MINUTES OF THE meeting

of the

ASSEMBLY Committee on Commerce and Labor

 

Seventy-First Session

March 21, 2001

 

 

The Committee on Commerce and Labor was called to order at 3:58 p.m., on Wednesday, March 21, 2001.  Chairman Joe Dini, Jr. presided in Room 4100 of the Legislative Building, Carson City, Nevada.  Exhibit A is the Agenda.  Exhibit B is the Guest List.  All exhibits are available and on file at the Research Library of the Legislative Counsel Bureau.

 

 

COMMITTEE MEMBERS PRESENT:

 

Mr.                     Joseph Dini, Jr., Chairman

Ms.                     Barbara Buckley, Vice Chairwoman

Mr.                     Morse Arberry Jr.

Mr.                     Bob Beers

Ms.                     Dawn Gibbons

Ms.                     Chris Giunchigliani

Mr.                     David Goldwater

Mr.                     Lynn Hettrick

Mr.                     David Humke

Ms.                     Sheila Leslie

Mr.                     Dennis Nolan

Mr.                     John Oceguera

Mr.                     David Parks

Mr.                     Richard D. Perkins

 

GUEST LEGISLATORS PRESENT:

 

Assemblyman Douglas Bache

 

 

STAFF MEMBERS PRESENT:

 

Vance Hughey, Committee Policy Analyst

Darlene Nevin, Committee Secretary

 

OTHERS PRESENT:

 

Jack Jeffrey, Legislative Advocate, Southern Nevada Labor Council, and Southern Nevada Building and Construction Trades Council

Bob Ostrovsky, Legislative Advocate, Employers Insurance Company of Nevada, and Nevadans for Affordable Health Care

Jim Jeppson, Division of Insurance, State of Nevada

Larry Hardy, Nevada Association of Insurance and Financial Advisors, and Nevada Association of Health Underwriters

Kami Dempsey, Las Vegas Chamber of Commerce

William Ebaugh, Owner, Sierra-Berkshire Associates, Inc.

Heidi Vasas, President, Clark County Association of Health Underwriters

Bob Bishop, President, KIA Insurance

Rebecka Caster, Owner, ABC Locksmiths

Warren Hardy, Legislative Advocate, National Federation of Independent Businesses

George Ruiz, Nevada Health Underwriters Association

Larry Matheis, Legislative Advocate and Executive Director, Nevada State Medical Association

Barry Lovgren, private citizen

Tom Wood, Legislative Advocate, Pharmaceutical Research and Manufacturers of America, and American Owned Products

Mark Nichols, Executive Director, National Association of Social Workers

Denise Duarte, member, Nevada Women’s Lobby

Martin Gallagher, member, Nevada Service Employees International Union Local No. 1107, and Registered Nurse, University Medical Center

Judy Phoenix, Psychologist, Nevada State Psychological Association

Maureen Brower, Legislative Advocate, American Cancer Society

LuAnn Tucker, Nevada Physical Therapy Association

Dorothy North, member, Bureau of Alcohol and Drug Abuse Advisory Committee

Vil Paskevicius, Program Administrator, Economic Opportunity Board Treatment Center, and President, Nevada Association of State Alcohol and Drug Abuse Programs

Guy Perkins, Chief Examiner, Life and Health, Division of Insurance

Lisa Black, Registered Nurse, Director at Large, Nevada Nurses Association

Jerri Woolston, Registered Nurse and Critical Care Nurse

Debra Bonsangue, Registered Nurse, University Medical Center, and member, Nevada Service Employees International Union, Local No. 1107

Nancyann Leeder, Nevada Attorney for Injured Workers

Bryon Slobe, Nevada State Fire Marshal

Carin Franklin, Registered Nurse, Operating Engineers Local Union No. 3

Beatrice Razor, Registered Nurse, Razor Collaborative Nursing

Danny Thompson, Legislative Advocate, Nevada State AFL-CIO

Ronald Dreher, President, Peace Officers Research Association of Nevada

Fred Hillerby, Legislative Advocate, Associated Pathology Labs

Dr. Henry Soloway, Associated Pathology Labs

Susan Dunt, Risk Manager, State of Nevada

Robin Keith, President, Nevada Rural Hospital Project

Wayne Carlson, Executive Director, Public Agency Compensation Trust

Don Jayne, Legislative Advocate, Nevada Self-Insureds Association, No. 200

Jerri Strasser, Registered Nurse, University Medical Center

Andy Anderson, Legislative Advocate, Nevada Conference of Police and Sheriffs

Phil Gervasi, President, Clark County School District’s Police Officer’s Association

Bob Gagnier, Executive Director, State of Nevada Employees Association

 

 

Chairman Dini called the meeting to order at 3:58 p.m.  A quorum was present.  Chairman Dini announced the Commerce and Labor Committee had met on the floor of the Chambers that morning.

 

Chairman Dini opened the hearing on A.B. 249.

 

Assembly Bill 249:  Authorizes certain insurers to offer policies of insurance covering employees for both work-related and nonwork-related illnesses and injuries. (BDR 57-250)

 

Assemblyman Douglas Bache, District No. 11, Clark County, presented A.B. 249 which would allow a casualty insurer authorized to transact health insurance to offer a product that included both workers’ compensation and health care in one policy.  Mr. Bache proposed that with the privatization of workers’ compensation coverage this would be a fitting option.  It would address constituents’ concerns that they visited one doctor for health care and another for workers’ compensation related care.  A.B. 249 would allow them to have one group of doctors for both types of claims.  Mr. Bache conveyed that was his intent for A.B. 249, although he observed it read differently than he intended.  Mr. Bache informed the committee Chapters 616A to 616D would still provide direction to determine if the claim was compensable.

 

Assemblyman Nolan asked Assemblyman Bache if the privatized Employers Insurance Company of Nevada (EICON) would now be able to write other health care insurance.

 

Mr. Bache responded that under A.B. 249, only an insurer licensed to do both health care and workers’ compensation could offer the combined coverage.  He added the Insurance Commissioner would make that decision.

 

Assemblyman Hettrick asked if the insurer was licensed for both functions, did Mr. Bache expect the insurers to keep their records separate.  He related it could be difficult because health care usually involved deductibles and co-pays whereas workers’ compensation did not.

 

Mr. Bache responded he had not contemplated that aspect and speculated it would be addressed by regulations the Insurance Commissioner would adopt.  Mr. Bache added this coverage had been made available in other states.  Mr. Bache suggested this change could “streamline” insurance coverage and make it more affordable for the employers.

 

Mr. Hettrick asked if it should be mandated in A.B. 249 that health care providers who chose to offer workers’ compensation must provide the work safety programs.

 

Mr. Bache replied the Division of Industrial Insurance would need to provide the regulations.  He clarified his intent in A.B. 249 was to allow the change and assumed regulations would come from the Insurance Commissioner or Industrial Insurance.

 

Assemblyman Beers asked if the providers were licensed under both provisions, whether they should not then be governed by both provisions.  He suggested they would meet the requirements of other workers’ compensation providers.

 

Chairman Dini determined this issue would require further examination from insurance laws and through the powers of the Insurance Commissioner.

 

Mr. Beers commented it was his understanding the change Mr. Bache was seeking was intended when state privatization of workers’ compensation first went into effect.

 

Chairman Dini asked if there were further questions from the committee.  He asked if there was anyone to testify for or against A.B. 249.

 

Jack Jeffrey, Legislative Advocate, representing the Southern Nevada Central Labor Council and the Southern Nevada Building and Construction Trades Council, expressed he was not opposed to A.B. 249.  He established his concern, however, that the provider would “push” the client toward health care and away from the workers’ compensation care because workers’ compensation provided more coverage and was more expensive.  He pointed out health care coverage lacked Permanent Partial Disability (PPD) awards and therefore, if A.B. 249 was passed, penalties should be established to address the aforementioned situation.

 

Chairman Dini asked if there was any testimony for or against A.B. 249.

 

Bob Ostrovsky, Legislative Advocate, Employers Insurance Company of Nevada (EICON), voiced his neutrality and related EICON could not provide the dual coverage because it was a “monoline” company; it provided casualty coverage only.  Life and health was not considered a casualty line.  If EICON was to sell health insurance as well, it would need additional licensing to do so.  Also, Mr. Ostrovsky stated, because EICON was a mutual holder company, the risk to the mutual owners of the company would have to be considered.  He added there would be a bill introduced this session changing EICON’s insurance code that might satisfy some of his concerns.  He further expressed his concern that the language in section 1, paragraph 2, allowed the employees to choose their own providers or network of providers.  He related health care networks were usually broader in the variety of providers, while workers’ compensation networks were smaller and composed of more specific types of providers.  He felt this difference might present problems when the insurer decided with whom he/she should contract.  Mr. Ostrovsky informed that “24-hour coverage” had been tried in other states, but he did not know how successful they were.  He also considered the necessity of separating all factors for accounting purposes.  Mr. Ostrovsky closed urging the committee to approach the issues in a cautious and well-informed manner.

 

Chairman Dini asked if there was any further testimony for or against A.B. 249.

 

Jim Jeppson, Division of Insurance, apologized that he was unable to discuss A.B. 249 with Assemblyman Bache and noted he was not present to either oppose or support A.B. 249.  He pointed out some basic differences between health insurance and workers’ compensation.  First of all, health insurance would be regulated by the Division of Insurance, which included many mandated benefits, and workers’ compensation would be regulated by the Division of Industrial Relations.  Workers’ compensation was highly regulated with all benefits prescribed by law.  He noted there were similar programs around the country with “24-hour coverage” operating under “tightly” regulated pilot programs with rules and regulations pre-established to help coordinate benefits and regulation between health insurance and workers’ compensation.  Lastly, Mr. Jeppson offered he had information in his office on similar programs offered in other states and the amount of their success.

 

Assemblyman Nolan noted A.B. 249 did not imply “24-hour coverage.”  He mentioned when this issue was addressed two years ago, Oregon was the only state that had tried the dual coverage and noted it was not very successful due to the “subtle differences” between the two different programs.  He asked Mr. Jeppson if he thought A.B. 249 implied 24-hour coverage.

 

Mr. Jeppson replied that if it was not 24-hour coverage, it was very close.  He also affirmed that Oregon had tried a 24-hour coverage program and he thought it was phased out.  He added other states had tested 24-hour coverage.  Such coverage seemed to be a combination of health insurance, which was usually 24-hour coverage and excluded, among others, job related injuries.  Mr. Jeppson added an illness or injury could arise which would not be addressed by either the health coverage or the workers’ compensation coverage.  He did not know how 24-hour coverage programs addressed that situation.  Mr. Jeppson related that questions could arise regarding deductibles and co-pays as well.

 

Chairman Dini closed the hearing on A.B. 249 and opened the hearing on A.B. 206.  Chairman Dini maintained that Sections 25 and 26 should never have been included in A.B. 206 and it was the decision of the chair to exclude those two sections.

 

Assembly Bill 206:  Revises provisions governing mandated benefits for health insurance. (BDR 57-293)

 

Bob Ostrovsky, Legislative Advocate, Nevadans for Affordable Health Care, clarified it was never his intent to repeal the mandates in current law referred to in Sections 25 and 26.  Mr. Ostrovsky noted he had served on interim health care committees during the last three interims and stated it was difficult to ask the committee to allow him another chance to create another.  He conveyed his disappointment that after the many subcommittee meetings, not one bill draft came forward to this Legislature.  Referring to the many mandates debated in prior sessions, their inclusion in the law and their costs, Mr. Ostrovsky suggested an interim committee be formed to focus only on mandates and their costs to determine whether or not they meet the criteria of “public good.”  Sections 13 through 21 of A.B. 206 directed the formation of the proposed committee, which would be comprised of members from both houses of the Legislature and would review the current mandates, their costs and benefits.  Mr. Ostrovsky revealed A.B. 206 omitted the provision for the committee to evaluate proposed mandates as well.  He reiterated the purpose of A.B. 206 was that mandates would receive an actuarial study, providing the committee with good numbers and knowledge to help them determine the impact of those mandates so they could prescribe policy.  Mr. Ostrovsky pointed out that in section 1 they asked that the Legislature not enact additional mandates during the period of the study.  Although this was his suggestion, he acknowledged the Legislature could probably not be bound from enacting additional mandates.  He did, however, ask that the committee consider moving any mandates from this session to the committee proposed by A.B. 206.

 

Mr. Ostrovsky explained that the structure of the proposed committee was modeled after the American Legislative Exchange Council (ALEC), and that a bill of similar form was adopted in Texas.  Mr. Ostrovsky expounded there were many concerned with the rising costs of health care and that mandates, although they were not the only factor involved, were a factor the Legislature could change.

 

Mr. Ostrovsky asked the committee to consider creating a committee to look at the mandates and hire an actuary to do studies of the mandates.  He also noted the period of time for the study would span two or three sessions so the committee could look at them over a period of time.  Mr. Ostrovsky emphasized the need to have a process in place.

 

Assemblywoman Buckley agreed there was a “tension” between the affordability of health care and mandated benefits.  Ms. Buckley acknowledged Mr. Ostrovsky’s frustration and noted previous attempts had not been productive and future attempts would be unproductive as well.  Ms. Buckley also stressed her objection to there being a committee that would review other legislators’ bills.  She remarked that Mr. Ostrovsky could present data at hearings supporting or denouncing prior legislation.  Ms. Buckley submitted she did not see a need for A.B. 206.

 

Mr. Ostrovsky responded A.B. 206 had a narrower focus and he had hoped that would improve its chances of success.  Secondly, he felt a committee composed of legislators would have the “weight” that advocates did not.

 

Assemblywoman Giunchigliani asked if there was similar legislation in the Senate, one that repealed the mandated benefits.  Mr. Ostrovsky did not recall there being a bill that repealed mandates, but that there was some proposed legislation regarding mandates.

 

Ms. Giunchigliani divulged she had looked at both bills and they were almost identical with regard to repealing the mandates.  She wanted to know if testimony was being duplicated.  Ms. Giunchigliani agreed with Mr. Ostrovsky’s focus on the committee, but also leaned toward Ms. Buckley’s position that the issue had been addressed so often before.  Ms. Giunchigliani voiced the fundamental issue was prevention, which was not covered by insurance, and until it was covered, there would be no need to deal with mandated benefits.

 

Assemblywoman Leslie stated there were some positive results of the interim committee although they did not present themselves in the form of bill drafts.  She pointed out that some of the ideas led to budget proposals such as the $5 million for uninsured families.

 

Mr. Ostrovsky acknowledged the Governor did put some items in the budget.  He clarified he had never taken the position that “all things covered by mandates were bad.”  He noted it could not be debated whether or not there were needs in the community for certain types of coverage, but the manner in which they would be paid could be debated.  In closing, Mr. Ostrovsky contended that legislators and citizens were obligated to assist those most in need.

 

Larry Hardy, representing the Nevada Association of Insurance and Financial Advisors and the Nevada Association of Health Underwriters, informed the committee they wrote over 90 percent of the health insurance for small companies and that was where costs were rising.  Mr. Hardy referred to a study that demonstrated the rate increases their clients were experiencing (Exhibit C).  He interjected his members had to face clients daily with rising costs, which in some cases increased by 100 percent.  Mr. Hardy expressed his support for A.B. 206 with the modifications proposed by Mr. Ostrovsky because he strongly felt something had to be done.  More and more consumers could not afford the rate increases, deductibles and co-payments and were asking what could be done.  Mr. Hardy remarked accessibility to health coverage existed but affordability did not.  For that reason, he expounded, employers were going to defined-contribution plans; they were refusing to pay more and shifting the costs to the employees.  Mr. Hardy declared that if the committee knew the costs, there would be no questions; the rising cost of insurance was a very serious situation.  He related companies were dropping their coverage and buying individual policies.  Much of the public was “being left on the street” without coverage because they had medical conditions that prevented them from purchasing their own necessary coverage.  Mr. Hardy concluded they could not understand why there was yet to be a solution.

 

Chairman Dini commented it was a national problem that affected every small business in the state.  He established the committee realized the problem, did not yet have a solution, but hoped they could work toward one eventually.

 

Speaker Perkins, referring to Section 17, paragraph 2, questioned how an actuary determined the social effect of a mandated benefit.  He expounded that the Legislature met every two years to determine good public policy and he did not see the responsibilities listed in Section 17, paragraph 2, as an actuary’s responsibilities.

 

Kami Dempsey, Las Vegas Chamber of Commerce, revealed about 84 percent of their approximately 6,400 members had 25 employees or less.  She conveyed the chamber’s support of A.B. 206 in context because it had always strived to insure the largest amount of employees in the most cost-efficient manner.  Ms. Dempsey instructed there was a direct correlation between increased amount of mandates and the number of people not insured.  Their surveys indicated 13 percent of employers dropped health coverage due to rising costs and the remaining 87 percent considered doing the same.  She related employers had a small amount of money to afford salaries, offer 401(k) options and provide health care benefits.  High costs of health coverage made it difficult for small employers to remain competitive with other employers.

 

William Ebaugh, owner of the actuarial firm Sierra-Berkshire Associates, Inc., stated he was also a small employer.  He communicated the rising costs of small group coverage was growing quickly in Nevada, especially in the northern part of the State.  He informed the committee he had worked with insurance companies, third party administrators, large employers, unions, and city and county governments searching for methods to reduce costs and forecast future costs.  He referred to another actuarial firm that had predicted health care costs of today would double by the year 2005.  He emphasized the committee needed to do what it could to assist in analyzing benefits of health care and the costs.  He further stressed the committee needed to know the impact on each mandated benefit and informed them that increases were usually higher than predicted.

 

Chairman Dini asked Mr. Ebaugh what he considered to be the biggest factor in the rising cost of health insurance.  Mr. Ebaugh replied costs were driven up by federal cost shifting, federal mandates, state mandates, and technology, but mostly by the costs of pharmaceuticals.  Pharmaceuticals accounted for 18 to 24 percent of the total health care delivered.

 

Chairman Dini ascertained it was a multitude of factors.  Mr. Ebaugh agreed and interjected that health care and health insurance were two different entities.  He clarified health insurance was a method to help pay for health care.  Chairman Dini affirmed his statement.

 

Assemblywoman Buckley informed that during discussion in Washington, D.C., on the topic of health care costs, much of the testimony supported the position that the largest contributor to increased health care costs was prescription drugs.  Ms. Buckley considered the possibility that rising costs of pharmaceuticals could be keeping people out of the hospital was an especially important debate.

 

Mr. Ebaugh commented it was predicted that pharmaceuticals would soon pass the costs of in-hospital health care.  He also affirmed that advertising had driven up the costs of pharmaceuticals.

 

Heidi Vasas, insurance broker, small business owner, and president of the Clark County Association of Health Underwriters, testified in support of A.B. 206.  She related that she had seen mandates steadily increase premiums for small business owners over the past 17 years.  She added that mandates had eliminated many insurance carriers and had also forced employers to opt for “excessively” high deductibles and co-pays.  As a result, employees were often unable to afford coverage for their dependents and even had to pay for part of their own premium.  Ms. Vasas submitted that whenever a mandate was added and insurance rates rose, more low-income workers dropped their coverage.  This, she projected, increased the number of “indigents” for the state to care for and was “fostering a vicious circle where no one would be insured in the future.”  She suggested “sunset” provisions be added to the mandates so their effectiveness could be measured as well as their effect on costs and the resultant increase in the number of uninsured.  In closing, Ms. Vasas projected that the “current path” was leading to the “extinction of insurance companies” and eventually socialized medicine.

 

Bob Bishop, President of KIA Insurance, expressed he was testifying more as a small employer than as an insurance broker.  He informed the committee he had nine employees and his office received a 61 percent increase in health care costs the previous October.  Specifically, they experienced increases from $178 to $291 for an employee, $536 to $875 for a family, and $390 to $636 for an employee and his spouse.  Mr. Bishop queried how families could afford these costs, expounding that for some the costs were more than their rent.  He communicated that he gave each employee $350 per month toward their fringe benefits, yet a family still had to pay $525 per month for their coverage.  Mr. Bishop perceived his families would rather have basic care protection they could afford than no coverage at all.

 

Mr. Bishop further informed the committee that the rates his agency paid were determined by their demographics and health conditions.  By insurance standards, they were considered a mature group with medical conditions, yet he had to provide maternity coverage.  Federal government had mandated maternity coverage for businesses with 15 or more employees, but Mr. Bishop was able to find only two carriers that would quote coverage without maternity benefits.  He clarified that if mandated benefits were increasing their costs, he and his employees would rather have the lower premiums and reduced coverage.  This way there would be at least some coverage for employees’ family members.

 

Mr. Bishop revealed mental imparity had been mandated to groups of 26 or more but the Attorney General later ruled the mandate violated the Health Insurance Portability and Accountability Act of 1997 (HIPAA) regulations.  It was then mandated to groups of two to fifty.  Mr. Bishop offered it would be ideal if every carrier was required to offer the same core benefits at a given rate, and the premium increased for each mandate an insured wanted to add.

 

Mr. Bishop apprised the committee that in the late 1980s, Sierra Health developed a basic plan designed to provide core benefits with reduced rates.  They sold only two cases with a total of about 13 covered employees.  The basic plan was intended to be an option for the small employer to purchase low- cost insurance with limited mandates at reasonable rates.  The standard plan was to be priced a little less than their preferred product.  However, marketing was unsuccessful.  The carriers priced the basic plan 30 to 40 percent higher than their most preferred product and only about 10 to 12 lower than their standard plan.

 

Mr. Bishop concluded mandates were only part of the problem.  Revealing that 24 percent of Nevada’s population was uninsured, Mr. Bishop cautioned that increasing costs of health care would yield even more of the public being uninsured.

 

Rebecka Caster, owner of ABC Locksmiths in Las Vegas, related her experiences as an employer of 23 employees.  She expressed it was embarrassing that she could not adequately insure her staff.  She revealed that several left her company because they could not afford the coverage and rising prescription costs, deductibles and co-pays.  She could only insure about 50 percent of her employees and none of their dependents.  She felt as loyal and hardworking as they were, they deserved better.  Most left for employment in the casinos who could offer affordable coverage due to their large numbers of employees.

 

Ms. Caster agreed that advertising was driving up the cost of prescriptions.  She also shared with the committee that her insurance company reduced her prescription to a five-day dosage rather than the doctor’s prescribed ten-day dosage.

 

Warren Hardy, Legislative Advocate, representing the National Federation of Independent Businesses, informed the committee they had 600,000 small businesses nationally and 2,500 small business members in Nevada of which 90 percent employed ten or fewer employees.  He indicated his statistics were very similar to those presented earlier by the chamber of commerce in terms of mandates having been eliminated for their employees.  Their members were surveyed and the results confirmed insurance benefits were very important to them, especially as it affected their ability to compete for employees.  Mr. Hardy established their support of the concept of A.B. 206 and encouraged the Legislature to look at the issue of mandated benefits.  Mr. Hardy recognized mandates were not the only reason for increasing costs of health care, but imparted the federation’s membership identified mandated benefits as the foremost contributor to those costs.  The federation would like to provide information to its members and supported the Legislature in obtaining this information.

 

George Ruiz, representing the Nevada Health Underwriters Association, informed the committee he had been an insurance broker in the Carson City area for 17 years and specialized in group health insurance for small employers.  He felt many of the mandates in the last five years were good mandates and thought the HIPAA law was necessary for portability and accountability, but did not address affordability.  Renewal trends were lower than the 35 to 70 he experienced annually.  He proposed low renewal trends were due not only to mandates, but mostly to prescription drugs and over utilization of benefits.  Mr. Ruiz did assert that mandates gave Nevada less “pull” in attracting insurance companies to Nevada.  Not only was Nevada less appealing because of its smaller population, but also increased mandates translated into less profit.

 

Mr. Ruiz contended current mandates should not be repealed, and future mandates should be carefully studied.  He related his insurance groups could not sustain further increases and reiterated earlier testimony that premiums were high in northern Nevada as well as in southern Nevada.

 

Larry Matheis, Legislative Advocate, Executive Director, Nevada State Medical Association, testified that even with the elimination of Sections 25 and 26, A.B. 206 would still be a “bad bill.”

 

First of all, he instructed, it was necessary to refocus the dilemma addressed by A.B. 206.  The problem rested in the process.  Consumers were for years being refused coverage because their specific condition was not covered by their policy.  Decisions were not being made by those directly involved.  The buyer, on behalf of a group, and another selling on behalf of an insurance company, were making the decisions as to what should be covered.  What so often happened was the insurer would not cover “that particular benefit that way, not that drug, not that treatment, not that surgery, not that specialist, not that hospital.”  As a result the public brought their concerns to their legislators and the benefits of coverage were defined more specifically in the form of mandates.

 

Mr. Matheis asserted “piecemeal” was not the best approach.  However, he added, the proposals in A.B. 206 would not work either because there was nothing to which the costs of benefits could be compared.  He emphasized a well-defined plan was needed that clarified “basic coverage” for everyone in Nevada so insurance companies could not “weasel out” of paying because the coverage was not defined in the policy.  Only then could such issues as relative cost of adding or removing coverages or the number of people affected be debated, because there would be a “common language” for everyone.  Thereafter, the consumer would have information about costs and benefits whenever they considered adding future benefits.

 

Mr. Matheis concluded that unless such a well-defined basic plan were available, legislation could not be supported that would restrain the consumer from coming before the Legislature to “make a case that their need or their family’s need was what they bought insurance for.”  Insurance was purchased, he emphasized, not because the consumer was hoping to use it, but in the event it was needed.  Insureds needed to pay for what they needed, otherwise their coverage, at any price, was not worth anything.

 

Assemblyman Hettrick voiced his agreement that insurance companies needed to cover what they said they covered; the insureds needed to know they actually had the coverage they thought they had.  He also stated that if Nevada added so many mandates that absolutely everything was covered, no one would be able to afford the coverage.  At the same time, if the insurance did not cover the needs of the insured, it was worthless.  He contended there needed to be some solution in between insurance filled with mandates and insurance that did not cover the insureds’ needs.  He remarked that might be the intent of A.B. 206, but he did not know if A.B. 206 was the answer.  Mr. Hettrick concluded the insureds had no control over the premiums and either they would be strapped with the payments or we, the taxpayers, would be.

 

Mr. Matheis agreed with Mr. Hettrick and added there had to be a “willingness to give up on some expectations in exchange for some predictability.”  He claimed there were no real statistics that indicated the growing number of uninsured in Nevada was the result of mandated benefits.  However, he recognized they had to make sure additional people, especially those in small businesses, would not also become uninsured.  Mr. Matheis reiterated there had to be a common agreement on the meaning of coverage before proceeding with any changes or additions.

 

He also submitted other “experiments” should be considered, perhaps placing the insured in the position of “owning” their coverage.  Mr. Matheis clarified that maybe the people affected by the coverage should be the ones who made the decisions about the coverage.  He felt part of the reason for the “disconnect between reality and this so-called marketplace” was that the wrong people were making the decisions.  He concluded that until all those involved reached a common agreement, the only recourse for the insureds would be to inform their legislators when their insurance did not cover what they expected it to cover.  He hoped that maybe this hearing was the opening for some “reality-based changes.”

 

Mr. Hettrick agreed the insured should have a say in the coverage they purchased and added that a system of defined contributions could force us there quickly.  And that could be a good thing.  The consumers could then “pick and choose” and pay premiums for what they wanted.  Mr. Hettrick interjected removing mandates was not anti-women; eventually in their lifetime they would not need certain coverage either.

 

Barry Lovgren, private citizen, related his concerns that Sections 2 through 12 eliminated specific mandates for home health care and substance abuse care.  This, he conveyed, raised general issues associated with mandates.

 

Mr. Lovgren stated he could relate to the small business owner, having been one himself.  Looking for affordable group policies forced him to buy the cheaper ones.  For example, if he could buy a policy at a lower price because it did not include treatment for substance abuse, he would do so.  Mr. Lovgren expressed the committee needed to give careful consideration to removing mandates.  He explained if the substance abuse mandate was eliminated, for example, it would mean the end of privately insured substance abuse treatment because no one would buy it.  This, he added, would apply to many of the other mandates.

 

Mr. Lovgren expounded on the costs to the policyholders.  With mandated coverage, costs were spread amongst all policyholders.  If the insureds who needed the specific coverage were the only ones buying it, the costs would be too high.  For example, if the only people buying substance abuse coverage were alcoholics and addicts seeking treatment, the premium would be unaffordable.  Mr. Lovgren perceived those costs needed to be spread amongst the policyholders.

 

Mr. Lovgren suggested the fiscal note was not adequate.  As an example, he explained that if privately insured substance abuse treatment was no longer mandated the demand for state subsidized services for substance abuse treatment would increase.  A.B. 206 did not provide for increased subsidization for those services.

 

Mr. Lovgren was concerned if the mandated benefits were removed, many would not be able to receive the needed treatment.  He wondered what the resultant effect on health care costs would be.  He also brought to the committee’s attention secondary costs that would result from eliminating mandated benefits.  Using the substance abuse treatment mandate as an example, he explained secondary costs would include emergency room visits, treatment for sclerosis of the liver, and any other complications.  Increases in social costs would include alcohol-related domestic violence, alcohol-related crime, DUIs, and any numbers of other social costs.  He concluded the Insurance Commission needed to balance social costs with costs of the policies.

 

Tom Wood, Legislative Advocate, Pharmaceutical Research and Manufacturers of America and American Owned Products, testified against A.B. 206.  Mr. Wood disagreed with section 1 arguing that neither the Legislature nor the administration should be prevented from making decisions that affected the citizenry, especially with the rapid changes in technology and availability of treatments.  Mr. Wood agreed with Assemblywoman Buckley that having been tested four or five times, a sixth time would seem pointless.  Additionally, Mr. Wood pointed out that all of the mandates considered for removal had already been tested in both houses of the Legislature.

 

In closing, Mr. Wood conveyed they were sensitive to the rising health care costs for the public, but he did not feel A.B. 206 solved the problem.

 

Mark Nichols, Executive Director, National Association of Social Workers, testified against A.B. 206 and described the proposed changes as unnecessary.  Mr. Nichols specifically targeted Section 17.  First of all, four years was not considered enough time to fully realize the social and financial impact of repealing mandates.  Secondly, the costs could not be measured in monetary costs alone.  The social impact also had to be considered.  Mr. Nichols referred to treatment for substance abuse and mental illness as specific illnesses that had serious social repercussions.  Third, he wondered if a study of removing women’s health mandates would fully reflect the costs.  He asked if women had to pay for coverage for all their health needs, how many would be able to afford such coverage.  Fourth, Section 17 should allow for input from those individuals and health care providers directly involved rather than rely solely on an actuary.  Fifth, Mr. Nichols recommended that Section 19 be revised to direct the committee that it could repeal or change mandates only if it did not have a social or economic affect.

 

In closing, Mr. Nichols expressed the committee could better utilize its time on issues “more important than shifting health care cost from the insurance industry’s profit margins to the residents” of Nevada, and urged the committee to vote against A.B. 206.

 

Denise Duarte, member of the steering committee, Nevada Women’s Lobby (NWL), testified on their behalf against A.B. 206.  She prefaced her remarks by relating to the committee her experience in the insurance industry.

 

Ms. Duarte agreed with Chairman Dini that lists of repealed mandates should be excluded and added they were opposed to any “moratorium” on benefits.  She considered it a “dangerous precedent” in today’s changing times.

 

Ms. Duarte adamantly opposed A.B. 206’s targeting health care coverage for women and children.  She remarked it was part of our society’s history that these coverages had to be mandated to be available, yet preventative screenings and treatments for the male population did not.  She stated A.B. 206 would review whether or not there was a demand for these coverages, although their need was already evident.

 

Ms. Duarte expounded women of reproductive age spent 68 percent more on out-of-pocket health care expenses than did men and many of the mandates targeted by A.B. 206 were instituted to end this “discrimination.”  Secondly, breast cancer, the leading cause of death in women between 15 and 54 years of age, was best detected by mammograms and early detection dramatically increased chances of survival.  Third, most women used contraceptives and hormone replacement therapy, and the cost of contraceptives was “far less than the cost of unwanted pregnancy or abortion resulting from unintended pregnancy.”

 

Ms. Duarte stated benefits that were included without the need of legislative requirement were not subject to review while mandates were, and wondered if that indicated coverages needed by women and children were only the ones considered necessary for review.  She added the benefits considered for review were life-saving and their value could not be measured.  She wondered why prostate exams and screenings did not require mandates nor justification as to their worth.

 

Ms. Duarte addressed other mandates that could provide early diagnosis and preventative or timely care.  She maintained there should be no restrictions to women’s access to OB/GYN services, as delays could impede care.  She argued for cytological screenings and mammograms, pointing out preventative care was more cost efficient than acute care.  Ms. Duarte also informed the committee coverage for mental illness would save money and that one in five families was affected by mental illness.

 

Ms. Duarte questioned how an actuary could adequately evaluate the effects of adding or repealing mandates and not be biased since most of their information came from the health insurance industry.  She pondered how anyone could justify “loss of life and productivity to individuals, families, society and the economy” that could result from the lack of needed coverage.

 

Ms. Duarte recognized that the study resultant of A.B. 206 would reveal increased expenses resulted from the mandates.  But, she perceived, if these costs were not spread amongst the insureds, the costs would be too great for individuals to afford themselves.  Such action would leave a multitude of people uninsured and create additional costs to the public health system.

 

Furthermore, Ms. Duarte indicated that the mandates addressed by A.B. 206 had been carefully studied by a previous Legislature as to their value and need and the Nevada Women’s Lobby believed those benefits were still necessary.  She closed her testimony declaring that any “health insurance product that is established to have inferior coverages for the female segment of the population is discriminatory in nature,” and asserted the NWL’s opposition to A.B. 206.

 

Martin Gallagher, member, Nevada Service Employees International Union (NSEIU) Local No. 1107 and a registered nurse at University Medical Center in southern Nevada, testified against A.B. 206.  He compared A.B. 206 with S.B. 212 of the Seventy-first Session, which sought to repeal mandates, and which he perceived as discriminatory because it targeted women, children, the socially challenged, the mentally ill, and those addicted to drugs and alcohol.  He felt the same way about A.B. 206.  Mr. Gallagher sympathized with employers not being able to offer their employees affordable coverage, but suggested it would be even worse to face the employees when they came asking for specific coverage that would be even more costly.  Mr. Gallagher reaffirmed his opposition to A.B. 206 and asked the committee to oppose it as well.

 

Judy Phoenix, Psychologist, representing the Nevada State Psychological Association, revealed results of an actuarial study funded by the American Psychological Association.  The study found full mental health parity would increase premiums by one dollar per month per member, and partial parity increased premiums by 90 cents per month per member.  The insurance industry had expected mental health parity for severe disabilities to cost up to six dollars per session.

 

Ms. Phoenix voiced her opposition to A.B. 206 and questioned whether actuarial data was reliable.  She asserted she was opposed to any decision regarding mandated services that was based entirely on actuarial studies because they did not reflect medical cost offset or the actual costs in human suffering.

 

Maureen Brower, Legislative Advocate, American Cancer Society (ACS), informed the committee the ACS opposed A.B. 206 for many of the reasons already presented this day and indicated she would leave them her written testimony (Exhibit D).

 

LuAnn Tucker, representing the Nevada Physical Therapy Association, related she purchased health insurance for herself and one employee.  Ms. Tucker apprised the committee that although the insurance was expensive, she would not be without it.  She would not have been able to afford the breast cancer surgery and treatments she was receiving without the mandated benefits on her policy.  She concluded A.B. 206 would eliminate many of the benefits she needed and was using.  Referring to A.B. 206 as a “step backwards,” Ms. Tucker strongly urged the committee not to support A.B. 206.

 

Dorothy North, member of the Bureau of Alcohol and Drug Abuse Advisory Committee and president of the Board of Examiners for Alcohol and Drug Abuse Counselors, presented statistics that supported her position against A.B. 206.  She revealed that substance abuse cost Nevada $1,008,824,676 annually in traffic accidents, other deaths, costs of criminal justice, and costs related to fetal alcohol syndrome births.  She also informed the committee 13.1 percent of Nevada’s population over 18 had been diagnosed with substance abuse.  Ms. North questioned the reasoning behind eliminating coverage for alcohol and drug abuse treatment.  A.B. 206 would only create “one more serious barrier” that would prevent many Nevadan’s from seeking the treatment they needed to arrest drug and alcohol addiction.  Ms. North asserted treatment should be available to those who needed it and that group insurance policies should provide those benefits.  Ms. North adamantly opposed A.B. 206 but requested if considered for passage, it be amended to retain the mandate for alcohol and substance abuse treatment.

 

Vil Paskevicius, Program Administrator, Economic Opportunity Board (EOB) Treatment Center, and President of the Nevada Association of State Alcohol and Drug Abuse Programs, conveyed their opposition to A.B. 206 and remarked insurance companies were the only ones to gain by its passage.  Mr. Paskevicius submitted, as did others who testified before him, that if alcohol and substance abuse were not treated, insurance companies would be treating the resultant physical problems caused by the abuse.  Mr. Paskevicius reiterated A.B. 206 should not be passed.

 

Guy Perkins, Chief Examiner of the Life and Health Section, Division of Insurance, pointed out mastectomy, reconstructive surgery and minimum hospital stays following childbirth from maternity and pediatric care were federal requirements.  If these mandates were eliminated, informed Mr. Perkins, the federal government would mandate them.

 

Lynn Maguire, President, Nevada Physical Therapy Association, submitted, for the record only, a letter (Exhibit E) in opposition to A.B. 206.  Marilynn Morrical, Licensed Alcohol and Drug Abuse Counselor, Consultant to Community Coalitions, Prevention and Treatment Programs, submitted for the record a letter (Exhibit F) in opposition to A.B. 206.  Paula Berkley, Legislative Advocate, submitted for the record a letter (Exhibit G) from Bill Bailey, DC, Chiropractic Physicians’ Board of Nevada, in opposition to A.B. 206.

 

Chairman Dini closed the hearing on A.B. 206 and opened the hearing on

A.B. 279.

 

Assembly Bill 279:  Provides for availability of industrial insurance benefits to providers of health care for exposure to certain contagious diseases. (BDR 53-123)

 

Assemblywoman Leslie, District No. 27, presented A.B. 279 on behalf of the Nevada Nurses Association and her constituent, Lisa Black.  Statistics presented by Ms. Leslie stated American health care workers sustained between 600,000 and 800,000 accidental exposures to blood and bodily fluids every year from needles and sharp objects present in the work environment.  Based on statistics that between 1 and 2 percent of patients were HIV positive, it could be assumed that 1 to 2 percent of needle sticks were HIV contaminated.  Ms. Leslie also informed the committee that between 2 and 10 percent of patients were Hepatitis C positive.  She related Hepatitis C was becoming known as a silent epidemic among health care workers and thousands of health care workers could be harboring infections of Hepatitis C.  Ms. Leslie revealed Hepatitis C could remain undetected for decades after the initial infection and 85 percent of those cases would become chronic.

 

Because treatment for HIV and Hepatitis C was so expensive, and because of the long interval between contracting the disease and diagnosis, many of those infected were denied workers’ compensation benefits.  When a health care worker requested their workers’ compensation benefits, they were often forced to prove the infection was contracted on the job, even if there had been a documented exposure at work.  A.B. 279 stated that a health care worker routinely and significantly exposed to potentially infectious blood or bodily fluids would be presumed to have contracted the infection on the worksite and would be entitled to coverage under their industrial insurance.  There would be an exception if it was proven that the employee had either been diagnosed with the infection previously or been infected with the pathogen outside of the work environment.  Ms. Leslie acknowledged there were several amendments to be presented and that she had seen some, but not all of them.

 

Lisa Black, registered nurse, representing the Nevada Nurses Association, announced there were several nurses and nursing students at the hearing both in Carson City and in Las Vegas who should also be recognized.  Ms. Black also related statistics supporting the large amount of accidental exposures to blood and body fluids to which health care workers were exposed every year putting them at risk of contracting HIV, Hepatitis B and Hepatitis C.  An American health care worker sustained occupational blood exposure every 39 seconds of every day, 365 days per year.  Bedside nurses sustained a clear majority of these exposures.  Nevada nurses suffered approximately 4,690 exposures annually.  Ms. Black informed the committee this issue had been brought to the Legislature during the last interim and was well received.  The original intent was for health care facilities to provide their caregivers with safer needle technologies to reduce chances of needle stick injuries.

 

Ms. Black informed the committee that federal legislation was passed in October 2000 that amended the federal OSHA blood-borne pathogens standard and included most of the contents of their original bill.  This amendment would prevent many needle stick injuries.  However, there was no legislation to protect the injured employee who was seeking workers’ compensation benefits.

 

Ms. Black related her own experiences to exemplify the dire need for the proposed legislation.  While caring for a gentleman infected with AIDS, she suffered a needle stick injury and was infected with HIV and Hepatitis C.  She was undergoing treatment and expressed her desire to live long enough to see her children grow into adulthood.

 

As difficult as it was being infected with AIDS and Hepatitis C, Ms. Black asserted it was especially difficult receiving health care benefits.  She informed the committee A.B. 279 was designed to provide legislation through which healthcare employees infected as a result of their employment could “more readily access the workers’ compensation benefits they are due.”  The basis of A.B. 279 was it created a “presumption.”  It would be presumed that healthcare workers who were regularly and significantly exposed to infectious blood and bodily fluids and had become infected with a blood-borne illness would be presumed to have contracted the infection during their employment.  This presumption would then make them eligible for workers’ compensation benefits.

 

Ms. Black explained employers were concerned they might be paying expenses for an infection the healthcare worker contracted elsewhere.  However, Ms. Black remarked, the level of exposure of a 40-hour week caring for many infected patients daily did not compare with the exposure to blood and bodily fluids outside the workplace.  She asserted healthcare workers “should not be excluded from benefits for an occupationally acquired illness based on some real or imagined lifestyle risk.”

 

Ms. Black informed the committee of the difficulties she experienced trying to receive workers’ compensation benefits.  Her claims were repeatedly denied and her life style was investigated.  It was even suggested that she intentionally inflicted herself with the needle stick injury.  She also related rumors circulated throughout the health care community accusing her of illicit behaviors.  The hospital sought to reduce her workers’ compensation benefit by 25 percent.  Ms. Black retained an attorney and legal battles continued for two years.  Ms. Black’s medications cost her $5,000 monthly.

 

Ms. Black emphasized the irony faced by those dedicated to caring for others.  When it came time for them to receive care, they had to face the difficulties of receiving benefits.  Ms. Black stated some would argue that addition of coverages would increase the costs of worker’s compensation insurance.  She maintained, however, that coverage was already included; it simply needed to be readily accessible.

 

Ms. Black commented Hepatitis C was becoming known as the “silent epidemic.”  With the increasing amount of exposure faced by healthcare workers, the battles to receive benefits would only increase.  She pronounced those who “placed their lives on the line” daily to care for others should neither struggle to receive benefits, nor be penalized for work related injuries by “invasive and demeaning investigations and accusations.”

 

Ms. Black urged the committee to support A.B. 279:

 

Send a clear message to the healthcare industry that improper workers’ comp denials for occupationally infected healthcare workers are unacceptable.

 

Ms. Black informed the committee issues had recently been raised with regard to Section 3 of A.B. 279.  She proposed deleting the provisions of Section 3 entirely.

 

Chairman Dini, asked Ms. Black for her interpretation of “clear and convincing evidence” on page 2, line 3.

 

Ms. Black replied the standard of “clear and convincing evidence” should be kept and would discourage such investigations as those to which she was subjected.  She submitted the language “a preponderance of evidence” left room for such investigations and would make claim denial more likely.

 

Jerri Woolston, registered nurse and critical care nurse for 24 years, informed the committee she received a needle stick injury two weeks after returning from maternity leave.  Her particular needle stick was categorized as “critical exposure.”  She would undergo regular testing and it would be nine to twelve months before she knew if she contracted HIV or Hepatitis C.  It was not until after the exposure Ms. Woolston realized she was not covered under workers’ compensation.  She acknowledged she would not be able to afford the necessary care if she contacted the infections and pleaded with the committee to support A.B. 279.

 

Debra Bonsangue, registered nurse, University Medical Center, member of Nevada Service Employees International Union (NSEIU) Local No. 1107, informed the committee she was diagnosed with Hepatitis C.  She had never used IV drugs; her husband was not infected with Hepatitis C; and she could not recollect needle stick injuries or contact with body fluids of patients infected with Hepatitis C.  She revealed she could remain asymptomatic for as long as decades before suffering liver disease and until then would live in fear of the symptoms that would eventually befall her.  She would one day become too ill to work, lose health benefits, and require a liver transplant.

 

Ms. Bonsangue felt she should be able to rely on her employers for workers’ compensation benefits especially after the years of caring for so many.  She would not be able to afford the health care on her own.  In closing, Ms. Bonsangue requested support of A.B. 279.

 

Assemblyman Nolan submitted that with passage of the blood-borne pathogens standards, inoculation with the heptivac series was required for health care workers.  He asked Ms. Bonsangue if she had received the inoculation.

 

Ms. Bonsangue replied she had been inoculated against Hepatitis B, and that there was no inoculation for Hepatitis C.

 

Mr. Nolan asked if the patient for whom she was caring carried Hepatitis C.  Ms. Bonsangue responded, “apparently someone did.”  She did not recall a needle stick but had many times been exposed to blood and body fluids.

 

Mr. Nolan empathized with Ms. Bonsangue and shared that as a paramedic he had contracted Hepatitis B.  He also had a subsequent needle stick.  He thought this issue had been addressed in previous sessions and described it as a “loophole” that would hopefully be closed this session.

 

Nancyann Leeder, Nevada Attorney for Injured Workers (NAIW), expressed their support of A.B. 279.  She pointed out, however, the wording in Section 3, subsection (1)(b)(1) would prevent A.B. 279 from applying to Ms. Bonsangue and others like her because she did not know whether the patient who infected her had been diagnosed with Hepatitis C.

 

Ms. Leeder explained her concerns that the establishing a presumption would cover some individuals but perhaps not others.  She related three experiences of individuals who were able to receive workers’ compensation benefits because their exposures were considered injuries, and it was determined the injuries required medical care.  Ms. Leeder clarified:

 

In fashioning an assistance to the health care worker who is exposed to a greater hazard than perhaps some other workers, we don’t want to exclude workers who presently are covered because they sustain injury.

 

Ms. Leeder concluded they did favor a presumption proposed by A.B. 279 for healthcare workers because of the “extreme magnitude” of hazards to which they were exposed daily, but reiterated they did not want to exclude other workers who would then not be able to prove their own cases.

 

Bryon Slobe, Nevada State Fire Marshal, related his experiences as the husband of an individual diagnosed with Hepatitis C.  He informed the committee of their obstacles, which included hiring a lawyer and fighting hospitals.  He stated his wife “had been put on trial.”  He voiced his support of A.B. 279 and stressed something needed to be done for victims in similar situations.

 

Carin Franklin, registered nurse, Operating Engineers Local Union No. 3, speaking on behalf of other union members, conveyed their support for A.B. 279 and added she would like to see not only health care workers covered, but other workers as well.  To reveal that Hepatitis was an enduring and easily contracted virus, she informed the committee the Hepatitis virus could live in a dried drop of blood for seven days.  She urged the committee to pass A.B. 279 to include other workers.

 

Beatrice Razor, registered nurse for over 40 years and in private consulting services, Razor Collaborative Nursing, announced she was exposed to HIV and tested.  She conveyed the fear of not knowing for an entire year whether or not she had contracted HIV and expressed her anger that a caregiver could possibly not be covered for the resultant medical needs.  She emphasized nurses worked hard to care for others and urged the committee to pass A.B. 279.

 

Danny Thompson, Legislative Advocate, Nevada State AFL-CIO, informed the committee many of the unions of the AFL-CIO covered nurses.  He emphasized the AFL-CIO’s support of A.B. 279 and shared the concerns of Nancyann Leeder.  He pointed out garbage workers were exposed to “everything that everyone else doesn’t want” and that six garbage workers in southern Nevada had been diagnosed with Hepatitis C.  Mr. Thompson understood there was another bill that sought an amendment to cover other workers and restated the urgent need of such legislation.

 

Ronald Dreher, President, Peace Officers Research Association of Nevada, communicated their support of A.B. 279.  He noted the “needle stick” law passed in the previous session helped the firefighters and police.  Mr. Dreher asked that the association be on record in support of the “presumptive” legislation contained in A.B. 279 which would help the nurses as well.

 

Fred Hillerby, Legislative Advocate, Associated Pathology Labs (APL), informed the committee he was in support of A.B. 279 and had some amendments to propose.  He deferred to Dr. Henry Soloway, Associated Pathology Labs.

 

Dr. Soloway stated he was in support of A.B. 279.  He noted, however, A.B. 279 included licensed health care workers but omitted many workers who were not licensed yet were significantly exposed.  Some of those were housekeepers in medical facilities and personnel who gave injections or drew blood.  He also listed several who were exposed to body fluids such as brothel workers, barbers, masseuses, manicurists, boxers, referees, ringside attendants, tattoo parlor employees and ear or body piercers.

 

Dr. Soloway indicated current law covered blood-borne illnesses, but suggested it be narrowed to include Hepatitis A, B, and C and HIV only.  He thought these diseases were of most concern to the public and added tests could be administered to determine whether or not they were contracted from exposure.

 

Referring to the bill draft itself, Dr. Soloway indicated “infectious antibodies” was a medically incorrect term.  He suggested the tests should be those approved by the State Board of Health, not the Legislature.

 

Dr. Soloway informed the committee tests should be performed immediately after the injury and at the appropriate intervals thereafter according to the incubation periods for each.  He submitted it would be helpful for the State Board of Health to define the tests.

 

Finally, Dr. Soloway expressed Hepatitis C was a significant illness in the United States and that 40 percent of those afflicted, whether health care workers or not, had no known injury or risk factor.  He noted the importance of tracing the disease to its source and maintained a method to test the individual soon after exposure, paid by the employer, was needed to determine whether or not that individual already had contracted the disease.

 

Dr. Soloway informed the committee there was now a risk-free Hepatitis B vaccine, a Hepatitis A vaccine recommended for school children, but still no vaccine for Hepatitis C.

 

Fred Hillerby referred to proposed amendments from APL (Exhibit H).  In Section 2, subsection 1, the amendment narrowed the focus to Hepatitis B, C and HIV.  In Section 2.2(b), the language “preponderance of evidence” was included but Mr. Hillerby noted other language was also changed to incorporate “safeguards” such that “preponderance of evidence” would not work against the employee.  Section 2.3 was amended to state that diagnosis had to be determined within one year after the date of injury.  Section 3.1 was amended to narrow the focus to Hepatitis B, Hepatitis C and HIV.

 

Mr. Hillerby stated the amendment to Section 3.2(b)(3) was important to protect the employee.  It required the blood test was approved by the State Board of Health and was “performed on the injured employee and the source patient and demonstrates that the infection in the employee resulted from the percutaneous injury.”  Mr. Hillerby noted additional safeguards were added.

 

The amendment proposed the addition of three new subsections to section 3.  Subsection 4 stated the employee had to be tested within 72 hours of the injury to indicate whether or not the employee already had the disease at the time of exposure.  This was one of the “built-in” safeguards referred to with the inclusion of “preponderance of evidence” in section 2.2(b).  Mr. Hillerby clarified the wording “has occurred as a result of the percutaneous injury” was a typographical error and needed to be removed from this section of the amendment.

 

Subsection 5 stated the subsequent testing needed to be performed within 12 months “following a medically appropriate incubation phase.”  Subsection 6 required that “supplemental testing of the etiologic agent in both the source patient and the injured employee” failed to prove “that the infection in both was caused by a different strain of that etiologic agent.”

 

Section 3.2(b) added “a preponderance of the evidence.”

 

Section 4 was added and stated if an employee refused to be tested following a “sustained or reported” percutaneous injury, they would not be eligible to claim compensation for infections that followed.  Section 5 provided protection for the “physician, supervising nurse or laboratory director” and gave them permission to order testing pursuant to Section 3.1(b)(3) to be performed on “a source patient involved in a percutaneous injury to a health care worker.”  Mr. Hillerby justified the addition of Section 5 by acknowledging the necessity of confirming whether or not the source patient had the disease at the time of the injury.

 

Assemblyman Perkins asked if “percutaneous injury” included exposures other than needle stick, such as splashing in the eyes.  Dr. Soloway replied that definition was in the original bill and not added by himself or Mr. Hillerby.  He read the definition of “percutaneous injury” from A.B. 279: “the parenteral introduction of blood or another potentially infectious material into the body of a provider of health care through his skin during the performance of his official duties.”  Speaker Perkins submitted that definition did not address all types of exposure.

 

Dr. Soloway responded that additions could be made to include eyes or injection of fluids or bodily secretions into the mouth or mucus membranes.  Speaker Perkins suggested “percutaneous injury” be replaced with “exposure.”  Dr. Soloway said that would suffice.

 

Assemblywoman Buckley observed some of the amendments improved A.B. 279, but asked for further explanation regarding the proposed Section 5 which gave the physician, supervising nurse or laboratory director permission to order testing on the source patient whether or not they consented.  She wondered how a patient could be tested without a “doctor-patient relationship.”

 

Dr. Soloway informed that throughout the United States, for at least the last fifteen years, the physician could order a test for a patient under his care who was involved in an exposure incident.  If the pathologist were doing tests on a patient in a hospital setting, that patient was presumed to be under the pathologist’s care also.  The patient’s physician or pathologist could order further tests on the patient.  Invariably, Dr. Soloway pointed out, there was a licensed physician in the state who could order the test on the patient if he thought it was medically necessary.

 

Assemblywoman Buckley asked if the test could be ordered even though the patient did not consent.

 

Dr. Soloway clarified that under Section 5, if a nurse, physician or laboratory director ordered the test, they would not be subject to any consequences from a regulatory board under Section 5.  He expounded that a hospitalized individual, or one under a doctor’s care, was not usually asked their permission to have a test run.  Most waivers signed by hospital patients indicated that any testing deemed necessary by the physician for the patient’s care was approved by the patient in advance.

 

Dr. Soloway acknowledged the issue of a patient refusing to be tested and suggested there might be other ways to deal with it.  He suggested that if the employee was tested within the first 72 hours and was found negative, and then within the appropriate incubation phase was found positive, the diagnosis would exist anyway.

 

Ms. Buckley reasoned that the patient’s consent referred to tests necessary for their treatment and tests addressed by Section 5 were not necessary for their treatment.  She also asked if the additional tests could “absolutely pinpoint” that the tested patient, and no one else, was the source of the infection.

 

Dr. Soloway responded the results would be “quite certain.”  He explained if the employee tested negative, he/she was not already infected at the time of the injury.  If the employee then converted, transitioned from negative to positive, within a week, for example, the infection would not be related to the injury.  But if the patient converted within the appropriate incubation period, there would be good reason to believe it came from the injury.

 

Ms. Buckley clarified she wanted to know whether or not the specimen from the patient would determine if the illness came from that patient.  Dr. Soloway explained the results of the test on the patient were very important.  If the patient tested positive for a specific strain of Hepatitis C, for example, and the employee tested positive for a different strain of Hepatitis C, proof existed the employee did not contract the Hepatitis C from that patient.  He added this was unlikely, however.  If the testing was performed, there could be no disagreement that “the incubation phase was appropriate; the infection was appropriate; and the strain of the infection was appropriate” to provide the substantial evidence.

 

Assemblyman Hettrick presented a hypothetical situation in which the patient contracted Hepatitis C two months prior, within the incubation period, of the incident in which the healthcare worker suffered a needle stick with that patient.  Would a test of the patient at that point manifest the patient was infected with Hepatitis C?

 

Dr. Soloway explained that a patient exposed to Hepatitis C would not be infectious for a couple of months.  It was possible the patient could be in the “window phase.”  He presented an analogy for HIV.  Out of the 12 million units of blood drawn annually, five or six “window cases” existed.  This exemplified the statistical rarity of the patient being in the window phase at the time of the exposure.

 

Mr. Hettrick concluded that even if one “hit the window” it would not be very long before the patient expressed the disease.  Dr. Soloway affirmed his conclusion.  Mr. Hettrick surmised that soon after exposure, the healthcare worker would be tested, and if they were diagnosed with the disease, the patient would probably be physically tracked or retested for the disease.

 

Dr. Soloway informed the committee there had been instances where HIV was involved that court orders were issued to take samples from original donors whose blood had been used in blood transfusions.

 

Mr. Hillerby addressed an issue addressed earlier by Dr. Soloway regarding inclusion of nonlicensed healthcare workers in A.B. 279.  He then referred to Nevada Revised Statutes (NRS) 616A.265, which stated:

 

The exposure of an employee to a contagious disease while providing medical services, including emergency medical care, in the course and scope of his employment shall be deemed to be an injury by accident sustained by the employee arising out of and in the course of his employment.

 

This indicated to Mr. Hillerby that there was already some protection for nonlicensed healthcare workers and was his reason for not proposing an amendment.  He felt the committee should include this in any discussions of A.B. 279.

 

Susan Dunt, Risk Manager, State of Nevada, provided data regarding potential fiscal impact (Exhibit I).  She maintained they wanted individuals with bona fide exposure to be covered.  Her concern was, especially with the growing numbers of Hepatitis C cases across the country not necessarily occupationally related, there was opportunity for abuse of A.B. 279.  She proposed amendments to assure there would be adequate protection to this benefit built in to A.B. 279.

 

Ms. Dunt noted A.B. 279 stipulated exposures would be reported according to policies of employers.  She requested that A.B. 279 document the state would develop a policy.  She advised there would be difficulty getting “budgetary approval” if, for example, pre-employment screening or certain reporting procedures were not mandated.  A.B. 279 needed to indicate that the state was expected to develop procedures; this would help them assure they would be “prudent” in administering this program.

 

Ms. Dunt also suggested the testing of the source patient and exposed employee be paid under medical investigation of the claim.  This would clarify that there was funding and prevent arguments as to who was responsible for payment.

 

Mr. Nolan noted it had been indicated during the hearing that the focus of A.B. 279 be narrowed to three diseases, but also brought to mind the relatively recent tuberculosis outbreak which spread into the medical community.  Therefore, he wondered whether or not A.B. 279 should be limited to the Hepatitis and HIV illnesses, thus “closing the door” to other illnesses.

 

Ms. Dunt acknowledged tuberculosis had been an issue, especially in the Department of Prisons.  She also realized there were individuals other than healthcare workers exposed to these illnesses.  However, she felt tuberculosis, being an airborne disease, was “in its own class” in that regard, as its source would be difficult to identify.

 

Vice Chairwoman Buckley asked if Ms. Dunt had shared her proposed amendments with Assemblywoman Leslie prior to the hearing and informed that would be the appropriate procedure.  Ms. Buckley asked Ms. Dunt if she was proposing the amendment requiring baseline screening of every employee, and added she considered it “extreme” in light of testimony already presented regarding causation.

 

Ms. Dunt responded the data they studied in risk management procedures recommended confidential, post-hire baselines be obtained to avoid “gray areas” when determining causation.

 

Vice Chairwoman Buckley asked if this constituted an invasion of privacy.  Ms. Dunt responded that was possible, but that she wanted to insure clarity regarding the latency period of testing.

 

Ms. Buckley stated that A.B. 279’s requirement of testing immediately upon report of the injury would determine if the employee had already acquired the disease.

 

Robin Keith, President of the Nevada Rural Hospital Project, expressed her concerns for healthcare workers and presented amendment proposals (Exhibit J).  She would encourage employees to follow safety precautions and proposed adding to Section 3.1(b) the following requirement:  “The employee was in compliance with the employer’s policies and procedures governing safe handling of sharp devices at the time of the injury.”

 

Because healthcare workers have the right to refuse the Hepatitis B vaccination and often do so, Ms. Keith proposed amending Sections 2.2 and 3.2 adding new language:  “The employee refused the employer’s offer of vaccination against Hepatitis B.”  She felt that if the vaccine were refused, any subsequent illness should not be covered under workers’ compensation.

 

Wayne Carlson, Executive Director, Public Agency Compensation Trust, provided some amendments that he did not have available until the hearing.  Their main purpose was to clarify the need for a test done fairly quickly after an exposure incident.

 

One of the first concerns Mr. Carlson addressed was the implications of a conclusive presumption.  He felt that applying conclusive presumption that employees in a certain field of employment contracted the disease at work, whether proven to be contracted at work or not, excluded others.  Hepatitis C, he related, affected all citizens regardless of their occupation.

 

Mr. Carlson stated that we have two systems of insurance in the United States:  workers’ compensation and health insurance.  He explained the purpose of workers’ compensation was to insure a worker for on-the-job injuries.  A conclusive presumption would violate the principle of workers’ compensation because it would not require proof the injury, or exposure, occurred on the job.  He added it would not always be possible to determine whether or not the exposure occurred at work.  He commended the amendments that required initial and timely testing.

 

Mr. Carlson indicated that under workers’ compensation certain occupations were covered.  He maintained that conclusive presumption, however, would almost force the insurance industry into a “24/7” coverage, a workers’ compensation coverage for everyone and elimination of the entire health care system.

 

Mr. Carlson pointed out the benefits of having one system instead of both a workers’ compensation system and a health system.  One benefit would be the presence of one administration and the resultant reduction of arguments over whether to cover an injury or not.

 

Mr. Carlson communicated that he was concerned about the costs involved with conclusive presumptions and submitted they would have been better dealt with in an interim committee.  He noted cost was an especially large obstacle in rural communities.  He submitted A.B. 279 as drafted could include other workers such as police, firemen, first aid and CPR certified, although he was not sure if that was the intent.  In smaller communities, high costs have been associated with broader insurance coverage, and layoffs have resulted in an effort to afford those costs.

 

Mr. Carlson estimated that costs for Public Agency Compensation and Trust (PACT) from the proposed legislation could be, over the period of 10 to 20 or 30 years, $20 million.  He reasoned funding needed to be started now.  Mr. Carlson claimed the funding would increase the costs by one third for the police, fire, ambulance and hospital categories, which currently comprised 60 percent of his total program revenue.  He revealed Mineral County alone expected to release eleven workers already, and would have to lay off one more.  Stating there were several bills addressing Hepatitis C, Mr. Carlson again cautioned that expanding the number eligible for benefits would increase costs, and recommended an interim committee give the issue deeper consideration.

 

Mr. Carlson submitted that insurance companies had been charging for non-occupational injuries for years without having to pay on them and suggested the committee give that consideration as well.

 

Mr. Carlson acknowledged the committee was already addressing some of his concerns, such as definitions, and prompt testing and documentation following an exposure.  He wanted to be sure the bill was not “too loose” so that unexpected costs would not impact their budget.  He claimed costs would be transferred to his organization whether individuals were self insured or fully insured.

 

Mr. Carlson concluded if the bill was clear and specific as to what exposures occurred at work and were covered, he was in support of A.B. 279.  However, if A.B. 279 added things beyond that intent, it would create the financial risks their budget could not predict.  In that case, he would oppose A.B. 279.

 

Assemblyman Oceguera asserted that Mr. Carlson’s testimony was misleading and that presumptive conclusive did not mean what it was intended to mean.  He claimed that every heart and lung bill was being fought.  He reasoned it was those employees afflicted with the heart and lung problems or the diseases who were paying the financial costs.  He disagreed that the term “presumptive conclusive” was being loosened.

 

Wayne Carlson argued that Mr. Oceguera’s statement was not accurate.  He retorted there were a number of cases being fought over factors other than conclusive presumption.  He contended his comments on conclusive presumption were intended to express his concern that a health issue could be presumed to have been work-related without consideration of other possible sources.  He was concerned with the resultant costs and he contended the committee needed to recognize those costs.  He reiterated health insurers were receiving a premium for the exposures addressed by A.B. 279, but the premise of “conclusive presumption” would shift those exposure cases to workers’ compensation, which was not charging premiums for such exposures.

 

Don Jayne, Nevada Self-Insured Association (NSIA) No. 200 related that several of his concerns had already been addressed during the hearing and referred the committee to his written testimony (Exhibit K).  The keynote from the self-insured perspective was that work-related illnesses contracted at work were covered.  He emphasized A.B. 279 needed to include a definition of the scope of work and clarification of the appropriate testing.  He acknowledged the merits of Dr. Soloway’s suggestions for testing and submitted that testing of the employees should be done at the onset of employment, at the time of the incident, and upon termination of employment.  He added that professionals such as Dr. Soloway could determine the appropriate testing.  Mr. Jayne asserted that occupational illnesses or injuries should be covered without the employees having to fight for coverage.

 

Jerri Strasser, registered nurse at UMC and member of NSEIU, referred to a comment made earlier that healthcare workers who refused hepatitis vaccines should not be eligible for benefits.  She informed the committee that regular blood donors such as herself could not receive some of the hepatitis vaccines.  She added it was an honor to donate blood for the benefit of others.  Ms. Strasser also expressed that, as closely as healthcare workers followed safeguards and reported exposures, it was very easy for an exposure to occur that was not so obvious.  She gave the example of a glove having a tear exposing a cut on a healthcare worker’s finger to body fluids.  Therefore, A.B. 279 should not make it so difficult to prove the exposure happened at work.  Ms. Strasser further indicated the growing shortage of nurses and asserted any suggestions by employers that more nurses could not be hired due to benefits being unaffordable would only worsen the shortages.

 

There being no further questions or testimony, Chairman Dini closed the hearing on A.B. 279.  Chairman Dini opened the hearing on A.B. 289.

 

Assembly Bill 289:  Limits definition of police officers who are eligible for workers’ compensation and certain other benefits as result of public employment. (BDR 53-393)

 

Susan Dunt, Risk Manager, State of Nevada, informed the committee the purpose of A.B. 289 was to “clarify and codify the legislative intent” regarding those classifications of police officers to which “conclusive presumption” for heart and lung disease benefits under workers’ compensation would apply.  Ms. Dunt related she did not want to limit or remove benefits for those employees currently entitled to them, but because of the increasing numbers of cases in litigation, perhaps the NRS 617.135 definition of “police officer” needed clarification.  The language proposed by A.B. 289 was intended to serve that purpose.

 

The modified definition would also provide the state a more accurate number of employees for which to budget annual physical exams.  This would also allow the state to offer preventative intervention for employees potentially at risk of heart disease.

 

Ms. Dunt reminded the committee peace and police officers continually sought to be included in the definition of “police officer.”  She informed the committee that comments from legislators in 1999 confirmed the State’s understanding that the heart and lung benefit for police officers was intended for “street cops or those who face the highest levels of danger and stress.”  Ms. Dunt related increasing instances of litigation by officers outside the definition of “police officer” who pursued heart and lung benefits.  She conveyed the Risk Management Division’s feelings that legislation should clarify who was included as “police officers” for coverage under the heart and lung bill.

 

Ms. Dunt referred to a chart (Exhibit L) that revealed the increasing costs for heart claims as well as costs partially funded through the Subsequent Injury Fund (SIF).  She interjected there was a move to eliminate the SIF.

 

Ms. Dunt reiterated the state could not budget for a preventative program for at-risk employees, if they did not know which officers would be included in the definition.  She added the financial liability would be too great.

 

In closing, Ms. Dunt acknowledged her office would take a careful look at the definition of “police officer” to see if there was a better way to define “high risk positions.”  She added expansion of the eligible base could make the benefit unaffordable and thus jeopardize the coverage for the highest risk positions.  She expressed her willingness to work with a subcommittee on this issue.

 

Chairman Dini asked Ms. Dunt how many cases they lost.  Ms. Dunt replied they lost three cases involving employees not on the “police officer” list over the last three to four years.  Chairman Dini remarked that in his opinion, A.B. 289 had not yet been justified by the testimony presented.  Chairman Dini asked if there were questions from the committee.

 

Speaker Perkins asked Ms. Dunt to relate the circumstances of the 1999 District Court case.  Ms. Dunt revealed the employee worked as a compliance investigator for the Taxicab Authority whose employees were not defined on the current list.  She related that the insurer initially denied the claim.  The denial was upheld at the first level of hearing, reversed at the appeals level, and upheld at district court.  Speaker Perkins asked if the Supreme Court made a decision and Ms. Dunt responded the case was settled before going to the Supreme Court.

 

Speaker Perkins asked if there was a prior Supreme Court case.  Ms. Dunt responded there was none she knew of.  Speaker Perkins thought the case occurred six years ago.  Ms. Dunt interjected there was a similar situation decided at the appeals level in, she believed, 1993.  Ms. Dunt clarified she was referring to the Department of Administration and the hearings level.

 

Speaker Perkins advised Ms. Dunt to be cautious when proposing legislation.  Instead of it becoming restrictive, it could become that much more inclusive should the wording of the statute need to be spelled out.

 

Andy Anderson, Legislative Advocate, Nevada Conference of Police and Sheriffs, submitted A.B. 289 specifically excluded some members of the Nevada Conference of Police and Sheriffs that were receiving benefits from the Heart and Lung Bill.  He added they would be willing to work with a subcommittee to address the definition of “police officer” in A.B. 289.

 

Mr. Anderson expounded that the duties of campus police had grown over the past twenty years from duties of security guards to “basically a full-fledged police department” and offered examples of their duties.  He offered they had essentially the same duties of city police officers.

 

Bryon Slobe, acting Nevada State Fire Marshall, sought to clarify the definition of “fire marshal.”  He offered fire marshals were neither recognized as firemen nor as cops.  Mr. Slobe informed the committee the members of his office were sworn state law enforcement officers who recertified annually.  Some of the many fire marshal duties he listed were fire investigations, HAZMAT investigations, arson investigations, and felony arrests.  He added they were armed, and due to serving 14 rural counties with only 8 fire marshals, they were assigned one to a car.  Investigating fires and methamphetamine labs exposed them to structurally and or chemically compromised structures.  They were also exposed to blood-borne pathogens.  The chemical exposures could result in lung problems in the future.

 

Mr. Slobe reasoned that the fire marshals should be included as peace officers and covered under the Heart and Lung Bill.  He further revealed that they had lost one chief deputy to an air-borne pathogen.  His death was a direct result of exposure from a fire/arson investigation.  Mr. Slobe concluded his comments requesting inclusion of fire marshals in the Heart and Lung Bill.

 

Assemblywoman Gibbons asked the panel to distinguish the difference between a peace officer and a law enforcement officer.  She also asked how airport firemen differed with regard to exposure.  Bryon Slobe considered peace officers the same as law enforcement officers and recognized they both enforced the law.  He stated that firefighters for the Airport Authority were firemen or firewomen; they did not investigate fires.

 

Ronald Dreher, President of the Peace Officers Research Association of Nevada and “representative of the professional peace officers of our state,” asked the committee to oppose A.B. 289.  He referred to their proposed amendment (Exhibit M), which allowed coverage for peace officers as defined by NRS 289.010, subsection 2.  He pointed out A.B. 289 limited the definition of “police officer” and thereby limited eligibility of peace officers for workers’ compensation benefits as well as the eligibility of their surviving spouses and children.  Mr. Dreher perceived it was not the intent of S.B. 404 of the Seventieth Session to exclude peace officers and their families.

 

Mr. Dreher suggested the committee needed to know what peace officers were, and again referred to the definition of “peace officer” in NRS 289.010.  Mr. Dreher proposed amending A.B. 289 by removing the word “only” and substituting “those peace officers as defined under NRS 289.010 (2).”  A.B. 289 as it was written eliminated many peace officers who were expected at any time to protect citizens’ lives while possibly endangering their own.  The intent of the Peace Officers Research Association of Nevada was to provide the same benefits to all peace officers.  In closing, Mr. Dreher requested the committee oppose A.B. 289 as written.  He acknowledged he would support A.B. 289 if amended.

 

Phil Gervasi, President of the Clark County School District’s Police Officers’ Association, informed the committee he submitted an amendment (Exhibit N) to A.B. 289.  Page two of his exhibit revealed Clark County School District’s recognition that A.B. 289 excluded the school district’s police officers from the “line-of-duty injury” other police officers in Nevada received.  Mr. Gervasi commented A.B. 289 would completely exclude them “from any type of compensation they deserved.”

 

The last two pages of his exhibit listed the 10,559 calls for service received by the Clark County School District Police Department over a seven-month period.  Mr. Gervasi pointed out these calls were similar to those received by police officers and claimed they performed the same duties as “street” police officers, only their jurisdiction differed.

 

Mr. Gervasi communicated they would like to be included as police officers in A.B. 289 and noted they were considered police officers under NRS 289.  He also informed the committee they were listed under the “police/fire fund” of the Nevada Public Employees Retirement System (PERS) but were not listed as police officers for the Heart and Lung Bill.  In closing, he asked the committee to review and consider his proposed amendments.

 

Bob Gagnier, Executive Director, State of Nevada Employees Association, asserted he opposed A.B. 289 as written.  He expounded upon the confusion wrought by the definitions.  The definitions within the statutes differed for “peace officer” and “police officer.”  Also the police/fire provisions within the early retirement system differed.  He proposed a “uniform” definition be written for all.

 

Mr. Gagnier described the current law as “ridiculous.”  He explained that Risk Management excluded caseworkers in the Department of Prisons from coverage because they were not “uniformed.”  Mr. Gagnier referred to page 2, lines 2 through 4 of A.B. 289, which read, ”Uniformed employee of; or forensic specialist employed by, the department of prisons.”  Referring to line 9, number 9, he ascertained the correctional officers at Lake’s Crossing did not have to be uniformed to be included.  Mr. Gagnier concluded A.B. 289 did not make sense and reaffirmed their opposition to the bill, as it was an effort to “exclude people who should otherwise be covered.”

 

Assemblyman Nolan related he viewed the Heart and Lung Bill as an “exceptional benefit for exceptional people.”  He conveyed his understanding of the original intent of the bill was to protect those police officers and firefighters who were subjected to sudden physical exertion which could cause stress and a resultant heart attack or heart condition, as well as those who over a long period of service exposed themselves to toxic and noxious environments which could cause chronic lung conditions.  He asked Mr. Gagnier if he was correct in his assumption.

 

Mr. Gagnier affirmed Mr. Nolan was correct.  He surmised, however, the description given by Mr. Nolan implied that “a large number of people in law enforcement who are subject to severe exertion all of a sudden are all police officers working the street.”  He contended that was not accurate.  In his opinion those individuals working in the department of prisons fit the category covered by the Heart and Lung Bill “more than anyone else” as their safety was in danger at any given time.  He noted that was especially true at the Northern Nevada Correctional Center because so much of it was open.

 

Mr. Gagnier clarified the heart coverage was based on the sudden exertion experienced, for example, by an officer riding in a car who had to react suddenly, and its affect on the heart.

 

Mr. Nolan agreed with the description and that it applied to the people being covered.  He submitted they were in a “precarious situation of fairness,” faced with deciding who would be covered.  He acknowledged, as well, the costs associated with expanding the coverage and asked Mr. Gagnier how these costs could be paid.

 

Mr. Gagnier said he did not have an answer to address the additional costs.  The Heart and Lung Bill originated in 1969, and Mr. Gagnier suggested the committee needed to recognize that conditions and situations changed over the years.  He presented two examples to make his point.  He noted campus police in Washoe County have until now been unarmed, but arming them was now being considered; it was not even a question in Clark County.  Secondly, the University at one time had security officers who were essentially “watchmen.”  Now they were “full-fledged” police.  He noted there were peace officers who had been murdered, yet peace officers were not on this list.

 

Danny Thompson, Legislative Advocate, Nevada AFL-CIO, mentioned he was concerned that school police were excluded by A.B. 289, but noted the amendment proposed by Mr. Gervasi included school police as well as park rangers and marshals in the definition of “police officer.”  He implied the Taxicab Authority in Clark County should be included as well.  Mr. Thompson reminded the committee the security personnel of the Clark County School District had been given the powers of police officers because of the increase in gang violence and lack of personnel available from Metro to respond to the campus violence.  Mr. Thompson emphasized campus police were police officers as were park rangers and marshals and asserted campus police deserved the coverage A.B. 289 sought to deny them.  In closing, he voiced support for Mr. Gervasi’s proposed amendments and offered to work with a subcommittee if the Chair so desired.

 

Assemblywoman Gibbons informed the committee the Washoe County District Attorney Investigators, who were peace officers, were excluded by A.B. 289 and also stood in opposition to it.

 

Assemblyman Hettrick agreed definitions needed to be improved and perceived security officers in the schools as police officers.  The amendment proposed by Mr. Gervasi included, in its definition of “police officer,” school security personnel in communities of 500,000 or more.  Mr. Hettrick declared, however, it had been proven schools were at risk regardless of their size.  If the definition was expanded, Mr. Hettrick felt it should not be limited to larger communities.

 

Nancyann Leeder, Nevada Attorney for Injured Workers (NAIW), testified against A.B. 289 and stated it would not allow coverage for the Capitol Police.  She informed the committee that several “non-line” officer positions required many years of police experience.  Therefore, non-line officers, such as the Capitol Police, had already experienced years of service and stressful situations that could have led to heart and lung problems.  Such was the situation with a current case involving a Capitol Policeman.

 

Wayne Carlson, referring to the proposal by Mr. Dreher to include peace officers, as defined in NRS 289.010, in the Heart and Lung Bill, pointed out NRS 289.190 gave powers of peace officers to “school police officers and other officers and employees of school districts.”  By this definition, the powers of peace officers could include all school employees.  Mr. Carlson reminded the committee of the fiscal impact which would result from such widening the eligibility list.  He informed the committee that costs per patient for heart and lung coverage averaged $250,000 per patient, and they must consider how the costs would be borne.

 

Chairman Dini acknowledged Mr. Carlson’s concerns and said they would be taken under consideration.

 

Assemblyman Hettrick informed the committee the Supreme Court had ruled that heart and lung benefits would extend for the life of the insured.  That ruling, he contended, created an “unfounded liability.”  He added the definition of “police officer” needed to be expanded but recommended limiting the lifetime benefit because of the immense impact from the costs.

 

Ron Cuzze, State Peace Officer Council, submitted, for the record only, a letter (Exhibit O) in opposition to A.B. 289.  Michael B. Neville, President, Washoe County District Attorney Investigators’ Association, submitted, for the record only, a letter (Exhibit P) in opposition to A.B. 289.

 

There being no further questions or testimony, the hearing on A.B. 289 was closed.

 

The meeting was adjourned at 7:42 p.m.

 

RESPECTFULLY SUBMITTED:

 

 

 

Darlene Nevin

Committee Secretary

 

 

APPROVED BY:

 

 

 

                       

Assemblyman Joe Dini, Jr., Chairman

 

 

DATE: