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#228 - Not What The Doctor Ordered: Medical Wastes Invade The Countryside, 09-Apr-1991

Across the land, rural people are being besieged by waste haulers hell-
bent on opening landfills (dumps) and incinerators for all kinds of
wastes. The southern and midwestern states are particularly hard-hit;
there the dumpers are conducting open warfare against local people.
Ironically, haulers are often using medical wastes to get a foot in the
door. Who could oppose "responsible, state-of-the-art disposal" of
wastes created by nurses and physicians rendering aid to the ill and
infirm? Some communities have even allowed themselves to be convinced
they have an obligation to take such wastes, almost a patriotic duty.

Unfortunately, the situation is not so simple as it may appear. The
nation's nurses and doctors are doing good as they produce their
dangerous wastes, but many of these wastes are unnecessarily dangerous
and some of them are just plain unnecessary; worse, the medical
community is handing dangerous wastes over to fly-by-night haulers who
are trucking them into the countryside where they think they can
bamboozle local people, or prey upon their sense of patriotism, or
simply dazzle them with money.

Unfortunately, there are no federal regulations covering medical waste
incineration. Each state must pass its own regulations and few have
done so; fewer still have developed effective enforcement. Though
proponents of new medical waste disposal facilities complain that they
are confined by a web of strict regulations, the truth is, medical
waste regulation is in disarray and the rule of the day is generally
"anything goes."

After the summer of '88, when the Jersey shore found itself awash in
needles and blood bags, doctors and their institutions (hospitals,
labs) were willing to pay very high prices to clean up their image in
the press. To get constituents off its back, Congress passed a half-
hearted statute, the Medical Waste Tracking Act. (That law merely tries
to create a paper trail for medical wastes in 10 states, as a pilot
test of a medical waste tracking system.) The media furor created a
business opportunity for anyone with a dump truck and the nerve to
paint "Hi-Tech Med- Waste--You Call We Haul" on its door. So the past
few years have witnessed an explosion in "medical waste processing"
companies--many of them brand new to the business. The big haulers like
Waste Management and BFI (Browning-Ferris Industries) jumped in and
created new divisions just to handle medical wastes--though these new
divisions use the same old polluting technologies their other divisions
have used for a decade--landfills and incinerators.

A recent report from the Citizens Clearinghouse for Hazardous Waste
(CCHW) can help people get these problems into perspective. Entitled
problem in particularly graphic terms, giving several short case
studies showing how unscrupulous haulers buy local officials (for
example, giving the mayor stock in the company), then bulldoze their
way into a community demanding the "right" to pollute the local
environment with body parts, needles and syringes, clothing and
equipment contaminated with deadly diseases, lead, mercury, cadmium,
and even some radioactive materials. Medical waste is not just Kleenex
and Band-aids, and the people bringing these wastes into rural America
are not on an errand of mercy.

As with all pollution problems, real solutions must begin at the
source. Medical practitioners simply use too many disposable items.
This is a complex problem. If a hospital offers you a stainless steel
bedpan, then pays a staff member to empty it, sterilize it and put it
back in the supply closet, they can't easily tally the expense and
charge you the way they can when they sell you a plastic disposable
bedpan and throw it out after one use. The patient buys each throw-away
and pays for it, itemized on the bill. Hospitals can mark up each item
and make a small profit. In this sense, disposables are good business.

Secondly, there's an army of aggressive sales people urging the latest
"innovation" on every doctor and every hospital administrator. The
plastics people are especially good at pushing their products and
they've got the medical world convinced that plastic throw-aways are
modern, steel reusables are not.

Thirdly, fear of aids--and of other infections and liabilities--induces
hospitals to use disposables. (This fear is not justified; reusable
items can be safe, but both doctors and patients have to be educated to
the facts.)

To handle the medical waste problem, the people who create medical
waste need to examine their daily routines, item by item, procedure by
procedure, and ask themselves why they use one product instead of

If they choose to use plastic items, they should require plastics that
contain no cadmium, no lead, and no chlorine. These are common toxins
in plastics and they make waste disposal dangerous. Doctors and medical
administrators could drive bad plastics out of existence if they wrote
careful contracts with their suppliers.

The number of disposable items should be decreased wherever possible.
Reusable items should be sterilized by autoclave (subjected to high-
temperature steam for sufficiently long to achieve sterilization);
modern autoclaves work faster and better than the old designs. A study
by California state government showed that regional autoclaves are the
cheapest way for hospitals to sterilize equipment--cheaper than each
hospital having its own autoclave, and cheaper than incineration. (See
RHWN #179). An alternative to the autoclave is microwave technology.

Sharps (needles and scalpels) should be collected separately,
sterilized, packaged securely, and sent to a landfill or processed by
patented proprietary techniques.

Organic materials, including body parts, should be shredded,
sterilized, then landfilled.

As Paul Connett of Work on Waste says, from a scientific viewpoint,
"using an incinerator to disinfect pathogens is like using a chainsaw
to cut butter."

(Falls Church, VA: Citizens Clearinghouse for Hazardous Waste [P.O. Box
6806, Falls Church, VA 22040; phone (703) 237-2249], 1990). $8.50. For
an additional $15, CCHW sells an excellent packet of 42 reprinted
articles on medical wastes. For $1.75 more, you get first-class mail

And get: Office of Technology Assessment, FINDING THE RX FOR MANAGING
MEDICAL WASTES [OTA-O-459; US GPO Stock No. 052-003-01204-9]
(Washington, DC: U.S. Government Printing Office, 1990). $4.75. 76 pgs.
Phone (202) 783-3238.

--Peter Montague



We have added a new database to Rachel (our online computerized data
system accessible to the public via modem). It contains 11,389 records
from the U.S. Environmental Protection Agency's Civil Enforcement
Docket; basically, it is a record of every civil lawsuit EPA has
brought against polluters in federal court from 1972 through 1990.
(There were not 11,389 suits brought; there were 2281 but they involved
11,389 separate defendants. In some individual cases, such as a large
Superfund lawsuit, a hundred or more individuals and companies might be
named as defendants.)

As with all the databases in Rachel, you can search this new one by
every word in every document. For example, you can type in a company
name like Westinghouse and get all the Westinghouse records. Or you can
type in Kingston and get all records for towns named Kingston. Or you
can type in a postal code for a state like NH (for New Hampshire) and
get all records for the state of New Hampshire. Type Davis and you'll
get several records about individuals named Davis who have been sued by

The raw data from this new database comes from U.S. Environmental
Protection Agency's Civil Enforcement Docket, sold on diskettes by
National Technical Information Service (NTIS; 5285 Port Royal Rd.,
Springfield, VA 22161; phone (703) 487-4650). Order item No. PB91-
591970S. $320.00.

Rachel stands for "Remote Access Chemical Hazards Electronic Library"
though it was really named for Rachel Carson, a true hero of our time.
To get a free account on the Rachel computer simply dial into 410/263-
8903 and log on.

--Peter Montague


Descriptor terms: epa; civil enforcement docket; computers; superfund;
lawsuits; courts; databases; ntis; waste disposal industry;
landfilling; incineration; medical communities; regulation; medical
waste; hazardous waste; nj; beaches; clean water; water pollution;
medical waste tracking act; wmi; bfi; cchw; studies; lead; mercury;
cadmium; radioactive waste; heavy metals; disposables; alternative
treatment technologies; autoclaving; paul connett; ota; brian lipsett;