BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                  AB 1202
                                                                  Page  1

          Date of Hearing:   May 8, 2013

                        ASSEMBLY COMMITTEE ON APPROPRIATIONS
                                  Mike Gatto, Chair

                   AB 1202 (Skinner) - As Amended:  April 17, 2013 

          Policy Committee:                              Labor and  
          Employment   Vote:                            7-0

          Urgency:     No                   State Mandated Local Program:  
          Yes    Reimbursable:              Yes

           SUMMARY  

          This bill requires the Occupational Safety and Health Standards  
          Board (OSHS Board) to adopt an occupational safety and health  
          standard for the handing of antineoplastic and other hazardous  
          drugs in health care facilities regardless of the setting.   
          Specifically, this bill:  

          1)Requires the OSHS Board to consider input from hospitals,  
            practicing physicians from impacted specialties (i.e.  
            oncology), organizations representing health care personnel  
            (i.e. nurses), and other stakeholders, and determine a  
            reasonable time for facilities to implement new requirements  
            imposed by the adopted standard.  

          2)Requires the standard, to the extent feasible, be consistent  
            with and not exceed recommendations in the National Institute  
            for Occupational Safety and Health (NIOSH) alert entitled  
            "Preventing Occupational Exposures to Antineoplastic and Other  
            Hazardous Drugs in Health Care Settings," as updated in 2010.   
            Further authorizes the standard to incorporate applicable  
            updates and changes to NIOSH guidelines.  

          3)Defines antineoplastic drug as a chemotherapeutic agent that  
            controls and kills cancer cells.  

          4)Defines hazardous drug as any drug so identified by NIOSH or  
            any drug that meets at least one of six criteria, as  
            specified.   

           FISCAL EFFECT  









                                                                  AB 1202
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          One-time GF administrative costs, of approximately $170,000, to  
          the Division of Occupational Safety and Health to develop  
          regulations for adoption by the OSHS Board, as specified.   
          Enforcement costs are expected to be minor, absorbable.  

           COMMENTS  


           1)Background  .  The OSHS Board, a seven-member body appointed by  
            the governor, is the standards-setting agency within the  
            California/Occupational Safety Health (Cal/OSHA) program. The  
            board has the responsibility to grant or deny applications for  
            variances from adopted health and safety standards and respond  
            to petitions for new or revised standards. The part-time,  
            independent board holds monthly meetings throughout  
            California.  

            NIOSH is the federal agency within the Center for Disease  
            Control (CDC) that is responsible for conducting research and  
            making recommendations for the prevention of work-related  
            injury and illness.  In 2004, NIOSH issued an alert that  
            identified more than 150 drugs as hazardous to both patient  
            and healthcare workers.  According to NIOSH, "Drugs are  
            classified as hazardous if studies in animals or humans  
            indicate that exposures to them have a potential for causing  
            cancer, developmental or reproductive toxicity, or harm to  
            organs. Many hazardous drugs are used to treat illnesses such  
            as cancer or HIV infection.  The 2004 list of drugs was  
            updated in 2010 and 2013.  The 2013 update includes 26 new  
            drugs and notes, "these additions are new drugs or existing  
            drugs that had new warnings from 2007 to 2009."  


            Under current law, the OSHS Board has the authority to  
            regulate the manufacture, handling and use of drugs that have  
            anti-cancer properties or are used to treat cancer by  
            employees. 

           2)Purpose  .  According to the CDC, "many hazardous drugs used to  
            treat cancer bind to or damage DNA (for example, alkylating  
            agents). Other antineoplastic drugs, some antivirals,  
            antibiotics, and bioengineered drugs interfere with cell  
            growth or proliferation, or with DNA synthesis. In some cases,  
            the nonselective actions of these drugs disrupt the growth and  
            function of both healthy and diseased cells, resulting in  








                                                                  AB 1202
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            toxic side effects for treated patients. These nonselective  
            actions can also cause adverse effects in health care workers  
            who are inadvertently exposed to hazardous drugs."  

            The CDC estimates about 8 million U.S. healthcare workers are  
            potentially exposed to hazardous drugs, including pharmacy and  
            nursing personnel, physicians, operating room personnel,  
            environmental services workers, workers in research  
            laboratories, veterinary care workers, and shipping and  
            receiving personnel.

            According to the author, "Workers can be exposed to  
            contamination without even knowing it. This occurs when they  
            create aerosols, generate dust, mix liquids, clean up spills  
            or touch contaminated surfaces when they prepare, administer  
            or dispose of hazardous drugs.  Regardless of early concerns  
            about exposure to hazardous drugs, current law provides no  
            enforceable standards for the handling of hazardous drugs to  
            ensure healthcare workers are protected. Unlike radiation,  
            there are no federal or state regulations to limit healthcare  
            workers' exposure to hazardous drugs.  Implementing and  
            regulating improved safety guidelines and standards will  
            significantly reduce the risk of healthcare workers and  
            patients being exposed to hazardous drugs. This includes  
            developing procedures for properly using and maintaining  
            equipment designed to protect workers from hazardous drug  
            exposure."

            This bill requires the OSHS Board to adopt standards  
            consistent with the 2004 NIOSH alert on hazardous drugs, as  
            specified.  






           Analysis Prepared by  :    Kimberly Rodriguez / APPR. / (916)  
          319-2081