MINUTES OF MEETING

      ASSEMBLY COMMITTEE ON HEALTH AND HUMAN SERVICES

 

      Sixty-seventh Session

      May 13, 1993

 

 

 

The Assembly Committee on Health and Human Services was called to order by Chairman Jan Evans at 1:35 p.m., Thursday, May 13, 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

      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:

 

      Mrs. Vivian L. Freeman (excused)

 

GUEST LEGISLATORS PRESENT:

 

      Assemblyman Scott Scherer, District 2

 

STAFF MEMBERS PRESENT:

 

      Kerry Carroll Davis, Research Analyst

 

OTHERS PRESENT:

 

      Jim Waddams, Nevada Hospital Association and Nevada Rural Hospital Project; Kay Bennett, Carson City Board of Supervisors; George Hawes, Carson Tahoe Hospital; Hale Bennett, Citizen; Kathy Shane, Washoe County Social Services; John Sarb, Division of Child and Family Services; Lt. Jim Nadeau, Washoe County Sheriff's Office; Michael McMahon, Nevada Association of County Welfare Directors; and Mary Ellen McCarthy, Nevada Legal Services.

 

 

Mrs. Evans opened the hearing on Assembly Bill 553.

 

AB 553      Increases number of persons that serve on certain boards of hospital trustees and increases amount of compensation certain trustees are entitled to receive.

 

Jim Waddams spoke in support of AB 553 on behalf of the Nevada Hospital Association and Nevada Rural Hospital Project.  The bill applied to rural hospitals, not hospitals where the board of county commissioners served as the hospital trustees.  The concept was to augment the expertise which could be brought to the management of a hospital program.  Mr. Waddams presented an amendment for consideration (EXHIBIT C) and indicated the fiscal impact would be borne by the facility and not by county government.

 

Kay Bennett, Carson City Supervisor and appointed member to the Carson Tahoe Board of Trustees, testified in support of AB 553 and discussed a possible amendment (EXHIBIT D).

 

Mr. Gibbons inquired if the rural counties felt the increased amount of compensation would impose an undue burden.  Mr. Waddams reiterated the increase would be borne by the facility and not the county.  Mr. Gibbons asked how many meetings per month hospital board members attended.  Mrs. Bennett replied she attended one regularly scheduled meeting plus two or three subcommittee meetings; however, she was not eligible to receive compensation because she was appointed by the board of supervisors.   Mr. Gibbons questioned the distinction between reimbursement for the rural and urban trustees.  Mr. Waddams noted it perpetuated a distinction which was already in statute. 

Mr. Toomin commented the fiscal note was not available and Mr. Waddams said he did not receive a copy of the fiscal note but the counties were asked to prepare one.  Mr. Toomin asked Mrs. Bennett if she received per diem expenses.  She responded no.  Mr. Toomin asked for clarification of the appointment process.  Mr. Waddams indicated the bill proposed the five member elected board would appoint two additional members among themselves.  Discussion ensued regarding the appointment process.

 

Mr. Petrak inquired about the attendance at the board meetings.  Ms. Bennett noted her board was very active and they had no absences.

 

Mr. Heller wanted to know what expertise was currently lacking on the hospital board.  Mrs. Bennett responded there was a need for people with different backgrounds such as banking, finance, or accounting.  It was a problem more specific to the rural hospitals.  Mr. Heller asked if the current board supported this legislation.  Mrs. Bennett indicated she would present these recommended changes to her board at the next regularly scheduled meeting. 

 

Ms. Augustine asked if the language on page 1, line 11 referred only to Washoe County.  Mr. Waddams said he would have that clarified.

 

Mrs. Evans raised several questions regarding the number of hospitals which would be affected and how many were in support of this legislation.  Mr. Waddams believed all the rural hospitals were in support of this bill. 

 

Mr. Petrak voiced his concerns regarding costs and wanted to know how many hospitals in Clark County would be affected.  Mr. Waddams answered none, the law excludes counties in excess of 400,000.  Discussion ensued regarding cost containment.

 

George Hawes, Carson Tahoe Hospital Board of Trustees, spoke in favor of AB 553.  He noted not all elected members were necessarily qualified to serve on the Board.   In response to a question from Mr. Toomin, Mr. Hawes did not know if a person appointed for a particular expertise, which was only needed for a brief period of time, would continue to serve a 4-year term.

 

Hale Bennett, former Carson Tahoe Hospital Board Member, indicated support for AB 553 and discussed individuals who would not run for election but would serve on an appointed basis.

 

Ms. Smith observed the campaign/election process destroyed opportunity for expertise.

 

Ms. de Braga asked what would happen if a person with a particular expertise could not be found and what process would be used to decide what expertise was needed.  Mr. Bennett said the board would determine what kinds of expertise they would like to have if it was available.  The need for a particular expertise would not go away, it would continue.

 

The following concerns were voiced by members of the committee:

      1)    Whether there had been any precedent for this approach.

      2)    Costs.

      3)    Having the board appoint additional members among themselves.

      4)    Whether small rural hospitals needed the additional members.

      5)    Domination by members of the board.

      6)    The need for expertise in a number of areas.

 

Mrs. Evans closed the hearing on AB 553 and opened the hearing on Assembly Bill 556.

 

AB 556      Authorizes formation of multidisciplinary teams to investigate deaths of children.

 

Scott Scherer, Assembly District 2, testified in support of AB 556 which established child death review teams.  This was already being done in Clark County.  Assemblyman Scherer read the testimony of Thom Reilly, Deputy Administrator, Child and Family Services (EXHIBIT E) and handed out the testimony of the National Association of Social Workers (EXHIBIT F).  This bill ratified what was being done in Clark County and provided a mechanism where information might be shared.

 

Mr. Gibbons questioned the need for more than one multidisciplinary team to investigate the death of a child.

 

Mr. Toomin inquired if any death under the age 18 would be investigated.  Assemblyman Scherer noted Clark County was currently investigating the deaths of children age six and under.  Mr. Toomin asked if the investigation team members were volunteers.  Mr. Scherer explained the bill was permissive and did not require any county to perform these investigations.

 

John Sarb, Division of Child and Family Services, spoke in support of AB 556 and stated this bill would give protection under the law for the sharing of information regarding the death of a child.  Multidisciplinary teams could function in different ways.  These teams could bring expertise not available in law enforcement investigations.  Mr. Toomin asked how these teams would be set up.  Mr. Sarb responded the CPS agencies in Washoe and Clark County would establish a committee.  In rural Nevada one committee would be convened on an ad hoc basis.  These would not be standing committees, the membership would be fluid.  The need would vary among communities.

 

Kathleen Shane, Washoe County Social Services, provided additional information in response to Mr. Toomin's question.  Each team would establish standards regarding which deaths they would review.  It would be based on what they could reasonably accommodate and who were the high risk children.  Each jurisdiction should establish a protocol for what it was going to review.  Ms. Shane indicated some clarification to the bill was needed and presented a suggested amendment (EXHIBIT G).

 

Lt. Jim Nadeau, Washoe County Sheriff's Office, expressed agreement with the concept but indicated some concerns.  The Sheriff's Office was sensitive to any interference with ongoing criminal investigations and contamination of witnesses.  Lt. Nadeau noted the amendment suggested by Ms. Shane would satisfy their concerns.

 

Mrs. Evans closed the hearing on AB 556 and opened the hearing on Senate Bill 369.

 

SB 369      Allows payment from fund for hospital care to indigent persons for hospital care rendered by hospital in another state.

 

Michael McMahon, Nevada Association of County Welfare Directors, discussed the intent of this legislation which was to provide language to enable the Indigent Accident Fund (IAF) board to consider paying out-of-state hospitals for providing care to victims of motor vehicle accidents within Nevada.  Mr. McMahon gave a brief history of the fund.  In response to a question from Ms. Augustine, Mr. McMahon noted the IAF board did not wish to fragment the trauma network which had been established.

 

Ms. Smith asked if this bill would affect the type of health care received.  Mr. McMahon said after an initial determination had been made, an individual's health care could be compromised.

 

Mary Ellen McCarthy, Nevada Legal Services, spoke in support of SB 369.  Ms. McCarthy noted poor people no more than rich people decided where they would be when a motor vehicle accident occurred.  This bill would affect a limited number of cases.

 

Mrs. Evans closed the hearing on SB 369 and asked for an update on Assembly Bill 503.

 

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

 

Ms. Smith discussed the compromise reached with regard to amendments to AB 503 (EXHIBIT H).

 

      ASSEMBLYMAN HELLER MOVED AMEND AND DO PASS AB 503.

 

      ASSEMBLYMAN PETRAK SECONDED THE MOTION.

 

      MOTION CARRIED BY THOSE PRESENT (MR. GIBBONS AND MRS. FREEMAN WERE ABSENT AT THE TIME OF THE VOTE).

 

Mr. Petrak asked the committee to review the proposed amendments to SCR 17 for consideration at the next meeting.

 

Mrs. Evans asked Mr. Toomin and Mr. Heller to meet with Assemblyman Scherer to work out the amendments to AB 556.

 

There being no further business to come before committee, the meeting was adjourned at 3:25 p.m.

 

      RESPECTFULLY SUBMITTED:

 

 

                             

      CONNIE CAMPBELL

      Committee Secretary

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Assembly Committee on Health and Human Services

May 13, 1993

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