MINUTES OF THE meeting
of the
ASSEMBLY Committee on Health and Human Services
Seventy-First Session
May 14, 2001
The Committee on Health and Human Serviceswas called to order at 1:46 p.m., on Monday, May 14, 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
COMMITTEE MEMBERS ABSENT:
Mrs. Vivian Freeman
Mr. Wendell Williams
GUEST LEGISLATORS PRESENT:
Senator Valerie Wiener, Senate District 3
Senator Dina Titus, Senate District 7
STAFF MEMBERS PRESENT:
Marla McDade Williams, Committee Policy Analyst
Darlene Rubin, Committee Secretary
OTHERS PRESENT:
Debbie Hosselkus, LSW, Deputy Administrator, Division of Mental Health and Developmental Services
Louis Ling, General Counsel, State Board of Pharmacy
Kevin Higgins, Chief Deputy Attorney General
Kevin Powers, Senior Counsel, Legislative Counsel Bureau
Fred Hillerby, State Board of Pharmacy
Alfredo Alonso, Soft Drink Bottlers Association
Sam McMullen, Retail Association of Nevada
Helen Foley, Clark County Health District
Mary Lau, Executive Director, Retail Association of Nevada
John Pappageorge, Republic Industries of Nevada
Joe Johnson, Toiyabe Chapter, Sierra Club
Mary Walker, Carson-Tahoe Hospital
Glen Savage, Clark County Health District
Chairman Koivisto announced the meeting would start as a subcommittee and, as both Senator Titus and Senator Wiener were testifying in other committees, she moved their bills back and opened the hearing on S.B. 540.
Senate Bill 540: Changes name of Nevada mental health institute to northern Nevada adult mental health services. (BDR 39-1442)
Debbie Hosselkus, Deputy Administrator, Division of Mental Health and Developmental Services (MHDS), stated the Division was requesting a change in the name of the Nevada Mental Health Institute to Northern Nevada Adult Mental Health Services. They felt the name change would better reflect the services provided and would bring the northern agency in line with the southern agency.
Assemblywoman Parnell asked if the Division ever serviced youth. Ms. Hosselkus responded in Washoe County, only adults were served. The Division of Child and Family Services handled the youth population. Ms. Parnell then asked if prison inmates, upon parole, ever came to the MHDS for temporary residency. Ms. Hosselkus said they did offer outpatient services, and the type of service would depend upon the individual and their needs.
Chairman Koivisto referred to Section 2, line 16, regarding the “revolving account,” and asked if the bill had to go to the Committee on Ways and Means, or was that merely to add the new name into that section. Ms. Hosselkus said that was simply changing the name. The revolving account was already in existence.
There were no further questions or testimony on S.B. 540. Chairman Koivisto returned the bill to committee awaiting the arrival of more members so that a vote could be taken.
Senator Wiener arrived and, accordingly, Chairman Koivisto opened the hearing on S.B. 397; however, she noted there was a conflict notice on the bill because of S.B. 52, which meant that Section 29 had to be changed to reflect the addition of advanced-practice nurses.
Senate Bill 397: Prohibits certain acts related to drugs and Internet pharmacies. (BDR 40-102)
Senator Valerie Wiener, District 3, introduced S.B. 397 which prohibited certain acts related to drugs and Internet pharmacies. She explained she had become involved with the issue over a year ago, in her role as a Senate appointee on the Attorney General’s Technological Crimes Advisory Board. She had learned a great deal in that capacity and in fact stayed on with the issue of Internet pharmacies and the lack of consumer protection for those who purchased prescription drugs on the Internet. She began working with the Attorney General’s Office, the Legislative Counsel Bureau, and the State Board of Pharmacy to develop the legislation that would serve as a model bill for other legislatures across the country. Senator Wiener provided her written testimony (Exhibit C), highlights of which were as follows:
Senator Wiener explained there was a sharp contrast between legitimate Internet pharmacies and “rogue” pharmacies. Legitimate on-line pharmacies, such as Drugstore.com, CVS.com, and PlanetRx.com, operated ethically and in the consumer’s best interest. For example, they:
“Rogue” pharmacies, on the other hand, had the following characteristics:
Foreign on-line Internet sites were worse, Senator Wiener explained, often requiring the purchaser to fill in only his name and quantity of desired medication, and submit the order with credit card information and delivery address.
Among other questions raised in dealing with Internet pharmacies:
Consumer Reports, in its February 2001 issue, stated that with the high cost of prescription drugs, it was easy to see why people would try to cut corners, but buying prescription drugs “via unlicensed on-line pharmacies was like playing Russian roulette.” Meridia, for weight loss, Prozac, to treat depression, and Zyban, to kick the smoking habit, were examples of drugs that could have serious to deadly side effects if not monitored.
Senator Wiener explained that Jupiter Communications, which tracked Internet businesses, estimated that the annual sale of prescription drugs on-line would rise from about $23 million to nearly $1 billion within the next few years. Some on-line sites would be legitimate, but many would not.
S.B. 397 addressed many of those concerns. The measure prohibited health care practitioners and others from prescribing prescription drugs through an illegal Internet pharmacy, as defined in Section 4, page 1, lines 9 through 18. Senator Wiener added that because of concerns raised by the Nevada Rural Health Project and the University and Community College System, regarding their telemedicine programs, there was an exception in Section 4, subsection 2, to protect those entities.
Other key definitions and sections were as follows:
Senator Wiener urged the committee’s support and passage of S.B. 397 as a critical first step toward consumer protection for the residents of Nevada.
Assemblywoman Tiffany asked whether any other state had this type legislation. Senator Wiener said there were none exactly like S.B. 397; however, Louis Ling and Kevin Higgins, who helped draft the bill, were present and could answer that more fully. Ms. Tiffany wondered if the other states’ legislation could assist Nevada in developing guidelines and regulations for certification.
Louis Ling, General Counsel, State Board of Pharmacy, responded that a handful of states were doing a registration only. The regulations had no “teeth”; basically all that was required to sell in that state was to register with its board of pharmacy. But if a seller did not register, there was no penalty and no way to get at those Internet pharmacies. The National Association of Boards of Pharmacy had a “VIPPS Certificate” which was the “verification of Internet pharmacy prescription suppliers.” The VIPPS had a lengthy checklist that pharmacies had to go through to become VIPPS-certified. Currently there were about 30 pharmacy sites that were VIPPS-certified. Mr. Ling said his Board intended to adopt the VIPPS certification standard. Constitutionally, the state had to allow individuals to apply to the board directly and not go through VIPPS, if they chose to do that. VIPPS could not be made the only certifier for the state of Nevada. Mr. Ling reported there were several VIPPS-certified pharmacies. It was a good standard, it assured that the pharmacy was licensed in all 50 states, it had liability insurance, and it would deal with most major medical plans.
Ms. Tiffany asked the difference between registration and certification and if there was a fee. Mr. Ling responded that registration was the responsibility of a licensing board. Certification, as used in the law, was handled by a private organization to which one applied and was required to meet certain standards. That had nothing to do with state licensure. The registration fee was $150 every two years. “Certification” was the word used in the bill, and the Board of Pharmacy was going to be licensing them, registering them as pharmacies, and certifying that they were not an illegal Internet pharmacy. Most would go through the VIPPS process. There was an advantage to having the VIPPS seal on the Web site, in that if someone wanted to see if the pharmacy was VIPPS-certified, he only had to click on that seal to connect with the VIPPS site.
Kevin Higgins, Chief Deputy Attorney General, reported that approximately 15 years ago it became clear the state of Nevada was behind the times in regulating telemarketers. Florida, California, Arizona, and Texas had passed massive telemarketing registration and licensing laws; most of those telemarketers found it was easier to move to the state of Nevada and set up shop in Las Vegas. For the past 15 years a great deal of time had been spent investigating the many complaints received from people across the country. It had taken several years to catch up with all those, and, meanwhile, people came to Nevada knowing they could get away with telemarketing schemes. In the last ten years, California had vigorously regulated and prosecuted insurance fraud, workers’ compensation fraud, and fraud rings. When Mr. Higgins commented to a Los Angeles Deputy District Attorney that there were no fraud rings in Nevada, the man responded that the attorneys and doctors who were running the fraud rings in Los Angeles had moved to Las Vegas. Mr. Higgins hoped with the Internet pharmacy issue that Nevada would get in step with the times more quickly.
Mr. Higgins believed that probably all of the illegal Internet pharmacies in Nevada were operating out of Las Vegas. Many thousands of prescriptions were filled daily. He noted that at a recent conference of Attorneys General of the United States, the Attorney General from Kansas approached Attorney General Frankie Sue Del Papa to ask when Nevada was going to do something about the Internet pharmacies operating in the state. Ms. Del Papa was surprised to know nothing about that. The Kansas man said someone from his staff, a 58-year-old woman who had children, just purchased 100 units of Viagra for $19.95 a pill. He was concerned that teenage boys would start buying Viagra, which would be readily available as long as they had a credit card.
Mr. Higgins related another incident that brought the problem to his office’s attention. A physician, employed by an Internet pharmacy, called to advise that, after signing many thousands of Internet prescriptions that had not included a consultation or medical history, he had learned that people were taking drugs that if combined with others could be fatal. Secondly, the company had fired him and kept his signature stamp. Mr. Higgins said he hoped to get ahead of the problem in Nevada. There were other bills pending on Internet fraud issues, and some of those issues had not been dealt with in as complete a way anywhere else in the country. There were jurisdictional questions about regulating people out of state; however, it was necessary to protect the citizens of Nevada from harm or injury. Also, the state did not want to become the haven for illegal telemarketers or illegal Internet pharmacies.
Several years ago, Mr. Higgins reported the Federal Trade Commission (FTC) had threatened Nevada, saying they were going to move in and take over complete jurisdiction of the telemarketing area, unless the state got “up to speed” on it. The present bill provided the opportunity through the pharmacy board to regulate those pharmacies and to prosecute them, and he thought they would relocate to other states.
Assemblywoman Berman stated she was alerted by Mr. Higgins’ testimony to a bill that had been brought which provided for individuals to fax a prescription to a pharmacist. She voted against that bill because she felt there was such an opportunity for fraud to come across the wires, just as Mr. Higgins had mentioned about the signature stamp. She asked if the Attorney General’s Office had received any complaints. Mr. Higgins said he had not received any type of complaints about wire fraud to which she referred.
Mr. Ling stated his office had not seen the fax machine as being a major source of prescription fraud; most pharmacies preferred the fax prescriptions over a telephoned-in prescription. It was the telephoned-in prescriptions where most of the fraud occurred. People would call in and pretend to be from a doctor’s office, and there was no way for most pharmacies to know that. Mr. Ling said they were just now trying to get pharmacies to get caller ID boxes, so at least they would know where that phone call was coming from. The fax machine usually printed the originating number at the top, which was of help.
Assemblywoman Tiffany noted it was difficult to get a bill passed with a felony attached to it. She asked how they had decided on a B and C felony and what were the standards.
Mr. Higgins stated the Category B and C felonies were determined by the seriousness of an intentional act; a C felony carried a term 5 years in prison, and a Category B was 15 years. They hoped it would get the attention of the people who were doing those things. A Category D felony did not have much of a fine attached, and a Category E felony did not amount to much. It was subjected to probate in just about all circumstances.
Kevin Powers, Senior Counsel, Legislative Counsel Bureau, stated the provisions in the bill relating to the Category B and C felonies were, for the most part, modeled after the existing Chapter 453, the Controlled Substances Chapter, where the provisions would reside. The idea in drafting those penalties was to make them consistent with similar crimes that already were defined in Chapter 453.
Chairman Koivisto stated she was glad he answered that question because, for those who served on the Assembly Judiciary Committee, they wanted to make sure that Mr. Anderson would not think the committee was doing something it should not be doing.
Assemblyman Manendo asked about the specific chapter. Mr. Powers said the idea was to consider all of the statutes in Chapter 453 and arrive at what seemed to be a rough approximation of equivalent conduct carrying equivalent penalties. Mr. Manendo said that a B felony carried a 3-to-15-year sentence and not more than $20,000 fine. He believed the chapter was 453.352.
Vice Chairman McClain referred to page 3, Section 11, subsection (a), and asked if that language was somewhere else in law and just put in here because the issue was the Internet. The cited reference stated the doctor had to physically examine someone within six months before issuing a prescription. She wanted to know if that was already in the law.
Mr. Ling said that standard was not in the law; it was new language and part of the statute. A way had to be found to define where that cutoff point was. The Nevada Board of Medical Examiners had, as a matter of policy, stated that Nevada physicians could not be prescribing without a physical examination of the patient; a bona fide doctor-patient relationship. Theirs was not tied to six months, but was tied to whether a physical examination had occurred at all. The other tie-in for that was for the practice to be illegal, it had to satisfy both (a) and (b). That defined the bad conduct at issue, without infringing upon legitimate telemedicine, because that was being encouraged in the state. Mr. Ling also provided a handout entitled “Points in Support of S.B. 397 (Exhibit D).
There were no further questions and Chairman Koivisto closed the hearing on S.B. 397 and asked the committee’s wishes. A quorum was present.
ASSEMBLYWOMAN TIFFANY MOVED TO AMEND AND DO PASS
S. B. 397.
ASSEMBLYWOMAN ANGLE SECONDED THE MOTION.
THE MOTION PASSED UNANIMOUSLY BY THOSE PRESENT.
Chairman Koivisto returned to S.B. 540 to ask the committee’s wishes.
VICE CHAIRMAN MCCLAIN MOVED TO DO PASS S.B. 540.
ASSEMBLYWOMAN TIFFANY SECONDED THE MOTION.
THE MOTION PASSED UNANIMOUSLY BY THOSE PRESENT.
Chairman Koivisto opened the hearing on S.B. 352.
Senate Bill 352: Revises provisions regarding regulation of food establishments. (BDR 40-1489)
Marla McDade Williams, Committee Policy Analyst, referred to the proposed amendment (Exhibit E), which she stated would replace the bill, take out the reference to nonalcoholic facilities, and go back and change the definition of a food handler. The proposed language for revision was underlined in paragraph 1 of the document.
Essentially, the “food handler” definition would be changed to state that the term did not apply to any person who handled, stored, transported, or sold food or otherwise came into contact with food that had already been permanently sealed or packaged for sale directly to the consumer. It would not include cases of incidental handling of potentially hazardous food that was already permanently sealed or packaged for sale directly to the consumer outside the normal and usual course and scope of their responsibilities or employment.
The second portion of the amendment added the definition of “potentially hazardous food” to the Nevada Revised Statutes (NRS) and made reference back to the definition as adopted by the FDA.
Ms. Williams advised parties had met last week and after considerable discussion all agreed on the language.
Assemblyman Manendo assumed the bill would have to go back to the Senate for their concurrence or lack thereof, and he wanted to make sure the Senate was agreeable. If they failed to agree, it would necessitate a conference committee and potential problems. He speculated it might be better to keep the bill as it was.
Alfredo Alonso, Soft Drink Bottlers Association, said he already had that discussion with the chairman of the Senate Human Resources Committee and he was comfortable with the language. Mr. Alonso thanked the retailers and the health district for the good compromise.
ASSEMBLYMAN MANENDO MOVED TO AMEND AND DO PASS
S.B. 352.
ASSEMBLYWOMAN ANGLE SECONDED THE MOTION.
THE MOTION PASSED UNANIMOUSLY BY THOSE PRESENT.
The Chairman opened the hearing on S.B. 544.
Senate Bill 544: Makes various changes to provisions governing practice of pharmacy. (BDR 40-400)
Fred Hillerby, representing the State Board of Pharmacy, reported that S.B. 544 was a “housekeeping” bill. He then deferred to Louis Ling, General Counsel, to provide background.
Louis Ling, General Counsel, State Board of Pharmacy, referred to his handout entitled “Points in Support of S.B. 544” (Exhibit F), and stated the bill was necessary to bring the Board into harmony with federal law, which was always changing in the interim. He noted highlights of the bill as follows:
Chairman Koivisto reported to the committee that there was a conflict notice on the bill in Section 5, regarding the advanced practitioner of nursing authorized for prescribing controlled substances.
Assemblywoman Tiffany noted, regarding electronic signatures, the only one who used that method currently was the Secretary of State; there was a certification process for doing that. She asked if the Board of Pharmacy intended to require that same process. Mr. Ling responded that the Board would look to the federal law for security requirements and follow those guidelines. The system currently in use by the Secretary of State did not apply to the Board of Pharmacy.
Assemblywoman Tiffany then asked if the Pharmacy Board would be allowed to charge a fee to do investigations on international companies. Mr. Ling said they would be allowed if they had to do an investigation that resulted in discipline. They had the authority to recover fees and costs, but only in that disciplinary context; otherwise, the Board would bear those costs.
Sam McMullen, representing the Retail Association of Nevada, accompanied by Mary Lau, Executive Director of the Retail Association of Nevada (RAN), stated they supported S.B. 544 as presently constructed. They asked for some changes that were now embodied in Section 12. Those changes were addressed by Mr. Ling in terms of the fining level being moved up to $10,000; however, they agreed to that so long as there was going to be a regulation drafting process that would set out and schedule the fines that were possible for the various levels of violation.
Chairman Koivisto asked about the pharmacist or the pharmacy being fined. Mr. McMullen said the fines could relate to any licensee, either a pharmacy or a pharmacist, and that was one of the things he had hoped would be clarified.
There were no further questions and Chairman Koivisto asked the committee’s wishes.
VICE CHAIRMAN MCCLAIN MOVED TO AMEND AND DO PASS
S.B. 544.
ASSEMBLYWOMAN SMITH SECONDED THE MOTION.
THE MOTION PASSED UNANIMOUSLY BY THOSE PRESENT.
Chairman Koivisto opened the hearing on S.B. 424.
Senate Bill 424: Revises provisions concerning unlawful disposal of certain types of waste. (BDR 40-61)
Senator Dina Titus, District 7, reported the bill dealt with illegal dumping of garbage and solid waste. The problem was especially bad in the Nevada desert because material stayed there forever. The bill was aimed at putting more teeth into existing prohibitions against desert dumping and assisting local government in their pursuit and prosecution of the offenders.
Continuing, she explained illegal dumping was also referred to as “open” dumping, “fly” dumping, and “midnight” dumping, because it was often dumped in open areas from vehicles along roadsides and done late at night. It occurred because dumpers sought to avoid disposal fees or the time and effort required for proper disposal. Materials frequently dumped included construction waste (e.g., drywall, roofing, shingles), abandoned cars, car parts, appliances, furniture, yard waste, household trash, and medical waste. If not addressed, illegal dumps often attracted more waste. Potentially hazardous waste included such items as asbestos, household chemicals, paint, automotive fluids, and commercial or industrial waste. Illegal dumping was a problem for several reasons; health risks items such as nails and sharp edges, as well as chemical fluid hazards. Further, rodents and insects were drawn to waste areas. There was an increase in the danger of fire, either spontaneous combustion or arson. Those areas negatively impacted proper drainage of runoff and contributed to flooding and erosion, and contaminated wells and surface water, and dumpsites served as magnets for additional dumping and other criminal activities that caused property values to decline.
Senator Titus concluded by saying the cost to local governments to clean up the dumps was significant. Nevada was highly susceptible to the problems of illegal dumping. Local government had been doing a good job at policing the problem, and volunteer groups like the Sierra Club and the Friends of Desert Wetlands also assisted them; however, more was needed because their efforts were curative and not preventative. The bill gave local governments greater subpoena powers, enhanced penalties, and also provided some funds for a better education.
Glen Savage, Clark County Health District, reported that over the last five years more than 2,200 complaints of illegal dumping had been received. In 2001, 700 additional complaints were projected. Local prosecutors had accepted over 500 cases in the last five years. They had prosecuted over 200, but about 125 cases were still pending. Also, 400 cases were still being investigated. The current process followed as prosecutors took approximately 150 days to handle; therefore, it was a long, drawn out affair for perpetrators to see the light of a courtroom.
Clark County Health District was very much in support of the bill and thanked Senator Titus. They had a number of conversations with community leaders, nonprofit organizations such as Sierra Club, plus the District Attorney’s Office and other prosecuting jurisdictions within Clark County, and all were very supportive of the measure.
Mr. Savage emphasized the importance of the opportunity for Clark County to establish an administrative hearing board. Many cases were being sent to local prosecutors and overwhelming the court system with those cases. The bill as proposed would give Clark County the opportunity to seek civil remedies, which would include corrective action orders, cleanup orders, compliance schedules and penalties, if necessary. Many times in the court system, a high standard of proof was required, and that included knowledge and intent. Many times the person doing the illegal dumping might be working for a company, and he might not have specific knowledge or intent to break the law but was caught. In discussing the evidence with the local companies who had hired that person and were willing to do cleanups and to pay what was necessary, but many times they felt that going through a criminal prosecution and getting a record was not necessary. As such, they were interested in the administrative hearing board process.
Senator Titus said there were certain aspects of the bill that had to do with subpoena powers and the penalties that were part of the bill had been raised. Some dumpers stated it was cheaper for them to take the risk of being caught instead of taking the waste to a proper facility. There was not a great deterrent as things now stood. Additionally, many judges currently were not invoking any kind of correction action; therefore, once an order was issued, which included a fine and a plea of guilty, the dumpsite remained and continued to be an eyesore.
Mr. Savage stated he had conversations with the LCB, and that Mr. McKenna, Senior Deputy Counsel, had helped write some of the language.
Assemblyman Manendo noted that it was a “quality of life” issue all over Nevada, particularly in the southern part of the state, and he asked what currently was the Clark County Commission doing. Were there regulations and penalties? Mr. Savage said the penalties could be as low as $200; however, the court system could waive those penalties if the perpetrator behaved for the next six months or a year. For the most part, the fines and punishments were very small and did not even pay the cost of cleanup. Mr. Manendo said “often there were comments from local governments saying we should not be butting into their business. But this was certainly a place where it was a positive.” He felt people would respond favorably in his and Senator Titus’ districts. He added a bill had also been passed by the committee that called for community service hours.
Assemblywoman Tiffany assumed Clark County was in favor of the bill; however, she asked if it would be a burden to add an administrative board. Mr. Savage said they did not believe it would be. They had already had discussions with Dr. Kwalick and some of the board members and they were very supportive. It gave the health district another avenue to work on those cases that were not of a criminal nature, but could be handled in an administrative process. There was still some work to do, he added, so far as rule making and ensuring due process was followed. Ms. Tiffany wanted to know if the air quality board could hear those cases. Mr. Savage said it could be the same board; however, the board was not set up currently to hear illegal dumping cases. Senator Titus said they would create a new regional air quality division, and she imagined they would then be hearing air quality problems; however, solid waste would be left in the health district, and that board would hear those and related cases.
Helen Foley, Clark County Health District, stated the issue was so important to Clark County Health District that they would absorb the cost of the creation of the new board to hear those administrative cases. Because the air quality would be going to another agency, they would not be combined.
John Pappageorge, representing Republic Industries of Nevada, strongly supported the measure and pointed out that the issue was not minor, but rather truckloads of debris were dumped in the desert. He stated it was not necessary for people to dump debris because his client picked up appliances such as washing machines, refrigerators, and other bulky items; as much as the homeowner could move to the curb.
Joe Johnston, representing the Toiyabe Chapter of the Sierra Club, expressed strong support for the bill. The southern Nevada chapter of the Sierra Club had volunteered in the past to clean up the desert and would continue to do so.
Chairman Koivisto closed the hearing on S.B. 424 and asked the committee’s wishes.
ASSEMBLYWOMAN SMITH MOVED TO DO PASS S.B. 424.
ASSEMBLYMAN MANENDO SECONDED THE MOTION.
THE MOTION PASSED UNANIMOUSLY BY THOSE PRESENT..
Chairman Koivisto turned next to S.B. 406 and invited Mary Walker to come forward with her testimony.
Senate Bill 406: Provides additional exception to prohibition against certain referrals of patients by health care practitioners. (BDR 40-596)
Mary Walker, representing Carson-Tahoe Hospital, noted one of the questions that had come up during the earlier testimony on the bill was addressed to the panel of Carson-Tahoe Hospital, about the difficulty in recruiting physicians. Ed Epperson, Hospital Administrator, responded there was difficulty for specialty-type physicians. Ms. Walker presented a letter from Ed Epperson (Exhibit G) stating some of those positions had gone unfilled for several years. The hospital was now trying to attract physicians from Portugal and other countries, because they had been unable to find interested physicians in the United States. From the mid-1980s to the mid-1990s, Carson-Tahoe Hospital and Carson City had a severe shortage of doctors. At that time, Ms. Walker was the administrative services administrator for Carson City, which included the health benefits and the group medical program, and she recalled new employees could not find physicians in Carson City. She added when legislators and lobbyists came here from Las Vegas or elsewhere and got sick, they could not find a doctor to assist them, and most ended up in the emergency ward for some minor problems because it was the only way to get care.
Ms. Walker explained in the mid-1990s when there was a new administration at Carson-Tahoe Hospital, partnerships were initiated with their physicians. One of the problems facing rural hospitals was they did not pay the salary as did urban communities like Washoe and Clark paid; as such, it was hard to attract physicians. Through partnership agreements, they had been able to attract enough doctors and general practitioners during the past 15 years; however, it had taken that long. Currently, there were only about three specialties not represented.
Ms. Walker concluded by saying, for rural hospitals to continue to attract and retain physicians, as well as maintain financial health, Ms. Walker urged support and passage of S.B. 406.
Assemblywoman Gibbons offered an amendment to the bill, to which Senator Amodei had agreed, to include the names of Assemblywoman Bonnie Parnell and Assemblyman Greg Brower in the bill, because of their assistance in the legislation.
Chairman Koivisto asked the committee’s wishes in regard to the bill.
ASSEMBLYWOMAN PARNELL MOVED TO AMEND AND DO PASS
S.B. 406, WITH THE AMENDMENT FROM ASSEMBLYWOMAN GIBBONS.
ASSEMBLYWOMAN ANGLE SECONDED THE MOTION.
THE MOTION PASSED WITH 8 YEAS. ASSEMBLYWOMEN LESLIE AND
TIFFANY VOTED NO.
Chairman Koivisto asked Assemblywoman Parnell to introduce the bill on the floor of the Assembly.
There being no further business before the committee, the Chairman adjourned the meeting at 3:15 p.m.
RESPECTFULLY SUBMITTED:
Darlene Rubin
Committee Secretary
APPROVED BY:
Assemblywoman Ellen Koivisto, Chairman
DATE: