From ER Doctor to Air Pollution Activist: An Interview with Dr. John G. Miller

In a companion piece to her Issue 23 feature article, “Air Apparent,” which looks at how America’s cities are coping with the persistent problem of air pollution, Hamida Kinge interviews a doctor at the front lines of the pollution-related health crisis.

This is your first of three free stories this month. Become a free or sustaining member to read unlimited articles, webinars and ebooks.

Become A Member

This interview is a companion piece to “Air Apparent,” a feature article about air pollution in America’s cities, now available to read in Issue 23. To see more work by Hamida Kinge on the topic of air pollution, click here. To buy Issue 23, click here.

About ten years ago, Dr. John G. Miller, 62, grew dismayed at seeing so many patients in cardiac arrest or suffering from severe respiratory illnesses related to air pollution coming from the twin ports of Los Angeles and Long Beach. The ports, a massive, continuous industrial complex, are the single largest source of pollution in the South Coast Air Basin, responsible for 25 percent of diesel soot and 50 percent of sulfur oxide, a key component in particle pollution. Locals refer to the ports as the “diesel death zone.” Cargo ships the length of hundred-story skyscrapers burn a tarry petroleum substance called “bunker fuel,” which combines with exhaust from 16,000 diesel truck trips per day, along with other port vehicles (cranes, freight trains, etc), to generate staggering amounts of smog and fine particle pollution. That pollution is linked to premature death, severe respiratory illnesses, birth defects and cancer.

To outsiders, it might appear that Dr. Miller is lucky; he’s got an amazing view of the Pacific from his home in Newport Beach, California. But the view is also of a brown cloud of smog. About ten years ago, Miller got involved with the local homeowners association, one of several organizations pressing the ports to clean up their emissions. He is now chairman of a subcommittee of the Port Community Advisory Committee and a board chair for Coalition for a Safe Environment. At the end of 2006, the twin ports passed a comprehensive Clean Air Action Plan to reduce port pollution by nearly one half in five years. Last year, Miller testified before the Senate on behalf of the Marine Vessel Emissions Reduction Act of 2007, which proposed a reduction in sulfur in fuel used when ships are near the U.S. coast. The bill did not pass and has not yet gone to review by the new Senate. Here, an interview with Dr. Miller.

  • The California Air Resources Board estimates that 3,700 Californians die prematurely each year due to pollution from the ports and cargo-related transport.

Dr. John G. Miller.

Next American City: How did you evolve from ER doctor to air pollution activist?

Miller: I started getting very active with this when I went down to a meeting of the board of harbor commissioners about ten years ago. Basically the board wanted yet another expansion project and they had prepared an Environment Impact Report that was totally bogus. And I saw a friend of mine question this and the harbor commissioners lied to my friend. When they were lying to my friend, they were lying to the public. They were rationalizing, externalizing the cost of doing all this shipping onto the backs of the people who can least afford it. The cost of doing business is borne by the population that lives downwind, who bear the burden of excess health effects. And as we began to review the Environmental Impact Reports we learned that they were basically elaborate rationalizations to evade, avoid and nullify the California Environmental Quality Act.

NAC: You told NPR in 2006 that your environmental activism can save more lives than your work as an ER doctor. Can you elaborate on that?

Miller: As I studied this issue of port-related air pollution I realized that if I could be helpful in diminishing the air pollution by even a few micrograms per cubic meter of this fine particle air pollution I’d save many more lives than I ever would as an ER doctor. I felt as a doctor that it was my responsibility to try to prevent disease rather than just trying to treat the effects of it – trying to treat the heart attack victim and the stroke victim and the person with cancer, and all of the kids with asthma and all of the people with chronic obstructive pulmonary disease and the children with birth defects. I came to understand that air pollution was causing a significant fraction of these problems and it’s just my duty to try to diminish this.

NAC: If the burden of port pollution-related health effects is borne by those who live closest to it, how does that affect health care costs for harbor communities?

Miller: We calculated the healthcare cost of this – the Sierra Club did this and I did this on my own. Let’s say using data from the South Coast Air Quality Management District or Union of Concerned Scientists, [take the] healthcare cost estimates from this pollution, and you divide it by the number of ship calls, you’ve got around $450,000-$500,000 per ship call. I’m sitting here looking out at the ocean right now. And I see three large cargo ships. So I’m looking at $1,350,000 worth of healthcare costs that are borne by the community so that all this wonderful foreign trade can be done. So some people see these ships coming in and they say, “oh great, we have jobs.” But I look at it as “gee, we have more pollution and more healthcare costs.” We’re subsidizing this foreign trade with our health.

NAC: Because the port is an enormous industrial complex, how do local advocacy groups keep track of port activity?

Miller: We have got a whole number of Environmental Impact Reports on port expansion projects coming to us that we’re trying to study. We have noticed that the [reports] were far better than they were in the past. They really are. And again it’s not from the goodness of their heart. The port likes to take credit for all these different things as if they’re our wonderful green, good neighbor. But they’re not doing this out of the goodness of their hearts, they’re doing it because we’ve raised hell with ‘em. It’s because they’ve been sued repeatedly over the patently absurd assertions in these reports that everything is ok. But they are doing better on the [reports].

NAC: You testified before the Senate in 2008 in support of the Marine Vessel Emissions Reduction Act. But the bill did not pass.

Miller: The bill was aimed at the fact that these foreign-owned ships have had a total free ride. They can just use our air as their toxic dumping site. Industry responds by saying “We’re all gonna be broke. This is gonna raise the price of consumer goods hugely.” And yet I think it was Jessie Marquez [executive director of Coalition for a Safe Environment] that first calculated that, if this were enacted, the raise in cost for a pair of imported tennis shoes would go up by one-fourth of one penny. That’s how much it would cost the consumer. Or for a 60-inch plasma TV to arrive, the fuel cost would be $0.43-$0.96 for a foreign-made television.

NAC: How did Marquez get that calculation?

Miller: Take the number of containers on a ship versus how much the extra fuel cost would be, then divide that by the number of containers on a ship, then divide that by the number of tennis shoes per container, and that’s how he got that number.

NAC: You said in your testimony that as an ER doctor you’ve seen hundreds of fatal or near-fatal cases of illnesses associated with air pollution in the south coast air basin. Can you talk about a few cases that stand out in your mind?

Miller: The first point is that whenever you see heart attack, stroke, chronic obstructive pulmonary disease, asthma, you may not be able to say that an individual case was related directly to air pollution and yet you know that an aggregate fraction of these are, very definitely.

A case that really comes to mind for me, because it involved the wife of a friend of mine, was a woman who had lived all her life in the South Coast Air Basin. She was the wife of one of the physician assistants that worked in our ER. She was 48 years old and she was a non-smoker. She had no risk factors other than breathing this air. And Debbie developed lung cancer. She just got a nagging dry cough and finally someone took an X-ray and there it was. And, as 90-95 percent of lung cancer victims do, she died after a lot of suffering. It was my job to prescribe some morphine tablets for her when she ran out in her last week of life. And I think her death was due to air pollution.

But I’ve had cases where the air was very polluted and you could just see it driving to the hospital. I would drive over that Vincent Thomas Bridge and if you could see that brown cloud extending inland, you knew you were gonna see a bunch of respiratory stuff in the ER [that night] as surely as the sun would rise. And most people with asthma, when they go to the ER it’s a big expense for the family but they go home. They get better for the time. But I remember a 14 year old boy that was brought in full cardiac arrest by the paramedics.

NAC: Is full cardiac arrest unusual for a teenager?

Miller: You bet it’s unusual. He had a bad asthma attack and [went into] full cardiac arrest. We saved his life. But I’ve had others who have died. And also as an ER doctor, we struggle to save people lives from asthma, chronic obstructive pulmonary disease, heart attacks and strokes, but sometimes the magic doesn’t work. We fail. And when that happens, I’m the person who has to walk down the hallway and sit down with the person’s family and explain that they didn’t make it. And, you know, I’d rather not have to do that so often. If I can do something to prevent that, that’s really a doctor’s job.

NAC: Can an argument be made that the health of many of the residents in the port community may already be compromised by things like smoking or poor diet or pre-existing health conditions?

Miller: Obviously that’s an argument that can be made. But then why is it necessary to impose even a further burden on people who are already at a disadvantage? This is sort of a “blame the victim” argument. [If] the person’s a smoker, does that give us the right to electively make the situation worse for them? This is an environmental justice issue – this broad swath of pollution that we’ve come to know as the diesel death zone. As it sweeps inland it disproportionately affects communities of color and lower socio-economic groups. That’s not fair. That’s not right. It’s not right for big corporations to put the burden of their pollution on the shoulders of the people who can least afford it.

NAC: Why have shipping companies been able to get what you call a “total free ride”?

Miller: On land, the AQMD is doing things like having programs for everybody in the basin to try to turn in their lawn mowers for electric lawn mowers. And they’ve got fume-scavenging gasoline pump equipment for gas stations that’s just tremendously expensive for the station owners and yet big ships have had a total free ride. Every time this was brought up in the past, the various [governmental environmental agencies] would sort of point their fingers in a different direction and say, “oh this is a federal issue,” or “oh this is a state issue” oh this is not our job. Although now some of the agencies including California Air Resources Board and South Coast Air Quality Management District are trying to do something.

NAC: The port is in fact attempting to get ships to use low-sulfur fuel.

Miller: They’re trying to get the ship owners to use lower sulfur fuel and lower polluting techniques. The Maersk company unilaterally instituted using low-sulfur fuel in the ships near the coast putting [to rest] the argument that shipping industry would say “oh we can’t do this. It’s not technically feasible. It’ll cost way too much.” And yet Maersk did it and they’re one of the world’s largest shipping companies. To their credit, they did it and they’re doing it.

NAC: Do you believe your health been affected or compromised by living in San Pedro?

Miller: I don’t know. I can’t say that my health is adversely affected but I can’t say that it isn’t. for example, I’m 62 years old and if I come up with coronary artery disease in a year or two or something, I can’t say that it’s due to the port or not. I’ve had some health problems but are they related to port air pollution. Gee, I don’t know. This is not like asbestos and Mesothelioma where there is a single marker disease for diesel exhaust air pollution. You have a whole spectrum of health effects so these are effects that you can’t say on an individual case are related to air pollution but in aggregate you know they are.

Some of the guys that work at the port – the guys who are International Long Shore Workers Union members who work in the highest polluted area right around the ships – they’ll have early heart attacks and strokes, lung cancer, throat cancer. And they’re starting to get it. They’re starting to think that, ya’ know, when they come to work and they find out that their friend had a heart attack over the weekend and he was only 52 years old, they’re starting to think maybe this is more than just bad luck.

NAC: What in your opinion is the Port getting right?

Miller: Gradually over time the ports have developed a lot of green p.r. and frankly a lot of it is greenwash. But they’re starting to do things that are meaningful, [for example] moving forward on this Clean Truck Program. The ports have also developed, through community demand, a number of air quality monitoring stations and networked them all around the port and so they’re beginning to study this issue more carefully. They’re also funding clean technology experiments such as the idea of this electric yard hustler truck…We continue to challenge them where they need to be challenged and try to support them where we can. There’s nobody who wants to close the port down. We’re not against reasonable port growth. But we see that there’s no technological reason why the present situation has to exist. [Shipping companies] can continue to do business but all of the players have to step up to the plate and heretofore the shipping industry has had a free ride.

NAC: Is there anything that you’d like to add?

Miller: We know this: Air pollution is associated with severe birth defects including these horrible cardiac defects that the child needs a million dollars worth of heart surgery before he’s three years old or he’s going to die. And yet you talk to conservatives and they’re strangely silent as soon as you propose any actions that would impose any sort of financial burden on industry. I find that very puzzling. They rant and rave about the rights of the unborn but then you point out that this stuff is harming the unborn but you can’t get them on-board to try to fix it. They’re always talking about how these really minimum-cost interventions are going to allegedly destroy all jobs and make us all poor. Last time I checked these huge shipping corporations were multi-billion dollar enterprises. And yet the family in Wilmington has to rush their child to ER because he can’t breathe and they’re scared that he’s going to die. And even if the doctors get the child back to a stable situation and get the child home, that family is faced with a $2,000 or $3,000 bill they can’t pay. That’s wrong. That’s wrong on so many levels.

Like what you’re reading? Get a browser notification whenever we post a new story. You’re signed-up for browser notifications of new stories. No longer want to be notified? Unsubscribe.

Hamida Kinge has written about everything from food security to ocean acidification to luxury cell phones. She was a 2009 fellow of the Scripps Howard Institute on the Environment and a 2008/09 reporting fellow of the Metcalf Institute for Marine & Environmental Reporting. She has contributed to Next American City, Grist, Philadelphia City Paper and U.R.B. domestically as well as Europe-based magazines Essential Macau and Straight No Chaser. For the past year, she has been teaching English as a foreign language to international students and business professionals. Hamida has also been a volunteer English tutor for the International Center in New York.

Tags: los angelesbuilt environmentcaliforniahealthair qualityports

Next City App Never Miss A StoryDownload our app ×

You've reached your monthly limit of three free stories.

This is not a paywall. Become a free or sustaining member to continue reading.

  • Read unlimited stories each month
  • Our email newsletter
  • Webinars and ebooks in one click
  • Our Solutions of the Year magazine
  • Support solutions journalism and preserve access to all readers who work to liberate cities

Join 1104 other sustainers such as:

  • Rodney at $5/Month
  • Chris in Chicago, IL at $10/Month
  • Anonymous at $60/Year

Already a member? Log in here. U.S. donations are tax-deductible minus the value of thank-you gifts. Questions? Learn more about our membership options.

or pay by credit card:

All members are automatically signed-up to our email newsletter. You can unsubscribe with one-click at any time.

  • Donate $20 or $5/Month

    20th Anniversary Solutions of the Year magazine

has donated ! Thank you 🎉