California’s Ban on Toxic Chemicals in Medical Devices is a Model for the Nation 

Dear Editor: 

California made history last week when Governor Gavin Newsom signed the Toxic-Free Medical Devices Act (AB 2300) into law, becoming the first state in the country to ban the use of the toxic chemical DEHP in IV bags and tubing. This landmark decision is a significant step in the right direction for patient safety.

DEHP (Di-2-ethylhexyl phthalate) is a chemical that makes polyvinyl chloride (PVC) plastic more flexible. Approximately 60-70% of IV bags and tubes used in California and nationwide are made with this chemical despite known links to breast, liver, lung, and testicular cancers. Because it’s not a stable molecule, DEHP leaches out of the plastic into medication and other fluids being infused into the bloodstream of patients, posing a major health risk to already vulnerable populations.

For cancer patients in particular, toxic IV bags and tubing represent a serious public health concern: DEHP promotes drug resistance, and interferes with chemotherapy’s ability to fight breast cancer, making cancer cells ‘immortal.’ Research also shows that patients with higher levels of DEHP in their system had higher rates of relapse and breast cancer mortality. This is especially frightening for the over 300,000 women each year who are battling breast cancer in the United States. These vulnerable patients deserve the most effective treatments possible. 

DEHP being a dangerous chemical is not news. For almost half a century, research has

highlighted the toxicity of DEHP leaching from medical devices into medicines and fluids being transfused. The American Academy of Pediatrics, the American Medical Association, the American Public Health Association, and the U.S. Food and Drug Administration have all urged hospitals and physicians to phase out PVC medical devices, especially those containing DEHP, which has been banned from toys on a national level since 2008 and from beauty and personal care products sold in California since 2020. Across Europe, DEHP-free IV bags have been the standard practice for decades and are now considered a market expectation.

The new law requires IV bags to be toxic-free by 2030 and tubing by 2035 in California, but Breast Cancer Prevention Partners (BCPP), where I serve as CEO, is urging hospitals in the state and around the country to sign this pledge committing to remove harmful medical devices from their systems as soon as possible. Cost-effective and safe alternatives exist now, there is no excuse not to make the transition. 

The pledge was already signed by CommonSpirit Health, the country’s largest Catholic hospital chain that operates more than 700 care sites and 142 hospitals in 21 states; and Sharp HealthCare, a nonprofit group in San Diego that includes four acute care hospitals and three specialty hospitals with approximately 2,600 physicians and 1 million patients seen annually.

Although the new law applies only to California, the national implications are vast. The majority of U.S. hospitals rely on a small group of manufacturers for their IV supplies. While one global corporation, Baxter International, supplies the majority of California and the nation’s IV bags made with DEHP and PVC, lagging behind in offering non-toxic alternatives, other manufacturers such as B. Braun, Fresenius-Kabi, and ICU Medical already sell FDA-approved DEHP-free IV bags.

Leading California health systems, including Kaiser Permanente, Loma Linda University Health, and City of Hope, made the change years ago. In fact, Kaiser Permanente successfully converted its entire hospital system to DEHP/PVC-free IV bags and tubing in 2012, demonstrating that a shift to non-toxic materials is both feasible and affordable.

The passage of the Toxic-Free Medical Devices Act is a vital step forward, but it is only the beginning of what must be a broader shift in healthcare. Patients should feel safe in hospitals instead of worrying about dangerous chemicals affecting their treatment. California has led the way; now the rest of the country should follow suit to ensure that patients receive care free from toxic exposure.

Suzanne Price

Suzanne Price is the CEO of Breast Cancer Prevention Partners.