As an emergency room physician, Caesar Djavaherian is naturally concerned with the health of his patients. But that mission, he said, is being pursued at the expense of the environment.
Consider the amount of waste that his department generates: "So currently every patient is examined using gloves," he said. "And then if they're vomiting, we have little plastic containers for vomiting, which everyone gets. Every patient is put into a bed with new sheets on it — it's all rubbed down with a disposable cloth, like a Clorox wipe. ... When we start an IV, insert a catheter, there's plastic. We use gowns — thick paper gowns — that are thrown away. All the packaging is plastic, certainly not recyclable. The medications come packaged in plastic. If you're using an IV, the liquid is also in a thicker plastic — two layers of plastic. ... The vast majority of the garbage we generate is paper and plastic."
Add all this up, multiply it by every patient seen every day, and it's a bit mind-boggling. "The amount of waste is unreal — it would turn your stomach," said Djavaherian, who works at North Bay Hospital in Fairfield and who's also the chief medical officer of ER Direct, an East Bay company that makes house calls, which the Express featured in March. "Every outpatient, every operating room, every one produces, in some cases, a small roomful of waste. ... It all goes into the garbage can. The garbage gets emptied six, seven times a day. I just wish more people were aware of this."
What surprises Djavaherian, who considers himself somewhat of an environmentalist, is that none of the ten hospitals he has worked for in his career have recycled this waste, which means the bulk of it ends up in the landfill. The question is, why?
While various federal and state laws and regulations prevent certain waste and patient records from being thrown into the recycling bin, Djavaherian believes there is plenty of material that could theroretically be recycled, reused, or swapped out for nondisposable items. And the effect could be enormous. Although reliable statistics on hospital waste in the United States are hard to come by, Practice Greenhealth — a nonprofit organization based in Reston, Virginia, that promotes sustainability in the health care industry — estimates that US hospitals produce more than 5.9 million tons of waste annually (or 33 pounds per staffed bed per day). But that number is based on data from its members, which have already reduced their waste streams. In other words, the actual amount of waste is likely much higher.
What is clear is that most of the plastic generated by the health care industry is not recycled. This is especially problematic given that the use of plastic has grown dramatically over the years, as medical suppliers have increasingly moved toward disposable items and packaging them in kits, in which one item may be used for a procedure and the rest are thrown away. Although some hospitals, like Kaiser, have begun setting aside these unused items and shipping them overseas, a recent article by the industry news site PlasticsToday.com noted that "American hospitals generate more than 400,000 tons of plastic and other packaging waste every year, and the percentage recycled is close to zero." Despite efforts to reduce medical waste in this country, overall the opposite has been true — the amount of waste generated has only increased. And so have the costs of disposing of it.
Many hospitals have begun to look at ways to reduce their energy consumption and waste output — mainly because of the huge costs associated with these factors — such as composting food, reducing water use, and recycling computers. But, in general, hospitals still lag behind the rest of society in terms of their recycling.
So why don't hospitals recycle more, and why isn't anyone holding them accountable? There are multiple possible explanations. Recycling isn't as easy as just throwing any plastic in a recycling bin: not all of the plastic used is recyclable, according to the Healthcare Plastics Recycling Council, and oftentimes items contain multiple kinds of material, which complicates their recyclability. There's also the issue of perceived costs — after all, hospitals would need to buy extra containers, hire more workers to sort the trash, and train its staff. And a wrong item thrown in the wrong bin could lead to fines in the tens of thousands of dollars.
But ultimately, experts agree, diverting recyclables from the waste stream would save hospitals money. As things stand now, rising medical waste-disposal costs aren't just burdening hospitals, they're burdening patients, too.
Hospitals are essentially hotels, so they produce a fair amount of trash. But regulations enacted to reduce infectious disease and environmental pollution appear to have led to an increase in waste.
Until relatively recently, the way we disposed of and treated our medical waste was essentially a "free-for-all." That's according to Mike Gastellum, managing partner and one of the co-owners of Hayward-based Barnett Medical Services, a company that transports and disposes of medical waste and also sells medical supplies to some 1,800 customers.
Back in the day, medical waste on the East Coast was essentially taken out onto barges and dumped into the middle of the Atlantic Ocean. When syringes and other garbage began washing up on beaches, Congress enacted the Medical Waste Tracking Act of 1988, which helped set the standards for government regulation of medical waste. The act expired in 1991, after which time states were given regulatory authority.