MINUTES OF THE meeting
of the
ASSEMBLY Committee on Commerce and Labor
Seventy-First Session
May 7, 2001
The Committee on Commerce and Labor was called to order at 3:52 p.m., on Monday, May 7, 2001. Chairman Joseph Dini, Jr. presided in Room 4100 of the Legislative Building, Carson City, Nevada. Exhibit A is the Agenda. Exhibit B is the Guest List. All exhibits are available and on file at the Research Library of the Legislative Counsel Bureau.
COMMITTEE MEMBERS PRESENT:
Mr. Joseph Dini, Jr., Chairman
Ms. Barbara Buckley, Vice Chairman
Mr. Morse Arberry Jr.
Mr. Bob Beers
Mrs. Dawn Gibbons
Ms. Chris Giunchigliani
Mr. David Goldwater
Mr. Lynn Hettrick
Mr. David Humke
Ms. Sheila Leslie
Mr. Dennis Nolan
Mr. John Oceguera
Mr. David Parks
Mr. Richard D. Perkins
GUEST LEGISLATORS PRESENT:
Senator Bernice Mathews, District No. 1
Senator Raymond D. Rawson, District No. 6
Assemblywoman Bonnie Parnell, District No. 40
Assemblyman Bob Price, District No. 17
STAFF MEMBERS PRESENT:
Vance Hughey, Committee Policy Analyst
Rebekah Langhoff, Committee Secretary
OTHERS PRESENT:
Danell Fanning, Certified Interpreter, Vital Signs Interpreting Service, Carson City, Nevada
Carrie Cormany, Private Citizen, Virginia City, Nevada
Heather Warner, Student, Stateline, Nevada
Barry Sewell, Private Citizen, Wells, Nevada
Karla Lentz, Interpreter, Carson City, Nevada
Gemma Waldron, Legislative Representative, Washoe County District Attorney’s Office, Reno, Nevada
Marcia A. Wilson, Private Citizen, Carson City, Nevada
Kim Gill, Private Citizen, Dayton, Nevada
Carolyn White, Private Citizen, Lyon County, Nevada
Dotty Merrill, Legislative Representative, Washoe County School District, Reno, Nevada
Beth Mammen, Management Analyst, Administrative Office of the Courts, Carson City, Nevada
Max Bunch, Justice of the Peace, Argenta Justice Court, Battle Mountain, Nevada
Mariteresa Rivera-Rogers, Coordinator of Interpreter Services, Eighth Judicial District Court, Las Vegas, Nevada
Charlotte Brothwell, Legislative Representative, Nevada Classified School Employees Association, Sparks, Nevada
Ann Drendel-Haas, Coordinator of Student Support Services, Carson City School District, Carson City, Nevada
Sammy Milburn, Private Citizen, Special Education Teacher, Las Vegas, Nevada
Lynda Simons, Private Citizen, Las Vegas, Nevada
Neena Laxalt, Legislative Representative, Nevada Podiatric Medical Association, Reno, Nevada
Mark Rawson, DPM, President, Nevada Podiatric Medical Association, Las Vegas, Nevada
Cathy Bax, DPM, Representative, Nevada State Board of Podiatry, Carson City, Nevada
John Ellerton, M.D., Vice Chief of Staff, University Medical Center, Representative, Nevada State Medical Association, Las Vegas, Nevada
Joseph Walls, M.D., Orthopedic Surgeon, Nevada State Medical Association, Las Vegas, Nevada
Paul Canalie, M.D., Orthopedic Surgeon, Las Vegas, Nevada
Michael Monroe, M.D., Orthopedic Surgeon, Foot and Ankle Surgeon, Las Vegas, Nevada
Troy Watson, M.D., Orthopedic Surgeon, Las Vegas, Nevada
Robert Barengo, Legislative Representative, Nevada State Board of Medical Examiners, Reno, Nevada
Larry D. Lessly, Executive Director, Nevada State Board of Medical Examiners, Reno, Nevada
Dr. Paul Stewart, Secretary/Treasurer, Nevada State Board of Medical Examiners, Reno, Nevada
Cheryl Hug-English, Member, State Board of Medical Examiners, Faculty Member, School of Medicine, University of Reno Nevada, Reno, Nevada
Michael J. Garcia, Registered Respiratory Therapist, President, Nevada Society of Respiratory Care, Las Vegas, Nevada
Carlton R. Insley, III, Program Director, Cardiorespiratory Sciences Program, Community College of Southern Nevada, Las Vegas, Nevada
Arthur Little, Director, Cardiopulmonary Services, Mountain View Hospital, President-Elect, Nevada Society of Respiratory Care, Las Vegas, Nevada
Donald Wright, Registered Respiratory Therapist, Vice President, Nevada Society of Respiratory Care, Las Vegas, Nevada
Chris Ferrari, Legislative Representative, Nevada Association of Nurse Anesthetists, Carson City, Nevada
Robin Keith, President, Nevada Rural Hospital Project, Reno, Nevada
Caroline Ford, Assistant Dean, University of Nevada School of Medicine, Director, State Office of Rural Health, Reno, Nevada
Greg Rollson, Director, Respiratory Therapy, St. Mary’s Hospital, Reno, Nevada
John Steinmetz, Director of Clinical Service, HealthSouth Rehabilitation Hospital, Las Vegas, Nevada
John Vergiels, Legislative Representative, Nevada Association of Mortgage Brokers, Las Vegas, Nevada
Cathie Jackson Ford, Regional Vice President, Nevada Association of Mortgage Brokers, Carson City, Nevada
Kami Dempsey, Legislative Representative, Las Vegas Chamber of Commerce, and Retail Association of Nevada, Las Vegas, Nevada
Sydney Wickliffe, Director, Department of Business and Industry, State of Nevada, Carson City, Nevada
Scott Walshaw, Commissioner, Financial Institutions Division, Department of Business and Industry, State of Nevada, Carson City, Nevada
Ted Wehking, Legislative Representative, Nevada Bankers Association, Reno, Nevada
Janice Pine, Legislative Representative, Saint Mary’s Health Network, Reno, Nevada
Fred Hillerby, Legislative Representative, Nevada State Board of Nursing, Reno, Nevada
Jim Caumiant, Legislative Advocate, Operating Engineers Local Union No. 3 AFL-CIO, Reno, Nevada
Chris Salm, Representative, Nevada Service Employees Union, Las Vegas, Nevada
Betty Razor, Representative, Nevada Nurses Association, Henderson, Nevada
Roll was called and a quorum was present. Chairman Dini opened the hearing on S.B. 245.
Senate Bill 245: Provides for regulation of interpreters for persons who are deaf or whose hearing is impaired. (BDR 54-231)
Danell Fanning, Certified Interpreter, Vital Signs Interpreting Service, testified in support of S.B. 245 and provided her written statement for the record (Exhibit C). Ms. Fanning indicated the purpose of the bill was to establish a minimum standard of skill for sign language interpreters working in the state of Nevada utilizing recognized national testing systems. She felt it was important to focus on a person’s mental and physical ability to interpret, and not on which sign system a person used. Ms. Fanning pointed out the effective date of the bill was July 1, 2003, for both court and medical interpreters and educational interpreters, and she noted those in opposition to the bill felt the effective date was unreasonable for educational interpreters due to the large number of interpreters employed.
Ms. Fanning read a letter in support of S.B. 245 prepared by Peggy Williams, who was unable to attend the hearing (Exhibit D). Ms. Williams indicated her deaf aunt was denied an interpreter at a hospital and was sent home with a note which stated she needed a new valve in her heart and without a new valve she would die. Ms. Williams advised that English was her aunt’s third language and the note “was not worth the paper it was written on.” Ms. Williams also advised she was the child of a deaf adult and was often called upon to sign for her mother. Ms. Williams indicated she learned to sign before she learned to speak, and she firmly believed there was a difference between a person who could sign and a person who could interpret, and she advocated the evaluation and documentation of the training and abilities of professional interpreters.
Carrie Cormany, Private Citizen, testified in support of S.B. 245 and provided her written statement for the record (Exhibit E). Ms. Cormany indicated her son became deaf at age five and at age six the school hired an interpreter part-time, however, the school district did not require the interpreter to have knowledge of American Sign Language, which was the modality her son used. Ms. Cormany was asked to pick up her son early from school everyday because the interpreter only worked four hours a day and she felt her son did not receive the same educational opportunities as the hearing students. Ms. Cormany indicated an interpreter was hired full time when her son was seven but Ms. Cormany wondered what good it did to require teachers to have a bachelor’s degree when interpreters were only required to take a few classes and could not adequately interpreter the subject matter being taught. Ms. Cormany asserted her son had the right to the same education as hearing children and urged the committee to pass S.B. 245.
Heather Warner, Student, provided a written statement in support of S.B. 245 for the record and told the committee, through the use of an interpreter, she was deaf and went to high school (Exhibit F). Ms. Warner indicated she had an interpreter at school but not for her last class because the interpreter was only hired part-time.
Mr. Nolan asked whether Ms. Warner’s interpreter was able to adequately interpret the class material in a way that was helpful and complete. Ms. Warner answered affirmatively.
Barry Sewell, Private Citizen, testified in favor of S.B. 245 via videotape and the use of an interpreter. Additionally, as Mr. Sewell was deaf, he provided a written copy of his testimony, together with a copy of his videotape for the record (Exhibit G and Exhibit H). Mr. Sewell indicated his son was also deaf and he told the committee of the difficulty he experienced communicating with the school district in his rural community about his son’s academic needs without the assistance of a qualified interpreter. The school district refused to hire a certified interpreter and the teacher’s aide the school district relied upon was only able to finger spell and practice limited signs. Mr. Sewell was concerned because his son could sign fluently and felt his son’s education was hindered by the lack of the interpreter’s ability to interpret. The school district informed Mr. Sewell that they were not required by law to provide a certified interpreter and would only provide a teacher’s aide. Mr. Sewell did not want his son to slow down his communication and education because the teacher’s aide provided by the school district could not keep up with him. Accordingly, Mr. Sewell now home schooled his son but he urged the committee to pass S.B. 245 to provide the deaf community with equal opportunities in life and employment.
Senator Bernice Mathews, primary sponsor the bill, noted the effective date for mandatory certification had been changed to 2003 due to the urgent need for certified interpreters in the educational area.
Chairman Dini expressed concern that rural counties may experience trouble finding qualified people for certification. Senator Mathews noted Chairman Dini’s concern was raised in the Senate hearing on the matter, and she did not feel extending the deadline for certification would address the concern. She felt the problem was the ability possessed by interpreters and not the availability of the interpreters.
Mr. Nolan asked how many different sign languages existed and wondered whether a specific language was subject to certification. Ms. Fanning responded there currently were 17 different sign systems used within the United States and S.B. 245 was not applicable to any specific language. The bill addressed the interpreter’s ability to work in a specific language or mode.
Mr. Nolan asked whether certification could be obtained through the community colleges that were teaching sign language. Ms. Fanning noted there was a critical national shortage of interpreters throughout the United States and stated both the Western Nevada Community College and the Community College of Southern Nevada offered interpreter training courses. Mr. Nolan asked whether the certification examination was administered as a part of the available classes. Ms. Fanning indicated testing was separate from the degree given by the colleges, but noted any community college could act as a test site for the certification.
Senator Mathews noted educational courses offered over the Internet would assist rural counties with the certification process because an individual would not have to leave home to take necessary courses.
Mr. Hettrick wondered whether video-conferencing could be used in the rural counties to allow a certified interpreter to appear by video and still satisfy the requirements of the bill. Mr. Hettrick noted video-conferencing would not work for educational purposes, but he felt it might reduce the impact on the rural counties. Ms. Fanning indicated interpreters in South Dakota and Wyoming used video-conferencing. Mr. Hettrick asked whether there was any way video-conferencing could be used for educational purposes. Ms. Fanning responded it could be done through the use of a computer monitor. Mr. Hettrick asked whether any provision of S.B. 245 prohibited the use of video-conferencing for interpreters. Ms. Fanning confirmed there was nothing in the bill contrary to the use of video-conferencing.
Mr. Beers inquired what part technology played in the bill. Ms. Fanning stated computers were 21 percent slower than the human mind and much less accurate.
Senator Mathews felt the real concern was the ability and proficiency of the interpreters. Chairman Dini noted it was children in school who were getting short-changed by the lack of certification of interpreters.
Mr. Hettrick asked what the typical salary was for a certified interpreter. Ms. Fanning noted pay for a certified interpreter depended largely upon region and level of certification. She stated an uncertified freelance interpreter in the state of Nevada was paid $15 per hour and a certified freelance interpreter was paid $20 to $30, depending on the level of certification. Ms. Fanning noted the pay for interpreters in Nevada was far below the minimum standards.
Mr. Hettrick asked whether there were statistics on the number of people in the school districts that needed interpreters. Ms. Fanning did not have any figures, but noted there were over 400 deaf students in Clark County alone, although she had no idea how many interpreters were employed by any of the school districts.
Ms. Fanning noted school districts paid wages according to a classification listing and she did not know whether interpreters were considered classified or unclassified employees. She indicated the effective date of 2003 was suggested by the Senate to allow the school districts more time to address the financial impact of the bill. Senator Mathews noted deaf children would continue to lack in education during those two years and felt it was crucial that the effective date of the bill not be further delayed.
Karla Lentz, Interpreter, told the committee she was the interpreter for Heather Warner, who previously testified, and she taught American Sign Language (ASL) at Lake Tahoe Community College. She noted she was hired part time as Ms. Warner’s interpreter without any evaluation of her skills, and she stated no one involved in the hiring process had any knowledge of sign language. Ms. Lentz stated Ms. Warner only had an interpreter half of the day and she felt the quality of Ms. Warner’s education without an interpreter was questionable. She also stated she received pressure from Douglas County to Sign Exact English (SEE), although Ms. Warner was an ASL signer. Ms. Lentz indicated that during her five years of teaching she had not met a qualified interpreter and she often had students in her sign language classes who were already working as interpreters and were struggling to learn the material in her class. Ms. Lentz stated she fully supported S.B. 245 and noted sign language was not innate and must be taught.
Mr. Nolan asked whether there were a wide variety of dialects between the different sign languages and sought confirmation that no one particular language was required for certification but rather that certification was based on proficiency in ability to interpret any language. Ms. Lentz indicated her understanding was that the evaluation process would focus on matching the interpreter with the person they were serving to ensure the language was a match. Ms. Fanning indicated that each assessment would match an interpreter’s ability to the test stimulus. She noted there were two levels of certification offered, and indicated a certificate of interpretation addressed a person’s ability to go from one language to another, while transliteration addressed a person’s ability to go from one language, such as English, to another form of the same language, such as some form of signed English. Ms. Fanning felt the bill established that the most important factor in certification was the preference of the deaf person being served and secondly whether the skills and ability of the interpreter matched the needs of the deaf person. The bill did not focus on the language of any particular system, school district or deaf person, but was solely based on an interpreter’s ability to manipulate language accurately and effectively.
Mr. Nolan wondered what would happen if a willing and able interpreter did not match the needs of a student in a rural county. Ms. Fanning pointed out the potential for drastic consequences when language was not interpreted accurately, particularly in the courts, and she felt the bill set a bar and those who were willing to work as interpreters should step up to the bar to ensure they were helping and not hindering. Ms. Fanning did not feel S.B. 245 handicapped rural communities and noted qualified interpreters were needed everywhere and the only way to ensure interpreters were qualified was to establish a standard.
Mr. Beers asked how many states fully regulated interpreters. Ms. Fanning indicated 5 states simply required identification from an association of interpreters and 28 other states had some form of regulation of interpreting. Ms. Fanning noted the bill included the most readily available national testing systems in Nevada.
Mr. Beers indicated he browsed a website that reflected some states only regulated interpreting for legal and/or educational purposes and he stated there appeared to be variations on qualifications. Ms. Fanning suggested Mr. Beers review the website for the National Association of the Deaf, which listed all 50 states and the requirements for certification in each state. Mr. Beers stressed that many states did not require certification and he wondered how prevalent regulation of interpreters was throughout the United States. Mr. Beers also noted the language contained in the bill was not the model language put together by the Registry of Interpreters for the Deaf (RID). Ms. Fanning indicated the initial bill did incorporate RID model language and the Senate would not approve the bill because it would have been too costly and cumbersome.
Mr. Beers asked how long the Americans With Disability Act (ADA) had been in place and wondered if the Act had encouraged people to choose interpreting as a career. Ms. Fanning indicated the ADA had been in place for ten years and noted there was an increase in people choosing interpreting for a career.
Gemma Waldron, Legislative Representative, Washoe County District Attorney’s Office, testified in support of S.B. 245. She told the committee of a case involving a deaf victim and deaf witnesses which went through the preliminary stages of the criminal process and it was not until later that it came to the district attorney’s attention that the interpretation was not up to standard. Ms. Waldron pointed out how important adequate interpretation was in a criminal setting in order to get to the truth of the matter at hand. Ms. Waldron indicated she handled a case in which a criminal defendant was deaf and used the services of a certified interpreter, and she stated she felt very comfortable with the interpreter’s skills and ability. She stated certified interpreters were crucial to advise deaf criminal defendants of their rights and, as a prosecutor, Ms. Waldron stated it was critical that defendants understand the process because their freedom was often at stake.
Assemblywoman Bonnie Parnell, Assembly District 40, stated her position was neutral on S.B. 245, however having been an educator, Ms. Parnell felt she represented the educational component of the bill. Ms. Parnell indicated there were areas within the state where access to classes necessary for certification was not readily available. Ms. Parnell introduced Marcia Wilson who advocated amendments to the bill with regard to educational interpreters.
Marcia A. Wilson, Private Citizen, told the committee she was a teacher for the deaf in Northern Nevada and read from prepared testimony (Exhibit I). Ms. Wilson felt some of the changes made to the bill presented difficulties, primarily in implementation. Ms. Wilson supported the intent of the bill but she believed interpreters working in the educational field were uncertified and she stated an effective date of five years was necessary in order to allow interpreters to become certified. Ms. Wilson stated Nevada was experiencing a critical shortage of interpreters and felt provisions were necessary to allow more time for people to become certified. Ms. Wilson asked the committee to consider an amendment allowing interpreters who were already working to be grandfathered in so that deaf children were not left without the few interpreters they already had.
Mr. Nolan felt deaf children in rural counties had just as much need as deaf children in other areas, and he expressed concern the bill would preclude uncertified people from assisting in rural counties leaving deaf children in those counties with no help at all. Mr. Nolan indicated he was not opposed to the idea of a grandfather clause in order to prevent a loss of services to deaf children.
Ms. Wilson indicated teleconferencing and remote interpreters could be used but time was needed in order to put those services in place. As to educational interpreters, Ms. Wilson noted there was not always the luxury of selecting from an interpreting agency in order to get a good match.
Ms. Leslie indicated she understood the concern over the time frame, but she felt two years was sufficient time to get people trained. She stated she would object to a grandfather provision because there could be an incompetent uncertified person currently working who would never be required to become certified. Ms. Wilson responded that although two years seemed like an adequate amount of time, it was not sufficient to develop training programs for interpreters, set up technology and put into place all necessary elements of the program. She indicated she would like to see interpreters receive an initial evaluation, obtain training and education in areas of weakness and then receive a re-evaluation for a level certification.
Ms. Parnell suggested a modification to Section 9 of the bill to amend the effective date from July 1, 2003, to July 1, 2005 in order to address the concern over the implementation time frame for those interpreting for educational purposes, while not perpetuating the problems caused by uncertified interpreters created by including a grandfather provision in the bill.
Ms. Fanning clarified the difference between a person who signed and a person who interpreted, and noted a signor was a person who was not yet fluent, while an interpreter must be fluent. She also indicated it was the responsibility of a professional interpreter to learn to match the needs of their client, and suggested an interpreter should withdraw if they could not match the needs of their client. Ms. Fanning did not believe that a grandfather provision was a good idea because people had no incentive to get the training and education necessary to provide adequate interpretation.
Kim Gill, Private Citizen, read from prepared testimony and told the committee about her deaf son, Jonathan (Exhibit J). Ms. Gill indicated she had no idea about all of the issues, cultural and medical, that surrounded deafness when Jonathan was diagnosed. With the help of the Carson City School District, and after conducting her own research, she decided on Signing Exact English (SEE) as her son’s modality of sign. Ms. Gill felt S.B. 245 was seriously flawed because it did not take into consideration the difference in the amount of time certification required for each of the different modalities of sign. She stated there were no programs available for SEE certification in the western United States and she questioned where SEE interpreters would go for certification. Ms. Gill believed S.B. 245 must be amended to extend the deadline for all interpreters to become certified to allow equal opportunity for all modalities of sign language. She felt that if the deadline for certification remained at July, 2003, the availability of SEE interpreters to deaf people who used the SEE modality would be severely decimated. Ms. Gill noted that American Sign Language (ASL) was a foreign language to a lifetime SEE signer. Ms. Gill concluded by urging the committee to adjust the deadline to allow interpreters of sign modalities other than ASL adequate time to become certified.
An article was submitted for the record without comment by Maureen Fradianni (Exhibit K).
Carolyn White, Private Citizen, spoke to the committee about being a rural interpreter and noted she lived in Lyon County and was employed in Storey County. Ms. White indicated she continually took classes to continue her signing education although she was not certified. She believed she could become certified within the two-year time limit imposed by S.B. 245 even with the limited opportunities available for education. Ms. White felt the longer the deadline for certification was extended the longer the education of deaf children suffered. She stated she was aware of a SEE workshop that was set up for SEE interpreters in September.
Dotty Merrill, Legislative Representative, Washoe County School District, indicated there were 473 students in the state of Nevada receiving services for the deaf or hearing impaired. Ms. Merrill stated there were 60 to 70 deaf or hearing-impaired students in Washoe County and there were 6 full-time classroom teachers serving those 60 to 70 students. She indicated Washoe County School District had approximately ten interpreters who were not certified teachers, but who were classified employees, and when all staff and students were added together there were about four children to one interpreter or classroom teacher. Ms. Merrill stated the teachers used both exact language and ASL and interpreted for students in the classroom and elsewhere. She expressed concern over the certification requirements for teachers who were already teaching as well as the conflict and cost of paying licensed interpreters more than classroom teachers were paid.
Chairman Dini asked whether any of the interpreters employed by the school district were certified, and Ms. Merrill indicated none of the interpreters were certified.
Mr. Beers asked whether interpreters, as classified employees, started at the teacher’s pay scale. Ms. Merrill indicated as classified employees, interpreters received an hourly wage between $8 and $12 per hour.
Beth Mammen, Management Analyst, Administrative Office of the Courts, read from prepared testimony from a neutral position on S.B. 245 (Exhibit L). Ms. Mammen provided the committee with information on the impact of S.B. 245 on the courts and the deaf community, which included information relating to background/statistics, limited resources, screening criteria/judges discretion, cost, affectivity and enforcement.
Senator Mathews noted the provision of the bill in Section 30 that required courts to utilize only certified interpreters effective October 1, 2001, should be amended to July 1, 2003.
Max Bunch, Justice of the Peace, Argenta Justice Court, stated it was essential to ensure defendants were protected and provided with their due process rights. Judge Bunch offered the example of a deaf person who appeared for a traffic citation and noted deaf persons generally brought a friend or family member who signed to interpret for them. Judge Bunch indicated his job was to ensure that the defendant understood what was happening and voluntarily entered a plea as to the charges against them. He noted a judge should have discretion to determine whether the defendant understood the proceedings and whether to go forward in writing or with the interpreter brought by the defendant. If the judge determined the defendant did not understand, a certified interpreter could be obtained. Judge Bunch acknowledged the courts would have to bear some of the costs associated with certified interpreters and he further acknowledged the use of video conferencing was a good idea, but he felt it would take some time and money for the rural courts to avail themselves of that opportunity. Chairman Dini noted some counties already conducted video arraignments.
Mariteresa Rivera-Rogers, Interpretation Coordinator, Eighth Judicial District Court, indicated she was also a federally certified court interpreter and stated she administrated the Americans with Disability Act (ADA) compliance and accommodations for persons with disabilities for the district court. Ms. Rivera-Rogers agreed that certified sign interpreters should be used for most court proceedings and noted that the Eighth Judicial District Court already used certified interpreters for court proceedings and, accordingly, would not be affected by the mandate of S.B. 245. Ms. Rivera-Rogers stated there was difficulty in procuring certified sign interpreters, noting there was a great demand for certified interpreters but only a limited number of certified interpreters. She stated the scheduling of certified sign interpreters was the most challenging task of her office, and her main concern was that compliance with S.B. 245 would be next to impossible with the current resources available. Ms. Rivera-Rogers stated delays of scheduled proceedings because of interpreters’ schedule should be anticipated and noted for hearings lasting over one and a half hours, it was necessary to schedule two interpreters to ensure the interpretation was accurate and did not suffer from interpreter fatigue. She noted her office imported out-of-state interpreters when needed, and stated the cost for importing certified interpreters would be prohibitive for many jurisdictions. Ms. Rivera-Rogers stated the technology necessary to utilize the possibility of video conferencing was not readily available in many courts.
Additionally, Ms. Rivera-Rogers noted many other instances, beside the courtroom, in which certified interpreters were utilized by the courts, including jury services, county commission meetings, and traffic school, and stated these situations deserved thoughtful consideration when assigning an interpreter who was qualified. She noted some situations did not involve complicated language or specialized vocabulary that would prevent a qualified, yet not certified, interpreter from doing an adequate job. In these situations, Ms. Rivera-Rogers believed that a judge should have the discretion to authorize a qualified interpreter to interpret if a certified interpreter was not available and noted this would be very important to rural courts.
Mr. Goldwater asked whether there were any statistics available on the number of hearing impaired people requiring interpreters from the courts. Ms. Rivera‑Rogers replied that during the year 2000 her office assigned 525 interpreters for different proceedings and the cost to the county was $21,156.
Charlotte Brothwell, Legislative Representative, Nevada Classified School Employees Association provided her written testimony for the record (Exhibit M). Ms. Brothwell stated classified interpreters in schools worked under the supervision of certified people and noted she heard more positive stories about uncertified interpreters than not. She indicated she did not know how school districts would be able to pay fully certified interpreters.
Ms. Fanning reiterated the point of the bill was not the disparity between the different languages that were used but was whether the interpreter, regardless of the language modality used, had the skill to interpret. She stated if a teacher, however compassionate, did not have good skills, the teacher would not be able to adequately teach the material. Ms. Fanning did not feel the comparison between the salary for a starting teacher and the salary for a fully certified interpreter was fair. As to the use of interpreters in the courts, Ms. Fanning stated she believed the judge should have the discretion to qualify any interpreter, and noted she was willing to work with the courts to establish guidelines.
Ann Drendel-Haas, Coordinator of Student Support Services, Carson City School District, asked the committee to consider the development of regulations that would provide specific guidance and policy to address the anticipated shortage of personnel should S.B. 245 pass. Ms. Drendel-Haas stated the federal law that governed the provision of all special education and related services was known as the Individuals With Disabilities Education Act (IDEA) and had been in existence since 1973, together with Section 34 of the Code of Federal Regulations, which further clarified the inherent requirements of IDEA. Ms. Drendel-Haas asked for the committee’s review and consideration of the governing language in Section 300.136, a copy of which was submitted for the record (Exhibit N). Additionally, Ms. Drendel-Haas felt the fiscal note attached to the bill was not accurate in light of the testimony provided regarding salaries.
Sammy Milburn, Private Citizen, Special Education Teacher, told the committee he was a certified interpreter and the oldest son of deaf parents. Mr. Milburn indicated he supported S.B. 245 because he had seen the impact of interpreters on his parents’ life. He stated his mother relied on interpreters for doctor’s appointments and noted her medical condition was serious. He stated several of his mother’s medical interpreters were not qualified and went beyond the scope of interpretation by giving her advice. Mr. Milburn noted there was no definition of a “qualified interpreter” for ADA purposes, and he hoped S.B. 245 would provide a clear definition of a qualified interpreter and promote a professional standard for all working interpreters. Mr. Milburn felt there would be no fiscal impact to school districts due to the cost for certified interpreters because pay schedules were already in place. As to the educational opportunities available for certification, Mr. Milburn noted there was a federal grant offered for a mentoring program to assist in the training of interpreters in rural and metropolitan areas.
Lynda Simons, Private Citizen, told the committee she had been deaf since birth and worked for the Clark County School District as a Special Education Administrator. Ms. Simons indicated she was responsible for screening and evaluating all interpreters in the Clark County School District and she felt only one-fourth of the people she evaluated were qualified to be educational interpreters. She believed interpreters should be certified to guarantee that interpreters were complying with the code of ethics, and she opposed any grandfathering provision for current educational interpreters.
Chairman Dini closed the hearing on S.B. 245 and opened the hearing on S.B. 405.
Senate Bill 405: Makes various changes relating to practice of podiatry. (BDR 54-38)
Senator Raymond D. Rawson, sponsor of the bill, indicated the Nevada Podiatric Association asked that a bill be drafted to allow podiatrists to amputate toes and to clarify confusing language contained in the NRS. He stated most concerns and objections regarding amputation were dealt with on the Senate side, and indicated amputations would be performed in hospitals or surgery centers at the same standards required of physicians. Senator Rawson advised that a change in the NRS in 1993 created confusion by listing podiatric physicians as physicians without clarifying all elements of the law or removing a previous section which listed podiatrists as allied health. Senator Rawson stated a podiatrist was educated to the doctoral or post doctoral level and was not allied health which was considered ancillary in the hospitals and included people who had as little as a two year certificate. He indicated podiatrists practiced in 80 percent of hospitals, but because of the confusing language, county hospitals referred to podiatrists as allied health, and accordingly, did not let podiatrists participate in staff privileges. Senator Rawson indicated there was not wide spread opposition by orthopedic surgeons or general surgeons because podiatrists and orthopedic or general surgeons often referred to each other. Senator Rawson concluded by stating his belief that the bill was well-conceived, good public policy, and in the best interest of all of the professions.
Neena Laxalt, Legislative Representative, Nevada Podiatric Medical Association, reviewed the provisions of the bill as it was reprinted from the Senate. Ms. Laxalt explained Section 1 allowed the amputation of the toe by a podiatrist who was certified by the board to perform the procedure and further provided the performance of amputations would only be allowed in a hospital or surgical center. Additionally, Section 1 mandated amputations by podiatrists to be performed with the same standard of care as other physicians. Ms. Laxalt advised Section 2 of the bill deleted the term “podiatry as defined in Chapter 635 of NRS.” As to Sections 3 and 4, Ms. Laxalt indicated the modifications clarified inconsistent language as pointed out by Senator Rawson. Ms. Laxalt concluded by advising she previously met with Dr. Ellerton and agreed to the amendment that he would later propose.
Mark Rawson, DPM, President, Nevada Podiatric Medical Association, stated the purpose of S.B. 405 was to allow podiatrists to amputate toes and to ensure podiatrists received medical staff privileges at all hospitals. Dr. Rawson provided the committee with information on the legislative history and background of the bill as it pertained to Sections 2, 3 and 4 (Exhibit O), a letter in support of S.B. 405 from Robert Larson, DPM (Exhibit P), and a written presentation from the Nevada Podiatric Medical Association on the bill and podiatry and amputations in general (Exhibit Q).
Dr. Rawson stated podiatric medicine was basically foot and ankle care, and noted there were seven podiatric medical schools in the country at which podiatrists were required to attend four years of post-college level education and one to four years of residency training. He indicated 43 states allowed podiatrists to amputate toes, together with every Veteran’s Affairs (VA) facility in the country. Dr. Rawson discussed Exhibit Q in detail, including the following:
Dr. Rawson noted compromises were reached on the Senate side to provide that amputations would only be performed in a hospital or surgical center and the same standard of care required of physicians would be required of podiatrists. However, he indicated Section 2 was still contested because podiatrists would no longer be classified as allied health. Dr. Rawson stated allied health was an ancillary term, used for ancillary members of hospital staff, such as psychologists, physical therapists, and occupational therapists, and a podiatric surgeon did not fit under allied health and should be classified as medical staff. Dr. Rawson noted podiatrists wanted to work with hospitals and did not want to be mandated as member of medical staffs but they wanted the opportunity to perform their specialty and would be subject to the same credentialing process as any other member of the medical staff.
Ms. Buckley indicated she was aware of information submitted to the University Medical Center (UMC) which contained a code list for procedures to be performed that included amputation of the foot at the ankle. She noted there was concern that currently amputation was illegal under statute, and she wondered what was implied by the inclusion of that procedure. Dr. Rawson responded it was currently illegal for a podiatrist to perform any amputation in Nevada and stated his understanding that UMC would make up its own list of procedures that podiatrists could perform at UMC and such a list would not be mandated. He did not feel amputation of the foot at the ankle should be on a credentialing list as the procedure would still be illegal for podiatrists in Nevada.
Chairman Dini noted the bill specifically provided that podiatrists could not amputate a leg or foot.
Dr. Rawson noted each hospital had its own process for credentialing. Typically, a list of procedures of the foot was provided to the podiatrist and the podiatrist checked off the procedures for which he was trained. He indicated he had seen a credentialing service in southern Nevada that listed amputation but he was not sure how amputation ever became a part of their credentialing.
Ms. Buckley noted the concern was that amputation was illegal and would continue to be illegal, and yet it was submitted on a doctor’s list of procedures to be performed. Dr. Rawson stated S.B. 405 provided only for the amputation of toes and noted a credentialing service had no authority over a hospital, surgical center, or the Nevada Revised Statutes.
Chairman Dini confirmed podiatrists were permitted to perform amputations in VA hospitals. Dr. Rawson indicated podiatrists had been able to perform amputations through the federal service for years.
Mr. Beers indicated he was confused as to why Section 3 was included in the bill, and stated he would hate to see every variety of physician added to the list over the coming years. He asked whether podiatrists had been discriminated against based on the classification as allied health. Dr. Rawson reiterated that Section 3 was the contested portion of the bill, and he indicated the reason for Section 3 was to take podiatrists out of the classification as allied health and classify podiatrists as medical staff because of their different definition as a physician and to allow podiatrists to practice their specialty at hospitals.
Mr. Beers sought confirmation that state law provided a definition of physicians that did not include podiatrists. Dr. Rawson stated NRS 635 concerned only podiatry, and podiatrists accordingly were not included in the statute that defined and pertained to physicians.
Mr. Beers asked what education was required of a medical doctor that was not required of a podiatrist. Dr. Rawson noted podiatrists attended specialized medical schools and specialized only in the foot and ankle.
Cathy Bax, DPM, Representative, Nevada State Board of Podiatry, indicated the Podiatry Board unanimously supported S.B. 405 and was prepared to adopt regulations for podiatrists who were trained to perform amputations.
John Ellerton, M.D., Vice Chief of Staff, University Medical Center, Representative, Nevada State Medical Association, indicated the Medical Association maintained its opposition S.B. 405. He expressed concern over the expansion of the podiatrists’ scope of practice in a legislative fashion and felt such an expansion would continue. Dr. Ellerton stated in the agenda for the recent county commission/board of trustees for UMC meeting, there was a contract presented that provided podiatric services for AIDS patients. He stated the contract included a series of codes and procedures supplied by the podiatrists, not a hospital or credentialing service, which included the code and a charge for amputation of a foot at the ankle and a number of other procedures, such as the radical resection of a tumor, which could often include amputation of a limb. Dr. Ellerton indicated he was gravely concerned that promises by the podiatrists asserting podiatrists did not want to expand their scope of practice were false promises. He noted the prices contained in the contract were rather expensive and did not support the claim of cost containment through the use of podiatrists.
Mr. Nolan asked, from a patient care perspective, why the medical association opposed the bill if podiatric physicians were educated and trained on how to perform the procedures and other states permitted the practice. Dr. Ellerton felt the issue was an example of ultimate specialization and stated the foot was attached to a person and many conditions of the foot were a result of or were in themselves complicated medical conditions. He stated it was difficult to accept that a podiatric physician was trained the same way a medical doctor was trained, and he noted podiatrists focused immediately on the treatment of diseases of the foot with no more general training in the function of the human body.
Mr. Hettrick asked whether the bill was truly an expansion of scope of practice for podiatrist or whether it was a clarification of the earlier law. Dr. Ellerton clarified that podiatrists were on staff at UMC but were defined statutorily as allied health personnel, which meant they had to have a sponsoring physician and the sponsoring physician had to have the privileges the allied health person was to have. He did not feel the earlier law made podiatrists independent members of the medical staff, with an independent section and an independent vote, and reiterated his belief that the bill was an expansion of the podiatrists’ scope of practice.
Mr. Hettrick agreed that under Nevada law the authority to amputate a toe was an expansion and asked whether podiatrists were trained appropriately to amputate a toe. Dr. Ellerton indicated it was his opinion that podiatrists were not trained adequately to amputate a toe.
Mr. Goldwater asked whether podiatrists were insured for liability against the procedures they were requesting to perform. Dr. Ellerton indicated podiatrists were not currently insured because podiatrists were not permitted by law to perform the procedures. Mr. Goldwater confirmed that if S.B. 405 passed, podiatrists would be required to become insured for amputation. Dr. Ellerton noted an amendment that did not make it out of the Senate proposed including podiatrists in NRS 41A, which defined medical malpractice.
Mr. Nolan asked what kind of anesthetic was used for the amputation of toes.
Joseph Walls, M.D., Orthopedic Surgeon, Nevada State Medical Association, advised amputation of toes would generally be performed under both regional and general anesthesia.
Dr. Ellerton continued by providing and reviewing a proposed amendment (Exhibit R) that he felt was necessary because the bill as currently written may be read to suggest that possession of a certificate from the state board of podiatry would automatically qualify a podiatrist to have privileges at a hospital. He suggested the addition of a new subsection in Section 3 of the bill to clarify the issue and indicated that a hospital was not prohibited from requiring a podiatrist to undergo the same credentialing process as other medical staff. However, Dr. Ellerton believed legislating credentialing was a dangerous precedent.
Dr. Walls presented his written testimony in opposition to S.B. 405 for the record (Exhibit S). As an orthopedic surgeon, Dr. Walls noted he had six to eight years more training than a podiatrist, and felt the bill was unnecessary because there were enough orthopedic and vascular surgeons available to handle the removal of appendages. Dr. Walls pointed out that not only did he amputate toes, but more importantly, he salvaged toes that looked like they needed to be amputated but did not. He provided the committee with several examples that supported his position and noted diabetes, vascular disease and trauma were the three major reasons to amputate a toe, none of which were treated by podiatrist in an emergency room. Dr. Walls felt the bill would have a fiscal impact because many of the patients who needed toes amputated were elderly and were covered by Medicaid, and podiatrists would have to be paid, together with a medical physician, while an orthopedic surgeon was paid once for both services. Dr. Walls also felt the bill was unclear as to the level of amputation and urged the committee not to pass S.B. 405.
Paul Canalie, M.D., Orthopedic Surgeon told the committee he respected the training of the podiatric profession and indicated he employed a podiatrist in his practice to assist in the care of his patients. However, in S.B. 405 Dr. Canalie foresaw the potential for a dangerous degradation of the quality of care of many individuals who were severely ill and could not afford the risk of a less than expeditious management of a problem involving amputation. Dr. Canalie showed the committee several photographs and explained the patients’ corresponding conditions. He spoke of one patient who presented with a nonviable dead toe and expected to have the problem corrected through amputation. Dr. Canalie advised the patient that amputation of the toe was not a viable option because of the patient’s overall debilitated state, cardiac condition and poor circulation, and the patient required an above the knee amputation to solve the problem. Dr. Canalie noted the main problem he saw was the lack of adequate removal of dead and infected tissue from foot wounds leading to worsening of the condition to the extent that the foot may not be salvageable. He noted in the cases he spoke of, the patients had been seeing their podiatrists regularly but the severity of the problem was not appreciated. Dr. Canalie asserted the ability to make a decision as to if, when, and how much of a person’s toe or foot to amputate required the knowledge of a person’s overall health and an appreciation of that person’s mobility, emotional status, heart disease and vascular condition and only an M.D. physician had an adequate knowledge base to understand the ramifications of systemic or whole body diseases as manifested within a foot problem. Dr. Canalie believed problems that required amputation of a toe were serious enough to a patient’s health that the decision process was best left to an M.D. He noted podiatrists were not expected or required to be competent in the treatment of patients with diseases that affected the whole body and had manifestations in the foot, and a depth of knowledge and training was necessary to understand the implications to the patient when those foot problems were treated. Dr. Canalie stated a podiatrist was not a medical doctor but rather was a limited license practitioner and could in no way provide the same standard of care as an M.D. Dr. Canalie urged the committee not to pass S.B. 405.
Michael Monroe, M.D., Orthopedic Surgeon, Foot and Ankle Surgeon, stated there was legitimate concern among physicians that if podiatrists were given surgical privileges to amputate toes there could be additional risk to the patient, including unnecessary additional surgery, higher level amputation and death. Dr. Monroe advised that conditions which required amputation of the toe nearly always involved multiple organ system pathology and other extremities, which were best understood by a medical doctor and were crucial in deciding the timing of surgical intervention. He stated the selection of the level of amputation was influenced by the patient’s general medical condition. Dr. Monroe acknowledged there were podiatrists who had the technical ability to amputate toes, however he believed the issue was whether those podiatrists had the experience and clinical judgment to determine in which patients only a toe amputation would be needed, noting the consequences of a wrong determination could be devastating to the patient.
Troy Watson, M.D., Orthopedic Surgeon, indicated he took care of a large number of patients with diabetes and foot and ankle problems. He expressed concerned about podiatrists, with their limited licenses, caring for patients with complex systemic pathology and noted diabetics could present with what seemed to be a benign condition, the effects of which could easily be underestimated and could lead to a higher level of amputation. Dr. Watson believed if medical doctors were involved early, many higher-level amputations could be prevented or an amputation avoided altogether. As to cost, he felt the medical doctor provided better care at a lower overall cost by avoiding unnecessary surgeries. Dr. Watson also felt continuity of care was an important point to consider and concluded by indicating he was opposed to S.B. 405.
Assemblyman Bob Price, District 17, appeared in support of S.B. 405, and told the committee he was a diabetic and had surgery on both feet by a podiatrist. He indicated his belief that podiatrists were qualified to amputate toes and noted podiatrists were allowed to perform amputations in VA hospitals.
Chairman Dini closed the hearing on S.B. 405 and opened the hearing on S.B. 91.
Senate Bill 91: Makes various changes to provisions governing practice of medicine and respiratory care. (BDR 54-290)
Robert Barengo, Legislative Representative, Nevada State Board of Medical Examiners, introduced Larry Lessly and Paul Stewart.
Larry D. Lessly, Executive Director, Nevada State Board of Medical Examiners, stated S.B. 91 provided for the regulation of respiratory therapists, added grounds for disciplinary actions against physicians, changed licensure requirement, and made it easier for physician assistants to practice their profession. Mr. Lessly noted Section 2 of the bill dealt with respiratory care and was almost identical to existing statutory language found in NRS 640B. He stated respiratory therapists were required to hold national certification in order to practice in the state of Nevada, but did not have a regulatory board, and there were no provisions made for disciplinary action for respiratory therapists. Mr. Lessly advised that respiratory therapists approached the Medical Board looking for a board to regulate their profession. The Medical Board felt it was appropriate that respiratory therapists be regulated and suggested the Medical Board regulate respiratory therapists as they regulated physician assistants.
Mr. Lessly stated Section 17 made a change in licensure requirements for physicians in the state of Nevada and noted three years of post-graduate training was currently required in order to get a license. He stated the training was intended to be progressive training and S.B. 91 set forth the requirement of 36 months of progressive post-graduate education.
Mr. Lessly indicated Section 18 made a change with respect to the designation of medically underserved areas and noted a physician was currently allowed to practice in underserved areas with only one year of post-graduate training and five years of experience as an allopathic physician. He stated there were currently very few applications for that type of license because the physicians who previously applied for the position were Vietnam era military physicians who had their training interrupted and did not finish. The amendment required the Medical Board to adopt, by regulation, the definition of medically underserved areas. Mr. Lessly indicated the intention was not to restrict the issuance of the special licenses, but to make the process as liberal as possible. An additional change provided any person who held a special license must work full time under the license in the underserved area before obtaining a regular medical license in Nevada.
Section 21 required those holding a locum tenems license, a license to substitute for another physician, or a temporary license to provide medical services for a community without adequate medical care, to meet licensure requirements in the state of Nevada. Mr. Lessly noted Section 21 also provided for a special license to a physician who was licensed in another state to engage in telemedicine. He stated currently a physician from out of state could come to Nevada to assist a Nevada physician with any patient on an irregular basis. However it was becoming a common event to have a doctor in another state read x-rays, and the board suggested a special purpose license to keep the honest doctors licensed within Nevada and accountable to the patients in Nevada.
Dr. Paul Stewart, Secretary/Treasurer, Nevada State Board of Medical Examiners, indicated the Medical Board functioned under the model act for medical practice in the United States and he believed Nevada was the model for other states to emulate regarding the Medical Practice Act. Dr. Stewart felt the modifications proposed by S.B. 91 improved an otherwise fine law and he urged the committee’s support for the bill.
Mr. Nolan indicated his understanding that the only way a disciplinary issue was brought before the Medical Board was if the complaint came from an outside source. He wondered how the Medical Board would be made aware of an error made by a respiratory therapist, or any other health care professional, working in a hospital. Mr. Lessly indicated the board received complaints from a myriad of sources, including the patient, the family of the patient, courts, doctors, interested citizens, and/or medical facilities or hospitals. Mr. Nolan confirmed that if S.B. 91 were passed the board would utilize the same process used to handle complaints against M.D.s and physicians’ assistants to address complaints against respiratory therapists.
With regard to Section 18, Ms. Giunchigliani asked whether there were many waivers requested by county commissions. Mr. Lessly indicated there were not many waivers requested by county commissions and noted the idea was to provide standards within the act.
Mr. Lessly continued by discussing the changes proposed in Section 22 of the bill and stated changes were necessary to ensure that after initial licensing, residents were reviewed again during each year of their post-graduate training. Mr. Lessly noted Section 23 of the bill was an attempt to provide physician assistants with more leeway in performing medical services, and the amendment proposed the physician assistant be allowed to perform services authorized by the supervising physician. As to Section 26, Mr. Lessly noted there was sometimes great difficulty locating physicians for license renewal and requested the board only be required to make reasonable efforts to notify a physician for license renewal. Section 27 of the bill changed the fee schedule for licenses and Mr. Lessly noted the board only charged what was necessary in order to regulate the profession and operate the self-funded board. He noted concern expressed by respiratory therapists over the fee for a license to practice and he stated his recommendation for the amount of the fee would be $100 for an application fee and $100 per year. He stated the reason for requesting a maximum amount was simply to avoid returning to the legislature each time a fee increase was necessary. Mr. Lessly indicated Section 28 made changes with respect to grounds for disciplinary action against licensees and included, but was not limited to, issues such as disruptive behavior, abusive conduct, comments which undermined patient’s trust in a physician or hospital, difficulty in working collaboratively with others, and conduct which violated the trust of a patient or exploited the relationship between the physician and the patient for financial or other personal gains. Section 29 required physicians to maintain timely, legible, accurate and complete medical records, and Section 30 removed the provision that physicians were not subject to disciplinary action solely for prescribing Laetrile or Gerovital because the language was superfluous. Finally, Mr. Lessly indicated the Legislative Counsel Bureau suggested the rest of the modifications in the bill in order to make the bill compatible with other provisions in NRS.
Chairman Dini asked for a further explanation of Section 21, and wondered whether that provision would hurt rural communities. Mr. Lessly indicated the provision became necessary due to a provision in NRS which provided that telemedicine constituted the practice of medicine and required licensure in Nevada. Mr. Lessly did not believe the provision would hurt rural communities but was simply an effort to bring out-of-state physicians practicing telemedicine under the Medical Board’s jurisdiction.
With regard to Section 28, Ms. Leslie asked whether a physician with a dual license in California and in Nevada would be subject to an automatic disciplinary action if the physician voluntarily surrendered his license in California. Mr. Lessly advised that a physician who surrendered his license in another state to avoid disciplinary action in that state was subject to disciplinary action or denial of licensure in the state of Nevada, and he could not recall any instance where the board did not deny such a license or take disciplinary action.
Cheryl Hug-English, Member, State Board of Medical Examiners, Faculty Member, School of Medicine, University of Reno Nevada, indicated her support for S.B. 91 and believed the modifications were clarifications of issues raised in the Medical Board meetings.
Chairman Dini asked whether the Board of Medical Examiners would seek input from the Nevada Rural Hospital Project and the Office of Nevada Rural Health in developing the regulations proposed in Section 21, subsection e. Mr. Lessly indicated the board would take help from anyone who wished to give it. Dr. Hug-English felt input from the Office of Rural Health would be welcomed.
Michael J. Garcia, Registered Respiratory Therapist, President, Nevada Society of Respiratory Care, confirmed earlier testimony that respiratory therapists approached the Medical Board seeking regulation of the respiratory therapist profession. Mr. Garcia stated Nevada was one of six states that did not license respiratory therapists and he noted currently respiratory therapists could be fired for a medical error and go next door and get another job because employers typically did not share that type of information. He also noted there currently were no continuing education requirements or disciplinary criteria for respiratory therapists.
Carlton R. Insley, III, Program Director, Cardiorespiratory Sciences Program, Community College of Southern Nevada, told the committee the state of Maryland instituted a method of regulating respiratory therapists similar to S.B. 91 which worked extremely well and increased the status of the respiratory practitioner and improved patient care.
Arthur Little, Director, Cardiopulmonary Services, Mountain View Hospital, President-Elect, Nevada Society of Respiratory Care, shared two stories with the committee regarding respiratory therapists who lost their license to practice in other states and moved to Nevada because there was no regulation of respiratory therapists.
Donald Wright, Registered Respiratory Therapist, Vice President, Nevada Society of Respiratory Care, told the committee he dealt with a respiratory therapist who sought employment using a forged credential belonging to his deceased father.
Chris Ferrari, Legislative Representative, Nevada Association of Nurse Anesthetists, indicated support for S.B. 91 and stated as the field of respiratory care expanded, it was important to keep appropriate regulation in place to protect the public.
Robin Keith, President, Nevada Rural Hospital Project, indicated support for S.B. 91 and stated she expected to participate in the meaningful development of regulations that would implement the bill, which she felt would potentially have a significant effect on rural health care.
Caroline Ford, Assistant Dean, University of Nevada School of Medicine, Director, State Office of Rural Health, supported the provision for 36 months of post-graduated progressive training as a responsible standard toward training and education of physicians. As to Section 18, she stated her office would work closely with the board as to the provision on the designation of medically underserved areas, as well as on Section 21 regarding telemedicine.
Greg Rollson, Director, Respiratory Therapy, St. Mary’s Hospital, expressed a neutral position on behalf of the respiratory therapists at St. Mary’s Hospital. Mr. Rollson expressed concern regarding Section 27 and acknowledged that the fees set forth in the bill were caps. However Mr. Rollson was concerned fees would be raised dramatically over a period of time and suggested the fees only be allowed to increase on a percentage basis. Mr. Rollson indicated support for the other provisions of S.B. 91.
Chairman Dini asked whether Mr. Rollson had a suggestion as to the amount of the fee. Mr. Rollson felt $100 as an application fee and $100 per year were reasonable but wondered what the fee would be in the future. Chairman Dini expressed his opinion that fees would increase as costs increased.
Ms. Giunchigliani noted that pursuant to the cap, the fee for a physician assistant could increase to the same amount as the fee for a physician, and noted the salaries for a physician assistant and a physician were not the same. Mr. Lessly stated it took as much effort to credential a physician assistant as it took to credential a physician and indicated the cost of regulating the profession for respiratory therapists would be less than physician assistants. He reiterated the fees were based on the cost of regulation.
Ms. Giunchigliani wondered whether the fee included examinations. Mr. Lessly indicated there was a $100 application fee and only examinations on Nevada law were administered. Ms. Giunchigliani asked whether the Governor had approved the fees, and Mr. Lessly indicated the Governor had not approved the fees because the bill did not increase the fee, it simply increased the cap.
Ms. Giunchigliani asked what process the Medical Board used when it raised fees. Mr. Lessly indicated a committee of respiratory therapists would serve as advisors to the board and the issue of a fee increase would be an item on the board’s agenda. Respiratory therapists could appear and testify as to whether a fee increase was appropriate.
John Steinmetz, Director of Clinical Service, HealthSouth Rehabilitation Hospital, voiced his opposition to the bill based upon the fee provision in Section 27, and noted there was the potential for becoming the most expensive licensing fee for respiratory care in the country and could adversely affect recruitment of respiratory therapists to the state. Mr. Steinmetz proposed the provision be modified to reflect that fees up to $200 could be imposed for application and issuance of license and up to $404 for bi-annual registration.
There being no other witnesses to testify regarding S.B. 91 Chairman Dini closed the hearing on S.B. 91 and opened the hearing on S.B. 198.
Senate Bill 198: Establishes bill of rights for persons whose financial or other business records are subject to examination by commissioner of financial institutions. (BDR 18-53)
John Vergiels, Legislative Representative, Nevada Association of Mortgage Brokers, stated S.B. 198 was a bill of rights for persons or companies being audited by financial institutions. He indicated support for the bill and its basic concept.
Cathie Jackson Ford, Regional Vice President, Nevada Association of Mortgage Brokers, stated new brokers in the state of Nevada were not given much information on how to conduct business, which made audits difficult. She noted the bill would allow individuals to discuss audits, which she felt would help to educate others on audit expectations.
Kami Dempsey, Legislative Representative, Las Vegas Chamber of Commerce, and Retail Association of Nevada, indicated support for S.B. 198 stating any information that could be provided to businesses was vital to the process. Ms. Dempsey noted 85 percent of chamber members had 15 employees or less and did not have accounting departments to track documentation. She felt the bill provided a much easier process for employers and supported the legislation.
Chairman Dini asked whether the provisions of the bill were already implied by the guidelines of the Financial Institutions Division. Ms. Dempsey felt the need for the legislation did not reflect the industry or the department, but felt that on rare occasions individuals conducting audits could use the lack of the legislation to harass simply because they were having a bad day. She stated if the bill were passed and its provisions made public, the employer would have more information on his rights and how to handle the audit process.
Ms. Giunchigliani asked for an explanation of subsection 11 on page 2. Mr. Vergiels was not certain, however, Mr. Humke offered his interpretation that the provision compelled the division to cite a regulation or statute under which the division was holding the licensee responsible. Mr. Vergiels indicated his belief that Mr. Humke’s interpretation was correct and noted the provision read clumsy and was stated backwards.
Sydney Wickliffe, Director, Department of Business and Industry, State of Nevada, indicated the Financial Institutions Division fell within her department. Ms. Wickliffe expressed opposition to S.B. 198 and believed the bill was contrary to the policy of the law which protected the public for the following reasons:
Ms. Wickliffe believed much of S.B. 198 was common sense and should not necessitate a law. She believed many of the bill’s provisions would weaken the regulatory authority of the state agency and urged the committee to consider the ramifications of passing S.B. 198.
Scott Walshaw, Commissioner, Financial Institutions Division, Department of Business and Industry, state of Nevada, believed the broad language allowing individuals to discuss audits or examinations would no longer make the results of the audits or examinations confidential and results could then be used for competitive purposes.
Ted Wehking, Legislative Representative, Nevada Bankers Association, stated the Nevada Bankers Association took a neutral position on the bill. Mr. Wehking noted banks represented a substantial regulatory jurisdiction and he indicated for the last 15 years he had enjoyed a great working relationship with the Financial Institutions Division.
As to Section 10, Mr. Hettrick asked whether there was a current law that prohibited a business from discussing its financial records. Mr. Walshaw indicated there was nothing in statute that prohibited a business from discussing its financial records, however, Mr. Walshaw believed Section 10 was written too broadly and would allow licensees to take the results of their examinations and use them for competitive purposes.
Mr. Hettrick asked for Mr. Walshaw’s thoughts on what would happen if business were provided advance notice of examinations. Mr. Walshaw felt it was fairly obvious what could happen if advance notice were provided.
Mr. Hettrick indicated his belief that the bill was well intended; however, he felt the language was too broad and should be tightened without harming the intent of the bill.
Chairman Dini closed the hearing on S.B. 198 and opened the hearing on S.B. 394.
Senate Bill 394: Revises provisions relating to practice of nursing. (BDR 54-1136)
Janice Pine, Legislative Representative, Saint Mary’s Health Network, stated Saint Mary’s, the Nevada Organization of Nurse Leaders, and the Association of Emergency Room Nurses supported S.B. 394 which protected nurse safety and privacy.
Fred Hillerby, Legislative Representative, Nevada State Board of Nursing, indicated S.B. 394 attempted to balance the privacy of nurses with the consumer’s right to know who was treating them. Mr. Hillerby felt a good balance was struck and urged the committee’s support of the bill.
Jim Caumiant, Legislative Advocate, Operating Engineers Local Union No. 3 AFL-CIO, indicated support for S.B. 394.
Chairman Dini indicated his understanding that there was quite a bit of revision from the original bill. Mr. Hillerby noted the original bill simply prohibited the requirement that a nurse’s last name be made part of a nametag, however, the Nursing Board felt it was necessary to ensure that employers could identify a nurse for complaint purposes.
Ms. Giunchigliani asked why a bill was necessary to remove nurses’ last names from a name badge. Mr. Hillerby explained the Nursing Board had a regulation that required the full name on the name badge because of consumer concerns. He noted recently there was an alarming increase in stalking and other assaults against nurses. Ms. Giunchigliani asked whether the Nursing Board would change its regulation based on the passage of S.B. 394. Mr. Hillerby indicated the Nursing Board would change its regulation upon passage of the bill and stated a letter was provided to the Senate indicating its intent to do so. Chairman Dini requested Mr. Hillerby to provide the letter for the record. Mr. Hillerby indicated he would be happy to do so, however, he explained that the letter had been adopted into the reprint of the bill.
Chris Salm, Representative, Nevada Service Employees Union, indicated support for S.B. 394.
Betty Razor, Representative, Nevada Nurses Association, provided her written testimony in support of S.B. 394 for the record (Exhibit T).
ASSEMBLYWOMAN LESLIE MOVED DO PASS S.B. 394.
ASSEMBLYWOMAN GIBBONS SECONDED THE MOTION.
THE MOTION PASSED UNANIMOUSLY BY THOSE PRESENT. SPEAKER PERKINS, MS. BUCKLEY, MR. ARBERRY, MR. GOLDWATER AND MR. NOLAN WERE NOT PRESENT FOR THE VOTE.
Chairman Dini appointed Mr. Parks, Mr. Hettrick and Ms. Leslie as a subcommittee on S.B. 245
ASSEMBLYMAN HETTRICK MOVED AMEND AND DO PASS S.B. 91.
ASSEMBLYWOMAN LESLIE SECONDED THE MOTION.
Vance Hughey, Committee Policy Analyst, pointed out three conflict notices on S.B. 91, which addressed conflicts with S.B. 271, S.B. 300, and S.B. 52, all of which had been passed by both houses and sent to the Governor.
THE MOTION PASSED UNANIMOUSLY BY THOSE PRESENT. SPEAKER PERKINS, MS. BUCKLEY, MR. ARBERRY, MR. GOLDWATER AND MR. NOLAN WERE NOT PRESENT FOR THE VOTE.
Chairman Dini appointed Mr. Goldwater and Mr. Humke as a subcommittee on S.B. 198.
There being no further business to come before the committee the meeting was adjourned at 8:36 p.m.
RESPECTFULLY SUBMITTED:
Rebekah Langhoff
Committee Secretary
APPROVED BY:
Assemblyman Joseph Dini, Jr., Chairman
DATE: