El Paso residents ask if a warehouse is silently poisoning them

When Cardinal Health, one of the largest medical device manufacturers in the country, hired Maria as an accountant in 2014, she was thrilled. It was her first job out of school, and she was excited about landing a coveted position at a multinational company. For the next year, she worked at the company’s warehouse in El Paso, where Cardinal received sterilized medical products that were eventually shipped to hospitals across the country. 

When she eventually left the job for a position at a major accounting firm, she viewed her time at Cardinal fondly. Her co-workers had been kind and supportive, and she was grateful to the company for giving her a start. Over the next decade, as she moved to Seattle and climbed the corporate ladder at the firm, she had no idea that she had been exposed to ethylene oxide, a toxic chemical used to sterilize medical devices, while working at the Cardinal warehouse.

While the chemical has been linked to breast and lung cancers in large peer-reviewed studies, attributing individual diagnoses to ethylene oxide exposure is not possible. But a Grist investigation that modeled self-reported ethylene oxide emissions from Cardinal Health’s El Paso warehouses found that levels near at least one of the facilities exceeded allowable limits. The modeling results also indicated that the warehouses expose about 90 percent of the city’s population to a cancer risk above 1 in 1 million — the level that the Environmental Protection Agency strives to keep the largest number of people below — and residents living closest to the warehouses can be exposed to risk levels as high as 1 in 5,000.

Nearly a decade after leaving Cardinal, in February 2023, Maria felt a lump in her breast. Alarmed, she immediately scheduled an appointment with her gynecologist, who ordered a mammogram, ultrasound, and biopsy. The results confirmed stage 3 triple-negative breast cancer. The cancer, she was told, was nonhormonal and had advanced to multiple lymph nodes, suggesting it had been developing for some time. She had no family history of breast cancer and tested negative for mutations in the BRCA gene, which indicates a lower risk of developing the disease.

The cause of the cancer has haunted her and remains unknown, but the diagnosis upended her life. Over the next several months, she received chemotherapy and immunotherapy, including 15 rounds of radiation. Then, in the fall of 2023, she underwent a unilateral mastectomy. All along, she struggled to comprehend why she, an otherwise healthy woman in her early 30s without a family history of breast cancer, had been diagnosed with such an aggressive form of the disease. She blamed herself, initially. She recalled seeing almonds in the grocery store one day and weeping because she’d always chosen unsalted almonds to reduce her sodium intake. 

“I was like, ‘What good did that do me?’ I got sick anyway,” she said. “That was really hard — knowing that I had tried to take care of myself and it still happened.”

Earlier this year, her partner came across the Grist story and shared it with her. When she read the piece, she learned about the dangerous chemical for the very first time and now believes there may be a connection. She discovered that in the years after she’d left Cardinal, as new studies about the chemical became available, the federal Environmental Protection Agency revised its toxicity, finding that ethylene oxide is 30 times more toxic to adults than previously understood. The chemical, the federal agency had concluded, was linked to cancers of the breast and lungs. 

“It was an ‘Oh my gosh’ moment,” Maria recalled. “Obviously, we don’t know [for sure], but before we were completely in the dark about the cause. I feel like something opened up, like it could be this.” (Maria asked to be identified only by her middle name.)

Richard Peltier, an environmental health researcher at the University of Massachusetts Amherst, said that “there’s no causality here,” but given that Maria worked at a facility with ethylene oxide emissions, her diagnosis is “certainly consistent with what you might expect to see with somebody who might have an extreme exposure to ethylene oxide.” 

“Seeing breast cancer in a 30-year-old that is triple negative, that’s a pretty extreme outcome for a young, presumably healthy person,” he added.

Roughly 90 sterilization facilities across the country utilize ethylene oxide to fumigate medical devices. When products leave these facilities, they continue to release some amount of the product. In the weeks and months after, as they sit in warehouses waiting to be shipped to hospitals, they continue to emit ethylene oxide. Along the way, thousands of sterilizer and warehouse workers, truck drivers, and residents in communities near these facilities are exposed to some amount of the chemical. 

Many of them have been left wondering if the cancer cases in their neighborhoods are tied to ethylene oxide exposure. In Illinois, residents who live near sterilization facilities have sued the companies for polluting their air and received multimillion-dollar verdicts and settlements. In Georgia, a jury awarded a truck driver $20 million for having unknowingly been exposed to ethylene oxide, or EtO. And in Salinas, a seaside town in Puerto Rico, researchers have undertaken a longitudinal study to better understand whether high cancer rates in a neighborhood can be linked to ethylene oxide emissions from a nearby sterilization facility.

In El Paso, residents on John Phelan Drive directly behind another of Cardinal Health’s two warehouses were largely unaware of the emissions of ethylene oxide a few hundred feet from their homes. Grist’s investigation indicated that residents on John Phelan Drive have been exposed to a cancer risk of 2 in 10,000. That is, if 10,000 people are exposed to ethylene oxide emissions from the warehouse, two are likely to develop cancer. EPA’s acceptable threshold is 1 in 10,000 — although experts have argued that even this standard is too lax.

Numerous homeowners on John Phelan Drive told Grist and El Paso Matters that they’ve developed allergies and respiratory issues in recent years and that they regularly experience headaches and dizziness, although it’s far from clear whether ethylene oxide emissions from Cardinal Health’s facility are a cause, or the primary cause, of their symptoms.

Maria Garcia, 63, has lived on John Phelan Drive near McCarthy Park since 2001. Over the last year, she said she started frequently experiencing headaches and dizziness, and is unsure about the cause. She has sought medication for symptoms that could be related to women’s health issues, but said she wonders whether the facility directly behind her house is the true culprit. 

“I thought I was very healthy. I donate blood and take care of myself. But I do feel dizzy lately, the last one year, more or less,” Garcia said. 

The middle-class neighborhood on the eastern edge of El Paso sits just east of a major business park where numerous companies have logistics facilities, but Cardinal Health’s warehouse is one of the closest buildings to their homes. It’s quiet, and residents are tight-knit on Garcia’s block; she was part of the neighborhood watch, and her children used to help clean graffiti off the rock walls at McCarthy Park across the street from her home.   

Garcia said she used to regularly take walks around the area with her neighbor, but increasingly they’ve had to turn around and go home once headaches set in after a few minutes of walking outdoors.

“The dizziness worries me a lot,” she said.

Another homeowner on the same street, Fernando Hernandez, said he’s developed allergy-like symptoms in recent years. And he wondered whether the facility’s ethylene oxide emissions were causing respiratory problems among neighbors or affecting backyard plants; he said trees and grass have died off in the backyards of numerous homes that back up to the warehouse. 

 “I want to know, because I’ve been having allergies every morning,” Hernandez said.

Other residents also said they’ve developed headaches or dizziness. Exposure to EtO could cause similar symptoms, but it all depends on the level of exposure, said Susan Buchanan, a clinical associate professor of environmental and occupational health sciences at the University of Illinois Chicago. 

“They could be having [symptoms] if the level were high enough,” Buchanan said in an interview, adding that she hasn’t previously seen ethylene oxide exposure high enough to cause significant symptoms in a community adjacent to a facility where EtO is present. “The workers are often the ones that are exposed to [EtO] the most,” she said. Still, she said the amount of EtO that facilities are allowed to permit in most states is usually not “up to date with the current medical knowledge about the risk of exposure,” she added.

“Many facilities are allowed to emit at levels that put people around the facility at risk,” Buchanan said. “Being exposed to ethylene oxide confers a higher risk of cancer.”

Richard Richter, a spokesperson for Texas Commission on Environmental Quality, said in a statement that the Cardinal warehouses received permits from the state and that “off-property impacts from ethylene oxide were evaluated to ensure that they meet all state and federal standards and are protective of human health and the environment.” Facilities that comply with the agency’s regulations “are not expected to cause adverse health or welfare (nuisance odor or vegetation) effects as a result of exposure to the emitted chemicals,” he said.

Cardinal Health did not respond to multiple requests for comment.

The Environmental Protection Agency under former president Joe Biden issued a rule in 2024 to force sterilization facilities throughout the U.S. to significantly reduce their emissions of ethylene oxide by installing pollution controls. The rule did not apply to off-site warehouses like the ones operated by Cardinal Health in El Paso, but was a starting point for regulating ethylene oxide emissions from the medical industry. 

In July, however, President Donald Trump gave sterilization companies a two-year extension to comply with the rule. Trump said the Biden-era rule would place “severe burdens” on sterilization companies and would “force existing sterilization facilities to close down, seriously disrupting the supply of medical equipment.”

A spokesperson for the EPA said that the Clean Air Act authorizes the president to exempt facilities if the technology to implement standards isn’t available and it is in the national security interests of the U.S. to do so. The agency is currently reconsidering its rules for sterilizers. 

One of the facilities that would have faced more stringent standards was a sterilization plant operated by Sterigenics in Santa Teresa, New Mexico, just west of El Paso. New Mexico’s attorney general sued the company in 2020 and said the facility was emitting excessive amounts of ethylene oxide into the surrounding area.

Aaron Szabo, who Trump selected to lead the EPA’s air quality office, was formerly a lobbyist for the sterilization industry. 

“They have an emphasis on not enforcing standards,” Buchanan said of the Trump administration. “They’re very clear. They want to promote economic development over environmental protection.”

With little protection from the federal government, residents and workers have sought recourse in the courts. In the case of Gary Walker, the truck driver in Georgia who sued a sterilization company and received a $20 million verdict, the jury accepted that his exposure to ethylene oxide while transporting sterilized products was linked to him developing non-Hodgkin lymphoma. Michael Geoffroy, Walker’s attorney, said that his law firm is careful to take on cases where the scientific literature backs up the plaintiff’s case. 

“We do have some minimum exposure amounts,” said Geoffroy. “There are many, many clients who have had the types of cancer that we know are caused by ethylene oxide, but we do not take their case because we can’t pinpoint the exact exposure or enough exposure to where we would feel comfortable having scientists get up under oath and testify and say that ethylene oxide was a significant causal factor in their cancer.”

Maria, the former Cardinal Health accountant, has been in remission since her mastectomy. She’s still fearful the cancer will return, but is grateful she has at least one plausible explanation for her diagnosis. Learning about the facility’s ethylene oxide emissions “put a stain” on an otherwise positive experience, she said. “It’s mixed emotions.”

We created an informational guide — available in English and Spanish — in collaboration with community organizations, nonprofits, and residents who have pushed for more EtO regulation for years. This booklet contains facts about EtO, as well as ways to get local officials to address emissions, legal resources you can reference, and more. You can view, download, print, and share it here.

If you’re a local journalist or a community member who wants to learn more about how we investigated this issue and steps you can take to find out more about potential EtO-emitting warehouses in your area, read this.