MINUTES OF THE
SENATE COMMITTEE ON HUMAN RESOURCES AND FACILITIES
Sixty-seventh Session
April 7, 1993
The Senate Committee on Human Resources and Facilities was called to order by Chairman Raymond D. Rawson, at 2:08 p.m., on Wednesday, April 7, 1993, in Room 226 of the Legislative Building, Carson City, Nevada. Exhibit A is the Meeting Agenda. Exhibit B is the Attendance Roster.
COMMITTEE MEMBERS PRESENT:
Senator Raymond D. Rawson, Chairman
Senator William R. O'Donnell, Vice Chairman
Senator Randolph J. Townsend
Senator Joseph M. Neal, Jr.
Senator Bob Coffin
Senator Diana M. Glomb
Senator Lori L. Brown
STAFF MEMBERS PRESENT:
Pepper Sturm, Research Analyst
Susan Henson, Committee Secretary
OTHERS PRESENT:
Jan Lewellyn-Davidson, Lobbyist, University Medical Center (UMC) of Southern Nevada
C. Edwin Fend, Lobbyist, American Association of Retired Persons (AARP)
Sheila Ward, Eagle Forum
Marsha Berkbigler, Lobbyist, Nevada State Medical Association
Jerry Ash, Lobbyist, President, Nevada Hospital Association
Chairman Rawson opened the hearing on Senate Bill (S.B.) 311.
SENATE BILL 311: Revises provision concerning examination of persons alleged to be mentally ill. (BDR 40-482)
Jan Lewellyn-Davidson, Lobbyist, University Medical Center (UMC) of Southern Nevada, testified UMC requested S.B. 311 be drafted on the advice of legal counsel. The bill codifies current hospital policy that the word "detention" means a lock down. UMC does not have a lock down unit, nor do any of the other acute care hospitals. When patients are brought in, whether on a voluntary or involuntary basis, they are given a medical evaluation. Based on that evaluation, the patient is either transferred to Southern Nevada Adult Mental Health Services or, if voluntary, and they agree to go, they are discharged and referred to Southern Nevada Adult Mental Health Services.
Senator Neal asked if this means hospitals will not maintain separate facilities for the mentally ill when they are in the hospital. Ms. Lewellyn-Davidson explained if a patient comes into the hospital on a voluntary basis, that patient is triaged, like other patients. Senator Neal pointed out the bill does not say anything about voluntary or involuntary basis. Ms. Lewellyn-Davidson explained Nevada Revised Statutes (NRS) 433A deals with admissions, either voluntary of involuntary. If a patient is on involuntary commitment, the hospital does not detain them, although they have a hold on them, with a policeman present, as the police are already at the hospital. The hospital does not have a separate room, but a separate bed is available, like all the other patients.
Chairman Rawson explained Senator Neal's concerns that at one time Nevada had a mental health unit where a person could be admitted. Ms. Lewellyn-Davidson concurred, but said in 1986 or 1988 the hospital did away with the locked unit, which was a psychiatric unit.
Senator Townsend read section 1 (NRS) 450.470 which says, "If the county hospital is located at the county seat. . . " He inquired if the provisions of the current law apply to Washoe County. Chairman Rawson indicated this bill would not affect that arrangement.
Senator Glomb said it was her understanding that legally the hospital cannot detain anyone, unless there is a specific hold, authorizing the detention. She asked if this was the reason for removing the word "detention." Ms. Lewellyn-Davidson confirmed the senator's understanding and explained the hospital does not have a separate lock down room.
Chairman Rawson closed the hearing on S.B. 311.
SENATOR O'DONNELL MOVED TO DO PASS S.B. 311.
SENATOR NEAL SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
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Chairman Rawson opened the hearing on Assembly Joint Resolution (A.J.R.) 18.
ASSEMBLY JOINT RESOLUTION 18:Urges Congress to consider effect of certain proposed legislation upon stability and unity of families in United States. (BDR R-783)
Senator Brown noted family impact statements have been put together since the early 1970s and questioned who puts those statements together. Chairman Rawson replied, "Congress." He explained the resolution from the Nevada Legislature would urge the Congress of the United States to give special consideration to the effect that proposed legislation, relating to human resources and the delivery of social services, would have on the stability and unity of families in the United States. Essentially, this is a statement from the states making Congress aware of the importance of families.
SENATOR O'DONNELL MOVED TO DO PASS A.J.R. 18.
SENATOR NEAL SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
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Chairman Rawson opened the hearing on Senate Joint Resolution (S.J.R.) 20.
SENATE JOINT RESOLUTION 20: Urges selection of Nevada as state for testing evolving National Health Program. (BDR R-1866)
C. Edwin Fend, Lobbyist, American Association of Retired Persons (AARP), spoke in support of S.J.R. 20. He testified the proposal follows AARP's desires and seems to be self-explanatory. Mr. Fend reiterated that AARP feels strongly about this proposal. He pointed out the Nevada AARP chapters have been writing to Washington, D.C. encouraging the representatives and Ms. Clinton to utilize this particular opportunity in Nevada. Mr. Fend expressed certainty that a national health program is close at hand and suggested Nevada's selection as a test site would offer the state the opportunity to evaluate and provide change to that program. He acknowledged that Nevada is not a large or politically powerful state and therefore should show an interest early, or the opportunity to evaluate the national program could be limited. Mr. Fend remarked that Governor Miller and former Governor Clinton worked closely, and it appears they have a good working
relationship, which could help Nevada's cause. Mr. Fend encouraged the committee to adopt this resolution.
Senator Glomb stated she and Chairman Rawson had the opportunity to go to Washington, D.C. for the White House Health Care Briefing and Consultation, and drew attention to the fact that other states were in Washington, D.C. vying for the test site slots.
Chairman Rawson noted some people have expressed concerns about becoming part of a federal program about which nothing is known, and the fear it could be detrimental or damaging to the state. In his opinion this resolution would be helpful in seeking the waiver needed this session. The chairman stated a timetable has been established and implementation of the federal program commences January 1, 1994. The implementation will be widespread among the states. Chairman Rawson said between now and then Nevada will need to get a waiver. He reiterated there is nothing binding in the resolution.
Senator Neal expressed concern that AARP's support of this resolution would be to the detriment of other programs which are attempting to curtail health costs.
Mr. Fend emphasized that is not AARP's position, but stressed Nevada needs to go forward in order to properly evaluate the program. It is AARP's opinion there will be certain test sites throughout the states trying portions of the program, and should Nevada be selected, it would afford the state a unique opportunity for input into a national program. As indicated in the resolution, Nevada is ideally suited to handle this type of program, with two large metropolitan areas and a lot of rural districts, which would test all aspects of the program. Mr. Fend maintained AARP is not going to put other health care proposals aside while supporting this resolution.
Senator Neal wished to point out the legislators have been talking about health costs since 1985 and have not yet been successful in controlling rising health care costs in Nevada. The senator expressed his concern that by supporting this particular measure, nothing else would get done this session, as the legislators might decide to take a wait-and-see attitude.
Mr. Fend wished to assure Senator Neal, AARP is not prepared to rest on their laurels and have this resolution go forward as the only proposal in the legislative session. He reiterated AARP's first priority, "Support legislation to reduce escalating costs of health care services, including hospitals, out-patient clinics, and other providers." He stated AARP will continue to support legislation to accomplish that priority.
Senator Glomb agreed with Senator Neal's remarks that the legislators need to continue looking at innovative approaches to controlling health care costs. Washington, D.C. has indicated the states will be afforded flexibility, so the legislators need to look at things unique to Nevada. The senator stated one of the key components for any state is an adequate management information system, in order to collect data and provide for the consumer, which Nevada does not have. She asked Mr. Fend if AARP would be in support of the legislature's efforts to get the necessary resources in order to establish a management information system which Nevada is going to need?
Mr. Fend could not say if AARP supported that particular plan, but imagined it would. He asserted AARP encourages and supports programs for managed care and reduced costs.
Senator Glomb suggested AARP might be called upon for help in putting the computer network management information system in place in order to deliver a comprehensive health care plan to citizens of Nevada, as well as the country.
Mr. Fend assured Senator Glomb that if this plan falls within the parameters of the national program, AARP would be glad to support efforts in this area.
Sheila Ward, representing Eagle Forum, spoke in opposition to S.J.R. 20. She provided the committee with a copy of The Phyllis Schlafly Report (Exhibit C), stating her testimony would be based on that report. Ms. Ward expressed concern about Nevada getting involved in a program they know little about. Ms. Ward pointed out under Clinton's plan health insurance would be controlled, health care benefits limited, and a tax due on premiums that exceed the basic plan.
Ms. Ward spoke about Oregon's health plan, which uses health care rationing, and establishes priorities for services. The services in the top half of priorities included withdrawal from alcohol and other drugs, sterilization procedures, birth control, and abortion. Procedures that ranked lower on Oregon's priorities included operations that might prevent blindness, surgical procedures for cerebral palsy, treatment for miscarriage, surgery for babies born with dislocated hips, and therapy for patients with metastatic cancer who had less than a 10 percent chance of living 5 years or more. She suggested that what a plan establishes as priority services may be different from an individual's needs. Basically, Clinton's plan deprives an individual of his right to choose a doctor or determine how much care is needed.
Ms. Ward referred the committee to page 3 (Exhibit C) which discusses medical Individual Retirement Accounts (IRAs) as the solution to the high costs of health care. She maintained health costs are high because people are spending somebody else's money.
Ms. Ward directed the committee to the chart on page 4 (Exhibit C). The average cost of the premium paid by employers to the insurance company is $4,500 per year. In the medical IRA, an employer spends $1,500 to buy health insurance for an employee, and puts $3,000 into the employee's medical savings account. This account belongs to the employee, and the unspent portion remains in the IRA account year after year. As long as this account is spent for health care, it remains tax free.
Senator Brown stated she had an opportunity to review Exhibit C and asked Ms. Ward if Eagle Forum sees S.J.R. 20 as prohibiting implementation of medical IRAs? Ms. Ward replied she did not know the answer to that question. The senator pointed out those people most likely to lack health insurance are persons working for smaller companies, unemployed persons, and persons who have major medical catastrophic kinds of problems. In her opinion, there is a hole in the proposed medical IRAs for people without income, and asked where that coverage would be coming from. Ms. Ward pointed out the medical IRAs would bring health costs down and stressed currently an individual must be working full time to be eligible for health insurance.
Senator Neal asserted when an individual suffers a serious injury or illness, and an ambulance is involved, the person does not select the hospital or the doctor. The ambulance company generally takes the individual to the hospital with which they have a contract. In addition, when a patient is in need of a service or product while at the hospital, they cannot ask the price of the product, or ask for a cheaper product, they are at the discretion of the hospital. He stressed medical IRAs may be a good plan for saving money, but the plan does not address the basic problem of rising health costs.
Ms. Ward said the medical IRAs will not solve all problems, but in her opinion, it is a good place to start.
Chairman Rawson said while in Washington, D.C. he noted the health care plans being discussed allow for significant adaptability for the states. He interpreted that to mean Nevada could do a fee for service plan, Nevada could set its own insurance plan, which could be managed care, or run by the state, like mental health, or it could do a medical IRA.
Marsha Berkbigler, Lobbyist, Nevada State Medical Association, stated they are not in opposition to the resolution, but wished to go on record with concerns about buying in blindly to a program about which the state knows very little.
Senator Neal asked Ms. Berkbigler if she represents the medical association? She replied, "yes." The senator asked why the medical association has not taken a public position on the rising costs of health care in this state. Ms. Berkbigler stated the medical association is very concerned about the continuing high cost of medicine in the state of Nevada, and the various factors which relate to it. She understands that lack of insurance for many Nevada residents has impacted the health of Nevadans, but wanted to emphasize the negative lifestyle of Nevada residents has also impacted the high cost of health care.
Senator Neal asked Ms. Berkbigler why the doctors do not get involved, or say anything about the high ancillary costs which are passed on to patients? Ms. Berkbigler did not have a response to that inquiry.
Jerry Ash, Lobbyist, President, Nevada Hospital Association, testified the association would probably be in favor of this resolution if more was known about the proposal coming out of Washington, D.C. He voiced concern about passage, encouraging the committee to wait until more was known. Nevada does not know what the program will do to Medicaid or Medicare. He concurred that passage of this resolution would be a message of endorsement to the Clinton administration from the Nevada legislature. Mr. Ash reminded the committee that historically Nevada is not happy with the decisions made in Washington, D.C., which impose things on the state, and urged caution in testing this idea first on the state.
Senator Glomb asked Mr. Ash what his concerns were regarding the plan. Mr. Ash stated the association was particularly concerned about the short term ideas, freezing rates paid for Medicaid and Medicare, discussions about freezing the rates hospitals and physicians charge to consumers, etc. Chairman Rawson pointed out the plan is not just discussing freezing, but also rolling rates back.
Mr. Ash stated he heard there are going to be fundamental systemic reforms of the health care system. The association feels any attempt to make the current system work by rolling back rates is only another attempt to make a broken system work, and they do not believe that is possible. The association is encouraged by the intent of the Clinton administration to provide universal health care and to extend public programs to "all persons." However, he pointed out the "all persons" group could add an additional 31 to 40 million people which could cost a great deal of money. On the other hand, the association has also heard discussions about how the administration needs to cut back on the amount of money being consumed by Medicare, Medicaid and Social Security, which usually means a reduction in services, or access to care.
Mr. Ash explained the American Hospital Association would like to see a system which includes a national commission that would determine what basic health care ought to be. After the commission determines the basic level of coverage needed, and the amount of money needed to provide that coverage, they would present it to Congress. Congress could then adopt that as the Medicaid program, with the basic level of services and the basic amount to be paid by the federal government for the public sector side of universal care. That program could then become the floor for the private sector side of universal care. On the private sector side, the employers would be required to provide that much coverage. Mr. Ash voiced his concern regarding the final form of managed care competition.
The association is encouraged by the overall approach the Clinton administration is making. There is a great deal of discussion about whether President Clinton will be thinking like a governor, allowing states to make decisions on their own, or like a president. It is Mr. Ash's opinion that President Clinton will be thinking like a president, as he has the federal treasury to protect. Being liberal with waivers for states, and allowing states to make decisions on their own may apply when it does not affect the federal treasury. However, when it is going to affect the federal treasury, former Governor Clinton is now President Clinton and will operate in that fashion. Mr. Ash pointed out when he returns to Washington, D.C. on the 27th, he may find the association will be solidly behind the plan once more is known about it.
Chairman Rawson closed the hearing on S.J.R. 20, and put it into a work session for further discussion.
Chairman Rawson pointed out the task force will be presenting its plan to Congress around the 1st of May. He and Senator Glomb received material about the plan while in Washington, D.C. and would be sharing that with the committee at the work session.
Chairman Rawson introduced amendments to S.B. 59 for discussion.
SENATE BILL 59: Makes certain changes regarding judicial review of request from minor seeking abortion. (BDR 40-500)
The chairman commenced with Amendment No. 262, which charges the supreme court with the responsibility to develop an expedited procedure. The language is standard, ensures the minor confidentiality and imposes a fine if the confidentiality is breached.
Senator Glomb had a question regarding the definition of abortion as seen in Amendment No. 144. It is her understanding the current definition includes miscarriages, and asked if this notification would be required for the young woman going through a miscarriage. Chairman Rawson replied, "no," but stated he would ask for clarification. It was his opinion the committee did not see the amendment in that fashion.
Chairman Rawson introduced Amendment No. 142, which provides that the state pays the cost for the birth of a child. He read for the committee:
1. If the supreme court issues a decision pursuant to NRS 442.2555 denying the performance of an abortion without the notification . . . , and the minor gives birth to the child and places the child for adoption, the welfare division of the department of human resources shall: (a) pay the medical and other necessary expenses related to the birth of the child; or (b) order the adoptive parents or the child-placing agency to pay those expenses, if the welfare division determines that the parents or guardians of the minor refuses or is financially unable to pay those expenses.
2. In making its determination, the welfare division shall consider: (a) the resources of the parents or guardian, including hospital and medical insurance; (b) other available sources . . . (c) the estimated cost of care; and (d) the debts and obligations of the minor and her parents or guardian.
3. An order issued pursuant to this section constitutes a debt owed to the minor by the adoptive parents or child-placing agency and is enforceable by any remedy provided by law.
Senator Glomb questioned that there are more than four amendments and they appear to be in conflict. Chairman Rawson pointed out others are making amendments to S.B. 59, and the committee is not entitled to know who is drafting the additional amendments. Amendments 142, 144, 145 and 147 are the committee amendments.
Chairman Rawson introduced Amendment No. 145:
1. The health division shall develop and distribute a pamphlet on the consequences of unintended pregnancies. The pamphlet must: (a) describe all options that are available to a minor who becomes pregnant; (b) include the requirements set forth . . . for notifying the custodial parent or guardian or an unmarried or unemancipated woman who is under the age of 18 years before an abortion may be performed; (c) include the procedures for requesting judicial authorization . . . (d) contain a statement of the importance of discussing any medical decisions . . . with a parent or guardian; and (e) include a statement of the importance of sexual responsibility and a discussion of the option of abstaining from sexual activity.
2. The pamphlet must be made available to pupils in public junior high schools and high schools in this state.
3. The health division may apply for all available grants and accept any gift or donations from any public . . . to carry out its duties . . .
Senator Coffin expressed concern that Amendment No. 142 differed from the amendment which was adopted by the committee, which did not include the adoptive process.
Chairman Rawson explained the amendments proposed and passed by the committee are in conflict with each other, particularly Amendment No. 147, which is causing most of the conflict. He pointed out it would be necessary to set up a complicated procedure on the senate floor to hear the first amendment, and if that passes, the other amendments, which are in conflict, cannot be considered. To resolve this problem, the chairman created a "super amendment," Amendment No. 262, to simplify the procedure.
Chairman Rawson summarized Amendment No. 262 for the committee. Section 2 of the amendment requires the court to establish simplified procedures to expedite review of a request and ensures confidentiality for the minor. Section 3 is the informational pamphlet provision, which incorporates the same language as Amendment No. 145 previously introduced. Section 4 of the amendment requires a certificate be issued to the minor after the failure of the lowest court (family or district court) to issue a decision, relieving the physician of risk. If the court does not issue a decision, the abortion is deemed granted. This language creates the least amount of conflict with the other amendments. Changing the language to "deemed denied," with an automatic appeal, as done in Amendment No. 147, creates a conflict. Section 7 deals with the state paying for the cost of the birth and adoption language.
Chairman Rawson suggested the committee consider adopting Amendment No. 262, and then consider it first on the senate floor. If Amendment No. 262 does not pass, the other proposed amendments can be heard one at a time.
A general discussion was held regarding section 4 of Amendment No. 262, as it differed from the amendment passed by the committee. Senator O'Donnell restated the language to clarify his understanding, "If the court does not render a decision within 1 judicial day, the abortion is deemed granted, and a paper issued for the minor to take to the physician." Chairman Rawson confirmed that as correct, which creates a friendlier process for those accessing the system.
Senator Glomb called for a point of order, stating in her opinion the committee is now in a work session, which was not noticed.
Chairman Rawson disagreed. The chairman, as a courtesy and in an effort to keep it an open process, brought the amendments in for the committee to review. He stated it is standard practice to do the work of the committee, and it is not necessary to notice every bill on a work session. Any bill that has been dealt with can be brought before the committee at any session.
Senator Glomb read for the chairman, standing rule 92: "Adequate notice shall be provided to the legislators and the public by posting information relative to the bills, topics and public hearings which are to come before committees. This requirement of notice may be suspended for an emergency by the affirmative vote of two-thirds of the committee." She expressed concern that the chairman wanted the committee to consider action on a new amendment on S.B. 59.
Chairman Rawson ruled on the point of order. He stated he has not declared a hearing, the bill has been previously heard, and after being heard, it is subject to work session or vote.
Senator Coffin expressed his concern that he was not able to review the amendments prior to the bill being reported to the floor.
SENATOR NEAL MOVED TO INTRODUCE AMENDMENT NO. 262.
SENATOR O'DONNELL SECONDED THE MOTION.
A discussion ensued between Senator O'Donnell and Chairman Rawson regarding the changes made to the original amendments approved by the committee. The chairman stated it was done to simplify the process and smooth out the conflicts.
Senator Brown remarked Amendment No. 142, as repeated in No. 262, has been changed from Senator Coffin's original proposal, and pointed out she would not have voted in favor of the amendment as written.
THE MOTION FAILED. (SENATORS COFFIN, TOWNSEND, GLOMB AND BROWN VOTED NO.)
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Chairman Rawson noted the bill was on for second reading tomorrow. Senator Coffin agreed to take Amendment Nos. 142 and 262 to the bill drafting advisor with Pepper Sturm, Research Analyst, for revision. The chairman emphasized there is no time table for voting on S.B. 59. The bill can be put on the secretary's desk until the amendment is corrected, and brought before the committee for further review.
SENATOR COFFIN MOVED FOR A FISCAL NOTE ON AMENDMENT 142.
SENATOR BROWN SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
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SENATOR BROWN MOVED FOR A FISCAL NOTE ON S.B. 59.
SENATOR GLOMB SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
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SENATOR GLOMB MOVED FOR A FISCAL NOTE ON AMENDMENT NO. 145.
SENATOR BROWN SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
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There being no further business, Chairman Rawson adjourned the meeting at 3:40 p.m.
RESPECTFULLY SUBMITTED:
Susan Henson,
Committee Secretary
APPROVED BY:
Senator Raymond D. Rawson, Chairman
DATE:
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Senate Committee on Human Resources and Facilities
April 7, 1993
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