[Pharmwaste] Can LTC facilities and prisons use the HH waste exclusion?

[William Yeman]

Barb,
 
What would Wisconsin's interpretation be for the following scenario:
 
A resident/patient at a long-term care facility is given a nicotine
patch to put on, but instead of putting the patch on he elects to not
use the patch that day and throws it in his trash basket. 
 
(Based on the quoted statement that a pharmaceutical that's "under the
control of the patient or resident of the long-term care facility WHEN
DISCARDED" would be subject to EPA's HHW exclusion, it appears that EPA
would regard the patch as excluded.)
 
Bill Yeman
NYSDEC
Albany NY
>>> "Bickford, Barbara J - DNR (Barb)" <Barbara.Bickford at Wisconsin.gov>
3/11/2013 1:12 PM >>>
Recently someone on the listserve suggested that the Federal Register
(specifically, 12/2/08 FR p 7352) would allow prisons and long term care
facilities to manage their residents’ wastes as household wastes.  We
think the quote from the Federal Register quote was taken out of
context.   Here is an excerpt from 12/2/08 FR p 73525 
http://www.epa.gov/fedrgstr/EPA-WASTE/2008/December/Day-02/f28161.pdf
c. Long-Term Care Facilities Nursing homes, assisted living centers,
and other long-term care facilities also may be subject to the RCRA
hazardous waste generator regulations. However, many long-term care
facilities may be unaware of the applicability of the RCRA hazardous
waste regulations to their hazardous pharmaceutical waste. Most
long-term care facilities generate two types of hazardous pharmaceutical
waste. First, the facility itself may generate hazardous wastes as a
result of its central management of pharmaceuticals in its pharmacy or
pharmacy-like area. These hazardous pharmaceutical wastes would be
subject to the RCRA hazardous waste generator regulations since the
pharmaceuticals are under the control of the facility, and, thus, the
resulting wastes are generated by that facility (see 40 CFR part 262).
The long-term care facilities, like other generators, are responsible
for determining whether the wastes it generates are hazardous wastes
subject to regulation under RCRA subtitle C. If so, the facility must
then manage the wastes accordingly. Long-term care facilities face many
of the same issues that health care facilities and pharmacies do in
managing hazardous pharmaceutical waste, as discussed above. Secondly,
patients and residents in long-term care facilities may generate
hazardous wastes. Those pharmaceuticals that are under the control of
the patient or resident of the long-term care facility, when discarded,
would be subject to RCRA’s household hazardous waste exclusion (40 CFR
261.4(b)(1)). Hazardous pharmaceutical wastes generated by the resident
are excluded from regulation because they are considered to be derived
from a household.
 
Our interpretation of the last three sentences is this:  If the patient
or resident can manage their own hazardous waste medications (e.g.,
nicotine patches or Coumadin), they can dispose of them in the garbage
or take them to a household medication collection program. If the
facility is managing medications for them (because the resident is
unable, due to incarceration or physical/cognitive inability), then the
facility is the generator.  For details, see
http://dnr.wi.gov/topic/HealthWaste/facility.html or
http://dnr.wi.gov/files/pdf/pubs/wa/wa1214.pdf 
Wisconsin DNR commented to DEA that it would be confusing to LTC
facilities if DEA’s determination of who can use collection boxes is
based on who owns the waste medications and if EPA and the states based
theirs on who controls or manages the waste medications. We hope EPA and
DEA can resolve this before the DEA finalizes its rules.   
Barb Bickford 
Wisconsin Department of Natural Resources 
608-267-3548            
barbara.bickford at wisconsin.gov 
 
 
 
 
 
 
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