A consortium of environmental groups has slammed hospitals for relying too heavily on polluting incinerators to solve their waste disposal problems and called on regulators to toughen up medical incinerator rules.
A report issued by the Washington-based Environmental Working Group earlier this month calls on hospitals to use alternatives to burning and on the Environmental Protection Agency to strengthen a regulation covering medical incinerators due to take effect in July.
At issue is whether medical waste incinerators will be regulated according to capacity, allowing small incinerators to operate with minimal pollution controls.
Environmentalists say the EPA is bending to industry pressure and going easy on hospitals by holding medical incinerators to a lower standard than that of municipal or industrial waste burners.
"We think the rule should require at least as much of hospitals as it does of hazardous waste incinerators," said Jackie Savitz, analyst and principal author of the report called First Do No Harm. "Hospitals should be the leaders, not the laggards."
But the EPA counters that critics should not jump to conclusions because the regulation is still in the works.
"Our goal is, has been and remains to develop the most protective rule ever, to make sure that public health is not threatened by pollutants from hospital incinerators," said David Ryan, an EPA spokesman. "The current criticism and comments are premature."
Opponents of a relaxed rule on medical incinerators have singled out dioxins as a particular problem. Medical incinerators now rank as one of the top sources of dioxins, according to the EPA. Dioxins are a group of toxic chemicals formed when common plastics, particularly polyvinyl chloride, are burned. These plastics are twice as common in hospital waste as in household waste, because of the wide use of disposable medical products.
But hospital executives aren't taking the criticism lying down.
"The fear is that these medical incinerators are pouring out tons of dioxin, when we're talking about ounces and grams," said David Seaman, executive vice president at the Michigan Health and Hospital Association. "It's raising a specter that's unnecessarily concerning the general public."
In defense of the EPA shift, Seamen said the original incinerator rule was "incredibly onerous" and that alternatives to burning are less practical than environmentalists say.
In addition, Seamen said, errors in the Environmental Working Group's analysis cast doubt on the report's conclusions.
According to the environmentalists' report, Michigan apparently leads the nation in medical incinerator capacity with 290 licensed incinerators. But Seaman said only 45 Michigan hospitals have operating incinerators. Furthermore, he said, incinerator use in the state is on the decline.
The original EPA medical incinerator rule would have required emissions monitoring and control equipment across the spectrum of medical incinerators to reduce dioxin emissions by an estimated 99%. But after receiving 700 comments on the first proposal, the EPA last June had a change of heart and issued a summary of "inclinations for the final rule," which appears to indicate smaller incinerators will be able to continue operating without the addition of pollution controls.
Regardless of their incinerators' sizes, hospitals are making matters worse by burning far more waste than necessary, according to the Environmental Working Group. Regulated waste-infectious waste that must be red-bagged and pathological waste that must be incinerated-constitute only about 15% of all medical refuse, the group said. But many hospitals persist in burning plastics anyway, often out of carelessness or to assure that incinerators operate smoothly. Plastic burns well and keeps incinerators well-stoked to deal with less easily combustible waste. Once incinerators are up and running, a "burn-it-all" mentality can take hold, hospital workers say.
To help remedy the waste problem, hospitals could more carefully sort plastics from the waste stream, then sterilize and put in landfills much of what is now burned.
That's what Dartmouth-Hitchcock Medical Center, Lebanon, N.H., did after decommissioning its incinerator in 1995 when it was faced with a costly repair to a deteriorating incinerator chimney.
"We stress every employee has to manage their own waste, whether it's infectious, recyclable or hazardous," said Laura Brannen, waste minimization coordinator at Dartmouth-Hitchcock.
During the past few years, infectious waste volume has been cut in half through worker education. And Dartmouth-Hitchcock estimates it will save more than $1 million during the next 12 years by autoclaving and using landfills rather than operating an incinerator to dispose of those wastes.
In addition to intensive waste management efforts like those at Dartmouth-Hitchcock, market forces appear to be turning the tide as well.
Even the Environmental Working Group's Savitz acknowledged an industry shift away from medical waste incineration.
"With the emphasis more on cost control*.*.*.*there's a trend back to reusable instrumentation," said Ed Grace, team leader for material management at Sinai Health System, Baltimore. "And that cuts down on the amount of biohazard wastes."
With the demise of patient billing codes that encouraged disposable products, reusable supplies are making a comeback, some experts say.
Bad habits bred by years of overreliance on disposable products are the biggest barrier to change.
But plastic waste should decline, and dioxin levels should fall, with or without tougher incineration rules.
"The way of the future is the way we used to do it," said William McFaul, president of McFaul & Lyons, Trenton, N.J., a materials management consulting firm. "It's a mind-set that has to be changed. People are looking for excuses."