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The paper trail tracking medical waste from hospital to landfill in Honolulu shows government agencies provide limited oversight and fail to require specific information about what’s discarded, an ongoing Civil Beat investigation found.

Six weeks ago, an intense middle-of-the-night rainstorm pounded the Waimanalo Gulch landfill. Its operator, Waste Management, decided to release a lake of contaminated stormwater into the ocean to prevent a catastrophic structural failure. But that rush of dirty water contained medical waste and other debris, which then began washing up on Leeward beaches.

From the get-go, officials with the State Health and Honolulu Environmental Services departments assured the public the medical waste was not infectious. Only treated medical waste is allowed in the landfill, and officials said there was paperwork to prove the syringes and vials of blood had been sterilized. But when Civil Beat asked the city, state and Waste Management for copies of those records, none of the three could produce them.

In a subsequent open records request to the city, Civil Beat obtained some records detailing medical waste disposal before the storm. These few records show there are many agencies responsible for handling medical waste, and oversight is split between a variety of agencies and private companies.

On Monday, Honolulu City Council members are expected to discuss asking the State Department of Health to require that all medical waste be incinerated. also urges the department to make “regular inspections of operating landfills to ensure that proper procedures and processes are being followed.” City Council member Tulsi Gabbard Tamayo is one of the Council members who introduced the measure.

“I have personally not found a single body that is responsible for this oversight,” Gabbard Tamayo told Civil Beat. “The city’s responsible for the landfill but they’re not responsible for anything before the waste gets to the landfill. I was very surprised to learn that when all this happened the Department of Health and the City said, ‘Oh, you know, we have documentation that shows the waste was sanitized.’ Much to our surprise, this documentation was only provided because the sanitizing company chooses to do it, not because they’re mandated to. The tracking that’s there is not sufficient.”

Landfill Takes Hundreds of Tons of Medical Waste

Officials report Waimanalo Gulch accepted nearly 164,000 tons of municipal solid waste in 2010. Waste Management’s Annual Operating Report — submitted in July 2010 — says the landfill accepted 972 tons of “treated medical waste” in a one-year period. The records Civil Beat obtained offer only a glimpse of those 972 tons.

Generators of medical waste include hospitals, nursing homes, dentist offices and many other facilities. They are required to submit reports detailing their treatment and disposal of medical waste. When Civil Beat asked the state Department of Health for the documents that proved the waste that went into the ocean was sanitized, a spokeswoman said the department no longer had the documents.

“We looked at it but we didn’t hang onto it,” Janice Okubo told Civil Beat in January.

Tripler

In response to Civil Beat’s record request for documents showing medical waste sanitization, city officials provided recent logs from two hospitals. One record shows Tripler Army Medical Center submitted a waste shipment record to Waimanalo Gulch on Dec. 31, 2010. It’s a two-page form, and details the following quantities of medical waste:

• One bin of general non-regulated medical waste
• No sterilized or treated sharps
• 12 treated red bags of general non-regulated medical waste

A spokeswoman for Tripler told Civil Beat in an e-mail that the hospital generated about 72 tons of medical waste in 2009, and about 84 tons of medical waste in 2010.

“Tripler Army Medical Center follows the Federal and State laws and regulations on the proper handling of regulated Medical Waste, from its point of generation within our hospital, through its steam sterilization and retorting process (converting to Solid Waste) performed on site at Tripler,” wrote Jan Clark, who works in public affairs for Tripler, in an e-mail to Civil Beat. “The documented turnover to licensed and certified transportation and disposal contractors, properly adheres to the federal and Hawaii state laws pertaining to the handling and disposal of waste and is monitored by the State of Hawaii’s Department of Health to assure compliance.”

Clark wrote that she couldn’t find the appropriate interview subject to field more specific questions about the shipment record Civil Beat obtained, the frequency with which the Health Department conducts on-site inspections at Tripler or how the hospital manages pathologic and radioactive waste. The chief of the hospital’s Environmental Services division, who is listed as a contact on the form, refused to comment. The transporter of waste from the Army hospital to the landfill is identified on the form as Rolloffs Hawaii, LLC.

“From a municipal waste standpoint, we have a contract with the Army that we take waste directly to Waimanalo Gulch,” Rolloffs Hawaii President Charlie Leonard told Civil Beat. “With medical waste, we have to have closed containers and they have to be labeled and marked clearly.”

Straub

Civil Beat also obtained a form submitted by Straub Clinic and Hospital on Nov. 15, 2010. The form only lists that date, the name of the hospital, hauler Horizon Waste, the name of the driver and vehicle license plate and Waimanalo Gulch as the destination. It also includes this statement: “I certify that the delivered material contained in the above referenced load is sterilized medical waste,” with a signature.

Repeated attempts by Civil Beat to set up an interview with Straub officials were unsuccessful. A woman who answered the phone at Horizon Waste was confused when asked about the transport of medical waste.

“We don’t do that,” she said. “We don’t handle medical waste.”

While there are no references to Horizon Waste in the documents the city provided to Civil Beat, a city spokesman told Civil Beat there are multiple haulers allowed to transport medical waste.

“The City has also been informed that SD Systems, Oahu Waste Services, Honolulu Disposal and King’s Disposal are permitted to transport sterilized medical waste to WGSL,” wrote city spokesman Markus Owens in an e-mail.    

Who Knows What Goes in the Landfill?

Tracking oversight of medical waste disposal is a challenge. Hospitals generate the waste, but private companies are contracted to transport it. Waste Management operates the landfill but the city owns it, and the state Department of Health provides the permit that allows Waste Management to accept treated medical waste.

“We’ll conduct an on-site survey of the hospitals to make sure they’re in compliance with the law,” said Keith Ridley, who runs the Health Department’s Office of Health Care Assurance. “There are a number of things that hospitals are surveyed on. Unfortunately, no one’s perfect. We always find something. We scrutinize long and hard enough that we always find something that needs to be improved. But I can’t think of any specific incident where any medical waste has been mishandled.”

Ridley’s office is responsible for inspecting the handling of medical waste at facilities, but not once the waste is shipped.

“As long as waste is contained or placed in leak-proof kinds of containers, it’s OK to be handled and labeled and transported as such,” Ridley told Civil Beat. “But unfortunately, once the waste leaves the facilities, it no longer comes under our immediate jurisdiction.”

The city’s director of Environmental Services testified before the City Council last month that Waste Management inspects the trucks that transport medical waste, but that company’s general manager, Joe Whelan, has refused repeated interview requests, citing an ongoing investigation of his company’s response to the January storm.

Rolloffs Hawaii President Leonard said while his company is well aware of the rules on handling medical waste, it has never faced an inspection from state or city officials checking for noncompliance issues.

“We haven’t had anybody come out,” Leonard said. “That’s never happened to my knowledge.”

The general manager of one of the companies that treats medical waste said he has heard from employees from the State Department of Health, but had never interacted with anyone from the city or Waste Management until medical waste began washing up on beaches.

“Never,” Hawaii Bio-Waste’s Edwin Arellano told Civil Beat. “I just only recently talked to these guys from the city and landfill with this thing that happened. Never before that.”

The approach on Oahu is in contrast to what’s done by a national leader in medical waste management. In San Diego, which has won awards for how it handles waste, many kinds of treated medical waste are also allowed to go in a landfill. But unlike the City and County of Honolulu, San Diego County is responsible for all facets of oversight. The county asked for a special designation so it could closely track medical waste disposal, rather than splitting duties with the larger California Health Department.

“When you have a big authorizing agency, it’s just not easy to ensure the laws and the regulations are followed,” said Maryam Sedghi, supervising environmental health specialist for San Diego County’s Hazardous Materials Division, in a January interview with Civil Beat. “For us, as a local agency, it makes a lot of sense.”

In San Diego, county officials follow medical waste from the hospital to the landfill, and Sedghi said the self-regulation by medical-waste generators and sanitizers in Honolulu would not be permissible there.

“Anyone who generates any biohazardous material or medical waste, we’re there,” Sedghi said. “We don’t accept any kind of self certifications. We ask the doctors to obtain a permit with us, and we inspect them on a regular basis.”

A Glimpse at Treatment

Hawaii Bio-Waste’s Arellano said his company closely tracks the medical waste it sanitizes — and regularly checks the efficacy of its equipment — but only until it reaches the landfill. As a result, he said there’s no way for him to verify whether the medical waste that was leaked from the landfill was treated at his facility.

“I bet even the landfill cannot even tell,” Arellano said. “It could be anybody. We all go to the same landfill cell. Hawaii Bio-Waste, Tripler Hospital, NCNS, Straub Hospital, all sterilizers go to the same cell. Waste that’s been washed out to the ocean is really hard to tell if it’s our waste.”

The Health Department assured the public in the aftermath of the storm that it knew the waste was non-infectious because non-infectious waste is allowed in the landfill. However the records obtained by Civil Beat raise questions about how the department can be so sure, given that there’s little independent inspection.

Hawaii Bio-Waste sanitizes about three to four tons of medical waste daily — several hundred tons a year — including pathological waste and chemotherapy waste, which cannot be put in a landfill and is placed in a container that’s heated at such a high temperature the contents turn into a “black carbon,” Arellano said.

“Placentas from Queens hospital, stuff like that,” Arellano said. “This process is at a high-temperature. Like incinceration, it works almost the same, but we don’t burn the content directly. We don’t just flame it and cook it.”

While Arellano said the in-house records he keeps are meticulous, the only record he is required to give to the state is an annual tally of how much waste he sanitizes. When Civil Beat requested the 2010 copy of that record, the State Department of Health heavily redacted it, saying it contained “proprietary information.” But in an open records request to the city, Civil Beat obtained recent logs recording sanitizers’ handling of medical waste.

Hawaii Bio-Waste submitted a “manifest for regulated medical waste disposal” on Dec. 30, 2010. It lists a bin containing more than seven tons of treated waste as having been shipped to Waimanalo Gulch, with the printed statement: “We certify that this bin of solids has been autoclaved and sterilized.” Rolloffs Hawaii is listed as the hauler.

NCNS Environmental Inc., another company that treats medical waste, did not return requests for an interview, but the city provided a record of sanitization that originated there. The medical waste certification from NCNS Environmental is similar to Hawaii Bio-Waste’s record. A log from Dec. 27, 2010 says the company sent more than five tons of medical waste — “with sharps” — to Waimanalo Gulch. West Oahu Aggregate Co., Inc., is listed as the hauler.

Joe Whelan, the landfill operator’s general manager, has repeatedly said there is no way to know just what went from the landfill into the ocean in January, or even how much contaminated stormwater his company released. But he and others emphasize they’re confident about the process for disposal of medical waste. That was the message in written testimony that Tim Steinberger, the city’s Environmental Services director, submitted to the state Land Use Commission on Feb. 2.

“The small amount of sterilized medical waste that escaped from the landfill is considered ‘special waste,'” Steinberger wrote. “Special waste is subject to profiling, which means that the company disposing of the waste must characterize it under federal and state guidelines, and provide documentation to show that it has been rendered noninfectious prior to disposal at WGSL (Waimanalo Gulch). DOH (The Department of Health) has verified that the medical waste accepted at the landfill had been properly sterilized according to law.”

Aside from meeting some federal standards with regard to medical certification, the Health Department’s Ridley said Hawaii doesn’t turn to other states or the federal government for guidance on how to manage the process.

“We don’t survey other state licensing agencies for example to see how their rules are,” Ridley told Civil Beat. “We also do the Medicare certification surveys, so as far as a national standard, that’s probably about as ‘national standard’ as we would get. The rules we have are fairly specific as far as how medical waste is treated within an office. Beyond that, it’s out of our jurisdiction.”