Medical waste in North Carolina, part two

Health care facilities often spend too much treating medical waste that isn’t regulated, which ultimately increases the cost of health care and wastes resources, according to Bill Patrakis, an environmental biologist at the North Carolina Department of the Environment and Natural Resources.

“Incineration is a pretty expensive way to get rid of something when there are less expensive options,” Patrakis said.

Patrakis is called upon often by hospitals and health care facilities that are looking for ways to cut expenditures on medical waste. Patrakis suggests monitoring what waste is being sent to incinerators and paying careful attention to the law, which says that only one type of non-hazardous medical waste, pathological waste, must be incinerated.

A flow chart of medical waste from the North Carolina Department of the Environment and Natural Resources.

“If I was as an environmental manager at a hospital and I wanted to save money,” Patrakis said, “I would be very interested in knowing what it is that I have to send to the incinerators and what I don’t have to.”

According to Peter Orris, chief of occupational and environmental medicine at the University of Illinois Hospital, it’s important to set up “a system of adequate separation in the waste stream.”

“If you can get people to segregate the garbage appropriately — and that’s not just preaching to people,” he said, “it’s setting up a system — you save millions of dollars.”

A look at the Salisbury Veterans Administration Medical Center

The W.G. (Bill) Heffner Veterans Administration Medical Center in Salisbury, N.C. drastically cut expenditures on medical waste by looking at what the facility was actually putting in the waste stream.

“Most of it wasn’t medical waste,” said Victor Cocco, Green Environmental Management Systems Coordinator at the Salisbury VA Medical Center. “We went back to state regulations and basically said, ‘well, this is what has to be in medical waste and right now we’re allowing some other things to go in there.’”

By cutting back on the amount of waste sent for incineration, the hospital cut costs dramatically, Cocco said. For instance, they stopped sending sharps for incineration, because according to the law they may be properly disposed of in a landfill.

Other than incinerating pharmaceuticals, the only type of waste the Salisbury VA Medical Center incinerates is hazardous waste, which includes pathological waste. Regular medical waste is sent to an autoclave, where it is steamed for sterilization and then sent to a landfill.

The Salisbury VA Medical Center holds about seven different contracts for medical waste disposal. Some hospitals, however, only use one contract.

“At some hospitals they come and pick everything up and everything goes to an incinerator,” Cocco said. “It’s very, very cost ineffective. I think that’s probably the worst way to handle it.”

Carole Troxler, a Professor Emeritus of History at Elon University and a member of the Blue Ridge Environmental Defense League (BREDL), agrees.

“If you’re negotiating a contract about what to take from your company it’s easy to let them just take all of it and then say you’re done with it,” she said, “but if you want to be responsible you need to figure out how to separate out what needs to be burned and what doesn’t.”

Recycling alternatives

Because the Salisbury VA Medical Center is under the federal government, it is regulated by federal mandates that don’t affect state owned facilities. For instance, the facility follows presidential orders to minimize unregulated medical waste with a recycling program.

One item particular Patrakis notes that does not need to be incinerated is “boxes and boxes of hospital records that they want destroyed for one reason or another,” he said.

One effect of burning chlorine-bleached paper products is the creation of dioxins, a highly toxic chemical. According to a BREDL report, Stericycle regularly burns paper and medical documents, which also serve as a source of fuel to keep the incinerator running.

Some health care facilities insist on burning medical documents to protect patient information. Health care facilities that choose this method tend to do so because the total destruction of waste offered by incineration is comforting, according to Haley Campbell, environmental health and safety technician at Wake Forest Baptist Medical Center, a private hospital run by Wake Forest University.

“The easiest way to track it and make sure no one gets a hold of it that’s not supposed to is to send it off to get burned,” Campbell said. “You know that once it’s there, it’s burned, it’s gone.”

The Salisbury VA Medical Center, however, recycles paperwork and medical documents with a shredder, which they contract through a local agency that hires disabled people.

“They come with a truck and shred everything on-site,” Cocco said. “It leaves the site shredded and we get credit for the paper. On top of it, not only do we get paid for it, but the handicap people who handle the process get paid for it, so it gives jobs for the handicap people in town.”

Wake Forest Baptist Medical Center also keeps their patient information secure by disposing of medical documents through shredding, according to James Brunner, an industrial hygienist at Wake Forest Baptist Health. In addition, patient information is blacked out on pharmaceutical bottles so that they can be recycled rather than incinerated.

Who is in charge of medical waste?

Cocco notes the importance of health care facilities designating specific jobs in environmental and waste management positions, he says, that are sometimes forgotten by public facilities.

“Overall, most public hospitals are in trouble,” Cocco said. “They do a great job at industrial hygiene, but when it comes to environmental it kind of gets slid off to maybe the head of engineering who might not have the training or the time to focus on it.”

Alamance Regional Medical Center was called for contact on more than eight occasions. When asked to speak with someone knowledgeable of medical waste disposal at the facility, the same two source names were offered by various telephone operators at the hospital: Bill Payne, director of facility engineering and safety, and Don Scott, director of plant operations. Scott was available briefly by phone once. Succeeding attempts to contact either Scott or Payne were not successful.

As the GEMS Coordinator at the Salisbury VA Medical Center, Cocco helps make environmentally conscious choices that save the facility more than twice Cocco’s salary, he said. However, before the GEMS Coordinator position, no one was reviewing the facility’s contract for medical waste disposal.

The hospital originally held its contract with Stericycle, but when Cocco began reviewing it he noticed a dramatic increase in what Stericycle charged the hospital from year to year.

“The company is allowed to have a cost of living raise,” Cocco said. “but when I came in and reviewed it, it wasn’t a normal cost of living increase like 3 to 7 percent — they were putting a hundred percent cost of living on it and maxing it without justification because we didn’t have anyone reviewing the contract.”

Cocoo also discovered surcharges of $450 that were unknowingly being placed on certain waste containers.

“They were getting away with it until I caught them,” he said. “That was one of the reasons I kicked them out of the contract.”

Cocco soon redid the contract with a minority company, who hired Stericycle as a subcontractor, putting Stericycle on closer watch and under stricter rules. The Salisbury VA Medical Center went from being charged $1.50 per pound of medical waste, to 0.37 cents per pound.

According to Cocoo, providing specific hospital jobs for environmental management not only saves money, but keeps waste that has harmful effects on the environment from being sent to the incinerator.

Wake Forest Baptist Medical Center also strives to cut costs by monitoring what is sent for incineration, according to Brunner.

“We have millions and millions of pounds of waste every year,” he said. “We have to find ways to curtail costs and one of the ways is that you don’t incinerate everything because it’s very expensive.”

Alternatives to incineration

There are alternative methods for treating and disposing of medical waste. With the exception of pathological waste, other types of non-hazardous medical waste can be treated by at an autoclave, which uses steaming as a sterilization process, compacts the waste and then disposes of it in a landfill. Stericycle owns and operates an autoclave facility in Concord, N.C., but according to a report by BREDL the autoclave facility operates under capacity.

Stericycle’s website indicates, “regular medical could be treated in an autoclave, but generators who prefer treatment by incineration send the waste to the Haw River facility.”

Alamance Regional Medical Center is one of the generators who prefers treatment by incineration. Their sole contract for disposal of non-hazardous medical waste is with Stericycle, according to Don Scott, director of operations at Alamance Regional Medical Center.

“We think incineration is the best method,” Scott said. “It’s an approved method and there’s nothing wrong with doing it. It’s better than throwing it in a trashcan. You can’t do that.”

Why some health care facilities continue to choose incineration for waste that has viable disposal alternatives is hard to say.

“For medical people, it’s very satisfying to burn something that may be infectious,” Orris said. “All of a sudden it doesn’t look infectious at all, it looks gray. Nothing survived the heat and it’s very comforting for them to look at, but as we learn more about it, we see it’s really not a good idea.”

Scott said that the hospital has considered alternatives to incineration, but right now it continues to incinerate.

“We think incineration is a better method,” Scott said. “If you just look at it, you’re better off to burn it. You still have a lot of material left when you microwave waste, and when you’re dealing with medical waste, the cheapest way isn’t always the best way.”

No matter what method hospitals and health care facilities choose for disposing of their waste, it’s important to consider the role community members can play in the process.

“No one is speaking up for the environment in the halls of the legislature and businesses,” Troxler warned. “Is it the patients who go to the doctors who need to ask the hard questions?: ‘Excuse me nurse, what happens with your red bag waste? Excuse me doctor, do you separate your plastics or incinerate them?’ That may be the only way for change to happen.”


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