialized installation of custom-engineered equipment” for capturing ethylene oxide “without disrupting operations or production of essential medical devices.”

The EPA has long regulated ethylene-oxide emissions from commercial sterilizers; the first US standards were issued in 1994. For two decades after that, when it revisited them, it didn’t see the need for tightening. But in 2016, the agency came to a different conclusion.

“It was a shock,” said Joseph Goffman, who worked in the agency’s Office of Air and Radiation at the time and later helmed it, referring to the finding that ethylene oxide was far more toxic than known. “It really triggered a sense of urgency.”

A colorless, odorless gas, ethylene oxide is used on equipment that can’t be sterilized by steam because of potential damage from heat or moisture. Some 20 billion medical devices — about half the US total — are treated with it each year, according to the EPA, including heart valves, pacemakers, surgical kits, gowns, drapes, ventilators, syringes and catheters.

There’s no ready substitute for ethylene oxide. But sterilizers can capture the gas before it’s released using equipment like scrubbers and oxidizers.

The EPA’s 2016 assessment relied mainly on large studies of exposed workers that found higher rates of certain cancers, particularly lymphatic and breast cancer, with risk increasing at higher exposure levels. It was supported by animal studies and mechanistic evidence — laboratory research showing how the chemical works in the body.

Greg Crist, the chief advocacy officer of the Advanced Medical Technology Association, or AdvaMed, a trade association for medical device companies, said his group believes the 2016 review “is flawed because it is based on unrealistic modeling and assumptions.”

Without admitting fault, Sterigenics has paid out millions of dollars to settle cancer and other illness claims since 2016. In October 2023, it agreed to pay $35 million to resolve 79 lawsuits in Georgia.

Community and environmental groups from around the country are now plaintiffs in a lawsuit challenging the administration’s authority to issue the exemptions. The US District Court for the District of Columbia has consolidated the case with others contesting Trump’s waivers, and will hear arguments on whether they should proceed together.

As of mid-April, the EPA had already received more than 6,000 comments from the public on the proposed rollback. Of the roughly two dozen posted online, which are mostly opposed, one reads in part, “I grew up in east Texas and was exposed to ethylene oxide most of my childhood. I was 30 years old when I found my breast cancer and now 11 years later I’m dying.”

At the EPA’s public hearing for the rule change on April 1, an AdvaMed executive emphasized how much the US needs a reliable domestic supply chain for medical equipment.

“Disruption in the ability to sterilize med tech domestically could shift critical medical supplies overseas, threatening our national sterile infrastructure,” said Khatereh Calleja, the group’s senior vice president of technology and regulatory affairs.

Calleja added, “Under the proposed revisions, if finalized, many EtO-level emission requirements will remain in place and unchanged.”

But if the 2024 rules are revoked, it will have a significant effect on how much ethylene oxide some plants can emit and how they can monitor their emissions. The EPA projects “health disbenefits” from the change and 7.8 additional tons of the chemical being released annually, about one-third more than without the rollback.

Many sterilization plants were built decades ago in light industrial zones that now border dense suburbs. For years, residents often didn’t know the facilities were there — much less that they could pose a cancer risk.

It was during the first Trump administration that the EPA identified 25 high-priority facilities and started doing outreach in surrounding communities. But as of March 2020, agency staff had met with residents in only nine of them, according to an EPA Inspector General report.

In interviews for this story, people living close to the Cobb County and Covington plants said they learned about the dangers after a wave of news reports about census tracts with airborne toxins in 2019. Some near the Cobb County facility only found out in 2020, when the Board of Tax Assessors lowered property assessment values near the facility there, citing “environmental air quality concerns.”

Rau, who drives a red Jeep named for the Greek witch Circe, read about the threat in the news in 2019 and sprang into action. She helped organize a community network that grew to thousands, appeared on national television and painted signs for a packed public meeting where residents faced Sterigenics executives.

Covington residents also wanted to know what was in their air, said Maurice Carter, who leads the nonprofit Sustainable Newton, which is a plaintiff in the lawsuit against the waivers. While Becton, Dickinson monitored its own smokestack emissions in 2019 and reported them to regulators, it was not required to make that information public.

So the city commissioned its own. Contractors placed monitors around Covington, detecting what officials described as “particularly high” levels of ethylene oxide in some neighborhoods. Then-Mayor Ronnie Johnston called the findings “higher than expected” and formally asked Becton, Dickinson — a major local employer — to halt operations.

Days later, state officials filed a legal motion and a judge signed a consent order shutting the plant for a week for new emissions controls. The order also required that the company report leaks above legal limits. Becton, Dickinson said it had already invested about $8 million in upgrades.

Georgia then adopted rules requiring sterilizers to monitor their emissions and report to the state if they had a leak in excess of a certain size. State and local officials were satisfied that this protected public health, so stopped funding public monitoring.

But Carter — who for decades has lived less than a mile from the Covington facility — and others were not satisfied. They didn’t trust companies to self-report and pushed for public disclosure of companies’ own continuous monitoring in the Biden administration’s 2024 rules.

With the recent offer of waivers, “I didn’t see anything about health data or new analysis,” Carter said. “All I saw was, ‘We don’t want to cost these companies money. If you need two years, we’ll give you two years. If you need more, we’ll give you more.'”

On a recent spring morning at a bakery in Covington, Carter, neatly dressed in a gold crew neck, spoke with visible emotion about the exemptions.

“This hits at a fundamental belief,” he said. “Businesses need to make money. But you don’t put profit above people’s health and the future we leave behind.”

Photo: The Becton, Dickinson sterilization plant in Covington, Georgia. Photographer: Kendrick Brinson/Bloomberg

Topics Pollution