Each day, the medical waste incinerator at Hilo Hospital burns about 110 twenty- to twenty-five gallon bags of infectious waste and 10 sharps containers, in addition to smaller volumes brought in from Honoka`a Hospital, clinics, doctors’ offices, and other agencies. But the required state permit to operate the incinerator expired six months ago, on May 1, 1994. Since then, every day of operation has been another day of violation of state and federal laws.
The hospital is operated by the state Department of Health — the same agency that is charged with ensuring compliance with federal and state clean air laws.
A Bad Actor
The existing incinerator was installed in 1985, but did not receive the necessary permit to operate from the Health Department’s Clean Air Branch until May 1989. The permit was good for five years, although one of the conditions in the permit required the hospital to make application for renewal, should it desire, two years before the permit’s expiration date.
Even before the permit was issued, the incinerator was generating complaints from people living and working downwind. By 1992, the hospital administration was asking the DOH’s Division of Community Hospitals for permission to hire a consultant to help the hospital determine the best course: refitting the existing incinerator, replacing it altogether, or finding a new treatment technology.
No consultant was hired, but in February 1993, Hilo Hospital did submit to the Community Hospitals Division a memo justifying purchase of a new incinerator. The memo was candid in describing the existing incinerator’s limitations:
“The capacity of the existing incinerator … is unable to meet the disposal needs of the hospital and other health care providers and the emission output does not meet emission standards of the DOH-Environmental Protection and Health Services Division. (Employees and residents of the nearby area complain regularly about air pollution caused by burning.) There is strong indication that based on current use and operational capacity of the unit that the permit to operate (PTO) will not be extended beyond May 4 [sic], 1994.”
The memo, from Romel Dela Cruz, the hospital’s assistant administrator, asked that $550,000 be included in the hospital’s capital improvement project funds in the state’s 1993-95 two-year budget.
By the end of the legislative session, however, the funds had been dropped.
Procurement Problems
Throughout 1993, the complaints continued. So did efforts by hospital administration to come up with an alternative.
By January 1994, Hilo Hospital tried again to get money in its capital improvement budget for purchase of a replacement to the incinerator — this time, not another incinerator, but an autoclave-compactor, a process that does not involve burning and for which no emissions permit is needed.
Once again, the Legislature failed to include the capital improvement request in the hospital’s budget. The hospital was left with no choice but to try to finance purchase of the replacement equipment with money earmarked for repair-and-maintenance activities in its operational budget.
A lease-purchase arrangement was worked out with an equipment vendor by June. When it was submitted to the attorney general for review and approval, however, the hospital was told to hold off on any action, pending clarification of new procurement rules.
By August, the hospital was asking the Community Hospitals Division for permission to acquire the autoclave-compactor on an emergency basis. Again, no luck.
What Next?
Aware that its permit would expire in May 1994, Hilo Hospital administrators wrote the Department of Health’s Clean Air Branch on March 16, asking that the permit be extended until August 31, 1994. “The extension is necessary,” wrote hospital administrator John H. Westerman, “because the hospital intends to discontinue use of the incinerator and replace it with an autoclaving system. Negotiation to obtain the equipment is near conclusion, but it will take approximately ninety days from the point of agreement to deliver, install, and have the equipment in actual operation.”
No response was ever received — and now the Clean Air Branch claims it never got the letter.
In any event, in August, Clean Air forwarded to the hospital an application package for renewal of the hospital’s permit to operate the incinerator. Reflecting the latest changes in federal regulations, the application process of 1994 is a far cry from what it was when Hilo Hospital first sought its permit to operate in the mid-1980s. Back then, “it was a couple of pages,” Dela Cruz said in a recent interview. Now, he said, he is told by the Clean Air Branch that he should hire a consultant to prepare the application for renewal of a permit for an incinerator he has been trying for three years to get rid of.
By late October, the hospital was preparing to publish a request for proposals for an autoclave-compactor system. Should the Department of Health refuse to let the incinerator operate in the meantime, options are limited — and expensive.
According to Dela Cruz, last year, a Honolulu-based firm (the same one that had a contract to deliver medical waste to the United Environmental Service incinerator in `Aiea) would have accepted the hospital’s medical waste, provided the hospital purchased containers for the inter-island shipments. Now that option no longer exists — a result, Dela Cruz says, of barge operators requiring a separate storage area for medical waste.
The only remaining alternative — besides stockpiling the waste — is shipment to the continental United States for disposal.
Maui Memorial Lacks Permit to Incinerate
Unlike Hilo Hospital, Maui Memorial Hospital has a new incinerator that probably could meet more stringent federal clean air rules that will go into effect next year. The incinerator, installed in 1992, replaced an aged system that was the subject of many complaints and several notices of violation from the Department of Health.
However, the new Maui incinerator shares one trait with its decrepit counterpart in Hilo: Both are operating without the required permits.
In mid-1993, Maui Memorial obtained an Authority to Construct permit (ATC) from the Clean Air Branch. Under the old permitting system, an ATC allows construction of an emissions source. After the source is built, the operator of the source was to seek a Permit to Operate (PTO), which governed the actual operation of the facility.
In November 1993, however, the Department of Health changed its permitting system. No longer was the two-step ATC-PTO permitting process in effect. Rather, sources of emissions would receive just one type of permit that would be in effect from the time they were built through their first years of operation. There are still two types of permits issued — covered or non-covered source, referring generally to the large and small emissions generators — but no longer is the process of obtaining a permit to operate a two-stage affair.
That “simplification” has its cost. In the case of Maui Memorial, the new incinerator’s Authority to Construct (issued under the old permitting system) expired August 1, 1994. The hospital did not seek an old Permit to Operate, since that system was being phased out by the Clean Air Branch.
Neither, however, has the hospital applied for a new non-covered source permit, although the Clean Air Branch sent the hospital (and most other facilities with existing permits) application packets last February.
Volume 5, Number 5 November 1994
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