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San Jose Mercury News Thursday, August 21, 2001 
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Environmentalists work to phase out incinerators, stop release of pollutants Treating medical waste
draws fire BY ANU MANCHIKANTI Call them the leftovers of medicine. The needle for your allergy shot. The appendix that was removed after a hurried trip to the emergency room. The gloves your doctor wore as she examined your throat. When a patient leaves the hospital or doctor's office, the question is, what to do with the medical waste left behind? Burn it to ash in an incinerator, sterilize it with steam in an autoclave or shred it and kill bacteria by heating it in a microwave? In all instances, say community and environmental groups, the worst option is incineration. Some hospitals treat a small portion of medical waste on-site, but most goes to facilities such as Integrated Environmental Systems in Oakland. Because IES is the only one of California's 11 commercial medical waste treatment facilities that uses incinerators, it has found itself the target of protesters who say it pollutes the air with cancer-causing dioxin. The activists have had an impact. Student concern at Stanford University, for example, led the administration to reduce the amount of waste sent to IES for incineration and to move to purchase its own autoclave, a device similar to a large pressure cooker. IES said last week it would reduce the amount of medical waste incinerated by 70 percent within six months. IES has had other problems this summer. In June, the company's permit was suspended because of a backlog of 1,470 barrels of medical waste. By law, the waste must be treated within seven days of receipt. The state suspended the company's permit for 30 days. The plant's two incinerators are still not operating at full capacity, though the company expects they will be by the end of August. Despite all the criticism, officials from IES argue that the service provided by incineration is necessary for proper disposal. ``It's the only facility of its type, certainly in Northern California,'' said company spokesman Jay Silverberg. ``The waste has to be taken out of the waste stream. I think everyone agrees with that.'' Medical waste, as defined by the U.S. Environmental Protection Agency, is any solid waste generated in the diagnosis, treatment or immunization of humans or animals. This includes bandages, syringes, gloves, laboratory waste and removed body organs. Fail to dispose of it properly, and you run the risk of infections. In 2000 alone, California generated an estimated 81 million pounds of medical waste, said Jack McGurk of the California Department of Health Services. By state law, some of it -- chemotherapy waste, expired pharmaceuticals and recognizable body parts and tissue -- must be put in special bags and incinerated. But hospitals don't stop there. Often other material, from IV bags to syringes, is also sent to IES for burning. This material creates the dioxin problem. About 25 percent of disposable plastic products used in health care contain polyvinyl chloride, according to Health Care Without Harm, an international advocacy organization. Burning it releases dioxin into the air. Altogether, 5 percent to 10 percent of the state's waste is incinerated -- far below the 90 percent of medical waste in the United States treated that way, according to the EPA. That figure is likely to be reduced. By 2040, the EPA estimates that 50 percent to 80 percent of the thousands of medical waste incinerators nationally won't be used anymore because of stricter standards on the equipment used. McGurk defends burning medical waste at IES, which spent $5 million to upgrade its incinerators in 1996, and the few hospitals in California that have small incinerators on-site. ``That's the best type of treatment to give it, because it turns it into a carbonized or mineralized product, especially the tissue part,'' said McGurk, chief of the environmental management branch for the state health services department. Although IES operates its own autoclave and microwave, 80 percent of the 10 million to 12 million pounds of medical waste sent there annually ends up being incinerated, Silverberg said. ``Where the company can use alternative technology, it does,'' he said. Medical-waste sorting varies from hospital to hospital. Needles, syringes and scalpels must be disposed of in special red, plastic containers. At some hospitals, the bulk of the waste might end up in incineration bags. More environmentally friendly hospitals separate waste requiring incineration from that eligible for microwaving or autoclaving. Unless the hospital can take care of the waste, it is taken to a facility such as IES. ``Once medical waste is treated, it becomes by definition solid waste and can go to a landfill,'' McGurk said. Health violations State investigators, tipped off by IES employees, found hundreds of excess barrels of medical waste in May and gave the company until May 29 to issue a plan to deal with the backlog. IES met that deadline, saying it would accomplish its goal by June 4. When that didn't happen, the state health department banned the company from accepting any new waste until the old waste was treated. After IES disposed of the backlog in 10 days, the health department issued a 90-day permit on July 12 that allowed IES to reopen. During the week the permit was suspended, the Bay Area Air Quality Management District, a regional agency dealing with pollution, cited IES for improperly containing its waste. ``IES took full responsibility for what occurred,'' Silverberg said. Several factors, he said, contributed to the backlog: an increased amount of waste was received after the Memorial Day weekend holiday, some equipment was down for routine maintenance, and IES was processing less waste to save energy. ``It should not have happened. It did,'' he said. ``The company has taken steps with working regulators to get the waste removed in an appropriate fashion and is taking steps to ensure this doesn't happen again.'' Since 1996, IES has been issued 103 notices of violation by the air quality management district, said representative Luna Salaver. Reacting to concerns Some Bay Area hospitals are responding to community concerns more than others. Stanford previously sent all its waste to IES for incineration, but 95 percent of its 2 million pounds of medical waste now is being sterilized in the autoclave at IES, said Louis Saksen, vice president for general services and radiology at Stanford University Medical Center. Stanford, he said, is working on a plan to install an autoclave within a year. At Alta Bates Summit Medical Center, which has campuses in Berkeley and Oakland, 100 percent of the waste was previously incinerated. Now medical staff members sort the waste and only 10 percent is burned, said Cindy Paget, director of environmental services. ``We feel we can do our part,'' she said. Oakland Children's Hospital has used its own autoclave for 10 years, processing 5 percent to 10 percent of its waste. The rest is sent to Fresno for sterilizing, except the small percentage that must be incinerated. The University of California-San Francisco still incinerates about 80 percent of its 1.5 million pounds of waste. ``In the past, we have chosen incineration because we felt comfortable that it was total destruction of any pathogens,'' said Ara Thamassian, assistant vice chancellor for research services at UCSF. Now, he said, the school is exploring alternative methods. Often, he said, trash that is not medical waste ends up in the special bags. After scares caused by medical waste washing up on beaches and other public places, clinical labs became paranoid and threw all trash into the medical waste bags, he said. ``People come in and have the newspaper,'' he said. ``They read the newspaper, and they drop it in the bag.'' Thus, the newspaper, styrofoam cups and whatever trash ends up in the bag for medical waste is burned, steamed or microwaved just like syringes, body parts and other medical waste. Cutting incineration On Aug. 14, IES pledged it would cut the amount of medical waste incinerated by 70 percent during the next six months. The total amount of waste processed will not be reduced, but alternative methods will be used for a large portion of what's now incinerated. The company will also test microwave treatment for some human tissues. Until now, only incineration was an appropriate method for these tissues under California law. The pledges came after McGurk mediated a July 23 meeting between the company and members of some environmental and community groups that formed the Coalition for Healthy Communities and Environmental Justice. McGurk drafted an agreement for both groups, but IES was the only one that accepted the terms. The coalition did not sign the document because there was no commitment to moving to zero-incineration. ``While a step in the right direction, it still would not result in a safe operation,'' said Bradley Angel, executive director of Greenaction in San Francisco. ``We're not willing to sell out on public health to strike a deal for the sake of striking a deal.'' Silverberg said that while the incinerators must continue to operate, the company knew that it would have to start to move the bulk of its waste to different technologies because of community concern. ``We knew at some point we were going to get to this point,'' he said, ``and it's come, and it's the right step to take.'' © 2001 The Mercury News. |