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PAGE 34 HEALTHWEEK MAY 23, 1988 Infectious waste disposal problems continue to grow Co"li"u~d from pog~ I and other health care facilities are losing alternatives lor managing this problem. ' Highly publicized incidents Air quality and landfill avail- abilitv aside, several other fac- tors compound the difficulty ol infectious-waste disposal, in- cluding publicity, AIDS and the lack ol a standard definition lor inlectious waste. In the past year, several highly publicized incidents have led to calls for tougher state and lederal regulation of inlectious medical waste. Last August in New )ersey, hypodermic needles, infectious waste and household trash washed ashore, closing 50 miles of beaches. Last June, several Indianapolis children were found playing with vials of AIDS-infected blood they took from a Dumpster near sev- eral doctors' offices. Also, the AIDS scare has waste haulers and landfill oper- ators nervous. 'There's an in- crease in what they perceive as inlected, . said Larrv Doucet, a consulting engineer in Peeks- kill, N.Y. 'If something looks like it has blood-a sanitary napkin, red dyes or what- e"er-they won't take it or they charge an exorbitant amount. . Some haulers charge hospi- tals up to $1.50 a pound to remove inlectious waste-or what appears to be infectious waste, consultants said. That's about 10 times the price haulers charge' the hospitals to dispose of their benign waste, experts said. Hauls waste out ol state 'We have to charge a higher rate because ol the additional distance we have to haul it,' said Bob Pandy, a spokesman lor Chambers Development Co., a landliU operator in Pitts- burgh, Pa. Since Pennsylvania landfills won't accept any medical waste, Chambers has to truck it to sites in West Virginia or Ohio. 'In some [New )ersey] coun- ties, hospitals are dealing with three dillerent haulers for each kind of waste-infectious, be- nign and benign that looks like it's infectious,' said Ed Abramovitz, director of hospi- tal management and planning lor the New Jersey Hospital As- sociation. 'We've got hospitals saying that their [total) cost for disposal has increased tenlold over the last two years. ' Further complicating the is- sue is lack of a uniform defini- tion-state or federal-lor infec- tious waste, much ol which Most Americans believe too little spent on AIDS Co"ti"u~d from pog~ I fight acquired immune defi- ciency syndrome. Tne poU was a random na- tional sampling of people 18 years of age or older and had a margin of error of plus or minus 3.1 percent. The telephone sur- vev was conducted Over a thr~week period in March. Bob Nielsen, vice president of SRI Gallup, said the poll shows that 'AIDS is a highly' feared disease and the average ..,merican wants something done ... because they don't see any solutions. ' Of single respondents, 63 '-:A~iltio:ii;~:;. - . "":'CFO ;. J .' "-:. ':~., . . S . :,.~ ':.~,,;;. . :";i' '_~.' - -. ;.;......":\...; . :.:.:....' - . :*"... - - .....:;.: ".:!'~.~. ...;,. Mobile MRI ,"",..'f;~,_ ~~':~IffiffiediaielY"~~l~ ,:Available for Short? ...... _. .' . .,1... or LOng Term Lias~..\.; :~ti.;An~dy~~ 4.l:i,&~ ': ?\-'lobile Medical ;;. .",:", D'll' '''''T'''' "..,..",>,. .: :~-..~-::..:~~...~~,.?f;~ . Call: (214) 424-2733"" percent think more spending is necessary (compared with 51 percent of married, separated or divorced people), 5 percent say funding is inadequate, and 22 percent believe spending is sulficient. The results also show that more-educated respondents favor more AIDS spending: 64 percent ol postgraduates cite inadequate funding, compared with 48 percent of those with less than 12 years of education. In addition. higher-income "A . IDS is a highly feared disease and the average American wants something done .., because they don't see any solutions. . people are more likely to cite insufficient spending. Last year the federal govern- ment spent more than $502 mil- lion on AIDS treatment, educa- tion and research. This year the U.S. Public Health Service estimates that the total AIDS bill will rise 89 percent to $951 million. Under the administration's budget proposal for 1989, $1.3 billion would be allocated for new AIDS education and prevention efforts authorized moves across state lines. Nearly 20 states don't define or regulate the handling ol iniec- tious waste, also called 'red bag' waste for the distinctive red bags that handlers are sup- posed to use. Disposing of infectious wastes is . as bad as it's ever been. . - Jim MclArney, Americall Society for Hospital Engilleering And in the more than 30 states with definitions, the rules vary greally.according to Nel- son Slavik, a health care consul- tant in South Bend, Indiana. Variety o{ components Depending on the state, in- lectious waste may include blood, blood products. body fluids, needles, 'sharps' (dan- gerous fragments), pathological waste and laboratory waste. Some states simply define it as 'any material capable of caus- ing infection. ' The state-to-state variations mean that infectious waste can include anywhere trom 5 per- cent to 80 or 90 percent of a hospital's total waste stream, Slavik said. Typically, states re- quire {acilities to steam-sterilize by Congress, for a 525 million AIDS research and testing facility at the National Insti- tutes ol Health, and {or a $72 million survey to determine the size of the AIDS population in the United States. According to the Health- Week/SRI Gallup PoU, twice as many rural respondents as ur- .ban dwellers believe AIDS ex- penditures are too high. But Nielsen doesn't find that surprising. . 'People are more willing to s"e spending in areas where the disease is more prevalent, ' said Nielsen. That reaction, he added, seems to be 'based on the lack of understanding and information. ' Generally, older respon- dents are less likely to see the need for increased spending. Forty-three percent of those 55 and over lavor more funding, compared with 62 percent of 18- to 34-vear-olds. 'Tne ~lder groups feel less threatened, and consistently the younger groups recognize there's more of a problem,' said Dr. J.T. Hamrick, acting dean ol the School ol Public Health and Tropical Medicine at Tulane University in New Orleans. O{ the races surveyed, Asians and Native Americans are the most unsure whether there is too much, too little or the right amount of AIDS lund- ing: 28 percent of that group say they don't know. That compares with 22 percent of Hispanics, 15 percent of blacks and 14 percent of whites. 0 ('autoclave ') their waste or burn it in an incinerator, then send the residue to a conven- tionallandlill or haz:ardous- waste site. As the cost and complica- tions of traditional disposal methods increase, hospitals are searching for alternatives. Medical SafenC Inc. of In- dianapolis offers one. It mar- kets a $250,000 hammermill that chemically decontaminates and then pulV'erizes waste into tiny, unrecognizable pieces. This reduces the volume eight- lold and also makes the waste acceptable at regular landfills. A smaller, $30,000 model is available for use by labs and clinics. Experts lavor incinerators Although some facilities report satisfaction with the ham- mermill, lewer than 20 have purchased the machine and most use the smaller version. Most experts, including the American Hospital Association, favor the use of on-site inciner- ators, which reduce the risks of handling infectious waste and the trouble of locating costly landfills that accept it. An AHA survey estimated that about two-thirds of hospi- tals have on-site incinerators for infectious-waste disposal, 16 percent use autoclave svstems and 17 percent send the;;' waste elsewhere. Tougher new regulations may make it difficult to install or modernize incinerators in some states, experts said. When the purchase or up- grade of an incinerator is under consideration, experts urge hospitals and other health care lacilitiesto work with consul- tants who understand state regulations and the finances of such proiects. Experts also warn hospitals and other facilities to be aware that inlectious-waste disposal can mean battles with regulators and an orten-hostile public. 'It's a real.mess right now, ' said Slavik. 'Hopelully, it's going to . straighten itself out, but I'm not going to hold my breath.' 0 AMI selling hospitals Seeks safety from possible takeover attempt Co"tinued from pase 1 not necessarily to avoid a takeover. He said the spin-off is the culmination of two years of restructuring moves. Shareholder bid unlikely Steven Reid, a health care an- alvst with Wedbush Securities in Los Angeles, said AMI's major shareholders are unlikely to launch a bid until they see how the spin-off and possible further restructuring 'shake out.' "It [the restructuril1gJ was d01le to squee=e Ollt some of the capital gains that a potential acquirer might get. - -Margo ViS nola, Salo/llon Bros. Despite Wall Street rumors, any leveraged buyout of the re- mainder of AMI would be diffi- cult because the company has such a huge debt load, he said. Even if all the $450 million after-tax gain on the divestiture were used to reduce debt, AMI still would owe a staggering $1.2 billion. AMI plans to use some of the proceeds to buy back stock. AMI shareholder Dr. M. Lee Pearce of Miami, who holds a 7.5 percent stake, told HealthWeek he would like to see more divestiture of un- needed assets. He said AMI should improve relations with doctors, enhance the value of larger facilities through joint ventures, and continue to repurchase shares and reduce debt. In the sale to an emplovee stock ownership plan, or ESOP, AMI will receive about $220,OOJ per bed. That's more than 40 percent higher than what Hospi- tal Corporation of America got in September, said Seth Shaw, hospital management analvst with Prudential-Bache Rese~ch in New York. However, Shaw said AMI's divested hospitals' are lar more profitable' than HCA's were. Last year the hospitals in AMI's ESOP had $135 million in operating income on $507 million in revenue-about 19 percent of the total. AMI will retain nearly a third interest inthe as yet un- named new company, to be based in Dallas. Kenneth S. George, director of AMI's Southwest region, will head the firm. George told HealthWeek his biggest challenge is 'attacking the $600 million in debt' the new company is assuming. He also said he would concentrate on expanding the hospitals, by internal growth or acquisition, and on improving profitability. In addition, said George. 'one ol my primary focuses is to convey the value of em- ployee ownership' to the new company's 10,000 employees. "We want to make a mark on the health care industry fott~ way we treat our people. ' ~ I i il :1 j I I I / I I I ! I I '1 I J I J II .[ i' !