Regulation of On-Site Medical Waste Incinerators in the United States and the United Kingdom: Is the Public Interest Being Served?
Manns, Leslie D., Journal of Economic Issues
Currently, the "vast majority of medical waste disposed of in the United States, and indeed the world, is done so via high-temperature incineration" [U.S. Congress, OTA 1990a, 3]. On-site hospital incinerators are quite common in both the United States and the United Kingdom. However, such incinerators may soon disappear due to new air pollution legislation enacted in both countries. This paper examines medical waste incineration and these legislative changes to determine if the public interest is being well served by legislative and regulatory processes.
Public concern for the environment appears to be increasing at the same time that explicit environmental regulations are being criticized more often by industries subject to these regulations. As a result, governmental action taken to protect the environment must seek to balance efficiency and equity while maintaining the flexibility to adjust to changing conditions [Reynolds 1981, 646]. According to Reynolds  and Kling , workable explicit regulations must be in harmony with the public interest. Ultimately, attaining an effective, explicit regulatory structure requires that such regulations conform to society's evolving understanding of issues and possibilities. Ongoing changes in the regulation of medical waste disposal shows how difficult this can be.
Both the U.S. Clean Air Act Amendments of 1990 and the United Kingdom's Environmental Protection Act of 1990 require the phasing in of much tougher air quality standards that on-site hospital incinerators will have to meet. In choosing to use explicit, function-specific regulations, both countries apparently are seeking to "improve efficiency" and "adjust the distribution of benefits, costs, or liability in conformity with the views of equity expressed through the political process" [Reynolds 1981, 646]. One major concern in both countries is the cost-augmenting nature of the new air quality standards. The cost to hospitals of upgrading antiquated on-site incinerators is often prohibitive at best and infeasible at worst.
The Role of Incineration in Treating Medical Waste
In both the United States and the United Kingdom, incineration is the most common method for disposing of medical waste. The benefits of incineration include total destruction/sterilization of waste, significant volume/weight reduction of waste, virtual elimination of the need to pre- process waste before treatment, and the ability to dispose of incinerator ash in landfills [U.S. Congress, OTA 1990b, 41]. The costs of using incineration include potential pollution risks associated with both gaseous/particulate emissions and incinerator ash, as well as increased costs related to meeting stricter pollution regulations [U.S. Congress, OTA 1988, 15].
One of the major problems associated with on-site hospital incinerators is the age of the equipment used. Most hospital incinerators in use today were installed in the mid-1970s or earlier. As a result, they "lack pollution control equipment, and [often] have low stack heights," which allows emissions to remain close to the ground in areas surrounding hospital incinerators, usually densely populated, urban areas [U.S. Congress, House 1988, 296]. Furthermore, these incinerators were originally designed to bum only pathological waste including body tissue and fluids. As the composition of the hospital waste stream has changed to include a large amount of disposables, especially plastics and lightweight metals, these incinerators have been used to treat wastes for which they were not designed. This only increases the likelihood that medical waste will be inadequately incinerated, leading to potentially significant environmental and/or public health problems [U.S. Department of HHS, ATSDR 1990, 7.5].
On-site Incineration of Medical Waste in the United States
In the United States, there are approximately 6,000 medical waste incinerators currently operating, about 5,000 of which are on-site hospital incinerators [Hearn 1994, 27]. …