<![CDATA[Medical waste management, essential for public health and environmental sustainability, is often hindered by systemic challenges and regulatory non-compliance at the operational level. This research is prompted by a management crisis at RSUD dr. T.C. Hillers Maumere, resulting in over 16 tons of accumulated waste due to incinerator failure a situation indicating a breakdown in management functions and internal information systems. The study evaluates the integration of Environmental Management Accounting (EMA), analyzes management performance, and assesses waste processing systems during this crisis. Using a sequential mixed-methods approach, the study examined 2022–2024 audited financial statements, documentation, and data from Focus Group Discussions and interviews. Results reveal that EMA implementation remains partial and reactive. Environmental costs, including IDR 109.7 million in 2024 for crisis-related maintenance, are fragmented and fail to serve as a strategic foundation. Management functions (POAC) exhibited systemic failures, particularly in oversight and strategic planning regarding UKL-UPL licensing risks. These findings underscore the necessity of a structured EMA framework for transparent cost reporting. Furthermore, the study advocates for transforming waste management into a core risk mitigation strategy and strengthening regulatory compliance at the top management level.]]>
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