REGIONAL REPORT : Medical Waste Dumping Law Debated : Health: Officials see it as preventive medicine, but say more inspectors are needed. Critics say the risk of infection is slim and enforcement is too costly.

In San Diego County, beach-goers from Imperial Beach to Oceanside report dozens of incidents of syringes, prescription drug vials and intravenous tubing washing on shore over a two-year period.

In Carson, police investigating drug sales at a home find six 100-gallon drums of medical waste, some containing blood, that were traced to a neighboring kidney dialysis clinic.

In Orange County, health officials receive a report of dumpsters oozing plasma products discarded in the trash by small laboratories and medical offices.

These and dozens of other horror stories of medical waste improperly dumped between 1988 and 1990 raised public alarm and prompted lawmakers to adopt a 1991 law extending guidelines for the disposal of medical waste to all medical businesses, including doctors, dentists and veterinarians.

The law, written by then-Assemblyman Tom Hayden (D-Santa Monica), encouraged local governments to set up programs, financed by fees charged to medical facilities. But it also provided them the option of leaving the responsibility to the state.

Twenty-four counties--including Los Angeles--took that option, leaving regulation of about 40,000 of the state’s 100,000 medical businesses to the state’s medical waste management program and its team of four inspectors. Thirty-four other counties and three cities developed local programs to deal with their medical waste.

Many public health officials say the state is not adequately staffed to oversee these 24 counties and agree that local agencies can do a better job. But others say that local regulation is a waste of money in tough economic times, and that the issue has been overblown by media coverage and public hysteria.

Health officials in Los Angeles County, home to more than 4,000 medical businesses, say the risk of infection or death because of exposure to medical waste is too low to justify the added bureaucracy of a local medical waste program--especially in times of tight budgets and hiring freezes.

“I didn’t think we should put one dime into something that was not likely to improve people’s lives,” said Shirley Fannin, director of Los Angeles County’s disease control program. “It’s like going after a gnat with a buffalo gun.”

Studies on the dangers of medical waste seem to support what Los Angeles County officials say.

There have been no documented deaths and only one case of infection associated with exposure to medical waste, even among medical health employees, who often get pricked or cut handling the waste.

“The general public’s health is not likely to be adversely affected by medical waste generated in the traditional health care setting,” concluded the U.S. Department of Health and Human Services in a 1990 study.

And in a position paper published last year, the Society for Hospital Epidemiology of America said that “the problem is less sensational than the media, general public and legislative reaction would imply.”

But public health officials who have developed local medical waste programs believe that tough regulations are a preventive measure that, like vaccinations, will help reduce death and illness in the long run.

“Sometimes you have people saying: ‘Show me the bodies,’ ” said Bob Merryman, director of environmental health for Orange County, which has developed a medical waste program enforced by two inspectors. “But I believe in prevention.”

After the series of summer scares, San Diego County developed one of the most comprehensive medical waste programs, including a team of 27 inspectors regulating the county’s estimated 2,500 medical facilities and other hazardous waste producers.

John Misleh, director of environmental health for San Diego County, said the efforts there have helped lower the number of incidents and complaints from 90 in the summer of 1989 to one or two per month.

State officials have urged local agencies to regulate their medical businesses.

“I think services can be given better on the local level than we can from Sacramento,” said John Winn, who heads the state’s Medical Waste Management Program. “We just have not been able to bring in the funds to support our staff at this point in time.”

He said that once the state’s financial picture improves, his program may be able to hire more inspectors. For now, the state must make do with the resources it has, he said.

Maria Seguritan, one of two state inspectors responsible for four Southern California counties, said that because of a backlog it sometimes takes her a week to respond to some complaints. “The job is getting done, it’s just not getting done right away.”

Gary Erbeck, director of environmental health for the county of Santa Barbara, decided against developing a local medical waste disposal program there because he said the state law is too restrictive and too costly.

But he fears that the state’s staffing may not be adequate to respond to a major emergency.

Most incidents of illegally dumped medical waste are generated by small medical facilities such as clinics and private medical practices, authorities say.

Last year, before Ventura County developed a local program, officials surveyed 791 medical business and found that 200, or about 27%, do not treat their waste before throwing it away.

To render the medical waste safe, it is either incinerated or treated with steam in an autoclave before it is thrown away. Needles or other sharp medical equipment must be treated with a disinfectant and disposed of in a special hard plastic container.

Hayden, now a state senator, said he drafted the guidelines in response to complaints from sanitation workers who discovered medical waste in public landfills and worried about being injured.

“Common sense dictates that where there is a presence of infectious agents some precautions ought to be taken,” Hayden said. “I don’t know any sane person who advocates throwing medical waste, including blood, into another person’s lap, which is what you are doing by throwing it out in an alley.”