Twelve-year-old John Johnson was playing with his buddy in a ditch behind his east Phoenix apartment earlier this month when he found a cardboard box stuffed with bloody needles. The seventh-grader raced home to show the discovery to his mother. "He was scared," recalls his mother, Sarah Fluhardy. "I could tell. His eyes were big."
Fluhardy got scared, too, when she saw the 30 used syringes in the flimsy, unsealed box.
"It just terrified me," says Fluhardy, 40, who is studying to be a radiology technician at Gateway Community College. "There's blood all over these needles. One of the syringes is halfway-full of blood."
In her medical classes, she says, she is cautioned to avoid handling blood-soaked refuse, especially used needles.
After her son assured her that he hadn't handled the syringes, Fluhardy started worrying about how to dispose of them-and how to make sure more bloody refuse isn't dumped where children can find it.
Concerned about diseases and remembering the frightening photographs of medical waste that had washed up on East Coast beaches in the summer of 1988, Fluhardy decided to ask authorities to dispose of the syringes properly and to investigate how the box got to the ditch behind her apartment, which is the area of Arcadia High School.
Her pursuit of answers has resulted in official reassurances, which she says she doesn't believe.
State and county health officials say there is no Arizona law that defines "medical waste" or regulates how such trash is handled outside hospitals. And while public health officials say more precautions are needed, at least two officials contend that the health risks to the public from medical waste are minimal.
Fluhardy, skeptical because of her classes at Gateway, says she started her own search for answers on January 3, the same day her son found the bloody needles, by calling the Phoenix Police Department.
The police referred her to the Maricopa County health department. (Police spokesman Kevin Robinson says the police don't have a policy regarding medical waste and handle complaints individually.)
When she got through to Mike Campbell, a supervising sanitarian for the county health department, Fluhardy says, she didn't get much help: "I said, `What do I do with these?' And he said: `Throw 'em in the garbage.'"
(Campbell says what he told Fluhardy was how to get rid of such waste safely by sealing it in a puncture-proof container before tossing it.)
Three weeks later, the box is still sitting on a shelf in Fluhardy's bedroom. She says she's afraid to simply seal it and throw it away because somebody else may pull it out of a trash heap and open it.
State law regulates disposal of medical wastes by hospitals, which are required to burn or sterilize the garbage they generate. But that law applies only to hospitals, says Barry Abbott, manager of the solid waste unit of the state Department of Environmental Quality.
"Medical waste in Arizona right now is just considered solid waste, like tires or grass clippings," Abbott says. "What we have are guidelines about how to handle it, but we don't have regulations about how to enforce those."
In 1990, the Arizona State Legislature passed a law directing the Department of Environmental Quality to write rules regulating disposal of medical waste outside hospitals. But lawmakers didn't give a deadline for finishing the rules, Abbott says, and the rules haven't been written yet. He says the department has been under a hiring freeze for nearly two years and the four people on his staff have other responsibilities.
Now the hiring freeze has been lifted, Abbott says, and he plans to hire someone to write rules concerning disposal of medical waste. That should take about six months, he says.
Then the rules have to be approved by the Governor's Office and the Attorney General's Office. "In two years, we could have some rules," Abbott says. "That's soon for us."
For all the talk about guidelines and rules, the question is this: Do people get sick from handling medical refuse?
The likelihood of that is "extremely remote," says Allen Hershkowitz, senior scientist at the Natural Resources Defense Council, an environmental research and advocacy group in Washington, D.C. "Dry blood implies dead viruses, in terms of AIDS. The exposure hazard is puncture wounds, not infection."
At least a couple of local public health officials agree. "There's a significant body of people in the medical field who don't believe medical waste is a problem," says Campbell, of the county health department. "I think the jury's still out on that."
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While people may worry about catching viruses from bloody syringes or bandages, most health experts aren't worried, says Norm Petersen, chief of the office of risk assessment in the state Department of Health Services.
The "crap" that washed up on the nation's beaches in the summer of 1988 focused attention on the issue, Petersen says, but after a two-year study, government investigators couldn't link medical trash to cases of AIDS or hepatitis.
Petersen says a lengthy report on medical waste to Congress, delivered in September 1990 by the Agency for Toxic Substances and Disease Registry, supports that view.
"The bottom line of that great, big, giant report is that there isn't any epidemiological evidence of a health risk," he says. "All they found is you step on a syringe and it's like you step on a nail. Most blood is not bad. We have sanitary napkins and Band-Aids all over the place in the city every day, and nobody gets hurt.