BILL ANALYSIS Ó Senate Committee on Labor and Industrial Relations William W. Monning, Chair Date of Hearing: June 26, 2013 2013-2014 Regular Session Consultant: Gideon L. Baum Fiscal:Yes Urgency: No Bill No: AB 1202 Author: Skinner As Introduced/Amended: May 24, 2013 SUBJECT Occupational safety and health standards: hazardous drugs. KEY ISSUE Should the Legislature require the Occupational Safety and Health Standards Board (OSHSB) to create an occupational safety and health standard for the handling of antineoplastic drugs in health care facilities? ANALYSIS Existing law provides for the Occupational Safety and Health Standards Board (OSHSB), which consists of seven individuals appointed by the Governor for four year terms. Two members must be from the field of management, two members must be from the field of labor, one member must be from the field of occupational health, one member must be from the field of occupational safety and one member must be from the general public. (Labor Code §§140 and 141) Existing law empowers OSHSB, by an affirmative vote of four or more members, to adopt, amend, or repeal occupational safety and health standards. The procedure to adopt, repeal, or amend occupational safety and health standards must follow the process for promulgating regulations, unless otherwise stated in Labor Code. (Labor Code §§142.3 and 142.4) Existing law requires that the Department of Occupational Safety and Health (DOSH) enforce all occupational safety and health standards adopted by OSHSB. (Labor Code §142) Existing law allows any employer to apply to OSHSB for a permanent variance from any occupational safety and health standard if the employer has an alternative practice or program that will provide equal or superior safety for employees. The standards board must issue the variance if it determines on the record that the preponderance of evidence supports that the employer's alternative practice or program are as safe as the standard. (Labor Code §143) Existing law requires that OSHSB develop or revise certain specific occupational safety and health standards, including bloodborne pathogens, hazardous substance removal work, agricultural field sanitation, and lead-related construction. (Labor Code §§144.7, 6380.5, 6712, and 6717) This bill would require OSHSB to create an occupational safety and health standard for the handling of antineoplastic drugs in health care facilities regardless of the setting. In developing the standard, the board must: 1) Consider input from hospitals, practicing physicians from impacted specialties, including oncology, organizations representing health care personnel, including registered nurses and pharmacists, and other stakeholders, and 2) Determine a reasonable time for facilities to implement new requirements imposed by the adopted standard. 3) To the extent feasible, be consistent with and not exceed recommendations in the National Institute for Occupational Safety and Health (NIOSH) 2004 alert entitled "Preventing Occupational Exposures to Antineoplastic and Other Hazardous Drugs in Health Care Settings," as updated in 2010. This bill would define "Antineoplastic drug" as a chemotherapeutic agent that controls or kills cancer cells. This bill would also make findings and declarations on the dangers of inappropriate handling of antineoplastic drug in an occupational setting. Hearing Date: June 26, 2013 AB 1202 Consultant: Gideon L. Baum Page 2 Senate Committee on Labor and Industrial Relations COMMENTS 1. What are Antineoplastic Drugs? Antineoplastic Drugs (also known as cytotoxic drugs) are drugs or agents used in chemotherapy cancer treatments to prevent the development, maturation, or spread of cancerous cells. For the patients who take these drugs, side effects include hair loss, fatigue, blood problems, and other health hazards. Although developed for cancer treatments shortly after the end of the Second World War, concerns about occupational exposure were not raised until the 1970s. According to the Center for Disease Control (CDC), the effects of exposure to Antineoplastic Drugs in the workplace can be quite significant. For example, a 2007 study on Antineoplastic Drug exposure in the workplace showed that nurses exposed to these drugs/agents took longer to conceive and had lower birthrates. Several studies have also shown a link between increased exposure to Antineoplastic Drugs and cancer. In short, the CDC recognizes Antineoplastic Drugs as a potential occupational health risk. 2. The 2004 NIOSH Alert The National Institute for Occupational Safety and Health (NIOSH), which is a part of the Centers for Disease Control and Prevention (CDC), published an alert in 2004 "to increase awareness among health care workers and their employers about the health risks posed by working with hazardous drugs and to provide them with measures for protecting their health." The alert concluded with: "Recent evidence summarized in this Alert documents that worker exposure to hazardous drugs is a persistent problem? In all studies involving examination of surface wipe samples, Hearing Date: June 26, 2013 AB 1202 Consultant: Gideon L. Baum Page 3 Senate Committee on Labor and Industrial Relations researchers have determined that surface contamination of the workplace is common and widespread. Also, a number of recent studies have documented the excretion of several indicator drugs in the urine of health care workers. Results from studies indicate that worker exposure to hazardous drugs in health care facilities may result in adverse health effects? To minimize these potentially acute (short-term) and chronic (long-term) effects of exposure to hazardous drugs at work, NIOSH recommends that at a minimum, employers and health care workers follow the recommendations presented in this Alert (emphasis added)." The NIOSH alert made set forth the following recommended procedures: 1) Assess the hazards in the workplace: § Evaluate the workplace to identify and assess hazards before anyone begins works with hazardous drugs. § Regularly review the current inventory of hazardous drugs, equipment, and practices, seeking input from affected workers. § Conduct regular training reviews with all potentially exposed workers in workplaces where hazardous drugs are used. 1) Handle drugs safely: § Implement a program for safely handling hazardous drugs at work and review this program annually on the basis of the workplace evaluation. § Establish procedures and provide training for handling hazardous drugs safely, cleaning up spills, and using all equipment and personal protective equipment properly. § Establish work practices related to both drug manipulation techniques and to general hygiene practices. 1) Use and maintain equipment properly: Hearing Date: June 26, 2013 AB 1202 Consultant: Gideon L. Baum Page 4 Senate Committee on Labor and Industrial Relations § Develop workplace procedures for using and maintaining all equipment that functions to reduce exposure - such as ventilated cabinets, closed-system drug-transfer devices, needless systems, and personal protective equipment. 3. Proponent Arguments : Proponents argue that registered nurses and healthcare workers by the nature of their work, which involves ill patients, contagious diseases, medical equipment and chemical exposures, are in constant danger of being exposed to harmful substances without even knowing it. Proponents note that nurses and other healthcare workers, who transport, prepare, administer and dispose of hazardous drugs can be exposed to these toxic agents in the air or on work surfaces, clothing, medical equipment and other surfaces. As a result, proponents note that nurses, other healthcare workers and nonclinical workers are at risk for exposure to hazardous drugs, which proponents argue can cause cancer, reproductive and developmental problems, allergic reactions and other adverse effects that can be irreversible even after low-level exposures. 4. Opponent Arguments : None on file. 5. Prior Legislation : SB 432 (DeLeon) of 2011would have required the Occupational Safety and Health Standards Board (OSHSB) to develop an occupational safety and health standard for lodging housekeepers. SB 432 was held in the Assembly Appropriations Committee. SUPPORT American Federation of State, County and Municipal Employees, AFL-CIO Hearing Date: June 26, 2013 AB 1202 Consultant: Gideon L. Baum Page 5 Senate Committee on Labor and Industrial Relations Association of Northern California Oncologists (If Amended) BD Medical Surgical Systems California Healthcare Institute California Labor Federation, AFL-CIO California Nurses Association California Pharmacists Association California Professional Firefighters National Lawyers Guild Labor & Employment Committee OPPOSITION None on file. Hearing Date: June 26, 2013 AB 1202 Consultant: Gideon L. Baum Page 6 Senate Committee on Labor and Industrial Relations