2014 -- H 7644

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LC004708

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2014

____________

A N   A C T

RELATING TO INSURANCE - ACCIDENT AND SICKNESS INSURANCE POLICIES

     Introduced By: Representatives McNamara, Valencia, Bennett, and Shekarchi

     Date Introduced: February 27, 2014

     Referred To: House Corporations

     It is enacted by the General Assembly as follows:

     SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness

Insurance Policies" is hereby amended by adding thereto the following section:

     27-18-82. Cancer patient safety and environmental protection. -- (a) Purpose. It is the

policy of the state of Rhode Island not to permit the introduction of pollutants into the

groundwaters and water systems of the state, or otherwise to be discharged in concentrations

which are known to be toxic, carcinogenic, mutagenic, or teratogenic as the same are defined in

the Rhode Island department of environmental managements groundwater quality rules and the

rules and regulations for hazardous waste management.

     (b) Findings. (1) It is acknowledged by medical experts that bodily wastes of patients

undergoing chemotherapy treatment may contain levels of chemicals that are toxic,

carcinogenic, mutagenic or teratogenic for a certain period of time, to such an extent that the

World Health Organization defines genotoxic waste as chemotherapy drug waste including urine,

feces and vomit from patients, which may contain potentially hazardous amounts of the

administered cytostatic drugs or of their metabolites, and which should be considered genotoxic

for at least forty-eight (48) hours and sometimes up to one week after drug administration.

     (2) The World Health Organization further states that any discharge of genotoxic waste

into the environment could have disastrous ecological consequences. The World Health

Organization core principles require that all personnel associated with financing and supporting

healthcare activities should provide for the costs of managing healthcare waste. This is the duty of

care. The World Health Organization places the responsibility for genotoxic waste on the chief

pharmacist and further states that the chief pharmacist also has the special responsibility of

ensuring that genotoxic products are used safely, and that genotoxic waste is managed safely.

     (3) The federal Occupational Safety and Health Administration ("OSHA") is the main

federal agency charged with the enforcement of safety and health legislation. OSHA, in concert

with the National Institute for Occupational Safety and Health ("NIOSH") and the joint

commission on healthcare, an independent, not-for-profit organization that accredits and certifies

more than twenty thousand (20,000) healthcare organizations and programs in the United States,

stated in a 2011 letter to every hospital in the country that "[s]ome of these drugs have been

known to cause cancer, reproductive and developmental problems, allergic reactions, and other

adverse effects that can be irreversible even after low-level exposures"; and

     (4) The American Cancer Society has published a comprehensive list of safety

precautions regarding the in-home personal hygiene for individuals undergoing chemotherapy

and their families. Therefore, for the protection of both the public health and the environment, the

general assembly shall require that standards as set forth pursuant to this section be observed to

address this serious safety issue.

     (c) Chemotherapy precautions following treatment. All physicians, pharmacists, or other

health care professionals licensed in the state of Rhode Island authorized to prescribe and/or

administer chemotherapy treatment shall:

     (1) Provide written notice from the prescribing pharmacist to each patient undergoing

such treatment as to the hazards posed to patients and their families of extremely hazardous

excretions, including, but not limited to, urine, vomit, and feces for a period following treatment

as generally determined by the food and drug administration label accompanying said

chemotherapy drug or drugs;

     (2) Provide a sufficient collection method so that providers and patients can safely collect

and contain extremely hazardous excretions for a period of time as determined by the United

States Food and Drug Administration ("FDA") and referenced on the relevant FDA prescription

insert(s); and

     (3) Provide for safe and proper disposal of said collected extremely hazardous excretions.

     (d) All expenses incurred as a result of this section shall be paid by Medicare, Medicaid

or any private insurance company providing health care insurance and licensed pursuant to this

chapter.

     (e) Receipt of notice from the party administering chemotherapy drugs or their agent is

responsible for proper disposal of the hazardous wastes by the prescribing pharmacist or chief

LC004708 - Page 2 of 11

pharmacist shall satisfy the responsibility of the prescribing pharmacist hereunder.

     (f) For the purposes of this section, "extremely hazardous excretions" shall mean any

excretion from a patient on a regimen of chemotherapy agents that are antineoplastic or cytotoxic,

during the period of administration and the time period referenced in subsection (c) of this

section, including, but not limited to, drugs listed in the NIOSH list of antineoplastic and other

hazardous drugs, as the same may be updated or amended from time to time.

     SECTION 2. Chapter 27-18.5 of the General Laws entitled "Individual Health Insurance

Coverage" is hereby amended by adding thereto the following section:

     27-18.5-11. Cancer patient safety and environmental protection. --

     (a) Purpose. It is the policy of the state of Rhode Island not to permit the introduction of

pollutants into the groundwaters and water systems of the state, or otherwise to be discharged in

concentrations which are known to be toxic, carcinogenic, mutagenic, or teratogenic as the same

are defined in the Rhode Island department of environmental management groundwater quality

rules and the rules and regulations for hazardous waste management.

     (b) Findings. (1) It is acknowledged by medical experts that bodily wastes of patients

undergoing chemotherapy treatment may contain levels of chemicals that are toxic, carcinogenic,

mutagenic or teratogenic for a certain period of time, to such an extent that the World Health

Organization defines genotoxic waste as chemotherapy drug waste including urine, feces and

vomit from patients, which may contain potentially hazardous amounts of the administered

cytostatic drugs or of their metabolites, and which should be considered genotoxic for at least

forty-eight (48) hours and sometimes up to one week after drug administration.

     (2) The World Health Organization further states that any discharge of genotoxic waste

into the environment could have disastrous ecological consequences. The World Health

Organization core principles require that all personnel associated with financing and supporting

healthcare activities should provide for the costs of managing healthcare waste. This is the duty of

care. The World Health Organization places the responsibility for genotoxic waste on the chief

pharmacist and further states that the chief pharmacist also has the special responsibility of

ensuring that genotoxic products are used safely, and that genotoxic waste is managed safely.

     (3) The federal Occupational Safety and Health Administration ("OSHA") is the main

federal agency charged with the enforcement of safety and health legislation. OSHA, in concert

with the National Institute for Occupational Safety and Health ("NIOSH") and the joint

commission on healthcare, an independent, not-for-profit organization that accredits and certifies

more than twenty thousand (20,000) healthcare organizations and programs in the United States,

stated in a 2011 letter to every hospital in the country that "[s]ome of these drugs have been

LC004708 - Page 3 of 11

known to cause cancer, reproductive and developmental problems, allergic reactions, and other

adverse effects that can be irreversible even after low-level exposures"; and

     (4) The American Cancer Society has published a comprehensive list of safety

precautions regarding the in-home personal hygiene for individuals undergoing chemotherapy

and their families. Therefore, for the protection of both the public health and the environment, the

general assembly shall require that standards are set forth pursuant to this section to address this

serious safety issue.

     (c) Chemotherapy precautions following treatment. All physicians, pharmacists, or other

healthcare professionals licensed in the state of Rhode Island authorized to prescribe and/or

administer chemotherapy treatment shall:

     (1) Provide written notice from the prescribing pharmacist to each patient undergoing

such treatment as to the hazards posed to patients and their families of extremely hazardous

excretions, including, but not limited to, urine, vomit, and feces, for a period following treatment

as generally determined by the food and drug administration label accompanying said

chemotherapy drug or drugs;

     (2) Provide a sufficient collection method so that providers and patients can safely collect

and contain extremely hazardous excretions for a period of time as determined by the United

States Food and Drug Administration ("FDA") and referenced on the relevant FDA prescription

insert(s); and

     (3) Provide for safe and proper disposal of said collected extremely hazardous excretions.

     (d) All expenses incurred as a result of this section shall be paid by Medicare, Medicaid

or any private insurance company providing healthcare insurance and licensed pursuant to this

chapter.

     (e) Receipt of notice from the party administering chemotherapy drugs or their agent

responsible for proper disposal of the hazardous wastes by the prescribing pharmacist or chief

pharmacist shall satisfy the responsibility of the prescribing pharmacist hereunder.

     (f) For the purposes of this section, "extremely hazardous excretions" shall mean any

excretion from a patient on a regimen of chemotherapy agents that are antineoplastic or cytotoxic,

during the period of administration and the time period referenced in subsection (c) of this

section, including, but not limited to, drugs listed in the NIOSH list of antineoplastic and other

hazardous drugs, as the same may be updated or amended from time to time.

     SECTION 3. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service

Corporations" is hereby amended by adding thereto the following section:

     27-19-73. Cancer patient safety and environmental protection. --

LC004708 - Page 4 of 11

     (a) Purpose. It is the policy of the state of Rhode Island not to permit the introduction of

pollutants into the groundwaters and water systems of the state, or otherwise to be discharged in

concentrations which are known to be toxic, carcinogenic, mutagenic, or teratogenic as the same

are defined in the Rhode Island department of environmental management groundwater quality

rules and the rules and regulations for hazardous waste management.

     (b) Findings. (1) It is acknowledged by medical experts that bodily wastes of patients

undergoing chemotherapy treatment may contain levels of chemicals that are toxic, carcinogenic,

mutagenic or teratogenic for a certain period of time, to such an extent that the World Health

Organization defines genotoxic waste as chemotherapy drug waste including urine, feces and

vomit from patients, which may contain potentially hazardous amounts of the administered

cytostatic drugs or of their metabolites, and which should be considered genotoxic for at least

forty-eight (48) hours and sometimes up to one week after drug administration.

     (2) The World Health Organization further states that any discharge of genotoxic waste

into the environment could have disastrous ecological consequences. The World Health

Organization core principles require that all personnel associated with financing and supporting

healthcare activities should provide for the costs of managing healthcare waste. This is the duty of

care. The world health organization places the responsibility for genotoxic waste on the chief

pharmacist and further states that the chief pharmacist also has the special responsibility of

ensuring that genotoxic products are used safely, and that genotoxic waste is managed safely.

     (3) The federal Occupational Safety and Health Administration ("OSHA") is the main

federal agency charged with the enforcement of safety and health legislation. OSHA, in concert

with the National Institute for Occupational Safety and Health ("NIOSH") and the joint

commission on healthcare, an independent, not-for-profit organization that accredits and certifies

more than twenty thousand (20,000) healthcare organizations and programs in the United States,

stated in a 2011 letter to every hospital in the country that "[s]ome of these drugs have been

known to cause cancer, reproductive and developmental problems, allergic reactions, and other

adverse effects that can be irreversible even after low-level exposures"; and

     (4) The American Cancer Society has published a comprehensive list of safety

precautions regarding the in-home personal hygiene for individuals undergoing chemotherapy

and their families. Therefore, for the protection of both the public health and the environment, the

general assembly shall require that standards as set forth pursuant to this section be observed to

address this serious safety issue.

     (c) Chemotherapy precautions following treatment. All physicians, pharmacists, or other

healthcare professionals licensed in the state of Rhode Island authorized to prescribe and/or

LC004708 - Page 5 of 11

administer chemotherapy treatment shall:

     (1) Provide written notice from the prescribing pharmacist to each patient undergoing

such treatment as to the hazards posed to patients and their families of extremely hazardous

excretions, including, but not limited to, urine, vomit, and feces, for a period following treatment

as generally determined by the food and drug administration label accompanying said

chemotherapy drug or drugs;

     (2) Provide a sufficient collection method so that providers and patients can safely collect

and contain extremely hazardous excretions for a period of time as determined by the United

States Food and Drug Administration ("FDA") and referenced on the relevant FDA prescription

insert(s); and

     (3) Provide for safe and proper disposal of said collected extremely hazardous excretions.

     (d) All expenses incurred as a result of this section shall be paid by Medicare, Medicaid

or any private insurance company providing healthcare insurance and licensed pursuant to this

chapter.

     (e) Receipt of notice from the party administering chemotherapy drugs or their agent

responsible for proper disposal of the hazardous wastes by the prescribing pharmacist or chief

pharmacist shall satisfy the responsibility of the prescribing pharmacist hereunder.

     (f) For the purposes of this section, "extremely hazardous excretions" shall mean any

excretion from a patient on a regimen of chemotherapy agents that are antineoplastic or cytotoxic,

during the period of administration and the time period referenced in subsection (c) of this

section, including, but not limited to, drugs listed in the NIOSH list of antineoplastic and other

hazardous drugs, as the same may be updated or amended from time to time.

     SECTION 4. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service

Corporations" is hereby amended by adding thereto the following section:

     27-20-69. Cancer patient safety and environmental protection.--

     (a) Purpose. It is the policy of the state of Rhode Island not to permit the introduction of

pollutants into the groundwaters and water systems of the state, or otherwise to be discharged in

concentrations which are known to be toxic, carcinogenic, mutagenic, or teratogenic as the same

are defined in the Rhode Island department of environmental management groundwater quality

rules and the rules and regulations for hazardous waste management.

     (b) Findings. (1) It is acknowledged by medical experts that bodily wastes of patients

undergoing chemotherapy treatment may contain levels of chemicals that are toxic, carcinogenic,

mutagenic or teratogenic for a certain period of time, to such an extent that the World Health

Organization defines genotoxic waste as chemotherapy drug waste including urine, feces and

LC004708 - Page 6 of 11

vomit from patients, which may contain potentially hazardous amounts of the administered

cytostatic drugs or of their metabolites, and which should be considered genotoxic for at least

forty-eight (48) hours and sometimes up to one week after drug administration.

     (2) The World Health Organization further states that any discharge of genotoxic waste

into the environment could have disastrous ecological consequences. The World Health

Organization core principles require that all personnel associated with financing and supporting

healthcare activities should provide for the costs of managing healthcare waste. This is the duty of

care. The world health organization places the responsibility for genotoxic waste on the chief

pharmacist and further states that the chief pharmacist also has the special responsibility of

ensuring that genotoxic products are used safely, and that genotoxic waste is managed safely.

     (3) The federal Occupational Safety and Health Administration ("OSHA") is the main

federal agency charged with the enforcement of safety and health legislation. OSHA, in concert

with the National Institute for Occupational Safety and Health ("NIOSH") and the joint

commission on healthcare, an independent, not-for-profit organization that accredits and certifies

more than twenty thousand (20,000) healthcare organizations and programs in the United States,

stated in a 2011 letter to every hospital in the country that "[s]ome of these drugs have been

known to cause cancer, reproductive and developmental problems, allergic reactions, and other

adverse effects that can be irreversible even after low-level exposures"; and

     (4) The American Cancer Society has published a comprehensive list of safety

precautions regarding the in-home personal hygiene for individuals undergoing chemotherapy

and their families. Therefore, for the protection of both the public health and the environment, the

general assembly shall require that standards as set forth pursuant to this section be observed to

address this serious safety issue.

     (c) Chemotherapy precautions following treatment. All physicians, pharmacists, or other

healthcare professionals licensed in the state of Rhode Island authorized to prescribe and/or

administer chemotherapy treatment shall:

     (1) Provide written notice from the prescribing pharmacist to each patient undergoing

such treatment as to the hazards posed to patients and their families of extremely hazardous

excretions, including, but not limited to, urine, vomit, and feces, for a period following treatment

as generally determined by the food and drug administration label accompanying said

chemotherapy drug or drugs;

     (2) Provide a sufficient collection method so that providers and patients can safely collect

and contain extremely hazardous excretions for a period of time as determined by the United

States Food and Drug Administration ("FDA") and referenced on the relevant FDA prescription

LC004708 - Page 7 of 11

insert(s); and

     (3) Provide for safe and proper disposal of said collected extremely hazardous excretions.

     (d) All expenses incurred as a result of this section shall be paid by Medicare, Medicaid

or any private insurance company providing healthcare insurance and licensed pursuant to this

chapter.

     (e) Receipt of notice from the party administering chemotherapy drugs or their agent

responsible for proper disposal of the hazardous wastes by the prescribing pharmacist or chief

pharmacist shall satisfy the responsibility of the prescribing pharmacist hereunder.

     (f) For the purposes of this section, "extremely hazardous excretions" shall mean any

excretion from a patient on a regimen of chemotherapy agents that are antineoplastic or cytotoxic,

during the period of administration and the time period referenced in subsection (c) of this

section, including, but not limited to, drugs listed in the NIOSH list of antineoplastic and other

hazardous drugs, as the same may be updated or amended from time to time.

     SECTION 5. Chapter 27-41 of the General Laws entitled "Health Maintenance

Organizations" is hereby amended by adding thereto the following section:

     27-41-86. Cancer patient safety and environmental protection.--

     (a) Purpose. It is the policy of the state of Rhode Island not to permit the introduction of

pollutants into the groundwaters and water systems of the state, or otherwise to be discharged in

concentrations which are known to be toxic, carcinogenic, mutagenic, or teratogenic as the same

are defined in the Rhode Island department of environmental management groundwater quality

rules and the rules and regulations for hazardous waste management.

     (b) Findings. (1) It is acknowledged by medical experts that bodily wastes of patients

undergoing chemotherapy treatment may contain levels of chemicals that are toxic, carcinogenic,

mutagenic or teratogenic for a certain period of time, to such an extent that the World Health

Organization defines genotoxic waste as chemotherapy drug waste including urine, feces and

vomit from patients, which may contain potentially hazardous amounts of the administered

cytostatic drugs or of their metabolites, and which should be considered genotoxic for at least

forty-eight (48) hours and sometimes up to one week after drug administration.

     (2) The World Health Organization further states that any discharge of genotoxic waste

into the environment could have disastrous ecological consequences. The World Health

Organization core principles require that all personnel associated with financing and supporting

healthcare activities should provide for the costs of managing healthcare waste. This is the duty of

care. The world health organization places the responsibility for genotoxic waste on the chief

pharmacist and further states that the chief pharmacist also has the special responsibility of

LC004708 - Page 8 of 11

ensuring that genotoxic products are used safely, and that genotoxic waste is managed safely.

     (3) The federal Occupational Safety and Health Administration ("OSHA") is the main

federal agency charged with the enforcement of safety and health legislation. OSHA, in concert

with the National Institute for Occupational Safety and Health ("NIOSH") and the joint

commission on healthcare, an independent, not-for-profit organization that accredits and certifies

more than twenty thousand (20,000) healthcare organizations and programs in the United States,

stated in a 2011 letter to every hospital in the country that "[s]ome of these drugs have been

known to cause cancer, reproductive and developmental problems, allergic reactions, and other

adverse effects that can be irreversible even after low-level exposures"; and

     (4) The American Cancer Society has published a comprehensive list of safety

precautions regarding the in-home personal hygiene for individuals undergoing chemotherapy

and their families. Therefore, for the protection of both the public health and the environment, the

general assembly shall require that standards as set forth pursuant to this section be observed to

address this serious safety issue.

     (c) Chemotherapy precautions following treatment. All physicians, pharmacists, or other

healthcare professionals licensed in the state of Rhode Island authorized to prescribe and/or

administer chemotherapy treatment shall:

     (1) Provide written notice from the prescribing pharmacist to each patient undergoing

such treatment as to the hazards posed to patients and their families of extremely hazardous

excretions, including, but not limited to, urine, vomit, and feces, for a period following treatment

as generally determined by the food and drug administration label accompanying said

chemotherapy drug or drugs;

     (2) Provide a sufficient collection method so that providers and patients can safely collect

and contain extremely hazardous excretions for a period of time as determined by the United

States Food and Drug Administration ("FDA") and referenced on the relevant FDA prescription

insert(s); and

     (3) Provide for safe and proper disposal of said collected extremely hazardous excretions.

     (d) All expenses incurred as a result of this section shall be paid by Medicare. Medicaid

or any private insurance company providing healthcare insurance and licensed pursuant to this

chapter.

     (e) Receipt of notice from the party administering chemotherapy drugs or their agent

responsible for proper disposal of the hazardous wastes by the prescribing pharmacist or chief

pharmacist shall satisfy the responsibility of the prescribing pharmacist hereunder.

     (f) For the purposes of this section, "extremely hazardous excretions" shall mean any

LC004708 - Page 9 of 11

excretion from a patient on a regimen of chemotherapy agents that are antineoplastic or cytotoxic,

during the period of administration and the time period referenced in subsection (c) of this

section, including, but not limited to, drugs listed in the NIOSH list of Antineoplastic and other

hazardous drugs, as the same may be updated or amended from time to time.

     SECTION 6. This act shall take effect upon passage.

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LC004708

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LC004708 - Page 10 of 11

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE - ACCIDENT AND SICKNESS INSURANCE POLICIES

***

     This act would require that protections related to the disposal of extremely hazardous

wastes generated by the use of toxic, carcinogenic, mutagenic, or teratogenic chemotherapy drugs

be implemented by pharmacists, physicians, healthcare providers, and insurers in the state of

Rhode Island.

     This act would take effect upon passage.

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LC004708

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LC004708 - Page 11 of 11