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SPEAKER 1: This is side two of the regional issues unit sampler. Burning Needles, a documentary on the problem of infectious medical waste disposal. For years, no one cared too much about what happened to trash. We threw it in the garbage can. Men came by in a big truck to take it away. Out of sight, out of mind.

Those days are over. Americans have discovered that our garbage doesn't magically disappear anymore. It's a costly, complicated problem. There's a new twist to the waste disposal dilemma, what to do with infectious medical waste.

Communities are finding out that the waste from operating rooms, and dental clinics, nursing homes, and veterinarians just can't be dumped at the local landfill, and perhaps shouldn't just be burned at the local incinerator. Experts say this is one of the troubling new questions in the struggle to protect the environment. Stephen Smith prepared this report.

[WATER SPLASHING]

STEPHEN SMITH: It washed up on beaches along America's Eastern Coast. Waves of used hypodermic needles, knotted coils of intravenous tubing, discarded blood bags, a nightmarish harvest of medical Krill sloshing back onto the beaches from garbage dumps out at sea.

Long stretches of coastline were closed. The public was stunned. And America had a new kind of environmental hazard to worry about. Unlike the litany of warnings about other pollution problems, the medical waste story touched on America's leading health fear, AIDS.

Even though scientists counseled that the HIV virus can't live very long outside the body, beachgoers were not convinced. This trash was too scary to ignore.

[BIRDS CHIRPING AND DOG BARKING]

Here in the Midwest, there are no oceans to cough up medical debris, but people who work here to protect the environment and those who work to bury and burn our garbage say there is still plenty to worry about. They worry that the growing truckloads of medical waste carted out of local hospitals each year may threaten the health of those who have to get rid of it and may be poisoning the air around incinerators that are burning it.

Public officials promise to crack down on how medical waste is handled, and hospital administrators say the problem grows more expensive by the year.

[PAPER RUSTLING]

Each day, some 190 hospitals in Minnesota pump out untold tons of trash. Some of it must be handled with special care, the used needles and rust-colored bandages. Here, in one of the operating rooms at Minneapolis Children's Medical Center, sterilized instruments are ripped from their paper sleeves and prepared for surgery on a small child.

SPEAKER 2: There's one more little jelly pad for you that goes down there kind of in a tickle spot. Did that tickle?

STEPHEN SMITH: The patient, Louis, lies quietly on the table. His straightforward gaze reflects the dull terror of waiting for something bad to happen. The boy is gently put to sleep with an anesthetic gas.

SPEAKER 2: We're just going to hold the mask there for a while, Louis, and you breathe that long enough, and you're good to go to sleep. Can you believe it? It's pretty crazy stuff, huh?

STEPHEN SMITH: Louis is here to have tubes put in his ears, a routine procedure. Not far from the operating table is a large, bright red plastic bag. This is where most of the waste generated by this operation will be tossed, whether or not it carries the potential for infection.

Diane Jacobson is the epidemiologist at Minneapolis Children's in charge of infection control. She says all of the waste from the operating room is handled as biohazardous waste.

DIANE JACOBSON: The reason for that is there is a potential that a good amount of this waste might be fluid-filled, saturated, and contain blood or other body fluids.

STEPHEN SMITH: Operating rooms produce much of the infectious waste, but other parts of the hospital also add to the load.

[COUGHING]

Here, in the intensive care unit, children with serious ailments are monitored by racks of sophisticated machines. Although some of these children do not carry contagious diseases, much of what they contact is still treated as red bag waste. Jacobson points out there is also a special way to handle things like needles and syringes. Being stuck by so-called sharps is one of the most frequently reported worker injuries in hospitals.

DIANE JACOBSON: We have a little box that's by each patient bedside, so that if the staff uses needles or other sharps, they would deposit them right in those sharps containers. They're kind of a puncture-proof-- not kind of, they are a puncture-proof container so that there isn't the potential that the needle could stick out the side or those kinds of things.

STEPHEN SMITH: Aside from the patient wards, another big waste producer is the medical lab, where viruses and bacteria are grown for disease research and testing. Much of the disposable lab materials are sterilized in a machine called an autoclave before being thrown out.

[MACHINES WHIRRING]

The stainless steel door of the autoclave is cranked open and steaming bags of cooked trash are pulled out onto a cart. From here, the bags go to a dumpster, and eventually, to a landfill.

[PAPER RUSTLING]

Diane Jacobson says the cost of medical waste disposal has gone up so much in recent years because so much more at the hospital gets thrown out.

DIANE JACOBSON: There has been a change, over time, in the healthcare world as there has been in our own world. We are much more likely to buy cardboard milk boxes and throw those out than our milkman to deliver glass, which we send back to them, which is something that I was familiar with as a child. You never see a glass milk bottle anymore.

The same kinds of things have happened in health care. In very early years, glass syringes that were used to draw blood samples, et cetera, were then cleaned, sterilized, disinfected between patients. Now, all of those things are plastic, so that the plastic syringe is used one time then thrown away. And there's a number of other products that now are disposable.

STEPHEN SMITH: Red bags that are not sterilized and landfilled normally get incinerated. The red bags from Minneapolis Children's end up here, an incinerator room at Abbott Northwestern Hospital just down the street. This machine burns tons of medical waste from both hospitals each week.

Infectious wastes from hospitals and clinics are routinely handled by as many as four or five different sets of people, doctors and nurses, janitors, incinerator operators, and garbage haulers. Handling infectious waste can be risky, not so much because of AIDS, but from the threat of hepatitis or tetanus.

Jennifer [? Pfeifer, ?] an epidemiologist with Hennepin County Medical Center, says the threat is still mainly hypothetical.

[? JENNIFER PFEIFER: ?] All the agencies are saying there are no documented cases, and even the waste haulers have not been able to document a case of getting a disease from being punctured from the garbage. However, I'm sure they've been punctured. But not every puncture results in infection.

STEPHEN SMITH: When the AIDS epidemic first appeared, hospital employees pushed for safer ways to deal with the infectious waste that could spread the disease. But they weren't the only ones who started to worry.

[MACHINES WHIRRING]

A dusty spray of metal, glass, and garbage tumbles from a fast-moving conveyor belt. This is a publicly owned plant in Duluth that takes in tons of the city's garbage every day, shreds it into fuel, and then uses it to burn sewage sludge. This plant is run by the Western Lake Superior Sanitary District.

And until recently, bags of medical waste came through with loads of household garbage. Plant worker Walt Anderson found out how hazardous medical waste can be.

WALT: I was up working on a conveyor, and there was some garbage up on the conveyor, and I pulled it out from underneath. And when it fell down, there were some sharps in with it and a needle stuck in the upper part of my leg.

STEPHEN SMITH: Anderson kept the needle and took it with him to a medical center, where he was given a blood test. He was worried about hepatitis, but fortunately, never got sick.

[ENGINE ROARING]

Debbie [? Bourgeault ?] drives a huge Caterpillar bulldozer up onto a mountain of trash at the sanitary districts landfill outside Duluth. It's common for her to spot red bags of medical waste in the mix. Even though many of the sharps are packed away in plastic, the containers burst like ripe melons under the weight of the cat, spewing needles and syringes all about.

[? DEBBIE BOURGEAULT: ?] We're in and out of the Cat a lot of the time, so we have to walk on it, and it's kind of scary. Nowadays, with AIDS and all the diseases you can get from being stuck, it's just kind of scary.

STEPHEN SMITH: Late last year, the sanitary district banned all medical sharps from the landfill. Chuck Williams, the district's executive director, says no employees have ever contracted a disease directly traceable to medical waste. But Williams couldn't ignore their fears about the tubes and syringes.

CHUCK WILLIAMS: If they become tangled in the mud on the tracks, and we have somebody that has to go in and work on that machine, and he sticks his arm in to work on it, and he comes out with a long needle sticking out of the palm of his hand, you got a tough job to convince him that he doesn't have anything to worry about. That it was handled properly because we have no way of knowing that.

STEPHEN SMITH: Williams would like to see all Duluth hospitals and clinics send all of their red bag garbage to special medical waste haulers. He says more and more are doing that. But Walt Anderson tells a story that shows how little some people who generate medical waste think about the problem.

WALT: A friend of mine, in fact, is a dentist, and I asked him, what do you do with yours, all your syringes from your dental work? He said, throw them in the garbage. I said, well, don't you put them in a separate, those red containers? No.

I said, well, why don't you-- what does the garbage man do with that? He says, I don't know. The garbage man probably comes 4:00 or 5:00 in the morning. I don't start till 9:00.

STEPHEN SMITH: Growing public fears about infectious medical waste prompted the Minnesota Attorney general's office to set up a task force to study the problem. The result was an infectious waste bill now being considered by state lawmakers.

The measure would require nearly all of the estimated 6,000 generators of infectious medical waste in Minnesota to figure out how much waste they produce to make sure the waste is explicitly labeled and to say how they plan to get rid of it.

University of Minnesota director of Environmental Health and Safety Donald Vesley says the new bill is a good idea, but not because the current system for handling medical waste is dangerous.

DONALD VESLEY: I'd say it's needed simply because of the amount of publicity and concern which it's generated and the fact that if there aren't any regulations, this is not going to inspire very much confidence in the public that these materials are being handled safely and appropriately.

STEPHEN SMITH: Whether or not Minnesota passes a new law, the biggest danger from medical waste may be in the pollution, pouring out of smokestacks where the waste is burned. Because there is so much plastic in medical waste, incineration is likely to produce health-threatening toxins, such as furans and dioxins.

State pollution officials learned recently that perhaps one in seven hospital incinerators don't have the required equipment to burn off dangerous gases and many others aren't being run properly. PCA air quality administrator Mike Valentine says small incinerators can be a significant source of pollution.

MIKE VALENTINE: Sometimes, the smaller facilities have greater problems with combustion, and poor combustion leads to the kinds of air toxics problems that we've been worried about lately with dioxins and so on. So being a smaller facility does not necessarily mean that the problems that could be created from the facility are proportionately smaller. They may well be very large problems locally.

STEPHEN SMITH: In the Central Minnesota town of Little Falls, a group called Preserve our Land successfully blocked the building of a commercial medical waste incinerator in town. Bob Lowman heads the group.

BOB: People all over the country say that they don't understand how some of the most dangerous chemicals that come out of an incinerator stack are formed, and they don't know how to stop them from coming out of the stack. So until we figure that out, we shouldn't set up any more incinerators, particularly large ones because once a private company or a public body spends $20, $30, $40 million on an incinerator, it's not likely if the air emissions don't look good after a year or so that they're going to shut that thing down.

STEPHEN SMITH: There are several proposals now for special medical waste incinerators in Minnesota. The Mayo Foundation in Rochester wants to build a new multi-million dollar plant. Mayo was fined recently by the state for unsafe operation of its old incinerator and for repeated violations of air pollution standards.

Victoria [? Lemberger ?] of the Minnesota Hospital Association says Mayo's interest in a new incinerator is unique, though. She says the cost of medical waste disposal is exploding. But even so, most hospitals won't pump money into fixing up their old incinerators.

[? VICTORIA LEMBERGER: ?] Hospitals, because of the reimbursement system, don't have a lot of access to capital. So if they're forced to make extremely expensive modifications to their existing incinerators, they may be forced to just shut the incinerator down and seek some other method of disposing of the waste.

STEPHEN SMITH: This medical waste burner in Eden Prairie is just such an alternative. The incinerator is owned by Browning-Ferris Industries Medical Waste Systems of Minnesota. It burns 8,000 to 10,000 pounds of medical waste each day. BFI Medical is one of the largest infectious waste disposal companies in the country.

The president of BFI Medical's parent company is William Ruckelshaus, former administrator of the US Environmental Protection Agency.

WILLIAM RUCKELSHAUS: Hospitals are very sensitive to public health issues associated with the way in which they handle things like their own waste. And as is true in so many areas of waste disposal, until somebody called attention to the fact that it wasn't always being handled safely, they didn't pay a lot of attention to it.

STEPHEN SMITH: BFI wants to build a new $1.5 million medical waste incinerator next to a landfill it owns in Pine Bend, just South of St. Paul. Company officials say the new burner is needed to meet the demand in the Metro Area and to replace the aging incinerator in Eden Prairie. One of BFI's public relations tools is a highly produced video introduction to the company.

SPEAKER 3: Two environments, so different, yet both critical to the quality of life on our planet. The health care industry, helping millions to be happy and productive. And the broader environment, so delicate, its balance can be easily destroyed.

Where the two meet, they pose one of our age's most important questions, how to successfully deal with the waste products of an industry that helps make possible a better quality of life or even life itself. One company has made the answer to that question its only commitment, BFI Medical Waste Systems. Comprehensive and cost effective waste services, specifically oriented to the unique needs of the healthcare community.

[MUSIC PLAYING]

JOANNE: I did see a tape on BFI's proposed medical waste incinerator.

STEPHEN SMITH: Pine Bend resident Joanne Eller wasn't convinced by BFI's sales pitch.

JOANNE: They had this medical waste incinerator like in the mountains of Colorado and people skiing around it. And I mean, it was just like-- I thought angels were going to come down from heaven and haul away the ash and blast the BFI, and it made me sick. That's not the way it is.

STEPHEN SMITH: Eller and other Pine Bend residents oppose the plan because they believe the area's air quality is already hurt by the Coke refinery and ammonia plant and BFI's landfill. Company officials say, however, that large state-of-the-art incinerators are actually safer for the environment than the many small, older hospital burners.

BFI medical owns nearly two dozen incinerators across the country and has plans for many more. The company is also interested in small towns like Livingston, Montana, where BFI and another firm from outside the state have said they want to burn medical waste in the community's garbage incinerator.

[HORN HONKING]

Livingston, Montana straddles a major East-West rail line. This used to be the transfer point for Yellowstone Park, about 60 miles to the South. Set in Montana's Paradise Valley, Livingston owes its existence to the stunning mountain wilderness that draws tourists from across the country.

Some of the people in Livingston worry their town is in danger of becoming more famous for garbage than landscape. BFI medical and a Seattle company, Sherway Incineration, offered lucrative contracts to burn hospital waste generated in big cities outside Montana. Mark Montgomery heads a local group called Citizens against Pollution. The group opposes importing infectious medical waste.

MARK: Our committee has looked into this a lot, and everybody pretty much agrees that the odds of someone getting AIDS or hepatitis or whatever from the burning of this medical waste is really, really remote. Those germs are going to be killed in that 1,400-degree fire.

It's the extra plastic. 30% of the medical waste is plastic, and the burning of plastic is very toxic, and our incinerator here has absolutely nothing to take those toxic fumes out of the air.

STEPHEN SMITH: Because infectious wastes often include human tissues and body parts, local anti-abortion activists like Jonnae Miller also oppose the plan.

JONNAE MILLER: When infectious waste comes in from out of state, more than likely, it will contain aborted fetuses. And we're just very much against having those shipped into Montana for us to dispose of.

[MACHINES WHIRRING]

STEPHEN SMITH: Livingston's incinerator is a smelly sheet metal building with a wide concrete floor, where heaps of garbage are piled a dozen feet high. A small bulldozer crams trash into the two fiery mouths of the machine. At the other end, a wet sludge of metal and ash dribbles out.

The burning of medical waste became a possibility in Livingston because the local incinerator is just barely solvent. To Ed Flat, manager of the Park County Refuse District, the Minneapolis and Seattle offer seemed good and the hazard seemed minimal.

ED FLAT: Well, there's a lot of other incinerators burning hospital waste, and they haven't been stopped, and it hasn't hurt anybody. So that's all we've really got to go on is what we've talked to other people.

STEPHEN SMITH: Livingston has the only municipal garbage incinerator in Montana, and the state is one of six in the nation with virtually no laws governing medical waste. When Livingston residents first read about the medical waste proposals, a petition drive against the idea netted 1,300 signatures in four days. 7,000 people live in town. Flat says the people overreacted, especially to the fears of more air pollution.

ED FLAT: We burn a lot of plastics now. I don't really see that burning hospital waste is that much greater than what we burned today.

STEPHEN SMITH: Public pressure seems to have killed the medical waste idea, at least for now, but may result in New state regulations. BFI Medical and Sherway Incineration appear to have turned their attention elsewhere.

[WATER SPLASHING]

Without money from the medical waste market, the operators of Livingston's incinerators say local residents will have to pay more for garbage disposal. Mark Montgomery says it's worth it to protect the environment in this town on the Yellowstone River.

MARK: We have the best trout river, trout fishing in the United States right outside our back door. We sit at the base of a million-acre wilderness area. We're 50 miles North of Yellowstone Park. Many, many people come through here and agree that it's some of the most beautiful country in the world. Now, do we want to be known for that, or do we want to be known for the medical waste capital of the world?

[BEEPING]

STEPHEN SMITH: Waste disposal is much more regulated in Minnesota than Montana. But even if the state does impose new restrictions on infectious waste produced in hospitals and clinics, some say the proposals are not enough. Bob Lowman of Little Falls says Minnesota should discourage the hauling of medical waste from one part of the state to another.

BOB: If you can ship waste away, regardless of what kind it is, it's a kind of an out of sight, out of mind mentality. But if you have to deal with it right on the local level, be it medical, be it hazardous, be it solid waste, then I think it-- people think more about it, and worry more about it, and hopefully, become more interested in things like recycling, changes to biodegradable packaging, et cetera.

STEPHEN SMITH: The opposition to medical waste incineration is just beginning. Some Minnesota officials believe it could be one of the hot environmental issues of the 1990s because more and more people are growing concerned about what burning garbage does to the air. Critics say that while incineration may be the most sanitary way to get rid of medical waste, in the long run, it may not be the safest.

As the red bags of infectious waste pour out of operating rooms and doctors offices, the questions are piling up, too.

[BEEPING]

SPEAKER 4: What is the end going to be right now?

[BEEPING]