The Senate Committee on Human Resources and Facilities was called to order by Chairman Raymond D. Rawson, at 2:09 p.m., on Wednesday, April 21, 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 Raymond D. Rawson, Chairman

Senator Maurice Washington, Vice Chairman

Senator Randolph J. Townsend

Senator Mark Amodei

Senator Bernice Mathews

Senator Valerie Wiener

COMMITTEE MEMBERS ABSENT:

Senator Michael Schneider (Excused)

GUEST LEGISLATORS PRESENT:

Assemblywoman Vivian L. Freeman, Washoe County Assembly District No. 24

STAFF MEMBERS PRESENT:

Patricia Di Domenico, Committee Secretary

OTHERS PRESENT:

Jill Smith, Esq., Director of Advocacy, Nevada Disability Advocacy & Law Center

Ed Gobel, Lobbyist, Council of Nevada Veterans Organizations

Kay Bennett, Board of Supervisors, Carson City

Chairman Rawson opened the hearing on Assembly Bill (A.B.) 141.

Vivian L. Freeman, Washoe County Assembly District No. 24, stated A.B. 141 resulted from an interim legislative committee study and introduced Carlos Brandenburg, Ph.D., Administrator, Mental Hygiene and Mental Retardation Division, Department of Human Resources. Dr. Brandenberg read from prepared testimony (Exhibit C) and explained the current law allows a client who is discharged from an inpatient psychiatry facility to be placed on convalescent leave for 10 days and any extension beyond that time must be issued by the court. He explained that the new language would allow clients who have been involuntarily committed to be placed on convalescent or conditional leave for a period not to exceed 6 months. This would permit greater flexibility in monitoring and rehospitalizing difficult clients who have a history of discontinuing their medication or treatment.

Chairman Rawson asked if there were any legal concerns about this bill. Ms. Freeman replied there were none. She referred to line 12, page 2 of A.B. 141 and said the verbiage "conditional release" maintains consistency and clarifies the intent. Ms. Freeman commented that during the committee hearings Jill Smith, Esq., Director of Advocacy, Nevada Disability Advocacy & Law Center, was the only opposition to this change.

Ms. Smith read from prepared text (Exhibit D) and opined that the change in language of the current convalescent leave statute was unnecessary. She stated the passage of A.B. 141 would subject a person who has been involuntarily committed to a mental health facility to be placed on convalescent or conditional leave for a period not to exceed a 6-month commitment. Ms. Smith added that this would occur even when they do not meet the commitment criteria of being a danger to self or others. Continuing, Ms. Smith said the discretion to extend convalescent leave if deemed necessary is already provided to the court under the current statute.

She pointed out that number 3, on page 2 of Exhibit D was a key factor that A.B. 141 will remove from the statute. Ms. Smith disputed the need to change the current language that prevents abuses of a person’s right to be free of the arbitrary seizure and detention when they pose no threat to themselves or others. She stressed that the language A.B. 141 seeks to change was deliberated during the last legislative session. It grants the judiciary the discretion to extend the length of time that an individual will remain on "convalescent leave" status if the facts and circumstances of the individual’s psychiatric condition warrant such extension. Ms. Smith stated that the new verbiage takes the 10-day language out completely and potentially subjects everyone to a 6-month sentence at the discretion of the director of the facility. She noted that the administrator of the Mental Hygiene and Mental Retardation Division has indicated the new language makes it easier for hospitals administratively. Ms. Smith stressed that administrative convenience is not a justifiable reason to limit an individual’s liberty. She stated that the requirements of due process mandate that a hearing is to be held and a legal determination made based on the specific facts and circumstances of the case in order to extend convalescent leave. Ms. Smith opined that the passage of A.B. 141 would make the extensions of convalescent leave automatic. Ms. Smith emphasized that Nevada Revised Statutes (NRS) 433A.390, section 2, subsection 3 should not be deleted. Concluding her remarks, Ms. Smith iterated that changes proposed in A.B. 141 were unnecessary and administrative convenience should not be outweighed by infringement of an individual’s liberty.

Chairman Rawson commented on A.B. 141 and asked if Ms. Smith‘s testimony was directed at the amendments to A.B. 141. Ms. Smith replied that she was speaking about the amendments. She elucidated on the current statute and practice. Ms. Smith explained that when a person is declared a danger to themselves and others by the court, a civil commitment occurs; thereafter, if the person is determined not to be a danger to themselves and others then they may be released. She pointed out that 10 days from that period if there has not been a motion brought before the court to extend their convalescent leave the leave becomes unconditional under the current statute. Chairman Rawson stated that it was an automatic process and it might cause neglect of the person. Ms. Smith said that if there was concern about an individual they could initiate a "legal 97;" then law enforcement could bring them to the facility but the individual would have to be determined to be a danger to themselves or others at that moment. She pointed out that caseworker calls or custody disputes could be abuses to this practice. Chairman Rawson referring to lines 23 through 32, page 2 of A.B. 141, remarked that in existing law the onus is on the medical director to determine if the individual is safe to be released. Chairman Rawson asked if that was correct. Ms. Smith answered in the affirmative.

Senator Washington related an incident concerning a person who was released from a facility but there was no follow-up supervision provided. He said the interim legislative committee deliberated on the issue to devise language that would suffice the needs of a person to stay out on a conditional release. Senator Washington stated the existing language in the statute was a compromise to provide supervision for an individual after being released. Chairman Rawson commented that there were two fears concerning this issue: one, the rights of an individual will be violated if they are kept institutionalized; and two, an individual being able to obtain necessary help. Chairman Rawson opined that due to the costs involved the tendency is to keep people out of institutions. Ms. Smith affirmed the analysis. She stressed that the proposed change in statute makes it easier for people to be brought into the facility and does not provide for any mandatory supervision.

Dr. Brandenberg disagreed with Ms. Smith. He said that there are clients who have a history of being incompliant with their medication and treatment. Dr. Brandenberg stated that the language change is not to make it administratively more convenient but provides the staff in state facilities a mechanism to facilitate the return of a client if it is warranted. Presently, the staff must go to a judge who issues a court order for the client to return to the facility, then the police must pick up the individual, all of which is time-consuming. Dr. Brandenberg noted that if the clinical staff determines a client needs to be returned to the facility because he or she is a danger to themselves or others, the lapse of time for their return might be critical and life-threatening. Concluding his remarks Dr. Brandenberg stressed that this was a very crucial issue.

Chairman Rawson indicated the complaint he receives is from individuals who have a suicidal family member and cannot get them admitted to a facility for their protection. Chairman Rawson acknowledged hearing instances where people are kept in a facility longer than they want to be but the complaints are not of that nature. Chairman Rawson noted that there was time to deliberate the issue but opined that A.B. 141 addresses the complaints most often voiced by his constituents. Senator Washington affirmed having received the same complaints from constituents and pointed out that there are safeguards in the bill to alleviate concerns. Chairman Rawson asked if there was any further testimony on A.B. 141. Ms. Smith responded that she had submitted written comments (Exhibit D) for the committee’s review. Chairman Rawson said that he would review the material prior to taking any action on A.B. 141 and, in addition, would like to work with her and Senator Washington on the issue.

Chairman Rawson closed the hearing on A.B. 141 and opened the hearing on A.B. 530. He then introduced P. M. "Roy" Neighbors, Esmeralda, Lincoln, Mineral and Nye counties, Assembly District No. 36

Assemblyman Neighbors stated A.B. 530 changes the maximum number from 6 to 8 times the Nevada Veterans’ Services Commission may meet in any fiscal year. Continuing, he said that the bill also provides for the commission to meet at any location selected by the chairman and shall arrange for the videoconferencing when practical. Summarizing the bill’s background Mr. Neighbors told the committee that recently at a well-attended meeting in Hawthorne they were put on notice that current law allowed them to meet in only two locations, Las Vegas and Carson City. He noted that witnesses before the Assembly Committee on Government Affairs testified that it was important for the Nevada Veterans’ Service Commission to have the authority to meet in all parts of the state so that more of Nevada’s veterans could attend. Mr. Neighbors said that under current law the meetings must alternate between the two cities. Continuing, Mr. Neighbors acknowledged that if the bill is passed every effort would be made to use videoconferencing, but veterans living in rural areas would come to the meetings in the area if called by the chairman. Mr. Neighbors urged the committee’s support of A.B. 530. Chairman Rawson asked if the commission could take action on issues when they met. Mr. Neighbors replied that they could meet but no action could be taken.

Senator Lawrence E. Jacobsen, Western Nevada Senatorial District, took responsibility for calling the meeting of the Nevada Veterans’ Service Commission in Hawthorne. He commented that when he became aware of the violation of current law it had been too late to cancel the meeting in Hawthorne, because all travel arrangements had been made and meeting notices were distributed. Senator Jacobson said that because of the location no voting had taken place. He indicated that the meeting in Hawthorne was less costly because everyone traveled by automobile. Senator Jacobson stated that videoconferencing is an alternative but is not available in all areas. Concluding his remarks, Senator Jacobson indicated that it would beneficial to the veterans in Nevada to hold meetings at various locations as needed.

Charles G. Abbott, Executive Director, Office of Executive Director for Veteran Affairs, stated that the Nevada Veterans’ Service Commission is a vital organization whose advice and input are important to the offices of the Governor and the executive director. He asserted that the intent of S.B. 530 is to allow the chairman flexibility in calling and holding meetings.

Ed Gobel, Lobbyist, Council of Nevada Veterans Organizations, applauded the concept of A.B. 530. He read an amendment (Exhibit E) which would replace section 1, subsection 3 of A.B. 530. Mr. Gobel explained this would allow meetings to be held at various sites and make the meetings accessible to everyone. He declared that in today’s world there is no reason for any veteran to be excluded; and it is imperative that all veterans receive consistent information. Mr. Gobel urged the committee to include the amendment to Assembly Bill 530. Chairman Rawson referred to the amendment’s verbiage "…No site may be selected more than once in any calendar year." Chairman Rawson inquired whether it would be a concern if the commission met at one location more that once a year. Mr. Gobel responded that it would not be a concern.

Chairman Rawson asked if it would be beneficial for the commission to have their own equipment. Senator Jacobson replied that there would be no objection. But, he reiterated that the chairman needs flexibility to call the meetings where needed. Chairman Rawson asked if the chairman would have more flexibility videoconferencing by deleting the verbiage "when practicable." Senator Jacobson replied that there might be a cost factor involved and videoconferencing does not always attract large numbers of people. Senator Mathews questioned whether there was adequate funding in the budget to accommodate videoconferencing. Chairman Rawson stated he would pursue the funding issue.

Chairman Rawson closed the hearing on A.B. 530 and opened the hearing on A.B. 94.

Mr. Abbott testified that the Office of the Executive Director for Veteran Affairs handles the two state veteran’s cemeteries that receive and distribute funds. Since 1990 all funds have been deposited and separately accounted for by the individual cemetery and in separate categories within the agency’s operating budget. He noted that a recent control and review had revealed that the Nevada Revised Statutes require the use of separate budget accounts for each cemetery. Mr. Abbott said the expenditures have been segregated by category; however, the revenues are recorded in the same general ledger account. He told the committee that the agency preferred to continue the existing practice and, therefore, needed to amend the wording of the Nevada Revised Statutes which resulted in A.B. 94.

Mr. Abbott read from prepared testimony (Exhibit F) and explained the need to amend A.B. 94 and the Nevada Revised Statutes (NRS) 417.145 to handle restricted donations made to the veterans’ home. Chairman Rawson commented that in the future there might be a need for a second veterans’ home in northern Nevada and other projects. Chairman Rawson inquired whether the amendment and A.B. 94 would include those additions. Mr. Abbott replied that the amendment and A.B. 94 were applicable to the current veterans’ homes and any other facilities or projects would need additional consideration. Chairman Rawson suggested changing the verbiage to "veterans’ homes and other projects" to avoid having to address this issue in the future. Chairman Rawson asked if the Assembly Committee on Ways and Means had reviewed the amendment. Mr. Abbott answered negatively.

Chairman Rawson closed the hearing on A.B. 94 and opened the hearing on Assembly Concurrent Resolution (A.C.R.) 6.

Kay Bennett, Board of Supervisors, Carson City, stated that Assembly Concurrent Resolution 6 was an excellent vehicle to reach out to the community. She voiced strong support of A.C.R. 6 and urged the committee to pass the bill. Senator Wiener inquired whether the adoption of the resolution would help raise money through grants. Ms. Bennett responded that the support shown by the Legislature in adopting the resolution would help in many ways.

Senator Washington asked what would constitute a community-based organization or provider.

John Yacenda, Ph.D., Deputy Director, Department of Human Resources, responded that he would be addressing that issue in his testimony. He indicated that the Department of Human Resources supports the philosophy of partnerships with the community. Dr. Yacenda said that the department does not have money in the Nevada Checkup Program budget to allow funds to be set aside for contracts with community-based organizations. He added that when funds are available the department would engage in the process and help community organizations accomplish the goals of the Nevada Checkup Program. Dr. Yacenda told the committee that the Health Care Financing Administration (HCFA) has introduced a new nationwide competitive initiative program. He said that HCFA would contract directly with community-based organizations to do outreach for the Childrens Health Insurance Program (CHIP). Dr. Yacenda emphasized that in order for a state to qualify there must be a commitment by the state to identify: the organizations; the communities; and the activities to be used to reach out to the families and children. He added that there is no financial commitment required but a commitment of personnel is necessary, which the Department of Human Resources will make. Dr. Yacenda explained that the department would be submitting a preliminary package to HCFA by May 5, 1999. In response to Senator Washington’s question, Dr. Yacenda said that community-based organizations generally are nonprofit entities based in communities serving a locale within a geographic location and have a volunteer governing board. He defined such organizations as; churches; Boy-Scout troops; Girl-Scout troops; or organizations that serve the communities in various ways.

Senator Washington questioned whether participation by a community-based organization was mandatory in the CHIP program. Dr. Yacenda replied that no community-based organization would be required to promote the program or solicit applications. Senator Washington asked if nonparticipation in the program would exclude them from future programs. Dr. Yacenda emphasized the key is to encourage all organizations to participate and not to exclude anyone. Concluding his remarks, Dr. Yacenda told the committee the recent statistics on the Nevada Checkup Program are: 11,616 applicants since the program’s inception; of which 6359 children were approved for the program, and 5380 children enrolled in the program.

Roberta A. Gang, Lobbyist, Nevada Womens Lobby, and the National Association of Social Workers, Nevada Chapter, voiced support of A.C.R. 6. Ms. Gang stressed the need for outreach to enroll children in the Nevada Checkup Program. She said that by using community-based organizations and essential community providers we will be reaching families that would not be reached by ordinary marketing techniques. Ms. Gang stated that there are misconceptions about the program because people believe that if they were not eligible for Medicaid then they would not qualify for the Nevada Checkup Program. In conclusion, Ms. Gang stated that the Nevada Womens Lobby and the National Association of Social Workers, Nevada Chapter, encourage all efforts to expand and market the Nevada Checkup Program through as many agencies as possible.

Chairman Rawson closed the hearing and requested a motion on A.C.R. 6.

SENATOR WIENER MOVED TO ADOPT A.C.R. 6.

SENATOR MATHEWS SECONDED THE MOTION.

Senator Washington stated that it would not affect his vote on A.C.R. 6 but he voiced his concern regarding the organizations that do not participate in or solicit for the Nevada Checkup Program being excluded from future programs.

THE MOTION CARRIED. (SENATORS TOWNSEND AND SCHNEIDER WERE ABSENT FOR THE VOTE.)

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Chairman Rawson adjourned the meeting at 3:22 p.m.

RESPECTFULLY SUBMITTED: