1. 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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2. 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