State, County Act to Tighten Rules on Medical Wastes

State and county health officials are taking steps that could lead to tightened regulation of infectious medical wastes, including those produced by small clinics and doctors’ offices, as authorities investigate how blood samples, used syringes and bandages have washed ashore on the state’s beaches and surfaced in its landfills.

The state Department of Health Services has put together a task force to study the spectrum of problems associated with the production, handling and disposal of infectious medical wastes, including the exemptions now afforded so-called low-level waste producers.

Meanwhile, the Los Angeles County Department of Health Services has been ordered to determine if the county should do what the state does not: subject all producers of infectious wastes to the same standard of conduct. The San Diego County Board of Supervisors took a first step in that direction last week.

“The whole issue of infectious waste is out of hand,” said Ralph Lopez of the environmental health section of the Los Angeles County Health Department. “What the state (task force) is hopefully going to do is zero in on . . . the gaps.”

One of the gaps, one state official said, is a longstanding dispute over the state’s authority to enforce waste disposal regulations on federal military installations.

The issue was highlighted earlier this week when health officials in San Diego and Orange counties linked to the military both medical wastes and unopened vials containing antiseptics that had washed ashore in their jurisdictions. The officials have not yet pinpointed the specific source.

Despite the recent incidents, several officials said they believe that California handles its medical wastes with more care than most states.

“I believe the system we have in place right now is woking pretty well. I think the incidents of illegal dumping like this are relatively few and far between,” said Bob Borzelleri of the state Department of Health Services.

“I think (the illegal dumping) basically represents people who are shoddy handlers who are going to be shoddy no matter what your regulatory approach,” he added.

Borzelleri said California’s problems are nowhere near as serious as those that last summer haunted East Coast beaches, where scores of syringes, blood samples and other potentially dangerous medical debris washed ashore.

California law requires that all producers of infectious wastes take specific precautions in the handling and disposal of needles and other sharp objects; human body parts, and so-called etiologic agents--viruses or micro-organisms capable of entering and harming the body. Violations can result in felony prison terms and tens of thousands of dollars in fines.

However, doctors’ offices, small clinics and other unlicensed health facilities that produce less than 220 pounds of potentially infectious waste each month are exempted from a host of other requirements governing everything from sterilization, incineration and burial procedures to the minimum strength of plastic disposal bags.

The San Diego County Board of Supervisors on Nov. 9 directed county attorneys to develop an emergency ordinance that would lift that exemption in all unincorporated areas of the county.

In addition to the medical wastes that have washed up on San Diego County beaches in the last three weeks, workers at the San Marcos landfill in San Diego County on Oct. 27 discovered as many as 14 red plastic bags containing human tissue and surgical instruments that had been improperly transported and buried at the dump. Both tissues and surgical instruments are classified as potentially infectious.

State law requires that such infectious materials be properly processed, placed in plastic bags and then sealed in leak-proof containers before the containers are buried. At the time, authorities said none of the potentially infectious materials found at the San Marcos dump had been properly incinerated or sterilized.

In Los Angeles County, health officials are studying a plan that would impose similar responsibilities on low-level producers of infectious medical wastes.

“All of us can remember some incidents throughout the county where you’d find some (potentially infectious medical) paraphernalia in a dumpster,” Lopez said.

“Where the big gap seems to be is the small producers. They’re not really reviewed. There are large numbers of doctors’ offices and medical clinics where people really have no handle on how much medical waste is being produced,” the health official added.

One Issue

San Diego County Supervisor Susan Golding has suggested legislation that would lift the exemption for low-level producers statewide.

That is one of the issues that the state infectious-waste task force will take up.

“Maybe there ought to be something that is uniform across the state,” said Jack McGurk, a task force member who is the chief of environmental planning for the state Department of Health Services.

The task force will “address the whole infectious waste management program from generation to handling, treatment, transport and disposal,” he said. “We’re looking at the waste streams and what’s being classified as infectious wastes, how are these things being handled.”

The task force will draw up a set of recommendations for presentation to state Health Director Kenneth W. Kizer.

State health officials are examining their ability to enforce infectious waste regulations on military installations.

“When it comes to hazardous waste handling, nobody is exempt,” Borzelleri said.

However, he added: “There has historically been some argument on the part of military facilities that the state might not have regulatory authority on their premises. . . . The position from the military in the past has been that they will go ahead and enforce good environmental practices, but the state did not have the authority to enforce.”

Orange County officials Thursday were investigating legal avenues for prosecution of the Navy or its contractors for allegedly dumping the vials of antiseptic used in biological warfare.

Navy spokesmen in San Diego continued to maintain that the vials probably are Defense Department materials, but could have been dumped by a number of military agencies or contractors and not necessarily by a Navy ship.