The Senate Committee on Human Resources and Facilities was called to order by Chairman Raymond D. Rawson, at 2:00 p.m., on Monday, March 8, 1999, in Room 2135 of the Legislative Building, Carson City, Nevada. The meeting was videoconferenced to the Grant Sawyer State Office Building, 555 East Washington Avenue, Room 4401, Las Vegas, 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 Raymond D. Rawson, Chairman

Senator Maurice Washington, Vice Chairman

Senator Randolph J. Townsend

Senator Mark Amodei

Senator Bernice Mathews

Senator Michael Schneider

Senator Valerie Wiener

GUEST LEGISLATORS PRESENT:

Senator Alice Costandina (Dina) Titus, Clark County Senatorial District No. 7

STAFF MEMBERS PRESENT:

Patricia Di Domenico, Committee Secretary

OTHERS PRESENT:

Chairman Rawson opened the hearing and invited testimony on Senate Bill (S.B.) 163.

Chairman Rawson summarized the intent of S.B. 163. He said S.B. 163 is an issue related to facilities that provide care for people who are unable to afford standardized housing or who may have a minor level of dependence. Chairman Rawson stated the homes register with the Bureau of Licensure and Certification in the Health Division but the bureau does not have authority to certify, license or otherwise approve the home; consequently, there is no way to assure adequate needs are being met.

Richard J. Panelli, Chief, Bureau of Licensure and Certification, Department, Health Division, Department of Human Resources, read from prepared testimony (Exhibit C). He noted 451 homes are registered with the bureau since the enactment of the 1995 statute. Mr. Panelli pointed out the bureau has investigated numerous complaints concerning the quality of care provided in these registered homes but lacks specific statutory authority for regulatory action. He enumerated on the fiscal impact to the bureau. Chairman Rawson asked the bureau’s position on the bill. Mr. Panelli replied the bureau is neutral. He commented there is no method to evaluate the provision of care in these homes. Mr. Panelli cautioned imposing restrictive standards might cause homes to close and displace the residence of these facilities. Chairman Rawson asked what the costs are to certify a home. Mr. Panelli estimated it would cost $300 to certify a home.

Chairman Rawson paused in the testimony on S.B. 163 to permit testimony by Senator Alice Costandina (Dina) Titus, Clark County Senatorial District No.7, on Senate Bill (S.B.) 161.

Senator Titus referred to a handout (Exhibit D) as a revision of S.B. 161. She explained the original bill was written for all facilities for the treatment of alcohol and drug abuse. She explained the intent was directed at halfway houses that do not administer treatment. Senator Titus gave background on the bill and explained the need for transitional housing facilities to be under the regulations of the Bureau of Alcohol and Drug Abuse (BADA). She called attention to pages 7 and 8, of Exhibit D, which deletes the verbiage relating to the "the fee for certification must not exceed $100." Senator Titus said this deletion would parallel an Assembly bill which removes that language from the BADA statutes.

Chairman Rawson invited additional testimony on S.B. 161.

Marilynn K. Morrical, Lobbyist, Concerned Citizen, testified in support of Senate Bill 161. She stated the bill would provide regulation of transitional housing that will become more prevalent in the future and will assure a minimum standard of care in those facilities. Ms. Morrical explained this is consistent with changes that have taken place to make programs and the bureau more accountable. BADA requires treatment programs to utilize the American Society of Addiction Medicine (ASAM) criteria for patient placement and statewide decisions. She said enforcement of this criteria will cause people at residential level care to be moved to an outpatient level. According to Ms. Morrical, not only would this affect their treatment process but also many will not have a place to live. Ms. Morrical stated ASAM recognizes transitional housing as a distinct level of care that is cost-effective.

Denise L. Everett, Lobbyist, Executive Director, Sage Wind, expressed her dislike for more regulations but favors S.B. 161. Ms. Everett stated their prime concern is for the health and safety of the facility’s clients but other transitional facilities might not have the same considerations. She voiced support of a regulatory body to oversee transitional housing. Ms. Everett noted S.B. 161 is a companion to Assembly Bill 265 and the two bills will work "hand and glove."

Dorothy B. North, Lobbyist, Nevada Association of State Alcohol and Drug Abuse Program, voiced her support of S.B. 161. She conveyed her support of legislation that protects the public health and safety and prescribes a standard of operation for transitional facilities. Ms. North stated the need for transitional facilities. Senator Washington asked if S.B. 161 would pertain to an alcohol and substance program such as Teen Challenge. Chairman Rawson asked if Teen Challenge was a residential facility. Senator Washington responded in the affirmative. Chairman Rawson replied it would not apply to that facility. Ms. North commented S.B. 161 applies to halfway houses where people reside but treatment is provided elsewhere.

Senator Mathews called attention to section 6, subsection 1, paragraph (b) of S.B. 161 and expressed concern with the amount of administrative fines imposed. Chairman Rawson opined the amount of fines would force facilities to adhere to the standards. Senator Mathews iterated her concern that the fine was too stringent. She commented the operation of a halfway house is a service to the community and does not involve a big profit. Senator Mathews added this might regulate them out of business. Senator Titus responded this bill is the result of recommendations from residents in older neighborhoods where halfway houses are being operated without any oversight. She stressed S.B. 161 is for the safety and welfare of the people in the halfway houses and the community. Senator Washington questioned the necessity to legislate the problem. Senator Titus replied the neighborhood services program in the City of Las Vegas reported their hands were tied and it would take legislation to bring these facilities under any regulatory standards. Chairman Rawson commented the state overrode the local zoning in allowing halfway houses to be placed. He said either state regulations need to be in place or the responsibility should be returned to the counties. Chairman Rawson added the cities and counties would not allow these homes to exist.

Chairman Rawson closed the hearing on S.B. 161 and opened the hearings for Bill Draft Requests (BDR) 34-1, BDR 40-497, and BDR 38-446.

SENATOR SCHNEIDER SECONDED THE MOTION.

THE MOTION CARRIED UNANIMOUSLY.

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SENATOR WIENER MOVED FOR COMMITTEE INTRODUCTION OF BDR 40-497.

SENATOR TOWNSEND SECONDED THE MOTION.

THE MOTION CARRIED UNANIMOUSLY.

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Chairman Rawson reopened the hearing and called for testimony in favor of Senate Bill 163.

Winthrop S. Cashdollar, Lobbyist, Executive Director, Nevada Health Care Association (NHCA), testified in support of the intent of S.B. 163. He defined the origin of the bill and stressed the originators concerns were how to extend scrutiny and oversight to homes for individual care without imposing financial and regulatory costs that would impact the homes to go out of business. Mr. Cashdollar implied the projected $300 licensure fee would be prohibitive. He emphasized residential homes would be subjected to the same regulations as the larger facilities. Mr. Cashdollar urged the committee to pursue the intent of S.B. 163 and address cost and regulatory issues.

Chairman Rawson asked if S.B. 163 should be returned to the department to develop regulations and proposals during the interim and report to the next session of the Legislature. Mr. Cashdollar replied this was not the first time this bill was introduced to the Legislature so there is an urgency. He pointed out there is a proposal for the Legislature to require an interim subcommittee on long-term care. Mr. Cashdollar related a conversation with the chief of the Bureau of Licensure and Certification concerning creating a separate category of regulations for individual care facilities. He said if the bill is not passed during this session of the Legislature then an interim effort should be pursued. Chairman Rawson commented the existing regulations would be demanding on smaller facilities but he expressed concern about passing regulations without prior review by the Legislature.

Chairman Rawson invited tesimony opposing S.B. 163.

Theresa P. Brushfield-Owens, Concerned Citizen, spoke on behalf of the Adult Care Association of Nevada concerning the physical impact S.B. 163 would have on the community. She acknowledged being unable to obtain data from the Bureau of Licensure and Certification (BLC) concerning the number of homes registered in the state. Ms. Brushfield-Owens stated the nursing home industry is a political and powerful entity in this state. She stressed the passage of Senate Bill 163 would cause the displacement of half the residents in registered homes to a skilled nursing facility. Ms. Brushfield-Owens noted there would be financial implications of S.B. 163 and she said the level of care would no longer be accepted in a licensed residential care facility for groups. She expounded on the cost of providing care for 100 to 200 people needing skilled-nursing care. Ms. Brushfield-Owens listed the costs as: ancillary services of physical, occupational, speech or respiratory therapy; medical equipment; prescription drugs; Medicaid rate for skilled nursing care at $110.51 per individual, per day; totaling $3300 per month or $39,600 per year, per individual. She said that would increase Medicaid costs by $3.9 million to $7.9 million. Ms. Brushfield-Owens pointed out residential care is the choice of the individual who would prefer to be in an unregulated home rather than a skilled-nursing facility. She emphasized people who choose individual care homes do so because they want to live and die as they choose without the interference of the government. Ms. Brushfield-Owens mentioned several bills and resolutions from the current legislative session that will impose regulations and cause small residential care facilities to go bankrupt or go out of business. She referred to the following bills:

Ms. Brushfield-Owens called attention to Senate Bill 383 of the Sixty-ninth Session.

She referenced the Southern Nevada Strategic Planning Authority’s Report which expounds on the rapid growth in population, lack of beds, and nursing personnel.

Brenda Oberlin, Concerned Citizen, pointed out the regulation of private group homes would take away privacy, compassion, and dignity. She said these regulations would impact the families financially, place emotional burdens upon them and undermine their security.

Sheila De Castroverde, Concerned Citizen, read from prepared testimony (Exhibit E) and spoke in opposition to S. B. 163.

Samuel T. Gee, Concerned Citizen, testified to the benefits of residential homes. He suggested regulations for residential homes should not be the same as group facilities. Mr. Gee opined many of the residential homes would not be able to continue providing care and families would be hurt in the process. Chairman Rawson explained S.B. 163 was the result of claims of abuse in residential homes.

An unidentified concerned citizen speaking from Las Vegas voiced her concerns with S.B. 163.

Dorothy Melton, Concerned Citizen, stated she is employed as a home health nurse and part of her testimony will be from that vantagepoint. She noted many elderly live in unsafe conditions. Ms. Melton said they have short-term memory loss and forget to take their medications or they overdose. She stated registered homes are a valuable residential alternative where people can retain a measure of independence in a safe environment. Ms. Melton, testifying as a concerned citizen, said she was a single mother of six children, the sole support of her family; including three grandchildren, her youngest child, and 80-year-old mother. She explained that recently she invested her life savings and purchased a residential home with the intent to work toward a licensed home. Ms. Melton

emphasized she will lose her investment, be out of work, and will have no means to support her family if S.B. 163 is passed.

Stephen Goulet, Concerned Citizen, testified he is a volunteer in a registered home and had worked in a nursing home. Mr. Goulet pointed out there is abuse in all facilities, not just the small residential homes. He said Nevada is trailing the other states in subsidizing for the elderly. Mr. Goulet noted the elderly population in Nevada is growing at a rapid rate and the cost of care necessary will eventually be the burden of the taxpayers. He suggested to the committee there should be incentives for residential homes instead of regulations. Mr. Goulet urged action be taken for abuse, but stated there is no need for legislative managers.

Sandie Bromell, Concerned Citizen, told the committee of two personal experiences. She related an unpleasant experience with a nursing home and a favorable occurrence with a residential home. Ms. Bromell stated abuse should be regulated but there should be a different level of regulations for residential homes.

Raven, Concerned Citizen, stated she has been a hospice volunteer for 14 years. Raven voiced her concern with S.B. 163. She told the committee she is 54 years old and disabled. Raven stressed S.B. 163 would create a financial strain on small business. She recognized the need for regulation throughout the industry for abuse. Raven urged further research and development on the bill.

Marilyn Dorckak, Concerned Citizen, testified as the owner of a registered home. She enumerated on the steps necessary to prepare for ownership of a registered home. Ms. Dorckak listed the extensive costs required to administer and maintain the facility. She emphasized the losses S.B. 163 would impact upon her business. Ms. Dorckak suggested existing homes be grandfathered in until there is a study to show the level of government control necessary to provide protection for the public in a registered home or allow a study for the next 2 years.

Solomon C. Advicula, Concerned Citizen, testified he had operated a group home in Las Vegas for 10 years. He stated most of the Philippine operators of group or residential homes oppose S.B. 163. Mr. Advicula described his residents as "family." He said abuse of residents should be treated on a case-by-case basis. Mr. Advicula stressed perpetrators of abuse should be tried and prosecuted to the full extent of the law.

Edith Kalland, Concerned Citizen, outlined the difficulties she experienced trying to become a proprietor of a 9- or 10-bed facility. She stated the government in Nevada is not user-friendly to its citizens. Ms. Kalland said the state would rather pay $3000 a month for a resident in a large nursing home than one-third to one-half that amount for a residential home. Ms. Kalland, compared the benefits available in Nevada with the expansive programs provided in her home state of Alaska.

Assemblywoman Christina R. Giunchigliani, Clark County Assembly District No. 9, requested the record reflect her written support of S.B. 163 (Exhibit F).

Chairman Rawson closed the hearing on S.B. 163 and opened the hearing on Senate Bill 197.

Senator Valerie Wiener, Clark County Senatorial District No. 3, gave a report of her personal and professional awakenings to fetal alcohol syndrome (FAS). She related her experience developing S.B. 197. Senator Wiener emphasized the focus for this legislation on one primary goal: to ensure that women do not drink alcohol during their pregnancies. She stressed it must be accomplished through the education of everyone involved with this issue. Referring to line 9 of the proposed amendment to S.B. 197 (Exhibit G), Senator Wiener added a postscript to the fourth "whereas," which talks about the "tremendous social costs" of FAS. She said each FAS baby costs society an additional $1.5 million to $2 million. Senator Wiener highlighted proposed changes in the substitute amendment.

Senator Wiener stated the intention was to replace continuing education mandates with informed choices. She emphasized it is better to work with someone and share a common goal through cooperation than to force-feed a requirement that has the potential to produce the opposite effect. Senator Wiener submitted a letter for the record from Dr. Bernard H. Feldman, Vice Chairman of the Department of Pediatrics at the University of Nevada Medical School (Exhibit H). She said this letter pledges the school will provide, without charge, vital continuing education units (CEU) training on FAS for those health care providers and other professionals described in this bill. Senator Wiener drew attention to section 13 of the substitute amendment, which deletes several of the original referral and reporting mandates. Senator Wiener pointed out section 16 retains provisions related to adoption, guardianship, and foster care; section 20 is deleted; and sections 11 and 12 are retained. Senator Wiener iterated her commitment to S.B. 197 and pledged a personal contribution of $1000 to the FAS account upon passage of the bill. Senator Wiener urged the committee to support S.B. 197.

John Yacenda, Ph.D., Deputy Director, Department of Human Resources, read from prepared testimony (Exhibit I) and stated the department supports Senate Bill 197. He reported 20 percent of women drink during pregnancy and FAS is a direct result of alcohol consumption. Dr. Yacenda defined growth retardation; physical, mental and behavioral abnormalities; central nervous system impairment (which includes; developmental delay, small head size, speech or language delay); and facial abnormalities as results of drinking during pregnancy. He said it cost $1.4 million to treat an individual with FAS for life.

Dr. Yacenda listed deletions from the original bill which required providers to: create and make referrals to the Department of Human Resources; maintain records or report on the number of pregnant women they treat; use guidelines for pregnant women developed by the University of Nevada School of Medicine. He mentioned the Department of Human Resources would not be required to conduct research of any kind pertaining to this issue. Dr. Yancenda referred to the deletion of section 20; and said in the amended bill, school personnel will not be expected to make assessments, provide treatment or make referrals to treatment programs for students suffering from FAS. He stated it would not be required to distribute information to patients in obstetrical units of hospitals; obstetric centers; family planning clinics and other health facilities. Dr. Yacenda added, there would not be a program to require the screening of pregnant women to determine if her fetus is at high-risk of developing FAS. He noted a new 800 number will not be created, but the existing 800 lines will be utilized. Dr. Yacenda indicated the Department of Human Resources strongly supports the concept of S.B. 197, and wants providers to be participatory in accessing information and using it in the practice of their professions.

Dr. Yacenda pointed out a subcommittee could be created for FAS by utilizing the existing Maternal and Child Health (MCH) Advisory Board which has a subcommittee structure. He said the Health Division would staff the subcommittee. Dr. Yacenda explained the subcommittee will work with the school of medicine to develop materials and provide input and other assistance. Referring to section 5 of the amended bill, Dr. Yacenda indicated the verbiage describes the members of the advisory subcommittee. He said the subcommittee’s annual report will be part of the report submitted by the MCH Advisory Board to the Governor and the Legislature. Chairman Rawson opined the changes were made to reduce the fiscal note. Dr. Yacenda affirmed and indicated the revised fiscal notes would show a zero fiscal note.

Senator Washington asked Senator Wiener if the program to distribute information is ongoing. Senator Wiener deferred answering the question to Colleen A. Morris, M.D., Director of Clinical Genetics Services, University of Nevada Medical School.

Dr. Morris, testified FAS is completely preventable. Reading from prepared text, page 1 of Exhibit J, she enumerated on FAS and the effects of FAS on the fetus. Dr. Morris indicated the consumption of alcohol is increasing amongst women and in Nevada it is of epidemic proportions. She referred to a graph on page 2, "FAS and Down Syndrome (DS) in Nevada Genetics Program" of Exhibit J which shows statistics from genetics clinics for the past 10 years. Chairman Rawson commented there are five or six times more mental retardation produced by FAS than DS. Dr. Morris agreed.

She called attention to the second graph on page 1 of Exhibit J, and explained the "Genetic Clinic" has kept records for the past 2 years of children referred to the clinic who have a history of prenatal exposure to alcohol but did not meet the criteria for diagnosis of FAS. Dr. Morris stated records are also kept on infants who have had prenatal exposure to drugs. She indicated children who do not have mental retardation due to alcohol might have secondary disabilities, such as behavioral or social problems.

Dr. Morris drew attention to page 3, of Exhibit J, "One Week in Genetics Clinic," which recorded 14 children who were referred to the clinic for possible FAS. She enumerated on the diagnosis; cost of placement; Medicare; and special education of the referred children. Calling attention to page 4 of Exhibit J, "FAS Facts," Dr. Morris listed the primary disabilities, secondary disabilities, and protective factors of children with FAS.

Dr. Morris responded to a question asked by Senator Washington prior to her testimony. She said recently there have been more programs to educate health care providers and the general public. She stressed the need for FAS prevention and child treatment of FAS.

Senator Washington asked how the subcommittee of the MCH Advisory Board would be funded. Dr. Yacenda replied the funding would come from the staff person assigned to that program as well as the infrastructure.

Dana R. Bennett, Lobbyist, Nevada State Medical Association, stated the association supports S.B. 197 and the proposed amendments.

Chairman Rawson requested a motion on S.B. 197.

SENATOR SCHNIEDER MOVED TO AMEND AND DO PASS S.B. 197.

SENATOR MATHEWS SECONDED THE MOTION.

THE MOTION CARRIED UNANIMOUSLY.

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Chairman Rawson called for any additional testimony on S. B. 197.

Kari Demetras, Chief Executive Officer, STEP 2, applauded the work of Senator Wiener and S.B. 197. She submitted for the committee’s information, "Northeast Communities Against Substance Abuse (NECASA)" (Exhibit K), concerning alcohol- and drug-related birth defects. Ms. Demetras requested S.B. 197 be expanded to include drug-related birth defects. Chairman Rawson commented there was serious consideration given to the drug issue when the bill was drafted, but Senator Wiener’s primary focus was FAS. Senator Wiener clarified that the people who work in the substance-abuse environment understand the issue of dual addictions. She added, this is in no way to exclude other addictions, but to focus on alcohol.

Dr. Yacenda explained there is a subcommittee on perinatal substance-abuse prevention. He said both subcommittees will be working hand-in-hand to deal with issues. Dr. Yacenda opined the issues will commingle and merge and there will be a better grasp of the complete spectrum of the problem. Ms. Demetras voiced her concern regarding the subcommittees working together. Chairman Rawson stated he would send a letter of intent to accompany the bill

Judy Reich, Concerned Citizen, speaking as the program director of television Channel 3 in Las Vegas, supported S.B. 197 and the amendments. She stated the importance of the media’s role in educating the public and pledged the continuance of programs to support this issue.

Anne Packingham, Concerned Citizen, spoke as a mother of two adopted children suffering from FAS and fetal drug effect (FDE) and declared her support of S.B. 197. She stressed the need for a major drug- and alcohol-prevention program in Las Vegas. Ms. Packingham pointed out there is constant focus on other educational programs, but there is no program for the most high-risk group of FAS and FDE. Ms. Packingham described the emotional, social, and physical repercussions of FAS and FDE on children and their families. She called attention to the growing population in Nevada and the increasing number of FAS and FDE cases. Ms. Packingham implored the committee to consider the enormous impact these children will have on the future of Nevada and urged them to vote for S.B. 197.

Susan Dalton, Concerned Citizen, told the committee she was the mother of a type-three FAS adopted child. She related the circumstances of her adopted son and told the committee the difficulties that are experienced by being a victim of FAS. Ms. Dalton spoke favorably about programs for early treatment of FAS children. She noted the long-term prognosis was bleak. Ms. Dalton suggested a one-cent tax be placed on all units of alcohol sold in Nevada or a lawsuit be filed against the makers and distributors of alcohol products.

Carol Stillian, Concerned Citizen, spoke on behalf of Clark County Department of Family and Youth Services in support of S.B. 197. She indicated 80 percent of Family Protective Service (FPS) cases have substance-abuse features. Ms. Stillian said the extra services that are needed to support affected families are costly but necessary. She emphasized CPS clients that remain untreated can step over into the juvenile justice arena. Ms. Stillian commended S.B. 197 for being proactive, preventative and an educational stategy for the families affected by substance abuse.

Donald Munn, Concerned Citizen, testified as a parent of four adopted children afflicted with FAS and related problems. He urged the committee to come to the aid of parents who adopt children with FAS or FDE.

Robert Hays Johnston, Deputy Chief, Bureau of Alcohol and Drug Abuse (BADA), Rehabilitation Division, Department of Employment, Training and Rehabilitation, voiced support of S.B. 197.

David Kaul, Integrated Services Case Manager, Tru Vista, opined that S.B. 197 is an opportunity to show compassion for pregnant mothers who are struggling with addictions. He said any accusatory, condemning or punitive language toward these women in the bill would have a negative result. Mr. Kaul stated an empathic intervention with these women, not a confrontational approach, would obtain success. Chairman Rawson commented Senator Wiener was adamant when preparing this bill that women not be condemned. He pointed out that section 12.1 of the proposed amendment (Exhibit G) addresses this situation. Chairman Rawson indicated any referral must be treated confidentially and may not be used in any criminal prosecution of the women.

Barbara Hunt, Director, Community and Clinical Health Services requested a faxed letter from the District Health Department (Exhibit L), stating their position on S.B. 197 be included in the record.

Chairman Rawson closed the hearing on S.B. 197 and asked the committee for their position on the amended version of S.B. 161.

SENATOR WIENER MOVED TO AMEND AND DO PASS S.B. 161.

SENATOR MATHEWS SECONDED THE MOTION.

Chairman Rawson called for discussion. Senator Washington stated his apprehension concerning regulating residential homes out of business. Chairman Rawson indicated that this issue could be addressed through a letter of intent submitted to the committee for approval.

Chairman Rawson called for the vote.

THE MOTION CARRIED UNANIMOUSLY.

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Chairman Rawson directed staff to coordinate S.B. 163 with other bills on the same issue. He indicated the need for an interim study on proposed regulations if S.B. 163 is passed and subsequently approved by the next legislative session.

SENATOR TOWNSEND MOVED TO COORDINATE S.B. 163 WITH OTHER BILLS ON THE SAME ISSUE.

SENATOR WIENER SECONDED THE MOTION.

THE MOTION WAS CARRIED UNANIMOUSLY.

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Chairman Rawson adjourned the meeting at 4:00 p.m.

RESPECTFULLY SUBMITTED:

Patricia Di Domenico,

Committee Secretary

APPROVED BY:

Senator Raymond D. Rawson, Chairman

DATE: