Critics Say State Bill on Disposal of Medical Waste Now Toothless

A proposed state law modeled after San Diego County’s strict new medical waste ordinance has been so watered down by doctors, dentists, veterinarians and other special interests that local environmental health directors now refuse to support it.

The California Conference of Directors of Environmental Health formally withdrew its backing of the measure in a letter sent earlier this month to Assemblywoman Sunny Mojonnier (R-Encinitas), who has sponsored the bill.

And San Diego County environmental officials say Mojonnier’s measure, which is moving through the Legislature, has been defanged and is a mere shadow of the local ordinance that cracks down on dentists and doctors who improperly dispose of hypodermic needles, infectious bandages, vials and human tissue. A special provision would allow San Diego to keep its tougher ordinance, however.

“There’s no enforcement teeth in it at all,” Gary Stephany, the county’s deputy director of environmental health services, said about the Mojonnier bill.

“It doesn’t hurt San Diego because it doesn’t stop us from having our own ordinance, but the (California) Dental Assn. came out really strong against it and got it basically killed for all practical purposes,” he said.

Mojonnier last week strongly disputed the characterization of her bill, saying it is “significant” legislation that “reached a middle ground” between the economic interests of small medical offices and the general need to protect public safety. The measure was approved Thursday by the Senate Appropriations Committee and will now go before the full Senate.

“You have to consider the source where that comes from,” Mojonnier said of the criticism. “If it’s not exactly their way, they don’t like it at all.”

But the state official who shepherded lengthy talks over the bill acknowledged that many of the tougher provisions were changed or taken out at the behest of groups made up of dentists, doctors, funeral home directors, veterinarians and others.

“This is how the bill came out through the process,” said Jack McGurk, chief of the Department of Health Services’ environmental health division. “It’s not, you know, a vastly new, ongoing inspection program of all doctors’ and dentists’ offices.”

At issue is Mojonnier’s decision to drop requirements in her bill that force small doctor and dentist offices to pay a fee, develop a disposal plan and submit to periodic inspections to ensure they are properly disposing of “sharps”--needles, razors, scalpels--and other medical and potentially infectious wastes. The fee would pay for a local inspection program.

Without that provision, environmental health directors say, there is virtually no change in the current state law that already allows small medical offices--the typical medical and dental practice--to escape hands-on regulation.

“This action no longer represents the basis of responsive local government . . . “ the group wrote to Mojonnier on Aug. 14, withdrawing its support.

A spokesman for the California Dental Assn. acknowledged that his group fought to have fees and inspections of its membership taken out of the bill because it was considered “overkill” that created a massive new bureaucracy. He said the average dental office produces perhaps a pound of medical waste a month--and that most of that is needles and other sharps that are already required to be boxed up for safety before being discarded.

“Perhaps there are little pieces of gum, but they are rinsed down the drain,” said William J. Keese, a dental association lobbyist. “You don’t have arms and legs and fingers, like you do in a surgical center.”

The issue of potentially infectious medical wastes became a hot topic for state and local officials two years ago following a rash of reports about syringes, hypodermic needles, drug vials, plasma bags and other clinical debris washing up on beaches or being discovered in commercial trash bins.

In San Diego, medical wastes washed ashore from Imperial Beach to Oceanside. County health officials eventually found that Tri-City Medical Center in Oceanside and Palomar Medical Center in Escondido had illegally sent dozens of bags with blood cultures, human placentas, surgical clamps and syringes to the San Marcos landfill in late 1988.

Orange County officials received a report in October, 1988, of “bleeding dumpsters” oozing plamsa products casually discarded in the trash by small laboratories and medical offices. And of the 35 complaints last year about medical or infectious wastes, 29 were found to be connected to unregulated small medical practices, say Orange County officials.

While state health officials convened a task force to investigate the issue, San Diego County officials moved quickly to close the loophole regarding the small medical offices. They also settled on a more definitive description of medical waste than what is contained in state law.

The county and 18 San Diego cities closed the loophole last July with ordinances that require even small offices to pay a $100 annual fee, draw up a disposal plan and submit to periodic inspections to make sure they are sterilizing the wastes on site or segregating them in special red bags for pickup by designated haulers. Criminal violations are punishable by a year in jail and up to a $10,000 fine.

About 1,400 small medical offices are covered by the new ordinances, and 400 spot inspections so far show that many doctors and dentists are either ignoring or are unaware of the new rules, said Dan Avera, a county health official.

“We’re finding out that they do generate a lot of the material and, in fact, just throw it in the back of their facilities and dumpsters that are not secured,” he said. “We’d have kids get into dumpsters and pull out the sharps.”

Modeled after San Diego County’s approach, Mojonnier’s bill originally called for permits, fees and inspections of the small offices, many of which are located in the same office complexes but don’t use combined storage for the wastes.

But that key provision was eventually weakened and dropped altogether in July after numerous meetings with the dentists and other special interests, said the San Diego legislator.

“We heard from people that we never even considered in the issue--everybody from veterinarians to funeral home directors,” Mojonnier said. “We’re not here to put anybody out of business. We’re here to solve a problem.

“Compromise is the art of politics,” she said. “That’s what we had to do to reach a middle ground so . . . you’re going to be able to deal with the problem at hand and still provide for the generator of waste to stay in business.

Mojonnier added: “One (side) said A, the other said Z. I found M.”

The result is a bill that redefines “biohazardous waste” in a way that environmental health officials and prosecutors say is much more useful because it details what constitutes medicial and infectious discards. Yet it continues to exempt doctor and dentist offices from direct regulation. All they are required to do is to keep a waste disposal manifest on hand to help authorities track the origins of future incidents involving medical discards.

And that, says San Diego’s Stephany, makes the program ineffective.

“Nobody inspects them to see that it’s done,” he said. “It’s like saying the restaurants have to maintain food temperatures, they have to do this and they have to do that. We found out a long time ago that unless you inspect them, some of them won’t do it.”