MINUTES OF MEETING

      ASSEMBLY COMMITTEE ON HEALTH AND HUMAN SERVICES

 

      Sixty-seventh Session

      June 28, 1993

 

 

 

The Assembly Committee on Health and Human Services was called to order by Chairman Jan Evans at 5:45 p.m., Monday, June 28, 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. Marcia de Braga

      Mr. James A. Gibbons

      Mr. William A. Petrak

      Mrs. Gene W. Segerblom

      Ms. Stephanie Smith

      Mr. Louis A. Toomin

      Mr. Wendell P. Williams

 

 

COMMITTEE MEMBERS ABSENT:

 

      Mr. Dean A. Heller

      Ms. Kathy M. Augustine

 

GUEST LEGISLATORS PRESENT:

 

      Senator Lori Lipman Brown, District No. 7

 

STAFF MEMBERS PRESENT:

 

      Pepper Sturm, Research Analyst

 

OTHERS PRESENT:

 

      Jon Sasser/Nevada Legal Services

      Myla Florence, Administrator/Welfare Division

      Rich Van Dellen/Clark County Fire Dept. and Southern Nevada         Fire Chiefs Association

      Larue Scull, EMS Coordinator/Clark County Health                 District   

      Yvonne Sylva, Acting Administrator/State Health Division        Sharon Ezell, Chief/Bureau of Licensure and Certification

      Sheryl Yount, program manager/Emergency Medical and Trauma         Services, Health Division

      Dr. Donald S. Kwalick, State Health Officer

      John Pappageorge/Clark County

      Sam McMullen/Nevada State Board of Nursing and REMSA

      Captain Randy Oaks/Las Vegas Metro Police

      Juanita Cox/representing Lee Fuller

      Jerry Zadny, Administrator/MHMR

      Jim Wadhams/Nevada Hospital Association

 

 

SENATE CONCURRENT RESOLUTION 51:      Urges Welfare Division of Department of Human Resources to provide alternative child care programs.

 

Jon Sasser/Nevada Legal Services, speaking at the request of Senator Brown, informed the committee federal and state funds were equally matched to provide employment and training opportunities to ADC recipients. By federal law, anyone participating in that program must have their child care expenses paid, the average rate being $300/month per family. SCR 51 would urge the Welfare Division to consider alternative types of child care such as the possibility of setting up latchkey type programs using professionally trained supervisors. He added, if the $300 cost per case was cut down, more people could be served in the jobs training program.

 

Myla Florence, Administrator/Welfare Division, indicated their support of the resolution.

 

As no one spoke in opposition to SCR 51, Mrs. Evans declared the hearing closed.

 

SENATE BILL 461:  Makes various changes regarding regulation of emergency medical services.

 

Rich Van Dellen/Clark County Fire Department and Southern Nevada Fire Chiefs Association, indicated SB 461 was presented by Senator Rawson at the request of the Southern NV Fire Chief's Association because of ongoing problems with EMS. His prepared testimony is submitted as Exhibit C.

 

Mr. Larue Scull, EMS Coordinator/Clark County Health District,

indicated support for SB 461 on behalf of the Health Department.

 

Responding to Mrs. Evans' inquiry, Mr. Van Dellen indicated the single biggest problem dealt with certificates for EMS providers and permits for ambulance services. The intent of SB 310 was certificates issued by the county health departments would be the Nevada certificates. In the l991 Legislature the state EMS office was directed to establish a registry of all certificates issued in the state whether issued by a district board of health or by the State Health Division.  The current problem involved the state's refusal to openly recognize county certificates.

 

Speaking in opposition to SB 461 was Ms. Yvonne Sylva, Acting Administrator/State Health Division. She expressed concern the bill fragmented the system and indicated she would be supportive of the development of a system which created a minimum set of standards for all Nevadans, not just those living in populations greater than l00,000.

 

Sharon Ezell, Chief/Bureau of Licensure and Certification, in opposition to SB 461, discussed specifics included in the bill (Exhibit D).

 

Ms. Ezell introduced Ms. Sheryl Yount, program Manager/Emergency Medical and Trauma Section, Health Division. Ms. Yount addressed allegations pertaining to Clark County. She refuted Mr. Van Dellen's assertion the state refused to recognize or acknowledge Clark County having recognition throughout the state. Noting she had been with the EMS since 1987, she indicated Clark County had always been recognized, and presently Washoe County, as it was the law.

 

Dr. Donald Kwalick, State Health Officer, stated he was opposed to SB 461 primarily because it splintered into three separate agencies what could or could not be done relative to standards for emergency medical services. He indicated there should be a statewide minimum for emergency medical services throughout the state. He added, all of the "health authorities" should have to agree as to a basic minimum that everyone should meet in order to safeguard the health and welfare of the people of the state.

 

John Pappageorge, representing Clark County, stated they concurred with Mr. McMullen's proposed amendment as to the deletion of Section 39 from the bill.

 

Mr. Van Dellen, responding to Mrs. Freeman's inquiry concerning minimum state standards, indicated Senator Rawson directed the state EMS office if the bill passed, to set a meeting with the State Health Division and both county EMS offices to come to an agreement as to minimum standards for EMS statewide.

 

Mrs. Freeman suggested a letter of legislative intent and Mr. Van Dellen said they would agree to one.

 

Sam McMullen stated he represented two clients: Nevada State Board of Nursing which related to Amendment 1 on the document entitled "Proposed Amendment to S.B. 461", and also Regional Emergency Medical Services Administration (REMSA) which related to Amendment 2. He discussed the aforementioned amendments as seen in Exhibit E.

 

Dr. Kwalich read a letter dated June 3, 1993 which had been sent to Senator Rawson which included recommended amendments to SB 461 (see Exhibit F).

 

Captain Randy Oaks, representing Sheriff John Moran/Las Vegas Metro Police, indicated they supported passage of SB 461.

 

Mrs. Evans appointed Ms. Smith as Chairman, and asked members de Braga and Gibbons to work together with representatives on a subcommittee.

 

SENATE BILL 533:  Makes various changes to statutory provisions regarding clients of and admission to mental health facilities.

 

Senator Lori Lipman Brown, District No. 7,  gave the following testimony:

 

       "SB 533 attempted to address the problem of for-profit counseling and drug rehab hospitals locking people up who voluntarily enter. These people come in for out patient counseling and kept there until their insurance runs out. The Senate heard testimony in a teleconference hearing about a contest in which employees won a bonus or commission in Charter Hospital if they filled up all the beds. We also heard testimony from Vegas from individuals who wanted some counseling and ended up not being allowed to leave. Coincidently, they were each cured on the day their insurance ran out except for the few who had relatives who came in and threatened harm if they weren't released. The others were all cured on the day their insurance ran out. People with better insurance seemed to take a lot longer to cure.

 

      "The first reprint which the Senate passed is a much milder version of the bill but it does help somewhat. And in its original version, SB 533 had very little support in the Senate. The first reprint passed the Senate 21 to 0 unanimously."

 

 

Senator Brown provided committee members with a copy of a letter from Dr. Norton Roitman (Exhibit G) describing some of the tactics previously addressed.

 

The first reprint, according to Senator Brown, took out some of the things bothering opponents such as the original version's requirement of hospital paying for an attorney and not receiving pay for treatment rendered.

 

Senator Brown further stated, "Apparently we do still need a technical amendment. This bill went through with two things in it which changed current law which have nothing to do with what this bill is trying to get at, but we caught it too late. The two changes (seen in Exhibit H)---Inadvertently, for some reason, the draft (first reprint) as amended came out with a change in the definition of what a client is.. we really didn't want to do that... the definition in this bill right now, if it were to pass the way it looks, would change a client to just someone who is kept involuntarily but a client could be other people, and the amendment would go back to the way it is right now on that. And the other part is that the bill does talk about the Office of Protection and Advocacy being of the Department of Commerce. That's a specification we didn't want to put on that office. Right now it's determined by the Governor apparently where that office is. So that the amendment would just simply mean that the person gets to contact an agency organization that receives money pursuant to (it tells the sections) to protect and advocate the rights of the mentally ill so that office could be wherever it is..with the amendment it wouldn't specify that it be in that particular part of the government. Specifically the bill gives certain rights to people in private facilities that people in public facilities currently have, including reporting any denial of their rights to the Commission on Mental Health and Mental Retardation, reporting instances of abuse or neglect, releasing voluntary clients upon their written request (which I think is really the heart of this bill), notification of an emergency admission to family members (so people know what is going on), and I didn't ask all the people to come back and re-testify for this hearing, but I would love to answer questions and I would ask and hope that you do an Amend and Do Pass to change those two things back to the current way that we do it and help some of these people."

 

Mr. Gibbons questioned the use and intent of the term, "verbal harassment." He indicated Judiciary had dealt with the issue and elected to delete it because of the First Amendment free speech challenge because it was vague and ambiguous. Using Mr. Gibbon's verbiage, Senator Brown thought the words "intimidation and coercion" would be more acceptable if "verbal harassment" was uncomfortable for the committee.

 

Jon Sasser referred to his two proposed amendments (Exhibit H) and said Senator Brown neglected to mention Senator Rawson had no problem with the technical problems being corrected.

 

Juanita Cox, representing Lee Fuller, told the committee Mrs. Fuller's daughter, Tiffany, would be interviewed on TV on ABC's Day One at 8 p.m. regarding abuse at the hands of Truckee Meadows Hospital in Sparks. She urged the committee to pass SB 533 so others would not have to face similar problems.

 

Jerry Zadny, Administrator/MHMR, expressed agreement with results of the bill and considered the amendments "wise and judicious."

 

Jim Wadhams/Nevada Hospital Association, expressed similar support for the bill and proposed amendments.

 

Discussion ensued regarding the language on Page 2, line 33. 

 

      MR. GIBBONS MOVED AMEND AND DO PASS SB 533 WITH AMENDMENT       (EXHIBIT H) TO INCLUDE AMENDING LINE 33, PAGE 2 TO READ,        "THE VERBAL INTIMIDATION OR COERCION OF THE CLIENT WITHOUT       REDEEMING PURPOSE."

 

      MR. WILLIAMS SECONDED THE MOTION.

 

      MOTION CARRIED WITH ASSEMBLYMEN TOOMIN, HELLER AND              AUGUSTINE ABSENT AT THE TIME OF THE VOTE.

 

      ********

 

Returning to SB 461, Mr. McMullen reviewed the amendment (specifically Item 1) in the letter sent to Senator Rawson (Exhibit F).

 

Yvonne Sylva stated her pleasure at being able to have reached an agreement and for the opportunity to work with the local districts in developing a consensus for all Nevada citizens.

 

      MR. GIBBONS MOVED AMEND AND DO PASS SB 461.

 

      MRS. SEGERBLOM SECONDED THE MOTION.

 

      MOTION CARRIED WITH ASSEMBLYMEN HELLER AND AUGUSTINE ABSENT       AT THE TIME OF THE VOTE.

 

There being no further business to come before committee, the meeting was adjourned at 6:55 P.M.

 

      RESPECTFULLY SUBMITTED:

 

 

                             

      CHRISTINE SHAW

      Committee Secretary

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Assembly Committee on Health and Human Services

June 28, 1993

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