The Committee on Health and Human Services was called to order at 1:35 p.m., on Wednesday, February 10, 1999. Chairman Vivian Freeman presided in Room 3138 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:

Mrs. Vivian Freeman, Chairman

Mrs. Ellen Koivisto, Vice Chairman

Ms. Sharron Angle

Ms. Merle Berman

Ms. Barbara Buckley

Ms. Dawn Gibbons

Ms. Sheila Leslie

Ms. Kathy McClain

Mr. Kelly Thomas

Ms. Kathy Von Tobel

Mr. Wendell Williams

COMMITTEE MEMBERS ABSENT:

Mr. Mark Manendo

GUEST LEGISLATORS PRESENT:

Assemblywoman Jan Evans

STAFF MEMBERS PRESENT:

OTHERS PRESENT:

H. Jill Smith, Esq., Advocacy Director, Nevada Disability Advocacy and Law Center (NDAL)

Joy Sawyer, NDAL

May Shelton, Director, Washoe County Department of Social Services

Ben Graham, Nevada District Attorney’s Association (NDAA)

Carlos Brandenburg, Ph.D., Administrator, Nevada Department of Human Resources, Division of Mental Hygiene and Mental Retardation

Cynthia A. Pyzel, State of Nevada, Senior Deputy Attorney General, Human Resources Division

Nile Carson, Deputy Chief, Reno Police Department

Chris Ferrari, Legislative Liaison, State of Nevada, Governor’s Office

Stan Olsen, Lieutenant, Las Vegas Metropolitan Police Department

Brian Lahren, Ph.D., Executive Director, Washoe Association for Retarded Citizens (WARC)

Richard Siegel, Vice President, ACLU of Nevada

Alan E. Fruzzetti, Ph.D., Assistant Professor of Psychology, UNR

Following roll call, Chairman Freeman opened the work session on A.B. 68.

Chairman Freeman asked Assemblywoman Jan Evans to discuss her bill, A.B. 68.

Assemblywoman Jan Evans identified herself as representing Assembly District 30. She explained A.B. 68 was a part of Nevada Revised Statutes (NRS) 432B, Protection of Children from Abuse and Neglect, which related to the presumption of immunity from civil or criminal liability. The legislature had taken steps to protect children from child abuse and neglect, including the availability of medical and hospital records to aid in the investigation and adjudication of abuse and neglect cases. To assure the availability of vital information to the people charged with protecting children, immunity had been granted to the medical profession for providing information to the law enforcement community. She stated further that, until recently, the flow of information in nearly every part of the state had been good. With new hospital administrators, attorneys, and new technology, some medical records were withheld in fear of potential civil lawsuits. A.B. 68 intended to reopen the issue of the availability of information long provided by updating the terminology and clarifying that release of records to investigate child abuse and neglect continued to be a high priority in Nevada. In essence, A.B. 68 was an extension of what was already codified in the Nevada Revised Statutes (NRS), and was intended to further assist the investigation and prosecution of perpetrators of child abuse and neglect.

Ben Graham, representing the Nevada District Attorney’s Association, reiterated the purpose of A.B. 68 was basically a technology updating. Although documents could be obtained through a grand jury subpoena or a search warrant, that was a protracted process which slowed the system down.

A.B. 68 provided a more efficient way to obtain needed documents and ensures the hospital’s immunity continued. Page 1 of the bill, in effect, expanded the immunity pursuant to NRS 432B.270 to cover any tests, records, or copies of tests provided to protective services or to law enforcement investigating those events. He added frequently the events were called to the attention of Children’s Protective Services by the medical profession. Certified copies of those records were obtained to assure their validity if a matter did go to trial. Further updating of A.B. 68, line 26, covered "X-rays or the performance of any medical tests" Line 33, "records of any medical tests performed or any medical records relating to the examination or treatment of a child and added, specifically, the prosecuting attorney’s office among those to receive such records or copies thereof. Further, in line 39, that each "photograph, X-ray, result of a medical test or other medical record be accompanied by a statement or certificate signed by the custodian of medical records" that those were true and accurate. Page 3 of A.B. 68 reiterated "medical test." Mr. Graham stated the passage of A.B. 68 would clarify the issue for the future.

Chairman Freeman asked why the language of the bill referred only to a medical test not to a medical exam, as they were quite different.

Assemblywoman Evans responded there was a need to distinguish between medical test which, typically, was specific and medical exam, a more comprehensive procedure. One of the reasons for that addition to NRS was because when investigators asked for results on those newer procedures some medical providers had not or would not provide those results because they were not specifically mentioned in statute. Ms. Evans recommended legal interpretation on the question of exam versus test.

Chairman Freeman stated the bill language needed to be accurate. For example, on lines 24-25, the investigator "could cause X-ray or medical test." Would that include an exam.

Mr. Graham responded that on page 2, lines 34-35, the language stated "or any medical records relating to the examination or treatment of a child pursuant to this section."

Chairman Freeman asked if that covered the question. Mr. Graham responded he believed it did; however, would make a telephone call for legal clarification and report back before the meeting ended.

May Shelton, Director, Washoe County Social Services, testified in support of A.B. 68. She stated she had been given authorization by Adrian Cox, Deputy Director, Clark County Family and Youth Services, to advise the Health and Human Services Committee they also supported the bill. Ms. Shelton added she would like to see test distinguished from examination and would be in favor further clarification.

Niles Carson, Deputy Chief, Reno Police Department, stated he supported A.B. 68.

Chairman Freeman temporarily closed the discussion on A.B. 68 and opened the work session on A.B. 140.

Chairman Freeman stated A.B. 140 and two other bills (A.B. 141 and A.C.R. 11, which followed on the agenda) was the result of an interim committee on outpatient civil commitment for the mentally ill, which she chaired. She asked Marla Williams to summarize the concepts dealt with by that committee.

Marla Williams, identified herself as Committee Policy Analyst, Health and Human Services Committee. She stated the Sixty-Ninth Session of the Nevada Legislature adopted S.C.R. 60 directing the Legislative Commission to study that issue. Outpatient civil commitment was a concept that required mentally ill patients to comply with a community-based program to avoid commitment to an institution. Treatment was usually characterized by short, recurring visits to a mental health clinic which provided treatment such as medication, individual or group therapy, day or part-day activities, or supervision of living arrangements. Nine legislators served on the committee who held five meetings including a work session, and the committee received extensive expert and public testimony regarding the mentally ill and available programs and services for that population. Additionally, the committee reviewed various laws and outpatient treatment programs in other states, as well as considered the results of prominent research on the subject. Although the committee did not adopt, or recommend the adoption of, a program of outpatient civil commitment for the mentally ill, the committee did make other recommendations relative to the mentally ill population in Nevada. In particular, the committee looked at ways to better serve mentally ill individuals living in the community and responded to family member concerns on how to best care and treat that population.

Ms. Williams further stated during the course of the hearings on outpatient civil commitment it became evident and clear to members on the committee that issues and concerns surrounding mental health were very complicated. They dealt with a variety of topics and the mental health system in general. Because the committee was not able to give many mental health-related topics the attention they deserved in that study, which was specific to one topic, they had adopted a recommendation for an interim study to look at the entire mental health system. Other items in the report, included supporting the expansion of community-based outpatient programs and exploring the possibility of establishing a mobile medication unit to assist non-institutionalized mentally ill individuals with their medication requirements. Further, it encouraged agencies that worked with children to develop training programs regarding mental illness and its warning signs.

Ms. Williams stated subcommittee members determined that Nevada was not yet ready for, or needed an outpatient civil commitment program, but it was decided the State of Nevada could continue to refine and improve upon its services to the mentally ill.

Ms. Williams then provided an introduction to each bill:

A.B. 140 addressed involuntary commitment proceedings and was recommended by Rosetta Johnson, President, Alliance for the Mentally Ill of the State of Nevada, and the mother of a mentally ill son. (Exhibit C).

Her written testimony stated, in part, family members were often frustrated when dealing with the mental health system, specifically in terms of making decisions, especially those that involved hospitalization. The decision to hospitalize was often based on a series of events rather than an isolated incident. She explained past as well as present behavior represented the mental health of an alleged mentally ill individual. The committee acknowledged her concerns and voted to recommend legislation that considered past mentally ill behavior at involuntary commitment proceedings, in addition to reviewing the incident at hand. It further agreed that the inclusion of past behavior in those proceedings could assist in establishing patterns of behavior and provided a better overall assessment of the mentally ill individual.

Chairman Freeman stated the interim committee met at the request of Assemblywoman Guinchigliani who had a bill last session, and Senator Reagan, who had concerns with the mental health system mainly in Las Vegas.

Carlos Brandenburg, Ph.D., Administrator, Division of Mental Hygiene and Mental Retardation, Department of Human Resources, testified in support of A.B. 140. He stated the bill developed as a result of family members and consumers who felt the courts had not considered the testimony of past behavior of the mentally ill. Dr. Brandenburg indicated he had spoken with Judge Scott Jordan who had assured him the Family Court in Washoe County was considering past behavior and he did not have a problem with the language being included in A.B. 140.

Richard Siegel identified himself as Vice President, American Civil Liberties Union (ACLU), of Nevada, and Professor of Political Science at University of Nevada, Reno (UNR). He was joined by Alan E. Fruzzetti, Ph.D.

Dr. Fruzzetti identified himself as Assistant Professor of Psychology, University of Nevada, Reno (UNR).

Dr. Siegel stated the language could be read as narrowing, but it was an interesting and confusing relationship because "we had all relevant testimony, and now we have a specific statement." The specific statement was inevitably clearer and preferred by the ACLU. He stated he could not feel the problem had been solved because testimony probative of the question would be included with testimony that was not probative to the question. In essence, his position was that was better than saying all relevant testimony, but it was not the ideal language, and would still allow testimony that would be heard by the presiding person and probably should be heard.

Assemblywoman Leslie asked Dr. Siegel what language he would suggest. He responded he was then unable to suggest language, however would like the opportunity to consult with others and perhaps develop more appropriate language. Although he allowed the language might be the best that could be found, but there was inherent ambiguity in what was being done.

Chairman Freeman stated they could offer an amendment, but it appeared Dr. Siegel and the ACLU were not ready.

H. Jill Smith identified herself as Advocacy Director, Nevada Disability Advocacy and Law Center (NDALC). Ms. Smith prefaced her testimony with the statement that NDALC was a nonprofit agency that offered comment and technical assistance on the legality of issues, but did not urge passage or non-passage of any bill.

Regarding who may be heard at a commitment hearing, Ms. Smith stated the commitment courts now had the discretion to consider relevant probative testimony in making determinations. Caution should be emphasized in allowing, by statute amendment individuals not subject to cross examination to testify as the usual procedural due process rights were not in place. She felt it was "treacherous" to mandate by statute, testimony that might not be relevant and could be hearsay. Also, the testimony as proposed in the statute indicated "any behavior," not just behavior related to mental illness. Most family members testified honestly and with relevant information they believed would help their loved one obtain appropriate treatment. However, in other instances, where the loved one had been placed in a facility by, for example, a district attorney's petition in the process of a divorce proceeding, or as leverage in a custody battle, abuses had occurred. Other possible scenarios included behavior with which other individuals might not have agreed, such as alternate lifestyles, past criminal or alleged criminal behavior. She stated the courts should be allowed to retain the discretion they already had under the current statute to hear what was deemed relevant testimony, and not be forced by statute to allow all testimony, no matter how outdated or erroneous. It was not necessary to open by statute an opportunity for abuse when the discretion was already there and the statute, as proposed, did not require amendment.

Chairman Freeman asked for a motion on A.B. 140, with no amendment.

ASSEMBLYWOMAN LESLIE MOVED TO DO PASS.

THE MOTION WAS SECONDED BY VICE-CHAIRMAN KOIVISTO.

MOTION CARRIED. FOR THE RECORD, ASSEMBLYWOMAN ANGLE

WAS OPPOSED.

Chairman Freeman opened the work session on A.B. 141.

Carlos Brandenburg, Ph.D., Administrator, Division of Mental Hygiene and Mental Retardation (MHMR), testified in support of A.B. 141 with the request that the committee improve the language in subsection 5. He felt the administrative officer should not be the one who made the decision. He suggested language be included that pertained to NRS 433A.250; that a decision was made by the evaluation team of which at least one member was the physician or psychiatrist, thus making it a clinical decision. He emphasized he wanted language that indicated such a decision had to be triaged through the administrative officer.

He stated further, on page 2, line 17, of A.B. 141, the language "detrimental to the public welfare" was vague. He added, judges who were committing individuals to the mental health system were uncomfortable with a vague statute such as that. He recommended the insertion of the language in NRS 433A.115 which outlined the mentally ill criteria.

Cynthia A. Pyzel, for the record, identified herself as Senior Deputy Attorney General for Mental Hygiene and Mental Retardation. She testified at issue was the concept of bringing someone back into the hospital that had already been civilly committed. It was currently referred to as "convalescent leave." She requested the Health and Human Services Committee consider the specific language, because there was some confusion in the statute as reference was also made to conditional leave and unconditional leave. She felt it would be of assistance to the general improvement of the law and actual practice in the field, to have consistency in the use of the term conditional leave or convalescent leave. Ms. Pyzel recommended one term be eliminated and the other term be used exclusively.

She further stated a provision existed for a person to be brought back in while on their overlying civil commitment; those commitments lasted up to 6 months at which point they "evaporate" unless another legal provision to civilly commit was begun. If, during that 6 months, the person was well enough to be discharged from the hospital, he was discharged. That provided for a continuing hold over that person; to have them brought back in if they were de-compensating during that time, eliminating the need to bring them through the whole civil commitment process again. The concern was, when bringing someone from the community back in to the hospital, was it was being done for the right reasons; because that person really needed the care. Exercising the authority given under that civil commitment provision was for the benefit of the patient and the community. As an additional safeguard, to protect the rights of the mentally ill in the hospital setting, a provision was added for bringing that person before the judge at the next judicial date the commitment hearing was held. At that time, an explanation and justification would be given and a determination made as to whether it was appropriate.

Ms. Pyzel stated, as the law now read, when discharging someone from the hospital who had been civilly committed, it was necessary to petition the court to "extend convalescent leave." If that was not done within 10 days of the discharge, the commitment ceased. That mechanism was thought to afford more security for providing treatment during that time and not to allow the inadvertent lapse of commitments and the inability to bring someone back in and help them without having another full blown hearing.

Chairman Freeman stated she had received a letter from Judge Jordan in support of the bill (Exhibit D). She added Judge Jordan was a Family Court judge in Washoe County, whose court she had visited in the Mental Health Institute in Sparks, and found very interesting. She stated, "we needed to give our judges the flexibility they need to allow the best services possible to the public."

Dr. Siegel, ACLU and UNR, reiterated Dr. Brandenburg's statement regarding page 2, line 11, of A.B. 141, concerning the evaluation team, and the medical people being at the heart of any recommendation. He stated his strong opposition to the phrase "detrimental to public welfare" as being hopelessly vague. He wanted to see the criteria spelled out, no broader than it was in the language that brought people to involuntary commitment initially.

Dr. Fruzzetti, UNR, added his support to narrowing the scope of the wording "detrimental to the public welfare" to the mentally ill definition as stated in NRS 433A.115, or even more narrowly defined as "dangerous to self or other" as being a necessary condition for involuntary commitment.

H. Jill Smith, NDALC, stated passage of the proposed bill would subject persons who had been involuntarily civilly committed to a mental health facility to being placed on convalescent leave or conditional leave for a period which could be as long as 6 months. The language was vague, therefore, it was uncertain how long that leave would be, even when such individual did not meet statutory commitment criteria of danger to self or others. The discretion to extend convalescent leave as deemed necessary was already provided to the court under the current statute. NRS 433A.390 provided the release of an involuntarily court-admitted client pursuant to subsection 2, became unconditional 10 days after the release, unless the admitting court within that period issued an order providing otherwise. The exact language changed by the current bill was the same language deliberated over and inserted into the statute last session. She added it was not necessary to change it again in order to obtain the release sought by the bill's proponents. It was clear from the new language inserted during the last legislative session the legislature specifically granted to the judiciary the discretion to extend the length of time an individual would remain on convalescent leave status, if the facts and circumstances of the individual's psychiatric condition warranted such extension. (Exhibit E.)

Ms. Smith further stated the Administrator of the Division of Mental Health and Mental Retardation had stated the changes sought made it easier for the hospitals administratively, and not because an individual's psychiatric condition warranted such an infringement. Administrative convenience was not a justifiable rationale for a manifest curtailment of individual liberty. The requirements of due process mandated a hearing be held and legal determination made under the specific facts and circumstances of an individual case in order to extend the convalescent leave. Passage of the proposed bill would serve to make automatic the extensions of such convalescent leave. An action meant to be considered on a case-by-case basis.

Ms. Smith concurred with Dr. Brandenburg and with Dr. Siegel about the vagueness of the language identified in section 5, page 2, of A.B. 141, and indicated prima facia agreement that NRS 433A.250 would be a good place to amend that language.

Chairman Freeman asked if Ms. Smith had read the letter from Judge Jordan. She responded she had not read it. Chairman Freeman provided her with a copy which she then read. After reading that letter, Ms. Smith stated she understood the objection and was prepared to address it.

A lengthy discussion ensued. Chairman Freeman and Assemblywoman Buckley expressed confusion regarding Ms. Smith's testimony. Ms. Smith re-stated much of that testimony.

Assemblywoman Buckley stated the current law allowed that conditional release program. The proposed language on page 2 of A.B. 141 provided the mechanism for the state to order someone returned under the conditional release program. Also, the manner in which it was done, i.e., 3 days written notice, and the companion provisions of NRS 433A which required notice and an opportunity to be heard before someone's liberty were deprived, also applied.

Ms. Smith responded in the last legislative session, in A.B. 375, language regarding the unconditional release had been inserted into the statute. NDALC believed that provided appropriate protection and still served the interest of the proponents of the bill, and allowed discretion to remain with the court. It did not impede the court's discretion to extend convalescent leave if the facts and circumstances warranted the extension.

Ms. Buckley stated Ms. Smith's position was still unclear. Ms. Smith responded the discretion already lay with the court pursuant to the language of the statute. That by inserting the 6 month language it would become the rule rather than the exception; it became more automatic.

Chairman Freeman stated she chaired the interim committee. Arguments before that committee had been made, and the language had been agreed upon at that time. She stated the time had come to vote on those bills (A.B. 140, A.B. 141, and A.C.R. 11), with amendments to A.B. 141 and A.C.R.11.

Ms. Smith recalled A.C.R. 60 had authorized a study by the interim committee on outpatient civil commitment, on which extensive testimony had been presented. In the process of those hearings, a compromise was reached that outpatient civil commitment would not be offered and instead the convalescent leave statute change would be offered. Those negotiations had not included NDALC, Ms. Smith advised, and given the opportunity to testify at those hearings she would have. She stated she was a member of the Nevada Mental Health Coalition (NMHC), chaired by Assemblywoman Leslie and Dr. Brian Lahren, and during discussions by that group, it had been decided there would be disagreement about recommendations to the Health and Human Services Committee. At that time, Assemblywoman Leslie had said Ms. Smith would have an opportunity to address that specific issue to the committee. She apologized for the absence of testimony that should have been given. In essence, she stated the proposed change was one that would not make a difference except to those who had to live under it.

Assemblywoman Leslie stated she tried to keep her personal work out of the Health and Human Services Committee; however, because Ms. Smith had brought it up, she would comment. The NMHC had offered the compromise position in April 1998, at which hearing Dr. Siegel, Rosetta Johnson, Ernie Neilson and Brian Lahren had represented the coalition. NDALC had been a member of the coalition, but Ms. Smith, who had been in the Las Vegas office, had not been involved at that time in that discussion. NDALC had met with Dr. Brandenburg, Washoe Association for Retarded Citizens (WARC), to work out their differences but it had not been accomplished. For that reason, NMHC had taken the prior stand, but had not followed up and taken a stand after that. In essence, it was one of those issues they were not going to agree on and Ms. Smith was free to state her position. For that reason too, NMHC had not been represented at the Health and Human Services Committee meeting.

Chairman Freeman stated that because the interim committee had voted unanimously in favor of these bills, we should proceed to vote.

Assemblywoman Gibbons asked if under A.B. 140, a person could testify and intentionally hurt someone with falsified information. Chairman Freeman responded based on information from legal representatives there did not appear to be a need for concern.

Cynthia Pyzel, Senior Attorney General for Mental Hygiene and Mental Retardation, offered to clarify the confusion. She stated with respect to A.B. 140, there were already safeguards provided. At the time a person went forward in a civil commitment hearing, the two independent examining doctors were present and were cross examined by both the district attorney and the public defender. Witnesses were also subjected to cross examination. That was the traditional method used by the court system to ferret out what was true and what was false. The other provision not highlighted in the testimony was the language itself was limited to talking about the present condition of the person at that moment in time, which justified putting a civil commitment hold on them. For those reasons, there already were inherent provisions that would not be obvious simply on a reading of that bill that helped to alleviate the concerns. Further, there were judges who were exposed to people who did not like each other in their courts. Family court judges presided over civil commitment laws by statute; they were the courts of original jurisdiction for those hearings. Also present would be the public defender, the district attorney, private counsel if retained, and NDALC who could interject itself when it felt appropriate.

Assemblywoman Gibbons wondered if, under the present statutes (NRS 433A.270, 433A.290) those safeguards were provided, could falsified testimony of family members be presented ex parte. Ms. Pyzel responded the context in which it would happen was a scenario where family members came into a hearing and stood up and said, "Your Honor, I have some information that would be of assistance to the court." They were essentially volunteer witnesses and the courts would routinely hear that.

Ms. Gibbons remarked it was necessary to vigorously safeguard the rights of the mentally ill in those proceedings. However, if they had written notice, a right to a hearing, a right to counsel, a right to cross examination, what then was the problem.

Dr. Brian Lahren, Executive Director, Washoe Association for Retarded Citizens (WARC), provided background on the discussions referred to by Assemblywoman Leslie, which had occurred in the context of the Nevada Mental Health Coalition. Specifically, it was understandable why the Division of MHMR wanted the amendment the Health and Human Services Committee had before them. For one reason, because they typically served the most severely disabled and most persistently mentally ill individuals in the State of Nevada. However, within the broader context of individuals who needed mental health services, were people who were situationally stressed, temporarily mentally ill, those who had experienced first-time bi-polar disorder or bio-chemical disorder and with proper medication were no longer a problem. There had been some instances of abuse reported of people being held inordinately under extended commitment statute and their insurance resources drained, or family members conflicted who had used the procedure to benefit themselves in the absence of the individual incarcerated. Thus, the 10-day limit had been provided in part to serve that larger fraction of the population. The most severely disabled part of the population consisted of a fraction of the total incidents of mental illness: they were just the most persistent, most expensive and most difficult. The larger fraction often had single incidences of mental health problems, were treated appropriately and effectively and upon discharge were often able to go about their lives with no further episodes. The idea the larger population could be protected by a shorter duration of commitment was the idea which brought the legislation forward. He added it was important to be specific which part of the population was being discussed, it had always confused the discussions, because it was possible to be on both sides of that issue depending on who was being discussed and what protection was sought.

Chairman Freeman commented on the difficulty in grasping the mental health issue unless one was involved with it on a daily basis but, because it so devastated the families of the mentally ill and those in the system, they had to be sure they did the right thing.

Chairman Freeman asked Cynthia Pyzel to work with Dr. Brandenburg and anyone else who was interested, on an amendment to A.B. 141, and to get it back to the committee as soon as possible because of the limited time frame.

Mrs. Freeman closed the discussion on A.B. 141 and opened the work session on A.C.R. 11.

Assembly Concurrent Resolution 11: Directs Legislative Commission to appoint interim committee to continue review and evaluation of services and treatment provided to mentally ill persons in this state. (BDR R-170)

Carlos Brandenburg, Ph.D., Administrator, Division of Mental Hygiene and Mental Retardation, testified in support of A.C.R. 11, to appoint an interim committee on mental health, with the following recommendations: (1) consider the mental health laws that already existed, which he described as "basically a patchwork of laws" that were antiquated and needed to be revised, and (2) review the mental health system in terms of children and adolescents.

Dr. Siegel, ACLU and UNR, supported the study proposed by A.C.R. 11. He had reviewed the history of mental health appropriations in Nevada for the Nevada Public Affairs Review, assisted by Brian Lahren, Washoe Association for Retarded Citizens and found, "we are in a very positive direction again." He stated the executive budget had indicated a significant increase for mental health. However, there was a huge gap between program needs outlined in writings on the subject and where "we still have to be." He reiterated Dr. Branderburg's statement the laws had come in a "patchwork" way and it would be a sound idea to review them. He stated the importance of the interim committee; it was important not simply to pass the legislation but to fight for that to be one of the interim studies. In his review of Nevada public policy, higher education had led the way in terms of advancement over the last 15 years. Mental Health was in a position to make some very prominent progress.

Brian Lahren, Ph.D., stated he also represented the Truckee Meadows Human Services Association (TMHSA), and was a member of the Nevada Mental Health Coalition (NMHC). Dr. Lahren testified in support of A.C.R. 11, stating it was very important to re-institute an interim study committee on mental health. Some of the greatest progress made in the state came from the two interim study committees which followed the 1995 and 1997 Legislative Sessions.

He stated, however, expanding the scope would achieve a significant effect. Mental health services in the state had been carved apart over time, and one of the most difficult and probably least well-served areas had been child and adolescent mental health issues. He would like the Health and Human Services Committee to encompass those various elements of mental health services under the scrutiny of that committee. To bring about a vision for the future that addressed the issues raised here, as well as how comprehensively mental health issues needed to be addressed. Child and adolescent mental health services, he stated, had languished over the past three or four legislative sessions and as a result the services were horribly inadequate.

Dr. Lahren went on to explain mental retardation also had not been reviewed for 11 years and many of the same issues and motivations that had prompted the request for the interim study committee applied to the mental retardation services. Population growth, standards of care, and many of the programs instituted 10 years ago had reached maturity and a clearer vision for the future was needed. Some of the programs instituted had never been fully funded or appropriately developed, and some of the aspects of care would not produce maximum positive results without further legislative support. He would like to see legislators more intimately familiar with the details of service in those areas. He recommended the services of the division and those other service areas, like child and adolescent mental health, even drug and alcohol abuse, be looked at, as all were related in the treatment of people with mental illness and mental retardation.

Chairman Freeman stated she had seen a bill draft submitted by Assemblywoman Jan Evans that addressed some of those issues. She added she also had questions about how those concerns had been handled.

Assemblywoman Berman thanked Dr. Lahren for raising those concerns and stressed the need to address adolescent suicide, for which there had been no support program. Dr. Lahren concurred and stated it was absolutely essential that pro-active dollars be directed to child and adolescent mental health, because the State of Nevada had the highest rate of suicide in the nation. He added, money spent early on in the course of mental illness was well spent; it reduced costs later on. "If we truly care about how we did things in this state we would do them in the most cost-efficient and effective way, and the way that would be the least obtrusive in people's lives."

Chairman Freeman stated amendments were needed in regard to evaluating criteria that determined if a person was mentally ill, and also there had been comments the mental health statutes be reviewed.

Assemblywoman Buckley recommended it be passed with amendments to add to the areas to be studied, namely, children's and adolescent's mental health issues, mental retardation programs, improvements and assessment of the existing programs and an examination made of mental health statutes.

Chairman Freeman asked about funding. She added because it was so important should the committee ask the commission to do part of the study. Ms. Buckley concurred it was important, and if it were passed would go on to the Committee on Elections, Procedures and Ethics and the Health and Human Services Committee would make its wishes be known in terms of priority.

ASSEMBLYWOMAN BUCKLEY MOVED TO AMEND AND DO PASS.

THE MOTION WAS SECONDED BY ASSEMBLYWOMAN BERMAN.

THE MOTION CARRIED. ASSEMBLYWOMAN ANGLE OPPOSED.

Assemblywoman Gibbons thanked Chairman Freeman for her hard work on that issue.

Chairman Freeman re-opened the work session on A.B. 68.

Ben Graham, Nevada District Attorney's Association stated he had contacted Chief Deputy Vicki Monroe, Crimes Against Women and Children Division, and had reviewed the bill with her. It was believed the language in reference to "examination" and/or "test" was adequate and on that basis urged a do pass.

Chairman Freeman stated no amendments had been offered to that bill and it could therefore go for a vote.

ASSEMBLYWOMAN LESLIE MOVED TO DO PASS.

THE MOTION WAS SECONDED BY ASSEMBLYWOMAN GIBBONS.

MOTION CARRIED UNANIMOUSLY.

Assemblywoman Buckley asked Chairman Freeman, as chair of the interim committee, for clarification on the committee's decision or recommendation on the District Attorney's petition of 2 years ago regarding involuntary commitment without notice by family members.

Chairman Freeman stated because of the civil rights ramifications and other factors, it had been a hot issue in Reno at that time. It was something the interim committee had taken under serious consideration. She added she had received a report and would be happy to discuss it with Ms. Buckley.

With no further testimony forthcoming, Chairman Freeman adjourned the meeting at 2:53 p.m.

RESPECTFULLY SUBMITTED:

Darlene Rubin

Committee Secretary

APPROVED BY:

Assemblywoman Vivian Freeman, Chairman

DATE: