O.C. Medical Waste Controls Found Lacking

A state audit’s finding that Orange County health officials failed to ensure that hospitals, labs and other facilities were properly handling, storing and disposing of medical waste has officials scrambling to make improvements to avoid a state takeover.

The county Health Care Agency’s environmental health division met a Tuesday deadline to submit an initial plan explaining how it will more closely monitor facilities that generate medical waste such as syringes, blood and bandages.

That plan came in response to a scathing Nov. 27 state audit that found widespread deficiencies and lapses in the county’s medical waste management program, including the failure in 1996 to inspect 159, or 80%, of the county’s “large quantity generators” of medical refuse.

The county also did not ensure that all labs and other medical facilities had a state-mandated “medical waste management plan” detailing what they handle and how it is disposed of, according to the report.

A field inspection of a medical waste storage facility by state auditors found that it “had no permit, no information on the users, no warning signs and the containers were overfilled.” The audit also found that the county had only one person assigned to the medical waste management program, which oversees more than 200 facilities, and that this employee had other, unrelated duties as well.

“To have no management plans, and no conducting of routine inspections, that seems to be an indication to us that nobody is really giving this program the management oversight it should be getting, and that is of grave concern,” said Jack S. McGurk, chief of the state Department of Health Services’ environmental management branch, which will review the county’s initial plan in the coming days.

If the state is not satisfied that the county has made improvements by Feb. 1, it will take over the medical waste program, McGurk said.

The audit did not say whether the lapses have caused a public health threat, but a state official said Tuesday that he didn’t believe any threat existed because most hospitals and other medical waste generators, to avoid problems with their own staffers and the media, have been conscientious about disposing of waste properly.

But without conducting inspections and keeping track of permits and other state requirements, the county has no way of knowing if such facilities are complying with the law.

“They really don’t have a good picture of that,” said McGurk, who called Orange County’s program the worst of six the state has audited this year in a continuing series of statewide inspections.

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County officials said they have now completed most of the overdue inspections, and other efforts are planned or underway, to meet the Feb. 1 state deadline.

“I would say we have some areas of deficiency that we were not keenly aware of,” said Jack Miller, the county Hazardous Waste Program manager who oversaw the medical waste program until 1995. “The audit brought that to our attention, and we jumped on it immediately. We plan to make the improvements.”

Environmentalists lamented the findings but said they were not surprised, because it is difficult to keep track of all producers of medical waste, especially small medical offices.

“It’s like littering,” said Gordon LaBedz of the Surfrider Foundation. “It’s impossible to regulate. All it takes is one thoughtless medical office to throw syringes in a storm drain and we get it on the beach. I think if they had 100 regulators they still would not be able to stop it.”

But McGurk said that while the county has been lax in overseeing the handling of medical waste, there was no evidence that the problems in the medical waste management program had anything to do with syringes and other waste turning up on local beaches last summer, forcing temporary beach closures.

The lack of inspections, McGurk said, was among the most troubling findings in the report.

McGurk said there should be at least one full-time inspector and at least another part-time worker to handle paperwork. Three years ago, the county had two people assigned to the program, along with a supervisor.

By the time the audit was completed, only one person, Robert Gregor, was assigned to the program and he did not work on it full-time.

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Gregor, chief of the radiological health division, which oversaw the medical waste program, left the job this month, Miller said. Gregor’s departure was not related to the audit, Miller said.

Steven K. Wong, assistant director of county environmental health services, who has assumed Gregor’s duties, could not be reached for comment.

Miller said the county now has four people--three of them reassigned from other jobs--conducting inspections and checking permits in an effort to catch up. Another worker will soon be hired to work exclusively on the medical waste program, bringing the total to two.

And the county has asked medical facilities to file updated medical waste management plans by Jan. 16--using new forms to replace outdated information in the county’s guidelines, another shortcoming noted in the audit.

Miller blamed the problem in part on state rules adopted in 1993 that required the county to process significantly more permits and handle other new duties, overburdening workers assigned to the program.

“We had some added permitting responsibility, and to get up to speed on that, it took time away from inspections,” he said. “I think it was just a case of too much work and not enough staffing.”

But Miller could not explain why he did not ask for additional staff when the workload increased, a move he conceded might have helped avoid the problems outlined in the audit.

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After the county’s December 1994 bankruptcy, the Health Care Agency decided not to seek additional funding for the program because of belt-tightening. But this month, officials decided to pay for an extra medical waste worker by imposing a $35 yearly fee on doctors’ and dentists’ offices that generate waste. The fee takes effect Jan. 1.

In evaluating the county’s response, McGurk said he will be watching for a commitment to erasing the problems.

“I want a long-term solution to the problem and I want to see a commitment on their [having] the personnel in place to carry out ongoing activities and not . . . just doing this in crisis mode,” he said.

Also contributing to this report was Times staff writer Shelby Grad.