MINUTES OF THE meeting
of the
ASSEMBLY Committee on Health and Human Services
Seventy-First Session
April 9, 2001
The Committee on Health and Human Serviceswas called to order at 1:30 p.m., on Monday, April 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
Mr. Wendell Williams
COMMITTEE MEMBERS ABSENT:
Mrs. Vivian Freeman
Ms. Sandra Tiffany
GUEST LEGISLATORS PRESENT:
Assemblyman Joseph Dini, Jr., District 38
Assemblyman Dennis Nolan, District 13
Assemblyman Bob Beers, District 4
Assemblywoman Barbara Buckley, District 8
STAFF MEMBERS PRESENT:
Marla McDade Williams, Committee Policy Analyst
Darlene Rubin, Committee Secretary
OTHERS PRESENT:
Steve Hanson, Deputy Fire Chief, Clark County Fire Department
Jim Spinello, Clark County
Rusty McAllister, Vice President, Professional Fire Fighters of Nevada
Gary Milliken, American Medical Response (AMR)
Bill Bradley, Nevada Trial Lawyers Association
Chris Ferrari, Regional Emergency Medical Services Authority (REMSA)
Jim Gubbels, Regional Emergency Medical Services Authority (REMSA)
Edrie LaVoie, Adoptive Parent
Peggy Pauley, Adoptive Parent
Wanda Scott, Department Child and Family Services (DCFS)
Elizabeth Breshears, Department of Child and Family Services
Frankie Sue Del Papa, Attorney General
Father Frank Murphy
Heidi Smith, Transplant Patient
Ginny Lewis, Deputy Director, Department of Motor Vehicles and Public Safety
Linda Bergstrom, Transplant patient
James Besson, Transplant patient
Ellen Beebee, Transplant patient
Paula Winne, Assembly Attaché
Debbie Pinjuv, Transplant Patient
Yvonne Sylva, Administrator, Department of Health
Note: Simultaneous video conference in Room 4401 of the Grant Sawyer Office Building, 555 East Washington Avenue, Las Vegas, Nevada.
Chairman Koivisto opened the hearing on A.B. 488.
Assembly Bill 488: Revises provisions relating to transportation by fire-fighting agencies of sick or injured persons to medical facilities. (BDR 40-181)
Steve Hanson, Deputy Chief, Clark County Fire Department, spoke in support of A.B. 488, and provided his written testimony (Exhibit C). He felt the language in the bill would allow fire-fighting agencies the ability to provide without question the care at the scene of an emergency, as well as provide care and transport from the scene to a hospital. Currently, the language did not allow for that. Mr. Hanson explained that many times fire fighting agencies would be on the scene, but in southern Nevada, there was a dual response system where private ambulance companies also responded. If the fire department arrived and found they needed to transport immediately they would do that based on the patient care, but currently the law was vague in that it did not actually cover transporting from the scene to a hospital. There were also departments in southern Nevada that provided transport and charged and recovered costs for that, and the proposed legislation would allow the county to bill to recover those costs.
Mr. Hanson noted that the bill also addressed liability for civil damages, which had been included to cover the transport; currently liability was covered on- scene only.
Chairman Koivisto inquired if the bill asked for coverage for civil damages. Mr. Hanson said the proposed bill would provide coverage in transport from the scene to the hospital, updating the language to coincide with updates in other sections of the Nevada Revised Statutes (NRS).
Assemblywoman Leslie asked if they currently transported patients to the hospital. Mr. Hanson said it was not done on a routine basis; occasionally if patient care dictated they did transport. The language in the bill would allow them to do that more frequently, as did other departments in the area such as Henderson and Las Vegas. Ms. Leslie asked if it would put them in conflict with the ambulance companies. Mr. Hanson was not sure if it would put them in conflict; however, it would allow them the opportunity to do what the other departments in southern Nevada were already doing. Currently, he said, Henderson did emergency 911 transport and the city of Las Vegas did some 911 emergency transport in an agreement with the private ambulance provider in Las Vegas. The proposed language allowed the country to provide the same service to the citizens in Clark County.
Ms. Leslie asked if that was being done anywhere else in the state outside of Clark County. Mr. Hanson was not aware that it was being done anywhere but in the southern part of the state, Las Vegas, Henderson, and Boulder City, however, that did not mean it was not being done elsewhere.
Assemblywoman Parnell referred to Section 1, “ambulance means a motor vehicle including without limitation a vehicle of a fire fighting agency,” and asked for an example of “without limitation,” which, she felt, was very broad. Mr. Hanson agreed that it was broad, however, whatever a fire fighting agency decided it wanted to transport in, whether a state EMS office or Clark County Health District vehicle, that vehicle would have to be inspected and approved, and given a certificate in order to transport. Currently, he added, with Clark County Health District, those regulations required that vehicle to meet certain specifications. If a fire fighting agency vehicle met that criteria it would be issued a certificate to do transport. Ms. Parnell was surprised, in that case, that the language had not simply stated, “ambulance means a motor vehicle” or “a vehicle of a fire fighting agency,” as that would be inclusive of anything they wished to use. Mr. Hanson agreed that might work, although “vehicle of a fire fighting agency” might also include an engine and they also provided EMS off the engine companies, however, they did not necessarily do transport off the engine companies.
Chairman Koivisto referred to Section 7, page 3, subsection 5, line 41, “or while transporting those persons to a medical facility is not liable for civil damages,” and asked for an explanation. Mr. Hanson said that was the same language throughout the bill, which was the part of state law that protected search and rescue people, volunteer ambulance, and, under Section 5, a person who either served as or volunteered for a fire department. The language was added to protect them as it always had protected the fire service at the scene, and now the protection was being extended while transporting.
Assemblywoman Leslie returned to her previous question about Las Vegas, Henderson, and Boulder City, which already transported, and she assumed no change in the law was required, but asked if the bill addressed only Clark County. Mr. Hanson said parts of the bill addressed Clark County. Las Vegas and Henderson were incorporated towns and he was not sure what the circumstances were. However, for the county, he had been advised the changes would be made to clear that up. In the law, as currently written, it did describe a fire fighting agency vehicle as only being able to provide care at the scene of an emergency. The problem with that was they did have situations where they transported from the scene to a medical facility and if that service was expanded it would be an issue in the future, therefore, he was asked to draft something that would clear that up.
Further, Mr. Hanson advised that he was a member of the Nevada Fire Chiefs’ Association and that issue had been raised at their last meeting and discussed with other fire chiefs around the state. All the fire chiefs had supported the change in the language because it made it clearer. When the language was put into the statute years before it was when they started providing service on fire trucks; that was the “fire-fighting vehicle” referred to. The new language made it clear that the care did not stop at the scene and they could continue to provide that care en route to the hospital.
Chairman Koivisto asked what happened now when a Las Vegas Fire Department (LVFD) ambulance went to the scene; was care only provided at the scene and did they have to wait for one of the other ambulance companies to arrive to transport. Mr. Hanson said currently in the city of Las Vegas there was an arrangement where the LVFD provided transport from the scene to the hospital on certain types of calls only, unless the patient’s condition warranted transporting. Currently those calls were limited to automobile accidents and there was a charge for that service. Other calls in the community would involve a response from not only the fire department but also the private ambulance company that had a franchise in the city of Las Vegas.
Vice Chairman McClain, who also worked for Clark County and was formerly a lobbyist, remarked they were always fighting to gain more flexibility for the counties because cities, by virtue of having a charter, were authorized to do many more broad ordinances. She asked why, in Section 2, the first line on page 2, stated “the term does not include person or governmental entity” originally, and now it was being changed to “private.” Mr. Hanson believed that meant the changes in the language did not affect the private entity that might already have a franchise or agreement or contract to provide that service. But the changes affected the fire service and the fire fighting agency vehicle.
Jim Spinello, representing Clark County, said his non-session occupation was in Clark County’s franchise division and he was familiar with all the franchises the county had, among which were the ambulance franchisees. His interpretation of the proposed legislation was to take them out of the definition of fire fighting agency. An ambulance company would not be defined as a fire fighting agency in the context of that definition.
Next to speak was Rusty McAllister, representing the Professional Firefighters of Nevada, who spoke in support of A.B. 488. He noted there were other entities in the state of Nevada that provided EMS transport currently. Carson City Fire Department did the EMS transport in Carson City; East Fork Fire Department provided the transport in the Gardnerville area, along with the other fire departments in southern Nevada that had entered into the EMS transport business. He was most familiar with the city of Las Vegas where currently, in southern Nevada, it was a dual response system. When a call was made to 911, a fire department unit and a private ambulance company responded to the scene. If the fire department arrived first and there was not a need for transport, the fire department had the ability to cancel the private ambulance company, and conversely, if the private ambulance was first on the scene and no transport was needed, they could cancel the fire department. Currently, the Las Vegas Fire Department had an agreement with the private ambulance company for LVFD to do up to 10 percent of the EMS transports in the valley. To date they had limited that to doing transport for all auto accidents, which freed up the ambulance company to respond to other calls. It also provided the agency with the ability to recover some of the fees or expenses involved in providing EMS care in a dual response system. Normally, he added, when they responded without the ability to transport or bill, they would have the expense of going on the call but the private ambulance would transport and have the opportunity to bill. Under the proposed legislation, they would be able to offset their costs somewhat. The Clark County Fire Department was interested in entering into that situation, although they did not have the ability to do so currently, just as the Las Vegas Fire Department could not do just any transports without prior agreements being worked out. He recalled it had been difficult for his agency to work out the details for transporting the 10 percent figure with the private companies. His agency had been working with that arrangement for two years and just recently built up to the 10 percent mark.
Assemblywoman Leslie said she now understood; however, she still would like an answer to her original question: why the cities could already transport but the counties could not.
Mr. Spinello responded that it was simply a function of government in Nevada, particularly as Nevada was one of the states that was most restrictive of its counties. Cities were created by charter and, in theory, they were able to do more because the citizens had incorporated themselves into the city and could therefore, empower. By ordinance, they could grant themselves a great deal of authority and power. Counties, however, were creatures of statute; created by the state and political subdivisions of the state and, in most cases, a district attorney would advise that following Dillon’s Rule, if state law did not specifically say one could do something, then one could not do it. That rule was interpreted strictly in Nevada. Mr. Spinello noted there had been a number of bills in the Government Affairs Committee that had sought to increase the counties’ authority, particularly in southern Nevada. Clark County was not only the largest county in the state of Nevada, but also it hosted the largest city in the state (Las Vegas). The population in unincorporated Clark County was greater than any other city in the state by about 100,000 people. In those unincorporated urban areas there were the same kinds of issues that Las Vegas or any other city had. This proposed legislation was one more attempt at trying to gain the same abilities as the city.
Further, Mr. Spinello added, one aspect of the franchise agreements with the two companies that provided ambulance service was a standby agreement which stated, in effect, if operations should cease for whatever reason, temporarily or permanently, the county had the right to take possession of the vehicles and equipment to operate the ambulance service. It was unclear in current statute if that was to occur, that the county could actually do it. It was hoped that under the emergency powers, what needed to be done to provide for the community could be done. If the county could not charge for the transport there would be a fairly significant cost to the taxpayer for all of those vehicles and the overtime. Accordingly, the inability to provide the service, charge for the service, and operate the ambulance service was something the terms of the proposed legislation would help to satisfy.
Mr. Spinello added it was not something that would occur without a great deal of preparation, thought, and planning on the part of the commission; however it was an authority the commission believed it needed to carry out its responsibilities just as the city councils were able to in their jurisdictions.
Assemblyman Manendo asked about Section 8, page 5, on whom would the fees be imposed. Mr. Spinello said they would be imposed upon whoever received the transport services. Mr. Manendo asked if that was the current practice. Mr. Spinello said it was. Mr. Manendo asked if taxpayers paid money to the ambulance services. Mr. Spinello said they were paying for the “first responder” services, which now were not billed. If someone was extricated from a vehicle, for example, or had other emergency services performed at the scene, there was no charge for that currently, nor would there be under the bill as proposed. However, if transport services were rendered from the scene of an emergency to a hospital, a charge would be made; the proposed bill contemplated that the county could provide that service and charge for it. Mr. Manendo tried to clarify the current practice that the fire department did not bill the resident, however, if a private company transported the resident was billed. Mr. Spinello said that was correct. Mr. Manendo wondered if the taxpayers might feel like they were already paying for that service through property taxes.
Mr. McAllister responded that the city of Las Vegas Fire Department, for example, on a dual response did not charge the private citizen for the call. The charge was made by the private ambulance company. If LVFD responded and transported, a fee was charged to the recipient; but it was a reduced fee in comparison to the private ambulance company. The citizen would have to pay a fee either to the LVFD or to the private company. It was an attempt by the local fire departments to become more involved, and Mr. McAllister reported, they arrived on scene 60 to 65 percent of the time before private ambulance companies. LVFD had paramedics and people trained to the same levels as the private companies. He did not feel the citizens were being double-taxed because they were paying a fee to the private ambulance company anyway. Under the current situation, when they paid their taxes they were not paying for the ability to be transported by the fire department. Their taxes paid for the fire department to be there, the equipment, and the stations, but the cost of doing the business of transporting was not figured into the taxes. Mr. McAllister added that if LVFD responded to an automobile accident and there were no injuries and no transport, there was no bill. In Henderson, the fire department did 100 percent of the transports and billed for all of those services, above and beyond the property taxes. Mr. Manendo wondered if that should be on the ballot in Clark County as an advisory question, to see what the citizens thought about it. If Henderson was doing one thing, would Las Vegas want to do a partnership?
Mr. Spinello responded that it was something cities were currently doing within their jurisdictions. There were various pricing methodologies, even subscription services where people paid an annual fee to be part of an ambulance subscription so they would not be billed if an ambulance was called. In other words, he said, it seemed fairly typical for people to be charged for the transport service. The proposed legislation was the result of the county looking for the authority to do what cities in Nevada currently were doing.
Next to speak was Gary Milliken, representing American Medical Response (AMR), a private ambulance company in Las Vegas. He had three areas of concern. First, there should be more language in the bill giving some authority to the county commission to determine the extent of the transport that would be done by Clark County. Second, it should only apply to emergency situations; the language in that regard was vague. He did not think the bill was speaking of facility-to-facility contracting; however, when reading certain sections it seemed to mean any kind of transporting. Therefore, the language should be clear that it applied to emergency transport only. Third, regarding liability and accountability, under the county cap their liability would be $50,000 per person. For AMR, liability was $1 million per person and $3 million per incident. Accordingly, Mr. Milliken did not see why there should be a discrepancy between what AMR’s liability was for an injured patient compared to what the county’s liability would be for an injured patient. Additionally, he agreed with Mrs. Parnell that Section 1 was very confusing. Finally, he also found confusing the language “a private entity which provides transportation of such persons to a medical facility.”
Assemblywoman Smith said that perhaps adopting an ordinance or regulation that would define the emergency situation as well as the percentages, as had been done in the cities, would be a way to handle what was missing in the bill. Mr. Milliken agreed with that approach and felt it would clarify the situation for both the county and the independent ambulance companies.
Mr. Spinello said as long as the definition was broad he would be in support of that approach. He added the rates were currently set by ordinance. Also, he said that all of the previous testimony on what the city had done in terms of the regulation, percentage, and so on, had been done without the requirement of state law restricting it. It had been done based on what the city council determined was needed at the time. The county would like that same kind of authority. If the county would not get that same authority then Mr. Spinello would like to see the same restrictions placed on the cities.
Next to speak was Bill Bradley, representing the Nevada Trial Lawyers Association, who offered some background on Chapter 41.500 and why he was opposed to any expansion under subsection 5. He noted the concept of the “Good Samaritan Rule” had been around for some time. It was originally intended for some well-meaning citizen who arrived upon an emergency and who provided gratuitously, on a volunteer basis, emergency medical care, to have some sort of exception from the standard law of negligence. Unfortunately, with the increasing role of cities in providing emergency care, there was more concern that the liability of quasi-county agencies was diminishing. Consequently, as Subsections 1 through 4 of Section 7 indicated, there was less standard of negligence when the provider was acting gratuitously and as a volunteer.
Further, Mr. Bradley said in view of the charges accompanying emergency transports, he opposed the language in subsection 5 and believed it should go back to any person who served as a volunteer. Once there was an employment relationship the volunteer status was removed, and once there was a charge it was no longer gratuitous. It was a normal business relationship and in his opinion, there should be liability in the event of negligence.
Mr. Bradley said he agreed with Mr. Milliken and noted that in the Judiciary Committee they had been trying to change the cap on sovereign immunity but because of the problematic financial condition of the state at present, Mr. Bradley did not believe there would be any changes. Nevertheless, he said it seemed unfair that one agency had very limited liability and their competitor had much different liability. Accordingly, he was opposed to subsection 5 and if there was a desire to return to the original intent of the statute he would strike the words “who is employed.”
Assemblywoman Smith asked about the cities and volunteer agencies that were also bound by that $50,000 cap, “it opened a can of worms in that arena.” Mr. Bradley said it expanded it; however, any city, county, state, or university employee who was negligent had the benefit of a $50,000 cap, unless there were federal civil rights violations then the cap was waived. Mrs. Smith asked about a volunteer fire department that charged. Mr. Bradley said that under the top three sections they would have exposure; under subsection 5 their exposure would be limited, and that was the reason he was concerned now that volunteer organizations were starting to charge. He felt subsection 5 should be amended to maintain it as a volunteer organization and a nongratuitous charge, to go back to the original concept of the “Good Samaritan Rule.”
Assemblyman Manendo felt it was too bad that cap had not been increased. He asked if there had been discussion in the interim about the possibility that firefighters would be transporting. Mr. Bradley said the interim subcommittee was only dealing with the issue of trying to find the money. He commented that as a recipient of emergency services, there was no more reassuring sound than that of the ambulance arriving. He did not want to do anything to interfere with that, however, as everyone was finding the need to charge, he did not think a charge should go without responsibility. He reiterated that everyone on the interim subcommittee was struggling for a way to find money because there was universal acceptance of the need to increase the cap, but trying to find the funds on the state side was extremely difficult.
Vice Chairman McClain reminded the committee that they were not talking about liability caps; the issue was putting the county on the same level playing field as the city that was under the same liability caps. The question before the committee was whether or not counties could be authorized to do the same thing that cities were already authorized to do under their charter.
Mr. Bradley said that in subsection 5, Section 7, the role was being expanded to transporting. The issues surrounding transporting had always been reserved for volunteers and under gratuitous charges.
Chris Ferrari, representing Regional Emergency Medical Services Authority (REMSA), a private, not-for-profit deliverer of emergency services in Washoe County, introduced Jim Gubbels, vice president of REMSA, who would testify.
Mr. Gubbels expressed three concerns within the bill that he felt would impact the public safety perspective. He felt A.B. 488 would impact all in the state who were regulated under the state EMS section. Clark County had its own individual county EMS, which impacted the cities, but for the rest of the state the bill would impact everyone including those in Washoe County, which was regulated under that bill.
In Section 1, Mr. Gubbels also questioned the term “without limitation” under a fire fighting agency vehicle. If that vehicle was to transport patients, for patient safety he wanted to make sure it had the same requirements that any other ambulance in the state had. He was uncertain why that term would even be used. If the words “without limitation” were removed the rest of section would be acceptable.
Section 6, subsection 5, Mr. Gubbels said, limited a fire-fighting agency to have only one licensed person in the vehicle to provide care. That was a decrease in the standard of patient care for the rest of the services. As a licensed ambulance company, Mr. Gubbels said he was required to provide two licensed personnel to render care. He was uncertain why the standard should be lowered. Also, there was a requirement under subsection 2, that if there should be a volunteer agency that had difficulty in acquiring staff they could apply for a variance, and that had been done in the past in the state. Therefore, he did not want to lower the standard of care rendered by a fire fighting agency unless there was some extenuating circumstances requiring it.
In Section 7, subsection 5, Mr. Gubbels said volunteer firemen and volunteer ambulance personnel were needed and he did not want to do anything that would require stricter compliance for them. However, under that section, it waived liability for the volunteer if they transported a patient. Mr. Gubbels felt a paid agency should be required to provide coverage for liability, just as his company was, should they render harm during transportation. Again, he was uncertain why that language was included in that section. He thought it should be left alone and “transportation” not added under the volunteer section.
Chairman Koivisto suggested that the people who had a stake in the bill work together to clarify the language that raised questions and try to work them out. If they could get the information to Marla McDade Williams before the next meeting, April 11, or at the latest by April 16, the bill could be voted on at that time.
Jim Spinello, representing Clark County, said he would be happy to do that. He felt he could readily agree with the comments he had heard. On the liability issue, he wanted to make sure the sovereign immunity cap was preserved for the jurisdictions.
Chairman Koivisto closed the hearing on A.B. 488 and opened the hearing on A.B. 336.
Assembly Bill 336: Requires provision of certain information and assistance to certain adoptive parents, prospective adoptive parents and other persons involved in adoption of child. (BDR 11-1186)
Paula Winne, assistant to Speaker Emeritus Dini and Speaker Perkins, reported she was at a meeting with Speaker Dini and several constituents who had approached him in the interim to put forth an adoptive parents bill of rights. At that meeting the constituents read the bill and agreed it was not what they wanted. Therefore, three amendments were proposed (Exhibit D). Ms. Winne said Speaker Dini wanted to delete the bill in its entirety and replace it with the following amendments:
Ms. Winne announced some constituents were waiting to testify regarding their reasons for bringing the bill forward.
Edrie LaVoie, a resident of Lyon County, was the adoptive parent of a son and daughter. While serving an internship with the Human Service Program at the University of Phoenix, she studied the adoption issues in the Lyon County and felt there might be similar issues in other rural counties. She stated past legislation and the Division of Child and Family Services (DCFS) had made great strides in the process. The original proposal to DCFS was to establish an Adoptive Parents’ Bill of Rights, a document that would be reasonable to the division and beneficial to prospective adoptive parents. Through the bill draft process she discovered many of the points in the proposed bill of rights were already mandated in law. Moreover, because the adoptive and foster care worlds were sometimes interrelated, the original proposal included some foster care issues that complicated the intent and made the proposed amendments necessary. Mrs. LaVoie provided her written testimony (Exhibit E).
Expanding on what Ms. Winne stated earlier, the first amendment, requesting an expedited evaluation from DCFS, would enable adoptive parents with special- needs children to be aware sooner of their eligibility for financial assistance to help with medical costs incurred for treatment of those special needs.
The second amendment, for development of a resource booklet by DCFS, would provide a detailed listing of all subsidies, assistance, and services offered to adoptive families, including services to children with special needs. The DCFS would also consider including the Adoptive Parents’ Bill of Rights as a page within the book.
Finally, the third amendment would ease the stress of the long wait by prospective adoptive parents by having DCFS notify them when they were found suitable by DCFS standards, although that would not mean the adoption had been approved and there may be other proceedings still pending.
Assemblyman Joseph Dini, Jr., District 38, explained how his constituents asked him to develop a bill on the Adoptive Parents Bill of Rights and now, with the proposed amendments, he felt it would greatly improve the adoption process. He noted that the next speaker, Peggy Pauley, and others like her, had been instrumental in the passage of A.B. 158 of the Seventieth Session that made various changes in statutory procedures for protection and placement of children. He added that Ms. Pauley was now a CASA (Court Appointed Special Advocate) in Lyon County.
Peggy Pauley, an adoptive parent, showed pictures of her daughter Briana, now 6, whose adoption was just finalized in November 2000, and her daughter Heather, age 5, whose adoption was finalized in July 1999. Mrs. Pauley advised she was an adoptive mother, a foster mother, and a CASA. She thanked Mrs. LaVoie for her project that prompted the amendments, and Speaker Dini for his continued care and concern for the abused and neglected children in Nevada.
Mrs. Pauley explained how being adopted into a permanent home was the dream of most foster children. She expressed respect for the work done by the DCFS workers who strived to improve the system and make foster children’s dream come true. She applauded the many legislators who worked to make the needed changes and additions to the statutes to make sure abused and neglected children had a safe, happy, loving, and permanent home.
Mrs. Pauley urged approval and passage of the proposed amendments to A.B. 336. As a case in point to the necessity for the amendments, she reported waiting more than two years for her daughter Briana to be tested for fetal alcohol syndrome (FAS). She added that often in utero damage was not detected until as late as age six or seven and in the years before that the child could be quite normal and productive. Some parents who adopted a seemingly normal child suddenly found they had medical, behavioral, or learning problems and were faced with unplanned expenses to treat those problems. Sometimes the parents were so overwhelmed by the situation the children were returned to the system.
The second amendment, Mrs. Pauley said, was so important for adoptive families because very often they were not aware of the subsidies or services available to adoptive parents with special-needs children. Often, too, she said that some parents did not want to face the prospect of what having a special- needs child meant and they rejected the information or help that was given to them; many thought that their love for the child would overcome all obstacles. In situations where parents were informed and rejected help or services, Mrs. Pauley suggested DCFS might have the parents sign a waiver at the time the brochure was given out stating that help had been offered and declined.
Regarding the third amendment, Mrs. Pauley echoed the sentiments of Mrs. LaVoie in the necessity for receiving early notification by DCFS of prospective adoptive parents suitability.
Chairman Koivisto asked if the amendment regarding early evaluation and availability of subsidy would be retroactive. Mrs. Pauley said it was not retroactive; if that subsidy was not applied for at the time of adoption the parent could not apply later, even if they could prove the child had the problems at birth. If, however, the parents applied at the time of adoption and were turned down because the child had no apparent problems, they could re-apply for that subsidy if problems developed later.
Assemblywoman Parnell referred to Section 1, subsection 1 of the bill and said she liked that language because it provided more information than the amendment appeared to. She recalled the discussion the committee had recently regarding grandparents who were now raising their grandchildren. What they wanted was information about services for the children, which seemed to be exactly what Mrs. Pauley was looking for. Ms. Parnell felt the amendment language was “watered down” and also referenced a different chapter; Chapter 432, and she would like to do what was needed to make as much information as possible available. Mrs. Pauley agreed and said the original language was what Mrs. LaVoie had written in the Adoptive Parents’ Bill of Rights. She had not done the rewriting and she thought someone else could address that issue. Ms. Parnell supported having any and all information available in the brochure.
Chairman Koivisto asked for representatives of DCFS to address Ms. Parnell’s concerns, and also asked if anything could be done retroactively so that when something like that came up it could be handled properly.
Wanda Scott, Adoption Program Specialist, Division of Child and Family Services, reported that one of her responsibilities was to administer and monitor the adoption subsidy program. There was a provision to assist families who came back through the system after they had adopted special needs children from the state of Nevada. The federal law permitted families to come back to apply for assistance after the fact. They were allowed through an administrative or fair hearing process to have their situation reviewed to determine whether or not assistance could or should be provided for children who might be eligible for the federal subsidy program. Ms. Scott said that in the 1997 Session, with the help of an adoptive parent, they obtained a budgetary appropriation to provide financial, not medical, assistance to families who did need to come back through the system to ask for support and assistance. DCFS had been able to assist many families who had not been able to get medical or financial assistance with some level of service through Children’s Mental Health Services programs as well, whether or not they were approved for adoption subsidy.
Ms. Scott concurred with Mrs. Pauley that many disabilities or conditions were not apparent early on; it could be three or four or more years later when the affects of drugs, alcohol, abuse or neglect surfaced. She added they had made some limited effort to address those families’ needs in one way or another. DCFS had also been able to use Title IV-B, Federal Social Service Support dollars, to develop funding streams that would allow families who might not need Medicaid assistance but simply looking for information and referral about where the services were for those children. Further, if services were found, was there funding to help pay for them. She also agreed with Mrs. Pauley that having a brochure setting out those services would be very helpful.
Chairman Koivisto asked if adoptive parents, unaware of their child’s special needs until sometime after adoption, were able to come back to DCFS and get a subsidy. Ms. Scott said “yes.” Generally it was a situation where either the agency was not aware of the special needs, or the family, if they were aware, had resources at the time the child was adopted. Years later, however, those resources were no longer available and DCFS tended to hear from families who needed assistance. Mrs. Koivisto asked Ms. Scott to cite where that could be found in statute. Ms. Scott said it was not in statute but in the DCFS policy manual. There also was a federal site where a family who had been denied assistance could request a fair hearing. She reported that the few cases DCFS had that fell in that category, where it was clear the agency made a mistake either in not providing that information to a family or, if DCFS could not identify what the special needs of the child were, the division had made an effort to provide that assistance without families having an administrative hearing.
Elizabeth Breshears, Clinical Program Planner III, Child and Family Services Division, asked Ms. Parnell if her earlier question had been answered. Ms. Parnell said it had been answered but she did not want the bill simply voted out with the proposed amendment as she felt too much would be left out. Chairman Koivisto said other changes would be made as well to tighten it up and strengthen it.
Ms. Breshears advised the reason the amendment was moved to Chapter 127 was because when she met with Assemblyman Dini’s constituents the issue had been adoption, and Chapter 127 was the adoption chapter. Also, the wording in reference to Chapter 432 as the bill originally stated, referred to individuals who “apply for children.” She said the wording should have been “apply to become licensed foster parents” or “licensed adoptive parents.” The deputy attorney general for the division had pointed out the need for those changes. It was then determined a brochure that had been updated by involving adoptive parents would be sufficient in setting forth the information and services. Ms. Breshears assured the committee that A.B. 158 had been taken very seriously. She then displayed an award the division won in Fallon with foster parents and child welfare workers, and stated they saw A.B. 158 as a step forward.
Chairman Koivisto asked the committee’s wishes in regard to A.B. 336.
VICE CHAIRMAN MCCLAIN MOVED TO AMEND AND DO PASS
A.B. 336.
ASSEMBLYMAN MANENDO SECONDED THE MOTION.
Assemblywoman Parnell asked if the bill would be amended as presented by Speaker Dini or would it be strengthened like the language in the original bill. Chairman Koivisto said the language would be strengthened.
VICE CHAIRMAN MCCLAIN MOVED TO AMEND WITH SPEAKER DINI’S AMENDMENT, TO STRENGTHEN THE LANGUAGE AS PROVIDED IN THE ORIGINAL BILL, AND TO CLARIFY THE RETROACTIVE PROVISIONS AND DO PASS A.B. 336.
ASSEMBLYMAN MANENDO SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY WITH THOSE PRESENT.
ASSEMBLYWOMEN FREEMAN AND TIFFANY WERE ABSENT FOR THE VOTE.
Chairman Koivisto closed the hearing on A.B 336 and opened the hearing on A.B. 497.
Assembly Bill 497: Revises provisions relating to anatomical gifts. (BDR 40-1210)
Assemblywoman Dawn Gibbons, District 25, was accompanied by Attorney General Frankie Sue Del Papa, who had helped a great deal with the legislation and the issue of organ procurement and transplant. Mrs. Gibbons reported she had worked with the Attorney General and other legislators, and various stakeholders to develop the amendment (Exhibit F) to A.B. 497.
Assemblywoman Gibbons advised that some in the audience were people who had had transplants and others were still waiting for transplants. The bill, she said, was about making a gift of life to someone in need of an organ transplant and the bill would make that possible.
Attorney General Frankie Sue Del Papa expressed strong support for A.B. 497 and her strong commitment to help implement the legislation upon passage. She also expressed her appreciation to Dawn Gibbons for bringing the legislation forward, and to the Department of Motor Vehicles and Public Safety for their extraordinary cooperation for the worthwhile endeavor. She also thanked the recipients and others who appeared to share their stories. Nearly everyone knew of someone who was waiting for, or who was a recipient of an organ. The waiting was the hard part, she added. Ms. Del Papa related a story of a woman whose husband was killed and who made the heroic decision to donate his organs; as a result 60 people were given life or helped in some way.
Ms. Del Papa said the Bureau of Consumer Protection named in the amendment was the right place to administer the bill’s anatomical gift account and the donor education program it would support. A task force to make the bill’s goal a reality would begin there. It was hoped that over the next interim the bill’s sponsors would work with the task force to come up with a five-year plan that would have a continuing role for many different stakeholders.
Ms. Del Papa felt the Department of Motor Vehicles (DMV) was the best place to begin the education process and, for the small investment of time by DMV employees to hand out donor registry enrollment materials and the collection of a voluntary gift of $1 or more, the availability of transplantable organs would be significantly improved. Nevada had approximately 1.4 million licensed drivers. Out of that number, close to 300,000 have chosen to say “yes” to being a potential organ donor on their driver’s license. The passage of A.B. 497 would do more to improve the gift of life.
Ms. Del Papa said that Senator Rawson had expressed support for the bill and planned to talk about getting people to register, because it sent a message that the person was serious about being a donor and wanted to be updated on what was happening in the field of organ donations. Too often, she said, families were approached in emergency rooms and asked to donate, and that might have been the first time they heard of it. She added that Assemblywoman Merle Berman had commended Assemblywoman Gibbons for her work and the strength of her commitment. She said also that Assemblywoman Barbara Buckley had expressed support for the bill and wanted to share the following statistics: in 1999, the number of organs recovered was 5.8 thousand from those who had died and 4.7 thousand from those still living. That meant only 1 in 7 of the 70,000 people on the national waiting list got a chance at the gift of life. Those numbers were unacceptably low. Every day, according to the Living Bank, Houston, Texas, more than 12 people on the national waiting list died for lack of an organ. The only organ procurement organization based in Nevada was the Nevada Donor Network, in Las Vegas, that served two transplant hospitals, Sunrise and University Medical Center, which only performed kidney transplants. Nevada must rely upon organ procurement organizations that operated in Nevada and other states to meet the needs of Nevadans within the national system. Washoe County and the Carson City area hospitals contracted with an organ procurement organization in California and Elko contracted with one in Utah. Until Nevada was large enough to have its own full service transplant hospitals and procurement network it must make the best use of the existing system. A.B. 497 would greatly improve Nevada’s participation numbers in those larger groups.
Ms. Del Papa said that Assemblywoman Chris Giunchigliani, who had expressed support, offered some additional statistics: There were over 74,000 people waiting for an organ transplant in the country. Most people who received the gift of life were living productive lives more than five years after their transplant surgery.
In closing, Ms. Del Papa thanked all the legislators who supported the bill, some of whom would be speaking, and she encouraged everyone to “step up to the plate” and become part of the program.
Next to speak, Assemblyman Bob Beers, District 4, said that since the meeting started four people had added their names to the national transplant waiting list; it was about 1 every 14 minutes. He expressed support for A.B. 497 which he said was very important to insure that Nevadans had a fair opportunity of receiving the transplant organs they needed. As of February 2001, people on the waiting list needed 47,000 kidneys, 17,000 livers, 1,000 pancreases, 4,000 hearts, 3,700 lungs, and a number of combinations thereof.
Assemblyman Dennis Nolan, District 13, spoke in support of the bill. He related his first experience with transplants and donors was as a paramedic transporting the procurement teams from the airport to the hospital and back, and watching how fast they had to move when the jet was met at the airport. Those team members talked of the patients waiting for organs and how the opportunity for saving their lives would be lost if they were not back with the organ in the shortest possible time. That scenario occurred every day in Las Vegas, and frequently in northern Nevada as well. Mr. Nolan also reported the case of a 6‑year-old boy who was one of his hockey skaters who developed liver failure and was hospitalized. The boy was frequently flown to UCLA Medical Center to await a transplant but something happened each time and the liver was not available and he would be flown back, each time getting closer to dying. Finally, though, the family received a call that the liver was available he did receive the transplant. The boy was now 13 and doing very well. In closing, Mr. Nolan urged support for A.B. 497.
Assemblywoman Gibbons reported that Debbie Pinjuv received her liver transplant last session, the day that Assemblywoman Jan Evans’ bill was passed, in which Attorney General Del Papa and Mrs. Gibbons and Senator Rawson had asked Ms. Evans to include Nevadans first on organ transplants.
Next to speak was Debbie Pinjuv, who had last appeared before the committee in 1999, eight weeks before she received her liver transplant. She said she could not recall what she said at that time and she remembered not being able to see very well as she was failing very quickly. Her doctor had told her husband she would not survive if she did not receive her liver in two weeks. Three days later she received a call from Stanford that they had a liver for her. She said now, two years later, she was working, playing tennis, and feeling just fine.
Assemblyman Manendo told Mrs. Pinjuv the committee was glad she was here, that she looked wonderful, and not only was she playing tennis, she was playing politics.
Father Frank Murphy, the next speaker, said he had appeared before the committee two years earlier. He represented the Transplant Network and had been very active in the interfaith movement in the Reno-Sparks area, mostly in the education of the church ministers and the synagogue rabbis to inform them of the importance of having their congregations consider the donation of their organs for the preservation of life. He expressed support for the amendment brought forward by Assemblywoman Gibbons.
Father Murphy particularly supported the idea that the money that would be given would increase the educational programs. He believed there was a vast need for education on the need for transplants. As a theologian, he knew there were some believers and some churches that were opposed to transplants for religious reasons. He thought that should be respected and be dealt with in such a way as those congregations would be able to understand the reasons for making that organ donation. Father Murphy said one of the most important things in distributive justice was the respect of the donor; the wishes of the donor had to be respected. Often the family had not respected an individual’s desire to be an organ donor when that desire was put on his driver’s license. The addition of the name of the person being placed on the National Register of Donors, and by meeting the condition that the donor’s family be notified of such a decision, should eliminate the unjust, unfair decisions made by family members which were contrary to the wishes of the person who wanted to be a donor.
Next to speak was Assemblywoman Barbara Buckley, District 8, who expressed strong support of the very worthwhile bill. She said, too, that the previous witnesses and the statistics given in the testimony clearly showed the need for the bill. She commended Assemblywoman Gibbons and Attorney General Del Papa for bringing attention to the important area of organ donation.
Heidi Smith, who had also appeared before the committee in 1999, said she had been on the transplant waiting list since 1996. Since 1998 she had been at the top of the list where she remains today. One of the difficulties with waiting so long was that the body disintegrated around the problem. As the body continued to fail it was patched up until a donor could finally be found. She said she had been patched up so many times she felt like a “retread tire.” She noted that anyone could need a transplant at any time, and it was important to get people to understand that and get on the donor program.
Virginia Lewis, Deputy Director, Department of Motor Vehicles and Public Safety, reported the department was very pleased to be part of the program and expand their role in increasing the number of participants. The department asked their customers who came in for a driver’s license if they wanted to participate in the program, now they would be able to give them a brochure and an enrollment form. That would be an educational service to the public and would improve what the department was doing.
Yvonne Sylva, Administrator, State Health Division, echoed other speakers in thanking Assemblywoman Gibbons for introducing the legislation, the Attorney General’s Office for supporting it, and every person who testified before the committee. She said it was a “bill about living.”
Chairman Koivisto thanked Mrs. Gibbons for a good presentation. She then noted that Larry Matheis, President, Nevada State Medical Association, had signed in support of A.B. 497, although he was not present to testify. Attorney General Del Papa remarked that Mr. Matheis had participated in one of the work sessions to develop the bill and amendments and was an integral part of the process.
Next to speak was Linda Bergstrom, a recipient of a liver transplant three years earlier. She reported being on the list for only six months but had been diagnosed with the disease in 1993. She quickly deteriorated, having esophageal bleeding, stints, and kidney problems due to the liver failing. She felt blessed to have received her liver in November 1997 and has felt very well ever since. Had it not been for the transplant she would not have seen two children graduate from college or been present for the birth of her grandson. She urged passage of A.B. 497.
James Besson reported he became ill in June 1996. He was told he had one week to live when he received a liver transplant in June 1998. He now played golf, went fishing, and worked, even though retired. He said one of the major objections he had heard from others about being an organ donor was the expense involved in keeping someone on life support. He asked that something be done to inform the public that was not necessarily true.
Chairman Koivisto responded that hopefully that would be part of the education portion of the legislation.
Assemblywoman Gibbons announced she would show a video of supporters for the bill as a backdrop to the testimony. She was aided by attaché, Dawn Lee.
Ellen Beebee reported being on the waiting list for about eight years. She had primary billiary cirrhosis, a slow progressing disease. Her main problem was the itching involved, which she likened to poison ivy, day and night. She had been on every drug without relief. Her insurance coverage permitted her to go to Cal Pacific, however, because she could not get a liver transplant there, her doctor wanted her to go to the Mayo Clinic in Phoenix.
Assemblywoman Smith thanked the participants who worked on the bill and all those who came to testify. She said someone close to her, in fact the person responsible for her being an assemblywoman, was waiting for a kidney. It was an issue very important to her and it seemed that education and public awareness was the key to the program’s success. She noted many reports and stories about people making a choice, and her own daughter, age 14, had announced she wanted to be a donor.
Assemblyman Manendo said he had made the choice to be an organ donor and was glad to see the DMV take on more responsibility in educating the public in that area. He commended all the people and agencies that had worked on the bill. He suggested making those brochures available in the student services areas of colleges. The education was so necessary, he believed.
Chairman Koivisto asked the committee their wishes.
ASSEMBLYWOMAN LESLIE MOVED TO AMEND AND DO PASS
A.B. 497.
ASSEMBLYMAN MANENDO SECONDED THE MOTION.
Marla McDade Williams, Committee Policy Analyst, brought to the committee’s attention some discussions before the meeting regarding subsection (d) of subsection 5 on page 3 of the proposed amendment, rather than saying that “the department shall periodically provide an organ and tissue donor registry with information from the department’s records as to the names, addresses, and births of donors contained in its records,” it would say something to the effect that “the department shall adopt procedures to periodically provide an organ and tissue donor registry with information from the department’s records.”
THE MOTION CARRIED UNANIMOUSLY BY THOSE PRESENT.
ASSEMBLYWOMEN FREEMAN AND TIFFANY WERE ABSENT
FOR THE VOTE.
Assemblywoman Gibbons acknowledged and thanked the committee for its support through the entire process.
With nothing further before the committee, Chairman Koivisto adjourned the meeting at 3:31 p.m.
RESPECTFULLY SUBMITTED:
Darlene Rubin
Committee Secretary
APPROVED BY:
Assemblywoman Ellen Koivisto, Chairman
DATE: