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The ongoing global environmental crises have promoted the discussion of environmental authoritarianism, which states that illiberal regimes, such as China, may become a new variant of ecological modernization as they are equipped to swiftly respond to the myriad of social and political disjuncture caused by environmental crimes. However, questions remain about the validity of the concept as the dumping of hazardous wastes has continued to create severe watershed pollution and environmental health threats in China even though medical and hazardous waste management laws were passed in 2003 and 2012 respectively. Based on data gathered in a community intervention project in Gansu province, this paper discusses how transformations in China’s rural healthcare system and deficiencies in grassroots governance constrained village shared governance, which, in turn, prevented the enforcement of environmental laws against the polluters. The findings suggest that without institutionalized public involvement, the implementation of environmental regulations by the authoritarian regime has only induced widespread neo-patrimonialism in resource management. This paper, therefore, suggests a fragmented authoritarian approach to deepen the understanding of environmental crime in an illiberal context.