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The red bags aren't arriving anymore from Regional Health Rapid City Hospital to the city's landfill.

"I don't know where they're going, or what they're doing with them differently, but they're not coming to us," Dale Tech, director of public works, said after a city meeting two weeks ago.

Six weeks ago, after a visit from state health investigators following media reports that Regional Health was sending unregulated medical waste to the local dump, a senior Regional official announced in a video posted to Facebook that environmental services contractors at the hospital had begun sorting waste at a third site.

Regional would not divulge the location to the Journal, but said in a statement issued through a spokesperson that along with other measures, "additional sorting has contributed to improved handling of waste."

"Whatever they're doing is working," said Tech.

By all reports, this clean streak has continued. Earlier this week, a spokesperson for the city confirmed it has "not received any waste loads from Rapid City Regional Hospital for approximately the past month." The Journal also requested records from the South Department of Health and found that investigators on May 2 surveyed "infection control" and determined the hospital "in compliance."

Safety violations, even improper waste stream management, can strike fear especially into hospital administrators as the payments back to hospitals for caring for patients on federal medical insurances programs, such as Indian Health Services, Medicare or Medicaid, can be jeopardized. 

A spokesperson with the Centers for Medicare and Medicaid Services confirmed four hospitals within the last year lost medicare reimbursement privileges due to safety violations. Over 750 hospitals, according to a list on Kaiser Health News, had medicare funding reduced by 1 percent as penalty for safety violations — an enforcement dating back from the Affordable Care Act.

In April, a medical watchdog group tied to the Boston Globe released records showing Regional Health Rapid City Hospital had a number of safety violations  — the second most — among teaching hospitals nationally. Many violations, including the improper disposal of syringes carrying personal medical information, stemmed from waste management. 

But the illegal dumping has come to a stop. 

"The steps we have taken have ensured that we are meeting all city, state and federal standards," said Regional Health in a statement.

Regulating medical waste escalated to a national concern when syringes from a boat carrying medical refuse washed ashore a New Jersey beach. Congress passed the 1988 Medical Waste Tracking Act, which expired three years later. Since then, state environmental agencies have adopted their own regulations. In South Dakota, officials with Solid Waste Management under the Department of Energy and Natural Resources can revoke permits to landfills. A spokesperson said the DENR has never done this and usually "works with the landfills" to achieve compliance.

Locally, the Rapid City Landfill doubled the price per load to deliverers not complying with rules. Regulated medical waste costs $87 per ton. The landfill routinely requests Regional Health to retrieve bags improperly disposed on its two to three trips a week.

While documented injuries to sanitation workers are rare, officials both in the city and Regional note their concern for the safety of workers who might step on a sharp object or be infected by bodily fluids, such as blood, coming into contact with workers or equipment.

It also remains unclear what caused the problem. State solid waste management officials in an interview noted the decomissioning of an autoclave — an oven that renders waste non-infectious — appeared to coincide with the reports from the landfill. Records show that the autoclave was shut down somewhere in late 2016 or early 2017. Stericycle, a national medical waste contractor, began hauling red bags to Denver.

But officials with Regional dismissed a single problem and focused instead on improving various processes. The western South Dakota health care giant posted cameras in the loading dock and have implemented more employee training on infection. That training is also mandatory. A CMS investigation from spring 2017 noted that few environmental services employees attended a non-mandatory training on Stericycle.

Regional Health insists these problems are in the past. The addition of a third, off-site sorting location prior to reaching Rapid City landfill, was announced as a new change in the May Facebook video. 

"Regional Health remains focused on meeting all regulations that govern the disposal of medical waste," Regional's statement read. "A month ago, we acknowledged that we were committed to doing more." 

The statement thanks caregivers for their "extra effort in making sure that Regional Health is a good environmental steward."

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