MINUTES OF MEETING

      ASSEMBLY COMMITTEE ON HEALTH AND HUMAN SERVICES

 

      Sixty-seventh Session

      May 6, 1993

 

 

 

The Assembly Committee on Health and Human Services was called to order by Chairman Jan Evans at 1:24 p.m., Thursday, May 6, 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

     

COMMITTEE MEMBERS ABSENT:

 

      Mr. Louis A. Toomin (excused)

      Mr. Wendell P. Williams

 

GUEST LEGISLATORS PRESENT:

 

      None

 

STAFF MEMBERS PRESENT:

 

      Kerry Carroll Davis, Research Analyst

 

OTHERS PRESENT:

 

      Jim Boscacci, Ralph Baker and Scott Young, Northern Nevada Center for Independent Living (NNCIL); Dr. John Kurlinski and Dr. Frank Gioia, American Academy of Pediatrics; Sharon Ezell and Sheryl Yount, State Health Division; Jan Lewellyn-Davidson, Dr. Terry Lewis, Dr. J.S. Surpure, Dr. Meena Vohra, Dr. Steven Karch, and Dr. James Tate, University Medical Center.

 

Mrs. Evans opened the hearing on Senate Concurrent Resolution 17.

 

SCR 17      Supports personal assistance services for persons with disabilities.

 

Jim Boscacci, Chairman of the Board, NNCIL, spoke in favor of SCR 17 with one proposed amendment (EXHIBIT C).

 

Mrs. Evans noted the resolution could be made more specific with regard to different groups, agencies and elected officials involved in the planning and development of programs for persons with disabilities.  Mr. Boscacci agreed and indicated a willingness to work with the legislature to take a national program to congress.

 

Ralph Baker, Member, Board of Directors, NNCIL, spoke in support of SCR 17 and discussed current personal assistance programs within Nevada (EXHIBIT D).

 

Mr. Petrak inquired what communication had taken place with the Nevada delegation regarding this issue.  Mr. Baker responded they had not yet met with anyone at the federal level but indicated their desire to do so.

 

Mrs. Freeman asked for an explanation of the Medicaid Waiver Program.  Mr. Baker advised the Waiver Program raised the eligibility requirements for people at risk of institutionalization.  There was brief discussion regarding how many people were being served and how many were on the waiting list.

 

Scott Young addressed the committee and asked to read the testimony of Paul Gowins (EXHIBIT E).

 

Mrs. Evans asked Mr. Petrak and Mrs. Segerblom to discuss the amendments with the appropriate parties and called a brief recess.

 

Mrs. Evans opened the hearing on Assembly Bill 541.

 

AB 541      Revises provisions governing content of regulations relating to centers for treatment of trauma.

 

Dr. John Kurlinski, American Academy of Pediatrics, read his prepared statement in support of AB 541 (EXHIBIT F).

 

Mrs. Evans asked if the State Health Division Committee on Emergency Medical Services for Children was in the process of developing trauma regulations for children.  Dr. Kurlinski said an EMS grant for children had been awarded to the state and indicated Dr. Gioia could better address the question.

 

Dr. Gioia explained the project was federally funded and was intended to enhance existing emergency medical services for children.  The mission was to focus on education of health care providers.  It was not charged with formulating guidelines or standards for care for pediatric trauma.  The American College of Surgeons addressed guidelines for pediatric care.

 

Dr. Kurlinski suggested a revision to Section 2 to allow a trauma center to be designated for both children and/or adults and consideration of a population limit with regard to the regulations.  In response to questions from Mrs. Freeman, Dr. Kurlinski noted the resources required by ACS might not be available in smaller communities.  The aim was to establish regulations which would be appropriate for the population.  The pediatricians did not want to get involved in battles between hospitals.

 

Mrs. Evans asked how pediatric trauma cases were currently being handled.  Dr. Gioia remarked they followed the same referral pattern as those for adults.

 

Ms. Augustine wanted to know how the new trauma unit at UMC would be affected.  Dr. Kurlinski was optimistic that with special regulations the proper health care providers would be recruited, therefore UMC might develop into a designated pediatric trauma center.  Dr. Gioia did not believe any institution in Southern Nevada made a claim to meet the ACS standards for pediatric trauma.

 

Mary Ellen McCarthy, Nevada Legal Services, raised a question regarding the number of people necessary in order to adopt the standards for the treatment of pediatric trauma set forth by the American College of Surgeons.

 

Sharon Ezell, Bureau of Licensure and Certification, testified in opposition to AB 541 (EXHIBIT G).

 

Mrs. Evans asked why the Health Division had not designated a particular pediatric trauma center for Nevada.  Ms. Ezell indicated no application had been received.

 

Ms. Augustine asked if the proposed amendment form Dr. Kurlinski would satisfy the Health Division's concerns.  Ms. Ezell responded yes.

 

Mrs. Segerblom inquired if children were being treated in the rural areas.  Ms. Ezell said children in these areas were first taken to the closest hospital and then transported to Reno or Las Vegas.

 

Jan Lewellyn-Davidson, University Medical Center, addressed the committee in opposition to AB 541 and introduced Dr. Terry Lewis, Director of Trauma Services.  Dr. Lewis discussed his concerns with the proposed legislation.  As written, the bill might establish a lesser standard of care for children than adults.  In addition, this law would cause the separation of families at the scene of an accident.  The state should develop trauma capabilities through regulation, not statute.  In 1994, a new document would be available from the American College of Surgeons.

 

In response to questions from Ms. Augustine, Dr. Lewis indicated UMC was designated as a level II trauma center for Southern Nevada and there was no age limit with regard to patients currently being treated.  Equipment was being continually upgraded, a pediatric intensive care unit had just opened, and a pediatric emergency room was being planned for the future.  It was arguable if a second trauma center for children was necessary.  University Medical Center had a general surgeon to provide trauma care for children with the assistance of pediatric specialists.

 

Ms. Smith asked how the family would be impacted with separate facilities.  Dr. Lewis believed the best interest of the injured patient was to arrive at the highest level of care.  The presence of a pediatric surgeon was just one component of a trauma unit.

 

Mrs. Freeman asked if the only thing UMC was lacking to be designated a pediatric trauma center was a pediatric trauma surgeon.  Dr. Lewis responded yes.  Mrs. Freeman asked what it would cost to hire someone with this specialty.  Dr. Lewis said it would depend on the role of the physician.  This specialty was extremely limited and probably would only serve approximately 2 percent of the population as a whole.  It would be difficult for the population base in Clark County to support this type of effort.

 

Dr. Jack Surpure, Director, Department of Pediatric Emergency Medicine, discussed the program at UMC.  Currently there were five pediatric, emergency medicine trained physicians on staff.  It was the only program of its kind in this part of the country.  In addition, they were involved in training and teaching, and anticipated establishing a pediatric residency program.  Dr. Surpure noted UMC's pediatric staff saw and treated 25,000 patients in the first quarter of 1993.  In his opinion, this bill tried to disqualify UMC as a trauma center.

 

In response to questions from Mr. Petrak, Dr. Surpure maintained good emergency care and trauma care for children should be of primary importance.  The relationship between the hospitals should be complimentary and not competitive.

 

Mrs. Segerblom asked how many students were in the program and how full was the trauma center.  Dr. Surpure indicated beginning in July he would see students every day in the emergency department and the trauma receiving area was quite busy.  In the future the third floor would be utilized as a pediatric emergency department.

 

Ms. Augustine stated the primary goal of this legislation was to increase the quality of care.  Dr. Surpure reiterated UMC was a trauma center with a commitment to pediatrics.

 

Dr. Meena Vohra, Director, Department of Pediatric Critical Care Medicine, explained there were only 28 pediatric centers in the country.  Most injured children were cared for in general hospitals.  The greatest improvement that could occur in pediatric trauma care would come from addressing the special needs of the pediatric injured patients in the adult trauma centers.  The new pediatric unit at UMC would have state-of-the art equipment.

 

Mrs. Evans asked what percent of all trauma patients were children.  Dr. Vohra responded 592 children and 2,500 adults were treated in 1992.

 

Dr. Steve Karch, Director of Quality Assurance at UMC, discussed the center's resources.  UMC currently saw 5 out of every 6 seriously injured children.

 

Mrs. Freeman asked if follow-up care was provided.  Dr. Karch said yes, everyone was evaluated for potential outcome and on-going treatment.

 

Mr. Petrak asked if staff was exchanged between the different hospitals.  Dr. Tate responded no, that had not occurred.  Dr. Tate made several comments regarding trauma, surgery and the training involved.

 

Mrs. Evans closed the hearing on AB 541.

 

There being no further business to come before committee, the meeting was adjourned at 3:15 p.m.

 

      RESPECTFULLY SUBMITTED:

 

 

                             

      CONNIE CAMPBELL

      Committee Secretary

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Assembly Committee on Health and Human Services

May 6, 1993

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