MINUTES OF THE
SENATE COMMITTEE ON COMMERCE AND LABOR
Sixty-seventh Session
February 10, 1993
The Senate Committee on Commerce and Labor was called to order by Vice Chairman Sue Lowden, at 1:30 p.m., on Wednesday, February 10, 1993, in Room 207/208, Cashman Field Center, Las Vegas, Nevada. Exhibit A is the Meeting Agenda. Exhibit B is the Attendance Roster.
COMMITTEE MEMBERS PRESENT:
Senator Randolph J. Townsend, Chairman
Senator Sue Lowden, Vice Chairman
Senator Ann O'Connell
Senator Mike McGinness
Senator Raymond C. Shaffer
Senator Leonard V. Nevin
Senator Lori L. Brown
STAFF MEMBERS PRESENT:
Denise Pinnock, Committee Secretary
Brian Davie, Senior Research Analyst
Frank Krajewski, Senior Research Analyst
OTHERS PRESENT:
Marc Hechter, Assistant General Manager,
Nevada State Industrial Insurance System (SIIS)
Beverly Plaks, Private Citizen
Michael Oren, Member, Bartenders Union #165
Vice Chairman Lowden called the meeting to order and indicated Marc Hechter, would discuss "willing provider and the language" as they perceived it.
Marc Hechter, Assistant General Manager, Nevada State Industrial Insurance System (SIIS), gave SIIS' perspective of how they think willing provider could work in the environment of managed organizations or in a series of managed organizations working for the system. They envision that any vendor to the system would be obligated to offer an opportunity to any provider to participate in the terms and conditions of their contractual arrangements. The providers would be signatories to the contractual arrangement and live within the rules established. Should the providers fail to comply, they would expunged from the contract. Mr. Hechter said "willing providers" means anybody, willing to live by whatever the various contracts are, will have an opportunity to participate. It does not necessarily mean a wide open panel.
Senator Townsend asked "under that provision would it require a willing provider to be a party to the contract?" He asked if a managed care organization and a willing provider are qualified, do they automatically become part of that panel and that managed care organization, or is it a separate action?
Mr. Hechter replied he did not think any vendor would be enthusiastic about having them as a signatory, but indicated they would have to be a signatory in some form, otherwise there is no control. If they are a signatory and they fail to perform, they are out. If they are not a signatory, they can still hide behind the language.
Senator Lowden noted some companies might not want contractual side arrangements with individual doctors, but will have to accept them into the arrangement without a signed contract.
Mr. Hechter agreed, but indicated it would be up to the winning bidders to manage their affairs the way they want. They are charged with the enforcement of the terms and conditions.
Senator Lowden stated the control is that you do not pay them. She then invited Beverly Plaks to testify.
Beverly Plaks, Private Citizen, said she was diagnosed as having a disease in her arm where the muscles and nerves short circuited. She had appointments with two doctors, neither of whom had taken an x-ray or done a neurological study. The doctors told her what she had, advised her to read up on the problem, and indicated it would lead to osteoporosis. She has not heard from her rating doctor nor anyone from SIIS. She has no idea what her rating is, what she will be offered, or at what percentage. She said, "the man sat there and said, off the record, I don't think you have reflex sympathetic dystrophy, you might have carpal tunnel syndrome. You can reopen your claim." Ms. Plaks indicated she was extremely dissatisfied and dismayed at the idea of reopening her claim. She stated that two people at SIIS said, "No problem. You can reopen your claim." She asked, "Why not take care of the claimant to begin with. See that they're properly diagnosed." She indicated she had lived with the problem for 13 months, practically had a nervous breakdown, gained 40 pounds, and is being told, after they rate her, she has got to go through it again.
The ombudsman woman at SIIS tried to see that her arm got x-rayed. Ms. Plaks went Tuesday, met with the head of the claims department, and was told no x-ray. The ombudsman woman contacted Ms. Plaks to determine if she had gotten her x-ray, and when Ms. Plaks said no, told her to come back Friday. When Ms. Plaks returned for the x-ray, they again said no. She said, "It's not an x-ray that I need, it's a neurological study. The rating doctor at least told me something worthwhile."
Ms. Plaks continued stating SIIS stopped paying her while she was waiting for her x-ray appointment. When she asked why she had not been paid, she was told she had been put in rehabilitation. She asked, "When were you going to tell me? Nobody tells you anything." She indicated she had not been notified of her rating appointment. The ombudsman woman was the one who informed her.
Senator Brown noted that lack of communication was something the committee has been hearing from claimants. She indicated she
felt secure that when they finish changing the system to managed care that people will have communication with their claims people and that their claim will be handled in a timely and kind manner.
Ms. Plaks indicated she went to every doctor SIIS had selected. She asked, "How they can diagnose by just telling me to grip something or touch something?" She asked how can you have the disease that will last the rest of your life without having an x-ray or a neurological study?
Senator Lowden indicated that Ms. Plaks could express her frustration by providing names of doctors with whom she was dissatisfied. She stated the committee needs to know the doctors who are not giving treatment. Senator Lowden explained that people come forward to complain, but do not provide specifics. She stated the committee needs names, facts, figures, exactly what happened. She said, "And until we have that information it's virtually impossible for anybody to do anything to remove these doctors from the system."
Ms. Plaks indicated she had the information.
Senator Lowden said, "That's exactly the kind of information we need to have and without those specifics we'll get nowhere. ... I wish more people would come forward with specifics. ... If one doctor is saying another doctor misdiagnosed you that's very frustrating."
Ms. Plaks indicated that the rating doctor just read her file and gave her a 5 minute examination consisting of running a wheel up and down her fingers.
Senator Lowden asked long it took to get an appointment when one doctor sends you to another doctor?
Ms. Plaks said it took from the end of June to December to see the doctor.
Senator O'Connell asked if her employer was any help during this time.
Ms. Plaks replied they went out of business.
Senator O'Connell noted Ms. Plaks was hurt in June and asked when the business went out of business.
Ms. Plaks replied about October.
Senator O'Connell summarized saying, "They did nothing for you between the time you were hurt until October."
Ms. Plaks agreed. She asked if she could get someone to write the information out for her, to whom would she send it. She was told Marc Hechter.
Senator Lowden asked if any one else wished to testify.
Michael Oren, Member, Bartenders Union No. 165, indicated he attended a seminar featuring the new SIIS director, and found out that there is a lot of bureaucracy, a lot of people that are shuffling paper, and nothing is getting done. He proposed labor, management, and government work cohesively as a team to get things straightened out.
At 2:15 p.m. Senator Lowden announced a 30 minute break.
Senator Lowden called the meeting back to order at 2:50 p.m. and called again for public testimony. There being no response, Senator Lowden informed the group they would meet the next day at 8:30 a.m.
The meeting adjourned at 2:52 p.m.
RESPECTFULLY SUBMITTED:
Mavis Scarff,
Committee Secretary
APPROVED BY:
Senator Randolph J. Townsend, Chairman
DATE:
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Senate Committee on Commerce and Labor
February 10, 1993
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