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February 2001

Managing Hospital Waste Is A Big, Nasty Deal

By Linda Remy

When people think of polluters, they rarely think of hospitals. Nonetheless, hospitals are polluters, and their responsibility magnifies because of their ethic to "first do no harm." While most of us are fed up with insurance companies "managing" our hospital stays, few of us want to know how hospitals manage their healthcare waste.

The truth is that hospitals are a major contributor to community pollution. While all employers whose workers commute contribute to pollution, hospitals contribute more than most. Thousands of employees, medical staff, suppliers, patients, and patient families travel, every day and night, to and from local hospitals.

Marin County is lucky to have three hospitals. Two operate under Sutter Health, one of the nation's largest healthcare conglomerates. Residents of the Marin Healthcare District publicly own Marin General Hospital. It operates under a troubling lease to a private corporation that today is a Sutter subsidiary. Sutter wholly owns Novato Community Hospital. These hospitals, together with Kaiser Terra Linda, are among Marin's larger employers. Sutter/MGH admits the most patients and has the most technologically advanced equipment. Thus, it creates the largest environmental burden among local hospitals and perhaps among Marin employers.

Hospitals make huge amounts of medical and solid waste. Waste products include sharp items such as used needles or scalpel blades, body parts, paper products, laboratory and pathology waste, bulk blood or blood products, uneaten food, radioactive wastes, and PVC (polyvinyl chloride) plastics. Radioactive wastes, mercury containing instruments (i.e., thermometers), and PVC plastics (which emit dioxin when burned) are among the most environmentally sensitive byproducts of healthcare.

Mercury attacks the central nervous system of the body; harms the brain, kidneys and limbs; and crosses the blood-brain barrier and placenta. Eating mercury in fish, meat, and dairy foods causes nervous system damage. Fish caught in the northern California coast, San Francisco Bay, and Tomales Bay have very high mercury levels. Recent fish-consumption advisories suggest we eat no more than two meals a month of firm fish like halibut or tuna, and people who eat one high-mercury fish should avoid the others. (SF Chronicle 12/03/00).

Dioxin is one of the most toxic chemicals known. It causes a variety of health problems. These include cancer, many conditions related to human reproduction, immune system impairment, and diabetes, as well as damaging the liver, spleen, bone marrow, and skin. Dioxin increases the toxicity of other pollutants. It persists for an extremely long time in the environment and the body, and concentrates drastically in the food chain. No amount of dioxin is safe.

To fulfill the medical ethic to "do no harm," Marin healthcare practitioners and facilities have a responsibility to create and implement sound waste disposal policies. These policies need to take into account worker safety, public health, and environmental concerns, and regulatory compliance.

One environmental, ethical and community issue to consider is the reputation and reliability of the waste disposal company and/or the treatment technology a hospital uses. As of December, several Marin physician groups and Marin healthcare facilities use IES to dispose of their medical wastes.

IES operates two medical waste incinerators at 499 High Street, in the middle of a low-income Oakland area near homes, stores, and workplaces. The incinerators emit toxic chemicals and metals, including dioxin and mercury. Thus, toxic medical waste created in one of the richest counties in the nation polluted one of its poorer neighborhoods.

An Oakland community group has been fighting against the incinerator for years. The San Francisco-based environmental group Green Action wants IES to switch to less harmful technologies, such as microwaving and autoclaving. Bradley Angel, a spokesperson for Green Action, said, "IES has a horrendous track record of environmental violations, and regulators have done very little to stop these breaches. This area, primarily populated by people of color, has become a dumping ground for some of the deadliest chemicals known to science." Angel called this "blatant environmental racism." (Daily Californian 10/25/00)

The Bay Area Air Quality Management District has cited IES for about 250 violations since 1990. In a 5-month period (October 1999 through February 2000), the Air District cited IES for 27 violations. These include numerous breakdowns, excessive emissions, inoperative monitors, and permit condition violations.

The Daily Cal article quoted Jay Silverberg, a spokesperson for IES, who rejected allegations that the company acted irresponsibly by incinerating medical waste at its Oakland facility. Silverberg is the former public relations spokesperson for Sutter/MGH.

That article also quoted Carolyn Kemp, a spokesperson for Sutter/Alta Bates. She said Alta Bates is not responsible for any possible public or environmental health problems arising from disposing their medical wastes at the IES facility.

Now that the public eye has turned on IES, it has been attempting to move the state's largest medical waste burning operation to the western edge of Stanislaus County. IES reportedly wants to burn 15,000 tons of waste annually, nearly double the 8,700 tons permitted in Oakland. (Modesto Bee, 12/13/00).

West Side residents and Modesto environmental activists have protested citing concerns over health, the environment, and the local agricultural economy. This heavily Hispanic area, already over-burdened by pollution, is still recovering from the Westley tire fire.

Managing medical waste is a major part of hospital cost saving strategies. We know from the nurse staffing cuts that Sutter is strong in cost saving strategies. According to Walsh Integrated Environmental Systems, Inc., (www.walshenvironmental.com), Sutter/MGH has had a "Waste Auditor" since July 14, 1999. The "Waste Auditor" allows Sutter/MGH to "perform a detailed waste audit, providing a snapshot of [its'] waste management situation.

To dispose of its medical wastes, MGH moved from IES to Browning Ferris Industries, recently acquired by Stericycle. With the merger, Stericycle became the largest regulated medical waste management company in North America. This company autoclaves certain medical wastes and incinerates those the law requires to be incinerated.

According to the most recent 10-K filing with the Securities Exchange Commission (03/30/00), Stericycle says that Browning Ferris Industries pleaded guilty to three violations under the Clean Water Act and agreed to pay $1,500,000 in fines and make a $100,000 community service contribution. In that same filing, Stericycle reports identification of three cases of active tuberculosis and 15 additional workers who tested positive for exposure to tuberculosis in their Morton, WA facility. "Officials of the Washington Departments of Health and of Labor and Industries concluded that workers were probably exposed to tuberculosis bacteria from the medical waste being processed at the Morton facility."

Stericycle has no California facilities to incinerate its pharmaceutical, chemo, or pathology wastes, and does this out of state. According to Green Action's Bradley Angel, Stericycle runs a commercial medical waste incinerator at the Lone Butte Industrial Park on the Gila River Indian Community Reservation in Arizona. Even though the tribal government is against the continued presence of the facility, they are unable to do anything about it because it operates under a sub-lease. Even though Sutter/MGH has made steps to reduce the environmental burden in California, our wastes now pollute other poor communities outside our state borders.

In December 1999, the Marin County Board of Supervisors passed resolution 99-168 stating that "a precautionary approach with a goal of zero exposure [to dioxin] is the only strategy that truly protects health." The Board resolved to reduce or eliminate the use of PVC plastics wherever possible. The resolution says it will urge Marin healthcare institutions to reduce PVC use and eventually become PVC-free without sacrificing patient care or worker safety. It also establishes a committee on environmental health issues to report to the Board of Supervisors with recommendations 120 days after its first meeting.

I called the Marin County Department of Health Services staff person assigned to implement the resolution. She said the Supervisors sent the letter to all Marin healthcare institutions per the resolution. The committee is not yet formed, but she said it is high on her agenda for the coming year. If you have an interest in this committee, call DHS. For the health of our community, it is important to start implementing this resolution soon.

The County joined San Francisco and Oakland, the Alameda County Health Department, California Medical Association, and American Public Health Association, which also have taken similar actions. Consistent with its legislative purpose and the goal stated in the lease of MGH -- to promote the health and welfare of the community -- ask the Healthcare District to adopt a similar resolution. Since Sutter/MGH is in the District's sphere of influence, ask the District to encourage the hospital to move further in this health and environment friendly direction, focusing particularly on reducing the use of PVC and mercury.

As a measure of its commitment to this concept, San Francisco recently banned mercury thermometers and started a program for its residents to exchange mercury thermometers for digital ones. Perhaps in their role as public officials, the Marin Health Department and the Healthcare District could jointly sponsor a similar program.

Some hospitals have returned to using stainless steel urinals and water containers to reduce PVC use. In preparing this article, I spoke with several Sutter/MGH nursing staff. They told me that Sutter/MGH has not made such simple changes in their units.

Healthcare and environmental activists can encourage our elected officials and our publicly owned Marin General Hospital and other healthcare providers to step to the forefront and become a role model in adopting more environment and health friendly programs.

Healthy Hospitals are an important part of a Healthy Community.

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