September 18, 2006
Full steam ahead | Nearly all Maine's hospitals are now using a unique medical waste treatment plant in Pittsfield
By Jeffrey Bouley
In early August, St. Andrews Hospital & Healthcare Center in Boothbay Harbor got a delivery of 30 red, 28-gallon bins to fill with medical waste like bandages, needles and bloodstained clothing to be hauled away for disposal. While the event itself wasn't unusual ˆ the hospital's medical waste is typically collected once a month anyway ˆ the bins and the destination for waste was new. For the first time, St. Andrews was being visited by a truck from the AHR Medwaste Treatment Plant in Pittsfield, a facility owned by the Maine Hospital Association and established last year with the goal of reining in costs related to medical waste disposal.
St. Andrews made the switch to the AHR facility because its contract with Illinois-based biomedical waste hauler Stericycle Inc. expired this summer. A little over a year ago, all 39 hospitals in the state also used Stericycle to haul their biomedical waste to Massachusetts for incineration. But the system left them with little control over potential cost increases or handling decisions, which is why the MHA decided to create a Maine-based facility to treat waste from all the state's hospitals.
Today, just three hospitals ˆ Mid Coast Hospital in Brunswick, St. Mary's Regional Medical Center in Lewiston and York Hospital ˆ still send their waste out of state. And with one or more doctor's offices, clinics, or other small-source medical waste producers signing on to the AHR plant almost weekly, according to Miles Theeman, the chair of MHA's steering committee for the medical waste plant, the facility is doing well in its goal of capturing all of the biomedical waste in the state.
But even if not every producer of bloody bandages, used needles or other medical waste signs on, health care providers in Maine have taken an environmental stand by treating and landfilling their own refuse, says Tamara Butts, director of business development and administration for the MHA. Maine's 39 hospitals together produce some 2.2 million pounds of medical waste each year. Hauling that waste to Massachusetts not only cost too much, it was still coming home to roost in the form of harmful dioxins emitted when the waste was incinerated and blown north.
Instead, the AHR Medwaste Treatment Plant steam sterilizes most of the waste, essentially turning it into normal garbage that can be more safely sent to a landfill. (For more on the process, see "Cleaning up the trash," page 23.) "Before we had this facility, hospitals were at the mercy of using a single transporter and had no say in the process, and they were subject to huge price increases any time a contract expired," Butts says. "Now, through their membership in the MHA, they are part of the running of the very facility that handles their waste."
The result is a more cost-effective way of transporting and disposing biomedical waste, she says, but one that took two-and-a-half years and a $1 million investment for the MHA to develop. That was a lot of time and money to put at stake, since the whole proposition was somewhat of a risk: Even with the MHA's member hospitals agreeing in principal that a new facility would be a good idea, it meant changing processes and dealing with new faces, with no guarantee it would work out as planned. But so far, Maine hospitals are pleased with the service, and the idea has even drawn national attention.
Improving handling, reducing waste
Although St. Andrews has just begun using the AHR plant, hospital officials say the transition has been seamless. "We were never unhappy with Stericycle per se, but there were no other options for hospitals here in Maine," says Ron Vachon, director of facilities at St. Andrews. "In terms of taking responsibility for our own waste, it made more sense for all of us to handle it in state at a single facility rather than paying someone out of state to do who knows what with it."
Theeman, executive vice president and chief operating officer at Affiliated Healthcare Systems in Bangor, agrees that there hasn't been a loss in quality or frequency of waste pickup at the six hospitals and various labs under his umbrella. If anything, Vachon says, there have been improvements in the waste handling ˆ most notably the adoption of the reusable plastic tubs to collect medical waste. The tubs are used to transport waste to the AHR plant and are then sterilized and returned to the hospitals. "Using the plastic totes has actually saved us a couple steps logistically in the hospital, so that's a benefit right there," Theeman says.
Previously, all Maine hospitals put their waste into cardboard boxes, which only produced even more garbage, points out Chris Kerr, president of Oxus Environmental LLC, a New York-based company that is contracted to operate the AHR plant. "Taking the cardboard boxes out of the equation has already reduced the waste stream by about eight percent," Kerr says. "It was certainly an investment to produce the plastic tubs, but the return to hospitals in the long run is substantial."
Oxus, known until recently as SteriLogic ME, is a division of New York-based SteriLogic Waste Systems, which serves upstate New York and northern Pennsylvania. SteriLogic was formed in 1997 to distribute biomedical-waste treatment equipment provider services that reduce the waste streams of the medical industry. In 1998, it expanded to include divisions that specialize in medical waste-stream management and the niche market of sharps (used needles and the like) waste management.
Although MHA owns the AHR facility, it decided to go with an experienced company like SteriLogic to operate the plant. "We needed someone who knew the logistics of handling medical waste already," says Jack May, CEO of Sebasticook Valley Hospital and the person who chaired the original MHA committee that looked into the feasibility of creating the AHR plant. "Oxus already runs a facility in New York, so we knew he not only had experience, but also a back-up facility close by."
Some savings, but the benefit of control
Although the MHA expects the facility to help hospitals collectively save about $300,000 a year, Butts admits that not all hospitals will actually reduce costs by using the new facility. Specifically, larger hospitals like Maine Medical Center can no longer use their size and volume of waste to broker discounts with waste haulers. But those larger hospitals have signed on with AHR, she says, because all hospitals in the state see value in having control over their waste hauling. "For our part, we aren't spending any more than we did before, and that's fine because we have better long-term control over costs and risks with the AHR plant," says Charlie Papa, who directs environmental, linen, parking, security and outdoor services at Maine Medical Center. "But it's going to mean a lot for smaller hospitals, particularly those in northern Maine that have low waste volumes and high cost. A tractor trailer going from Massachusetts to Fort Kent is going a long way and costing you a lot of money."
But even the smaller hospitals haven't seen huge savings, though most of them notice a difference. "We are a small generator of waste relatively speaking, so we didn't save a ton, but we saved enough to make it well worth our while," May says. "Plus, I don't have to worry about some company with no vested interest in my future raising my rates."
Cost wasn't the only uncertainty removed when the AHR plant opened. By relying on an out-of-state hauler and out-of-state treatment facility, say May and Papa, Maine hospitals could have found themselves without a disposal option if changes to state regulations in Massachusetts, for example, banned the importing of waste from other states. "If someone did that to us and we weren't prepared for it, our ability to react would have been difficult at best," says May. "Now that's not a worry."
Even if there is a problem at the AHR plant that temporarily interrupts the waste treatment process, Oxus has a plant in New York as a backup, note May and Kerr. As the remaining three Maine hospitals come on board with AHR, along with smaller waste producers like medical offices and labs, the need for Oxus' New York facility should decline as well. "I really look forward to seeing more people come on board so we can invest even more into the infrastructure of the Pittsfield plant and have not just more capacity but also more back-up equipment," Vachon says. "To do that effectively we really need everyone to come on board, from the smallest providers on up to larger non-hospital waste generator, like Jackson Labs."
Adding to the list of clients using the AHR treatment plant is one of the MHA's goals, because the plant can handle more than five million pounds a year ˆ at least twice as much waste as it currently treats. That means veterinary clinics and nursing homes could potentially be added to the mix.
A statewide strategy for such a wide range of medical waste sources is unprecedented in the country, as far as Butts knows. There is a cooperative waste handling arrangement among some hospitals in Virginia, she says, and in some states large hospitals handle their own waste treatment, but nowhere else has something like this taken place.
For that reason, hospitals elsewhere in the country may be looking to the AHR Medwaste Treatment Plant as they evaluate their own operations, say hospital executives involved in the project. "The governor is constantly asking Maine hospitals to find ways to cut their costs, and while biomedical waste may be a relatively small part of an overall hospital budget, it isn't unimportant," says Theeman. "The AHR facility really gives us a way to control our own destiny. We're learning a lot from that change in thinking and I think other states can as well."
St. Andrews made the switch to the AHR facility because its contract with Illinois-based biomedical waste hauler Stericycle Inc. expired this summer. A little over a year ago, all 39 hospitals in the state also used Stericycle to haul their biomedical waste to Massachusetts for incineration. But the system left them with little control over potential cost increases or handling decisions, which is why the MHA decided to create a Maine-based facility to treat waste from all the state's hospitals.
Today, just three hospitals ˆ Mid Coast Hospital in Brunswick, St. Mary's Regional Medical Center in Lewiston and York Hospital ˆ still send their waste out of state. And with one or more doctor's offices, clinics, or other small-source medical waste producers signing on to the AHR plant almost weekly, according to Miles Theeman, the chair of MHA's steering committee for the medical waste plant, the facility is doing well in its goal of capturing all of the biomedical waste in the state.
But even if not every producer of bloody bandages, used needles or other medical waste signs on, health care providers in Maine have taken an environmental stand by treating and landfilling their own refuse, says Tamara Butts, director of business development and administration for the MHA. Maine's 39 hospitals together produce some 2.2 million pounds of medical waste each year. Hauling that waste to Massachusetts not only cost too much, it was still coming home to roost in the form of harmful dioxins emitted when the waste was incinerated and blown north.
Instead, the AHR Medwaste Treatment Plant steam sterilizes most of the waste, essentially turning it into normal garbage that can be more safely sent to a landfill. (For more on the process, see "Cleaning up the trash," page 23.) "Before we had this facility, hospitals were at the mercy of using a single transporter and had no say in the process, and they were subject to huge price increases any time a contract expired," Butts says. "Now, through their membership in the MHA, they are part of the running of the very facility that handles their waste."
The result is a more cost-effective way of transporting and disposing biomedical waste, she says, but one that took two-and-a-half years and a $1 million investment for the MHA to develop. That was a lot of time and money to put at stake, since the whole proposition was somewhat of a risk: Even with the MHA's member hospitals agreeing in principal that a new facility would be a good idea, it meant changing processes and dealing with new faces, with no guarantee it would work out as planned. But so far, Maine hospitals are pleased with the service, and the idea has even drawn national attention.
Improving handling, reducing waste
Although St. Andrews has just begun using the AHR plant, hospital officials say the transition has been seamless. "We were never unhappy with Stericycle per se, but there were no other options for hospitals here in Maine," says Ron Vachon, director of facilities at St. Andrews. "In terms of taking responsibility for our own waste, it made more sense for all of us to handle it in state at a single facility rather than paying someone out of state to do who knows what with it."
Theeman, executive vice president and chief operating officer at Affiliated Healthcare Systems in Bangor, agrees that there hasn't been a loss in quality or frequency of waste pickup at the six hospitals and various labs under his umbrella. If anything, Vachon says, there have been improvements in the waste handling ˆ most notably the adoption of the reusable plastic tubs to collect medical waste. The tubs are used to transport waste to the AHR plant and are then sterilized and returned to the hospitals. "Using the plastic totes has actually saved us a couple steps logistically in the hospital, so that's a benefit right there," Theeman says.
Previously, all Maine hospitals put their waste into cardboard boxes, which only produced even more garbage, points out Chris Kerr, president of Oxus Environmental LLC, a New York-based company that is contracted to operate the AHR plant. "Taking the cardboard boxes out of the equation has already reduced the waste stream by about eight percent," Kerr says. "It was certainly an investment to produce the plastic tubs, but the return to hospitals in the long run is substantial."
Oxus, known until recently as SteriLogic ME, is a division of New York-based SteriLogic Waste Systems, which serves upstate New York and northern Pennsylvania. SteriLogic was formed in 1997 to distribute biomedical-waste treatment equipment provider services that reduce the waste streams of the medical industry. In 1998, it expanded to include divisions that specialize in medical waste-stream management and the niche market of sharps (used needles and the like) waste management.
Although MHA owns the AHR facility, it decided to go with an experienced company like SteriLogic to operate the plant. "We needed someone who knew the logistics of handling medical waste already," says Jack May, CEO of Sebasticook Valley Hospital and the person who chaired the original MHA committee that looked into the feasibility of creating the AHR plant. "Oxus already runs a facility in New York, so we knew he not only had experience, but also a back-up facility close by."
Some savings, but the benefit of control
Although the MHA expects the facility to help hospitals collectively save about $300,000 a year, Butts admits that not all hospitals will actually reduce costs by using the new facility. Specifically, larger hospitals like Maine Medical Center can no longer use their size and volume of waste to broker discounts with waste haulers. But those larger hospitals have signed on with AHR, she says, because all hospitals in the state see value in having control over their waste hauling. "For our part, we aren't spending any more than we did before, and that's fine because we have better long-term control over costs and risks with the AHR plant," says Charlie Papa, who directs environmental, linen, parking, security and outdoor services at Maine Medical Center. "But it's going to mean a lot for smaller hospitals, particularly those in northern Maine that have low waste volumes and high cost. A tractor trailer going from Massachusetts to Fort Kent is going a long way and costing you a lot of money."
But even the smaller hospitals haven't seen huge savings, though most of them notice a difference. "We are a small generator of waste relatively speaking, so we didn't save a ton, but we saved enough to make it well worth our while," May says. "Plus, I don't have to worry about some company with no vested interest in my future raising my rates."
Cost wasn't the only uncertainty removed when the AHR plant opened. By relying on an out-of-state hauler and out-of-state treatment facility, say May and Papa, Maine hospitals could have found themselves without a disposal option if changes to state regulations in Massachusetts, for example, banned the importing of waste from other states. "If someone did that to us and we weren't prepared for it, our ability to react would have been difficult at best," says May. "Now that's not a worry."
Even if there is a problem at the AHR plant that temporarily interrupts the waste treatment process, Oxus has a plant in New York as a backup, note May and Kerr. As the remaining three Maine hospitals come on board with AHR, along with smaller waste producers like medical offices and labs, the need for Oxus' New York facility should decline as well. "I really look forward to seeing more people come on board so we can invest even more into the infrastructure of the Pittsfield plant and have not just more capacity but also more back-up equipment," Vachon says. "To do that effectively we really need everyone to come on board, from the smallest providers on up to larger non-hospital waste generator, like Jackson Labs."
Adding to the list of clients using the AHR treatment plant is one of the MHA's goals, because the plant can handle more than five million pounds a year ˆ at least twice as much waste as it currently treats. That means veterinary clinics and nursing homes could potentially be added to the mix.
A statewide strategy for such a wide range of medical waste sources is unprecedented in the country, as far as Butts knows. There is a cooperative waste handling arrangement among some hospitals in Virginia, she says, and in some states large hospitals handle their own waste treatment, but nowhere else has something like this taken place.
For that reason, hospitals elsewhere in the country may be looking to the AHR Medwaste Treatment Plant as they evaluate their own operations, say hospital executives involved in the project. "The governor is constantly asking Maine hospitals to find ways to cut their costs, and while biomedical waste may be a relatively small part of an overall hospital budget, it isn't unimportant," says Theeman. "The AHR facility really gives us a way to control our own destiny. We're learning a lot from that change in thinking and I think other states can as well."
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