The Committee on Commerce and Labor was called to order at 4:00 p.m., on Wednesday, April 21, 1999. Chairman Barbara Buckley presided in Room 4100 of the Legislative Building, Carson City, Nevada. Exhibit A is the Agenda. Exhibit B is the Guest List. All Exhibits are available and on file at the Research Library of the Legislative Counsel Bureau.

COMMITTEE MEMBERS PRESENT:

Ms. Barbara Buckley, Chairman

Mr. Richard Perkins, Vice Chairman

Mr. Morse Arberry, Jr.

Mr. Bob Beers

Ms. Merle Berman

Mr. Joe Dini, Jr.

Mrs. Jan Evans

Mr. David Goldwater

Mr. David Humke

Mr. Dennis Nolan

Mr. David Parks

Mrs. Gene Segerblom

COMMITTEE MEMBERS ABSENT:

Ms. Chris Giunchigliani

Mr. Lynn Hettrick

GUEST LEGISLATORS PRESENT:

Senator Raymond C. Rawson, Senate District 6

STAFF MEMBERS PRESENT:

OTHERS PRESENT:

Senator Raymond D. Rawson, Senate District 6, introduced Senate Bill 7 that he had drafted. The bill allowed certification and training for phlebotomists. Handling blood and blood products could be dangerous and training was required for protection. National programs were established to train people but there were no certification programs in Nevada.

Dr. Beth Pitonzo, Program Director of Medical Laboratory Programs, Community College of Southern Nevada, spoke on behalf of Senate Bill 7. Approximately 70 students a year graduated from the phlebotomy program. A rigorous lecture and laboratory course as well as clinical experience was required of each student. National accreditation standards were met for the program. Successful students were eligible to take a national certification exam at the end of the program. In spite of national certification and completed education the only way a student could obtain a license to practice in Nevada was to spend an additional 6 months training and experience in a licensed laboratory. Neither the national certification nor the education received at the college was recognized by the State of Nevada. That limited employment opportunities upon graduation and did not encourage individuals to seek formal education.

Dr. Pitonzo said the bill sought to recognize the education attained and was consistent with other licensure requirements for other levels of laboratory personnel. The bill had the support of Las Vegas hospitals and reference laboratories. The bill positively affected the students and the patients who required health care. Individuals were encouraged to take the formal training for phlebotomy if the academic process was recognized, resulting in an increased quality of patient care of Nevada.

Chairman Buckley asked Dr. Pitonzo to define "waived test" for the committee.

Fred Hillerby representing Associated Pathologist’s Laboratories, replied that the Clinical Laboratory Improvement Act imposed federal controls over laboratory activities. Many tests were performed by individuals on themselves such as blood glucose, pregnancy, urine dip sticks, protime, hemoglobin and more than 25 other tests. The variety of those self-tests referred to as "waived tests" increased yearly. The Federal Government’s only concerns were that the tests were performed in accordance with the manufacturer’s instructions. The state continued to control the licensing of professional personnel who administered the various tests.

Chairman Buckley ascertained that under the terms of the amendment the individuals would be required to be licensed or obtain certification. She inquired about the standard training time for technicians.

Dr. Pitonzo replied each facility that trained phlebotomists on-site had to submit documentation that demonstrated required guidelines were met. The time required was 6 months.

Assemblyman Beers referred to past experiences regarding his concerns of applicability to three specific organizations that administered programs.

Dr. Pitonzo explained that the three specific agencies identified were the agencies that administered the certification exam and did not run the program. Any college could access the guidelines for taking the exam. The three agencies were named to be consistent with current Nevada law. The board of health had approved them as the certifying agencies and all offered phlebotomy certification exams.

Assemblywoman Evans inquired if there were other institutions in the state in addition to the Community College of Southern Nevada (CCSN) that offered or would offer the course mentioned.

Dr. Pitonzo replied there were two other community colleges that offered the phlebotomy program. She named Truckee Meadows and Western Nevada in collaboration with Carson Tahoe Hospital. However, it was not known if they followed national accreditation standards in their programs.

Mr. Hillerby referred to their proposed amendment and elaborated that it extended the courtesy of bedside testing privileges from the hospital setting to other areas such as homes when the patient was not able to leave home. Bedside testing facilitated a rapid diagnosis of the patient and immediate prescription of medications by the physician.

Assemblyman Nolan wondered about the health care situation in the rural areas. If there was no certified health care technician available to go to the home would the bill preclude others from assisting.

Mr. Hillerby answered currently the laboratory assistant could not leave the laboratory and go out to assist a person in their home. However, the amendment would make that possible provided the person was associated with a laboratory. A physician’s assistant could not do it because they were governed under federal and state laws unless they were associated with a laboratory.

Richard J. Panelli, Chief, Department of Human Resources Health Division, State of Nevada, provided additional information in (Exhibit C). Although regulations and a 6-month training program existed for laboratory assistants there were no specific guidelines for phlebotomists. The laboratory assistant category covered every person who worked in a laboratory, collected a specimen, prepared a specimen, or worked in a toxicology department. The state Board of Health considered the type of work a laboratory assistant would do. If the work was just phlebotomy the person would be taught to do the punctures, and during the rest of the 6-month time they would be merely observed. The requirements were not as demanding or extensive as Dr. Pitonzo indicated her class work would be.

Mr. Nolan mentioned that Corning Nichols, a large toxicology laboratory based out of California, authorized several locations to collect samples for various state and federal requirements. After the samples were procured they were packaged and sent to a laboratory out-of-state. He wondered if the bill affected that process or individuals currently involved in that work.

Mr. Panelli replied the bill would not affect them in any way. The collection of urine in any laboratory test, unless done through catheterization, was not regulated in the State of Nevada.

Chairman Buckley referred to the exhibit provided by Mr. Panelli and questioned the meaning of "Expands the group of individuals who can perform tests to laboratory assistant who have historically been excluded from performing laboratory tests."

Mr. Panelli clarified that under the Nevada statute the Board of Health established the regulations that governed the licensing criteria, duties, and minimum qualifications for personnel who worked in laboratories. Laboratory assistants had been specifically prohibited from performing any laboratory tests. The proposed legislation allowed laboratory assistants not currently allowed to perform tests be allowed to perform "waived tests." The Health Division did not have any objection to that but the current regulation needed modification to match the statute.

Chairman Buckley asked if there were concerns about laboratory assistants performing "waived tests."

Mr. Panelli replied there were no concerns as long as the rest of the articles in the bill were followed; the individuals were trained and competent, manufacturer’s instructions followed, and safety regulations that the state Board of Health had adopted were followed. The state Health Division believed that the change would enable individuals to receive care without traveling long distances to the laboratory.

Chairman Buckley questioned the proposed exclusion of all outpatient centers from the licensure requirements.

Mr. Panelli replied that every location or laboratory where tests were performed must be licensed. The bill precluded outpatient centers from obtaining a license and their business would be under the auspices of the licensed laboratory. Oversight would be of the main laboratory and the outpatient centers would be considered a branch or subunit. There were no issues from a health care position.

Chairman Buckley inquired whether the fiscal note had been brought up on the Senate side. She questioned the rationale of increased staff time to travel to a private residence when outpatient centers existed licensure free from the main facility.

Mr. Panelli clarified it would not require more staff time going to a private residence, but the additional board costs involved were travel costs to new permanent locations for laboratories. All laboratory locations were visited and new locations required additional visitations.

Mr. Hillerby added that increased fees were acceptable to the laboratories if required.

Chairman Buckley closed the public hearing on Senate Bill 7 and opened the hearing on Senate Bill 241.

Sharon Shaffer, Chairperson of the State Funeral Board, stated section 1 of the bill required a license for each funeral establishment. Section 2 of the bill prohibited a person from serving on the board for longer than two consecutive terms. Sections 3 and 4 of the bill clarified the educational requirements for a license to practice embalming and for registering as an apprentice embalmer. An applicant for a license to practice embalming or a person registering as an apprentice embalmer was required to have 2 years of instruction at an accredited college or university. The bill clarified that credits earned at an embalming college or school of mortuary science did not fill the requirement. Section 5 of the bill authorized certain persons to order cremation of a deceased person. All adult children acting jointly could order cremation under current regulations and that requirement had caused many problems. If the change was adopted that section would provide that the majority of the adult children of a deceased person could order cremation. If there were only two children both must agree. A written summary of S.B. 241 (Exhibit D) was provided for the committee. A proposed amendment was requested upon passage of the bill but was not requested in the senate.

Chairman Buckley invited questions from the committee.

Assemblyman Nolan inquired if there was a college or school of mortuary science in the State of Nevada.

Ms. Shaffer replied there was none.

Chairman Buckley said changing the effective date for passage and approval would be considered. She closed the public hearing on S.B. 241.

ASSEMBLYMAN DINI MOVED TO AMEND AND DO PASS S.B. 241.

ASSEMBLYMAN PARKS SECONDED THE MOTION WITH THE AMENDMENT TO CHANGE THE EFFECTIVE DATE TO PASSAGE AND

APPROVAL.

Mr. Beers asked if the bill required practicing funeral directors to return to school.

Robert Auer, Deputy Attorney General, responded it would not. Funeral directors originally were licensed under the law. Several legislative sessions ago the legislature amended the law so that the owners of funeral establishments would also be licensed as well as the funeral director who managed the establishments. Funeral directors desired to be in charge of more than one funeral establishment. The intent was to make the law clear that if the funeral director were licensed at more than one establishment then they would be responsible for anything that went wrong at that establishment. That applied to individuals who were already licensed funeral directors.

Chairman Buckley wanted to know if the credits received at the embalming college or school of mortuary science which were not applicable for academic credit would apply to new applicants or those already licensed. She inquired if there were any licensed individuals who held a license that would not be able to work because of the change in the requirements.

Mr. Auer replied the change reflected the original intent of the provisions. In the past individuals that attended mortuary college were only instructed in the technical art of embalming. The additional limitations would not prohibit anyone with a current license from working.

Ms. Shaffer elaborated, that in the past, if a manager of a funeral home left there was no one left to protect the clients. The responsibility was placed on the owner of the establishment when they were required to be licensed.

Chairman Buckley reminded the committee there was a motion on the floor.

MOTION CARRIED.

Mary E. Manna, Executive Secretary/Office Manager, of the Nevada State Board of Cosmetology supplied Exhibit E to the committee as she introduced herself and board member Kay Collins. No cosmetology schools were currently available in rural Nevada which prompted the introduction of the bill. Ms. Manna testified from the exhibit provided that the changes requested attempted to reduce costs. In an attempt to accommodate new residents it was suggested the National Exam be taken in Nevada. The final change requested a verbal checklist for new owners to open a cosmetology business. New businesses were the first to receive compliance inspections. That change allowed the staff to handle growth in a more efficient manner.

Chairman Buckley questioned the apprentice program and whether an acute need existed.

Ms. Manna replied that individuals who had not completed all required course work moved into rural areas and schools or colleges were not available to them. The board received many calls every week regarding the problem.

Assemblyman Beers asked what was the current licensing cosmetology fee.

Ms. Manna replied the examination fee was $70 for the exam and $15 for the application. The biannual licensing fee was $40 and reciprocity fee was $100. The new proposed cosmetologist apprentice fee would be $15 for the application and $100 for operator permit. The apprenticeship program for electrologist set the standards for the proposed fees. The fee was higher than the one charged a cosmetologist. The apprenticeship program proposed was comprised of a 3,600 hour program completed in 1 ½ to 2 years. During that time forms were provided to record hours. The costs covered would be printed forms, permits, application packets, and monitoring of the program along with routine compliance inspections. In 1985 the board requested the statewide apprenticeship program be eliminated because of abuses and inadequate training. The current request was in response to hardship in the rural counties and long distances individuals were required to travel to obtain the training.

Chairman Buckley closed the hearing on S.B. 13.

ASSEMBLYMAN DINI MOVED TO PASS SENATE BILL 7.

ASSEMBLYMAN PERKINS SECONDED THE MOTION.

MOTION CARRIED.

ASSEMBLYWOMAN BERMAN MOVED TO PUT S.B. 7 ON THE CONSENT

CALENDAR.

ASSEMBLYWOMAN SEGERBLOOM SECONDED THE MOTION.

MOTION CARRIED.

Chairman Buckley turned to the work session documents.

Vance Hughey presented a copy of the work session document for review (Exhibit F). No amendments were proposed to the bill.

Chairman Buckley said that there were no proposed amendments or controversy and no opposition to the bills.

ASSEMBLYMAN PERKINS MOVED TO DO PASS SENATE BILL 24.

ASSEMBLYWOMAN BERMAN SECONDED THE MOTION.

MOTION CARRIED.

ASSEMBLYMAN GOLDWATER MOVED TO PLACE IT ON THE CONSENT

CALENDAR.

ASSEMBLYMAN DINI SECONDED THE MOTION.

MOTION CARRIED.

ASSEMBLYMAN GOLDWATER MOVED TO DO PASS S.B. 99.

ASSEMBLYWOMAN BERMAN SECONDED THE MOTION.

MOTION CARRIED.

ASSEMBLYMAN DINI SECONDED THE MOTION.

MOTION CARRIED.

Vance Hughey reviewed the bill for the committee.

ASSEMBLYMAN GOLDWATER MOVED TO DO PASS S.B. 100.

ASSEMBLYMAN BEERS MOVED TO DO PASS S.B. 100.

ASSEMBLYMAN DINI SECONDED THE MOTION.

MOTION CARRIED.

ASSEMBLYMAN GOLDWATER MOVED TO PLACE ON CONSENT

CALENDAR.

ASSEMBLYMAN NOLAN SECONDED THE MOTION.

MOTION CARRIED.

Chairman Buckley adjourned the committee meeting at 5:00 p.m.

RESPECTFULLY SUBMITTED:

Cleone Bujalski,

Committee Secretary

APPROVED BY:

Assemblywoman Barbara Buckley, Chairman

DATE: