Northwell, Great Neck Water Pollution Control District at odds over sewage disposal from patients with communicable diseases

A $785,788.44 sewer bill. Dueling allegations about plumbing, pathogens and a potential public health risk.

Those are some of details of a $100 million lawsuit that lawyers for North Shore University Hospital, flagship of Northwell Health, the largest health care provider in New York State, filed last week against the Great Neck Water Pollution Control District, the small sewer district which has processed the hospital's wastewater for the last 70 years.

The 60-page complaint in State Supreme Court in Nassau County details a bitter standoff between the hospital and the district over how to handle sewage from 12 isolation rooms currently operating in the hospital’s new surgical pavilion.

Those rooms are specially designed to keep patients with infectious diseases away from other patients while they receive care, but the district says that the plumbing system they share with the rest of the hospital could be a vector for contamination if the sewage backs up or if hazardous waste from the rooms reached the district's treatment plant. 

The hospital says those concerns are baseless, but sewer district officials have asked for a separate plumbing system for those rooms and a holding tank for their potentially contaminated wastewater. These measures, the hospital says, would cost at least $66 million while their installation would disrupt critical patient care and provide no safety benefit. 

In 2023, Northwell reported revenue of $16.9 billion; the sewer district, which serves 25,000 people living in North Hempstead Town villages and unincorporated parts of the town, had a budget of $13.3 million. 

According to the lawsuit, the district didn't raise its concerns until last fall, as the three-year, $600 million construction job on the pavilion ended — long after detailed building plans were circulated, reviewed and approved by local and state officials. 

The hospital is asking a court to compel the district to continue its sewer service until it can make a new agreement with another provider, ending "excess flow charges" it says the district is charging improperly, citing an April bill of more than $785,000. That bill was driven up by broken meters that were stuck at maximum, according to the suit. The suit says the district maintains Northwell exceeded its water use limit.

The suit did not provide a detailed accounting of how the $100 million claim was calculated, but said that estimate covered damages "if the district’s refusal to treat sewage from North Shore is allowed to continue." (The district has said its sewage treatment for the hospital has continued "uninterrupted.") The suit said the damage estimate was conservative and did not include "reputational harm." 

In a statement, Northwell spokesman Joseph Kemp said the hospital already follows waste disposal protocols "consistent with the highest standards followed by the facilities specifically designated by the State Department of Health to treat patients with highly infectious diseases."

Lessons from the pandemic

The district has not filed a response to the lawsuit, but in a statement forwarded Thursday by a representative, district superintendent Christopher Murphy said the hospital’s current isolation room plumbing creates risks at the hospital, in sewers and at the district's treatment facility.

"All of us have learned from pandemics that no level of health risk is acceptable," he wrote. "By taking reasonable precautions, such as those outlined in the corrective action plan, we can prevent crises that are currently unknown but could emerge in the future. Addressing these deficiencies is critical to safeguarding the health and safety of patients, staff, and the broader community."

The hospital said in its suit that there is "no evidence" that pathogens from hospital waste have any greater potential to interfere with sewage treatment than pathogens from residential or other sources. "Viruses contained in sewage discharged to sewer treatment facilities without pretreatment do not pose a significant risk to sewage treatment plant workers, human health, or the environment," the suit stated.

The practice of discharging waste from isolation rooms directly into sanitary sewer systems has been followed for more than half a century "by all hospitals in the United States, including all Northwell facilities," according to the suit. 

In a phone interview, Natalie Exum, assistant professor in environmental health and engineering at Johns Hopkins University's Bloomberg School of Public Health, said the sewer district's request appeared unusual. 

Wastewater treatment plants typically require personal protective equipment for their workers and apply an array of methods to remove pathogens before releasing the treated wastewater into the environment. Those techniques may include chlorination, ultraviolet radiation, sand filtration, treatment with ozone and anaerobic separation, she said.

"There are infectious materials going down the drain all the time that could make people sick," she said. "That’s why wastewater treatment plants exist, to separate our waste from humans and remove those pathogens."

In an emailed statement, North Hempstead Town Supervisor Jennifer DeSena said Northwell is "a world-class provider of health care … I trust that they and [the district] will resolve these matters quickly for the sake of our residents."

Christopher Malone, professor of political science and associate provost at Farmingdale State College, said it was not unusual for Long Island's hundred's of small municipalities — villages and school, water, fire, sewer and water districts — to enter into contracts with outside entities in some cases larger than the taxing district.

But it was unusual for a business relationship to explode into public acrimony and a lawsuit, he said.

"It tells you that [the hospital] was getting nowhere with the municipality up until this point," Malone said, adding that the eye-popping sum demanded in the suit could serve a strategic purpose for other municipalities with whom the health care system contracts. "Looking down the road, they're going to talk to other municipalities, and they're going to listen, or else they're going to throw a $100 million lawsuit at you."