MINUTES OF THE meeting
of the
ASSEMBLY Committee on Health and Human Services
Seventy-First Session
May 9, 2001
The Committee on Health and Human Serviceswas called to order at 1:30 p.m. on Wednesday, May 9, 2001. Chairman Ellen Koivisto presided in Room 3138 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:
Mrs. Ellen Koivisto, Chairman
Ms. Kathy McClain, Vice Chairman
Mrs. Sharron Angle
Ms. Merle Berman
Mrs. Dawn Gibbons
Ms. Sheila Leslie
Mr. Mark Manendo
Ms. Bonnie Parnell
Mrs. Debbie Smith
Ms. Sandra Tiffany
Mr. Wendell Williams
COMMITTEE MEMBERS ABSENT:
Mrs. Vivian Freeman
GUEST LEGISLATORS PRESENT:
Senator Dina Titus, Senate District 7
Assemblywoman Barbara Cegavske, Assembly District 5
STAFF MEMBERS PRESENT:
Marla McDade Williams, Committee Policy Analyst
Darlene Rubin, Committee Secretary
OTHERS PRESENT:
Paul Gowins, Disability Forum
Gary Milliken, Government Relations
Dr. Neal Marek, Las Vegas
Janice Pine, Saint Mary’s Health Network
Rick Panelli, retired Chief of the Bureau of Licensure and Certification
Alex Haartz, Deputy Administrator, State Health Division
Patricia Jarman-Manning, Commissioner of the Consumer Affairs Division
Mary Walker, Carson-Tahoe Hospital
Mary Nemitz, Nevada Rural Hospital Project
Caroline Ford, Assistant Dean, University of Nevada School of Medicine and Director of the State Office of Rural Health
Dr. James Colgan, Urologist, Carson City
Steven Smith, CEO, Carson-Tahoe Hospital
John Berkich, Carson City Manager
Thomas Metcalf, Chairman of the Board of Trustees, Carson-Tahoe Hospital
Patricia Glen, Pro Life League of Nevada
Tammy Klippenstein, Executive Director, Casa de Vida
Robert Payant, Executive Director, Nevada Catholic Conference
Myra Sheehan, President, Nevada Trial Lawyers Association
Bill Welch, President, Nevada Hospital Association
Don Nelson, Nevada Life Issues Forum and Education
Lynn Chapman, Nevada Eagle Forum
Alexis Miller, Planned Parenthood Miramonte and Planned Parenthood of Southern Nevada
Chairman Koivisto opened the hearing on S.B. 324, and invited Paul Gowins to discuss the bill, while awaiting Senator Titus’ arrival.
Senate Bill 324: Requires that toilet facilities in public buildings and places of public accommodation be identified with signs discernible by blind and other visually impaired persons. (BDR 28-78)
Paul Gowins, Disability Forum, provided some background on the measure. Mr. Gowins originally became involved in the bill as the state Americans with Disabilities Act (ADA) coordinator, when he was called on to say why such legislation was needed. He was at first uncertain about the need for the bill, because signage already existed, but after speaking with many of his blind friends he discovered there was a need. He told of a sight-impaired woman friend in a Las Vegas casino who could not find appropriate signage and ended up in the men’s restroom. Mr. Gowins stated the bill sought to relocate the signage and make it accessible to those with visual impairments.
Chairman Koivisto asked, because of the small amount, if review by Senate Finance was necessary. Mr. Gowins said it was not necessary. He also noted the requirements had been reduced to reflect that when there was a vestibule in the hallway leading to such restroom facilities, it would require that the signage be put in a visible area. The bill contained an agreement that Public Works would look at the signage and make sure it worked.
Senator Dina Titus, District 7, explained the bill had come at the request of an outstanding organization in southern Nevada known as Blind Connect. The group included Gene Peyton, who was active in the mediator’s group, and Bonnie James, a former lobbyist for the Chamber of Commerce. Blind Connect provided services, outreach, information, and assistance to people who were visually impaired. She pointed out that some things most took for granted were major challenges for those who could not see. Amazing scientific progress had been made in recent years in the area of sight enhancement, and society, institutions, and public buildings had come a long way toward being more blind-friendly, but more needed to be done.
Under the ADA passed in 1990, there were certain requirements for signage that had been very helpful. However, one of the problems not addressed previously, but which was addressed in S.B. 324, was the location of restrooms. Often restrooms were at the end of a long hall, and if there was no sign at the beginning of the hall or the foyer that led to those restrooms, it could not be found by the sight-impaired. The bill required that signs which already had been placed and met the current ADA standards, be placed at the end of a long hallway, vestibule, or foyer, so one would know before traveling in that area where the restroom would be. She added that it was very simple, but sometimes, simple things made a big difference.
Assemblywoman Smith asked if the effective date meant that all of the signs would need to be up in the buildings in compliance by that date. Mr. Gowins said the language could be clarified to state what was actually meant. However, there was a complaint mechanism in the bill so that once a complaint was made about noncompliance it would be remedied, and that was probably the most practical way to do it.
Senator Titus said originally there had been a fiscal note attached to the bill, because public buildings would have to pay for signs, as well as private buildings, however, the March of Dimes agreed to pay for the signs if someone could not afford it so that cost had been taken care of.
Assemblywoman Gibbons was concerned about small businesses, and how they would know about the legislation. Mr. Gowins responded that, as was the case with many types of legislation, the small business owner might not know until someone complained, unless they paid attention to the requirements. Currently, the ADA had requirements, but it was likely that eight out of ten businesses would say they did not know those requirements existed. He felt that any business that was large enough to have two restrooms and long hallways would be able to afford a $55 sign. Also, there was not an immediate fine for noncompliance; the complaint could be resolved by putting up the sign.
Senator Titus noted that Blind Connect and other associations had made a commitment to try to get the word out through public service announcements. It was not a bill that would affect small businesses, generally, because they would not have restrooms at the end of long halls. She added the bill was directed at casinos and the like, and those businesses had compliance officers who paid attention to such legislation.
Chairman Koivisto closed the hearing on S.B. 324 and asked the committee’s wishes.
ASSEMBLYWOMAN GIBBONS MOVED TO DO PASS S.B. 324.
ASSEMBLYMAN MANENDO SECONDED THE MOTION.
Vice Chairman McClain asked if Section 5 should be removed, as it was an unfunded mandate. Senator Titus stated that section was not needed, as it passed out of Senate Finance. Chairman Koivisto did not believe an amendment was needed, and requesting one might delay getting the bill back.
THE MOTION PASSED UNANIMOUSLY BY THOSE PRESENT.
Senator Titus thanked Gene Peyton, who was in Las Vegas and had intended to testify, however, with the bill passage it had not been necessary.
Chairman Koivisto closed the hearing on S.B. 324 and opened the hearing on S.B. 483.
Senate Bill 483: Requires state board of health to license mobile medical facilities and facilities for refractive laser surgery. (BDR 40-1482)
First to speak was Gary Milliken, representing Dr. Neal Marek, who had requested the bill, and whom he introduced to provide background.
Dr. Neal Marek, Las Vegas, reported that over the past ten years he had a satellite office in Pahrump and had enjoyed practicing in that small town. However, during that period he had to send many of his patients back to Las Vegas for additional testing, lab work, therapy, and surgery for medical treatment that was not available or accessible in that rural area. That, of course, involved travel, time, and inconvenience for the patient, as well as the patient’s family or friends who wanted to be supportive. There was a lack of medical facilities in many small rural areas statewide. Most of the medical facilities were located in Reno or Las Vegas. There was a large underserved area, and that need could be met with the help of mobile units. Mobile units were large tractor-trailers that could be moved from location to location, brought into small rural areas and provide high-quality medical care. Dr. Merak noted that mobile units had been providing various services for 10 to 20 years, including dental care, mammograms, MRIs, CT scans, and other care in underserved areas.
Dr. Marek stated the goal of S.B. 483 was to make certain the care delivered in those mobile units met the standard of care as found in any medical facility. Therefore, it was requested the State Board of Health regulate and license those units. Dr. Marek urged the committee’s support of the measure.
Gary Milliken provided the reprinted bill with amendments (Exhibit C) and noted page 2, Section 4, subsection 4, stated “The board shall adopt separate regulations for the licensure of mobile units which take into consideration the unique factors of operating a facility that is not in a fixed location.” He added, the board would establish regulations and be the overseer.
Assemblywoman Smith asked if the legislation addressed the large mobile units that only performed lab and X-ray activities. She reported that her union had a unit that did that for members through the health plan. Dr. Marek believed the legislation covered mobile units that met the criteria of medical facilities that were listed in the Nevada regulations; some units might fall under those regulations and others might not. For example, a dental unit might not fall into those regulations because it was not a medical facility. Or possibly a mammogram unit might not be licensed by the Board of Health. It would depend upon the regulations the board would adopt. Certain units, if considered a medical facility, were listed in Nevada Revised Statutes (NRS) 449.0151, and those would be covered; if not listed in that statute, then they would not be. Mrs. Smith, to clarify her question further, said it appeared the mobile unit was being defined in the medical facility language, and she wanted to know if that lab and X-ray-type of unit was considered a mobile unit. She did not have a problem regarding the licensing, however, wanted to make sure that it was understood. She cited subsection 1 of Section 1 stated, “specially designed, constructed and equipped to provide for the diagnosis, care, and treatment.” The units she referred to did not provide diagnosis, care, or treatment, but they did all the blood work and X-rays. She was not sure if that unit would fall into that category but wondered if the intent was for that unit to fall into that category. Dr. Marek thought the intent was to regulate the mobile units that were providing services that were listed as a medical facility. If they provided care that was not regulated currently or did not meet the definition under the facilities, then the intent was not to regulate those units. Mrs. Smith was still unclear on that point.
Mr. Milliken stated that when the bill was drafted the attempt was to cover a mobile unit that was related to a facility. In Section 1, subsection 2, it stated, “operated by any of the medical facilities described in subsection 1 to 13 inclusive below.”
Assemblywoman Smith felt that answered her question. In other words, she said, if they were not providing any of those mentioned services, even though they were providing medical services, they would not be required to be licensed under that provision.
Chairman Koivisto asked who would own the mobile units; would there be an issue in regard to the ownership. Dr. Marek said the ownership, just like any ownership interest and particulars in the existing facilities, would be the same for the mobile units. He said they were not asking for anything different. If there were certain requirements or prohibitions against the ownership interest in the existing medical facilities, then he would request that they be the same for the mobile units.
Assemblywoman Parnell asked if Dr. Marek saw the bill as indirectly having a negative impact on those units already in operation, or discouragement for anyone to operate such units. She stated she was a strong supporter of the mobile units, and mentioned a dentist with a mobile unit that came to the school where she taught in Carson City. The rural areas, she noted, would probably depend solely on such units, and she in no way wanted the bill to harm the potential of increasing the numbers of mobile providers. Mr. Milliken said that was certainly not their intent either. Dr. Marek wanted to get a mobile unit in relationship to his facility, and the law was gray on what could or could not be done. The bill did not apply to dental units.
Assemblywoman Berman asked if the bill applied to Dr. Merak’s van. Dr. Merak said it would apply to any mobile unit that requested to be licensed and met the regulations provided by the Board of Health. Once those regulations passed, then he would like to apply for licensure. Ms. Berman asked how many mobile vans were operating currently, and how many more might operate as a result of the bill, besides Dr. Merak’s. Dr. Merak said that presently, since there was no mechanism for licensing or regulating the vans, he did not believe any existed. There were mobile units that provided health care or dental care, and mammograms, which would not fall under the jurisdiction of the bill. The demand, he felt, was high, since there were many underserved rural areas. With passage of the bill, he believed there would be interest in providing services in those areas. Ms. Berman asked if right now the bill would only benefit Dr. Merak. Dr. Merak responded that, if passed, anyone with a mobile unit could apply for licensure and supply medical care. He added that he would like to provide services to his patients. Ms. Berman asked the committee if they knew of anyone else that was interested in the bill also.
Mr. Milliken said there had been no other testimony in the Senate on the bill.
Assemblyman Manendo asked if the bill would also apply to the “cow bus,” or was that something different. Mr. Milliken did not think it would apply. But, he added, the bill related to a mobile unit connected to a medical facility. For example, Saint Mary’s Health Network had a mobile unit. He then cited page 3, Section 5, of the bill, the additional language on lines 32 through 36 covered the mobile unit that Saint Mary’s operated in Washoe County.
Assemblywoman Gibbons asked if the mobile unit would act to lower the cost of health care. Dr. Merak thought it would afford the opportunity to provide care to the rural and underserved areas, and any time there was competition, whether in health care or any other business, it would have an effect to lower health care costs. To illustrate, he said to think about when a patient had to travel to a distant larger city to have procedures done, there was attendant expense in travel costs, overnight stay in a hotel and so on, and if family members or friends wanted to be supportive of the patient, they too, would have that expense. If the services could be provided in the patient’s familiar surroundings, it would improve the quality of care and eventually lower the cost for patients.
Mr. Milliken stated that part of the bill had been changed in the Senate, however, there was another minor change on page 1, Section 1, subsection 2, as follows: “Licensed by the board and operated as any other medical facilities described in subsection 1 to 13.”
Assemblywoman Tiffany asked about Section 6, subsection 2, of the amended bill that stated, “The provisions of subsection 1 do not authorize the health division to inspect a mobile unit that is operated by a medical facility which is accredited by the Joint Commission on Accreditation of Healthcare Organizations or the American Osteopathic Association,” and she wanted to know what the American Osteopathic Association had to do with anything. Mr. Milliken stated that was similar to language found in Section 5 that had been requested by Janice Pine to cover the mobile unit for Saint Mary’s, and she could probably give a reason for that.
Dr. Merak stated that Saint Mary’s, an accredited hospital, was inspected annually or more often, and Ms. Pine requested that they inspect the entire hospital including her mobile units.
Janice Pine, representing Saint Mary’s Health Network, stated that Rick Panelli knew the answer to the question. It was her understanding that language applied to hospitals, and that the Osteopathic Association must conduct some surveys. The major hospitals in Nevada were all Joint Commission on Accreditation of Health Care Organizations (JCAHO) accredited, but there was something already in statute about the American Osteopathic Association (AOA). She added that she felt clarification was needed about the mobile units and whom the bill would affect, and so on.
Richard Panelli, recently retired chief of the Bureau of Licensure and Certification, but testifying as an individual, stated the AOA was another accrediting organization, just as the JCAHO was, and that particular language was already in statute and also in all the federal regulations for Medicare and Medicaid. If one of the hospitals chose to seek accreditation under the AOA, it was felt to be equitable to include that language. There was no hospital in Nevada accredited only by the AOA. If a decision were made to remove the reference to the AOA it would not affect any of the health care facilities licensed or accredited in the state of Nevada.
Assemblywoman Tiffany said she wanted to check with bill drafting before passing the bill to see why the AOA was included. Chairman Koivisto said the committee would like clarification from bill drafting on that item.
Chairman Koivisto then asked for an explanation of the amendment.
Senator Titus thanked the committee for allowing her to use the bill to address another serious problem that had recently come to her attention, and the bill’s sponsors had also agreed to that. She referred to the handout (Exhibit D), which included a number of newspaper articles about the recent Lasik laser eye surgery craze, and the medical and economic risk consumers took when they chose that option for better eyesight. Lasik surgery centers were becoming a big business across the country; approximately 2.6 million Americans were expected to get Lasik surgery in the current year. Ads were abundant on billboards and in newspapers, and it was the most popular surgery in the United States. Senator Titus stated that many people in the legislature had it, including herself, and were very happy with the results. However, like any medical procedure, Lasik surgery had some risk involved. The FDA Web site had a great deal of information on that, but some of the risks were that the results might not be lasting. Some patients developed severe dry eye syndrome, some lost their vision, others suffered from headaches, infections, halos, and starbursts, which meant poor night vision. Some of the Lasik surgeries were performed by very skilled and respected doctors and were conducted in facilities attached to doctor’s offices. Those were licensed and regulated by the State Health Division. Others, however, were performed by doctors who were on contract in surgery centers that simply housed the Lasik machines. They were often in makeshift storefront situations. Those latter situations did not meet the current definition of “surgery center” in state statute and, therefore, were not regulated at all. All they had to do was get a business license in order to operate. Because serious eye surgery was being conducted in those facilities, Senator Titus felt those should be regulated and overseen by the State Division of Health, which was what the bill and amendment would require.
The second problem with those facilities was also being addressed in the amendment. In addition to the medical risk, there were also economic risks. Some of the Lasik companies were “fly-by-night” operations; they would set up shop, do some operations for awhile, declare bankruptcy, and leave, sometimes leaving the country. They left their patients needing follow-up care, many of them had paid deposits that they lost; there was no medical oversight, and they also lost their money. The problem of the economic loss was addressed in Section 8 of the bill (Exhibit C), which would not only require those facilities to be licensed and regulated by the Health Division, but would also require that they post a bond in order to get and renew their license to operate. Senator Titus stated the amendment would protect the public’s health, their eyes, and their pocketbook, and she urged the committee to bring the surgery centers under some kind of oversight. She added that Mr. Panelli had helped draft the amendment, along with a number of others including Jeanette Belz, the Nevada Ophthalmologists Association, Bob Barengo and Larry Leslie, Board of Medical Examiners, Larry Matheis, Nevada Medical Association, and Patricia Jarman, the state’s consumer advocate.
Assemblywoman Smith asked why the Lasik surgery facilities were not regulated as surgery centers for ambulatory patients. Senator Titus said she was shocked to learn they were not regulated. Apparently, it was because there was no follow-up; a patient simply went in, had the surgery, which took about 30 minutes, and then the patient was gone. But, the businesses called themselves “surgery centers,” and she believed that it was just too risky to require nothing more than a business license for those facilities.
Alex Haartz, Deputy Administrator, State Health Division, advised that Mr. Panelli was recently retired, however, knew more about those issues than anyone. In response to Assemblywoman Smith’s question, “surgery” was a misnomer, and that was the primary reason why those types of facilities had never been regulated. Also, they were fairly new within the last few years. The amendment to the bill attempted to capture those freestanding facilities and, as Senator Titus had pointed out, there were many that already operated and were regulated, but they were attached and part of an already-licensed medical facility. The amendment would bring that type of medical practice under the definition of medical facility and provide a mechanism at the state level to license those that operated on a freestanding basis. Mr. Haartz believed there might be 10 to 15 of those particular businesses operating, and they would not have problems with those that set up independently, operated on a long-term basis, and established themselves in the community. However, they did have concerns about the quality of health care provided to Nevadans who, in good faith, went to a business and then found the business closed sometime during their medical procedures.
Assemblywoman Berman related that several plastic surgeons had contacted her before session began and asked her to present a bill that skin resurfacing, or laser resurfacing, only be done by plastic surgeons, because there were dermatologists, general practitioners, ear, nose and throat doctors, and others who were doing that type of procedure. She decided not to present that bill because she felt it was not her right, or the legislature’s, to decide who could or could not do surgery; that was a patient’s decision to make. Ms. Berman felt that the bill sponsors here were asking the same thing, to take away someone’s ability to practice a certain procedure.
Senator Titus did not feel it was the same thing. Doctors had to be licensed, and the doctors who used those facilities would still be licensed. The bill did not affect who performed the surgery, it only provided regulation and oversight of the freestanding facility where the surgery was performed. It was not a jurisdictional fight among different kinds of doctors to control a certain kind of procedure, such as was suggested by the plastic surgeons.
Mr. Haartz stated the bill did not deny anyone the ability to be licensed; the bill stated that to operate that type of medical facility, a business license was needed for the community jurisdiction, as well as compliance with the regulations adopted by the State Board of Health, and a license from the Health Division, Bureau of Licensure and Certification. As part of the protection to the consumer, an operator had to meet the regulations adopted by the board, and in the amendment it did address adopting special regulations that took into account those special considerations for a freestanding center. The other issue was the protection of the consumer, which entailed posting a surety bond as a requirement of their licensure, in accord with NRS 449 for a number of other types of medical and residential facilities. He did not see it as denying anyone the ability to establish a practice and to provide services, it just required a little more regulation. Ms. Berman asked if that meant it was the facility and not the physician that was being regulated. Mr. Haartz said that was correct.
Assemblywoman Tiffany asked why the amendment was not done in the Senate. Senator Titus said the problem with the bankruptcy and the Lasik company had just unfolded in the last couple of weeks, and it was just a matter of timing, not because it had been opposed in the Senate. Ms. Tiffany then asked if most of the physicians were “D.O.s” and that was the reason for including the American Osteopathic Association in the bill language. Mr. Haartz responded that was not the case. However, he had found the actual reference that language had been taken from: Nevada Administrative Code (NAC) 449.310, paragraph 2, it was in the hospital regulations that currently existed, and it gave the exemption to the same organizations as currently existed for hospitals. He added the language had been set up to meet the needs of Saint Mary’s that had some mobile units in operation, so they would not have duplicate surveys and additional oversight by the State Health Division, when they were already overseen by the JCAHO.
Mr. Panelli stated to Assemblywoman Smith, who had asked why they were not within the same category as an ambulatory surgical center, that in NAC 449.9743, “surgery” was defined and the laser surgery was specifically excluded during the development of that process. There had been extensive conversations and debates held at the State Board of Health prior to the adoption of that definition of “surgery,” and it excluded “laser surgery.”
Patricia Jarman-Manning, Commissioner of the Consumer Affairs Division, voiced support of Senator Titus’ amendment dealing with the Lasik centers. Recently there had been referrals from the Governor’s Office of patients who had gone into a Lasik center, paid their money up front, and were told afterwards that they did not qualify for the surgery, and would have to wait to receive a refund check. Then the center went out of business and the patients had not received their refund. In the course of investigation, the business owners had been tracked down, but it was uncertain whether anything could be done to get the refund due. Therefore, the division supported any legislation that would stop that situation from occurring in the future, and, Ms. Manning added, there were more and more businesses that were requiring up front payment.
Chairman Koivisto asked if there was any testimony in opposition. There was none. Therefore, she asked the committee’s wishes.
ASSEMBLYWOMAN LESLIE MOVED TO AMEND AND DO PASS
S.B. 483 TO INCLUDE THE AMENDMENT FROM MR. MILLIKEN.
ASSEMBLYWOMAN SMITH SECONDED THE MOTION.
Chairman Koivisto noted the committee would need an answer on Assemblywoman Tiffany’s concern about the review by the American Osteopathic Association.
THE MOTION PASSED UNANIMOUSLY BY THOSE PRESENT.
The Chairman closed the hearing on S.B. 483 and opened the hearing on S.B. 328.
Senate Bill 328: Revises provisions regarding requirement to obtain prior approval of certain expenditures for new construction by or on behalf of health facilities in certain counties. (BDR 40-408)
Alex Haartz, Deputy Administrator, State Health Division, appeared on behalf of the Department of Human Resources. Currently, under NRS 439A.100, the director’s office had responsibility for conducting a preliminary review and approval process in Nevada in certain circumstances where medical facilities were looking to remodel or do new construction in excess of $2 million. The director’s office had been working with the various counties, Carson City in particular, to establish a pilot project in which Carson City could be carved out and conduct the review at the local level, instead of being conducted by the state. The review was commonly known as “certificate of need” (CON), and had a very long history in Nevada as a way of determining the need and establishing an appropriate health care infrastructure within a geographic area.
Mr. Haartz stated S.B. 328 began where there was a process in which a county could choose to participate and conduct a certificate of need review and that had been amended out previously in the Senate. At present, the bill provided an opportunity for Carson City to establish a pilot project over the next biennium to assume those responsibilities. While Carson City would assume that responsibility, the director’s office and the Department of Human Resources would continue to conduct a certificate of need review in the remaining rural counties. Mr. Haartz was accompanied by Mary Walker, representing Carson-Tahoe Hospital, and other individuals who would speak in support for the bill.
Chairman Koivisto asked if the division would do the certificate of need for Clark County. Mr. Haartz said Clark County did not fall under that requirement based on population, nor did Washoe County.
Mary Walker, representing Carson City, Douglas County, Lyon County, and Carson-Tahoe Hospital, provided background on the concept, which she stated began last year during the interim. Periodically she met with legislators; Assemblymen Dini, Hettrick, Brower, and Assemblywoman Parnell, and Senators Amodei and Jacobsen. During one of the tri-county legislative meetings, they discussed the Governor’s Fundamental Review Committee, and the concerns many of the rural communities had in regard to potential shifting of services down to the smaller rurals. Legislators had directed her group that instead of saying they would not take any services, to look at the types of programs they could take. The certificate of need was one of the programs they felt they could do locally.
They had gone to the Department of Human Resources last year and started working with them in regard to the proposal to allow the rural counties to assume the responsibilities of the program, if the rural counties so chose. Ms. Walker said they worked with the Department of Human Resources, the Nevada Rural Hospital Project, the Office of Rural Health at University of Nevada, Reno, the Nevada Hospital Association, and Nevada Association of Counties, in regard to the proposal. When the bill was heard in the Senate, the Director of the Department of Human Resources was concerned about the smaller communities being able to opt in and out of the program, and how she would be able to have her work plans established. They finally agreed that if Carson City was ready to develop the program to let it be a pilot program. Carson City would establish the ordinances, regulations, and as a minimum would take the same general laws and the same regulations the state followed and use those as a basis for the ordinances. Over time, the other rural counties would have an established program they could follow.
Ms. Walker added that because it was a pilot program, they added Section 11 on page 6 of the bill, which required legislative oversight. Therefore, each calendar quarter, Carson City would have to report to the Legislative Committee on Health Care, as well as report to the Director of the Legislative Counsel Bureau. The bill was approved unanimously in the Senate, by both the Human Resources Committee and on the Senate floor.
Ms. Walker stated they appreciated working with the state and other organizations. It had been a group effort, and she felt it would work out very well.
Mary Nemitz, representing the Nevada Rural Hospital Project, stated the certificate of need process intended to prevent unnecessary duplication of services, and to ensure the health care facilities and services that were proposed in rural areas were necessary and needed. Her group believed the decisions about health care services could appropriately be made at the local level where the needs and resources were understood, and local conditions could be dealt with. She said it made sense for the counties to provide that service since it was the counties who were ultimately responsible for providing health care needs to their citizens. As a result of the bill, the Carson Board of Supervisors would adopt an ordinance taking the CON process for their communities for any proposed facilities and services in excess of $2 million, which was already in the NACs.
Carson City was selected because they were looking at a new facility and the local government had the resources and was willing to do the work involved in the pilot program for the rest of rural Nevada. Ms. Nemitz said the goal through the pilot program was to develop a model ordinance and model procedures for other county commissions to follow when determining the needs of the local health care facilities and services. Part of the discussion had been the careful consideration of the factors that would be considered in making that decision. Important considerations included factors that were already included in the NACs with respect to proving the need. In addition, a comprehensive and objective assessment of the impact of the proposed facility on the community and the local health care delivery system should be done by a third party knowledgeable about health care delivery in Nevada. Ms. Nemitz added that all the people involved in the process had spoken to Caroline Ford, who would comment shortly.
In conclusion, Ms. Nemitz said the amended version of S.B. 328 was the result of an agreement between the Department of Human Resources, Carson City, Carson-Tahoe Hospital, and the members of Nevada Rural Health Project, for Carson City to take over the CON process for their community and develop a model that could apply to other rural counties. Ms. Nemitz noted there was a sunset on the bill in 2005.
Caroline Ford, Assistant Dean, University of Nevada School of Medicine, and Director of the State Office of Rural Health, stated her comments reflected a partnership her offices would have with Carson City and the state of Nevada in looking at technical assistance on the legislation. Her office had been partnered with the University of Nevada Cooperative Extension Service to do some economic assessment in rural counties of the impact of rural health care. The longer and more detailed that analysis, the more they had seen the kinds of factors that affected fluctuations, good and bad, in terms of insertion of new facilities, construction of other facilities, bringing in new or altered health services in the community, and they would like to be able to be partnered with the County Commissioners on that effort.
Ms. Ford said they were often in a state of crisis when they worked with the Boards of Commissioners; health care was in disarray, the financing was either going away or not adequate to support the service being continued, fluctuations in health care personnel were dictated by services coming in and out of areas. It would be refreshing to use the approach offered by the process under discussion to work with the commissioners on looking for key factors for them to judge whether or not a service was needed in the community, and what the economic impact would be for that service. Her office was currently looking at developing a technical assistance center with Oklahoma, and looking at further development of modules that would assess the impact of physicians’ services or particular health services within individual facilities as well as within communities. Currently, they were starting to expand their analysis to look at rural parts of urban counties.
Ms. Ford said they would welcome the opportunity to participate in the pilot program with the County Commissioners and the state. By relaying what happened with local conditions to the Health Care Financing Administration (HCFA) and to other federal agencies, they might be able to initiate new programs that would address how a different model of services delivery could be addressed, or maybe even get money to initiate how a program might be a demonstration model in a community.
Assemblywoman Leslie directed her remarks to Mr. Haartz and stated she had looked up the statute, because it seemed the legislature had been amending that chapter a lot. She counted that since 1971, it had been amended ten times. She noted there was at least one rural legislator who would “like to get rid of this completely.” Therefore, her question was, “if the pilot program was approved, was it the department or division’s position that they would come back to the legislature with a recommendation for a concrete goal for the state, so it would not be Carson City one time, Elko another, and so on.” Mr. Haartz said absolutely, that was the case. The pilot program would give everyone an opportunity to see over the next two years how valuable it was to perform at the local level, and be able to make a more informed decision whether the activity should be continued.
Ms. Ford commented that currently the CON application was being debated and a decision to be rendered on that would occur in Pahrump, regarding building a new hospital facility there. There were new models that potentially could affect how a facility was built. It was cautionary when a community wanted something to happen but perhaps did not have the tools to do the economic impact, and then looked at all the other factors. It was good to know there was still some mechanism available that would provide at least the information by which a local government could make that decision.
Assemblywoman Leslie did not want to eliminate it completely, however, to return every two years and do the program for one community after another did not seem a satisfactory way to handle it. What was needed was a more global perspective, and she wanted to see the division make some recommendations with Ms. Ford’s input about how it could be fixed semi-permanently.
Dr. James Colgan, a urologist in Carson City, voiced support for the measure.
Steve Smith, CEO, Carson-Tahoe Hospital, voiced support for the bill and felt that for any community, it was better to make the decision locally. While it had to do with competition, it also had to do with access. If for-profits came into a community, that often blocked the access for indigents and others. If the current facility could not have all or the majority of the business, often what was taken away was only the for-profit or money-making ones, and then the county picked up the taxes to support the remainder.
John Berkich, Carson City Manager, spoke in support of S.B. 328. He understood what would be imposed on the city; they were used to being the “guinea pig” for pilot projects, and they were anxious to take it on. They would like to set the path for the rest of rural Nevada.
Thomas Metcalf, Board Chairman, Carson-Tahoe Hospital Board of Trustees, echoed the remarks of his colleagues in support of the bill.
Assemblywoman Parnell, Carson City, District 40, voiced support for S.B. 328. She thanked all of the people who had worked so hard for the last few years to prepare the legislation that they hoped could be used to help all the rural areas in their need for health care.
Chairman Koivisto asked the committee’s wishes on the measure.
ASSEMBLYWOMAN PARNELL MOVED TO DO PASS S.B. 328.
ASSEMBLYWOMAN GIBBONS SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY BY THOSE PRESENT.
Chairman Koivisto closed the hearing on S.B. 328 and opened the hearing on S.B. 191.
Senate Bill 191: Makes various changes regarding possession, care, custody and disposition of and liability for certain newborn infants. (BDR 38-736)
Assemblywoman Barbara Cegavske, District 5, was co-sponsor of S.B. 191 and provided background on the measure. She stated the bill would begin the process of addressing the complex issue of infant abandonment in Nevada. It would develop a greater network of resources for a parent who had, for a variety of reasons, chosen to hide a pregnancy and abandon a baby. The bill would help to reduce the risk of death for an infant by giving that parent, or parents, the option of leaving their newborn with emergency service professionals, rather than leaving the child on the side of a road, or in a trash can or dumpster.
Mrs. Cegavske had long been concerned about the health and safety of children in our communities. The issue of infant abandonment was not immediately brought to her attention until she learned about a project called “The Garden of Angels.” The Garden of Angels was a burial plot project in California, the final resting place for 44 abandoned children. The children buried there ranged in age from newborn to five years old. Each child was given a name and their presence in the Garden of Angels had given them a voice.
Mrs. Cegavske felt there was a responsibility to respond to the best of our ability to the cry of those children, and many others, who were not fortunate enough to have such a burial. S.B. 191 was part of that response. It was not the end of all solutions to the issue; however, it would provide an immediate alternative to the parent, or parents, who were considering abandoning their baby. She trusted that S.B. 191 would have a positive impact on babies abandoned in dangerous and life-threatening situations in Nevada; however, a solution should be provided for a situation in the event a parent did not make use of the opportunity and made a decision to abandon their baby in a dangerous manner that resulted in death. She felt the state should be prepared to provide the child with a burial in the same manner as that provided by the Garden of Angels, in California.
Mrs. Cegavske said she had worked for the last year with Mr. Ken Knaws of Palm Mortuary and Cemeteries in Las Vegas, to establish a similar Garden of Angels in the Las Vegas area. Palm Mortuary Crematories had donated space on an as-needed basis for approximately 130 burials. Additionally, Palm Mortuary was donating a statue in memory of the abandoned children laid to rest there. The cemetery was located at 7600 South Eastern Avenue, Green Valley. Mrs. Cegavske was very grateful that space was so graciously provided, and it was her sincere hope that it would never need to be used. S.B. 191 would, however, ensure that the cemetery plots remained available in case of need.
Also, Assemblywoman Cegavske added, the Garden of Angels in California had requested, because it was personal for them, that their name not be used for the above cemetery space. Therefore, the Chairman of the Senate Human Resources Committee asked her and the Junior League ladies of Las Vegas, who had become involved in the project, and Dema Guinn, to come up with a name for that area. She then asked for suggestions from the committee members.
Mrs. Cegavske thanked everyone who worked so hard on the measure, including Senator Washington, with whom she traveled to Colorado from a meeting in Wyoming. They had the opportunity to sit on the Floor of the Colorado Legislature when they were discussing that bill. It had been interesting to see the different sides and issues brought up. Their bill was passed, but it had taken several days of debate on the Floor; it was also interesting to see their style of debate. She had been very inspired by the bill and when she learned Senator Rawson had the same idea, they decided to collaborate and do one bill instead of two. She appreciated the Senator’s willingness to do that.
Chairman Koivisto had read the background paper on the study of infant abandonment legislation and asked why the age of 30 days or less had been chosen. Mrs. Cegavske responded that it had been heavily debated and, as she had not been a member of the subcommittee that looked into that aspect, she did not know what the rationale had been. What she had learned was that they were trying to leave enough time and space in between where a mother abandoned her baby and went through any of the postpartum depression episodes that might be experienced. That period would give enough time so that if the mother had a change of heart or whatever was wrong, they would still be able to change their mind. Another part of the rationale was that the process of adopting took so many days, and they had looked at that also.
Assemblywoman Berman reported that in Clark County alone 17,556 new mothers suffered “baby blues” or short-term depression; 3,290 to 5,400 were severely depressed, and 219 mothers experienced psychosis. Postpartum mood and anxiety disorders were the most common complications of childbirth, but an overlooked health concern.
Chairman Koivisto asked in what time period had those statistics occurred. Ms. Berman responded it was based on the preliminary 2000 birth statistics in Nevada.
Assemblywoman Leslie referred to Section 1, where it stated the child had to be delivered to a provider of emergency services, and asked what happened if a mother abandoned the baby outside the hospital; would she be subject to child abandonment charges. It was mentioned specifically throughout the bill that she had to deliver the child to the emergency services provider. Mrs. Cegavske said she understood that the child, unharmed, had to be brought to a safe haven. Those were the conditions, and if met, no charges would be made against the parent. Ms. Leslie said as she read the bill, the parent had to personally give the child to the provider of emergency services, not just leave it in the waiting room or someplace similar. Mrs. Cegavske thought someone would be able to clarify that. What had been discussed was whether one left an infant by the door, or outside the door, or by a trash can, and that was similar, she said, to the “drive-bys” where someone would take whoever was shot and drop them off at the hospital. If the individual died outside, the hospital was not responsible because they did not make it inside. But, if a parent was bringing an infant in, the law stated if the infant was brought in unharmed, the parent would not be charged.
Ms. Leslie was not at all against the concept, however, wanted to make sure the committee understood it and there was a plan to communicate that to the public. Also, she wanted to know if the public would be encouraged to do that, in lieu of just dumping the infant. Mrs. Cegavske said they did want to make sure the public understood that if there was an unwanted pregnancy, there was a solution, another place to take the infant.
Vice Chairman McClain said that reading further on in the bill, there was a definition of provider of emergency services, which also included firefighters and police. Therefore, apparently a parent could hand the infant over to a policeman or firefighter. She also asked about page 2, line 33, under (c) it stated: “Must not be required to provide any background or medical information regarding the child but may voluntarily do so,” which she thought was too lenient. Mrs. Cegavske said she had not been involved in the writing of the bill, and she thought someone from the Junior League might come up to discuss more of the writing, however, there were rational reasons why some of those things were put in. That particular section had to do with the parent who was abandoning the child and might feel, if they provided any information, it would be a resource to track the parent down, and the purpose was to make sure the infant was brought to a safe place instead of a trash can. Mrs. Cegavske agreed with Ms. McClain that it would be best to know as much as possible about the child.
Vice Chairman McClain said the assumption was being made that the mother would be the abandoning parent. Were there provisions that would keep one parent from abandoning a child without the other knowing. Mrs. Cegavske said there were provisions for that.
Patricia Glen, representing the Pro-Life League of Nevada, an organization that had provided assistance to distressed pregnant women for 27 years, expressed support for S.B. 191, the “Baby Safe Haven” bill. She reported there were some young mothers who were overwhelmed at the birth of a child. They might be unable to provide a suitable home, or they might be facing an extraordinarily stressful situation that prevented their keeping the baby. Rather than disposing of the child in a harmful manner, they needed to be assisted in providing a loving home for the baby. Those women were often fearful of approaching an authority figure to relinquish their newborn child. S.B. 191 offered a compassionate solution to those mothers’ problems. Ms. Glen provided her written testimony (Exhibit E) and urged the committee’s support and passage of the bill.
Next to speak, Tammy Klippenstein, Executive Director for Casa de Vida, a home for unwed pregnant women in Reno, stated they provided a loving and supportive environment for young women faced with a distressed pregnancy. Many of their clients were teenagers who were frightened, disillusioned, and desperately in need of kindness and emotional support. Ms. Klippenstein provided her written testimony and informative brochure on Casa de Vida (Exhibit F), and strongly encouraged the committee’s support and passage of S.B. 191.
Robert Payant, Executive Director, Nevada Catholic Conference, and also representing the Religious Alliance in Nevada (RAIN), made up of the leadership of the Methodist, Lutheran, Presbyterian, Episcopalian, and Catholic churches in the state. Mr. Payant spoke in favor of S.B. 191. The bill had attracted some very interesting titles; the “Safe Haven” bill and the “Baby Moses” bill. Moses, he said, was put in a basket and placed in the Nile River, not handed to anyone but watched carefully by the mother of Moses until found by the daughter of Pharaoh. That was the idea, that a caring mother placed the child in a safe haven. Mr. Payant added that the life of babies was so precious, it was hard to face or think about the desperation that a mother must have after carrying a baby to term, given birth, and then choosing to abandon the child. Heroic mothers would place their babies where they could be found, and the bill seemed to assist them in doing that. The exemption from criminal prosecution for such a person was certainly a small price to pay to avoid any more dumpster babies.
The bill achieved two important things, Mr. Payant added. First, it did immunize the desperate woman who had chosen to protect her baby by giving it a safe haven. Second, it also clarified the method by which the courts could determine that parental rights could be terminated and hopefully, as others had said, the child could be placed in a permanent adoptive home.
Mr. Payant stated the amendments, made since it was heard in the Senate, had generally strengthened the bill. It was particularly important that the bill provided for publication of notice of termination of parental rights, which was so vitally important, so that adoptions would not be overturned. There had been some question by members of the committee about the language permitting the child, rather than being handed to a person at the emergency services agency, hospital, fire station, or so on, to be abandoned by two different methods. One, on page 2 of the amended bill, starting at line 24, stated “to leave the child in the physical possession of a person who the parent has reasonable cause to believe is an employee of the provider, or on the property of the provider in the manner and location where it was likely that the child will be found.” Then language was added in the amendment to provide that the “mother must immediately contact the provider by phone as to where the child has been left.” Mr. Payant felt that was a step forward. He felt if it was made too difficult or complicated, the mother might be unwilling to leave her child in the manner desired.
Mr. Payant noted there had been another question regarding where the child could be placed, and said that when certain places were listed, others were naturally eliminated. For example, in times past, babies were often left on the steps of a convent, and he hoped if that were the case and the mother did that, she would not be prosecuted if she called the convent and reported the baby being left there.
Chairman Koivisto asked Mr. Payant if he was referring to language that had been removed. He said the language had been added in regard to leaving the child “in a manner and location that the parent has reasonable cause to believe will not threaten the physical health or safety of the child,” and must get in touch with the place where the child was left and advise someone.
Assemblywoman Leslie thanked Mr. Payant for pointing that out, as that was her concern. Her other concern had to do with the language: “and immediately contact the provider through the local emergency telephone number.”
She wanted to make sure that people understood that obligation and asked if they did not, could they be prosecuted. Mr. Payant felt it was most likely discretionary; if one left the baby in a safe place where it would be found, but not make the phone call, the parent might not be prosecuted. Ms. Leslie felt it might be incumbent on the Catholic church, and others who supported the bill, to help make sure that people understood what the rules were. Mr. Payant felt that was a very good suggestion.
Myra Sheehan, President, Nevada Trial Lawyers Association, voiced support for the bill. In response to Ms. Leslie’s question, Ms. Sheehan said the way she read the bill, it did authorize an obligation to the parent who dropped a child off to do more than just place the child in a safe location to be found. They must take that extra step to contact the provider so that someone knew the child was there. If they did not make the contact, she believed that left the door open to prosecute them. However, she also believed they would not be prosecuted if the child was found safe. The concern was, if a child was left in or by a dumpster, or the back door of a hospital, and the extra effort was not made to make contact and the child stayed outside overnight and froze to death, was that abuse or neglect.
Ms. Sheehan stated there was an additional side that Bill Welch would be discussing in more detail, however, for a provider, there was some ambiguity in the statute section that read: “a parent shall leave the child in the physical possession of a person,” and in that, there was immunity and liability language where it stated: “you are immune from civil and criminal liability if you are a provider that takes physical possession of that child.”
The problem with that section was that it was ambiguous in the sense of the provider’s obligation. Also, was the provider protected from any liability if that child was not in their physical possession. The ambiguity came in where it stated:
. . . in the physical possession of a person who the parent has reasonable cause to believe is an employee of the provider, or on the property of the provider in a manner and location that the parent has reasonable cause to believe will not threaten physical health or safety of the child, and immediately contact the provider.
Once that was done, then there was no liability on the part of the parent. Thereafter, where did the liability fall, Ms. Sheehan asked, because there was no follow-through by stating “and then the provider takes physical possession of that child.” Accordingly, some clarification was needed, because there were two things happening in that section. First, Assemblywoman Leslie’s concern that it was a two-prong obligation, leaving the child and then notifying someone and also, once the provider was notified, did the provider have to take possession before there was any liability there for the provider. If the mother had not done both things, left the child and made an effort to notify, then there was exposure as far as her criminal liability or civil liability dealing with abuse or neglect.
Assemblywoman Leslie assumed the parent would have to prove that she had made that call. If she called the emergency numbers for providers, most of those were recorded so that would be proof. However, if she did not call that way, or if she told a nurse on her way out the door, where would the proof be. Ms. Leslie wanted the bill to work but she felt uncomfortable about many things.
Ms. Sheehan felt everyone wanted the bill to work. She said every day she tried to interpret the laws that were created. There was no perfect bill, and what legislators had to ask was: would the good that came out of the bill be better than any damage that could result. She added that under current law, a parent who dropped off a newborn was going to be convicted of abuse or neglect regardless of the circumstances, whether they notified the hospital or not. That also brought up the question of whether the provider had an obligation to try to get information from that person. They were obligated to report abuse and neglect. Ms. Sheehan stated she could not say there were not problems in the bill, but it would be harder to say that the bill did more harm than good.
Chairman Koivisto asked if it would help to add, “or otherwise inform the provider” in the line where it stated to immediately contact the provider through the local emergency telephone number. Ms. Sheehan said it would help. She also felt there needed to be language to clarify “and that provider takes physical possession of the child.”
Assemblywoman Smith said when she read “the local emergency telephone number” to her that meant one number, 911, or something like that, rather than calling the emergency room number to say “I’ve just left a baby out front.” Therefore, she felt there was a problem with that wording.
Ms. Sheehan felt the language should be broader in that regard and it would make the bill better.
Vice Chairman McClain was concerned about one parent dropping the baby off without the consent of the other parent, and she asked if that was addressed in the bill. Assemblywoman Cegavske noted that on page 6, Section 6, subsection 3(e)(1), it addressed the rights of the other parent. She said none of the women who worked on the bill language were present to clarify that further. There was concern about one parent, usually the father, not knowing about the action, and once he knew, what happened.
Chairman Koivisto felt that Ms. McClain’s concern had been about the father of the child, married to the mother or not, who did not want the responsibility of the child and, without the mother’s knowledge, took the child to an emergency provider and left it, would the mother have recourse.
Ms. Sheehan felt that issue was a criminal act, felony child abduction. No parent had the right to take a child or do what he or she wanted with that child. There was a presumption in the bill that it would more likely be the mother who abandoned a newborn. There was also a presumption that either the father did not care or did not know. There were provisions in the law already, and it appeared the provisions were covered in the bill, to give notice to a parent or a father, even if unknown, as to abandonment. If the parent was unknown, that notice was done through publication. When a woman had a child and the father did not know, was an issue that could not be addressed in the present bill. It was something always being dealt with in paternity actions or adoptions. She mentioned the “putative father bill” that they were trying very hard to make work. It was already in the law that there should be notice. The presumptions in the bill were, if it was known that the mother dropped off the child, there was a presumption that the mother had abandoned that child and it changed some things in the law. But if the child was dropped off and it was unknown whether the mother or the father did it, then it would have to be published that “the parental rights of Baby M who was dropped off at the hospital have been terminated.”
Vice Chairman McClain offered the following scenario: A young lady had a baby, the father did not want to be bothered with it. She was not feeling good for a few days and the father offered to take care of the baby, and he drops it off. He has immunity, but she has no idea where her baby is. She calls the police, and while they were pursuing the abduction angle, the baby is already in protective services being prepared for adoption. Ms. McClain worried about those paths not crossing. Ms. Sheehan said all she did was family law, and what Ms. McClain had described was a situation she was quite familiar with. The law protected against those types of things as best it could, and the bill did not change anything that could already be done. What the bill would do, in essence, would be to hopefully eliminate “dumpster babies.” The bill sponsors wanted young women to know that they could deliver a child safely to a provider and their names would not be disclosed nor would they be pursued. The fallout from that, if any, would come out anyway, Ms. Sheehan added. She noted the questions being asked were good ones, they were things that were dealt with every day in the law, and the bill would not change that or affect it in any way. The focus of the bill is on one particular issue, “dumpster babies.”
Bill Welch, President of the Nevada Hospital Association, stated support of the legislation. He did not want to cause any delay or jeopardy to the bill and felt the sponsors had attempted to provide the appropriate protections for all parties involved, as throughout the bill there were provisions for protections. However, as Ms. Sheehan had presented, there was one area that, if it could be clarified, would be supportive. Section 1, subsection 3(a)(2), by adding at the end: “and the provider has taken physical possession of the child.”
Physical possession had been referenced throughout the legislation in many locations, and by simply adding that wording it would clarify it. Mr. Welch reiterated that he did not want to do anything to jeopardize the legislation. He was supportive of it, but in talking with the Legislative Counsel Bureau (LCB) and Ms. Sheehan, there was a question that the above would be resolved.
Assemblywoman Parnell agreed that was the weakest section of the bill and, if that was going to be amended, she suggested that being less specific about contacting the emergency provider through the local emergency number would be a better way to go. She asked if anyone had a problem with “immediately contact and inform the provider.” The less specific or restrictive language would go toward the goal of the bill, which was to have unwanted babies delivered safely to a provider.
Mr. Welch said that the provider was not necessarily going to be the one contacted directly and the child would be left at a safe location before the emergency service provider contacted a hospital facility. The hospital facility then would have authorized staff go to the location and take physical possession of the child. There was a small window of opportunity for something unfortunate to happen to that child. If “contacting the provider” were to be added, it would also be very helpful, then the provider could be contacted directly.
Chairman Koivisto asked if adding “or otherwise inform the provider” after “local emergency telephone number” would cover that to Assemblywoman Parnell’s satisfaction. Ms. Parnell agreed.
Vice Chairman McClain asked Marla McDade Williams, Committee Policy Analyst, about the bill in Chapter 432B on the Safe Families and Adoption Act, and wondered if anything in the current bill conflicted with that, would LCB notify the committee. Ms. Williams said that was correct.
Don Nelson, Nevada Life Issues Forum and Education, expressed support for the bill. They believed that each person from the moment of birth had infinite value and inherent worth, and all were created bearing incredible gifts for humanity. The example of Moses rescued by the Pharaoh’s daughter was proof what a difference one person could make.
Lynn Chapman, State Vice President of Nevada Eagle Forum, stated they supported the bill.
Alexis Miller, Planned Parenthood Miramonte and Planned Parenthood of Southern Nevada, supported the bill but felt it was more important to get the child out of harm’s way than to prosecute the parent. She would prefer to see in the intent, specifically at page 2, line 35, that they would not be prosecuted provided the child was safe and not abused. Also, she expressed concern about how to let people know of this bill. There were low cost or no cost means of doing that through media coverage, public service announcements, posters, and health classes, so that teens who were sexually active would get that information. She added that the bill was a “band-aid” to a larger problem; sex education and state-funded family planning were needed to prevent the unintended pregnancies, unwanted and abandoned babies.
Chairman Koivisto asked Assemblywoman Cegavske to speak about the intent of prosecution. Mrs. Cegavske said the intent of that section was to make sure that if a child had been abused that the law did not remove the possibility of prosecuting the offender. There needed to be a condition that if they had abused the child, they were still held accountable. The thrust of the bill was to give people an alternative to placing a baby in a plastic bag and putting it in a dumpster. There must be that avenue in the law that would prosecute someone who abused an infant.
Chairman Koivisto felt that with having that avenue available to the parent, it would avoid the abuse. Mrs. Cegavske said there had been comments among those young people who had disposed of their baby, that had they known they would not be prosecuted they would have left the baby in a safe location. They did not want their parents, or schoolmates, or anyone to know they had that child, and the only thing they knew to do was to hide it. Under the bill, if they left the baby with emergency personnel, they could walk away.
Alexis Miller said that met her concerns. She asked if the words “leave on property” could be removed. Chairman Koivisto said that had been dealt with.
Chairman Koivisto noted that May Shelton, although not present at the time, had signed on in support of the bill. Ms. Cegavske noted, too, that Ms. Shelton had been very involved in the bill and amendments.
Mrs. Koivisto asked the committee’s wishes.
ASSEMBLYWOMAN ANGLE MOVED TO AMEND AND DO PASS S.B. 191, WITH AMENDMENTS BY MR. WELCH AND MS. SHEEHAN TO ADD ON PAGE 2, LINE 29, “THROUGH THE LOCAL EMERGENCY TELEPHONE NUMBER OR OTHERWISE INFORM THE PROVIDER, AND THE PROVIDER HAS TAKEN POSSESSION” ON PAGE 30.
ASSEMBLYWOMAN PARNELL SECONDED THE MOTION.
THE MOTION PASSED UNANIMOUSLY BY THOSE PRESENT.
Ms. Cegavske noted a name for the infant cemetery, “Little Blessings,” had been suggested.
There being no further business before the committee, Chairman Koivisto adjourned the meeting at 3:50 p.m.
Darlene Rubin
Committee Secretary
APPROVED BY:
Assemblywoman Ellen Koivisto, Chairman
DATE: