2014 -- S 2803

========

LC005138

========

     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: Senator Christopher S.Ottiano

     Date Introduced: March 25, 2014

     Referred To: Senate Health & Human Services

     (by request)

It is enacted by the General Assembly as follows:

1

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

2

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

3

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

4

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

5

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

6

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

7

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

8

rules and regulations for hazardous waste management.

9

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

10

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

11

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

12

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

13

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

14

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

15

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

16

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

17

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

18

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

19

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

 

1

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

2

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

3

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

4

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

5

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

6

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

7

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

8

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

9

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

10

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

11

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

12

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

13

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

14

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

15

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

16

address this serious safety issue.

17

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

18

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

19

administer chemotherapy treatment shall:

20

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

21

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

22

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

23

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

24

chemotherapy drug or drugs;

25

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

26

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

27

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

28

insert(s); and

29

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

30

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

31

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

32

chapter.

33

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

34

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

 

LC005138 - Page 2 of 10

1

pharmacist shall satisfy the responsibility of the prescribing pharmacist hereunder.

2

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

3

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

4

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

5

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

6

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

7

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

8

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

9

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

10

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

11

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

12

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

13

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

14

rules and the rules and regulations for hazardous waste management.

15

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

16

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

17

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

18

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

19

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

20

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

21

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

22

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

23

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

24

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

25

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

26

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

27

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

28

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

29

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

30

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

31

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

32

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

33

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

34

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

 

LC005138 - Page 3 of 10

1

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

2

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

3

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

4

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

5

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

6

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

7

serious safety issue.

8

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

9

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

10

administer chemotherapy treatment shall:

11

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

12

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

13

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

14

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

15

chemotherapy drug or drugs;

16

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

17

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

18

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

19

insert(s); and

20

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

21

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

22

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

23

chapter.

24

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

25

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

26

pharmacist shall satisfy the responsibility of the prescribing pharmacist hereunder.

27

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

28

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

29

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

30

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

31

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

32

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

33

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

34

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

 

LC005138 - Page 4 of 10

1

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

2

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

3

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

4

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

5

rules and the rules and regulations for hazardous waste management.

6

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

7

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

8

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

9

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

10

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

11

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

12

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

13

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

14

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

15

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

16

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

17

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

18

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

19

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

20

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

21

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

22

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

23

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

24

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

25

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

26

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

27

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

28

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

29

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

30

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

31

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

32

address this serious safety issue.

33

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

34

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

 

LC005138 - Page 5 of 10

1

administer chemotherapy treatment shall:

2

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

3

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

4

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

5

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

6

chemotherapy drug or drugs;

7

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

8

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

9

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

10

insert(s); and

11

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

12

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

13

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

14

chapter.

15

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

16

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

17

pharmacist shall satisfy the responsibility of the prescribing pharmacist hereunder.

18

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

19

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

20

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

21

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

22

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

23

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

24

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

25

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

26

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

27

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

28

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

29

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

30

rules and the rules and regulations for hazardous waste management.

31

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

32

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

33

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

34

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

 

LC005138 - Page 6 of 10

1

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

2

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

3

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

4

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

5

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

6

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

7

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

8

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

9

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

10

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

11

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

12

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

13

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

14

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

15

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

16

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

17

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

18

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

19

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

20

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

21

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

22

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

23

address this serious safety issue.

24

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

25

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

26

administer chemotherapy treatment shall:

27

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

28

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

29

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

30

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

31

chemotherapy drug or drugs;

32

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

33

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

34

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

 

LC005138 - Page 7 of 10

1

insert(s); and

2

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

3

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

4

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

5

chapter.

6

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

7

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

8

pharmacist shall satisfy the responsibility of the prescribing pharmacist hereunder.

9

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

10

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

11

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

12

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

13

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

14

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

15

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

16

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

17

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

18

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

19

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

20

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

21

rules and the rules and regulations for hazardous waste management.

22

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

23

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

24

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

25

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

26

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

27

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

28

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

29

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

30

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

31

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

32

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

33

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

34

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

 

LC005138 - Page 8 of 10

1

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

2

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

3

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

4

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

5

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

6

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

7

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

8

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

9

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

10

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

11

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

12

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

13

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

14

address this serious safety issue.

15

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

16

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

17

administer chemotherapy treatment shall:

18

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

19

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

20

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

21

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

22

chemotherapy drug or drugs;

23

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

24

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

25

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

26

insert(s); and

27

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

28

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

29

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

30

chapter.

31

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

32

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

33

pharmacist shall satisfy the responsibility of the prescribing pharmacist hereunder.

34

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

 

LC005138 - Page 9 of 10

1

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

2

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

3

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

4

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

5

     SECTION 6. This act shall take effect upon passage.

========

LC005138

========

 

LC005138 - Page 10 of 10

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE - ACCIDENT AND SICKNESS INSURANCE POLICIES

***

1

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

2

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

3

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

4

Rhode Island.

5

     This act would take effect upon passage.

========

LC005138

========

 

LC005138 - Page 11 of 10