MINUTES OF THE
SENATE COMMITTEE ON HUMAN RESOURCES AND FACILITIES
Sixty-seventh Session
June 2, 1993
The Senate Committee on Human Resources and Facilities was called to order by Chairman Raymond D. Rawson, at 2:15 p.m., on Wednesday, June 2, 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 Bob Coffin
Senator Diana M. Glomb
Senator Lori L. Brown
COMMITTEE MEMBERS ABSENT:
Senator Joseph M. Neal, Jr.
GUEST LEGISLATORS PRESENT:
Assemblywoman Erin L. Kenny, Clark County, District No. 4
Assemblyman Richard D. Perkins, Clark County, District No. 23
STAFF MEMBERS PRESENT:
Pepper Sturm, Research Analyst
Susan Henson, Committee Secretary
OTHERS PRESENT:
Richard Van Dellen, Paramedic Quality Assurance Director, Clark County Fire Department
Dennis Nolan, Mercy Ambulance, Las Vegas
Captain Randy Oaks, Lobbyist, Las Vegas Metropolitan Police Department
Sharon Ezell, Chief, Bureau of Licensure and Certification, Nevada State Health Division
Donald Kwalick, M.D., State Health Officer
Stephen Dean, Vice President Operations, Mercy Ambulance Service, Reno
Fred Hillerby, Lobbyist, Associated Pathologists Laboratories, Las Vegas
David Rowles, Director, Administration, Clark County Health District
LaRue Scull, Emergency Medical Services Coordinator, Clark County Health District
Myla Florence, Administrator, State Welfare Division
Chairman Rawson opened the hearing on Senate Bill (S.B.) 69.
SENATE BILL 69: Authorizes sale of controlled substances or dangerous drugs to certain persons and agencies that provide emergency care in order to stock ambulances and other authorized vehicles. (BDR 40-706)
The chairman stated this bill allows ambulance crews to restock supplies of controlled substances and was previously passed out of this committee. The assembly has presented a simple amendment which deletes the word "division" and inserts the word "authority." Essentially, they want permission from the proper authority and recognize it might not always be the division.
SENATOR GLOMB MOVED TO CONCUR ON S.B. 69.
SENATOR BROWN SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS O'DONNELL, NEAL AND TOWNSEND WERE ABSENT FOR THE VOTE.)
* * * * *
Chairman Rawson presented Bill Draft Request (BDR) 34-1852 and BDR 43-1986.
BILL DRAFT REQUEST 34-1852: Authorizes board of trustees of school district to allow reading or posting of certain historical material in public schools.
SENATOR GLOMB MOVED TO INTRODUCE BDR 34-1852.
SENATOR BROWN SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS O'DONNELL, NEAL AND TOWNSEND WERE ABSENT FOR THE VOTE.)
* * * * *
BILL DRAFT REQUEST 43-1986: Authorizes court to require person convicted of driving under the influence of intoxicating liquor or controlled substance to visit trauma center or certain other facilities.
SENATOR GLOMB MOVED TO INTRODUCE BDR 43-1986.
SENATOR BROWN SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS O'DONNELL, NEAL AND TOWNSEND WERE ABSENT FOR THE VOTE.)
* * * * *
Chairman Rawson opened the hearing on Assembly Bill (A.B.) 529.
ASSEMBLY BILL 529: Requires board of trustees of school district to establish program of instruction relating to child abuse for younger pupils. (BDR 34-1536)
Assemblywoman Erin L. Kenny, Clark County, District No. 4, testified before the committee to encourage support of A.B. 529. She told a story of her family watching a Disney show on television entitled Winnie the Pooh, Good Touch - Bad Touch. The premise of the show was clear, it was entertaining, nonthreatening and informative with a fresh approach to learning about a delicate subject. Assemblywoman Kenny pointed out this helps to illustrate that children can be empowered with knowledge. It is the duty of adults to teach children what is acceptable and what is not acceptable behavior with regard to abuse. She asserted the average age of child abuse begins at 4 years, and therefore children must be taught as soon as possible to protect themselves. Nevada is the leading state in the nation for child abuse. Parents must reinforce this safety lesson as they do with any other lesson they teach, such as when to cross the street, how to do multiplication tables, or when children tell someone they are being abused. Assemblywoman Kenny pointed out there was no opposition to this legislation in the assembly. She then introduced Richard D. Perkins.
Assemblyman Richard D. Perkins, Clark County, District No. 23, urged support of A.B. 529. He told the committee he spent 2 years of his law enforcement career dedicated to investigating the crimes of sexual assault and child abuse, and received extensive training in this area. Assemblyman Perkins stated he drafted policy for the Henderson Police Department and continues to teach training in the academy about this subject matter. He insisted it is time to stop teaching our children to be victims. Assemblyman Perkins stated he feels it important to begin breaking the cycles of abuse and be proactive enough to prevent future abuse. He cited statistics from the Department of Justice that 1 out of 3 girls and 1 out of 5 boys will be sexually abused before reaching the age of majority. Of those, 80 percent, or more, will be abused by somebody they know, as abuse is a cyclical problem handed down through the generations. An abused child is more inclined to grow up and be an abusive parent than a child who is not abused. Studies have shown it is easier for a known person to build a rapport with a child and know that child's vulnerabilities. A child is always taught to mind their elders, mind the baby sitter, and mind the authority figures. The child is not taught to mind their elders, "except if they are tying to sexually abuse you."
Assemblyman Perkins stressed A.B. 529 will help educate children so they will not be programmed to be victims. He referred the committee to a book entitled, Good Touch, Bad Touch, Secret Touch, which was a good tool while he was an investigator in explaining to a child the difference between what is appropriate and what is not, and to reinforce that a child is not responsible for acts imposed upon them by an adult.
A discussion ensued between Senator Coffin and Assemblyman Perkins regarding normal, natural parenting behavior being accidently mistaken for inappropriate treatment by a parent. Assemblyman Perkins agreed the possibility always exists that a child will misunderstand what has occurred. However, educating children will help them discern the difference between a good touch and a bad touch, and what is appropriate versus inappropriate behavior. Assemblyman Perkins pointed out the burden of proof is on the child and consequently a great many child abuse cases go unreported.
Chairman Rawson announced the committee was ready to take action on the bill and indicated he would accept written testimony (Exhibit C Original is on file in the Research Library.) from those present who wished to go on record regarding A.B. 529.
Chairman Rawson closed the hearing on A.B. 529.
SENATOR GLOMB MOVED TO DO PASS A.B. 529.
SENATOR BROWN SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS O'DONNELL AND NEAL WERE ABSENT FOR THE VOTE.)
* * * * *
Chairman Rawson opened the hearing on Senate Bill (S.B.) 461.
SENATE BILL 461: Makes various changes regarding regulation of emergency medical services. (BDR 40-63)
Richard Van Dellen, Paramedic Quality Assurance Director, Clark County Fire Department, also representing the Southern Nevada Fire Chiefs Association (S.N.F.C.A.) Emergency Medical Service Council, presented a letter from the S.N.F.C.A. (Exhibit D), expressing their written support of the bill and a proposed amendment. Mr. Van Dellen then read verbatim from his prepared testimony (Exhibit E), which gave a brief history of S.B. 461, and voiced his support for this legislation.
Chairman Rawson emphasized this issue has been a continuing problem he has dealt with in five sessions and he would like to see it resolved. He stated there are compelling reasons why Nevada should have a state certifying agency. Currently, there are different standards within the state, due to diversity in size and location, so the state tends to adopt a lesser standard, which is significantly handicapping both Washoe and Clark County.
Dennis Nolan, Mercy Ambulance, Las Vegas, stated in 1987 Mercy Ambulance was also involved in adopting and promoting the passage of the initial senate bill which allowed them to operate under the Clark County Health District. Mercy Ambulance employs about 150 full time paramedics and emergency medical treatment (EMT) personnel, and an additional 100 part time EMTs and paramedics, which makes them the largest provider of emergency medical services within the state. Many of those individuals are recruited from out-of-state. They come into the state for training and stay for a period of time to get their state certification through the county before returning to their home. In most cases, the individuals can achieve reciprocity throughout the country with their national registry certification, or even with state certification issued through the Clark County Health District. However, in some instances, when the individual seeks employment in another part of the country or area, the employer, when attempting to get information about that individual through the state Health Division, has been told the individual does not exist or does not possess a state certificate. This has a rather dramatic effect on the individual paramedic or EMT who is looking for gainful employment in another part of the country. Mr. Nolan voiced his support of the amendment to S.B. 461, with the hope this would resolve the issue at hand.
Captain Randy Oaks, Lobbyist, Las Vegas Metropolitan Police Department (METRO), representing Sheriff John Moran, METRO, stated the sheriff of each county in Nevada, by statute, must maintain a search and rescue function. Within the metropolitan police department, that function falls under Captain Oak's bureau of special operations. There are four full time personnel and 26 volunteers who operate by Clark County health standards at an EMT intermediate level. Captain Oaks expressed support of S.B. 461 because personnel may be called to other areas of the state, as well as abiding by the federal response system to operate in other areas of the country when necessary.
Sharon Ezell, Chief, Bureau of Licensure and Certification, Nevada State Health Division, testified in opposition to S.B. 461. Ms. Ezell stated she found the previous testimony interesting as she has never received personal contact from those individuals to discuss the issues. Ms. Ezell stated she has been with the division for 7 months, presents an open-door policy and is willing to discuss any problems. Ms. Ezell read from her statement (Exhibit F) which set out three major objections to the bill. She called attention to a survey conducted in 11 different states, in which all of those states said they would not accept a county certification and indicated they would only accept state certifications to assure there are minimum standards. Ms Ezell provided the committee with the results of that survey (Exhibit G).
Chairman Rawson asked Ms. Ezell if she allowed reciprocity with the counties. Ms. Ezell replied, yes, the state should be doing that, and if that is not happening, she would like to know about it.
Chairman Rawson stated he would like to see the state's interests acknowledged, but emphasized the need to resolve this issue during this session. Ms. Ezell asked the chairman if he would entertain amendments to address some of the state's concerns. The chairman declared they would be happy to receive amendments to this bill, but reiterated it is late in the session and in order to move this along the amendments must be received this week. Chairman Rawson asked Ms. Ezell to elucidate her function at the bureau.
In response to Chairman Rawson's question, Ms. Ezell stated she is the bureau chief for licensing and certification which includes the emergency medical services (EMS) unit that certifies EMTs and paramedics, licenses ambulance attendants and also issues ambulance permits.
Chairman Rawson asked Ms. Ezell if she runs any examinations. She replied she has a supervisor by the name of Sheryl Yount who supervises that unit and, in addition, there are specialist type positions that run examinations and collect data for certification of personnel. The chairman asked Ms. Ezell how many people in the state are certified. In response to the chairman's question, Ms. Ezell indicated she did not have that information with her today, but would provide it to him.
Chairman Rawson wondered if the state was under any time frame to produce a database to collect data to establish the number of personnel in the state. Ms. Ezell noted the state was mandated to establish a registry and, although the registry has been programmed, a problem arose when it was discovered Clark County's data was not compatible with the state's system. Ms. Ezell emphasized there is a hard copy of their registry.
Donald Kwalick, M.D., State Health Officer, remarked there are minimum standards statewide, and a district or county may go beyond those minimum standards if they so desire. However, he stated he feels a problem could arise if everybody has a separate system operating autonomously creating fragmentation of the total system.
Chairman Rawson asserted there are counties who want to produce a more stringent, sophisticated standard than the state standards, and upon doing so are not accepted by the state. Dr. Kwalick agreed that a better, more stringent standard should be recognized and remarked it is his understanding this problem had been settled several months ago.
Senator Brown asked if anything would stop an individual licensed through the county from taking the state EMS certification, if they wanted to be recognized elsewhere. Ms. Ezell replied no.
Stephen Dean, Vice President Operations, Mercy Ambulance Service, Reno, testified his company provides ambulance service in Virginia, Indiana, and another state, in addition to Nevada. Mr. Dean stated he is not in opposition to the bill, but has a concern about reciprocity. He pointed out it is important that the EMTs and paramedics be able to go to other states and have their certification from this state recognized by those other states.
Fred Hillerby, Lobbyist, Associated Pathologists Laboratories, Las Vegas, pointed out their only concern deals with section 39 of the bill, which goes beyond the authority extended to any health professional, other than a physician, which gives the counties the
ability to allow EMTs to do laboratory tests of whatever kind. The broad language allows laboratory functions to occur without licensure, except by county to county, and noted this is not the way laboratories are licensed in this state.
Chairman Rawson asked if Nevada Revised Statutes (NRS) 450B deals with someone who is certified? Mr. Hillerby stated that section of the statute deals with EMTs, collecting blood specimens, administering drugs, and emergency procedures. The new language in the bill makes this definition much broader.
David Rowles, Director, Administration, Clark County Health District, representing Dr. Otto Ravenholt, stated the Clark County EMS function is directly under his supervision for the day-to-day material matters, and Dr. Ravenholt is the medical director for the program. Mr. Rowles suggested amending the language in section 39, line 28, page 14, after "board of health" by inserting, "when on duty and functioning with a permitted service." This language would narrow the scope of that individual being able to only do those lab functions in the context of a permitted service, which is regulated by the Clark County Health District. It is Clark County's opinion this language is essential to reduce the opportunity for free lance individuals doing lab services out of their trunk.
Chairman Rawson asked Mr. Hillerby if this amendment would address his concerns. Mr. Hillerby stated it is one thing to draw a sample, but it is another to do the test without any proficiency.
Mr. Rowles pointed out that what is before the committee says the Clark County District Board of Health will adopt controls by regulation regarding that. If that were to be proposed, it would have to come before a public hearing and have public testimony taken. He stressed as he reads this, the ability to do what Mr. Hillerby is concerned about would be regulated by the Clark County District Board of Health, and the language just proposed would narrow that to only a permitted facility, which would include Mercy Ambulance and the fire departments. It significantly narrows that function and puts the responsibility on the permitted service.
LaRue Scull, Emergency Medical Services Coordinator, Clark County Health District, stated that primarily the laboratory procedures referenced in this proposal have to do with drawing dex stix or chem stik, or in essence checking for blood sugar, strictly for medical purposes. These tests would be ordered to determine the level prior to administering normal saline or other medications, and would allow the physician at the hospital to have an idea as to the patient's condition.
Mr. Rowles remarked that what may be done or may not be done is circumscribed by strict protocol. He stated the Medical Advisory Board of the Clark County Health District Emergency Medical Services meets once a month to discuss medications that may be used, or may not be used, under certain circumstances.
Chairman Rawson asked if the committee were to add to this language related to the EMS mission, would there be any concern.
Mr. Rowles and Mr. Nolan stated they would not have a problem with the language. Chairman Rawson indicated he would attempt to draft some language to narrow the scope and address those concerns.
Mr. Nolan commented the only test being performed in the field is a simple dex stik, which requires sticking the finger and taking a drop of blood. The emergency medical field is rapidly changing and currently new technologies are being introduced that might, in the future, allow some other type of diagnostic testing that might be to the advantage of the patient in an acute setting. Mr. Van Dellen asked the chairman to give consideration to language allowing a bit of latitude to accept the new innovations as they become standard procedure.
Chairman Rawson commented he understands the problems and feels they can be addressed. He presented the University Medical Center's (UMCs) proposed amendments to S.B. 461 (Exhibit H), and reviewed those briefly with the committee. The chairman pointed out certain sections of S.B. 461 should be amended to incorporate changes previously approved in S.B. 69, thus avoiding a conflict.
Mr. Rowles stated he was before the committee representing the Clark County Health District EMS unit and wished to make a comment regarding his observation of this bill. There does not appear to be anything in the bill that is inimical to the maintenance of quality service in Clark County as far as emergency medical services go. He agreed there have been discussions over the years regarding a uniform standard of care. There is nothing in this bill that prohibits Clark County Health District, Washoe County, and the state from independently, amongst themselves, developing and agreeing upon a standard of care.
Mr. Rowles remarked the providers of service work together to try and improve services. The absence at present of a uniform statewide standard of care has not restricted this group from going ahead and demonstrating their concern for the care of the patient, and irrespective of whether there is a statewide standard of quality of care, this group will continue to do the best for the patient.
Mr. Rowles stated he has been in the medical emergency services business for well over 20 years, and in fact the organization of the Clark County EMS predated the organization of the state program. The county EMS functions under regulations adopted by the District Board of Health, and has had a decent relationship with the state EMS personnel. Occasionally there are differences of opinion, but not to a point where something could not be worked out. In his opinion, this bill basically clarifies what the county EMS has been doing and what was legislative intent for the last 6 to 8 years, and in that sense the county has been performing similar to what this bill now clarifies.
Chairman Rawson suggested charging the state EMS to develop a consensus on the state standard of care. The state's mission would be to try to bring the various counties together with a minimum standard of care and anybody that is above that minimum has an automatic reciprocity with the state.
Mr. Rowles stated he would be comfortable with that suggestion, but would like to recognize Dr. Kwalick, who has already been hard at work trying to do that very thing. Mr. Rowles emphasized Dr. Kwalick's efforts should not go unrecognized, nor in any way should continuance of his efforts be undermined. Everybody seems to be
interested in developing standards that are uniform throughout the state.
Mr. Van Dellen drew attention to S.N.F.C.A., EMS Council Chairman's proposed amendment (Exhibit D) to section 1 of the bill, which simply takes the hospital, rescue unit or ambulance service which meets minimum requirements established by the state board of health, and lumps them together and divides them by population.
Chairman Rawson questioned if this amendment is necessary. Mr. Van Dellen replied, yes.
Chairman Rawson mentioned he would gather all the pertinent information and put this issue on the calendar for Monday's work session.
Chairman Rawson closed the hearing on S.B. 461, and opened the hearing on Assembly Concurrent Resolution (A.C.R.) 37.
ASSEMBLY CONCURRENT RESOLUTION 37: Urges State Welfare Administrator to develop program to encourage certain recipients of Medicaid to participate in educational program on family planning. (BDR R-1430)
Chairman Rawson stated he has been asked to hold this issue but encouraged anyone wishing to speak to step forward.
Myla Florence, Administrator, State Welfare Division, voiced support of A.C.R. 37. She remarked the amendments satisfy the department's concerns with regard to the original resolution. Ms. Florence then read from her prepared statement (Exhibit I).
Chairman Rawson asked what family planning means by the state's definition. Ms. Florence remarked that family planning is primarily an educational component of the relationship between the health care provider and the patient to hopefully avoid unintended pregnancies, to advise individuals of their alternatives in terms of abstinence, contraception, etc.
The chairman asked if there are penalties for those who become pregnant while on the Aid to Dependent Children (ADC) program. Ms. Florence noted that has not been a part of the state's discussions. She pointed out some states have attempted to implement penalties, but there have been legal challenges to those kinds of measures.
Chairman Rawson closed the hearing on A.C.R. 37 and indicated he would wait for Assemblywoman Freeman to go on record prior to entertaining a motion.
Chairman Rawson presented an amendment to S.B. 57 (Exhibit J) which in effect says the county may elect to exclude from eligibility for cash grants, or to provide a different standard of assistance to a person who is deemed to be employable and who has no responsibility.
SENATE BILL 57: Authorizes county to exclude indigent person deemed to be employable and with no dependent children from cash grants for necessary maintenance. (BDR 38-216)
The chairman reiterated this amendment was worked out between Jon Sasser, Nevada Legal Services, and social services, which in essence lessens the county's standard.
A discussion ensued among the committee members regarding amendments suggested at the prior hearing. Senator Brown thought there was an amendment presented which allows the county to exclude someone from welfare if they refused to accept a job, and also allows them to prioritize women and children, or any other group.
Chairman Rawson pointed out this amendment takes that into consideration as it says the county may exclude from cash grants, or establish a different standard if they are employable and will not work and have no responsibility for a dependent child. In addition, the amendment states a person shall not be deemed to be employable if he faces a serious barrier to employment and complies with reasonable job search requirements imposed by the board.
Senator Glomb asked if all the parties who previously testified on A.C.R. 37 are in agreement with the amendments? Chairman Rawson replied, yes, all parties indicated their agreement with the amendment presented to the committee.
SENATOR GLOMB MADE A MOTION TO AMEND AND DO PASS S.B. 57.
SENATOR TOWNSEND SECONDED THE MOTION.
THE MOTION CARRIED. (SENATOR NEAL WAS ABSENT FOR THE VOTE.)
* * * * *
There being no further business, the chairman adjourned the meeting at 3:23 p.m.
RESPECTFULLY SUBMITTED:
Susan Henson,
Committee Secretary
APPROVED BY:
Senator Raymond D. Rawson, Chairman
DATE:
??
Senate Committee on Human Resources and Facilities
June 2, 1993
Page 1