Expensive disposal treatment of medical waste unnecessary

Now that the dust has settled from the March medical waste scandal at U.S. Enviromedical Corp.'s North Las Vegas plant, a few things are clearer.

A Las Vegas SUN review has found:

--Scientific studies indicate the type of waste at issue in North Las Vegas was no more dangerous than ordinary household garbage.

--While nobody suggests dumping waste of any kind in an impromptu hole near a populated area is okay, state and local laws in Nevada and several surrounding states allow untreated medical waste to be deposited in sanitary landfills.

--Silver State Disposal Service, currently the only medical waste hauler in Las Vegas, is the only local entity requiring that all medical waste be specially treated.

--Most hospitals appear to be too timid to publicly challenge Silver State's policy, fearing bad public relations.

"A lot of (waste) that we do put in doesn't really need to be treated any differently," said Pete Jenkins, manager of environmental services at St. Rose Dominican Hospital in Henderson. "Perception's a lot of what drives this, I believe."

"Medical waste ... has got a lot of public anxiety in the background that isn't always related to scientific interpretations of what the risk factor is," said Dr. Otto Ravenholt, former chief health officer of Clark County.

Occupational Safety and Health Administration regulations require sharps, such as needles and glass slides, to be transported in rigid containers and other medical waste to be placed in double plastic bags before transport.

According to federal and Nevada regulations, those boxes and bags can be placed as is in standard garbage dumps. But Silver State doesn't allow this. It charges hospitals extra for handling and treatment of these medical waste boxes and bags.

This means Las Vegas hospitals are arguably wasting tens of thousands of dollars every month having their medical and infectious waste specially treated. Silver State charges 10 times more to haul and treat medical waste than it charges for regular garbage, according to company rate sheets.

But no hospital wants to be the only one that doesn't treat its waste. As long as some hospitals are paying for treatment and disposal, the others have little choice in a competitive environment but to follow suit, said Jenkins.

"That's pretty much the way you have to play the game today," Jenkins said.

The issue of medical waste disposal has jumped into the national consciousness a number of times, most forcefully in the late 1980s when syringes began washing up on New Jersey beaches.

The issue surfaced again in Las Vegas in March, when U.S. Med was found to be illegally dumping medical waste on its property. The company ceased operations, and North Las Vegas revoked its business license. U.S. Med is suing to recover its license.

U.S. Med and Silver State have been in a series of disputes over the years, most concerning Silver State's refusal to accept U.S. Med-treated medical waste into its Apex landfill for anything below what U.S. Med calls "exorbitant" prices.

Though U.S. Med disinfected its medical waste with a chemical mixture, Silver State insists that all medical waste delivered to its Apex dump be treated by autoclaving, which is steam sterilization.

"We want to protect the health and safety of our employees and all Nevadans, and that's why we insist that all medical waste is treated," said Keith Lynam, a Silver State spokesman.

But no federal, state or local law requires Nevada companies to treat their medical waste in any fashion before depositing it in a landfill.

"The laws actually permit the waste to go directly to a landfill without treatment en route," Ravenholt said.

In fact, two of the three states bordering Southern Nevada -- Utah and Arizona -- also allow untreated medical waste to be deposited in landfills. U.S. Med deposited its waste in Arizona landfills.

California's requirements are stricter -- medical waste must be treated before going to a landfill. Arizona is considering stricter regulations. And Nevada's Washoe County departs from state regulations by requiring pre-dump treatment of medical waste.

Yet scientific evidence suggests that medical waste properly deposited in a landfill -- in medical waste boxes and bags -- is no more harmful to the public than everyday household garbage.

In 1990, Congress commissioned a Centers for Disease Control study of the issue: "Research indicates medical waste does not contain any greater quantity or different types of microbiological agents than does residential waste," states the report.

"Properly operated sanitary landfills provide microbiological environments hostile to most pathogenic agents. Therefore, untreated medical waste can be disposed of in sanitary landfills."

The CDC report cited scientific comparisons between household garbage and medical waste.

"Research conducted in West Germany indicates residential waste contains as much or more identical bacteria and fungi as medical waste," states the report. "These results have been confirmed by research conducted for the (Environmental Protection Agency) by the University of Cincinnati."

But Lynam maintains that waste treatment is necessary to prevent airborne disease.

"We disagree," Lynam said of the CDC report. "Silver State Disposal has never had a case of airborne disease infection, and there's a very good reason for that. Our strict policy of not accepting untreated medical waste is the reason."

Lynam said scientific research shows that untreated medical waste can cause disease. As evidence, he offered a series of articles in Waste News, a disposal industry trade publication, about a medical waste treatment facility in Morton, Wash., where two workers contracted tuberculosis from medical waste.

The Morton disposal workers were employed at a facility where medical waste was being shredded and treated prior to disposal, not at a landfill where untreated waste was dumped. According to the articles, they contracted TB because worker protection measures were not properly followed.

According to waste disposal experts, proper worker protection measures are necessary no matter what type of waste is being handled. Provided that these measures are followed, there is little indication that workers who handle medical waste are any more likely to contract disease than those who handle other types of waste.

In fact, the most infectious diseases found in the United States -- hepatitis, tuberculosis and HIV -- either do not live long outside the human body or can be easily controlled by "typical barrier containment," which essentially means keeping them away from people for a week or two, said Sven Rodenbeck, one of the CDC report's authors.

Les Gould of the Nevada Division of Environmental Protection said Nevada law requires landfilled medical waste to be covered with 6 inches of dirt daily and 36 inches when that section of the landfill is full, measures intended to "lock-in" the waste and reduce the risk of airborne infection.

Despite the scientific evidence, area hospitals that pay only 4 cents per gallon to have their regular trash picked up must pay 41 cents per gallon to dispose of their medical waste, according to Silver State rate sheets.

"I know we pay an awful lot of money that several years ago, when I started in this business, we did not," said Randall Hempling, administrator of Lake Mead Hospital.

The difference in Lake Mead's monthly bill is astronomical. The hospital pays $150 a month to dispose of its regular trash. For its medical waste, the hospital pays $1,500 to $2,000 monthly, Hempling said.

"We just end up having to pass those costs along," said Lake Mead's Hempling.

Higher medical waste disposal bills cost each of Lake Mead's 500 monthly patients an extra $5, Hempling said.

The reason hospitals are paying high premiums for a service the government doesn't make them buy is simple, hospital officials say: the public is anxious about what it perceives as the potential harmful effects of medical waste, and wants that waste treated differently.

In a 1997 report, the American Medical Association agreed.

"The general public perceives that biohazardous waste from medical facilities poses a considerable risk to public and environmental health, despite the lack of evidence of significant public and environmental health problems," the report concludes.

And in many cases, that public anxiety appears to be driven by the very medical waste disposal companies that stand to benefit from stricter medical waste disposal standards.

"Because of intense and often misleading media coverage of this issue and a lack of understanding of disease transmission, the states and the federal government created strict regulations, which aggravated the problem by defining more waste as infectious," wrote doctors William A. Rutala and David J. Weber in a 1991 New England Journal of Medicine article. "The result is an extraordinary increase in cost with no environmental or public health benefit. The medical-waste policies that have evolved from perceived risks over the past few years should be supplanted by rules based on scientific considerations."

"If the new rules won't benefit the public health or protect the environment, who will they help?" wondered an editorial in the American Medical Association's American Medical News in 1992. "Medical waste companies, that's who. These companies are lobbying hard for broad new requirements that will transform the nation's physicians and dentists into cash customers."

Lynam disputes any suggestion that Silver State's policies are based on economic considerations.

"We aren't driving this because of dollars," Lynam said. "We're driving this because of public health and safety."

But health care industry representatives tentatively agree with the AMA view.

"I could probably agree with that," said St. Rose Dominican's Jenkins when asked about the AMA article.

"I think that drove a lot of that," said Columbia Sunrise's George Jones, director of safety and support services, when asked whether the waste disposal industry is driving tougher regulations.

"I'm sure to some extent that's true," said David Barron, facility manager at Boulder City Hospital. "You have so many special interests out there that drive a lot of stuff."

Lake Mead's Hempling said costs are only part of the problem.

"We've kind of been hampered by just the overall change in the handling of the waste," Hempling said. "I think we probably go into an overkill kind of mode. Most of the time we throw more in there than we need to."

"They have produced very costly requirements on medical offices," said Lawrence P. Matheis, executive director of the Nevada Medical Association, of the stricter rules.

No expert thinks it's okay to dump medical waste in a hastily dug hole in a populated area. The point they make is that as long as government handling regulations are followed when medical waste is transported, there's no reason it can't be safely deposited in an approved landfill.

"If there isn't a scientific or public health reason to do more than what is done in the facilities already in terms of the double bagging and the protection against pointed objects," Matheis said, "then any additional work that is done is an excessive cost."

But Silver State says that by treating the waste before it goes to a landfill the company avoids any future liability for harm to its workers. Plus, Silver State will never face the possibility of having to 'clean up' its dump if more restrictive regulations are passed in the future, the company argues.

"Our strict policies protect the health and safety of our employees in Nevada," Lynam said.

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