Ethylene Oxide Lawsuit in North Carolina

The EPA and international health agencies have linked ethylene oxide to lymphoid cancers (non-Hodgkin lymphoma, lymphocytic leukemia, myeloma), breast cancer, and stomach cancer. The International Agency for Research on Cancer (IARC) classifies EtO as a Group 1 carcinogen — the highest classification, meaning there is sufficient evidence it causes cancer in humans.

On July 17, 2025, President Trump signed a proclamation invoking Clean Air Act Section 112(i)(4) to grant 41 ethylene oxide commercial sterilization facilities a 2-year extension to comply with the EPA's March 2024 NESHAP emission standards. The 2024 NESHAP rule required sterilizers to reduce EtO emissions by more than 90% through installation of proven pollution control technologies. The Trump exemption allows these 41 facilities — including Covidien/Medtronic in North Haven, CT, Professional Contract Sterilization in Taunton, MA, Sterigenics in Atlanta, GA, and Cosmed in Erie, PA — to continue operating under their pre-2024 emission levels for an additional two years. The administration argued the delay was necessary to prevent medical device supply disruptions, though critics note that compliant pollution control technologies were commercially available and several facilities had already begun installation.

After medical devices are sterilized with ethylene oxide, they continue to release residual EtO gas for days or weeks as the chemical slowly desorbs from packaging and product materials. When these sterilized products are stored in large distribution warehouses, the accumulated off-gassing can produce significant ethylene oxide emissions — thousands of pounds per year in the case of large facilities like the BD warehouse in Four Oaks, North Carolina. Unlike sterilization facilities, warehouses typically have no emission controls (scrubbers, catalytic oxidizers) and no air monitoring equipment, so the EtO escapes directly into surrounding communities through building ventilation, loading dock openings, and structural gaps.

The EPA maintains a public database of ethylene oxide-emitting facilities through its National Air Toxics Assessment (NATA). You can also check the EPA's AirToxScreen tool or the Toxics Release Inventory (TRI). Major facilities include Sterigenics locations in Georgia and Illinois, Becton Dickinson in Georgia, and numerous others across the country.

The impact is mixed but on balance may help plaintiffs more than it hurts them. On the negative side, the rollback weakens regulatory negligence per se arguments — claims based on the theory that a defendant's violation of an applicable regulation automatically establishes breach of duty. With the compliance deadline extended, defendants can argue they were in compliance with applicable standards. However, the rollback strengthens several other categories of claims. The industry's successful lobbying for a compliance delay demonstrates willful disregard for community health, which supports punitive damages. The very act of seeking the exemption is an implicit acknowledgment that current emission levels pose a cancer risk. And internal communications between industry groups and the administration, obtainable through litigation discovery, may reveal the extent to which companies understood the health consequences of delayed compliance. The $363 million Kamuda verdict included substantial punitive damages precisely because the jury found the defendant prioritized finances over community safety — the same dynamic the exemption demonstrates at a national scale.

No. The EPA's 2024 NESHAP rule for ethylene oxide requires sterilization facilities to reduce EtO emissions by more than 90%, but this rule explicitly applies only to facilities that perform sterilization operations. Warehouses and distribution centers where sterilized products are stored and off-gas are not covered by any federal emission standard. There is no federal requirement for warehouses to install pollution controls, conduct air monitoring, or report their EtO emissions. This regulatory gap exists because the EPA has not established a Clean Air Act source category for EtO warehouse emissions. No state has enacted specific warehouse EtO regulations either, leaving communities near these facilities with no regulatory protection.

In September 2023, a Cobb County, Georgia jury awarded $363 million to a woman who developed breast cancer after years of living near the Sterigenics sterilization facility in Smyrna, Georgia. The jury found Sterigenics liable for negligence and awarded both compensatory and punitive damages. This was the first major EtO case to go to trial and set an important precedent.

Illinois is the most advanced, having enacted the Ethylene Oxide Emissions Standards Act in 2019 following the Willowbrook crisis. Illinois's law requires EtO emitters to meet health-based emission standards more stringent than the pre-2024 federal NESHAP, and the Illinois EPA has independent enforcement authority. Georgia has strengthened EtO oversight through the Georgia Environmental Protection Division (EPD), requiring facility-specific emission controls at Sterigenics and other operators. Connecticut and Massachusetts are actively exploring state-level EtO regulation in direct response to the Trump exemption, with Connecticut DEEP evaluating independent enforcement authority over the Covidien North Haven facility and Massachusetts reviewing PCS Taunton's state permits. New York's DEC has announced a review of all EtO facility permits. While no state has a comprehensive EtO regulatory framework comparable to Illinois's, the trend toward state-level action is accelerating as federal enforcement retreats.

Yes. While there is no specific federal regulation covering warehouse EtO emissions, the absence of regulation does not shield warehouse operators from civil liability. State common law provides multiple legal theories for warehouse exposure claims: negligence (the operator knew EtO is a carcinogen and failed to install available emission controls), strict liability for abnormally dangerous activity (storing large quantities of a known carcinogen near homes), and nuisance (chronic exposure to a carcinogen interferes with the use and enjoyment of residential property). Attorneys in North Carolina and Georgia are actively developing these claims, and the strong scientific evidence linking EtO to cancer — the same evidence that supports claims against sterilization facilities — applies equally to warehouse exposure. If you have been diagnosed with lymphoma, breast cancer, leukemia, or another EtO-linked cancer and lived near an EtO distribution warehouse, a free case evaluation can determine whether you have a viable claim.

No. While exposure evidence strengthens your case, you do not need to prove your exact exposure level. Proximity to the facility, duration of residence or work, EPA emissions data, and your cancer diagnosis together build the case. Expert testimony and EPA modeling can estimate your likely exposure.

The EPA maintains several publicly accessible tools to check EtO exposure risk at your address. The AirToxScreen tool (formerly NATA) models estimated cancer risk from air toxics at the census tract level. The Toxics Release Inventory (TRI) database lists facilities that report EtO emissions. You can search both at epa.gov using your residential address. Additionally, state environmental agencies maintain facility lists. If you lived within 5 miles of a sterilization facility, chemical plant, or industrial facility that uses EtO, you may have been exposed. An attorney can conduct a detailed proximity and exposure analysis as part of a free case evaluation.

The cancers most strongly linked to ethylene oxide include non-Hodgkin lymphoma (the strongest association, with a 56% risk elevation in heavily exposed workers per the NIOSH/Steenland meta-analysis), breast cancer (41% risk elevation in female EtO workers), lymphocytic leukemia (88% risk elevation in high-exposure workers), multiple myeloma, and stomach cancer. The EPA classifies EtO as carcinogenic to humans based on the weight of evidence across all cancer types. IARC classified EtO as a Group 1 definite human carcinogen in 1994. If you have been diagnosed with any of these cancers and have a history of EtO exposure, you may have a viable legal claim.

Individual EtO cancer settlements typically range from $100,000 to $10 million depending on the type and severity of cancer, proximity to the facility, duration of exposure, age at diagnosis, economic losses, and whether the claim involves wrongful death. The largest EtO verdict to date is $363 million (Kamuda v. Sterigenics in Georgia), while batch settlements in Illinois have averaged roughly $300,000-$500,000 per plaintiff. Wrongful death claims, occupational exposure claims (workers inside facilities), and claims involving particularly close proximity or long-duration exposure tend to settle at the higher end. An attorney can provide a case-specific valuation after reviewing your facts.

EtO cancer cases typically take 1-3 years from filing to resolution. Cases resolved through batch settlement negotiations may conclude in 12-18 months. Cases that proceed to individual trial typically take 2-3 years due to discovery, expert depositions, and trial scheduling. The Georgia and Illinois courts have developed efficient case management procedures for EtO claims. Some factors that affect timeline include whether your case is filed in a jurisdiction with an active EtO docket, the complexity of your exposure evidence, and whether the defendant chooses to settle or proceed to trial.

Workers' compensation is typically the exclusive remedy against your direct employer for workplace injuries. However, EtO facility workers may have civil claims against third parties — including the manufacturers of the sterilization equipment, the chemical suppliers who provided the EtO, the facility designers who specified inadequate ventilation systems, and in some cases the facility owner (if different from the employer). These third-party civil claims are not barred by workers' comp exclusivity and can produce significantly larger recoveries. Some workers have also successfully argued that their employers' conduct was so egregious that it fell outside the workers' comp exclusive remedy — for example, deliberately disabling safety monitors or concealing air monitoring results.

The key evidence for an EtO cancer claim includes: (1) Proof of proximity — residential records, employment records, or utility bills showing you lived or worked near an EtO-emitting facility; (2) Duration — evidence of how long you lived or worked in the exposure zone; (3) Cancer diagnosis — pathology reports, treatment records, and oncology records documenting your cancer type and diagnosis date; (4) EPA emissions data — your attorney will obtain facility-specific emissions records and EPA modeling data; (5) Economic damages — documentation of lost wages, medical bills, and other financial losses. You do not need personal air monitoring data. Expert epidemiologists and exposure modelers can estimate your exposure level based on proximity, duration, and facility emissions data.