MINUTES OF THE
SENATE COMMITTEE ON HUMAN RESOURCES AND FACILITIES
Sixty-seventh Session
June 18, 1993
The Senate Committee on Human Resources and Facilities was called to order by Vice Chairman William R. O'Donnell, at 4:00 p.m., on Friday, June 18, 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 Joseph M. Neal, Jr.
Senator Bob Coffin
Senator Diana M. Glomb
Senator Lori L. Brown
COMMITTEE MEMBERS ABSENT:
Senator Randolph J. Townsend
GUEST LEGISLATORS PRESENT:
Assemblyman Larry L. Spitler, Clark County, District No. 41
Assemblyman Wendell William, Clark County, District No. 6
STAFF MEMBERS PRESENT:
Pepper Sturm, Research Analyst
Susan Henson, Committee Secretary
OTHERS PRESENT:
Christopher A. Donohue, President, Hearing Impaired Program Parents Advisory Committee (HIPPAC) of Clark County
Carole A. Vilardo, Lobbyist, Nevada Taxpayers Association
Marvin Leavitt, Lobbyist, City of Las Vegas
Paula Treat, Lobbyist, Desert Springs Hospital
Vernon Manke, Health Care Financial Analysis Unit (HCFAU)
Christopher Thompson, Chief, Heath Care Financial Analysis Unit
Patricia Morse Jarman, Executive Director, Commission for Hospital Patients
Dr. Jerry Zadny, Administrator, Mental Hygiene and Mental Retardation Division
Cynthia Pyzel, Deputy Attorney General, Mental Health/Mental Retardation
Janice Pine, Lobbyist, Saint Mary's Regional Medical Center
Ivan Ashleman, Lobbyist, Lake Mead Hospital Medical Center
Vice Chairman O'Donnell opened the hearing on Assembly Bill (A.B.) 207.
ASSEMBLY BILL 207: Directs appointment of task force to study feasibility of establishing course work in American Sign Language in certain public schools. (BDR S-274)
Assemblyman Larry L. Spitler, Clark County, District No. 41, stated A.B. 207 is on the second reprint. He became interested in deaf issues in 1985 when the legislature enacted the telephone device for the deaf (TDD) bill, which created surcharges assessed to telephone bills to fund a program administered by the Public Service Commission (PSC) and provided telecommunication devices for the deaf. Since that time, it has been learned there are a larger number of deaf in the community than originally calculated. Assemblyman Spitler commented this led to his interest in attempting to introduce sign language in the public schools. He began by working with one of the board of directors of the Sign Design Theater, who helped craft the first bill.
Assemblyman Spitler noted the Department of Education turned in a $30 million fiscal note, thus forcing the bill creators back to the drawing board. A.B. 207 sets up a task force to do a feasibility study. The bill encompasses the deaf community to provide the solutions as to what they feel could be done in the public school system. A.B. 207 has gone through the education department and Assembly Committee on Ways and Means, and is asking for an appropriation of $3,812 to cover the cost of the meetings.
Christopher A. Donohue, President, Hearing Impaired Program Parents Advisory Committee (HIPPAC) of Clark County, a member of the board of directors for the Sign Design Theater Company, as well as the father of a 6 1/2 year old deaf daughter, testified he has been authorized by unanimous vote to express HIPPAC's full support of A.B. 207. HIPPAC is comprised of parents with hearing impaired children in the Clark County School District and the Community College of Southern Nevada. The children are from both the oral only method of education, as well as signing, and an oral method known as total communication. HIPPAC recognizes that sign language is a valid form of foreign language communication. This bill would lead to public awareness and greater acceptance of those who use sign language. Mr. Donohue stated the Sign Design Theater is a nonprofit charitable organization which is comprised of hearing and deaf children between 3 and 18 years old. These children perform dance routines and sign language interpretation of various music, ranging from Le Miserables, Beauty and the Beast, to rock and pop. Easily 35 percent to 40 percent of the 90 plus members of Sign Design Theater have expressed their support of this bill and have stated their desire to take additional sign language classes in school, with some exploring career opportunities in deaf education and interpreting.
Mr. Donohue stated attracting qualified teachers in many special education fields is difficult as school districts across the country are scrambling for the same group of people. The search for these educators and qualified interpreters for the hearing impaired is no different. By recognizing sign language as a foreign language and offering it as an elective in public schools, Mr. Donohue believes it would begin to develop a pool of local people who could continue on with their sign language training and help alleviate the critical shortage of sign language educators.
Mr. Donohue remarked that as a father of a deaf daughter, who is fully mainstreamed in a hearing first grade class, he urges support of this bill. Currently, the education system recognizes foreign languages such as Spanish, German, French and Russian, and pointed out it is difficult to understand why the education system cannot also recognize American Sign Language (ASL), which is the third most used language in the United States. He stressed his daughter's hearing impairment is a problem to overcome, not a barrier to her achievement. Ms. Donohue did point out that if his daughter must take 2 years of a foreign language, that she cannot hear, in order to gain entrance to a state university, the system is telling her she does not deserve admittance regardless of her academic standing or achievements.
Mr. Donohue emphasized A.B. 207 is a critical first step in helping to achieve parity for hearing impaired children, as well as general acceptance by the hearing world.
Vice Chairman O'Donnell commented with the advent of the American Disabilities Act (ADA) and the fact that the public seems to be more compassionate in dealing with the handicapped, he does not see any problem with the bill.
Mr. Donohue delivered three letters to be introduced into the record for those individuals unable to testify (Exhibit C).
Vice Chairman O'Donnell turned the gavel over to Chairman Rawson, who closed the hearing on A.B. 207.
SENATOR BROWN MOVED TO DO PASS A.B. 207.
SENATOR O'DONNELL SECONDED THE MOTION.
THE MOTION CARRIED. (SENATOR TOWNSEND WAS ABSENT FOR THE VOTE.)
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Chairman Rawson opened the hearing on A.B. 468.
ASSEMBLY BILL 468: Makes various changes relating to powers and composition of board of trustees of consolidated library district. (BDR 33-92)
Assemblyman Wendell Williams, Clark County, District No. 6, introduced A.B. 468 on behalf of Clark County and pointed out it is supported by the City of Las Vegas as well. He stressed a problem has surfaced due to previous legislation which needs to be corrected.
Assemblyman Williams stated one of the problems which exists with the Las Vegas Clark County Library District (LVCCLD) stems from the fact that it is independently financed. He pointed out it is the only entity in the state of Nevada where tax dollars go straight to a particular district, monies collected from property tax and sales tax earmarked exclusively for libraries, and that entity has no elected representatives. This means the library district never has to appear before an elected body to obtain annual financing, thus allowing it to be unaccountable.
Assemblyman Williams said in fiscal year (FY) 1992 the LVCCLD collected $11.5 million in revenues. This sum represented operating expense only and did not include the $80 million bond that was authorized in 1981. This particular financial condition came about through two events, the 1983 and 1985 session of the state legislature. In 1983 the library district disregarded state law and in 1985 the district misled the legislators.
Assemblyman Williams continued on and explained that in 1981 the legislature put caps on property tax increases and 2 years later, during the legislative session, local governments complained about the restrictive limits and requested greater flexibility. A compromise was eventually drafted that enabled local governments to raise property taxes, but if they did, voters could sign a petition forcing a rollback election. The Clark County entities promptly boosted property rates causing many rollback petitions. In every instance, when the high levels were placed on the ballot, they were rejected by the people. A.B. 449 of the Sixty-second Session stated that each local government shall on or before June 7, 1983, publish in a newspaper of general circulation, in its territory, a notice, covering one-quarter of a page, setting forth the rate of property tax and advising citizens that the escalating rate could
be rolled back and outlined the procedure for the rollback.
ASSEMBLY BILL 449 OF THE Revising certain limitations on local SIXTY-SECOND SESSION: government revenue; repealing provisions for lowering the rate of certain taxes on retail sales.
Under Nevada Revised Statutes (NRS), local governments include special districts, which encompasses library districts, subject to the provisions of A.B. 449 of the Sixty-second Session. The district never purchased the required and mandated ad in the newspaper, so the heightened property tax rate was never reduced. Accordingly, the property tax hike imposed by the library district was illegal. In FY 1982 to 1983, the district collected $290,945 in property tax. The following year, after the illegal tax hike, they received an increase of 118 percent in property tax that came from the taxpayers, went directly to the district, and did not go through any elected body. In 1983 the overpayment was not a one-shot, and thus has compounded over the past 10 years, costing the taxpayers of Clark County millions of dollars.
The assemblyman remarked that in 1985 the district was under county control and had to have its budget approved by the Clark County Commissioners. During the 1985 legislative session, the library district introduced Senate Bill (S.B.) 158 of the Sixty-third Session and asked that it be declared an emergency measure, which was then taken to the voters that spring.
SENATE BILL 158 OF THE Provides for establishment of
SIXTY-THIRD SESSION: consolidated library districts.
(BDR 33-1683)
S.B. 158 of the Sixty-third Session transformed the county library district into a consolidated district. During the hearing on that particular bill, the current majority leader, who now serves in the senate, asked the director of the library district if this consolidated district would create a negative financial impact on the other entities in Clark County and his response was, "absolutely not." Later, legislators learned they had been misled. Upon achieving consolidation, the district took a bigger part of the sales tax, leaving local governments in Clark County with less money. The district began receiving a windfall of taxpayer dollars, while at the same time operating without the scrutiny of any elected body.
Assemblyman Williams pointed out prior to 1985, the district received funding from property tax, sales tax, and motor vehicle privilege tax. During the 1984 and 1985 FYs, the district received $668,433 in property tax and the year after they initiated the illegal hike, they received $2,438,576 in property tax. Before the illegal hike in sales tax, the district received $1,344,806 in sales tax, and the year after the illegal hike, they received $2,370,058, an increase of over 122 percent. From 1987 to 1991, that figure has jumped to over $10,000,629.
Assemblyman Williams declared the legislature was misled, the property tax hike was illegal, and as a result Clark County taxpayers have been paying millions and millions of dollars which go directly to this particular entity. Many Clark County taxpayers have complained they have no one to go to when they have problems with the Clark County Library District. The district is made up of 10 trustees, five of which are appointed by the city council, and the remaining five appointed by the county commissioners, which is the city council and county commissioners only involvement. When a taxpayer or citizen has a problem with the library district, neither the city council nor the county commissioner can answer their concerns.
Assemblyman Williams stated A.B. 468 would allow the city council and the county commissioner's financial staffs, as they do with the Metropolitan Police Department, to get together to review and approve the budgets. The City of Las Vegas, as well as the Clark County Mayor testified in the assembly in support of the bill.
Assemblyman Williams outlined two things that need to happen. First, pass this legislation which will allow approvals to take place by elected officials and, in the future, disallow tax dollars from taxpayers going to an entity which has no elected officials serving on the board, to insure an accountability. He stressed there is a great deal of frustration in Clark County concerning the way things are happening. Assemblyman Williams remarked he has received complaints and responses from people as far away as Overton who have tried to place bids with the library district, people who have produced documentation of their submitted bids, which are for one-quarter of what the district is paying in some situations, and were told the district pays what they want and to whom they want. The district's policy manual gives this authority to an executive director, who handles the dollars.
Assemblyman Williams pointed out the library board recently met and voted unanimously to tear down part of an auditorium currently under construction in west Las Vegas. On four separate occasions, Assemblyman Williams stated he went to the district and asked for an emergency review. He said last summer he met with the Chairman of the Board, as well as Senator Neal, along with the person who designed the library, to point out the plans were wrong and the building was being constructed incorrectly. On November 18, 1992, a press conference was held on the steps of City Hall, to ask the board for an emergency review of the site before too much of the building had been done, and further errors were perpetuated. Assemblyman Williams reiterated the board voted unanimously last
week to tear down part of the structure, which will cost almost $1 million, and this emphasizes the lack of accountability.
Chairman Rawson questioned Assemblyman Williams on the illegal tax increases, and felt if it was truly illegal there should be remedies available, either through the attorney general, the district attorney, or other sources. He wondered if there has been some determination made that it was an illegal act.
In response to questioning by the chairman, Assemblyman Williams replied that according to the law, the district was supposed to purchase an ad in the newspapers to advise voters of the increase in property tax so the voters would have the option of rolling it back, and the district did not do that. Due to the inadvertence, the higher property tax has stayed in place. Chairman Rawson noted it is suspect and appears to be an improper situation, stressing there should be remedies available, if it is determined it is illegal. Assemblyman Williams asserted he is continuing to pursue some other sources in an attempt to make a determination and stated he has been contacted by a gentleman offering his own money to do a grand jury investigation.
Assemblyman Williams pointed out in 1987, the district went to the legislature and asked that library trustees be exempt from filing financial disclosure forms. However, this measure was killed at the end of the session.
Chairman Rawson reviewed the library district representative's suggested amendments with Assemblyman Williams. The chairman commenced with page 2, line 6, "the trustees may appoint an executive director for the consolidated library district who serves at the pleasure of the trustees." They would like to change the word "may" to "shall." Assemblyman Williams recognizes that the language is permissive, but does not have a concern with the change. He pointed out there are some people who feel the executive director should be a librarian, but the district disagrees with that. Assemblyman Williams said he does not have strong feelings about it either way.
Chairman Rawson asked Assemblyman Williams if there is an executive director, and if so, who does he serve? Assemblyman Williams stated there is an executive director who is an employee of the trustees, so it is his opinion the trustees could remove the executive director. The chairman asked Assemblyman Williams if he would have any problem changing the word to "shall," to which he replied no.
Chairman Rawson moved to line 16 of the amendment. Assemblyman Williams feels this language is to assure that the executive
director of their choice can be someone who is not necessarily a librarian. He agrees the director should have some experience.
The chairman continued on, moving to line 22, and the recommendation that the following language be struck, "the trustees of a consolidated library district shall not propose an issuance of bonds or any other form of indebtedness without the approval of the proposal by the board of county commissioners." The chairman thought Assemblyman Williams would want to retain the above language until the language on page 3, lines 8 - 12 is accepted. The amendment changes the word "approval" to "recommendation." They are asking that there be scrutiny, but not the ultimate authority. Assemblyman Williams stated he feels that particular word is the whole bill. He said the members of the assembly felt the same way, and the language currently in the bill is what was passed by the assembly.
Chairman Rawson pointed out the library representatives are recommending that lines 25, 26 and 27 be struck, "If the trustees appoint an executive director pursuant to subsection 6 of NRS, it is not required to comply with paragraph b of subsection 1 of NRS." It was agreed this language was redundant, as it has been covered.
Finally, the chairman stated they are asking the brackets be struck on line 44, which would allow them to keep a separate account established. Assemblyman Williams stated the tax commission has concerns about that particular language.
Senator Neal remarked that he was responsible for most of the language in the bill when serving as the chairman for human resources, which allowed the library district to have a separate account, and also allowed expansion of their district. As the library is not a governmental entity, such as a city or police department, the purpose of the bill was to establish funding for building and books. As there was not a system as is in place now, the legislators felt this was necessary in order to allow the library system to develop. Senator Neal stated he understands the request for changes, but wondered if the library is fulfilling its mission in terms of developing a library system for the citizens, as that was the primary purpose.
In response to Senator Neal, Assemblyman Williams stated in his opinion the library is not fulfilling its purpose. In reviewing the budget for the three libraries most recently built, two of the sites were allocated $100,000 for site art, while the third site, the west Las Vegas Library, received none. The two sites received $300,000 for furniture and the west Las Vegas site received nothing. The district told the west Las Vegas library administrator if he wanted money for funding, it should be taken out of the operating cost budget.
Assemblyman Williams pointed out the library district received donated land with a stipulation that a certain amount of site art be purchased from individuals who it was found are related to the same individuals who donated the land. The library district was offered a national person to talk to some of the artists who paint and produce some of the site art, and that person volunteered services for free. The library district refused and said they would rather spend the money, and in turn spent over $1 million. Assemblyman Williams commented that the discrepancies are so great it has allowed people to become selective and biased in many cases, and has left many situations unattended. He stated when the $80 million bond issue came before the citizenry in 1991, the district placed huge trailers on the property of the west Las Vegas property and paid staff to encourage people to vote for the bond, but did not include that particular facility in the bond. The library district contracted with KNPR radio for public service announcements (PSAs), at $25,000 per year, which libraries normally receive for free. The library district held a retreat at the Mt. Charleston Library. They did not stay overnight, and they own the facility, yet they paid the Dan Hart Associates a large fee for the retreat. The library district has a public relations department which contracts services out at $125 per hour, without allowing any other public relations firm to bid. The district recently hired Rakeman Plumbing for work at the Mission Center for $26,000 to repair several toilets, which once again was not put out for bid.
When he inquired, Assemblyman Williams was told the library district policy manual takes care of the employees. He asked the library director for a copy of their affirmative action plan, which he promised to deliver, but never did. When confronted at another time, the director said he did not have one. The director also advised the district has no ties to the Clark County policy, but when asked again for the affirmative action plan, the director said they use the one with the county. Clark County says they do not.
Senator Neal remarked the bill only permits the county commissioner to approve the budget. It does not establish any type of regulation to control the trustees. It was his understanding the trustees goal was to provide library facilities, resources and trained staff to meet the informational needs of all of the residents of the district. Senator Neal asked Assemblyman Williams if he was suggesting that is not being done. He noted there are two library facilities within his senatorial boundaries, which should be the same for Assemblyman Williams, and asked if there are problems with the other facility.
Assemblyman Williams clarified he can only quote those people he has talked with, those who deal with libraries, again as far away as Overton, Nevada. He suggested the discrepancies would be
recognized more readily if the budget was reviewed and approved by two entities.
Senator Neal pointed out there were no libraries being built in Clark County until the current mechanism was put in place, which allowed the board to pass bonds and collect taxes for funding. The senator stated in 1981 his committee put forth a bond issue for $20 million to build library facilities throughout the state, and since the population was growing so fast, this appeared to be the best mechanism, rather than tying it into the politics of the county and city to make a determination as to what the libraries should do, as they had not done anything. Senator Neal asked Assemblyman Williams what would be the result of passing this piece of legislation.
In reply to Senator Neal's question, Assemblyman Williams remarked that with this legislation, the taxpayers of Clark County would not have their tax dollars going into an entity which has no elected officials, no governmental review and no accountability. He acknowledged that this bill may not straighten out all the problems with the library. However, with $11.5 million from sales and property tax, coupled with the $80 million bond, there should be some accountability to the taxpayers as to the distribution of those sums. He pointed out after one library was built, the same construction company built a house for the director of the library district. Upon completion of the director's house in Mt. Charleston, the foreman for that particular job started working for the library district at the top of the salary scale.
Senator Neal addressed the approval language, which Assemblyman Williams previously stated was the heart of the bill. He questioned if that language should be used to determine the type of books the library should purchase. Assemblyman Williams agreed it probably could, and stressed for the first time 2 months ago the Las Vegas Clark County Library allowed the west Las Vegas Library to select the kinds of books they wanted. The main focus should be to allow the citizens input as to the type of books they want on the shelves.
Assemblyman Williams pointed out there is no language in the $80 million bond issue which speaks to building a museum. Yet, one has been built and the district is attempting to build another one 2 miles from the first museum.
Chairman Rawson acknowledged the lack of accountability, but also recognized that the library districts have been able to do some things that would not have happened without the mechanism which is currently in place. He asked Assemblyman Williams if he feels there is a prejudicial use of resources, has his community been left out, or has the whole community been left out. In other words, has the library district been selective, or is there a general problem with the process.
Assemblyman Williams stated he has a general problem, as well as a specific problem. The people of Overton and throughout Clark County have voiced strong opposition to the way things are currently being done in the library district.
Senator Brown asked Assemblyman Williams if he feels this bill would address the politicking which appears to take place within the library district. She said she was contacted by many people in her neighborhood who are upset that they did not receive the library promised and indicated they would probably never vote for another bond issue without some accountability.
Assemblyman Williams once again pointed out the large disparity on how things are done. When citizens in his community asked about types of books, the library district stated they did not know what types of books the people wanted. However, the Summerlin Library, which has not yet opened, is fully stocked with books and when asked how those books got there, the district replied they talked with folks and got an idea of what books they wanted in the library. The library district purchased all the tapes, records and CDs for KNPR radio and the director even tried to give one-fourth of the new building on Las Vegas Boulevard to KNPR. Assemblyman Williams indicated other nonprofit radio stations and community radio stations in other districts should at least get the opportunity to bid for contracts, such as the $25,000 for PSAs.
Carole A. Vilardo, Lobbyist, Nevada Taxpayers Association, stated she is particularly interested in the passage of this bill and totally supports what is proposed in the bill in section 3, page 2, which states, "the trustees of the consolidated library district shall not propose the issuance of bonds, or any other form of indebtedness without the approval of the proposal by the board of the county commissioners." She stated she has received phone calls from nonmembers looking for a place to call challenging the way the library district money is being spent. Ms. Vilardo found, when attempting to track this information, there is a hospital district, airport district, a library district, etc. When she called the county to pick up the budget detail for the library district, where the other budgets are kept, she was told it was not on file there, but was kept with the library district. She attempted to confirm something on the bond issue because the changes being made were different than the changes proposed to the citizens. Normally bonds, including an airport or hospital bond, must go to the GOBC to show that the bond is within the confines of the tax rate, the assessed value, etc., then to the school district, and lastly to the county commission for final approval. The library district
went to the General Obligation Bond Commission (GOBC) without any detail, and back to the library district.
Ms. Vilardo mentioned a second area of concern, which deals with the monetary expenditures. Libraries are complaining they have no money to purchase books, yet expensive art pieces and PSAs are purchased. She urged passage of the bill which would add a measure of accountability.
Senator Neal asked Ms. Vilardo what she meant by accountability. Ms. Vilardo responded, "accountability to the taxpayer." If a taxpayer approves a bond issue, there is an expectation the money is going to be used in a certain manner, such as a percentage for books, a percentage to build a library, a percentage to refurbish a library, etc. When the taxpayer sees the money is not being spent as expected, questions and complaints surface.
Senator Neal said he had not heard that particular complaint, but rather some commissioners complaining over the fact that certain big buildings are going up, called libraries, that they are not associated with.
Ms. Vilardo reiterated her involvement with this issue came about because individuals complained that although a bond issue just passed, the libraries claimed they had no money for books. Information regarding distribution of funds is not readily available to the public.
Senator Neal said he has no problem with that issue as long, as it does not interfere with the mission of the library. If there is a problem with debt service management, then the committee should deal with that particular problem.
Ms. Vilardo reiterated there should be an easier way to track expenditures.
Marvin Leavitt, Lobbyist, City of Las Vegas, indicated his support of A.B. 468 and stressed this does not speak to his criticism of the library and its operations. Currently, the city council has the opportunity to appoint or replace members of the library board, which provides on-the-spot accountability.
Chairman Rawson asked Mr. Leavitt if he had any concerns about making it a political process. Mr. Leavitt stated he feels the political process would make it easier for citizens to access what is happening in the district and it is his opinion an elected official has more accountability to the citizenry than an appointed official, who is one step away from the direct election process.
Chairman Rawson closed the hearing on A.B. 468 and opened the hearing on A.B. 444.
ASSEMBLY BILL 444: Makes various changes relating to hospitals. (BDR 40-606)
Paula Treat, Lobbyist, Desert Springs Hospital, testified A.B. 444 received no opposition testimony and passed unanimously through Assembly Committee on Ways and Means and the assembly floor. Ms. Treat stated the bill has two parts, and directed the committee to lines 10 through 14, page 1, which refers to patient billing, and the reflected charges. She explained this language will make the reflected charges the agreed rate in the contracts, versus all charges for services, which is very confusing for patients. It is hopeful this change will alleviate some of the misunderstandings and complaints and would affect all hospitals. Ms. Treat pointed out the second change appears on lines 37 through 44, page 3, which relates to the charge master. Desert Springs Hospital foresees possible financial difficulties due to the lack of a comprehensive managed care program, and a variety of other issues, and thus is asking for charge master flexibility, allowing up to a 4 percent rate increase.
Senator Neal asked why Desert Springs should be allowed to increase their charges by 4 percent simply because they do not have an obstetric or pediatric unit? Ms. Treat replied that Desert Springs Hospital anticipated the managed care program was going to be a more comprehensive package that would have made it a level playing field for all hospitals, which has not happened.
Senator Neal pointed out the requested 4 percent increase is in addition to the Consumer Price Index (Medical Care Component for All Urban Consumers) increase.
Chairman Rawson recognized that Desert Springs Hospital charges per stay are lower than the other big five hospitals, and even if they did increase their rates by 4 percent, they would still be less than the other hospitals. Senator Neal responded that Desert Springs Hospital is already allowed to increase their charge master by the Consumer Price Index (CPI), and this bill would then allow another 4 percent added to that figure.
Ms. Treat noted this would be the first time the charge master has had a change since the law restricting an increase was passed. Senator Neal read section 8, lines 22 through 36 of the bill, and indicated the CPI increase has been averaging about 8 percent to 9 percent per year. He stressed in addition to the CPI increase, Desert Springs Hospital is asking for an additional 4 percent increase.
Ms. Treat pointed out there can be no changes in the charge master without the director's approval. Chairman Rawson suggested there is another control on this increase. The bill merely lists the mechanism for the increase, and this can only come in to play if certain other things come about.
Vernon Manke, Health Care Financial Analysis Unit (HCFAU), stated the CPI increase allowable each year of the charge master freeze, for the year beginning July 1 1992, was 7.8 percent. Before May 1st of this year, the CPI increase allowable beginning July 1, 1993 is 6 percent. Mr. Manke asserted it is his understanding the requested 4 percent increase in this bill is in addition to CPI increase, but it is to compensate for the problem Desert Springs Hospital has with the provider tax.
In response to questioning by the chairman, Mr. Manke clarified his interpretation of the bill that if a major hospital does not have an obstetrical or pediatric unit, they may increase their rates up to 4 percent, and Desert Springs Hospital is the only hospital that qualifies. However, coupled with the CPI increase, that figure could amount to a 10 percent rate increase, and he did not know if it would have any bearing on what they did with Medicaid or Medicare otherwise.
Chairman Rawson pointed out Desert Springs Hospital did not end up with certain services, for whatever reasons, and the effort in this bill is to try not to penalize them because they do not have those services. Senator Neal remarked that as the Certificate of Need (CON) is no longer in existence, Desert Springs Hospital could get those services.
Christopher Thompson, Chief, Heath Care Financial Analysis Unit (HCFAU), noted the requested rate increase would apply to bill charges only, in addition to the CPI increase. Chairman Rawson pointed out a small percentage of the patients are on bill charges, whereas the majority of the patients are on contractual arrangements. Presumedly, 70 percent of the patients would not see an increase in their bill. Mr. Thompson agreed with that statement.
Senator Neal asked if the term bill charges is synonymous with charge master. Mr. Thompson stated that term would apply to all charges on the charge master. The senator reiterated any item on the charge master would first be raised by the CPI, and then an additional increase of 4 percent would be applied.
In response to questioning, Mr. Thompson stated if this bill passes, Desert Springs Hospital will be allowed to raise their bill charges up to 4 percent. Ms. Treat once again emphasized Desert
Springs Hospital has kept their prices lower than the other major hospitals.
Chairman Rawson closed the hearing on A.B. 444. The chairman remarked he would hold A.B. 468 over until Monday, at which time the committee would take action.
Chairman Rawson stated he has been asked by the front desk to pass a suspension of Senate Standing Rule 92. A discussion ensued and the chairman remarked it would still be his intention to give adequate notice when possible.
SENATOR GLOMB MOVED TO SUSPEND STANDING RULE 92.
SENATOR COFFIN SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS O'DONNELL AND TOWNSEND WERE ABSENT FOR THE VOTE.)
* * * * *
SENATOR COFFIN MOVED TO DO PASS A.B. 444.
SENATOR BROWN SECONDED THE MOTION.
THE MOTION CARRIED. (SENATOR NEAL VOTED NO. SENATORS O'DONNELL AND TOWNSEND WERE ABSENT FOR THE VOTE.)
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Chairman Rawson presented amendments to S.B. 447 for review by the committee prior to introduction on the floor.
SENATE BILL 447: Prohibits under certain circumstances surreptitious electronic surveillance on property of public school, on grounds of state facility or on campus of University in Community College System of Nevada. (BDR 34-1668)
Chairman Rawson opened the work session on S.B. 93.
SENATE BILL 93: Creates board to regulate cost of health care. (BDR 40-224)
Pepper Sturm, Research Analyst, testified regarding the potential fiscal impact of the proposed amendments to S.B. 93, referring to Attachment B of the work session document (Exhibit D). He stated he spoke with the insurance commissioner about sections 1 through 4 of the amendments, concerning enhancing the authority of the Commission for Hospital Patients. It was determined no additional staff would be required, and there would be no fiscal impact. Mr. Sturm stated with regard to sections 5 and 6 of the amendments, the cost of the two studies would be approximately $50,000 in contract money for the biennium.
Chairman Rawson clarified S.B. 93 relates to patient bills, and the ability to check the accuracy of patient charges, and gives the director the opportunity to investigate disputed charges and to fine for violations.
A discussion ensued between the chairman and bill requester Senator Neal regarding the bill's fiscal impact and directing the bill to the finance committee.
Patricia Morse Jarman, Executive Director, Commission for Hospital Patients, testified she is in agreement with the proposed amendments as they relate to the Commission for Hospital Patients.
In response to the chairman's question, Ms. Jarman stated she is an unclassified employee, appointed by the Commissioner of Insurance, with the approval of the Governor. Senator Neal noted Ms. Jarman is the lowest paid director in the state of Nevada.
SENATOR NEAL MOVED TO AMEND AND DO PASS S.B. 93.
SENATOR COFFIN SECONDED THE MOTION.
Senator Glomb asked for further clarification. In response to the senator's question, Chairman Rawson explained the amendments proposed by Pepper Sturm, as outlined in Attachment B of the work session document (Exhibit D), would replace sections 1 through 30 of the bill.
Senator Glomb asked if the new language deletes the board, and wondered how this new bill would work with S.B. 359, which is pending in senate finance.
SENATE BILL 359: Makes various changes relating to cost of health care. (BDR 57-1725)
Senator Neal stated the bill eliminates the board. The senator pointed out his motion does not expressly re-refer to finance, but suggested adding a recommendation that the finance committee consider an increase in salary for the director.
Senator Brown questioned the $1,000 fine for each violation of NRS 679B.500. Ms. Jarman pointed out as executive director she does not personally have the authority to fine an entity, but rather makes a recommendation based on a continued violation after notification of the error in charges.
There being no further discussion, a vote was taken.
THE MOTION CARRIED. (SENATORS O'DONNELL AND TOWNSEND WERE ABSENT FOR THE VOTE.)
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Chairman Rawson opened the hearing on S.B. 533.
SENATE BILL 533: Makes various changes in provisions governing admission to and hospitalization in mental health facilities and hospitals. (BDR 39-1490)
Chairman Rawson declared there are three sets of proposed amendments, one from Mental Hygiene and Mental Retardation Division (MH/MR) attachment C, one from the Office of Advocacy and Protection, attachment D, and one from Washoe Legal Services, attachment E of the work session document (Exhibit D).
Dr. Jerry Zadny, Administrator, MH/MR, stated after listening to the testimony previously taken on S.B. 533, language was drafted that better dovetails with the existing statute. He noted the purpose is to protect persons placed in psychiatric units involuntarily, to give them notice of their recourse to get out of that unit, and to penalize individuals who keep them in the unit unfairly. Mr. Zadny pointed out some of the provisions in the existing language are difficult to work with, such as the 15 minute notice, notice to anyone, etc. The idea behind the new amendments is to achieve the sponsor's purpose, in ways that apply to the private sector as well as the state agencies.
Cynthia Pyzel, Deputy Attorney General, MH/MR, referred to page 7, section 1 of attachment C (Exhibit D). She stated the language found to be confusing, the issue of whether the commission on mental health and mental retardation should be reviewing denials of rights in private sector facilities, was removed. Deletion of that language makes it clear the commission would have oversight authority of the private, as well as the public facilities, which is the intent.
Ms. Pyzel went on to section 2 of attachment C (Exhibit D), an amendment proposed to the unlawful acts section that defines abuse and neglect of clients in mental health facilities. There have been concerns and problems with respect to the definitions currently on the books and their vagueness, and the inability to go after staff found to be in violation.
In response to Senator Glomb's question, Ms. Pyzel stated the language defining abuse and neglect grafted into the Nevada statutes left several items out, making the definition confusing. The purpose of this amendment is to clarify that this language deals with abuses of power by employees over clients in the facilities.
Mr. Zadny stated the way the law currently reads, acts that could be felonies, if committed on the streets, are considered misdemeanors because they were perpetrated on a client in the facility. The new language says they are cumulative to any other penalty prescribed by law. The goal is to make the abuse less likely to occur and the punishment more severe.
Ms. Pyzel explained the new language defines neglect more clearly. Currently, the whole process is treated as abuse and neglect and the division wanted to clarify that these are two separate types of actions and omissions. In addition, there is a new section 3, attachment C (Exhibit D) which addresses the concern of keeping people against the rules and laws set forth by the legislature for admission and discharge in the facilities. This section makes it abundantly clear violation of this constitutes the act of false imprisonment.
Senator Brown asked if someone is involuntarily in lock up, would they still have to wait up to a week for a court to consider whether they should be in the unit, and would they still be billed if the court finds they should never have been locked up. Ms. Pyzel stated the proposed amendments have not made any substantive changes to the admission laws. After talking with Mr. Zadny, the district judges who preside over commitment hearings, and the Office of Protection and Advocacy, it is felt the protections existing in current laws are sufficient, and changing the time lines for the court hearings is inappropriate as the courts would not be able to accommodate all the things they have to do in terms of notifying individuals, performing the mandatory examinations, etc.
Mr. Zadny emphasized it is difficult to change the time lines from 14 days down to 7 days. He explained with these amendments there are a variety of things the physician and the facility must assert should they want to pursue involuntary commitment, and if they misrepresent when making those assertions, they are guilty of false imprisonment and can be prosecuted. The physician and the facility would be liable for the wrongful retention.
Senator Brown acknowledged that when the individual is released, the insurance company would still get charged and the individual would have lost a week, however, the individual could sue. Senator Brown asked what kind of proof an individual could provide after the fact that would substantiate he was not a danger and should not have been retained in the unit for the specified time.
Ms. Pyzel remarked there are a whole series of provisions set out in the statutes for allowing people access to telephones, attorneys, family members, etc. should they feel they are being held improperly. In addition, clinical judgment comes into play in terms of whether that person is in need of care and can be discharged.
Mr. Zadny pointed out section 4, attachment C, (Exhibit D) opens the door and makes it easier for individuals to leave a facility. He stressed there has to be a balance so if an individual is admitted on a voluntary basis and is found to be a danger to himself and others, the facility has a duty and the ability to retain that individual, as a practitioner is bound ethically. When a voluntary commitment goes to court to become a involuntary commitment, a psychiatrist, other than the psychiatrist making the original determination, takes a look at the individual for an evaluation.
Mr. Zadny explained the writ of habeas corpus is a remedy available, not only to the state agencies but also to the private individual, and would bring the individual back before the court for a fair and independent hearing. This is a mechanism to allow a person to get out of false imprisonment.
Chairman Rawson clarified the amendments provide the same safeguards a person would have if incarcerated, the right to contact an attorney or family member.
Ms. Pyzel pointed out in the current law the rights of patients apply to individuals in public as well as private facilities. However, the commitment procedures were different for the public and the private facilities. In the proposed amendments (Exhibit D), Ms. Pyzel stated she attempted to make the commitment procedures the same for private and public facilities.
In response to Senator Glomb's inquiry, Mr. Zadny explained MH/MR's proposed amendments (Exhibit D) would replace the existing language in S.B. 533. Ms. Pyzel continued with the review of the amendments through section 9 (Exhibit D).
Mr. Zadny commented on the amendments proposed by the Office of Protection and Advocacy (OPA), attachment D (Exhibit D). Mr. Zadny stated he objects to section 2, the 15 minute time intervals, which appears to be unrealistic and unworkable. He expressed no objection to section 3, which talks about setting up forms for use by a client to request release.
Mr. Zadny remarked section 4 is unreasonable, and not one he could support, purely as a matter of public policy. This section is asking hospitals to pay for attorneys fees, which would place a heavy burden on the facilities.
Mr. Zadny commented that section 5 is merely a housekeeping measure which extends protections.
Chairman Rawson asked Mr. Zadny if he would like to incorporate any of the suggested amendments or language from the Office of Protection and Advocacy, attachment D, or Washoe Legal Services, attachment E, to the proposals made by MH/MR. Mr. Zadny stated there are none he would like to add, but wished to go on record as objecting to section 6, subsections 5, 6 and 7, section 7, 10, 11 and 12 of POA's suggested amendments as shown in attachment D (Exhibit D).
Janice Pine, Lobbyist, Saint Mary's Regional Medical Center, asked for clarification that all references are not to just hospitals, but a public or private mental health facility. Chairman Rawson confirmed that understanding.
Ivan Ashleman, Lobbyist, Lake Mead Hospital Medical Center, suggested adding language to protect the physician and facility from liability for the release of a patient. He stressed there is a tremendous amount of case law in California where psychiatrists have been held responsible for the release of a patient who turned out to be a danger to the general public. The psychiatrist is required by law to act upon a patient's demand for release. He suggested adding language granting immunity to physicians and facilities from a third party suit.
SENATOR BROWN MOVED TO AMEND AND DO PASS S.B. 533.
SENATOR GLOMB SECONDED THE MOTION.
The chairman reiterated he would add language in section 4 to allow immunity from third party suits and would report the bill back to the committee for further review.
Senator Brown asked if someone is psychotic and dangerous, but admitted voluntarily, how can the facility hold that individual. Mr. Zadny advised in the public sector, the practice and policy is to immediately file an involuntary petition. The individual is put on emergency hold, advised they are no longer in the facility voluntarily, and a petition is filed. The facility has a duty to protect citizens as well as the general public from harm.
THE MOTION CARRIED. (SENATORS NEAL, O'DONNELL AND TOWNSEND WERE ABSENT FOR THE VOTE.)
* * * * *
There being no further business, the meeting was adjourned at 5:58 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
June 18, 1993
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