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