National Diabetes Volunteer Leadership Council

April 17, 2014

The Honorable Richard Pan Chairman, Assembly Committee on Health State Capitol, Room 6005 P.O. Box 942849 Sacramento, CA 95249-0009

RE: AB 1893 Oppose Unless Amended

Dear Chairman Pan:

We are writing on behalf of the National Diabetes Volunteer Leadership Council (NDVLC) to express significant concerns and opposition, unless amended, to AB 1893. The legislation mandates patients with diabetes and other chronic diseases who use medical sharps (e.g., needles, syringes, lancets and other medical sharps) purchase a sharps container whenever purchasing one of these items. The bill envisions an unworkable framework within the existing healthcare system, creates a punitive approach for people with chronic diseases whenever purchasing medical supplies, and the fact sheets and supporting materials authored by the bill sponsors and the California Product Stewardship Council lack truth and are so inflammatory to people with diabetes they demand a strong response including calling upon the authors to issue a retraction.

The NVDLC is a new volunteer leadership organization comprised of past national officers of the American Diabetes Association. Our members served as lay professionals in the highest national volunteer leadership positions available within the American Diabetes Association and in most cases serve as volunteers in its community organizations today. As national leaders our members have unique perspective as adults living with diabetes, parents of children with diabetes, and/or CEOs of leading American businesses. We've had a hand in advocating for people with diabetes across the country on issues ranging from discrimination matters to health reform and are acutely equipped to speak to the impact of AB 1893 on people with diabetes in California.

The rhetoric put forth by the bill authors and the Califomia Product Stewardship Council, the organization sponsoring the legislation, is wholly unnecessary. Suggesting most people with chronic diseases flush needles and syringes down toilets or toss them in the trash because they don't know how to properly dispose of them is wrong, irresponsible, mean spirited, and Jacking in scientific basis or fact. It is imperative the authors and the California Product Stewardship Council apologize to people with diabetes and everyone with a chronic disease for perpetuating such a slanderous myth. There is no point behind such statements and it leads us question the merits of the bill when seeing the statement in advertisements, online and in fact sheets.

We're confused as to what problem the legislation is attempting to solve. Our organization fully believes people with diabetes and others with chronic conditions are the ones most likely to remain responsible when it comes to disposing sharps. By comparison, there is ample evidence those who use IV drugs are much less likely to dispose of syringes in the correct manner. Quite frankly, when it comes to containing potential HIV and hepatitis transmission, this is the very population waste handlers want to ensure correctly dispose of sharps. Yet, this legislation does nothing to reach the IV drug using population when it comes to furthering syringe disposal messaging and processes.

Further complicating matters with AB 1893 is the fact it mandates the purchase of one disposal option by patients over several cheaper sharp containment and destruction options available and approved by the FDA, EPA, state and local health authorities and leading national groups like the American Diabetes Association. These disposal options include the use of empty bleach bottles, empty detergent bottles and needle clippers which make syringes inert. The bill unfortunately mandates only those with chronic diseases or the best actors do something and that something is to spend more to care for themselves even when cheaper options are available. This leads us to conclude the legislation lacks a meaningful purpose and instead aims to score political points we don't appreciate.

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The legislation also creates a sizable conflict with existing health insurance reimbursement when it is available and exacerbates problems with Medi-Cal and Medicare coverage. Several large employers today provide reimbursement for sharps disposal systems making this legislation redundant when coverage exists. When it comes to Medi-Cal and Medicare the programs today do not cover disposal programs and California cannot place a purchase mandate on the patient or a drug or sharps manufacturer due to federal reimbursement law. The state today though can enact a law requiring the Medi-Cal program to cover sharps disposal items including disposal containers. Perhaps a better approach for the legislation is to petition the Obama administration to require coverage for these items as essential health benefits in the insurance exchange, Medicaid and Medicare for people with chronic diseases.

This legislation appears to benefit one manufacturer in the sharps business over multiple others who often perform the service in a more effective way and at a cheaper cost. This manufacturer is also one of the top financial contributors to the California Product Stewardship Council and is featured prominently on its website and in its recent advertisements. It is interesting this manufacturer chooses to further discredit messaging by suggesting the very people who use its products are not responsible when caring for themselves and those handling their refuse. Enacting this legislation may benefit this manufacturer but it will not enhance the safety of waste handlers though given the small market share of its products in California today.

The NVDLC and the authors do agree on one point and that is additional data is necessary on the impact of sharps in the waste stream. However, the data gathering provision in the bill as drafted is far too weak to prove meaningful. We suggest making the data gathering provisions mandatory on relevant state agencies and waste haulers doing business in California.

One final legislative suggestion for consideration involves requiring waste handlers and hoteliers to place signs or labels of some form on waste bins streSSing disposal of used sharps in said bins is against state law. Considering the state outlawed the placement of sharps in the general waste stream in 2008 it is common sense to have such warnings on waste, recycling and compost bins along with similar signage in hotels for those traveling through the state.

Our experience as leaders in the fight against diabetes across the country and in California taught us over several decades that people with diabetes really do the right thing day in and day out. We'd like to offer some words of advice in closing to those trying advance a cause by picking on people with diabetes and others with chronic health conditions. Please don't demean us or our cause. We can be an important ally in any effort. Picking a fight with, in the words of the California Product Stewardship Council, "diabetics" proves much less than worthwhile to any cause.

Thank you, in closing, for your time and consideration of our remarks. AB 1893 is a provision which we cannot support unless several provisions harmful to the interests of people with diabetes are dropped and the legislation is significantly amended. Further, the language utilized to promote this legislation at the expense of people with diabetes is completely unjustified and calls for a correction of the record and retraction by those authoring the documents.

Sincerely,

~~ President

Larry Ellingson Vice President

cc: Asm. Matt Stone Asm. Susan Talamantes Eggman Committee Staff