Legislature(1999 - 2000)
04/05/2000 03:28 PM House L&C
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HB 440-PROTECTION FROM NEEDLE & SHARPS INJURIES CHAIRMAN ROKEBERG announced the first order of business would be HOUSE BILL NO. 440, "An Act relating to needle stick and sharps injury protections and the use of safe needles by health care facilities and health care professionals; relating to the vaccination of health care workers against diseases transmitted by blood borne pathogens; and providing for an effective date." Number 0168 REPRESENTATIVE HALCRO moved to adopt the proposed CS for HB 440, Version D [1-LS1580\D Cramer 4/5/99], as the working document before the committee. There being no objection, it was so ordered. Number 0206 REPRESENTATIVE HARRIS explained that the bill had been called to his attention by the nurses' association and was being introduced in both the House of Representatives and the Senate. [HB 440 was sponsored by the House Community and Regional Affairs Standing Committee, which Representative co-chairs.] He invited testimony from Angie Schmitz, Staff to Senator Kim Elton, sponsor of the companion bill in the Senate. Number 0256 ANGIE SCHMITZ, Staff to Senator Kim Elton, Alaska State Legislature, came forward to testify. She stated: House Bill 440 brings needed protection to health care workers from accidental needle stick injuries. Health care workers are of particular risk on the job because of the danger of disease transmission. Accidental needle sticks can transmit blood borne diseases such as hepatitis B, hepatitis C and Human Immunodeficiency Virus (HIV), in addition to others. Nationwide, health care workers are estimated to suffer between 600,000 and 1 million accidental needle sticks per year. For the state of Alaska, that translates to approximately 1,300 to 2,200 needle sticks per year. Between 50,000 and 60,000 health care workers nationwide have contracted serious diseases from needle sticks in the last decade. On average, one health care worker per week is exposed to HIV. The seriousness of HIV is well known, but less well known are the serious effects of hepatitis C, which is now estimated to eventually lead to the deaths of more health care workers than does HIV. Medical workers are four times more likely than police officers to die from a job-related injury. Safer devices are available. They have been approved for marketing by the Food and Drug Administration (FDA), but many health care workers still do not have access to these devices. It is estimated that nationally only 15 percent of hospitals use safer devices. They cost a little bit more up front, but studies show that facilities can save money in the long term by reducing testing and follow-up care for workers who are accidentally exposed to diseases. The cost for testing following a high- risk needle stick is $3,000, even when no infection occurs. A serious infection can cost up to $1 million, including lost time and disability payments as well as treatment. California was the first state to pass a safer needle law. In that state, health care employers are expected to save $100 million per year thanks to reduced needle stick accidents. Five states have already passed safer needle legislation and there are bills similar to this one pending in 20 states besides Alaska. The American Nurses' Association has made safer needle legislation a national priority, and this bill is strongly supported by the Alaska Nurses' Association as well as the Teamsters and Laborers unions. Number 0450 MS. SCHMITZ continued: There are two parts to the bill. The first, Part A, requires health care facilities to evaluate safer devices. All of the other parts call for regulations from the Department of Labor concerning safer devices. Within those regulations, there is a requirement that safer needles be included as engineering work practice controls. There is one exception. If an evaluation committee at least half of whom are front-line health care workers determines that the devices jeopardize the care or safety of themselves or of the patient, then they may not be used. There is a requirement that facilities institute a procedure for selecting devices and include that in their exposure control plan, and a requirement that the exposure control plan be updated as new technology is developed, at least once a year. There is also a requirement for a sharps injury law, which records information about needle sticks, including the type and brand of the device involved. In addition, the Department of Labor can adopt regulations concerning other aspects of needle safety, including training and education requirements and measures to increase vaccinations. Also, the Department of Labor is required to assist employers in complying with these requirements, and they will need to compile a list of sources of information on safer devices. MS. SCHMITZ volunteered to speak to the changes between the original bill and the proposed CS. She explained that in the new CS, dentists are excluded from the requirements of the bill, based on [Alaska] Dental Society testimony that experience with these devices shows they are not particularly effective for intra-oral use. For example, Novocaine is not delivered well and there are problems with bulky devices. Also, no concerns about needle sticks have been voiced by dental hygienists. Therefore, references to dental devices have been removed from the definitions section. MS. SCHMITZ said that originally a six-month evaluation period was required. That has been changed to "as long as necessary to evaluate devices," and there is involvement of front-line health care workers in the decision about how long that should be. In addition, there were a couple of other places where wording was clarified. There [formerly] were references to an evaluation committee in a section that didn't talk about an evaluation committee. There was language in Section 1[(a)] which may have been interpreted to say one only needed to evaluate devices that were already in use, which was not the intent. Number 0666 REPRESENTATIVE HALCRO noted that the bill mandates that the Department of Labor and Workforce Development (DLWD) shall adopt certain regulations; however, he noted the absence of a fiscal note. He asked if there is one from that department. MS. SCHMITZ said a fiscal note has not been received from the DLWD. She theorized that much in HB 440 is what that department is already doing as part of federal Occupational Safety and Health Administration (OSHA) regulations and a recent compliance directive. Number 0756 MARY WEISS, Registered Nurse; Member, Alaska Nurses Association, testified via teleconference from Anchorage. She urged passage of HB 440. She believes it will greatly help protect health care workers, not just the doctors and nurses but also the laundry, housekeeping and nursing assistance employees throughout the state. CHAIRMAN ROKEBERG asked MS. Weiss if she worked in an institutional setting. MS. WEISS answered that she works as the Research Coordinator for the University of Alaska Anchorage School of Nursing. She offered to speak to the training the nursing students receive in the skills lab and she also offered to relate some of the concerns the students have, in clinical settings, with needles. She specified that her information is from the students, not from direct observation. CHAIRMAN ROKEBERG noted that there had been a request from the university to make sure that lancets were covered under this legislation. He asked if she had an opinion on that. MS. WEISS said yes, she made that suggestion to her director. Although the bill enumerates various types of needles, lancets are not included. In the university skills lab, students do some work with diabetic testing in which they use lancets. Any time that one is working with blood, there is some kind of risk for exposure. Therefore, she thought it would be good to mention lancets unless the desire was to keep them under "any other category of device used at the employer's facility where there is a sharp injury risk." Number 0895 CHAIRMAN ROKEBERG asked if lancets would be covered under blood- drawing devices. MS. WEISS explained that a lancet is not necessarily a blood drawing device. She referred to page 2, line 9, paragraph (8). Number 0931 REPRESENTATIVE HALCRO asked if there are any health care facilities that have voluntarily embraced needle stick prevention. MS. WEISS said she has heard that all three of the large hospitals in Anchorage have varying degrees of commitment to needle-less devices. That lack of standardization is one of the problems for students and faculty. Nursing students have mentioned one facility that they thought was especially good because it had a room that was set up with the exact materials used in a clinical setting; anyone could use the room and work with the equipment in order to get the feel of it. The students also thought this was a very good idea because they recognized their degree of inexperience was just manual dexterity; working with needles and working around blood is so critical that students want to be able to have [as high a] level of expertise as possible before they are actually in the [actual] setting. Although Ms. Weiss did not know if the three hospitals had accepted this voluntarily, she did know that there are some OSHA regulations regarding this; however she understood those to be voluntary guidelines. Number 1040 WANDA KATINSZKY, President, Alaska Nurses Association, testified via teleconference from Anchorage. She said the Alaska Nurses Association is a constituent member of the American Nurses Association. The state organization represents bargaining units at Central Peninsula General Hospital and Providence Alaska Medical Center. Therefore, she speaks for more than 6,000 nurses throughout Alaska. She informed the committee that she is also a registered nurse and has worked with hospital implementation of OSHA guidelines. MS. KATINSZKY remarked that she wished HB 440 were not necessary. However, the nurses' association has taken informal surveys throughout Alaska and those surveys have found a wide variation in the availability of safe needle products. She recognized that many facilities have done a good job implementing federal guidelines. However, the American Nurses Association is championing this cause due to the visible lack of response by employers. This problem with compliance was highlighted in the executive summary of the Maryland Study Group on Health Care Worker Safety, which states, "although the OSHA bloodborne pathogen standard includes language on the use of engineered sharps protection, it has not been an effective tool in promoting widespread use of engineered sharps injury protection." This study group [ultimately] recommended passing state legislation, which was enacted in 1999. MS. KATINSZKY reiterated earlier testimony that annually, health care workers suffer 600,000 to 1 million injuries from conventional needles and sharps. Of those injuries to health care workers, nurses suffer the majority. She asked, "Why is this allowed to happen when over 80 percent of needle stick injuries are preventable with use of safer needle devices?" Although these safer needle devices have been on the market for more than a decade, less than 15 percent of facilities nationwide have employed the use of these safer devices. MS. KATINSZKY asked, "What does it take to protect our health care workers?" She replied, "It will take strong state legislation instead of compliance directives, which is what we currently have." She pointed out that the compliance directives are merely interpretations of standards that change with different administrations. Therefore, a permanent solution, this legislation, is necessary. She also pointed out that compliance directives are subject to legal challenges and interpretations of the standard, and therefore passing a state law would remove ambiguity. MS. KATINSZKY stated that this bill makes good business sense because the employer is not required to purchase all safety devices but rather requires the employer to evaluate products using front-line workers to determine what works best in their particular facility. She expressed the need to use a scientific approach to evaluate the products and decrease the incidence of needle stick injury. She related her belief that done correctly, the cost of implementing these devices will decrease over time due to the cost savings realized from a reduction in exposure, follow-up and treatment. A study in California reported an estimated overall savings of over $100 million per year as a result of fewer needle stick injuries and the illnesses that result. She informed the committee that it is estimated that annually, 1,000 workers will become infected and according to the American Hospital Association, one serious infection by bloodborne pathogen can quickly add up to $1 million or more. CHAIRMAN ROKEBERG expressed concern about setting up an evaluation committee for a small doctor's office, perhaps staffed with just two people. "Who's on the committee?" he asked. Number 1293 MS. KATINSZKY said that is a good point in that it doesn't always take a committee to get things done. She thinks if she was in that facility and having to implement a program, her biggest concern would be determining where the injuries are occurring. She noted that syringes are the main [source of injuries]. CHAIRMAN ROKEBERG clarified that his question was how one would have a committee in a very small office. Number 1331 MS. KATINSZKY said the committee probably would consist of the nurse, assuming that there is a nurse, or the office manager where there are medical attendants rather than nurses. Number 1360 DONNA THOMPSON, Registered Nurse, testified via teleconference from Washington. She informed the committee that she has been a nurse for 16 years. Ms. Thompson related how she was exposed to hepatitis while working in the burn center in Anchorage in 1989. She explained that her exposure to hepatitis was through infected blood and body fluids during long dressing changes and tubbing. She was diagnosed in December of 1989 and in March of 1990 was in a coma and was transported to the University of Washington hospital in Seattle, where she had a liver transplantation. Ms. Thompson informed the committee that she has three children. The two youngest ones had to be immunized with gamma globulin at the time she was diagnosed with hepatitis. She related the difficulties that [this disease] created for her family. For herself, she was debilitated, during this short illness of three months, to the point where she didn't have the strength to get up to use the bathroom. Furthermore, it would be an hour ordeal to merely take a shower. Number 1482 MS. THOMPSON informed the committee that after about 21 days in the hospital she was discharged on an outpatient basis and remained in Seattle for close monitoring for another six weeks. After that time, she returned to Alaska. She noted that in total, she was off from work a little over a year and a half. When she returned, she had a lot of difficulty getting her job back because "they" were reluctant to rehire her due to her immunodepression status and the drugs that she would have take in order to maintain the transplant. However, she did successfully return to work, but only after threatening legal action. She informed the committee that she was never terminated from the hospital. MS. THOMPSON informed the committee that she worked in an outpatient care facility at that hospital for approximately three years. In 1992 [or 1993], after her liver transplant, she received her first needle stick, which was very devastating after going through the transplantation. She explained that the needle stick happened during an endoscopy procedure, during which the lights are down low and [the nurse is] watching a monitor and caring for the patient. She specified that the needle stick occurred after she had given the medication; she inadvertently stuck herself when she turned. She attributed the needle stick to the low lighting. Since that time, she has taken a break from nursing and is currently working in an office now. MS. THOMPSON informed the committee that she has been re- diagnosed with hepatitis again due to recurrence from the original exposure. Therefore, the virus is still present in her body, although the liver transplantation gave her a healthy liver. She said, "Now I'm reinfected. What my future is right now is uncertain. It just depends on the virus and how rapidly it does develop." She noted that, at the initial transplant, her pathologist projected her life expectancy would be to age 65. Now that she has active hepatitis again, she indicated that her life expectancy may be shorter than 65. CHAIRMAN ROKEBERG thanked Ms. Thompson very much for her testimony. Number 1711 MAGGIE FLANNAGAN, Registered Nurse and a health and safety officer for her union, which represents nurses at an acute health care facility in Alaska, testified via teleconference from Anchorage. She informed the committee that the nurses she represents are very upset that in the facility where they work, one person in authority can block hundreds of health care workers from having these protective devices. She said, "What our facility proves is that having the devices on site is not enough. We still have health care workers who do not have access to these protective devices." She explained that [the employees of this facility] are requesting a product evaluation committee that includes participation from front-line workers as well as a better tracking system of needle stick injuries, both of which are provided by this bill. With a better tracking system, the high-risk situations or procedures associated with these injuries can be identified and work can be done to reduce or eliminate these hazards. MS. FLANNAGAN emphasized that it is important for legislators to know that needle stick injuries are a silent epidemic. She indicated that for these health care workers, who have had their lives devastated after acquiring diseases from these injuries, to testify in public about the personal tragedies only furthers their pain. Therefore, she asked the legislators to hear their voices through her words. MS. FLANNAGAN explained that many of these individuals suffer the consequences of these needle stick injuries in silence because they're afraid to call friends, co-workers and family members. She noted that although the committee has heard about the risks of needle stick injuries related to HIV, Hepatitis B and C, there are 20 diseases that can be transmitted with these exposures. Ms. Flannagan returned to the fear that many of her co-workers have regarding sharing their stories in public, although they are sharing them in private. From those stories, Ms. Flannagan has heard of health care workers who have waited months, [and even] years, to see if their injury resulted in disease transmission. In the meantime, they need to use safe-sex precautions with their spouse and they worry about transmitting these infections to family members. Number 1840 MS. FLANNAGAN pointed out that these safer needle devices also protect the health care consumer. For example, in December a school nurse in Anchorage was performing a routine tuberculosis skin test on a child and accidentally used a needle that had already been used by someone else. In this case, Ms. Flannagan believes that a safer needle device could have protected this child. Furthermore, she believes that safer needle devices could prevent some of the incidents that she has witnessed across the nation. She informed the committee that she has worked with high-risk infants in four different hospitals across the nation and has found infants with needles in their beds, in their blankets and has even found a baby lying on a bare needle. MS. FLANNAGAN informed the committee that it is considered a safe practice to tape needles into the IV lines of newborns while delivering piggyback medication. However, she emphasized that the tape is not enough; this system does fail even with the best technique. She explained that in these situations usually a child is moving around and the tape will catch on the blanket which results in a bare needle in the bed with the child. Although the disease transmission in such an injury is very low, she asked why a child should endure such an injury when safety products are available. She also pointed out that other patients, patients who are sedated, confused, combative, or having seizures, are at risk with these kind of injuries. Furthermore, needles can be used as potential weapons against health care workers in the mental health [profession]. Number 1911 MS. FLANNAGAN remarked that many health care workers are injured through no fault of their own. For instance, nurses find needles in the beds of patients they are transporting or health care workers are stuck by other people or they find improperly disposed needles. Ms. Flannagan said, "What I'm asking you to understand is that no matter what the reason for the exposure, the blaming needs to stop, the protection needs to start, and our health care system needs to be made safer." She informed the committee that she has had a high-risk needle stick while drawing blood from an infant of a known intravenous drug abuser. Ms. Flannagan urged the committee "to consider this bill a matter of life and death for our health care providers." She urged the committee to support HB 440. Number 1979 CAROL CLAUSON, Registered Nurse, Alaska Nurses Association, testified by teleconference. She informed the committee that she had suffered a needle stick from a high-risk patient, a patient with a history of drug use. This incident was very traumatic to Ms. Clauson, who wondered who would [take care] of her young children if she had contracted a fatal bloodborne disease. Ms. Clauson noted her support of this legislation. In conclusion, she highlighted the importance of the involvement of front-line worker in the product evaluation of [safety devices of] this nature. Number 2026 DON NOVOTNEY, Registered Nurse, came forward to testify. He said he has been practicing as an infection control nurse for about 11 years. He gave a demonstration, saying: We have an intravenous (IV) tubing at the top connected to a bag. It [the tubing] comes down to a patient's hand. There are injection ports. We don't want needles in those injection ports. A needle hurts anybody who gets stuck with it. This [needle at the top] is far away from the patient, the one down here is a little closer. Sometimes blood can back up into there, and if there is a metal needle in there, and it pulls out, it's a danger. There are devices that screw into the connectors, the injection ports. There is also one that clips on like a clothespin. These ports are precut. They provide a safe IV set. There is blood drawing equipment. CHAIRMAN ROKEBERG asked about the IV: "If you want to avoid any kind of needle [and] use these other types of devices, what's the cost differential there?" MR. NOVOTNEY said they are very similar in price, a penny or two [difference]. CHAIRMAN ROKEBERG asked why they are not more universally used. Number 2093 MR. NOVOTNEY explained that the hospital where he works is affiliated with hundreds of hospitals; as a result, the group of hospitals has great buying power. They provide workers with one type of needle-safe tubing, not two or three or four like the industry provides. A hospital worker has only one choice. A hospital such as Columbia, which has great buying power because it negotiates a contract with the supplier, will provide a safe needle device from that supplier. He then turned to product evaluation, which he didn't foresee in hospitals of this size because such hospitals have negotiated a contract to buy from only one supplier in return for a price break. Therefore, if the hospital breaks that contract, its costs increase. Number 2136 MR. NOVOTNEY showed another device that goes into an injection port and connects to a large rubber tube that the lab uses to draw blood. CHAIRMAN ROKEBERG asked how one gets the blood out. MR. NOVOTNEY said: This is what a phlebotomist would use. There is a needle sticking out, a sharp needle on the end of this that plugs into a tube. There's some mechanics involved in all of this. We have to be responsible and pay attention. If I don't pay attention, I'm going to stick myself, even with a clean needle. Now, this needle that's been dangling here like this goes into a vein. And when you are finished, you slide a hard plastic cover up over it. CHAIRMAN ROKEBERG asked, "So the sheath is really the primary method of safety in that regard?" MR. NOVOTNEY agreed, but reminded the committee that a human being has to activate it. He continued: When I start an IV, this plastic part stays in the vein. I have a sharp needle here that nobody would want to get stuck with. We have a device that we have been using for about five or six years that slides up over the steel needle that makes it safe - unless it goes into a trash compactor. We're human beings. We may not activate this. Everyone has to take some responsibility in their practice. Number 2221 CHAIRMAN ROKEBERG asked if a percentage of the devices used in the institutional care facilities of this state have safe needle devices. Or is there a problem? MR. NOVOTNEY said he thinks there is a problem in regard to the availability of safe devices as well as [the fact that the users of these devices are ] human beings; for example, would a person use one when another device is quicker? He noted the difficulty in teaching an old dog new tricks. CHAIRMAN ROKEBERG asked about the availability of safe devices. MR. NOVOTNEY informed the committee that when he looked for [the safer device at his workplace], he found it on the back shelf behind just a plain needle and a steel syringe. He explained the safety device as follows: This is a safety syringe. After I give an intramuscular injection, it goes over the top, locks in place, and I can't disable it. But I still have to throw this in a sharps container as well as taking this one and putting a needle on it. MR. NOVOTNEY commented that half the needle sticks at the institution where he works can be found in the garbage. CHAIRMAN ROKEBERG asked if there is a cost differential. MR. NOVOTNEY said the traditional [needle stick] costs about six cents and the safer one costs about 13-14 cents; it's about double. CHAIRMAN ROKEBERG observed, "What you have in your hand is probably about the most used commodity in a medical setting." MR. NOVOTNEY clarified that in hospitals, very few injections are given because IV tubing is being used. However, in doctor's offices one would see syringes. He said, "And for all immunizations to bring immunization rates up in Alaska, they're using this." Mr. Novotney expressed his desire for the Emergency Medical Services [EMS] and the cities and boroughs [to use the safer alternatives]. He explained: When a patient comes to us, the EMS is not using the same thing we are using, a safe needle system, a needle-free system. They are at risk. When they move a person, we have to swap all of our tubing over because [it doesn't] fit. Number 2341 MR. NOVOTNEY turned to the use of lancets [in regard to diabetes]. He explained: This device [now] is activated. The pin is pulled out. It's ready to poke somebody. It's fired. I can't re- fire this now; it is covered up. There's a sharp device that you can't get at. The same thing goes with scalpel blades. In the operating room, they'll take a scalpel blade out of an aluminum packet, place it into a blade holder, use it on a patient, now it's dirty, and you have to take something like a pair of pliers or some kind of locking instrument, grasp it and pull it out. But any piece of metal is springy, and can spring out. Having a blade on a handle would be very good. The health care system already [is implementing] the exposure control plan that came out of the Center for Disease Control and was published in the Federal Register ..., [but] is it being enforced? I would put my money on it that the Department of Labor [and Workforce Development] that enforces OSHA in the State of Alaska has not visited many health institutions and looked at needle safety. If we could make them [syringes] all like this, it would be great. But we are still using syringes and needles. If we can eliminate that, there will be fewer needle sticks. Number 2433 REPRESENTATIVE HALCRO noted a reference made earlier to school nurses. He asked if there is any kind of safety device for the device used to give TB tests. MR. NOVOTNEY explained that previously a four-pronged testing device had been used. However, that device did not give accurate results. Therefore, Juneau schools now use a 1 cc syringe in order to go underneath the skin and inject one-tenth of a milliliter of purified protein derivative tuberculosis. Two days later, [the nurse] examines and evaluates [the site]. CHAIRMAN ROKEBERG thanked Mr. Novotney for the demonstration. He asked what the definition of "sharps" is. [Because of the tape change, some of Mr. Novotney's response was not recorded.] TAPE 00-43, SIDE B Number 0004 MR. NOVOTNEY indicated that anything that is sharp, usually made of metal - such as needles and IV starts that can pass through a [protective plastic] glove - would be considered a "sharp". Number 0041 BARBARA HUFF TUCKNESS, Director of Governmental and Legislative Affairs for Teamsters Union Local 959, came forward to testify. She provided the committee with a copy of a presentation on South Peninsula Hospital, in Homer, where there is a very proactive, safety-conscious hospital director. The South Peninsula Hospital hospital has been implementing many of the safer tools for the past four and a half years. In regard to whether there is a cost difference, Ms. Huff Tuckness said there is. She specified: The cost - as has been previously testified - even the initial testing for needle stick injuries runs $5,000- $6000. If, indeed, there is an actual infection, you are looking at up into millions of dollars. So from a short-term perspective, there is a difference in cost. From a long-term perspective, it is well worth the cost. MS. HUFF TUCKNESS commended South Peninsula Hospital for its proactive approach, but noted that in some of Alaska's other hospitals [such a proactive approach for safer tools] is not necessarily the case. She pointed out that this very small community hospital has had some very positive results. In conclusion, Ms. Huff Tuckness said, "We are supporting HB 440." Number 0138 CHAIRMAN ROKEBERG asked about the companion measure, SB 261. Ms. HUFF TUCKNESS said SB 261 was in the Senate Finance Committee and was expected to move tomorrow. CHAIRMAN ROKEBERG said, "I hope it gets cleaned up over there before it makes even further progress." REPRESENTATIVE CISSNA asked if the Senate version has changed from the version before this committee. MS. HUFF TUCKNESS answered that there is an identical [proposed] CS in each house. Number 0178 DWIGHT PERKINS, Deputy Commissioner, Department of Labor and Workforce Development, came forward to testify. As far as the allegation that the department has not been to any hospitals checking on this, he had made a note of that, he said, and will find out. CHAIRMAN ROKEBERG asked about a fiscal note. MR. PERKINS said there is not a fiscal note, and if the department had produced one, "It would have been a zero." He noted that he had provided this committee - and the committee hearing the companion bill - a three-page handout. The handout says that the requirements will enhance health care worker involvement and safety by requiring employer policies that work with potential at-risk parties in order to develop a common solution to injury prevention. He noted that OSHA had issued a compliance directive on November 5, 1999, which was subsequently adopted by the Labor Standards of the Occupational Safety and Health Program. He explained that states adopt the federal regulations by reference as they come out to be in compliance with the federal plan. CHAIRMAN ROKEBERG asked, "Are you saying that the regulations are already in place?" Number 0236 MR. PERKINS clarified that the regulations are in the process of being put in place; however, it will be two years before they are implemented by the federal government. He remarked that the department thinks this is a good piece of legislation. Furthermore, his staff and OSHA have been working with the sponsor of the Senate companion bill, and he thinks they have worked out the department's concerns. "To my knowledge we are OK with this legislation, we have no objection to it and it would be a zero fiscal note if there was one," he said. CHAIRMAN ROKEBERG asked how "evaluation committee" is defined in the regulations. MR. PERKINS replied that he did not know because he has not been personally involved with this particular piece of legislation. CHAIRMAN ROKEBERG asked if the department is going to enforce this. He also asked, "How do you enforce it against small employers? What size of a health care provider would this affect?" Number 0302 MR. PERKINS said he could get those answers. CHAIRMAN ROKEBERG told him it is not in the bill. He added: If they define employer as meaning an employer having an employee with occupational exposure to blood or other material potentially tainted with blood pathogens, that means a doctor with one nurse has to have an evaluation committee under this statute. It doesn't work. MR. PERKINS said he would have to check on that. There may be something in the regulations about that. CHAIRMAN ROKEBERG continued: Front-line health worker, then that means the nurse would tell the doctor he's gotta do that the way the bill is drafted now. This is probably good legislation but it is not drafted very artfully. MR. PERKINS said he knows this committee is well qualified to make the adjustments to the legislation. CHAIRMAN ROKEBERG remarked that he remains skeptical. "If you could bring back to this committee the regulatory scheme and how you do this with no cost and enforce it, that's what I'd like to know," he said. Number 0363 REPRESENTATIVE BRICE related his assumption "that if it is going to be under OSHA standards, that this standard would be investigated and reported just as any other OSHA violation might be." He pointed out that if he worked in a dangerous construction situation, he could call OSHA to come out and [perform an inspection]. MR. PERKINS affirmed that. REPRESENTATIVE BRICE surmised, then, that a nurse working with [devices] that are not in compliance with this bill could call OSHA and have them [perform an inspection]. MR. PERKINS replied, "We would be there." REPRESENTATIVE BRICE then addressed Chairman Rokeberg by saying that a committee could be anything; it could be made up of one or two people. CHAIRMAN ROKEBERG acknowledged that, but asked, "Don't you get my point, Tom?" REPRESENTATIVE BRICE said he understands what Chairman Rokeberg is saying, but he does not think it is wrong. CHAIRMAN ROKEBERG expressed the need to clarify it. He then addressed Representative Harris: This is a committee bill, but it has some support from the other side of the building. Because of that, I'd like to appoint a subcommittee to actually fix this bill, not the "black hole" subcommittee, but a real one. Number 0444 REPRESENTATIVE HALCRO suggested that Chairman Rokeberg's concern could simply be remedied by eliminating the word "committee" and inserting the word "process." Therefore, it would read as follows: "an employer shall establish an evaluation process ...", which doesn't mandate a committee. CHAIRMAN ROKEBERG said that is one of his major concerns. He expressed the need to hear from the "house business" and to clarify the "lancet" issue. In addition, he expressed the need to hear from the hospital groups and other health care providers, none of whom were represented at the meeting today. Therefore, Chairman Rokeberg announced that he wasn't going to close the public testimony on this bill because he is concerned that this is kind of a de facto health care mandate and thus he needs to be convinced otherwise, because it's a cost driver. However, he believes this is a good concept that shouldn't be lost. He asked Representative Harris if he wanted to work with a subcommittee of develop a CS. REPRESENTATIVE HARRIS said he would be happy to do it either way. CHAIRMAN ROKEBERG appointed a subcommittee consisting of Representatives Harris, Brice and Halcro "to come up with the answers to some of these questions." Number 0521 REPRESENTATIVE HALCRO acknowledged that the committee has not heard from the hospitals and other health care providers, "but my opinion from the testimony we've heard today, when they're charging $5 for a Tylenol with codeine, I'm sure they can afford seven cents extra for a needle that can protect their workers." CHAIRMAN ROKEBERG specified that he is more concerned about the small practitioner and "how this all fits together." "How do you have an evaluation committee or how do you have any enforcement of that rule at a small level. Quite frankly, I think this is probably a labor-management issue, and I don't know if the legislature needs to be right in the middle of that unless there is a public policy involved, and we need to be cognizant of that." He added, "I think we have a federal policy and . . .if we need a state statute to protect the workers properly, then we should do that." CHAIRMAN ROKEBERG announced that the committee would hold open public testimony on HB 440 and look forward to a report from the subcommittee on this bill. He indicated that other problematic bills will also result in the appointment of subcommittees in order to work out [the problems]. [HB 440 was held over.]
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