Millions at Risk From Burned Hospital Waste

Waste management policies of one of the largest hospital associations in the United States are endangering the health and environment of millions of people, the "Health Care Without Harm" coalition said in a report released here on Febrary 2.

That conclusion likely will fuel opposition to medical waste incineration in many parts of the developing world, where the practice is being promoted despite local opposition, activists predicted.

In its report, the coalition of some 70 U.S.-based health organizations blasted the policies of the American Hospital Association for being guided by a consultant who had vested interest in promoting medical waste incinerators, which emit toxic chemicals such as mercury and cancer-causing dioxins.

The consultant, Larry Doucet, of the New York firm of Doucet and Mainka, also designs and engineers incinerators. Doucet, according to Health Care Without Harm, allegedly misrepresented the dangers of medical waste incinerators and lobbied hard to weaken environmental regulations.

The consultants action constituted an "enormous conflict of interest," according to the coalition of doctors, nurses, and public health experts.

"The AHA needs a second opinion," said Dr. Michael McCally, professor and vice chairman of community medicine at the Mount Sinai School of Medicine, in New York. "The AHA can prevent its 5,000 hospitals from harming the public, but first they must stop listening to Doucet and start looking at the latest findings on dioxins and mercury."

Doucet did not return requests by journalists for comment but AHA spokesman Rick Wade defended the association's choice of consultant. "I'm having trouble seeing the conflict in hiring someone for this position who knows a great deal about incinerators," he told IPS.

"Health Care Without Harm" maintained, however, that the AHA, widely considered among the most powerful lobbying groups in Washington, has compromised its independence by "ignoring a mound of scientific evidence and relying on flawed advice."

Scientific authorities -- including the U.S. government's Environmental Protection Agency (EPA) and the American Public Health Association -- recognized that medical waste incinerators emit toxic chemicals that cause cancer, birth defects, testicular atrophy and other debilitating diseases, said "Health Care Without Harm."

In 1994, the EPA found that dioxins were carcinogenic and also can cause severe health disorders such as birth defects as well as endocrine, reproductive and immune system disorders. The threat in part comes from the incineration technique itself, and partly because hospitals use, and then discard, especially high amounts of dioxin-releasing chlorine in the form of bleach and plastic-like polyvinyl chlorides, commonly known as "PVC." Mercury, which is poisonous, is used in thermometers.

Human exposure to dioxins released by incinerators is not limited to breathing in polluted air. Once released into the air as invisible particles, the dioxins eventually settle in soil, water, and on grass. In turn, they are eaten by animals, such as cows, and are stored up in animal fat. Next, they are passed on to humans through the food chain.

Breast-feeding infants are most at risk from dioxins emission, consuming 15,000 to 30,000 times the safe level of dioxins, according to the EPA's 1994 report. Additionally, an estimated 1.6 million pregnant women and women of child-bearing age are at risk of mercury contamination from eating fish.

While the EPA has suggested the use of pollution control devices on incinerators to diminish the emission of dioxins, Health Care Without Harm is calling for an end to unnecessary incineration and the phase out of the use of PVC and other toxic chemicals.

"From Cleveland and Baltimore to the South Bronx, often these incinerators are put where officials think there will be the least resistance -- in communities of color and poor communities," Brody told IPS. "But people are fighting back against this environmental racism."

Opposition also has spread in parts of the developing world, where the World Bank has promoted medical waste incinerators over the objections of some of its own staff.

"It's dioxins versus scavengers," a Bank spokeswoman told IPS. In India, for example, the lending agency has sought to protect rag-pickers and make it impossible for people to reuse contaminated needles and medical equipment.

Most Indian hospitals dump their waste in municipal landfills or other sites easily reached by the rag-pickers. These people provide a valuable service, reducing the volume of waste in the dumps -- but at tremendous risk to their health from infectious medical waste. Many do this work with bare hands, and on bare feet. Injuries from sharp objects and noxious chemicals are common, according to social workers. However, the Bank, under pressure from health and environmental groups here and in the borrowing countries, last year suspended a number of hazardous waste projects and assembled a task force to study the technology.

Groups protesting the Bank's projects included the Calcutta-based Drug Action Forum of West Bengal, the Indian Campaign Against Medical Waste Incineration, and the Washington-based Multinationals Resource Center.

Until these groups raised their voices, the Bank had sought to silence its own critics, according to internal documents and sources. Officials in the Bank's South Asia department in January 1996 recommended against relying on "imported high-technology incinerators that are expensive to purchase and difficult to maintain."

Instead, the Bank staffers favored "appropriate technologies." Noting that incinerators produce toxic ash that requires special handling, some officials suggested that, instead, medical waste be sorted, shredded, and disinfected with steam, microwaves, or chemicals. Hospital and general waste could be separated, and the former guarded against rag-pickers, the spokeswoman said.