Wyoming doesn’t specifically define medical waste or how to properly get rid of it, so Teton County clinics end up shipping their used needles and other biohazards to Salt Lake City.
“That has always been a concern of mine,” said veterinarian Dan Forman, owner of Spring Creek Animal Hospital and chairman of the Teton District Board of Health. “But we have always tried to hold ourselves to the highest standard and use companies that dispose of the waste based on federal guidelines.”
Wyoming regulations lump medical and infectious waste in with the definition of solid waste. Varying levels of guidance are in place. The Wyoming Department of Environmental Quality generated recommendations from the Environmental Protection Agency Guide for Infectious Waste Management and relies on federal rules, like those from the Occupational Safety and Health Administration, for compliance. The Wyoming Division of Health and Medical Services requires institutions to create and follow “acceptable plans” for their own medical waste streams. The Wyoming Department of Health’s Healthcare Licensing and Surveys ensures that health care facilities handle waste appropriately while waste is on the premises but has no role once waste leaves the facilities.
The lack of overarching state regulation “really hasn’t been a big issue,” said Luke Esch, an administrator for the DEQ’s solid and hazardous waste division. “We really haven’t heard much about it.”
Rick Starkey, the administrator of Teton Outpatient Services, said local providers take medical waste disposal seriously despite the lack of state-specific regulations.
“That’s one thing nobody messes with,” he said.
Soiled gauze, extracted teeth
Medical waste is any potentially infectious waste material: human tissue, body fluids, anything that came into contact with blood, needles, syringes, bedsheets and much more.
Esch said some bigger hospitals in the state — though not St. John’s Medical Center — have their own internal incinerators and deal with a lot of medical waste themselves. A patchwork of industry accreditation keeps providers in compliance with their own rules.
“The responsibility is on the hospitals and the medical community to make sure their wastes are disposed of properly,” Esch said. “We haven’t ran into problems with folks.”
Esch stopped short at saying there wasn’t a need for formalized state regulation. But he said medical waste disposal “hasn’t risen to a level of being something that would necessitate further regulation.”
“Our hospitals and our medical communities are responsible individuals and don’t want anyone to be impacted by their wastes,” Esch said. “The only reason somebody could be in trouble from our regulations is if they dump the bag of medical waste outside of a permitted facility.”
At a federal regulatory level there’s much more that waste generators could get in trouble for, like not syringes and needles in puncture-resistant containers.
Too hazardous for landfill
West Bank Sanitation doesn’t accept medical waste, nor does the Teton County Trash and Transfer Station.
At the trash and transfer station that’s because of the amount of handling involved and the hazardous nature of the waste. It’s too easy for workers to come into contact with things like needles because waste isn’t just thrown into a truck and immediately dumped in a landfill. There are several steps in between. People on the floor, for example, sweep and clean up items after a claw machine grabs the trash to put on a truck.
Landfills can choose what types of waste they accept, Esch said. There are many kinds in the state, ranging from construction and demolition to solid waste and industrial landfills.
“Some choose not to accept those types of wastes for a variety of reasons,” Esch said. “Using a professional company provides certainty that you will be able to get rid of material when you need to on a consistent basis.”
Stericycle is a medical waste disposal company that seems to be the provider of choice and likely the only one that services Teton County.
The company — which recently settled a class-action lawsuit accusing it of using a price-increasing scheme that inflated customers’ annual bills — picks up biohazardous medical waste from physician offices, hospitals, nursing homes, tattoo parlors, labs, dialysis centers, dental offices, veterinary clinics, pharmacies and funeral homes around Wyoming.
Other companies, like Cyntox and Sasnpro, advertise services elsewhere in the state.
Medical waste generators can protect themselves by hiring companies to do the dirty work (literally) for them.
“I know they have to follow the guidelines of the EPA, and if they break the rules they’re in trouble and we’re not,” Starkey said. “We try to be very consistent with how we do things, and that works out really well. I’m not going to break the law or let anybody break the law.”
Stericycle did not respond to requests for comment, but local organizations that use it all said medical waste from Jackson ends up in Salt Lake City.
In other parts of the state, like Cheyenne, medical waste goes to the closer city of Denver. That’s because, to the best of Esch’s knowledge, there are still no commercial medical or infectious waste treatment, storage or disposal facilities within Wyoming.
For the foreseeable future, disposing of medical waste will be a big cost for those in the medical community, especially in a rural areas. Most facilities in Wyoming, unlike some states like California, do not charge a flat biohazard fee that helps offset the cost.
In 2016, Stericycle disposed of 11.65 tons of St. John’s medical waste. Last year it disposed of 10.66 tons. In 2017 that cost the hospital about $16,000.
“We continue to look at ways to decrease our regulated medical waste due to the environmental impacts and the costs to the hospital,” said hospital employees Phillip Fox and Lisa Smith said in a statement.
The Teton County Health Department spent $3,153.96 on medical waste disposal last year.
Starkey said Teton Outpatient Services sends anything biological, like something biopsied, to the hospital for disposal. Other than that, Stericycle handles its waste, and High Country Linen takes care of bloody linens.
“Bedding is the biggest,” he said. “It’s what people lie on.”
Surgical drapes also make up a large part of waste, but needles do not.
“Needles are becoming passe because there are safer ways of drawing medicines up than sticking a patient,” Starkey said. “There’s less chance of exposure. We try to avoid needles.”
Still, people who have diabetes or give themselves allergy shots have to dispose of their needles. The health department’s county nurse manager, Janet Garland, said the department offers a collection service. It costs the department over $250 per month, but she said that’s worth it “to try to reduce needles in the landfill.” Sharps — anything used to puncture the skin — are received in approved containers inside the building at 460 E. Pearl St. Containers are also available for sale to the public for $3 to $6 — or free if needed.
“It is very expensive to dispose of biohazardous waste and sharps in an environmentally acceptable and medically acceptable manner to reduce the spread of disease,” Forman said. “It is extremely expensive to do things right. It is not only a legal obligation, in my mind, but also a societal and environmental obligation to do that.”