MINUTES OF THE

      SENATE COMMITTEE ON COMMERCE AND LABOR

 

      Sixty-seventh Session

      April 28, 1993

 

 

 

The Senate Committee on Commerce and Labor was called to order by Chairman Randolph J. Townsend, at 8:30 a.m., on Wednesday, April 28, 1993, in Room 227 of the Legislative Building, Carson City, 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

 

OTHERS PRESENT:

 

Bobbie Gang, Lobbyist, Nevada Pharmacists Association

Keith Macdonald, Executive Secretary, Nevada State Board of            Pharmacy

Fred Hillerby, Lobbyist, Nevada State Board of Pharmacy

Jeff Monaghan, President, Nevada State Board of Pharmacy

Louis Ling, Deputy Attorney General, Nevada State Board of Pharmacy

David Chan, Chairman, Chain Drug Council

Laura Weber, Pharmacist, National Association of Chain Drug Stores

Mary Santina, Lobbyist, Retail Association of Nevada

John Beeston, M.D., American Association of Retired Persons

Peggy Epidendio, R.N., Chief, Nevada Medicaid Office, Welfare          Division, Department of Human Resources, State of Nevada

Joe Brown, Lobbyist, National Rx Services of Nevada

Art Clayton, Pharmacist, National Rx Services of Nevada

Art Berliner, Pharmacist, Pharmacy Group of Nevada

Rochel Spiro, Pharmacist

Robert Fox, Pharmacist

Larry Matheis, Lobbyist, Nevada State Medical Association

Danny Thompson, Lobbyist, Nevada State American Federation of          Labor-Congress of Industrial Organizations

Bill Webb, Pharmacist

David Moredock, Pharmacist

Helen Foley, Lobbyist, Nevada Nurses Association

 

 

 

Chairman Townsend opened the hearing on Senate Bill (S.B.) 368. 

 

S.B. 368:   Revises definition of "institutional pharmacy."

 

Bobbie Gang, Lobbyist, Nevada Pharmacists Association, testified in support of the bill.

 

Keith Macdonald, Executive Secretary, Nevada State Board of        Pharmacy, submitted written testimony (Exhibit C) supporting the bill.

 

Senator O'Connell clarified the bill would allow the board to regulate pharmacies serving nursing homes.

 

Senator Townsend closed the hearing on S.B. 368.  The next item of business was S.B. 399.

 

S.B. 399:   Provides for regulation of supportive personnel in pharmacies and counseling of patients.

 

Fred Hillerby, Lobbyist, Nevada State Board of Pharmacy, testified in favor of the bill.  He submitted a "Statement of Responsibility; Corporate" (Exhibit D).  The statement addressed the concern that a pharmacist would be held responsible for errors made by supportive personnel the corporation hired. 

 

Mr. Hillerby explained that in order to free up the pharmacist to counsel patients, the pharmacies would be utilizing supportive personnel.  Those persons would, under the supervision of a pharmacist, fill prescriptions and label bottles.

 

Mr. Hillerby submitted "Planned Regulatory Objectives" (Exhibit E), and "Board of Pharmacy; OBRA Regulatory Objectives" (Exhibit F).  He explained the board would be registering all the personnel involved, as a means of tracking them. 

 

Senator Lowden expressed concern about how the pharmacists would be supervising the supportive personnel.  Jeff Monaghan, President, Nevada State Board of Pharmacy, explained the technician would leave the original prescription on the counter along with the filled bottle, and the package the medication came from.  The pharmacist would initial the prescription after checking the work.

 

Mr. Monaghan submitted written testimony supporting the bill (Exhibit G).

 

Senator O'Connell asked about people ordering drugs through mail order houses, and from outside the country.  Mr. Monaghan stated there was not much the board could do about counseling those people. 

 

Mr. Macdonald explained the counseling would be offered in the pharmacy, along with published information. 

 

Senator Brown asked what would be done to ensure an owner would not encourage a lack of counseling.  Mr. Macdonald said the board was not bashful about disciplining pharmacies for infractions. 

 

Mr. Monaghan listed the minimum qualifications and requirements for supportive personnel. 

 

Senator O'Connell asked if the cost of health care might not be driven up because of the added role of counselor.  Mr. Macdonald said the lower cost of the supportive personnel would balance the additional cost.

 

Senator Brown asked why the whole section on pharmacy technicians, including the registration fee, was deleted.  She said, "If we're registering the support personnel, why do we have no registration fee for any of them [pharmacy technicians], then?"  Mr. Hillerby said the board did not want the confusion of both terms (pharmacy technician and supportive personnel) in the statute. 

 

Senator Townsend pointed out that without the registration, the board would have no way of keeping track of the supportive personnel.   

 

Louis Ling, Deputy Attorney General, Nevada State Board of Pharmacy, cited cases where pharmacists and pharmacies had been

disciplined.  Licensees had been put on probation, fined, and/or suspended or had their licenses revoked.

 

Senator Shaffer asked how many new persons would be hired as support personnel.  Mr. Monaghan anticipated the 174 existing positions would triple. 

 

Senator Shaffer asked how many inspectors there were to monitor the personnel.  Mr. Macdonald said there were normally three full-time investigators and one part-time.  He estimated there were approximately 1,000 sites to be investigated. 

 

Senator Lowden asked about the number of technicians who had been disciplined by the board.  Mr. Macdonald said there had not been any, but that two had been disciplined by the hospital in which they worked.  He stated those technicians would not be eligible for certification or licensing ever again.  Senator Lowden stated she would be much more comfortable with having supportive personnel doing the work the bill suggested if they were being monitored by the board.  Mr. Macdonald said if the senator could convince the administration of the state of the necessity, the board would have no problem doing that. 

 

David Chan, Chairman, Chain Drug Council, stated his organization's support of the bill.  He urged the committee to pass the bill.

 

Laura Weber, Pharmacist, National Association of Chain Drug Stores, commented on the training of the support personnel, and the exams some of the chains administered.  She said her organization was putting together a training manual for the smaller drug stores.  Ms. Weber pointed out that most of the personnel were not hired off the street; they normally transferred from clerk positions.  She explained the method of tracking used in Arizona. 

 

Senator Brown asked if the tracking information was shared from state to state.  Mary Santina, Lobbyist, Retail Association of Nevada, suggested using minimum standards in policy and procedures manuals.  The state board would be able to audit that manual. 

 

Senator Townsend commented that Nevada licensed its car salesmen, who did not have "as high a public policy health interest as someone who does what a tech[nician] does."  Ms. Weber stated that she felt the way to "put meat into legislation" was to discipline the pharmacist.  She said that would make the pharmacist a great deal more interested in what the supportive personnel were doing.  Ms. Weber stated a disciplinary clearinghouse would be proposed at the end of May 1993, which would make information from all the states available.   

 

John Beeston, M.D., American Association of Retired Persons (AARP), submitted written testimony supporting S.B. 399 (Exhibit H).

 

Senator O'Connell asked if the AARP would still support the bill if counseling drove the cost of prescriptions up.  Dr. Beeston stated the AARP was in favor of counseling, and since it was federally mandated it was going to happen anyway.  He said it only made sense to use the people who were the most qualified to do that counseling: the pharmacists.  If they needed to use lesser skilled people to facilitate the time to counsel, the AARP would support that practice. 

 

Senator O'Connell wondered about the value of the counseling if it were not written down.  Dr. Beeston said he envisioned a future where there were printers beside the cash registers which would print out all the drug interactions, and other information. 

 

Peggy Epidendio, R.N., Chief, Nevada Medicaid Office, Welfare      Division, Department of Human Resources, State of Nevada, testified in support of the bill, and submitted written testimony (Exhibit I).

 

Joe Brown, Lobbyist, National Rx Services of Nevada, also testified in support of the bill (Exhibit J).

 

Art Clayton, Pharmacist, National Rx Services of Nevada, stated his support of the bill.

 

Art Berliner, Pharmacist, Pharmacy Group of Nevada, submitted written testimony (Exhibit K) in favor of the bill.

 

Rochel Spiro, Pharmacist, testified in support of the bill (Exhibit L).

 

Robert Fox, Pharmacist, submitted testimony supporting S.B. 399 (Exhibit M).

 

Larry Matheis, Lobbyist, Nevada State Medical Association, commented on the counseling portion of the bill.  He said there should be a written record of the counseling.  He pointed out there was the possibility of litigation.  Mr. Matheis said:

 

      We want to express, for the record, going beyond the federal requirement, our biggest skepticism about this law is that Congress thought it up.  And they thought it up, not after Congressional hearings, not after exhaustively looking at the subject, they stuck it into that thousand page budget bill that they do at the end of the year.  The last time we got hooked in one of these and decided to go beyond what was the minimum requirement, was when the Board of Nursing took on the licensing of nursing assistants, which you know you just repealed, because it turned out to be a real costly mess.  Part of that we see as a danger here.  The federal regulations haven't yet really been written.  What requirements are there going to be?  What kind of detailing record is there going to be on all this?  We don't know, and I don't trust ... if I don't trust Congress, I absolutely don't trust [Health Care Financing Administration] HICFA....HICFA has made an abominable mess of Medicaid, they've made an abominable mess of many of the Medicare rules, and they're now going to start digging into this new area.  I think we can anticipate that there is going to be unanticipated workload.  So, in moving from not having a requirement for counseling to beyond what the federal law is, which is for Medicare and Medicaid patients, to all patients, we may be biting off something more than we want.  We're not recommending that that not be done, just that we be alert to that because the federal rules have yet to come down the pike.

 

Ms. Weber clarified that HICA had released implementing regulations in October 1992, giving the boards the authority to address the counseling within their own states, through regulation or legislation.

 

Mr. Matheis argued that that was exactly where Nevada was when the state passed the nursing rules.  HICFA had done the same thing, then came up with subsequent clarification.

 

Danny Thompson, Lobbyist, Nevada State American Federation of      Labor-Congress of Industrial Organization, introduced Bill Webb, Pharmacist.  Mr. Webb submitted a petition (Exhibit N. Original is in the Research Library.) opposing the bill. 

 

Senator Townsend asked why the minimum standards used for hospital pharmacy technicians could not be used for the supportive personnel, also.  He asked Mr. Monaghan to consider the idea.

 

Mr. Thompson commented that pharmacists already counsel patients, and the bill was designed more to lower the cost for the retail organization. 

 

David Moredock, Pharmacist, submitted a handout (Exhibit O) opposing the bill as written.  The handout included recommendations for statutory changes.

 

Helen Foley, Lobbyist, Nevada Nurses Association, spoke against the bill for her organization.  She opposed the change of language from "under direct supervision" to "under the direction and supervision of a pharmacist."  Ms. Foley said the Attorney General's Office had interpreted the new language to mean the pharmacist did not have to be on the premises.

 

Senator Townsend explained the bill would go to subcommittee for further study.  As there was no further testimony, the hearing on S.B. 399 was closed.

 

Senator Townsend stated Bill Draft Request (BDR) S-1909 had been brought to the committee.

 

BDR S-1909:Extends date upon which Public Service Commission of Nevada must report to legislature concerning alternative plan relating for regulating public utilities that provide telecommunication services.

 

      SENATOR O'CONNELL MOVED FOR COMMITTEE INTRODUCTION OF BDR S-1909.

 

      SENATOR NEVIN SECONDED THE MOTION.

 

      THE MOTION CARRIED UNANIMOUSLY.

 

      * * * * *

 

As there was no further business, the meeting was adjourned at 9:55 a.m.

 

 

 

            RESPECTFULLY SUBMITTED:

 

 

 

                                    

            Denise Pinnock,

            Committee Secretary

 

 

 

APPROVED BY:

 

 

 

 

                                      

Senator Randolph J. Townsend, Chairman

 

 

DATE:                                

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Senate Committee on Commerce and Labor

April 28, 1993

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