MINUTES OF MEETING

      ASSEMBLY COMMITTEE ON HEALTH AND HUMAN SERVICES

 

      Sixty-seventh Session

      May 11, 1993

 

 

 

The Assembly Committee on Health and Human Services was called to order by Chairman Jan Evans at 1:35 p.m., May 11, 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

      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:

 

      Ms. Marcia de Braga

 

GUEST LEGISLATORS PRESENT:

 

      Senator Dina Titus

 

STAFF MEMBERS PRESENT:

 

      Kerry Carroll Davis, Research analyst

      Brian Davie, Senior Research Analyst/LCB

 

OTHERS PRESENT:

 

      Helen Foley, Nevada Nurses Association

      Larry Matheis, Nevada State Medical Association

      Bobbie Gang, Nevada Women's Lobby

      Jan Gilbert, League of Women Voters

      Michelle Bero, NV Association of Counties

      Mary Ellen McCarthy, Nevada Legal Services

      Mike McMahon, NV Assn. of County Welfare Directors

      Myla Florence, Administrator/NV State Welfare Division

     

SENATE BILL 184   Permits physician to authorize registered nurse to make pronouncement of death under certain circumstances.

 

Brian Davie, Senior Research Analyst/LCB, at the request of  Senator Raymond Rawson, gave a description of Senate Bill 184 (Exhibit C.) He explained the bill was mainly designed for patients in long-term care facilities who were expected to die from a long-term illness or disease. Under current law, a physician must be called in to sign a death certificate and authorize release of a body. SB 184 would accommodate physicians and help speed the process for the families and the medical facility when a death occurred from expected causes and the attending physician was not immediately available.  The original bill would have allowed a registered nurse to sign the certificate of death. The Nurses Association felt it gave too much broad authority to a registered nurse; thus the amendment allowed them to sign a pronouncement of death that would, within 24 hours, have to be verified by a physician with a signature on the death certificate.

 

Following Mr. Davie's presentation, concerns such as the following were raised by committee members:

 

      1) Why the 120 day time limit?

      2) What was the difference in skill required to make a             determination of death between a doctor and a nurse?

      3) Pronouncement of death was based on cardiovascular              only, to the exclusion of other criteria.

      4) Proponents of the bill were not available for comment or          clarification.

 

Helen Foley, Nevada Nurses Association, speaking in support of SB 184, explained nurses do not "diagnose" but could pronounce someone dead, and clarified "pronouncement of death" meant a declaration of the time and date when the cessation of the cardiovascular and respiratory functions of a patient occurred.

 

Ms. Foley further explained one of the reasons SB 184 was introduced was as a convenience to the families, and she reiterated Mrs. Segerblom's prior observance that nursing homes were staffed with registered nurses but not necessarily with doctors.

 

Larry Matheis, Nevada State Medical Association, affirmed they supported the bill for similar reasons and noted it was his understanding the bill was requested from physicians who worked with Aids patients and had to do with the unpredictability of the exact time of death and the exhausting schedule experienced by everyone in the care giving field.

 

Mr. Gibbons addressed the issue of potential liability...whether it was advisable for someone to make a pronouncement of death based only on cardiovascular stoppage...where extraordinary health care measures could possibly have been taken to restart the heart.

 

A concern expressed by Ms. Augustine involved the physician signing the death certificate within 24 hours who "may or may not" have actually seen the body but would be taking the word of the nurse as to the actual time of death.

 

The subject of organ donations was raised. Mr. Petrak noted the law stipulated an organ must be removed a certain number of hours after a proclaimed death...so he wondered if the death certificate was not signed by the doctor, how could that take place? Mr. Matheis indicated he would research that question.

 

Both Mr. Heller and Mrs. Segerblom acknowledged the stress a family experienced upon death of a loved one and agreed the measure would alleviate future problems.

 

Mrs. Evans gave SB 184 its "last rites" and declared the hearing closed on that bill.

 

      *******

 

SENATE BILL 343:  Requires certain facilities used by members of public to have sufficient number of water closets and urinals for use by patrons.    

 

Senator Dina Titus, District 7/Clark County, speaking in support of SB 343 (otherwise known as the "Potty Parity" bill), handed out a packet entitled "BACKGROUND INFORMATION RE: S.B. 343", (Exhibit D), which is on file in the Research Library.

 

Senator Titus cited the Women's Movement as having achieved enormous success in many spheres of American life; however, the one that until recently was not mentioned was bathrooms. The issue began to get attention in 1990 when a young woman was arrested and tried for using the men's rest room at a concert in Houston resulting in a $700 misdemeanor fine. Eventually acquitted, she got the issue on the agenda. This led to studies with the following conclusions:

 

      1) Women average 153 to 181 seconds in a bathroom; men average between 84 and 113 seconds.

      2) Measuring length of lines at public rest rooms...women need more rest rooms than men.

      3) Older people take longer - more women.

      4) Women have children with them - takes longer.

      5) Women do shopping, carrying packages - takes longer.

 

Senator Titus further indicated California, New York, Pennsylvania and Washington had enacted similar "potty parity" statutes so Nevada was not alone in recognizing this problem. She noted this was extremely timely here in Nevada and had now "come to a head."! She cited the class action suit against Reno's Pioneer Theater which could result in millions of dollars because of the inequity in the number of rest rooms.

 

Committee members posed questions and offered comments, the consensus applauding the bill.

 

Bobbie Gang/Nevada Women's Lobby, indicated the Women's Lobby had identified six issues (Exhibit E), one of which was "JUSTICE AND EQUITY FOR WOMEN AND FAMILIES," containing the statement "All women and children have the right to equitable and just treatment under the law: both in writing and in practice." She encouraged committee members to pass SB 343.

 

Jan Gilbert/League of Women Voters, also expressed her support for SB 343.

 

Mrs. Evans indicated she would contact Mr. Lang of the Fiscal Division for clarification on his calculations, and she declared the hearing closed on SB 343.

 

      *********

 

SENATE BILL 104:  Revises definition of "county of residence" for purpose of determining eligibility of indigent person for benefits from county.

 

Michelle Bero/NV Association of Counties, stated SB 104 was needed for the purpose of being in compliance with the constitution. She noted if the previously drafted bill was ever tested in court it would lose, as it was determined unconstitutional by federal court cases.

 

Mary Ellen McCarthy, Nevada Legal Services, agreed the present statute was unconstitutional if challenged in court. She pointed out just within the last two months a California court had invalidated some residency restrictions on Aid to Dependent Children that the State Welfare Division in California tried to impose again because of the constitutional problem of the right to travel. And that, she said, would be the basis for the challenge to the present statute.

 

Following a brief discussion on residency requirements,

 

      MRS. FREEMAN MOVED DO PASS ON S.B. 104.

 

      MRS. SEGERBLOM SECONDED THE MOTION.

 

Mrs. Evans asked for additional comments for discussion. Mr. Heller inquired from Mike McMahon, Nevada Assn. of County Welfare Directors, as to individuals not coming into the state because counties had their own criteria to distribute welfare benefits. Mr. McMahon responded under NRS 428, county commissioners were required to set forth their own policies and procedures as far as how health and human services would be administered in their county. Within that, they were also required to specify eligibility requirements for their program.

 

In view of the fact a motion was made and seconded, Mrs. Evans asked if there was any further discussion. There was not.

 

      MOTION CARRIED WITH MR. TOOMIN IN OPPOSITION AND MR.            WILLIAMS ABSENT AT THE TIME OF THE VOTE.

 

      *********

 

ASSEMBLY BILL 503:      Authorizes welfare division of department of human resources to recover benefits paid for assistance to medically indigent.

 

Ms. Smith discussed the subcommittee report on AB 503 as follows:

 

"Most conflicts were resolved; however, a policy matter on which the entire committee should make a determination involved the question of 'knowingly fail' vs. 'known information.' Two letters (Exhibits F and G) speak to the issue.

 

'Knowingly fails' implies intent, planning to cover up information. This would be more difficult for the Welfare Division to prove; 'Known information' is a certainty that information is known. Problem: Dealing with the elderly segment of the population who may have the propensity, perhaps, not to remember everything; also, some of the monetary issues being dealt with could be 30 to 40 years old. 'Known information' would give the Welfare Division more latitude."

 

Myla Florence, Administrator/Nevada State Welfare Division, concurred with Ms. Smith's assessment and noted the burden for the Welfare Division to prove "knowingly intent to withhold" would be a difficult one. Proposed Amendments to AB 503 were submitted as Exhibit H.

 

Mrs. Evans read aloud the letter (Exhibit G) from Mr. Henry Cavallera, representative of the Alzheimer's Association, declaring his objection to subsection l.(b) in AB 503.

 

Mr. Heller reminded the committee the subcommittee had previously voted 4-0 in favor of passing the amendments; Mrs. Smith agreed; however, subsequently the letter from Mr. Cavallera was received and the issue became a policy decision the committee as a whole should consider.

 

Mary Ellen McCarthy offered additional comments regarding the language currently structured in the amendments: "It talks about an overpayment for someone failing to report known information. If someone deliberately fails to report certain information, but it doesn't affect eligibility, there is no overpayment. The clarity of this section in the various translations has gotten extremely vague and subject to legal challenge. If the department wants to enact a statute to provide a penalty for someone falsely filling out an application, that may or may not be appropriate to do, but to call it an overpayment from someone who has never been overpaid, seems quite strange."

 

A letter dated May 6, l993 to Chairwoman Evans from Mary Ellen McCarthy (Exhibit I) is submitted along with the draft containing alternative language received from Deputy Attorney General Nancy Angres.

 

Mrs. Evans asked Ms. Smith to meet with Ms. McCarthy and Ms. Angres to work on alternative language changes.

 

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

 

      RESPECTFULLY SUBMITTED:

 

 

                             

      CHRISTINE SHAW

      Committee Secretary

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Assembly Committee on Health and Human Services

May 11, 1993

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