Medical waste in North Carolina, part 1

As long as we have hospitals, medical waste will be unavoidable; the question is, what do we do with it? 

Imagine 27 million pounds of medical waste: blood stained bandages, syringes, IV bags from chemotherapy, human tissue, organs and limbs. Now picture it being incinerated by the largest medical waste treatment company in the United States less than 15 miles down the road from Elon University.

Turns out, you don’t have to imagine it.

There are 57 medical waste incinerators still in operation in the United States. 14 of them are commercially owned and the medical waste treatment company Stericycle operates eight of them, one of which is located in Haw River, just east of Burlington. Since Stericycle took over the facility in 1999, this is the site where many producers of medical waste in North Carolina, and 26 other states from Vermont to Wisconsin, send their medical waste to be burned.

What exactly is medical waste? This chart breaks the waste stream up into its different categories. Graphic by Katy Steele.

The environmental impact of incineration

According to a study by the Environmental Protection Agency, medical waste incinerators are the leading producer of dioxins, a highly toxic chemical that’s formed when organic substances are burned in the presence of chlorine. Dioxins are known carcinogens and the main substance in the chemical warfare gas, Agent Orange. They are one of many air pollutants emitted from Stericycle’s smokestacks that environmental advocates consider a public health concern.

Tom Mather, a spokesman for the North Carolina Division of Air Quality (DAQ), the department in charge of issuing the air quality permit to the Stericycle facility at Haw River, said that the DAQ pays very close attention to emission from the facility.

“It has an up-to-date permit,” he said, “and we’ve made changes to the permit and feel like we are addressing the concerns.”

Incineration still creates air pollutants, however, according to David Mickey, former Zero Waste Coordinator for the Blue Ridge Environmental Defense League (BREDL).

Smoke stacks at Stericycle's facility in Haw River.

“Incineration involves risks for public health regardless of how well the facility is run, or how well the state might monitor their permit,” he said. “They’re still going to have emissions — it’s part of the system.”

Polyvinyl chloride (PVC) plastics and chlorine-bleached paper are non-regulated medical waste products that often end up incinerated, yet it is known that they produce dioxins when burned.

“If you incinerate a lot of the plastics and industrial chemicals we use today you get dioxins,” said Peter Orris, chief of occupational and environmental medicine at the University of Illinois Hospital. “Every bit of dioxin that is added to the environment is not a good idea.”

Other emissions coming out of Stericycle’s smokestacks include: lead, a heavy metal that can damage the brain; particulate matter linked to lung cancer, also known as soot and dust; arsenic; and mercury, a potent neurotoxin that can hinder brain development.

Since 2000, Stericycle has received 11 permit violations from the DAQ, more than half of them for violating pollution and emission standards set by the EPA. Violations issued in both 2002 and 2004 were for exceeding the allowable level of mercury emissions. Data released by the DAQ ranking the top 60 mercury emitters in the state from 2007-2010 ranks the Stericycle facility in Haw River at number 21.

Medical waste incineration and local government          

According to, Carole Troxler, a member of BREDL and professor emeritus at Elon University, it’s up to local government to protect their citizens and the environment.

“Local government used to think that the buck stopped in Washington and that all they had to do was comply with rules from the EPA and Congress,” Troxler said. “But the buck starts in Washington and heads in this direction — it comes right back to our local government and they don’t exactly have a track record for caring much about protecting our environment.”

In Nov. 2010, the state Environmental Management Commission adopted rules making stricter emissions guidelines imposed by the EPA enforceable on July 1, 2013 instead of Oct. 6, 2014. Before this however, Alamance County Commissioners voted not to pass a resolution that would have forced Stericycle to meet the stricter guidelines even earlier — by 2012 instead of 2014.

Linda Massey, an Alamance County commissioner voted against the resolution and reiterated that she doesn’t believe pollution from the Stericycle facility is an issue.

“I know people who have worked [at Stericycle] for 14 or 15 years and they don’t even wear a mask in there,” Massey said. “If the people who work there aren’t afraid of what they’re doing, I think that’s a good sign there’s no contamination coming out that affects them.”

Air pollutants from the smokestacks can accumulate in the air and travel through wind currents. The elderly, pregnant women and young children, people with asthma and those within five miles of the incinerator are at the greatest risk for being aversely affected by the emissions.

“I wouldn’t live there,” said Therese Vick, community organizer at BREDL. “I wouldn’t want my children to live close to it either.”

At least 13 schools and 23 daycares are located five miles or less down the road from the incinerator. Alamance Community College, which also houses a childcare facility, is 0.7 miles away.

Massey noted that she depends on the EPA to monitor if Stericycle is meeting the set guidelines.

“You’ve got to get rid of all that waste somehow,” she said, “and if Stericycle can do it and still be in compliance with the EPA, then I don’t have a problem with it.”

According to Troxler, however, it’s the city commissioners’ responsibility to protect the environment and their local citizens, yet they often get so caught up in only meeting state regulations that they don’t see the bigger picture.

“They’re still in the mindset that all we have to do is satisfy the state regulations and we’re home free,” Troxler said. “Well, they may be meeting state regulations, but they’re exposing citizens to harm.”

Medical waste incineration and North Carolina state law

According to North Carolina state law, the only type of medical waste required to be incinerated is pathological waste, meaning human tissue, organs, body parts and carcasses of infected animals.

Of the 27 million pounds of waste burned at Stericycle in the 2009-2010 year, only a portion of it was actually pathological waste, according to Bill Patrakis, an environmental biologist at the North Carolina Department of the Environment and Natural Resources.

“All this other stuff they are incinerating, as far as we’re concerned, does not need to be incinerated,” he said, “but they choose to incinerate it anyway.”

According to Stericycle, 40 percent of the waste they handle is pathological, 40 percent is regular medical waste, 15 to 20 percent is chemotherapy medical waste and 1 to 2 percent is pharmaceutical waste.

For non-pathological waste there are alternative treatment and disposal methods, such as autoclaving. Stericycle runs an autoclave facility in Concord, N.C., which uses steaming as a sterilization process, compacts the waste and then disposes of it in a landfill.

Currently, no state law exists mandating that hospitals and waste generators use incineration alternatives for waste that doesn’t fall within the pathological category— instead, it’s up to the waste generator to decide where their waste goes.

“I’m just guessing if hospitals understood the law, they could probably save themselves thousands of dollars,” Patrakis said.

According to a report by the EPA, 2 to 3 percent of hospital waste has no treatment alternative to incineration, but this does not mean only 2 to 3 percent of total hospital waste is incinerated.

“Often, inadequate waste segregation due to poor waste management techniques and lack of staff training will result in more waste sent to incinerators than necessary,” the EPA report said.

Patrakis noted that Stericycle might not necessarily know exactly what is going into the incinerator.

“What goes to Stericycle for incineration is whatever the hospitals send them,” he said, “and Stericycle isn’t obliged to check every box that comes to their incinerator and say, ‘This can be incinerated and this can’t.’”

Patrakis said this responsibility rests on Stericycle’s clients — those actually generating the medical waste.

“Stericycle is just hired to do a job,” he said. “It’s really the health care centers that need to do a better job determining what needs incinerated and what doesn’t.”

According to Patrakis, there are no state laws through the N.C. Division of Waste Management mandating waste generators make environmentally conscious choices by segregating their medical waste.

“The Division of Waste Managment doesn’t get involved in waste segregation, and I’ll tell you why,” he said. “Up until the waste leaves the hospital or facility, it’s their responsibility. Once it gets to the treatment plant, at that point, it becomes the waste hauler’s problem. Its’ up to the hospital administration to tell their staff, ‘This is how we want you to segregate it.’”

Across the board, the segregation, treatment and disposal of medical waste is handled differently at federal, private and public health care facilities.





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