The Senate Committee on Commerce and Labor was called to order by Chairman Randolph J. Townsend, at 7:30 a.m., on Tuesday, February 23, 1999, in Room 2135 of the Legislative Building, Carson City, Nevada. Exhibit A is the Agenda. Exhibit B is the Attendance Roster. All exhibits are available and on file at the Research Library of the Legislative Counsel Bureau.

COMMITTEE MEMBERS PRESENT:

Senator Randolph J. Townsend, Chairman

Senator Ann O’Connell, Vice Chairman

Senator Mark Amodei

Senator Dean A. Rhoads

Senator Raymond C. Shaffer

Senator Michael A. (Mike) Schneider

Senator Maggie Carlton

GUEST LEGISLATORS PRESENT:

Senator Bob Coffin

Assemblyman Joseph E. Dini, Jr.

STAFF MEMBERS PRESENT:

Scott Young, Committee Policy Analyst

John L. Meder, Committee Policy Analyst

Ardyss Johns, Committee Secretary

OTHERS PRESENT:

Chairman Townsend opened the meeting announcing he would hear testimony on Senate Bill (S.B.) 210 at the request of an individual who, because of time constraints, would have to leave the meeting early.

SENATE BILL 210: Provides for regulation of persons who counsel alcohol and drug abusers. (BDR 54-163)

Gary Short-Meneley, Clinical Director, The Ridge House, stated he had a problem with the way in which the bill is written. He referred to section 8 where it states the purpose of the bill is to require professional standards for alcohol and drug counselors. He said the Bureau of Alcohol and Drug Abuse already does this with quite a strict set of standards for certified drug and alcohol counselors as well as a strict set of standards governing their conduct. He pointed out it takes a total of 10,000 hours of a combination of education and experience to qualify just to take the test.

Referring to section 26 regarding the requirements for licensure, Mr. Short-Meneley stated that having worked in this field for a number of years, he did not see where it should be required to have that level of education. He agreed that perhaps more education should be required, such as a 4-year degree or an associate’s degree in substance abuse counseling. But, he added, requiring a master’s or doctoral degree would restrict access to the field for a number of people who would be well qualified to do this type of work. In addition, he explained, it would restrict access as well to clients, many of whom are indigent and cannot afford substance abuse services, and the state’s funding is such that there is not money enough for treatment as it is now. He pointed out that people who go for a master’s degree or a doctorate are not generally the people who work for the least amount of money. He said this is rather a low-paying field as far as counseling professionals go, which is good in the sense that it does allow access to treatment for many clients who would not be able to receive it otherwise.

Mr. Short-Meneley stated it would be a particularly difficult problem in the rural counties where the courts are requiring evaluations and treatment and the populations are low, claiming it would be difficult to bring in people with those types of degrees. He said many of the people coming into this field in the future will not be able to afford that kind of education. He noted most of the counselors are very qualified and professional and the educational requirements should not be elevated to the level required in the S.B. 210.

Mr. Short-Meneley drew attention to a letter written by John N. Chappel, M.D., Professor of Psychiatry and Behavioral Science, University of Nevada, Reno, School of Medicine (Exhibit C), identifying him as an expert, well-known in his field. Doctor Chappel noted in his letter, dated February 22, 1999, there should be a provision to grandfather in all currently certified substance abuse counselors and interns. He said there should be some recognition for the experience of recovery from addiction. A person with 5 years of sobriety, he added, who is currently working a 12-step program of recovery with a sponsor, a home group, and regular step work, should have the equivalent of credit for 2 years of college training. He claimed, while recovery from addiction does not guarantee counseling competence, it helps greatly with empathy and the ability to establish a working relationship with a suffering alcoholic or drug addict.

Chairman Townsend closed the hearing on S.B. 210 promising to reopen it after the first bills on the agenda had been heard. He opened the hearing on S.B. 45.

SENATE BILL 45: Excludes certain persons from definitions of "junk dealer" and "secondhand dealer." (BDR 54-97)

Wallace Beinfeld, Director, Beinfeld Productions, Antique Arms Shows, stated his business produces, among other things, collectible oriented trade shows, primarily firearms, in Los Angeles and Reno. He said almost everything available at his shows is collectibles and antiques which is considered personal property because everything is acquired from individuals. He gave, as an example, "grandpa’s old gun, or some painting in the house, or some boots or saddles." He added that most people attending the shows are from states other than Nevada. Because of this, he added, it is extremely impractical for them to be licensed in the State of Nevada and, therefore, run the risk of being arrested for a misdemeanor if they do not keep the required paperwork. He pointed out the participants in these shows number in the thousands and bring millions of dollars to Nevada in the form of not only sales tax revenue from the shows themselves, but from the hotels and services utilized by the participants. A recent canvassing of several hundred of these participants, he said, indicated they felt threatened by having to perform a license requirement that they might not be able to perform, and therefore might not come to the shows if they are in danger of being arrested for a misdemeanor.

Mr. Beinfeld concluded, stating collectibles and antiques brought to trade shows, which consists mostly of out-of-state dealers, should be exempt from onerous and probably unenforceable provisions of the existing law.

Senator Carlton asked what kind of regulations there were for dealing with the firearms going from state to state.

Mr. Beinfeld replied there are several layers of regulation starting with the individual counties where the acquisition or sale of firearms must be reported. He said the Nevada justice department requires the sale of a firearm to a person be reported to the state, and the federal government, through the national Federal Bureau of Investigation (FBI) program, requires an immediate phone call to the FBI for the clearance of an individual.

Chairman Townsend explained in order for a locally based business to make a purchase, it is required to have a buy/sell license in which a card is filled out and merchandise is held for 7 days. He further stated, the police pick up the cards every day and try to match them with any description of stolen property. He said that this week, in Las Vegas, a purchaser of antique wristwatches, pins, and jewelry, ran a full-page advertisement in the newspaper wanting to buy those items at a premium. Chairman Townsend mentioned that of concern is the fact there has been a noticeable increase of property break-ins after these kinds of announcements. Without reporting requirements, he added, a person could make a purchase, leave town, and law enforcement never knows. He asked Mr. Beinfeld if he saw a way to help with that issue but added that he realized Mr. Beinfeld’s business was not a trade show, but a buying service.

Mr. Beinfeld agreed that an announcement of the desire to purchase certain merchandise could be a magnet for people who have stolen property, but stated S.B. 45 is quite clear in specifying the type of event or show, so Senator Townsend’s question would not arise.

Senator Schneider noted it had been brought to his attention by one of his constituents in Las Vegas, who deals in antique gaming chips, that this is an ongoing problem. He said dealers and collectors come in to these trade shows from all over the nation and suddenly have to be licensed. He asserted not only do those dealers feel it is unnecessary to be licensed, the Las Vegas Metropolitan Police Department does not want to license them. He added that because of recent licensing requirements for small antique shops, a lot of those businesses have been forced to close. He stated that as a result, there would soon be no antique shops in Las Vegas, only pawn shops.

Robert R. Barengo, Lobbyist, Nevada Collateral Loan Association, stated the reason these reporting practices now include antique shops and trade shows in addition to pawn shops, is because they are similar in the merchandise they buy. While a pawn broker, pawns it for return of investment, the buy-and-sell people buy it and keep it, he said, and both have to report. He emphasized S.B. 45 would totally remove the requirements for reporting and licensure. He pointed out there was no definition in the bill of what a show is, so an individual could say they were organizing a show at a local motel to buy all secondhand goods, using as an example, silverware. He said that after that advertisement has run, all of the silverware in town is being stolen, claiming this as the reason for reporting requirements. While he acknowledged Mr. Beinfeld’s business as being legitimate, he said S.B. 45 would leave the door open for others that are not.

Alfredo Alonso, Lobbyist, Superpawn, stated he was in agreement with Mr. Barengo adding his clients are not trying to put anyone out of business, but simply trying to avoid the individuals who stay at a hotel for a few hours, sell some goods, and then leave. He said the pawn community is really who takes the heat when that happens. He stated he would be willing to work with the sponsor of the bill to address some of these problems.

Chairman Townsend closed the hearing on S.B. 45 and opened the hearing on S.B. 140, which he pointed out, was Senator O’Connell’s bill.

SENATE BILL 140: Requires insurers to include certain information concerning general premium tax on notices of renewal. (BDR 57-468)

Senator Ann O’Connell, Clark County Senatorial District No. 5, explained since premium taxes are the third largest source of income to Nevada’s General Fund, the tax should be separated out in the premium payment, so that the residents know there is a tax on their insurance. She said, after talking with insurance agency representatives, she found this might not be as simple as it sounds. She asked Senator Townsend, as chairman of the committee, for the opportunity to work out some of the problems that had been identified. One of those problems was timing, she explained, due to the coming millennium; and another, due to the different ways the taxes are reported by individual companies. She suggested if the committee felt there was any merit to this bill, the various issues involved could be worked out in a subcommittee meeting.

Chairman Townsend recognized this bill as an important issue to pursue and allowed Senator O’Connell the opportunity to resolve any problems necessary to go forward with S.B. 140, upon which he closed the hearing. He then opened the hearing on S.B. 177.

Renee Diamond, Administrator, Manufactured Housing Division, Department of Business and Industry, presented a letter dated February 22, 1999, from the Manufactured Housing Division (Exhibit D), which said that S.B. 177 would add some language to Nevada Revised Statutes (NRS) chapter 461 in regard to manufactured buildings standards. Ms. Diamond said those standards are not to be confused with the manufactured-homes standards which, she emphasized, are different than those for manufactured buildings. She said S.B. 177 adds language to the requirements in NRS 461.170 which is the listing of codes and standards for manufactured buildings. The new language adopts the standards of construction that are compatible with the Americans with Disabilities Act, which, she noted, are not currently included in the standards. She requested, also in section 1, subsection 1, the date January 1, 1993, be changed to 1998, so those standards already adopted would be more current in the statute.

Ms. Diamond stated the changes in section 3 will ensure that when the state approves plans, which is their statutory responsibility, the local jurisdictions will have notified the state of changes made within their authority. She told the committee she had no problem with some technical corrections to this section, suggested by Nevada Manufactured Housing Association, and would support an amendment process. She pointed out section 5 would raise the fines for infractions of this chapter, or regulations adopted pursuant to the chapter, from $500 to $2500 and declared the current fine is not realistic. She said it is so small that the economics of these expensive units might make a manufacturer decide that he would rather pay the fine than follow the statutes or regulations.

Referring to the repealed section of S.B. 177, Ms. Diamond said the placement of the insignia at the factory does not ascertain that it is in compliance with many local ordinances and regulations of all the cities and counties throughout Nevada. She added since this cannot be ensured, the language should be removed from statute because it is not accurate.

Chairman Townsend asked Ms. Diamond to give a brief example of the difference between a manufactured home and a manufactured building.

Ms. Diamond described a manufactured home as one made for everyday living with kitchen, bath, etc., and produced with United States Department of Housing and Urban Development (HUD) standards. She noted a manufactured building is generally a commercial building, used for things like health clinics, personnel centers, training centers, etc. Because of this, she continued, they have to have standards for accessibility and safety, and since safety is taken care of in the Manufactured Housing Divisions’ plan approvals, the language in S.B. 177 would add accessibility. She concluded manufactured homes and manufactured buildings are inspected differently.

Charles W. Joerg, Lobbyist, Nevada Manufactured Housing Association, stated he generally agreed with Ms. Diamond’s comments and then offered a proposal (Exhibit E) which, he stated, makes some slight technical changes to the language in S.B. 177. He pointed out the change in section 1, subsection 3 was intended to make sure the overall control of codes, standards and regulations remained with the state agency. Further, he said, in section 4, subsection 2, the intent is to make sure it is clear that local governments have the ability to control the slope, site, and zoning requirements which are, after all, local issues. Section 4, subsection 3, he concluded, would be completely removed since it would already be addressed in the proposed amendment in section 1, subsection 3.

Mr. Joerg referring to Ms. Diamond’s proposal to change the 1993 date in section 1 to 1998, stated he was in agreement and further suggested adopting language used elsewhere in other statutes. He explained that the most current versions of those various standards and codes are adopted automatically as opposed to putting a specific date, which has to be changed every time a standard is changed.

Ms. Diamond told the committee she liked the idea and suggested it be adopted with the other proposed amendments.

Chairman Townsend closed the hearing on S.B. 177 and reopened the hearing on S.B. 210.

Dorothy B. North, Lobbyist, Nevada Association of State Alcohol and Drug Abuse Programs, and Nevada Association of Addiction Counselors, stated S.B. 210 was the culmination of much thought and effort put forth by many professionals in the alcohol and drug abuse counseling field. As with other health care and counseling professions, she said, licensure is a natural part of the evolution of alcohol and drug counseling as a profession. She declared certification of alcohol and drug abuse counselors in Nevada has served an important purpose for a long time; but added, the juncture has been reached that requires a tightening of the requirements and sets forth a higher standard for people who wish to work in this field. She stressed higher standards imposed by passage of S.B. 210 will serve the consumer well by protecting the public from unqualified persons representing themselves as counselors as well as enhancing managed care and insurance billing. She added it would require after the year 2001, a master’s degree in either nursing or an appropriate field of social sciences before an individual could be licensed as an alcohol and drug counselor. She pointed out a grandfather clause that protects those who are currently certified in this state as well as those currently interning.

Addressing Mr. Short-Meneley’s concern, voiced in his testimony earlier regarding the ability to hire people with those types of degrees, Ms. North pointed out the fact that her operation, based in Elko, Nevada, has both inpatient and outpatient clinics that cover seven counties in rural Nevada. Consequently, she declared, it would impact her operation the same as anyone else’s, but added that the point has been reached where a higher standard of qualifications must be required. She said the bill takes what is currently on the books as the certification law and moves it into licensure and raises the bar for who will sit for the licensing exam. She acknowledged that although it would cost more to hire people for the job, it is an important enough piece of legislation to warrant consideration, and urged the committee to pass S.B. 210.

Senator Rhoads noted Mr. Short-Meneley had indicated it would put a hardship on rural Nevada to find qualified people. He acknowledged the fact that it is very difficult, at times, to attract doctors and counselors to rural Nevada and asked Ms. North if she concurred. She replied her operation currently attracts people with master’s level education and noted with over 800 people currently certified in Nevada, the majority of those people already have master’s degrees.

Senator Rhoads asked if anyone now working for Ms. North did not have a master’s degree. She told him she did have interns indicating the internship piece in S.B. 210 allows them, while they are doing their internship and while they are going to school, to work under the supervision of an alcohol and drug abuse counselor. Therefore, she concluded, this would not eliminate the intern program.

Helen A. Foley, Lobbyist, Marriage and Family Therapists, stated it is almost impossible to be a marriage and family therapist without dealing with alcohol and drug abuse problems. She pointed out when there are behavioral problems with young children, it is found many times to possibly be due to an alcoholic parent or some other type of abuse in the home with a controlled substance. Because of this, she continued, it is extremely common for marriage and family therapists to deal in the area of alcohol and drug abuse.

Ms. Foley said while marriage and family therapists have no problem taking a test to become an alcohol or drug abuse counselor, they believe there should be an inverse relationship between the level of education and the number of hours required. She added that everyone in the field of marriage and family therapy must have a master’s degree and must have a required number of hours of training, and stated the 4,000 hour requirement on page 7, line 9 of the bill, is excessive. Particularly, she stressed, for someone with a master’s degree who has been well trained in this area. She concluded she would like to work things through with Ms. North and try to come to an agreement on a more acceptable number of hours.

Alicia Smalley, Lobbyist, President, National Association of Social Workers, Nevada Chapter, speaking on behalf of licensed clinical social workers who, she stated, are already licensed to practice psychotherapy and to diagnose and treat mental emotional behavior disorders, conditions and addictions. She said she agreed with Ms. Foley on this issue and would like to see some kind of certification these social workers can still get without having to do another 4,000 hours.

Chairman Townsend called attention to the fact that everyone who had testified today on all of the issues, had expressed their willingness to work with other people to iron out differences and expressed his hope that other committees would take note and follow suit.

Robert H. Johnston, Deputy Chief, Rehabilitation Division, Department of Employment, Training and Rehabilitation, stated S.B. 210 creates a board of examiners whose duties include the responsibility of regulating drug and alcohol counselors. Consequently, he said, the bill revokes the Bureau of Alcohol and Drug Abuse (BADA) responsibility to certify substance abuse interns and counselors in Nevada. But, he noted, this shift of duties does not speak to the needed regulation of detoxification technicians and therefore, BADA submitted some language that it recommends be included in the bill (Exhibit F).

Mr. Johnston pointed out there were also some questions related to the limited scope of internship responsibilities and Exhibit F also includes language addressing those issues.

Vilius Paskevicius, Administrator, Treatment Center, Economic Opportunity Board (EOB), of Clark County, and President, Nevada Association of Alcohol and Drug Abuse Programs (NASADAP), and Secretary, Nevada Association for Addiction Counselors (NAAC), read his testimony from a prepared statement (Exhibit G). In summary, he said the organizations he represents are strongly in support of enactment of legislation that establishes the licensure of drug and alcohol abuse counselors. Included in Exhibit G, he pointed out, is a summary of those states that have enacted some form of licensure, a statement from NASADAP and an article from the National Association of Alcoholism and Drug Abuse Counselors (NADAC).

Kevin Quint, MBA, Executive Director, Churchill Council – New Frontier, identified himself as a substance abuse treatment provider in rural Nevada and a member of the advisory board on the certification of counselors. He stated he was in support of S.B. 210. He said that even though the certification process has been effective in bringing about more professionalism and competency to the field of alcohol and drug abuse counseling, there is still a lack of parity between substance abuse treatment professionals and other licensed disciplines. This leaves a gap in the substance abuse treatment field, he added, and many insurance carriers and other third-party payers will not recognize substance abuse counselor certification. He pointed out a trend in the nation to move from certification to licensure.

Mr. Quint claimed he was originally opposed to requiring a master’s degree for licensure until he understood the issue. He explained if only a bachelor’s level or less were the requirement, substance abuse would still not be on par with the other licensed fields. He noted another concern was that such a move would exclude people from the field causing a shortage of substance abuse counselors and destroying the fabric of the field. In order for the field to compete in a growing market, he remarked, the standards must be raised to a level equal to those required in other areas. He pointed out four basic benefits of upgrading certification to licensure. First, he said, it would increase the ability to access contracts and money sources. He stated it would increase recognition of the substance abuse field as a viable group of providers through increased professionalism as well as increase recognition of substance abuse itself, as a problem that is worthy of this kind of attention. And finally, he concluded, it would be in keeping with national standards.

Senator Carlton asked how this would affect the nonprofit agencies in regard to getting volunteers and certified people in their ranks.

Mr. Quint responded his is a nonprofit organization and while that issue is a problem, it has always been a problem. He said the idea is to raise the standards in order to dig deeper into money sources and increase funding, therefore increasing the ability to attract and recruit better people.

Mr. Paskevicius suggested that by becoming licensed, money could be collected from insurance companies, thereby requiring less from state funds. Addressing Senator Carlton’s question regarding volunteers, he said there are still volunteers, but they are used for things other than counseling which they are not qualified to do anyway.

Ms. North stated while S.B. 210 will not necessarily fix every problem, it does raise the bar in terms of what should be required to achieve professional licensure and it will give greater access to third-party payments.

David S. Gibson, Lobbyist, Clark County Public Defender, speaking on behalf of the Clark County Drug Court Program, stated after reading S.B. 210, his only concern was with the master’s degree requirement. While it is not a problem in Las Vegas, he said, the rural areas might have a problem attracting people with that level of education. He asked the committee to consider an alternative language to provide either for a master’s degree or a large number of hours in the field coupled with a bachelor’s degree. He explained it might allow the drug court program to draw counselors from the communities, or to get people to move into the area where the counselors are needed. He concluded he is in support of S.B. 210.

Dave Kaul, NC, CADC, Integrated Services Case Manager, Tru-Vista, stated licensure is the next logical step for substance abuse counselors but added he had some trepidation about the effect this may have on access to treatment for limited-resource families. He declared this will raise the cost of treatment and maintained the money would have to be found somewhere in order to pay for that treatment. He told the committee he was fearful specifically for the family and the adult drug court clients because their treatment is paid for with county and state funding, which pays very little. Further, he stated, these are clients who normally would not access treatment, but are being coerced by the legal system or social service system to access treatment, in order to have a felony removed from their records, or to be reunified with their children. He said the county and state pay for that treatment and are effectively saving money by keeping people out of prisons and keeping children out of foster care. He recognized S.B. 210 as having merit in protecting and advocating for consumers so they know what they are getting when they sit down in front of a certified or licensed alcohol and drug abuse counselor. But, he added, the impact must be considered regarding the money needed to pay for that higher standard.

Chairman Townsend told meeting attendees that a work session on S.B. 210 would be held on March 9, 1999, giving everyone time to reread the bill and see what issues could be agreed upon. He closed the hearing on S.B. 210 and opened the hearing on S.B. 219.

Senator Bob Coffin, Clark County Senatorial District No. 3, said he was in favor of S.B. 219 which, he stated, would enable the Shriners Hospital to send their physicians from southern California to Nevada to screen children in order to determine eligibility for treatment at their facilities.

Assemblyman Joseph E. Dini, Jr., Lyon, Storey counties, part of Carson City Assembly District No. 38, acknowledged he was a member of the Kerak Temple in Reno and said he had watched the Shriners Hospitals in operation for many years. He claimed they had the most outstanding doctors on the West Coast and did a tremendous service of treating children. He said there were no Shriners Hospitals in Nevada and therefore the southern Nevada people go to the one in Los Angeles; the people in the north go to Sacramento; and those in eastern Nevada go to Salt Lake City. He told the committee anything that could be done to make it easier for these doctors to come to Nevada to evaluate children for eligibility would be beneficial to the children of Nevada.

Richard A. Davis, Chairman, Board of Governors, Shriners Hospitals for Children, told the committee S.B. 219 was requested because of the need to address the situation regarding the visiting doctors. He said there were 22 Shriners hospitals in North America, 4 of those serving Nevada. Those hospitals, he explained, provide treatment for orthopedic problems, burn victims and spinal injuries, at no cost to the children, their families, or the State of Nevada.

Earl "Joe" Darnold, Treasurer, Board of Governors, Shriners Hospitals for Children, stated the budget this year to cover all Shriners hospitals was $490 million which, he added, was funded strictly through the Shriners and not in any way through federal, state or municipality. He said Clark County alone has over 1300 burned or crippled children taken care of by the Shriners Hospital in Los Angeles which is 280 miles away. The Shriners spend over a hundred thousand dollars per year just getting children to the hospital he said, and this amount is not included in the $490 million budget, but by each individual Shrine Temple. One way to reduce the cost, he asserted, is to bring doctors to Las Vegas to determine eligibility for treatment, instead of having to pay for travel for the children and their parents to fly to Los Angeles.

Mr. Darnold said the request is not for the doctors to practice medicine per se, in Nevada, but only to look at children the Shriners might be able to help or children who are already patients of the Shriner Hospital.

Senator O’Connell asked which Nevada hospital a traveling doctor would utilize to screen crippled children or those who have been badly burned.

Mr. Darnold replied that in southern Nevada, Desert Orthopedic in Las Vegas, a group of 22 doctors, allows the use of their facility free of charge. The burn victims are screened at University Medical Center (UMC) in Las Vegas, he added, before being transferred to one of three Shriners’ burn facilities, Sacramento being the closest.

Donald B. Proud, Potentate, Kerak Shrine, told the committee S.B. 219, if approved, would be a tremendous help in support of the Shriners’ ability to take care of the children of Nevada.

Colin F. Moseley, M.D., Chief of Staff, Shriners Hospital for Children, Los Angeles, California, identified himself as an orthopedic surgeon specializing in the care of children and added he had been the chief of staff at the Shriners Hospital in Los Angeles for 12 years. He said his hospital cares for a number of patients from out of state and by the very nature of the kinds of problems the doctors treat, a lot of the children are followed as they grow and develop over the years. A number of them are followed through their twenty-first birthday resulting in a very large number of follow-up visits, and having to send those patients to the hospital in Los Angeles results in a tremendous cost in transportation. Not only for the Shriners here in Nevada, he added, but also a tremendous cost for the families who have to arrange time off work and to make arrangements for other members of the family. He said with that in mind, outreach clinics are performed to reduce those costs. He told the committee a doctor visits the clinics four times a year seeing up to 100 patients on the day of the visit.

Dr. Moseley mentioned that within his hospital are seven or eight different areas of expertise practiced by different doctors. He stated the most efficient way to take care of the outreach clinics would be to rotate those doctors so the whole breadth of their services could be done locally, at the convenience of the patients and their parents. Presently, he pointed out, only one of those doctors, who specializes in spinal problems, is licensed to practice medicine in the State of Nevada, and therefore, is the one who attends all of the clinics. This means, he continued, if a child has a spinal problem, he or she can get follow-up visits and consultation locally. Dr. Moseley added if, however, it involves a dislocated hip, a club foot, a burn or a disease like Rickets, he or she would have to be transported to the hospital in Los Angeles to see the doctor with the needed expertise. He acknowledged although some inroads have been made into the question of cost and convenience, it is really not done as well as it could be if the necessity of transporting patients to Los Angeles for follow-up treatment were eliminated.

Dr. Moseley told the committee the doctors who work in the Shrine hospitals are very highly focused taking care of orthopedic and burn problems and because of this narrow mandate, those doctors see patients on a regular basis that the orthopedic surgeons in Nevada communities might not see in a lifetime. Consequently, he stated, those doctors would actually provide a service to Nevada pediatric-orthopedic surgeons in the outreach clinics by providing them with an escape hatch for their own practice. He explained if they see a patient with a condition with which they are not familiar, the patient can be referred to the outreach clinic for a second opinion. A Shrine Hospital doctor could then determine if the child needs care that can be provided only at a Shrine Hospital or if it is something that can be treated locally.

Dr. Moseley said due to the fact that medical treatment is provided at no cost, the Shriners attract patients who are not able to access appropriate medical care because of the cost involved. Therefore, he explained, there would be no threat of the Shriners’ doctors stealing business from local doctors. In fact he added, a very comfortable relationship has developed with the pediatric-orthopedic surgeons in Nevada in that they have offered to be in attendance at the outreach clinics from time to time.

Dr. Moseley testified that even though it would be possible for his doctors to become licensed in the State of Nevada, eight different doctors would have to be licensed at considerable inconvenience, expense and delay. He gave as an example his own personal situation with respect to licensure. He said the prerequisites to apply for a license would take about a year, which would involve taking another accreditation exam and then the additional time to go through the licensure procedures in this state. He concluded S.B. 219 would reduce that substantial delay and inconvenience and therefore reduce the cost of the care provided to the children of Nevada.

Senator Rhoads asked if there were any other western states that do what S.B. 219 proposes.

Dr. Moseley replied each state is different in how they provide for this kind of activity noting a similar bill currently under consideration in Colorado. He claimed New Mexico furnishes a facility for visiting doctors to provide their services, and said Arizona is in a similar situation as Nevada. He added his doctors also do clinics in Mexico where they are provided temporary licensure.

Larry D. Lessly, J.D., Executive Director, Board of Medical Examiners, stated he was quite surprised to see this legislation and referred to correspondence between his office and Dr. Moseley (Exhibit H). In the first letter he pointed out, dated June 26, l998, Dr. Moseley inquired about some exception to Nevada’s licensing statute in order to accomplish the treatment he previously described to the committee. In Mr. Lessly’s reply dated July 6, 1998, he provided Dr. Moseley with the statutory exceptions under which he could have his physicians come into Nevada and perform this service. He stated he assumed the problem had been solved after receiving Dr. Moseley’s second letter dated July 16, 1998, in which he said he was proceeding to license his physicians.

Mr. Lessly, referring to Mr. Darnold’s testimony in which he stated the doctors would not actually be practicing medicine per se, told the committee that what those physicians do in this state is, by definition of statute, the practice of medicine. He maintained if it were not, they would not need a license to do it.

Mr. Lessly insisted he did not see why there should be a problem, since NRS 630.261 allows the Board of Medical Examiners to issue a special license to a physician licensed in another state who comes into Nevada to care for or assist in the treatment of his own patient in association with a Nevada-licensed physician. He said he has no question about the qualification of the physicians who work for the Shrine hospitals and other philanthropic medical associations, but told the committee they could not pass a bill to take care of a medical staff in one hospital in California. That is special legislation he declared. He pointed out this bill is extremely broad in its scope and contains specific statutory exception from all the provisions in Nevada’s licensure law and regulations. He said that means, among other things, that the Board of Medical Examiners could not deny a license to a physician if he had been convicted of some kind of malpractice or violation of a medical practice act in another jurisdiction. He explained a physician could have been convicted of a felony or had offenses involving moral turpitude or even fraud.

Mr. Lessly concluded S.B. 219 is inappropriate special legislation that attempts to address a problem, which he said in his opinion, does not exist.

Richard J. Legarza, J.D., General Counsel, Board of Medical Examiners, reiterated Mr. Lessly’s testimony and told the committee the bottom-line point was that this legislation is unnecessary.

Lawrence P. Matheis, Lobbyist, Nevada State Medical Association (NSMA), acknowledged the outstanding work performed by the Shrine hospitals as an adjunct medical service for Nevada, and stressed NSMA has no desire to harm the Shriners’ ability to continue to perform those services. He wanted to know what they perceived to be the problem and what needs to be done if there is a problem. He asked what exactly is needed or desired to be done that is not allowed under existing law and suggested Dr. Moseley and the Board of Medical Examiners get together to work out any necessary accommodations. As a last resort, he added, if it is determined that statutory changes are needed, a very narrow statutory change might be reviewed.

Dr. Moseley said the problem was in the nature of the association of the Shriners’ doctor with the Nevada doctor. He explained that his understanding from correspondence with Mr. Lessly, was that the association required local doctors to accept responsibility for the care of the patient; not just being in the position of a supervisor or a loose association. He said even if there were a local doctor who was willing to sign a paper stating he was accepting responsibility for the care of a child, it would be a sham because he is not in a position to actually take or accept responsibility. He told the committee the provision provided in New Mexico for example, is a different kind of association in which a doctor there accepts the responsibility of becoming the supervising doctor and reporting to the medical board. He added they do not actually accept responsibility for the child and concluded, this is a very important distinction.

Mr. Lessly explained if a physician is licensed to come into Nevada and perform medical services, he and the local physician are both responsible.

Chairman Townsend said it was his understanding there was a physician on Dr. Moseley’s staff who was licensed in Nevada and inquired as to why that physician could not accommodate the other Shriner physicians. Dr. Moseley replied it would require the licensed physician to be physically in Nevada at each of the clinics. Mr. Lessly stated the physician was not required to be here; only that he be responsible as the associated licensed physician no matter where he is.

Chairman Townsend suggested Dr. Moseley spend some time looking at this option before S.B. 219 comes before the committee again next week. He closed the hearing on S.B. 219 and opened the hearing on S.B. 220.

Christopher P. Howard, Managing Director, Howard Consulting Group, told the committee the essence of S.B. 220 is to license consultants in much the same way accountants, attorneys and other professional service providers are licensed. He said the idea is to ensure client service and to protect the consumer of those services. The way it stands now, he added, a person simply has to declare himself one, which does not necessarily mean he is qualified to deliver services. He asserted out of over 100,000 consultants in the United States, there are approximately 5,000 who are certified, so the penetration into the profession from a certification standpoint is pretty low.

Mr. Howard stated that because consulting is a broad business and has a lot of different components, it would be very difficult to test people on specific knowledge. However, he added, it would be very easy to test people on ethics.

Senator Rhoads asked Mr. Howard to define consultant. Mr. Howard told Senator Rhoads his definition of a consultant is someone who provides professional services with regard to giving advice for the operation of a business. He explained that could include areas of marketing, finance, human resources and information technology. He said the impact, both positive and negative, a consultant can have on a business, can be substantial.

Mr. Howard declared it was a consumer-protection issue that needs to be addressed in regard to S.B. 220. He justified it is not a mechanism by which anyone would be restricted from practicing. He said, in his opinion, any good practitioner would want to be licensed, allowing their client access to a board if they had a complaint as opposed to immediately going to the courts. As it stands now, he stated, bad consulting advice can put someone out of business and the consultant can continue to practice badly unsupervised by anyone.

Senator O’Connell told Mr. Howard when a consultant who is licensed and has all of the best intentions gives advice that does not work out, it does not necessarily mean that consultant was not qualified. Mr. Howard agreed it would not necessarily de facto mean that, but it would at least be considered by a board who would look at it and resolve the issue.

Senator Shaffer asked if a license was taken away from a consultant by a board, what would stop the consultant from just continuing to practice. Mr. Howard answered that while it would be possible for the consultant to do just that, at least he would no longer be able to present himself as a licensed consultant.

Robert A. Ostrovsky, Lobbyist, Nevada Resort Association, stated S.B. 220 is too broad an addition to the statute. He told the committee he does not believe this to be a consumer bill but rather a bill for business, and if businesses want to make a decision about who they want to hire to give them advice, that is their choice. He said businesses have the right to sue if someone gives them bad advice and added, the courts have been good over the years at sorting those out. He pointed out S.B. 220 does things that other boards do not have the ability to do such as maintaining more than one office in the state and employing its own attorneys. He called attention to section 35, which gives the proposed board full and absolute subpoena power, and to section 43 where it addresses what records must be kept and to whom those records belong. He said he has not seen adequate need for this kind of regulation and concluded, stating he and his clients stand in opposition to the bill.

Mr. Howard acknowledged wording in the bill that somehow implies some things were overly restrictive. However, he said that can be fixed and does not obviate the need for the bill in the areas he had previously discussed.

Fred L. Hillerby, Lobbyist, Nevada Society of Certified Public Accountants, concurred with Mr. Ostrovsky in opposing S.B. 220. In addressing Mr. Howard’s remark regarding testing someone’s ethics, Mr. Hillerby said he did not see how a test could be written for good moral ethics. If he was not of good moral character, he added, he could surely figure how to handle a test. Mr. Hillerby noted he could understand the need of some people to look for some sort of extra credentials in order to present to clients their ability to do what they say they are able to do, but concluded the bill is too broad in scope.

Chairman Townsend told the committee a work session would be scheduled to further address the issues and then closed the hearing on S.B. 220.

There being no further business, the meeting was adjourned at 10:40 a.m.

RESPECTFULLY SUBMITTED:

Ardyss Johns,

Committee Secretary

APPROVED BY:

Senator Randolph J. Townsend, Chairman

DATE: