MINUTES OF THE meeting

of the

ASSEMBLY Committee on Commerce and Labor

 

Seventy-First Session

May 9, 2001

 

 

The Committee on Commerce and Labor was called to order at 4:02 p.m., on Wednesday, May 9, 2001.  Chairman Joseph Dini, Jr. presided in Room 4100 of the Legislative Building, Carson City, Nevada, and by videoconference in Room 4412 of the Grant Sawyer Building, Las Vegas, 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 Chairwoman

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.                     John Oceguera

Mr.                     David Parks

Mr.                     Richard D. Perkins

 

COMMITTEE MEMBERS EXCUSED:

 

Mr.                     Dennis Nolan

 

GUEST LEGISLATORS PRESENT:

 

Senator Mike Schneider, Clark County Senatorial District 8

Senator Mark Amodei, Capital Senatorial District

Senator Raymond Shaffer, Clark County Senatorial District 2

Senator Maggie Carlton, Clark County Senatorial District 2

 

 

STAFF MEMBERS PRESENT:

 

Vance Hughey, Committee Policy Analyst

Darlene Nevin, Committee Secretary

 

OTHERS PRESENT:

 

Mary Lau, Executive Director, Retail Association of Nevada

Brad Worthley, Mystery Shopping Providers’ Association and Market Research Association

Dan Musgrove, Legislative Advocate, City of Las Vegas

Peter Krueger, Nevada Petroleum Marketers and Convenience Store Association

Andrea Boggs, Private Investigator, Manuel, Daniels, Burke International, Investigators for the New Economy

Peter Maheu, Managing Partner of Global Intelligence Network, Las Vegas, Nevada

Mike Rizer, Investigator, President, and Owner of Gold Coast Investigations

Dorothy Williams-Jamal, Private Investigator, President, Williams-Jamal, Ltd.

Gina Crown, Licensed Investigator, Owner of Crown Stanley and Silverman, President of the Nevada Investigative and Protective Services Association

Dan Crate, Licensed Private Patrolman, member of the Private Investigators Licensing Board

Danny Thompson, Legislative Advocate, Nevada State AFL-CIO

Gordon H. DePaoli, Nevada Life and Health Insurance Guaranty Association

Ben Dasher, Chairman, Nevada Life and Health Insurance Guaranty Association

Matthew Sharp, Legislative Advocate, Nevada Trial Lawyers Association

Fred Hillerby, Legislative Advocate, Nevada State Board of Dental Examiners

Lee Drizin, Counsel, Nevada State Board of Dental Examiners

Linda Sheldon, Great Basin Primary Care Association

Bobbie Gang, Legislative Advocate, Nevada Women’s Lobby

Joanne Marriott, Private Citizen

Sally Ellis, Health Coordinator, Economic Opportunity Board of Clark County, Child and Family Services Division, Head Start Program, Las Vegas, Nevada

Jacqueline Mador, Registered Nurse, Manager of the Pediatric Emergency Department, University Medical Center, Las Vegas

Dr. Michael Rodolico, Executive Director, Health Access Washoe County (HAWC)

Patricia van Betten, Vice-Chairwoman, Nevada Health Care Reform Project, and the Nevada Nurses’ Association

Dewey Tuggle Jr., Licensed Dentist

Helen Foley, Legislative Advocate, PacifiCare, and representing Marie Soldo, Sierra Health and Life Insurance Company and Health Plan of Nevada

Steve Hansen, CEO, Nevada Rural Health Centers

Bob Ostrovsky, Legislative Advocate, Nevadans for Affordable Health Care

Janice Pine, St. Mary’s Health Network

Fay Orshoski, Benefits Director, MGM Mirage

Elizabeth Gilbertson, Culinary Health Fund, Las Vegas

Robin Keith, President, Nevada Rural Hospital Project

Mike Johnson, Manager, Outreach Programs, St. Mary’s Health Network

Bill Elliott, Health Director, Yerington Paiute Tribal Health Clinic

Ron Sparks, Executive Director, WICHE Program

Dr. Larry Champagne, President, Nevada State Board of Dental Examiners

Maury Astley, Executive Director, Nevada Dental Association

Joel Glover, General Dentist

Dennis Arch, General Dentist, Nevada State Board of Dental Examiners

Christine Forsch, Nevada Dental Hygienists’ Association

Dr. J.S. McElhinney III, General Dentist

 

PARTICIPATING VIA VIDEO CONFERENCE FROM LAS VEGAS:

 

Dr. Eric Skinner, President, Southern Nevada Dental Society

Dr. Steven Saxe, President, Nevada Division of the American Association of Oral and Maxillofacial Surgeons

Becky Harris, Private Citizen

 

Chairman Dini called the meeting to order at 4:02 p.m.  A quorum was present.  Chairman Dini announced the order in which the bills would be heard.  He opened the hearing on S.B. 416.

 

Senate Bill 416:  Exempts certain persons and governmental entities from provisions governing licensure of private investigators. (BDR 54-933)

 

Mary Lau, Executive Director, Retail Association of Nevada, related that Senator Schneider sponsored S.B. 416 at the request of Brad Worthley.  Mr. Worthley would testify in support of S.B. 416 pending Senator Schneider’s arrival at the hearing.

 

Brad Worthley represented the Mystery Shopping Providers’ Association and the Market Research Association.  Both consisted of “thousands” of organizations throughout Nevada and the United States.  Mr. Worthley remarked the organizations “operated under a code of conduct, ethics and professional market research standards.”

 

Mr. Worthley distinguished mystery shoppers from private investigators.  Private investigators investigated known or suspected behavior that could result in prosecution.  Mystery shoppers participated in a “normal shopping or dining experience” and related that experience.  Mr. Worthley maintained not allowing customers to provide feedback regarding service was unhealthy for businesses and consumers.

 

Mr. Worthley revealed that mystery shoppers utilized survey forms indicating specifically what was to be evaluated.  Evaluations assessed hospitality, such as the greetings.  The mystery shoppers were not looking for theft.  They would check for correct change in “maybe 1 out of 10 surveys” simply as a training tool.  He added it was illegal in Nevada for a customer in a restaurant or hotel to submit a comment card, unless they were a private investigator.

 

Mr. Worthley contended that most of the opposition to S.B. 416 would come from private investigators.  He predicted private investigators would accuse mystery shoppers of being untrained and unqualified.  Mr. Worthley contended that mystery shoppers maintained high standards of training.  A “shop” was not performed without the client’s approval of the training in advance.  Mystery shopping companies were “under comprehensive international association laws that provided ethical standards and practices that must be met.”

 

Mr. Worthley expected private investigators to complain about unfair competition.  He asserted that private investigators charged approximately $100 for a “shop” that mystery shoppers would perform for $15 to $20.  Mr. Worthley resolved passage of S.B. 416 would provide opportunities for private investigators to perform the same “shopping” at competitive prices.  However, it would not allow mystery shoppers to do the “integrity based” shopping done by private investigators.

 

Mr. Worthley denied anticipated accusations that there was no employee recourse.  The industry did have an appeals process.  An employee, who received a “poor” mystery shop, could appeal to the client.  The appeal would go to the mystery shopper industry.  It would then be decided if the “shop” should be redone.  Usually the “shop” would be redone at no cost to the client.  A proposed amendment provided that a single shopping report could not be used for employee disciplinary action or termination.

 

Mr. Worthley divulged that mystery shopping was a means of rewarding employees for outstanding customer service and identifying opportunities to improve customer service.  It was not used to identify employees who should be terminated.  Mystery “shops” would not be substantial proof in a court of law as a basis for employee dismissal.

 

Mr. Worthley declared private investigators would claim that mystery shoppers would reduce tax revenue in Nevada.  He argued mystery shoppers were mostly independent contractors who, like others, paid their own taxes and spent their money in the state.

 

Mr. Worthley also alleged private investigators were trying to protect the casino industry.  He maintained mystery shoppers did not perform “integrity” shops.  They were not assessing honesty and integrity; their business involved “incentive and training type shops” such as retail stores, theaters, restaurants, health clubs and apartment complexes.  Many “shops” in casinos were “looking for somebody to do something wrong.”  He felt those “shops” should be done by licensed private investigators.

 

Mr. Worthley supported his argument that private investigators were concerned solely with protecting the casino business.  He related that Peter Maheu, a licensed private investigator, talked to Michael Baer, president of Mr. Worthley’s association, and asked that language be added to the bill to exempt casinos.  If such language were added, Mr. Worthley informed, Mr. Maheu would probably approve S.B. 416.

 

Mr. Worthley closed his testimony stating S.B. 416 was not the same legislation that appeared two years ago.  He also revealed it was the same legislation that passed the California and Arizona legislatures with no opposition and with the support of private investigators.  He asked that “misinformation not cloud the vote.”

 

Chairman Dini asked if there were any questions.

 

Assemblywoman Buckley referring to page 2, lines 27 and 28, posed a hypothetical situation.  Lines 27 and 28 exempted from being licensed as a private investigator, one who evaluated customer service, as long as the information was “not used as the sole basis to discipline or discharge an employee of the business.”  Ms. Buckley deduced if a waitress was marked “rude” on one account, and marked “late” by the employer on another account, discipline or termination would be allowed under the language provided.

 

Mr. Worthley responded that termination of an employee required three “very specific” forms of disciplinary documentation in many states, perhaps Nevada as well.  The discipline had to be for the same issue, (or repetitive).  Assemblywoman Buckley countered by asking what would happen in a state with “at will employment.”  Mr. Worthley replied the same law existed in almost every state requiring at least three pieces of documentation.  He could not provide Ms. Buckley with the Nevada law that required such.

 

Senator Schneider, Clark County Senatorial District 8, emphasized that mystery shopping served to improve quality, not to terminate employees.  He further added that with union contracts any three violations of the same type had to have occurred within a specified amount of time such as six months or one year.

 

Assemblywoman Buckley reiterated her concerns about Section 1, subsection 13, of S.B. 416 and referred to the hypothetical situation she had given.  She presented that many businesses did not have union contracts to protect employees and again asserted there was no state law requiring three instances of documented rudeness.  Senator Schneider replied federal laws made that provision.  Ms. Buckley maintained she knew of no federal law that would protect an employee such as that which she referenced.

 

Chairman Dini asked if rules existed for the use of surveillance cameras.  Mr. -Worthley responded there were separate laws in each state covering audio and video recording.

 

Senator Schneider declared Nevada was the only state without mystery shoppers and he had not heard of employees in other states being abused by mystery shoppers.  He described the issue in Nevada as “another board protecting territory,” and a conflict of two industries.  Mystery shoppers were involved in customer service and public relations; private investigators were “retired cops.”

 

Dan Musgrove, Las Vegas, referred to a newspaper article published in the Las Vegas Sun, July 16, 2000, entitled “Mystery shoppers in limbo” (Exhibit C).  The city of Las Vegas had planned to “shop” local governments under a program created by the University of Georgia.  The “shop” would allow local governments to “shop” themselves, to evaluate interaction between local governments and citizens.  However, private investigators accused such “shopping” was against the law, that the city would have to contract with private investigators.  Mr. Musgrove explained it would be cost prohibitive to employ private investigators.  As a result, the city would not be able to participate in, or reap the benefits of, the study conducted by the University of Georgia.

 

Chairman Dini asked Mr. Musgrove about the costs of hiring private investigators.  Mr. Musgrove explained the minimum cost for private investigators was $100.  The “shops” through the University of Georgia study would cost between $10 and $20.

 

Mary Lau, Executive Director, Retail Association of Nevada, testified in favor of S.B. 416 and disclosed she was co-owner of a private investigation firm.  She related the significant difference between “courtesy shopping” and “integrity shopping”; only private investigators should perform “integrity shopping.”

 

Ms. Lau understood the concerns regarding page 2, lines 27 and 28, and noted “shop” results became part of the “personnel jacket.”  She conveyed her willingness to work with the sponsors of S.B. 416 to avoid the use of “shop” results as a sole purpose for termination.  Ms. Lau felt S.B. 416 provided a “comfort level” as amended, because “shops” would be preannounced.  She commented that because Nevada was an “at will state” she would support whatever gave a “comfort level” to the employees.  In closing Ms. Lau noted she had never anticipated S.B. 416 to include “integrity shops.”

 

Peter Krueger, Nevada Petroleum Marketers and Convenience Store Association, offered support of S.B. 416.  He informed the committee most of his members represented major oil companies who were concerned about their image and considered customer courtesy essential.  S.B. 416 would allow them to continue the oil company courtesy and review.  None stated anyone had been disciplined as a result of a “courtesy shop.”  Mr. Krueger related the businesses he represented were too small to perform their own “shops.”  He concluded his testimony asking the committee’s support of S.B. 416.

 

Chairman Dini asked if there were any questions.  He asked if there were other proponents of S.B. 416.

 

Danny Thompson, Legislative Advocate, Nevada State AFL-CIO, testified against S.B. 416.  He related the hardships faced by those terminated from employment and strongly reminded the committee that Nevada was an “at will” state; such as, an employee could be terminated for any reason.

 

According to AFL-CIO union contracts, termination had to stem from “just cause” and the employee had to, for the most part, undergo progressive discipline.  Those procedures were sometimes bypassed if, for example, an employee in the casino industry insulted a guest.

 

Mr. Thompson emphasized that “shop” companies were out-of-state companies and needed to be licensed.  Their “shops” had profound impacts on employees’ lives.  He explained there were qualified individuals in Nevada who were “professional, licensed in Nevada, paying taxes in Nevada, paying liability insurance on their employees and their business, paying workers compensation, and doing this kind of work.”  Mr. Thompson re-emphasized his opposition to S.B. 416 and reiterated the necessity of licensing “shoppers.”

 

Andrea Boggs; Private Investigator with Manuel, Daniels, Burke International, Investigators for the New Economy, testified against S.B. 416.  Nevada licensed investigators opposed S.B. 416 because it would:

 

• Deregulate an entire class of Nevada professional investigators who provided “mystery shopping” as well as observed behavior of Nevada employees;

 

• Eliminate accountability for the investigation;

 

• Eliminate requirements for liability coverage;

 

• Permit “mystery-shopping” services to avoid all taxes; and

 

• Not offer the accused employee the right to confront their accuser, as the accuser would not be operating under regulations.

 

Ms. Boggs accused that out-of-state “mystery shoppers” had misrepresented themselves.  They:

 

• Did more than conduct simple surveys and questionnaires;

 

• Were regulated in at least ten states, although they said they were not; and

 

• Caused disciplinary actions against employees and took “a lot of money out of the state of Nevada tax‑free.”

 

Peter Maheu, Managing Partner of Global Intelligence Network, Las Vegas, Nevada, provided the committee with a booklet, (Exhibit D).  He referred to Section 2 of Exhibit D, which was an e-mail from a mystery shopping association to its members that discussed evading taxes.

 

Section 3 of Exhibit D was another mystery shopping association e-mail, which requested its members to “help keep track of which states are aggressively pursuing members in challenging their ‘shoppers’ as Independent Contractors.”

 

Section 4 of Exhibit D was an e-mail from a mystery shopping association that asked its members in which states they could legally audio or video mystery shop.  Mr. Maheu interpreted this as indicating they would audio or video mystery shop in Nevada.

 

Section 5 of Exhibit D was a mystery shopper report that resulted in termination of the employee.

 

Section 6 of Exhibit D was an internal memo from the Assistant General Manager of a major Strip property to its Director of Customer Relations acknowledging poor “shopping” reports could result in progressive discipline.

 

Section 7 of Exhibit D was an internal memo suggesting “training or discipline” as the solution to problems resulting from a mystery shopping report.

 

Section 8 of Exhibit D related instances of a mystery shop, any of which could have resulted in the discipline of employees.

 

Mr. Maheu noted that Mr. Musgrove had never contacted Global Intelligence Network, and said his company would have matched whatever bid was received from the University of Georgia.  Mr. Maheu urged the committee to vote against passage of S.B. 416 and to consider the evidence provided and “not the verbiage that had gone before.”

 

Mike Rizer, Investigator, President and Owner of Gold Coast Investigations, testified against S.B. 416.  Gold Coast Investigations provided mystery shopping/spotting services to casino clients, both union and non-union, and reiterated Nevada was an “at will” state.  He emphasized the necessity of an accurate and thorough report that was an overall evaluation of positives as well as negatives.  Mr. Rizer shared with the committee that out-of-state “shoppers” were often not available when terminated employees sought wrongful termination legal actions.

 

Dorothy Williams-Jamal, Private Investigator, President, Williams-Jamal, Ltd., testified against S.B. 416.  She informed the committee that Williams-Jamal, Ltd. completed between 150 and 200 “shops” monthly.  Questionnaires were used and “shops” often resulted in hearings.  In compliance with Nevada Revised Statutes (NRS) 613.160, they made their employees available for those hearings.  Fifteen percent of the hearings resulted in employee disciplinary actions or terminations.  Ms. Williams-Jamal clarified opposition to S.B. 416 “had nothing to do with casinos”; rather its purpose was the protection of the citizens of Nevada.

 

Gina Crown, Licensed Investigator, Owner of Crown Stanley and Silverman and President of the Nevada Investigative and Protective Services Association, testified against S.B. 416.  She expressed her concerns about the complexity of mystery shops.  She asserted the Mystery Shopping Providers’ Association represented companies throughout the United States that performed the “full scale” of mystery shopping services.  The association went “far beyond courtesy tests.”  “Shops” included strategic financial transactions, honesty regarding money handling, complex testing in banking institutions, land development testing, and video mystery shopping that utilized hidden cameras.

 

Ms. Crown stressed it was ”impossible” to deregulate a portion of the mystery shopping industry.  She related California passed legislation that attempted deregulation and it was abused.  Violations were being documented for purposes of remediation during the next California legislative session.

 

Ms. Crown also pointed out non-licensed mystery shopping companies did not have bona fide employees; they were paid with goods, not money.  There was no accountability.  She emphasized her full support for the regulation of mystery shopping.

 

Dan Crate, Licensed Private Patrolman and member of the Private Investigators Licensing Board, asked the committee to consider the impact passage of S.B. 416 would have on industry, the community, and the ability of the Board to enforce and follow the statutes. 

 

Mr. Crate testified the NRS defined “investigator” by listing 21 different talents or activities.  He claimed between 11 and 13 of the activities of a “mystery shopper” were contained in the definition of “private investigator.”

 

Mr. Crate also noted, contrary to Mr. Worthley’s earlier testimony, that room and opinion cards were not excluded or illegal in Nevada.  Rather, surveys were encouraged and mystery shopping was “embraced, active, and considered necessary.”  In closing, Mr. Crate related it was his understanding the casino industry was not opposed to the Board’s position.

 

Mr. Crate stated it was unfortunate the city of Las Vegas could not participate in the University of Georgia study, but it was not due to any wrongdoing.  He also added there was a misconception about costs of services, that the business was too lucrative to give up, and that the private investigators would overcharge.  The only current requirements were for investigators to have a background check, have resources to be financially accountable for any wrongdoing, and that they be available to present themselves if there were any questions by the user of the investigator’s services.

 

Senator Schneider presented an amendment proposed by the Culinary Workers Union, Local 226, which was distributed to the committee (Exhibit E).  The amendment suggested deleting the words “as the sole basis to” from Section 1, subsection 13(b).  Senator Schneider recommended adoption of the amendment because mystery shopping was not intended to terminate employees.

 

Danny Thompson, Nevada State AFL-CIO, noted the AFL-CIO represented all of the unions in the state of Nevada.  They opposed S.B. 416 even with the amendment.  They believed “mystery shoppers” should be licensed and conduct business like other Nevada companies.

 

Chairman Dini closed the hearing on S.B. 416, and opened the hearing on S.B. 252.

 

Senate Bill 252:  Makes changes concerning Nevada Life and Health Insurance Guaranty Association Act. (BDR 57-683)

 

Gordon H. DePaoli, representing Nevada Life and Health Insurance Guaranty Association, introduced Ben Dasher, chairman of the Association, to the committee.  Mr. DePaoli informed the committee that the Nevada Life and Health Insurance Guaranty Association Act was taken from the Life and Health Insurance Guaranty Association Model Act (the “Model Act”), which was adopted in 1970.  The Model Act had since been amended several times and S.B. 252 would make the Nevada Life and Health Insurance Guaranty Association Act current with the Model Act as revised through 1999.  Mr. DePaoli related that seven states had adopted all of the amendments to the Model Act; eight were considering the amendments, and fourteen more states indicated they would consider the amendments within the next two years.  He added language in the Model Act had been modified in some cases to conform to the drafting style utilized in Nevada, but that the substance of the Model Act changes was substantially included in S.B. 252.

 

Mr. DePaoli explained S.B. 252 would:

 

• Improve policyholder protection;
• Expedite coverage;
• Reduce risks of litigation;
• Improve Guaranty Association operating efficiency;
• Facilitate Guaranty Association participation in insolvencies; and
• Accommodate consistency of approach.

 

Assemblywoman Buckley asked why the provision in Section 16, “Venue in an action against the association arising under this chapter lies in Washoe County,” was necessary.  She asked if such a provision could hurt a consumer in Clark County who would be forced to retain a lawyer in Washoe County.

 

Mr. DePaoli explained the provision existed because the association was headquartered in Washoe County.  The Model Act recommended that any litigation arising should be conducted in a court having experience with regulatory affairs.  He added there was a recommendation that guaranty association litigation be concentrated in a single venue for the same reason.  Mr. DePaoli related that in his experience, “they had been involved in only one round.  It was an original action filed in the Nevada Supreme Court.”  He could not say that, in his experience, a court in Washoe County, or any other county in Nevada, was more suited to that type of litigation.  He added that if venue was allowed in any county in which the plaintiff resided, the Association could be litigating similar kinds of issues in district courts throughout the state.

 

Chairman Dini asked Mr. DePaoli how many years he had been representing the Association.  Mr. Dasher replied that Mr. DePaoli had represented the Association for about 15 years.

 

Matthew Sharp, Legislative Advocate, Nevada Trial Lawyers Association, supported S.B. 252 with the exception of Section 23, subsection 1(h), which limited what could be collected from the Association.  He felt legitimate coverage issues to get the “wronged party whole,” could be barred by those provisions.

 

Assemblyman Goldwater asked Mr. Sharp to clarify his remarks.

 

Mr. Sharp explained each of the provisions of Section 23, subsection 1(h), which read:  “(1) This chapter does not provide coverage for:  (h) An obligation that does not arise under the express written terms of the policy or contract issued by the insurer including”:

 

• (1) “Claims based on marketing materials”; (The example would be an individual purchasing a policy based upon certain representations that were not consistent with the contract.)

 

• (2) “Claims based on side letters, riders or other documents that were issued by the insurer without satisfying applicable requirements for filing or approval of policy forms”; (That referred to items within the contract that were not approved by the Nevada Insurance Commissioner.  The insured could fall victim to an insurance company that had not complied with the Nevada Insurance Commissioner’s provisions).

 

• (3) “Misrepresentations of, or regarding policy benefits”; (That would be similar to claims based on marketing materials, fraudulent statements, and the purchase of a life insurance policy guaranteed at a certain premium, when it was actually a different premium).

 

• (4) “Extra-contractual claims”; (That would include any of those previously mentioned).

 

Mr. Sharp explained the Guaranty Association hoped to avoid having to pay punitive damages and such.  Mr. Sharp was concerned about recourse for those who were defrauded by paying premiums they should not have had to pay.

 

Assemblyman Goldwater disclosed he was licensed to sell life insurance.

 

Mr. Sharp clarified that the provision would only apply to the situation in which an insurance company sold a “bad” product that defrauded people, and then had to approach the Guaranty Association when the company was short of the funds to pay the claims.  The provision would provide a remedy for insureds who were defrauded.

 

Assemblyman Goldwater asked if the provision helped the Guaranty Association escape paying costs resulting from a fraudulent transaction.  Mr. Sharp affirmed that was correct.

 

Mr. DePaoli stated Section 23, subsection 1(h), was not meant to forbid an insured from making a claim against an insurance company or the estate of an insolvent insurance company.  The purpose was to limit the coverage of the Guaranty Association to matters, which were covered expressly in the insurance contracts.  The Association’s main purpose was to:

 

Provide benefits based upon the policy, but not to get involved in extra-contractual claims, and to allow, to the extent there were any remedies in these insolvencies, for those to be made against either the insurer, the estate of the insolvent insurer, or against whoever committed the act that was set forth.

 

Assemblyman Goldwater, referencing the agent/agency relationship, claimed if the agent said something untrue, even though it might not be expressly written in the policy, a claim still had to be covered.  He asked why the same relationship would not follow with the Guaranty Association.

 

Mr. DePaoli replied it was primarily because of limitation.  “The coverage was limited to begin with” and the focus of the Guaranty Association should be on “the express provisions of the contract.”

 

Mr. DePaoli explained the Guaranty Association could be drawn into litigation.  If an insurer were accused of misrepresentation, the Guaranty Association could become involved; not only with what must be covered, but also, as to whether or not certain claims were made.  “It’s just a matter of conserving limited resources.”

 

Mr. Goldwater felt Section 23, subsection 1(h), made sense.  He asked Mr. Sharp to restate his opposition.

 

Mr. Sharp was concerned about insureds having recourse when, for example, they were sold a life insurance policy that was sold “differently than written.”  He recognized the argument for placing a limitation on those damages, but also acknowledged insureds were paying premiums to be part of the Guaranty Association.  He could not accept people being defrauded and not having some kind of “remedy”; often insurance companies went bankrupt and left no alternative for the insured other than through the Guaranty Association.

 

Chairman Dini asked if there were any questions or further testimony.  He closed the hearing on S.B. 252 and opened the hearing on S.B. 2.

 

Senate Bill 2:  Requires provider of insurance coverage for prescription drugs to disclose certain information regarding use of formulary and to continue coverage for prescribed drug under certain circumstances. (BDR 57-597)

 

Senator Amodei presented S.B. 2, which was a product of the concerns presented by physicians regarding formulary changes at mid policy.  It impacted patient care rights in terms of “what was prescribed and what was working for them.”  Sections 2 and 3 contained the major contents; the following sections applied the same provisions to group health insurance, group benefit plans, carrier contracts, society benefit contracts, contracts for hospital or medical services, health maintenance organizations (HMOs), preferred provider organizations (PPOs), and prepaid limited health service organizations.

 

Senator Amodei quoted part of S.B. 2, Section 3:

 

Except as otherwise provided in this section a policy of health insurance which provides coverage for prescription drugs must not limit or exclude coverage for the drug if the drug had previously been approved for coverage by the insurer for a medical condition . . .

 

He revealed the objective was to allow the continuation of proven treatment, with regard to prescriptions, despite changes in formularies for those plans that used formularies.  Senator Amodei related there were provisions under which information concerning formularies had to be released.

 

The committee was hearing S.B. 2 as a First Reprint.  Modifications were made on behalf of organizations providing health care and pharmaceutical representatives.  Senator Amodei related there was no opposition to the amendment in committee or on the floor.

 

Assemblywoman Buckley considered S.B. 2 good legislation.  She voiced the need for formularies to be easily understood, and asked if the bill would apply to “Senior RX.”

 

Senator Amodei replied it was their intent to include “Senior RX” and offered that if close scrutiny revealed a gap for “Senior RX,” he would approve an amendment to make S.B. 2 applicable to “Senior RX.”

 

Chairman Dini asked if there was further testimony.  He closed the hearing on S.B. 2 and opened the hearing on S.B. 378.

 

Senate Bill 378:  Revises provisions relating to dentistry and dental hygiene. (BDR 54-1230)

 

Fred Hillerby, Legislative Advocate, Nevada State Board of Dental Examiners, informed the committee the Board had requested S.B. 378.  He introduced Lee Drizin, Counsel to the Board.

 

Mr. Drizin stated S.B. 378 “cleaned-up” the statutes governing the Dental Board’s disciplinary proceedings.  The provisions of Section 1 were similar to those of eight other boards.  It afforded civil immunity to anyone who in “good faith” and without “malicious intent” filed complaints with the Board, furnished information to or by the Board, or to action as the Board regarding disciplinary procedures.  Section 2 allowed dentists who were granted limited licenses to put their licenses from other states on an inactive status while they were in Nevada.

 

Assemblyman Goldwater asked what prompted the need for the liability.  Mr. Drizin related the Board had experienced a series of complaints and there had been attempts to get the Board to disqualify itself by making it a litigant in state, as well as federal district court action.  When the Board tried to dismiss litigation on the basis of absolute immunity the law still was not codified with respect to the Nevada State Board of Dental Examiners.  Statutes required that any actions initiated against the boards were brought in good faith, but that did not eliminate “frivolous” complaints.  The boards found themselves absorbed in litigation without the ability to have any kind of “disincentive.”

 

If an individual incurred attorney fees and lost, that was the extent of their loss.  S.B. 378 provided that a defendant who was the prevailing party in a civil action brought against it could recover attorney fees.  The court would then be able, if the lawsuit was deemed “frivolous,” to declare attorney’s fees sanctioned against the party or plaintiff.

 

Chairman Dini closed the hearing on S.B. 378 and opened the hearing on S.B. 133.

 

Senate Bill 133:  Authorizes board of dental examiners of Nevada to issue certain licenses without examinations or clinical demonstrations to dentists and dental hygienists licensed in other jurisdictions under certain circumstances. (BDR 54-241)

 

Senator Raymond Shaffer, Clark County Senatorial District 2, principal sponsor of S.B. 133, informed the committee that Senator Carlton, who had invested much time and effort in S.B. 133, would present the bill to the committee.

 

Senator Maggie Carlton, Clark County Senatorial District 2, related S.B. 133 was discussed at great length in the Senate Subcommittee on Commerce and Labor.  S.B. 133 was intended to increase access to dentists for the thousands of Nevadans currently underserved.  Senator Carlton asserted it would not lower the standards of competence, as “safeguards” were built into S.B. 133 to prevent lower standards.  She remarked steps taken in previous sessions to alleviate the shortage of dentists in Nevada had not been successful.

 

Senator Carlton informed the committee Nevada ranked among the bottom of the nation in dental access.  Medicaid recipients and the uninsured had difficulty accessing dental care through Nevada Check-Up, Children’s Health Insurance Program (CHIP), and other programs.  Nevada had the lowest dentist per capita population in the Western states with 4.28 active dentists per 10,000 Nevada residents.  Clark County had 4.19 dentists per 10,000 residents; Utah had 9.19 dentists per 10,000 residents; and California had 7.7 dentists per 10,000 residents.  Constituents complained about the difficulty of scheduling dental appointments.

 

Senator Carlton described S.B. 133 as a “compromise bill,” or a “shape shifter.”  It had gone through changes in the full committee hearing, in subcommittee, and on the Friday before the deadline.

 

Senator Carlton noted that dentists coming to Nevada under S.B. 133 would remain subject to all dental board oversight and regulations, as would other dentists.  The same would apply during the two‑year temporary licensure that preceded their obtaining a permanent license.

 

Senator Carlton prefaced her presentation of S.B. 133, the First Reprint, by stating the one thing eliminated in all the sections was the clinical demonstration; applicants would still have to take the written portion of the test.

 

Section 2 provided for the issuance of temporary licenses to practice dentistry.  It was the “five year-two year” portion, which provided a dentist from another state, with a clean five-year record, could be temporarily licensed in Nevada.  It also allowed the temporarily licensed dentist to apply for a permanent license after two years, without having to take the clinical exam, if that two-year period held a clean record.

 

Section 3 provided regulation for the issuance of a specialist’s license without the requirement of a clinical demonstration.  Section 4 made restricted geographical licenses available to provide more practitioners in rural areas and areas of underserved populations.  Senator Carlton reminded the committee the safeguards of the Board’s supervision and disciplinary actions were maintained through those sections.

 

Section 7 provided for the licensing of board certified diplomate specialists from other states.  Senator Carlton explained to the committee that all the dentists had taken a clinical examination in another state.

 

Senator Carlton clarified the remainder of S.B. 133 was the original language; the preceding testimony covered, basically, the subcommittee’s provisions.  The remainder addressed the dental school.  Senator Carlton also stressed the “five year‑two year” provision had a sunset of four years and she would be monitoring the dental board during that time.

 

Chairman Dini asked for clarification of Section 4.  Senator Carlton explained Section 4, subsection 1(a), provided that an underserved rural area, within an urban core, could petition the Board of County Commissioners to petition the Board of Dental Examiners for dentists in that area.

 

Section 4, subsection 1(b), provided for the issuance of a restricted geographical license if the applicant met the requirements, and the director of a federally qualified health center or nonprofit clinic submitted a request for services to an underserved population.

 

Section 4, subsection 2, listed the safeguards common to all of S.B. 133 regarding licensing and payment of fees.  Included was the applicant’s obligation to submit the statement required by Nevada Revised Statutes (NRS) 631.225, the “child support statement,” which would help spouses with delinquent child support.

 

Section 4, subsection 3, provided a restricted geographical license would not be issued to an applicant with a blemished record.

 

Section 4, subsection 4, required a written examination.

 

Section 4, subsection 5, provided the restricted geographical licensee had to request licensing from each additional county in order to practice in it.  The licensee also could not engage in private practice or accept compensation unless it was paid by a federally qualified health center or nonprofit clinic.

 

Section 4, subsection 6 required the licensee to notify the Board of the contract’s termination within seven days of its expiration, in writing, and surrender the restricted geographical license.

 

Section 4, subsection 7, provided a restricted geographical licensee could petition the board for an unrestricted license without a clinical demonstration or practical examination under certain conditions.  Senator Carlton referred to this as the “Americorps type, Peace Corps provision”; the practitioners performed for three years in rural settings, after which they could apply for a permanent license to practice anywhere in the state.

 

Senator Carlton informed the committee there was a “glitch” in the copy of the floor amendment.  The revocation portion referred to “chapter” instead of “section”; an amendment would be forthcoming.  Senator Carlton notified the committee another proposed amendment would be brought forward by the Board requiring continuing education, as was required of all licensed practitioners of dentistry.

 

Assemblyman Hettrick complimented Senator Carlton on the thoroughness of her presentation.  Assemblyman Arberry commended the sponsors of S.B. 133 and acknowledged the urgent need of dental care for Nevada’s children.

 

Linda Sheldon, Great Basin Primary Care Association, presented the committee with the Dental Underserved Survey, (Exhibit F) conducted by the Primary Care Development Center.  The survey compared the numbers of uninsureds with the population.

 

The population of Clark County was recorded as 1,294,506, with 270,130 persons uninsured.  In addition 10,326 children were enrolled in Nevada Check Up, many of whom did not have access to dental care.  There were 49,127 enrolled in Medicaid.

 

Results in Exhibit F revealed what percentage of a dentist’s patients were on Medicaid.  Fifty-six dentists in Las Vegas accepted Medicaid and five accepted a sliding fee scale.  Forty-three of the fifty-six dentists who accepted Medicaid served less than 20 percent of their patients under Medicaid or Nevada Check Up.  Ms. Sheldon related similar statistics for Northern Nevada.

 

Bobbie Gang, Legislative Advocate, Nevada Women’s Lobby, acknowledged the limited access for low-income families to dental services had been a problem for many years.  No attempts thus far had alleviated the dilemma.  She emphasized the need for a solution, and urged the committee to support S.B. 133.

 

Joanne Marriott, a private citizen and single mother whose family was enrolled in Nevada Check Up, testified in support of S.B. 133.  She related that none of the dentists in her community accepted Nevada Check Up.  With the help of the Great Basin Primary Care Association she found a dentist but had to wait several months for an appointment.  She had to take a day off from work without pay and drive to Reno for that appointment.

 

Sally Ellis, Health Coordinator, Economic Opportunity Board of Clark County, Child and Family Services Division, Head Start Program, Las Vegas, Nevada, testified in favor of S.B. 133.  She provided pictures that portrayed tooth decay in some of her Head Start children.  Head Start was federally mandated to provide children with dental screening within the first 45 days of entry into the program and complete follow-up work within 90 days.  She related that throughout her 13 years as a Head Start nurse, the children went without timely dental care and the program was not in compliance with federal regulations.

 

Ms. Ellis informed the committee access to dental care was decreasing, and the number of children in need of dental care was increasing.  Children she taught in Head Start moved on to the Clark County School District where school nurses were being inundated with more and more children needing emergency dental care.

 

Miles for Smiles, a mobile dental van, received calls from school nurses for children in urgent need of dental care.  In one school, 400 of 1,000 children were rated “5,” which meant they experienced pain and abscesses.  In another school, 175 of 650 children were rated “5.”  Forty-six at-risk schools were on the waiting list for assistance from Miles for Smiles.  Ms. Ellis emphasized abscessed tooth infections could be life threatening in children because they were located nearer the brain and blood vessels.

 

Ms. Ellis commented that dental disease was one of the most common health problems among children and youth in Clark County and in Nevada.  She noted low‑income and medically underserved families were denied access to basic dental services because most dental providers were unwilling to accept Medicaid, self-pay or sliding scale fees.  Ms. Ellis added most dentists were uncomfortable working on children five years of age and younger.

 

Assemblyman Goldwater asked Ms. Ellis to clarify that dentists were not accepting self-pay.  Ms. Ellis affirmed that many were not accepting self-pay in Las Vegas for Head Start children.  Mr. Goldwater noted Medicaid reimbursements were small and more competition would mean more dentists accepting Medicaid payments.  Ms. Ellis added that Head Start programs in Elko and Ely took children, with their Nevada Medicaid, to Salt Lake City, Utah, to access follow-up dental care.

 

Ms. Ellis continued.  Some of the effects from dental neglect were “severe toothache, inability to chew food, psychosocial problems, impaired nutrition and weight loss, failure to thrive and even severe disfigurement.”  In children with all 20 baby teeth, most of Ms. Ellis’s Head Start children had between 15 and 20 cavities.

 

Ms. Ellis supported her contention that dental neglect was a crisis for Nevada children.  Nevada’s State Dental Needs Assessment data showed that:

 

• The most common referral from physicians for low-income children were for dental services.
• Sixty-seven percent of children examined had decay in permanent or primary teeth.
• Approximately 37 percent of children surveyed had not seen a dentist in the past year.

 

Prevention and education were crucial to arresting dental disease.  It would be five years before results would be realized from the addition of fluoride to Clark County’s water system.  Every child should be seen by a dentist at age one and every six months thereafter; however, children of low-income families did not have that access.

 

Ms. Ellis supported geographic licensure and access to specialists, and divulged that she represented only one segment of the population.  Mentally ill, mentally challenged, and seniors in long-term care, were a few of the many who lacked adequate dental care.  She asked the committee’s support in “safeguarding the dental health of Nevada’s children and families.”

 

Chairman Dini asked if many problems would be relieved once the dental school “got into full swing” and Ms. Ellis replied she hoped so.

 

Assemblywoman Giunchigliani thanked Ms. Ellis for her assistance with the passage of the fluoridation law in Clark County.

 

Jacqueline Mador, Registered Nurse, Manager of the Pediatric Emergency Department, University Medical Center, Las Vegas, informed the committee that in a two-year period, 1,302 children received emergency medical care for dental conditions.  Ten were ill enough to require inpatient hospitalization.  The hospital was limited in its ability to refer children for definitive dental care and the growing population would only amplify the problem.

 

Dr. Michael Rodolico, Executive Director, Health Access Washoe County (HAWC), informed the committee that HAWC Community Health Center was a nonprofit entity that included one dentist, one hygienist, and doctors of internal medicine, pediatrics and family practice.  They managed 6,000 dental visits annually in a clinic built through local charitable foundations.

 

The State Division of Health conducted a study to qualify HAWC for a federal dentist.  Findings showed that Washoe County had 1.8 dentists for 34,000 uninsured, in contrast to 5, 6, 7, 8, or 9 dentists per 10,000 in other states.  To qualify for a federal dentist, HAWC only needed to show a 1 to 5,000 ratio.  With only three federal dentists available for transfer that year, and 100 applications for those three dentists, HAWC qualified and received one uniformed federal dentist to treat their children.  “That’s what happens in third world countries,” Dr. Rodolico continued, ”I think that’s an outrage and I would think we would have more pride in what we provide for our children.”

 

The federal dentist was “not really doing family dentistry, he was triaging emergencies every day.”  Some days 20 to 30 individuals were lined up for emergency care.  Dr. Rodolico shared they had “children swelling and oozing pus and in great pain” they could not make time to treat.  Those patients had to be seen by medical doctors.  Some children had to be admitted to the hospital because the infection was so great; it affected their kidney function and immunization function.

 

Dr. Rodolico urged the committee to support S.B. 133.  He thought it “ridiculous” that Nevada refused reciprocity to “dentists that came from the best dental schools in the country.”  He stressed S.B. 133 was not a money bill and was “an opportunity to allow thousands of children better access to health care.”

 

Dr. Rodolico referred to an ad in the newspapers taken out by the Executive Director of the Nevada Dental Association, which urged the defeat of S.B. 133.  Dr. Rodolico related his colleagues considered the ad “outrageous, the height of hypocrisy and greed, to deny care to the poor while denying access to other dentists in this community.”  Some referred to those dentists campaigning against S.B. 133 as a “dental cartel”; that is, by controlling access and pricing, they controlled supply.  “And by controlling the supply of qualified dentists they controlled the access of our most vulnerable population.”

 

Assemblywoman Leslie asked Dr. Rodolico about the long wait for routine appointments and what happened to those appointments that had to be rescheduled to allow for emergencies.  Dr. Rodolico replied the clinic did triage on the phone and in the clinics, and children took priority; “a child in pain took priority.”  Dr. Rodolico added some of the dentist’s appointments were scheduled for January 2002 as non-emergency appointments.

 

Patricia van Betten, Vice-Chairwoman, Nevada Health Care Reform Project, testified in support of S.B. 133.  Ms. van Betten represented the Nevada Nurses Association on the Project.  Their goal was to “assure all Nevadans comprehensive and affordable health care coverage and to improve the quality of health care.”

 

Ms. van Betten, a retired school nurse, stressed the urgency of accessible dental care and the negative affect of chronic pain on a child’s ability to learn.  She related the difficulty parents and school nurses faced in finding dental care for the children.  She also noted Nevada had the poorest ratio of dentists to patients in the country and suggested S.B. 133 would allow access to “affordable dental care by qualified dentists in rural and urban Nevada.”

 

Dewey Tuggle Jr., Licensed Dentist, referred to his testimony (Exhibit G), which had been faxed to all committee members.  In section 4 of his testimony, Dr. Tuggle compared the licensure requirements for law, medicine, chiropractic medicine, veterinary medicine and nursing with those requirements for dental licensure.  Dentistry and dental hygiene were the only professions that required a clinical demonstration for licensure.  Dr. Tuggle noted the Nevada board exam was given in California, not Nevada.  Nevada dentists were educated outside of Nevada and the cost of the exam was $10,000.  Dr. Tuggle asked the committee to consider the burden facing dentists coming to Nevada.

 

Helen Foley, Legislative Advocate, PacifiCare, and on behalf of Marie Soldo, Sierra Health and Life Insurance Company and Health Plan of Nevada, testified in support of S.B. 133.  Ms. Foley referred to newspaper ads that accused Health Maintenance Organizations (HMO’s) of supporting S.B. 133 so they could contract with dentists “from the bottom of the national barrel.”  Ms. Foley stressed that HMO’s required background checks of all practitioners.  She described the opponents’ activities as “scare tactics and misinformation,” as well as a “smoke screen to redirect your attention away from the issue at hand.”

 

Ms. Foley informed the committee the HMO’s were aware of the enormous need for quality oral health care in Nevada.  She considered S.B. 133 a “legislative remedy” that would increase the supply of dentists as well as “provide enough safeguards to guarantee qualified dentists.”

 

Steve Hansen, CEO, Nevada Rural Health Centers, a federally qualified health center, operated 13 medical primary care clinics in urban and rural areas of Nevada that experienced about 52,000 patient visits annually.  The services health providers found most difficult to obtain were dental services.  Mr. Hansen shared one of many incidents that resulted from the deficiency of access to dental care.  A physician treated an individual for pain who a few hours later pulled out his/her own tooth with a pair of pliers.  The patient required additional care because of the subsequent injury sustained.

 

Mr. Hansen asserted, “The issue of supply and demand needed to be changed.”  For example, the clinic in West Wendover, Nevada, related statistics showing 4,500 of its population was on the Nevada side and had no dentists.  One thousand of its population was on the Utah side and had three dentists.  In closing, Mr. Hansen emphasized his organization’s support of S.B. 133.

 

Bob Ostrovsky, Legislative Advocate, Nevadans for Affordable Health Care, related he had served with Assemblywoman Leslie on the Interim Committee on Public Health.  That committee consisted of a broad base of individuals including business, health care providers, insurance companies, and others.  They unanimously voted to support a provision that would allow testing through one of the regional boards, passage of which would qualify the individual in a certain number of states.

 

The interim committee also recognized the problem went beyond Medicaid and Nevada Check Up to the general population of the state.  Mr. Ostrovsky contended the state needed between 60 and 70 new licensees annually to cover the loss of practitioners leaving communities through death, retirement, moving their practice, or other reasons.

 

Referring to an earlier question as to whether or not the dental school would solve the problem, Mr. Ostrovsky noted that at the point where S.B. 133 would “sunset,” four years out, assuming the dental school got funding, 70 new dentists could be realized from the first class and could compensate for the turnover of dentists.  He hoped new dentists would also keep up with the need of Nevada’s growing population.  Mr. Ostrovsky felt the public health committee wanted a “forward look down the road.”

 

Mr. Ostrovsky added it would be difficult to convince new dentists to practice in rural areas where patient flow might be a little lower.  He urged the committee to listen to the statistics, pass S.B. 133, monitor it for the next two years, and make adjustments later.

 

Janice Pine, St. Mary’s Health Network, referring to page 3, line 6, said the testimony in the Senate stated “clinic” would include the mobile vans that provided dental care to children in Washoe County and surrounding rural counties.  Also, referring to page 3, line 31, Ms. Pine wanted the dentists in the mobile vans to have the ability to practice in the rural areas.

 

Chairman Dini asked if the dentists would have to apply for each geographical area.  Ms. Pine understood they would not as long as they applied through Washoe County.  Chairman Dini replied the committee would consult the Legislative Counsel Bureau staff.

 

Fay Orshoski, Benefits Director, MGM Mirage, said she was responsible for purchasing and managing the benefit plan for MGM Mirage employees.  Fifty thousand were on the self-insured plan including employees and dependents.  A common complaint from the insureds was the inability to obtain dental appointments; they would have to wait between two and four months.  Also, many dentists did not accept new patients.

 

Elizabeth Gilbertson, Culinary Health Fund, Las Vegas, testified in support of S.B. 133.  The Culinary Health Fund covered about half of the workers in the gaming properties as well as others—50,000 employees and 120,000 people in Clark County.  They covered those insured through the Culinary Union.  She had been responsible for oversight of the plan in Las Vegas for ten years.  They offered medical and dental benefits, and the participants felt strongly about their coverage.  The Culinary Health Fund provided comprehensive dental benefits, but there was inadequate access to dental services.

 

She referred to her packet “Ensuring Dental Access for All Nevadans,” (Exhibit H).  Statistics documented the increase in Nevada’s population since 1992.  Statewide growth was 66 percent while growth in Clark County was 86 percent.  The number of active dentists decreased by 3 percent in the same time period.

 

Exhibit H also revealed the ”Nevada State Dental Board Pass Rates.”  Forty states used regional boards.  The pass rates in 1999, reported by the American Dental Association, were:

 

• New England Board            62 percent
• Southern Board            87 percent
• Central Board            87 percent
• Western Board            91 percent

 

The pass rate for Nevada in 1999 was 41 percent.  Ms. Gilbertson maintained the shortage of dentists in Nevada could be alleviated by the passage of S.B. 133, which would address the quality of care as well as the need for more dentists in rural and urban Nevada.  She urged the committee to pass S.B. 133.

 

For the record only, Ms Gilbertson also submitted “Dental Disaster,” an article from the Las Vegas Review-Journal (Exhibit I).

 

Robin Keith, President, Nevada Rural Hospital Project (NRHP), testified in support of S.B. 133.  She informed the committee that the NRHP first became interested in the bill because residents in underserved areas showed up in hospital emergency rooms.  “ER doctors are not dentists.  The best we can do is dispense pain pills, antibiotics, and good advice about seeing a non-existent dentist.”  That was costly and did not solve the problem.  Ms. Keith referred to her packet (Exhibit J), which included:

 

• NRHP’s article “Nevada’s Dental Shortage”
• Dental Initiatives Across Nevada
• NRHP’s article “An Open Letter to Nevada Policy Makers from Organizations Concerned with Nevada’s Dental Crisis”
• Miles for Smiles “Children’s Oral Health Information Fact Sheet: Oral Health Disease and Need”

 

Ms. Keith considered Section 4 of S.B. 133, which was proposed by the Board of Dental Examiners, a positive step toward alleviating the shortage of dentists.  Section 4 allowed dentists licensed in other states to obtain licenses in Nevada in order to practice in rural and urban areas as designated by the Office of Rural Health.  Ms. Keith assured the committee the board would not propose legislation that compromised the quality of care.

 

Mike Johnson, Manager of Outreach Programs for St. Mary’s Health Network, informed the committee one of their programs was St. Mary’s Take Care-A-Van Dental Services.  They provided dental sealants to children in the Washoe County, Lyon County, Carson City, and Churchill County areas with grant funds from Maternal and Child Health Grants, Title V.  He witnessed the need of dental care for young children and stated St. Mary’s had received a grant for another Take Care-A-Van, a dental facility that would service the same areas.  They had received help from the Nevada Western Interstate Commission for Higher Education (WICHE) program in obtaining dentists licensed by the dental board to do sealant work.  Mr. Johnson added Section 4 of S.B. 133 would provide dentists to “make the project a reality.

 

Bill Elliott, Health Director, Yerington Paiute Tribal Health Clinic, informed the committee that reservations and rural areas experienced poor dental health mainly because of the limited access to dentists.  Mr. Elliott divulged there were two operatories that stood vacant because they could not recruit for a dentist.  He felt S.B. 133 would increase their ability to recruit for qualified dentists.

 

Two volunteer dentists came on weekends through the WICHE program, but the patient load was more than they could cover.  People were turned away daily because of the lack of dentists.  Mr. Elliott felt he could meet the needs of rural Nevada in Lyon County if he had a full-time dentist.

 

Ron Sparks, Executive Director, WICHE program, affirmed S.B. 133 would help WICHE provide dental care to the underserved areas.  Geographic licensure would provide the incentive to keep dentists in Nevada.  Speaking for Caroline Ford, State Office of Rural Health of the University of Nevada, Reno, Mr. Sparks noted S.B. 403, a capital fund, would help fund the rural offices for those dentists that come to practice in Nevada.

 

Chairman Dini asked how many dentists came in through the WICHE program annually.  Mr. Sparks responded 10 dentists were graduated per year, 5 of whom were required to practice in the underserved communities; the other five could practice anywhere in the state.  Mr. Sparks added that when the dental school became a reality, the intention was to “fund five slots” for students of that school with the requirement that the graduates practice in underserved communities.

 

Senator Shaffer thanked the committee for their time and asked them to “look favorably” on S.B. 133.  Chairman Dini invited the opponents of S.B. 133 to testify.

 

Fred Hillerby, Legislative Advocate, Nevada State Board of Dental Examiners, stated they did not oppose S.B. 133 entirely, but were especially concerned with Section 2.  He introduced Dr. Larry Champagne, president of the board.

 

Dr. Larry Champagne, President, Nevada State Board of Dental Examiners, claimed S.B. 133 would bring “drastic” changes to the licensing of dentists.  He declared it was the board’s sworn duty to carry out policies set by the Legislature as well as to protect the oral health of Nevada’s citizens.

 

The Board opposed Section 2, which allowed for “untested and potentially unqualified dentists to obtain a license.”  The board felt the best way to protect the oral health of Nevadans was through clinical examination of prospective licensees.  Dr. Champagne said Nevada was nationally known for its high quality of dentistry.  He claimed that was a direct result of their examination process.

 

Dr. Champagne described the examination as thorough, reasonable, and constantly updated.  He contradicted previous testimony that three‑quarter gold crowns and dentures were seldom utilized and did not need to be included in the examination.  Because of the growing senior population in Nevada, Dr. Champagne claimed dentists needed to be well versed in procedures involving dentures.  Dr. Champagne further indicated examinations were administered at least twice each year and that licensees were tested on “procedures taught in every dental school in the country and performed every day in dental offices.”

 

Dr. Champagne maintained the increase in new dental licenses had kept pace with the population increase in Nevada, and he expected similar increases in the near future.

 

Dr. Champagne predicted S.B. 133, with its current language, would drastically alter the standards of licensing in Nevada.  Section 2 would allow unqualified dentists to receive a license if they had a license in another state for five years and had no reportable incidences of malpractice or board actions.  Under that provision, dentists would receive an unrestricted two-year temporary license to practice anywhere in the state, and after their probationary period they would receive a permanent license.  Dr. Champagne submitted that it often took longer than five years for complaints to surface.

 

Dr. Champagne described dentistry as a “cottage industry.”  It was performed in the practitioner’s private office with little or no contact with his or her peers.  He suspected the “errant practitioner” could practice for a significant period of time before his or her pattern of substandard care was brought to the attention of the Board.

 

Dr. Champagne also perceived that monitoring the licensees for two years would be very difficult, expensive, and perhaps impossible.  In that case, they could virtually practice without being observed.

 

Dr. Champagne informed the committee the Board was seeing applicants who had been out of dental school in excess of five years, many of whom had problems with their practices in other states, or others who also had been unsuccessful in their practices.  He felt such dentists saw Nevada as “greener pastures” and a place to which they could bring their problems and past experiences with them.  Dr. Champagne witnessed the problems encountered by many of those practitioners in performing entry-level dental procedures when they had been out of school longer than five years.  If S.B. 133 passed as written, he projected the Board would be licensing those same practitioners without examination to treat Nevadans.

 

Dr. Champagne acknowledged the need for dental practitioners in rural and underserved areas.  He declared that even with the increase in dental licenses granted in the past few years, “few if any” of those licensed, practiced in the rural underserved areas or participated in federally qualified programs serving the indigent populations of Nevada.  The Board shared the concerns of others regarding service to those communities.

 

As a possible solution, the Board offered two amendments to S.B. 133, which were approved by the Senate.  Those amendments would allow practitioners from other states to establish practices in the underserved areas at the request of either the county commissioners or the directors of federally qualified programs.  The dentists would be required to possess a license from another state, serve at least three years in that geographically restricted area, and have a clean practice record, after which they would receive an unrestricted license.  The Board felt that monitoring requirements of those individuals would be minimal and would place practitioners in the areas of greatest need.

 

The Board had also proposed amendments that would allow specialists who were diplomates of their specialty board, and who planned to limit their practice to that specialty area, licensure without having taken the exam.

 

Dr. Champagne speculated dentists practicing in Nevada, as a result of the licensing provisions of Section 2, would have little motivation to practice in a rural or underserved area, knowing they could receive an “unrestricted license by untested, unmonitored credentialing, and practice in any area of their choice.”  He added the State Board of Dentistry took an oath to protect the oral health of the citizens and that S.B. 133 would not only decrease the quality of dentistry but the “underserved” would continue to be underserved.

 

Dr. Champagne informed the committee that the Board was going through many changes but the system “was not broke.”  He restated their opposition to Section 2 and offered their support of Sections 3 and 4.  Dr. Champagne asked the committee to consider all ramifications of S.B. 133 and continue supporting quality dentistry in Nevada.

 

Assemblyman Goldwater asked Dr. Champagne about practitioners who came in from other states and went through the full process of licensing, both the written and clinical.  Dr. Champagne clarified the only written exam concerned the jurisprudence; the board strictly licensed the clinical section of that exam.  Any written test would be taken previously through the National Board Examination, administered by the American Dental Association.

 

Assemblyman Goldwater asked if there were many applicants who passed the written exam, yet failed the clinical exam.  Since S.B. 133 would eliminate the clinical exam, Assemblyman Goldwater wondered how important the clinical exam actually was.  If those who passed the written exam generally passed the clinical exam as well, “would it be such a bad thing” to do away with the clinical exam?

 

Dr. Champagne expressed confusion regarding Assemblyman Goldwater’s question but replied the Board viewed the clinical exam as the “backbone of the quality issue.”  He felt elimination of the clinical exam would be a disservice to the citizens.  He added the pass/fail rate varied anywhere from 48 percent to 70 percent.

 

Assemblywoman Leslie asked if any out-of-state dentists who failed the clinical exam ever sued the Board over the exam.  Dr. Champagne replied that to his knowledge, none had.

 

Assemblyman Hettrick asked Dr. Champagne to clarify his objection to Section 2.  Dr. Champagne replied that Section 2 gave the candidate an unrestricted license without any type of monitoring.  He anticipated large numbers would come to practice in Southern Nevada, seeing it as an “economic Mecca.”  Dr. Champagne felt monitoring new dentists without clinical examination would be a financial burden on the Board, as well as a “policing” problem.  The board would become more of a policing agency than a licensing agency.

 

Assemblyman Hettrick recognized the merits of S.B. 133 and observed that if rural areas needed service, the county commissioners had to request it.  However, Section 2 did not provide the same requirement.  Dr. Champagne responded that according to Section 2, any dentist licensed in another state, with a “clean” five-year record, could apply for licensure and practice anywhere in Nevada as he or she chose.

 

Assemblyman Hettrick acknowledged Dr. Champagne’s objection to Section 2.  He asked that if Section 2 remained, would it not be fair that Section 4 eliminate the county request provision.  He wondered why there should be a county request provision in Section 4 if there was none in Section 2.  Assemblyman Hettrick observed the most underserved areas in the state were clearly the rural areas.

 

Fred Hillerby reminded the committee the Board came forward with two proposals in Sections 3 and 4 to address the need for dental positions in rural Nevada.  Section 4 was basically modeled after the Nevada State Board of Medical Examiners’ residency requirement.  Practitioners who did not have a three-year residency requirement had to be requested by a county commissioner and practice only in the rural areas, he believed for three years.  After that time they could apply for an unrestricted license.

 

Mr. Hillerby explained the twofold reasoning behind the provisions.  The community was recognized when the County Commission specifically requested a practitioner.  The practitioner could practice only in that underserved area.  Secondly, it was seen as a “good vehicle” for those in the WICHE program to serve in rural Nevada and repay their loans.  They could obtain an unrestricted license after three years without passing the examination.  That was considered a good compromise for rural Nevada.

 

Mr. Hillerby continued that as supporters went through the process of developing the compromise, they considered the needs in the rural areas of Washoe and Clark Counties.  They recognized, as well, the needs of federally qualified health centers and nonprofit clinics.  For example, the St. Mary’s van could go outside Washoe County and there would not be a problem with their getting licensed.

 

Chairman Dini countered that the medical board had asked the committee to repeal a similar section of S.B. 378 because no one applied to work the three years in rural areas.  He wondered if the same problem, resulting in no candidates coming to Nevada, would arise with the proposed dental licensing provisions.

 

Assemblyman Hettrick agreed and asked why Section 4 required the geographical or county requests, but Section 2 did not.  It seemed to be more difficult for rural areas to receive dental practitioners.

 

Assemblywoman Buckley thought that under Section 2, anyone who practiced for five years could apply for licensure regardless of where they lived.  She felt Section 4 would let a dentist with less experience, receive an unrestricted license after only three years, because of the greater needs in the rural areas.

 

Fred Hillerby replied Section 4 did not require dentists to have any experience; they only had to be licensed.  After practicing for three years, they would be eligible for an unlimited license.  Section 2 required five years of experience, and a temporary license for two years; a total of seven years, for an unrestricted license.  They felt three years practice was sufficient in the rural areas.  Mr. Hillerby also affirmed for Chairman Dini that the Board did not know if many would take advantage of the provisions, but that the rural citizens thought it was a good idea.  He also added that the provision for the specialists was intended to provide pediatric dentists to meet the needs of children.

 

Assemblywoman Giunchigliani established there was no reciprocity in Nevada.  She asked how many hours of continuing education were currently required for a licensed doctor.

 

Dr. Champagne responded 12 hours were required annually, plus four hours of cardiopulmonary resuscitation, for a total of 16 hours annually.  The hours were “readily available” in Las Vegas, Reno, and other locations via the Internet.

 

Assemblywoman Giunchigliani asked why the amendment from the Board requested 30 hours of continuing education credits.

 

Fred Hillerby explained the provisions of the amendment proposed by the Nevada State Board of Dental Examiners (Exhibit K).

 

• Since the proposed legislation was basically eliminating the examination, the Board changed “Any person is eligible to take an examination” to “Any person is eligible to apply…”

 

• The Board felt that because the applicant had not been examined, 30 hours of continuing education in the clinical sciences would serve as a monitoring device and a “guarantee” that the practitioner was keeping “current.”

 

• “Chapter” was changed to “section” with regard to the licensing provisions for specialists.

 

• Forty hours of continuing education in clinical sciences was required of the restricted geographical licensee.

 

• Changed “chapter” to “section” in Section 4, page 4, line 18.

 

Assemblywoman Giunchigliani asked what was included in “clinical sciences.”

 

Dr. Champagne responded “clinical sciences” included the typical procedures performed by a general dentist including root canals, crowns, bridges, prosthetics, oral surgery, and perodontics.  The required training was not to include practice management or motivational courses; rather, they should enhance the dentist’s clinical proficiency.

 

Dr. Champagne affirmed for Assemblywoman Giunchigliani that the 12 hours currently required was also in the clinical sciences.  Responding to her inquiries, Dr. Champagne informed Ms. Giunchigliani that dentists could perform oral surgery and root canals, if qualified.  They could refer to other practitioners or specialists if they felt a specialist was better trained in a particular procedure.  General dentists would not perform surgery, jaw reconstruction, and treatment of fractures, for example.

 

Ms. Giunchigliani wondered why the proposed amendment would increase the continuing education from 12 hours of clinical sciences to 30 hours, and what would be contained in those hours.  Dr. Champagne assured Ms. Giunchigliani extending the 12 hours to 30 would not be a problem in the clinical sciences.  One course in endodontics, a root canal for example, was an eight‑hour “day” course.  Ms. Giunchigliani said she would like to see what was offered around the state to be sure the continuing education hours were accessible to all who needed them.

 

Ms. Giunchigliani noted she did not like to “mess” with licensing boards, but felt there was a reciprocity issue the Board had not addressed.  It was her opinion that dentists who had already passed a national test should not be subjected to further testing to be licensed in another state.  She described the issue as one of “access without jeopardizing a practice,” and noted she did not approve the amendment “at this point.”

 

Mr. Hillerby maintained access was an issue of economics and whatever the Legislature decided with regard to licensure, it would not cure access by itself.  He hoped that whatever the committee decided, they would not do anything that jeopardized the public.

 

Maury Astley, Executive Director, Nevada Dental Association, informed the committee the Association worked to support the Board on some of the amendments.  Addressing Assemblyman Hettrick’s concerns, Mr. Astley explained Section 4 did not require a five-year experience somewhere else.  Therefore, the dentist was not only untested by Nevada, but also lacked experience.  Section 4 allowed the county to decide, based on its need, whether or not to accept one of those dentists.  It also provided dentists who did not want to take the exam, the incentive to go someplace where they could actually provide some help.

 

Mr. Astley stated the Association did not support the “five-two” amendment of Section 2.  They contended anyone who qualified under Section 2, since they were not restricted anywhere, would choose to practice in Las Vegas rather than in the rural or underserved areas.  Section 2 therefore “diminished” the effectiveness of Section 4, the geographic provision.

 

Mr. Astley referred to his document, (Exhibit L), which presented the pass and fail rates for Nevada’s dental examination.  Reported pass and failure rates had been deceptive because they did not reflect the passing rates of those who retook the failed portions of the exam.

 

Mr. Astley noted the 100 dentists licensed in the year 2000 represented a 15 percent growth in Nevada’s dentist population.  He explained the Culinary Union’s claim that the dentist population was not keeping pace with the increase in Nevada’s population was based on the past ten years.  Mr. Astley presented that the increase in dentists in the last year or two exceeded the increase in Nevada’s population.

 

Mr. Astley also explained the Board did not require four exams.  The dental exam was a two-part exam; the additional “exams” were the retakes.

 

Referring to Exhibit L, Mr. Astley pointed out dentists who were accused of not taking patients, often did not receive enough compensation to “even cover their overhead.”  Dentists began their practice in debt from college expenses and incurred further debts from equipping their offices.  Dentists ran approximately an 80‑percent overhead.  Medicaid only paid between 60 and 65 percent on each claim.  He concluded, any plan that paid less than the cost of overhead would not attract providers.  He contended Section 2 would only bring more dentists into Las Vegas with the hopes that those dentists would accept the lower reimbursement plans.  Mr. Astley did not expect that would happen; the dentists, like anyone else, would not “go somewhere where they do not get paid.”

 

The Nevada Dental Association approved of the geographical and specialist provisions of S.B. 133 because they addressed the concerns presented during the legislative interim.  They also asked the dental board to reassess their exam, specifically with regard to the denture exam.  Mr. Astley stated that few dentists “set teeth” anymore.

 

Mr. Astley restated the Association’s opposition to Section 2.  If S.B. 133 passed, he would follow it closely.  He added, however, that hygienists should be included in Section 2.  Otherwise, the number of dentists would increase, but there would be no one to perform the cleanings.

 

In closing, Mr. Astley contended the best solution would be to provide better reimbursement and participation in the health programs.  The result would be more providers.  Also, the legislation should focus on bringing dentists to the rural and underserved areas.

 

Joel Glover, General Dentist, spent 15 years on the Board of Dental Examiners, and was past president of the Nevada Dental Association.  He agreed the issue raised by S.B. 133 was one of access.  In his experience of treating Medicaid patients, Dr. Glover was frustrated because of the shortage of pediatric dentists to treat the many Medicaid children.  He informed the committee there were pediatric dentists who were not being paid for their services because there were so many children in need of their services.

 

He emphasized the importance of access and felt the Nevada State Board of Dental Examiners should be lauded for their amendments to Sections 3 and 4 of S.B. 133.  He compared those sections with the Navy’s educating young dentists in exchange for their service.  Naval dentists served one year for each year of training.  He asserted the only way to provide dentists to the underserved areas of Nevada would be through contracts.

 

Dr. Glover stated that he and Mr. Sparks, Director of Western Interstate Commission for Higher Education (WICHE), had considered a program wherein Nevada students, upon their return from dental school, would serve in the underserved areas.

 

Dr. Glover reiterated the urgency of access.  He said access needed to be remedied contractually and through funded programs.  Young dentists could not be expected to incur costs that exceeded their reimbursement.  Dr. Glover shared that he, an established dentist, could afford to perform some charity work; a starting dentist could not.

 

Dr. Glover was especially concerned that under Section 2, those who came to practice in Nevada could “bypass any reasonable reason” to practice in the underserved areas, urban or rural.  He expressed dentistry’s concern and efforts to address the access problem in Nevada.

 

Dr. Eric Skinner, President, Southern Nevada Dental Society, supported and complimented Dr. Champagne and the Nevada State Board of Dental Examiners.  He noted the Board increased the number of dentists while maintaining quality.  Dr. Skinner referred to the terminology “clean record” used in Section 2.  With statistics from California, he demonstrated how difficult it was to lose, or have suspended, one’s license for practicing dentistry.  He was concerned that without some clinical competence demonstrated, Nevada’s standard of care would be diminished.

 

Dr. Skinner addressed the issue of access.  Earlier testimony revealed that patients had to wait months to be seen.  It was his understanding that all the panels were closed.  He explained that if he wanted to be a provider for an insurance plan, and its panel was closed, he could not become a provider for that plan.  Dr. Skinner proposed that was not a problem of access or availability.

 

Dr. Steven Saxe, President, Nevada Division of the American Association of Oral and Maxillofacial Surgeons, reminded the committee of the letter he had e-mailed to them (Exhibit M).  He contended the issue addressed by S.B. 133 was that which was “perceived to be,” a shortage of dentists in Nevada, especially in the rural areas.  He declared, that according to statistics from the Nevada Dental Board of Examiners, the number of dentists in Nevada had increased by nearly 20 percent statewide in the past two years.

 

Dr. Saxe informed the committee Nevada had the lowest rate of dental malpractice in the nation.  He named many of the programs in Nevada that provided access to dental care in the rural areas and testified more than $6 million in services had been donated each year since 1998 in Southern Nevada alone.

 

Addressing the limited access to dental care in the rural areas, Dr. Saxe related that other states faced similar challenges.  In a response similar to S.B. 133, New Mexico lowered its standards and yet, 89 percent of new dentists sidestepped the rural areas to practice in the cities as they did prior to “dumbing down” the test.  Dr. Saxe projected the outcome would be worse in Nevada with its “explosive” growth in Clark County.  He maintained there was no incentive in S.B. 133 for newcomers to practice in rural areas with their “outrageous” expenses from dental school and the technology necessary to set up their practice.  Dr. Saxe advised the committee that if providing practitioners to the rural areas was their motive, they needed to be aware that similar legislation failed elsewhere.  He offered to help in any way he could, and asserted S.B. 133 would only “denigrate” the level of dental care in Nevada.

 

Countering claims that Nevada’s exam was “too tough,” Dr. Saxe noted roughly 60 percent of all applicants passed the Board exam.  He cautioned against allowing the other 40 percent to practice dentistry.  An “under-skilled” dentist could make mistakes that plagued patients throughout their lifetime.  S.B. 133 would allow the “40‑percenters” to practice in Nevada.  “Their only hurdle would be to just put in their time in a backwater community, with low standards, and they could be licensed to work on Nevada families.”  S.B. 133 would announce, ”The fastest growing state in the United States now has the lowest standards of dentistry.  If you are good enough for anyone, you are good enough in Nevada.”  Dr. Saxe maintained the only impact of S.B. 133 would be the “dumbing down” of Nevada’s standards.

 

Dr. Saxe claimed statistics presented earlier were incorrect and should be substantiated with references.  In closing, he asked the committee to “vote their conscience.”

 

Becky Harris, Private Citizen, suggested the committee consider reimbursement issues.  She related findings from a study conducted in South Carolina.  That state found that increasing reimbursement rates under Medicaid resulted in 30,000 more people receiving care in a one‑year period.

 

Ms. Harris noted several states dealt with access issues, but none were “willing to compromise their standards to allow dentists to come in untested and unqualified.”

 

Colorado and Kansas proposed student loans or loan forgiveness programs.  In Arizona community health centers allowed dental services such as WICHE to be provided.  Minnesota allowed capital and service expansion grants to nonprofit community clinics to draw dentists.  Massachusetts was trying to pass a pilot program for dental sealants.  Hawaii was considering special geographically restricted licenses.

 

Ms. Harris contended S.B. 133 allowed dentists to practice anywhere they wanted yet provided them no incentives to work in rural areas.  She predicted when S.B. 133 sunset, the Culinary Union and the rural communities would still have difficulty finding access to care.

 

A recent study in Nova Scotia, conducted by the American Dental Association, found children from lower socioeconomic groups had more tooth decay when access was not an issue.  Ms. Harris claimed the committee was not seeing the underlying problems if they looked only at access.  They needed to consider education of the general public.

 

Assemblyman Goldwater challenged arguments that S.B. 133 did not provide incentives for dentists to practice in rural areas.  People of varying professions desired to live in rural areas for a number of reasons.

 

Assemblyman Goldwater wondered what “types” of people were being licensed and if Nevada’s standards were too high.  He asked the Board if they had socioeconomic, racial, and gender-based profiles of those licensed individuals.

 

Dennis Arch, General Dentist, Nevada State Board of Dental Examiners, said the Board application was anonymous.  The application did indicate ethnicity, and records of such information were not kept.

 

Assemblyman Goldwater asked if there were any women on the Board.  Dr. Arch replied there were two female hygienists on the Board and one female member at‑large.  A female dentist, no longer on the Board, had served nine years and had been president of the Board.  Assemblyman Goldwater asked if there were any African Americans on the Board.  Dr. Arch replied there were none at the present time but there had been in the recent past.

 

Christine Forsch, Nevada Dental Hygienists’ Association, asked that if dental hygienists were added to Section 2, a clause be included that provided the hygienists must have graduated from an accredited program.  An alternative would be to have the phrase included in the restricted geographical section on page 3, lines 12 and 13, providing that eligibility for a restricted geographical license included that one had to be otherwise qualified for a license to practice dentistry or dental hygiene in Nevada.  She testified there was one state that licensed dental hygienists who had not graduated from accredited programs.

 

Dr. Arch reiterated the Nevada State Board of Dental Examiners’ opposition to Section 2.  He stated the amendments they brought forward to Senator Shaffer were “responsible and rational” and addressed the incentive needed to attract dentists to the rural areas.  The incentive was the licensing of the dentist following the three years of practice, after which he or she could leave to practice in any other location.  Section 2 did not provide incentives to practice in rural areas.

 

The Board had also proposed that those who were specialists for a specified period of time and diplomates of their particular boards would not need to take the general dental examination.

 

Regarding Ms. Giunchigliani’s earlier concerns of reciprocity, Dr. Arch commented that Section 2 was not reciprocal.  Dr. Arch reminded the committee the Board had passed more than 100 new dentists in 2000 and would continue to do so as long as they had qualified candidates.  He noted there had been a “problem with some dental schools and qualified candidates.”  That was why Nevada had examinations.  In closing, Dr. Arch offered the Board’s continued service to the people of Nevada and asked the committee to vote against Section 2.

 

Dr. J.S. McElhinney III, General Dentist, had practiced in Reno, Nevada, for 23 years.  He informed the committee that before he came to Reno he had spent a month practicing in a Culinary Union clinic.  He contended one of the chief problems with the Culinary Union insurance plan was their low reimbursement rates.  Because of large overhead costs, few dentists could afford to accept the low reimbursements.  That was reflected by low “access” to dentists.

 

Dr. McElhinney asserted S.B. 133 was a “money bill; everything about this bill has to do with money.”  Average overheads in Nevada were running between 70 percent and 85 percent.  Reimbursement from the Culinary Union plan, for a tooth extraction, was 29 percent of his fee; reimbursement for a simple routine cleaning was 56 percent of his fee.

 

He disclosed that when he practiced in the clinic in Las Vegas, hygienists had 30 minutes to perform a procedure on which he would typically spend 4 hours.  Reimbursement plans did not allow adequate time to do quality work.  Dr. McElhinney reasoned that no one could be expected to “work below the cost of providing the service.”

 

He pointed out his overhead did not include any income for himself.  Many “normal” plans required discounts of between 20 and 40 percent.  Dr. McElhinney reiterated that low reimbursement was one reason so few Medicaid patients could be seen by any one dentist.  He surmised Nevada could “flood the state with dentists, but no one will accept these plans if they reduce the profitability below the cost of doing business and leave the doctor with no income.”  Dr. McElhinney concluded that, if Nevada wanted dentists in the rural areas, it would need to subsidize them.

 

Chairman Dini requested those who had not yet testified from Las Vegas to submit their testimony in writing.

 

For the record, approximately 6,000 form letters from citizens of Nevada were fax’d to the committee in opposition to S.B. 133.  Approximately ten forms were fax’d in favor of S.B. 133.

 

Chairman Dini closed the hearing on S.B. 133.  The meeting was adjourned at 7:42 p.m.

 

RESPECTFULLY SUBMITTED:

 

 

Darlene Nevin

Committee Secretary

APPROVED BY:

 

 

                       

Assemblyman Joe Dini, Jr., Chairman

 

 

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