MINUTES OF MEETING

      ASSEMBLY COMMITTEE ON HEALTH AND HUMAN SERVICES

 

      Sixty-seventh Session

      March 30, 1993

 

 

 

The Assembly Committee on Health and Human Services was called to order by Chairman Jan Evans at 1:35 p.m., Tuesday, March 30, 1993, in Room 330 of the Legislative Building, Carson City, Nevada.  Exhibit A is the Meeting Agenda, Exhibit B is the Attendance Roster.

 

 

COMMITTEE MEMBERS PRESENT:

 

      Mrs. Jan Evans, Chairman

      Mrs. Vivian L. Freeman, Vice Chairman

      Ms. Kathy M. Augustine

      Ms. Marcia de Braga

      Mr. James A. Gibbons

      Mr. Dean A. Heller

      Mr. William A. Petrak

      Mrs. Gene W. Segerblom

      Ms. Stephanie Smith

      Mr. Louis A. Toomin

      Mr. Wendell P. Williams

 

 

COMMITTEE MEMBERS ABSENT:

 

      None

 

GUEST LEGISLATORS PRESENT:

 

      Assemblyman John Marvel

 

STAFF MEMBERS PRESENT:

 

      Marla McDade, Research Analyst

 

OTHERS PRESENT:

 

      Dr. Bob Daughtery and John Yerxa, University of Nevada School of Medicine; Dr. Donald Kwalick, Health Division; Dr. Thomas Scully, Board of Medical Examiners; Helen Foley, Nevada Nurses Association; David Rowles, Clark County Health District; Stephanie Beck, Washoe County District Health Department; Larry Matheis, Nevada State Medical Association; Robert Vanselow, Nevada Academy of Physician Assistants; Mary Liveratti, Aging Services; and John Sarb, Division of Child and Family Services.

 

Mrs. Evans requested committee introduction of the following Bill Draft Requests:

 

BDR 40-1183Requires fee for analysis of controlled substance be collected from certain defendants before or at same time that any fine is collected.

 

      ASSEMBLYMAN FREEMAN MOVED FOR COMMITTEE INTRODUCTION OF BDR 40-1183.

 

      ASSEMBLYMAN PETRAK SECONDED THE MOTION.

 

      MOTION CARRIED UNANIMOUSLY.

 

      * * * * * * * * * * * * * * *

 

BDR 39-912  Makes various changes concerning mental illness and retardation.

 

      ASSEMBLYMAN AUGUSTINE MOVED FOR COMMITTEE INTRODUCTION OF BDR 39-912.

 

      ASSEMBLYMAN DE BRAGA SECONDED THE MOTION.

 

      MOTION CARRIED UNANIMOUSLY.

 

      * * * * * * * * * * * * * * *

 

BDR 38-747  Makes various changes regarding administration of state welfare programs.

 

      ASSEMBLYMAN SEGERBLOM MOVED FOR COMMITTEE INTRODUCTION OF BDR 38-747.

 

      ASSEMBLYMAN PETRAK SECONDED THE MOTION.

 

      MOTION CARRIED UNANIMOUSLY.

 

Mrs. Evans opened the hearing on Assembly Bill 3.

 

AB 3        Expands authority of physicians' assistants in certain counties, physicians and registered nurses to provide care in ambulance or air ambulance.

 

Assemblyman John Marvel, District 34, explained AB 3 was drafted to address a problem in Humbolt County, however it was a good statewide bill.

 

Dr. Bob Daugherty, Dean, School of Medicine, spoke in support of AB 3 and suggested it was unnecessary to limit the bill to rural counties.  He recommended an amendment with regard to language in Section 1, subsection 6, which would make the bill more applicable on a statewide basis.

 

John Yerxa, Physicians' Assistants Program Coordinator, School of Medicine, described the training for Physicians' Assistants and what they do to provide health care (EXHIBIT C).

 

Ms. Augustine asked for an explanation of the educational requirements.  Mr. Yerxa said the typical PA program consisted of one year classroom education and one year of full-time clinical experience.

 

In response to questions from Mrs. Freeman, Mr. Yerxa indicated training for PA's in Nevada was affiliated with the School of Medicine on a statewide basis.  The degree of supervision was specified by the Board of Examiners.  There were 57 PA's licensed in Nevada and they were primarily concentrated in the urban areas.

 

Mrs. Segerblom inquired if Elko had been successful in recruiting a physician.  Mr. Marvel responded the Elko hospital  had recruited three doctors.

 

Mr. Petrak asked if PA's were qualified to deliver babies.  Mr. Yerxa responded it depended on which program the PA graduated from.

 

Mr. Gibbons asked several questions regarding licensure and liability.  Mr. Yerxa indicated Physician Assistants were certified by the Board of Medical Examiners and were required to practice under the supervision of a physician.  The supervising physician was always ultimately responsible.  Malpractice insurance was carried by the supervising physician.  There was brief discussion regarding liability.

 

Ms. Augustine called attention to Section 6, subsection 2, line 21 regarding exempt status.  There was discussion about the differences between and EMT and a PA.

 

Mr. Heller questioned how other states dealt with similar problems.  Mr. Yerxa noted in other states PA's were allowed to ride in ambulances.

 

Dr. Kwalick, State Health Officer, spoke in favor of AB 3 and offered one additional change (EXHIBIT D).

 

Dr. Thomas Scully, State Board of Medical Examiners, offered clarification of several questions previously asked.  The Board of Medical Examiners determined on a case-by-case basis what duties a PA could perform.

 

Responding to questions from the committee, Dr. Scully indicated PA's were created by the legislature in 1978.  Nurse Practitioners and PA's had different backgrounds and different scopes of practice.  A PA could also be certified as an EMT based on existing regulations.  However, certification as an EMT was a barrier to getting PA's to work in certain rural areas.  Each individual PA would have to come forward and ask for exemption under the statute.  A determination would be made by the Board of Examiners.

 

Helen Foley spoke on behalf of the Nevada Nurse's  Association.  An amendment was offered which was identical to the language submitted by the State Health Division (EXHIBIT E).  Ms. Foley clarified the State Board of Medical Examiners would have to adopt regulations regarding individuals who would be allowed to ride in an ambulance.

 

David Rowles indicated Clark County Health District was in support of the concept but had some concerns with the language of AB 3.  Mr. Rowles discussed the current regulations and proposed another amendment for consideration (EXHIBIT F).

 

Stephanie Beck, Washoe County District Health Department, indicated support for the amendment submitted by Mr. Rowles.  She emphasized the need to provide licensing for the various levels of professionals working in emergency services.

 

Larry Matheis, Nevada State Medical Association, indicated support for AB 3.

 

Ms. de Braga wondered if the outlying and isolated communities in the urban centers would still have to tap this resource.  Mr. Matheis noted the urban counties have anticipated this problem in their EMS planning.

 

Bob Vanselow, a Physicians' Assistant from Las Vegas, voiced his concern regarding the population limitation of 35,000.  There was brief discussion regarding which counties would be excluded.

 

Mrs. Segerblom asked if Mesquite and McDermitt had their own ambulance.  Mr. Vanselow believed their ambulances were staffed by volunteers.

 

Mrs. Evans closed the hearing on AB 3 and referred the bill to subcommittee for consideration of the proposed amendments.

 

Mrs. Evans asked for testimony on Senate Bill 223.

 

SB 223      Requires advocates for residents of facilities for long-term care and ombudsman for aging persons to perform each other's duties on temporary basis.

 

Mary Liveratti, Division for Aging Services, presented her prepared testimony (EXHIBIT G).

 

Mrs. Segerblom asked about visitations to the care centers by the ombudsmen.  Ms. Liveratti said visitations were made in response to complaints and briefly explained the complaint procedure.  The Health Division was responsible for routine visitations.

 

Mrs. Evans asked who could be appointed to serve on a temporary basis.  Ms. Liveratti indicated, depending on staffing, other people have been utilized to do investigations.

 

Mrs. Evans closed the hearing on SB 223.

 

Mrs. Evans asked John Sarb, Division of Child and Family Services, to present additional information requested by the committee on Senate Bill 81.

 

SB 81Provides for establishment of fees for child and family services.

 

Mr. Sarb handed out the requested materials and offered an explanation of the data (EXHIBIT H).

 

      ASSEMBLYMAN AUGUSTINE MOVED DO PASS ON SB 81.

 

      ASSEMBLYMAN DE BRAGA SECONDED THE MOTION.

 

      THE MOTION CARRIED UNANIMOUSLY.

 

Mrs. Evans asked Mr. Williams if he had any final comments regarding ACR 26.  Mr. Williams reiterated the bill represented a real effort for reform and urged support.

 

      ASSEMBLYMAN TOOMIN MOVED TO ADOPT ACR 26.

 

      ASSEMBLYMAN SEGERBLOM SECONDED THE MOTION.

 

      THE MOTION CARRIED UNANIMOUSLY.

     

 

      * * * * * * * * * * * * * * *

 

      ASSEMBLYMAN FREEMAN MOVED TO REREFER ACR 26 TO WAYS AND MEANS.

 

      ASSEMBLYMAN HELLER SECONDED THE MOTION.

 

      THE MOTION CARRIED UNANIMOUSLY.

 

 

There being no further business to come before committee, the meeting was adjourned at 3:05 p.m.

 

      RESPECTFULLY SUBMITTED:

 

 

                             

      CONNIE CAMPBELL

      Committee Secretary

 

 

     

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Assembly Committee on Health and Human Services

March 30, 1993

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