MINUTES OF THE

SENATE Committee on Commerce and Labor

 

Seventy-First Session

May 9, 2001

 

 

The Senate Committee on Commerce and Laborwas called to order by Chairman Randolph J. Townsend, at 7:00 a.m., on Wednesday, May 9, 2001, in Room 2135 of the Legislative Building, Carson City, Nevada.  Exhibit A is the Agenda.  Exhibit B is the Attendance Roster.  All exhibits are available and on file at the Research Library of the Legislative Counsel Bureau.

 

COMMITTEE MEMBERS PRESENT:

 

Senator Randolph J. Townsend, Chairman

Senator Ann O’Connell, Vice Chairman

Senator Dean A. Rhoads

Senator Mark Amodei

Senator Raymond C. Shaffer

Senator Michael A. (Mike) Schneider

Senator Maggie Carlton

 

GUEST LEGISLATORS PRESENT:

 

Assemblywoman Christina R. Giunchigliani, Clark County Assembly District             No. 9

Assemblyman David E. Humke, Washoe County Assembly District No. 26

Assemblyman John J. Lee, Clark County Assembly District No. 3

 

STAFF MEMBERS PRESENT:

 

Scott Young, Committee Policy Analyst

Gayle Nadeau, Committee Secretary

 

OTHERS PRESENT:

 

Fred L. Hillerby, Lobbyist, Nevada Optometric Association

Jeanette K. Belz, Lobbyist, Nevada Ophthalmological Society

Karen Yates, Sierra Nevada Reporters

Louis Ling, General Counsel, State Board of Pharmacy

John P. Sande III, Lobbyist, Merck Medco Managed Care

Mary Lau, Lobbyist, Retail Association of Nevada

Ron Bingaman, Director of Pharmacy Administration and Compliance,

            Safeway, Incorporated

James L. Wadhams, Lobbyist, Anthem Blue Cross & Blue Shield

Mary Manna, Executive Secretary/Office Manager, State Board of             Cosmetology

Dr. Sae E. Lee, Board Member, State Board of Oriental Medicine

Maureen Lamerdin, Concerned Citizen

Diane Crowne, Concerned Citizen

Tom R. Skancke, Lobbyist, Nevada Society of Oriental Medicine

Joan McSweeney, Concerned Citizen

Herman “Herb” Roth, Concerned Citizen

Shauna Swainston Haipola, Concerned Citizen

Judge Jack Lehman, Department 10, Eighth Judicial District Court, Clark   County

Judge Peter I. Breen, Department 7, Second Judicial District Court, Washoe             County

 

Senator Townsend opened the hearing on A.B. 491.

 

ASSEMBLY BILL 491:  Authorizes optometrist to collaborate with ophthalmologist under certain conditions. (BDR 54-1280)

 

Assemblyman David E. Humke, Washoe County Assembly District No. 26:

I really have little to say except that Mr. Fred Hillerby is carrying this bill, essentially, for some folks.  I think they have worked out some compromises in the Assembly, and we hope you will like it.

 

Fred L. Hillerby, Lobbyist, Nevada Optometric Association:

The bill initially started out with an intent to develop opportunities for business relationships.  It was sponsored by one of my individual clients, Eye Care Associates of Northern Nevada.  Unfortunately, the bill was drafted a little too narrowly for the pleasure of the Assembly.  After further consideration, the client decided that probably it had been.  We had been approached by Jeanette K. Belz, Lobbyist, Nevada Ophthalmological Society, to represent ophthalmology this session about an amendment to that bill.

 

Assembly Bill (A.B.) 491 is a bill to address something that occurs almost exclusively between optometry and ophthalmology.  Although the bill drafters did not like the word “comanagement,” we show “collaborate.”  For a number of years, starting in the 1980s, optometry and ophthalmology have, in fact, comanaged.  It started off with cataracts, for which the optometrist would make the initial diagnosis and refer the patient to an ophthalmologist for the surgery, and the ophthalmologist referred the patient back to the optometrist to do follow-up care.  Medicare recognized this practice and provided for payment to both practitioners.  The division of fees, if you will, should be related to services provided by each, which is typically about 80/20 percent.  It is a flat fee for cataract surgery.  The ophthalmologist gets 80 percent of that fee, and the optometrist gets 20 percent.  Medicaid has been reimbursing on that basis since the 1980s.  With some of the new laser surgery, we see a similar practice. 

 

Basically, A.B. 491 addresses patient protection, ensuring the patient is aware there will be a comanagement or collaborative arrangement and understands the roles each of these practitioners will perform, giving the patient choices.  If patients want to stay with the ophthalmologist once they have had the surgery, they can do that.  We have a statement that is signed by the patient, witnessed, and placed in the patient’s file in the optometrist’s office in which they acknowledge what is going on.  Also, part of that statement indicates the practitioners are licensed by different licensing boards.

 

Jeanette K. Belz, Lobbyist, Nevada Ophthalmological Society:

Mr. Hillerby described the process perfectly.  That is exactly what happened.  The only thing I would like to add is that the written documentation the patient would sign would also be kept in the ophthalmologist’s records.

 

Senator Townsend closed the hearing on A.B. 491.

 

Senator Townsend opened the hearing on A.B. 622.

 

ASSEMBLY BILL 622:  Makes various changes to provisions governing practice             of court reporting. (BDR 54-533)

 

Karen Yates, Sierra Nevada Reporters:

I am the immediate past president of the Nevada Court Reporters’ Association.  This is not our bill, but I am here to express the association’s support for the bill.  We believe the Certified Court Reporters’ Board of Nevada needs to remain strong, and there has not been a fee increase for quite some time.  The increased fees are supported by our membership, and the jurisdiction over agency owners, as well as individual court reporters, is important to ensure the quality of the court reporting profession in this state.

 

Senator O'Connell:

Ms. Yates, whose bill is this?

 

Ms. Yates:

It is the certified court reporters’ licensing board’s bill.  I had expected to see someone either at the table with me or in southern Nevada; I do not see them.

 

Senator Townsend:

The amendment process by the Assembly reduced all the original fees, I noticed, from $250 to $100, $300 to $150, et cetera.

 

Ms. Yates:

Yes, we were delighted with that, actually.  The initial fees were quite high, but we had understood them to be a cap, and a cap that would not be reached for a number of years.  Although we did not have anything in writing from the licensing board guaranteeing us how much it would go up at first, we were pleased that one of our membership had successfully lobbied for this amendment.  And it passed on the Assembly side, so those amendments do have our support.

 

Senator Townsend:

How long does it take to get trained as a court reporter?

 

Ms. Yates:

It varies, but anywhere from 2 to 4 or 5 years.  It is a lengthy process.  It is hard schooling.  It is boring, but the job is great.

 

Senator Townsend:

Well, I have a high respect for what you do.

 

Senator Townsend closed the hearing on A.B. 622.

 

Senator Townsend opened the hearing on A.B. 415.

 

ASSEMBLY BILL 415:  Revises provisions relating to pharmacy. (BDR 54-104)

 

Assemblyman John J. Lee, Clark County Assembly District No. 3:

I am introducing A.B. 415.  It is enabling legislation to do two important things.  It is to allow the prescribing practitioner to use all available technology to transmit their prescriptions to pharmacies, and to allow Nevada’s pharmacy students to begin their internships as soon as they are enrolled.  I became interested in the “e-Prescribing” issue through my sister who is a pharmaceutical technician in a retail pharmacy in Las Vegas.  She made me aware of just how dangerous some physician’s handwriting is when the prescriptions are received by the pharmacies that interpret it and read it.  When I looked into it, I found that Nevada’s present status would not allow for use of almost all “e-prescribing” devices.  A.B. 415 will allow “e-prescribing” using all possible technologies.  The State Board of Pharmacy will be directed to create regulations to address the confidentiality, security, and other issues relating to “e-prescribing.”  With A.B. 415, doctors will be able to use computers to generate their prescriptions, thus assuring an easier-to-read and a safer prescription.

 

In A.B. 415, section 1 states as new language the general proposition allowing the use of electronic and computer devices to transmit prescription data to pharmacies.  Section 2 amends Nevada Revised Statutes (NRS) 639.0745 to require the board to create regulations to ensure the security and confidentiality of transmission of the data between the practitioner and the pharmacy, the practitioner and the patient’s insurer, and the pharmacy and the patient’s insurer.  Section 2 also adds language regarding the security and authenticity of the practitioner’s identity.

 

Section 3 amends NRS 639.137 to allow Nevada’s pharmacy students at the Nevada College of Pharmacy to begin their internship upon their enrollment in the school.  The State Board of Pharmacy will create regulations ensuring that the pharmacy students are allowed to work only up to their level of schooling.  Section 4 amends NRS to allow prescriptions to be electronically transmitted.  Section 5 amends to remove from the State Board of Pharmacy the ability to issue private reprimands.  This language is also contained in                    Senate Bill (S.B.) 315 and will be heard in the Senate Committee on Commerce and Labor. 

 

SENATE BILL 315:  Makes various changes to provisions concerning             administration of Nevada occupational safety and health act.                  (BDR 53‑577)

Section 6 of A.B. 415 amends NRS to allow prescriptions for controlled substances to be transmitted electronically if federal law allows this in the future.

 

I have no heartburn on section 7, although I would like section 7 to ride on its own.  If it looks as if section 7 is going to cause the demise of this bill, I would surely like to pull it out, but I am entertaining it in this bill at this moment.

 

Louis Ling, General Counsel, State Board of Pharmacy:

We have been working with Assemblyman Lee and are gratified to see somebody in “e-prescribing.”  This is the very cutting edge of pharmacy technology, and the way this bill is drafted it is going to allow the board the flexibility today and into the future to be able to address whatever technology comes up that is going to be helpful to Nevada’s pharmacies and pharmacists.  The State Board of Pharmacy, of course, is strongly in support of this bill.  The board was in support of section 7 in its original form and is in support of section 7, which is the uniform prescription benefit card language, as it is now amended.  There are, basically, just two very simple reasons.  One is there is an Arthur Andersen LLC (an accounting/auditing/consulting firm) study which shows pharmacies are now spending up to 20 percent of their time every day dealing with insurance issues.

 

This seems to be a very simple first step towards alleviating some of that time pressure, particularly in an era right now where we are living with a shortage of pharmacists.  Anything we can do to loosen up some time in that pharmacy and allow pharmacists to do their jobs, rather than adjusting insurance concerns, would be very useful to the pharmacy and pharmacists.

 

Additionally, as I was driving up here this morning, I thought how interesting this bill is.  We actually have on one end of the bill the highest of high tech, and we are trying to encourage the use of computers in any way possible.          The other side is a 40-year-old technology, a little plastic card.  And, we are arguing about what should, could, or ought to be on a little plastic card.  It seems pretty simple to me.  What ought to be on there is what is necessary to process an insurance claim.  So the intent behind this bill is to loosen up some time for the pharmacist and to allow that consumer, who is standing on the other side of that counter, to have what he or she expects, which is that their prescription will be paid for and the information necessary to pay that claim will be on the card so the pharmacist does not have to spend half an hour trying to find that information.  And, maybe, not be able to process the claim, anyway.

 

John P. Sande III, Lobbyist, Merck Medco Managed Care:

I am here on behalf of Merck Medco Managed Care and, primarily, section 7, which I understand was amended into A.B. 415 on the Assembly side.  We are supportive of it from the standpoint that any identification card will comply with the requirements of the National Council for Prescription Drug Programs.  I will probably be submitting some very technical proposed amendments to the sponsor of the bill, Assemblyman Lee.  It is mainly verbiage to make sure the language does comply with those requirements.  I will provide that in writing today.

 

Mary Lau, Lobbyist, Retail Association of Nevada:

This bill was presented, originally, by the State Board of Pharmacy, because of its concerns about the prescription drugs, having to get claims paid, and making sure that information is available to pharmacists.  We did work through several work sessions on the bill and had agreements on language.

 

Ron Bingaman, Director of Pharmacy Administration and Compliance, Safeway, Incorporated:

From an industry standpoint, I would like support section 7.  As stated earlier, due to the Arthur Andersen study that now details that pharmacists spend approximately 20 percent of their time trying to resolve billing issues for managed care prescriptions.  To give you some other national perspective on this, currently there is a shortage of approximately 7,000 pharmacists nationally.  And this is expected to increase at the rate of about 5.5 to            6 percent a year.  In 1999, 2.87 billion prescriptions were filled.  That is expected to increase by 40 percent by 2004 to approximately 4 billion prescriptions.  It could go even higher depending on what the national Medicare program generates.

 

So, it is essential from a board’s perspective, to ensure patient care in this state, that all the pharmacist’s time is used most efficiently.  And, that is in the area of patient care, counseling the patients on drugs or their particular health state.  We, as an industry, fully support this bill to ensure, as Mr. Ling stated, that when a prescription comes in and a prescription card is presented, all the information required by the insurance company is on that card to quickly and efficiently process that claim.

James L. Wadhams, Lobbyist, Anthem Blue Cross & Blue Shield:

My amendment is rather simple and, unfortunately, it is going to be like a stick in the spokes of this wheel going down the road, but I think it is important nonetheless.  We would request the deletion of sections 7 and 8, for several reasons.  First of all, the information they are requesting will not fit on the card, a very simple physical problem.  As we move towards the technology of microchips, perhaps some of it could be imbedded in the card, which would contain the entire policy.

 

Secondly, from a jurisdictional standpoint, the Division of Insurance, as this committee is well aware, is required to make sure that insurance benefit cards and policies are readable and can be processed, if that is the appropriate word.  So, we would object to this section as not being within the physical limitations of the size we are talking about.  We appreciate the difficulty, but I think that has to be accommodated through a regulation process, rather than legislation that might prove to be impractical.

 

Assemblywoman Christine R. Giunchigliani, Clark County Assembly District No. 9:

I serve on the Assembly Committee on Commerce and Labor, and on A.B. 415 there was a separate bill that dealt with section 7, which we voted against.  What happened then is Assemblyman Lee’s bill was still available, and Speaker Emeritus Dini asked if he could put that amendment on A.B. 415.  There was some concern, but Assemblyman Lee said he would allow the amendment, but he did not want that to jeopardize the legislation.

 

Senator Townsend closed the hearing on A.B. 415.

 

Senator Townsend opened the hearing on A.B. 551.

 

ASSEMBLY BILL 551:  Revises provisions relating to practice of cosmetology.             (BDR 54-1133)

 

Assemblywoman Giunchigliani:

Assembly Bill 551 was requested by a large spa owner businessman in the southern part of the state.  He worked with Mary Manna, the Executive Secretary of the State Board of Cosmetology, in this amendment.  Both parties agreed to the bill as amended, and there should not be any opposition to it.  It simply allows for demonstrators of cosmetology to perform certain services, but they still have to sit for the exams and prove they understand the health and safety factors.

 

The other key change is in section 2, which clarifies that food and beverages should not be in the area where they are actually practicing.  It allows the larger spas that are getting into far greater areas, other than just doing hair and nails, to have the ability to move walls, or to look at their plans, because there were problems with how people from the cosmetology board were inspecting the plans versus how the codes were set up.  So, they worked this out with the State Board of Cosmetology.

 

Senator O'Connell:

Why is this needed after all of the time we spent in 1995 or 1993 on this issue?

 

Assemblywoman Giunchigliani:

I believe the effort was regarding apprenticeships.

 

Senator O'Connell:

No.  The issue happened to be in department stores.

 

Assemblywoman Giunchigliani:

From what I understand this allows the option within their premises, after they have been licensed.  Apparently it is allowed in department stores, but they did not have the ability to do it within the spas.  An apprenticeship program was in the original bill and the cosmetology board argued against that language, so they deleted that and put in the language for demonstrators of cosmetology.  My understanding is it does not conflict with anything we currently have, it just clarifies what skills are required, what tests they have to take, and the fact that they have to be licensed within the establishment.

 

Senator Townsend:

The issue was a very complex one.  It was about department stores, where they have a substantial amount of cosmetics and where various individuals, trained by the cosmetic companies, will put makeup on one eye and allow the customer to take a look at it.  That does not require a license.  Now, the spas I have seen, which are substantial establishments, are pretty exciting places.  They also represent different kinds of cosmetic companies for both hair and face products.  The issue is whether it is any different from what we are allowing the department store person to do.  We do not want the State Board of Cosmetology saying, “Well, you are a licensed cosmetology establishment; therefore, you do not get the same benefits that a department store person gets.”  That is not right, because then you are going to drive all those people that work for this person over to the other establishment.

 

Assemblywoman Giunchigliani:

My understanding, Senator, on line 5, section 2, is the reason they put this in is to very narrowly define it for those only at a cosmetological establishment for the sole purpose of selling cosmetics.  I think it narrowed it to that so it did not affect what we did with the department store individuals.  Then they created the criteria for them to be able to work within that establishment.  So, again, they were not in conflict even with the individuals who can do the facials, et cetera.

 

Senator Townsend:

The issue became whether we licensed aestheticians, which is a separate licensing issue.  What we do not want to do is create a separate category because you happen to work on one side of the street doing the same thing that you do on the other side of the street.  I do not want this spa person disadvantaged.

 

Assemblywoman Giunchigliani:

Held to a different standard.

 

Senator Townsend:

Exactly.  Now, if they are only going to represent a single client, and that is all they are going to do in that cosmetological establishment, then they should be able to play by the same rules as the person who works in the department store.  We tried to be consistent on the committee.  What has been the problem on section 5 regarding food and beverage sales?

 

Assemblywoman Giunchigliani:

The State Board of Cosmetology approves plans.  As they have gotten into larger and larger establishments, they were denying building plans that have met building safety codes, but they did not like the wall and the coffee over there.  It infringed on the businessperson’s plan design.  It is my understanding section 5 fixes that so the board still has reviews, but they do not change people’s building plans that have been approved by the building and safety departments.

 

Senator Townsend:

Ms. Manna, could you give us some insight into the first issue regarding individuals referred to as demonstrators of cosmetics?

 

Mary Manna, Executive Secretary/Office Manager, State Board of Cosmetology:

The demonstrators Senator O'Connell mentioned from several years ago are the employees behind retail counters, which were exempted from our jurisdiction.  The exemption put into our law that, as long as they were in a retail establishment, acting as a retail person and simply selling cosmetics, they were not required to be licensed.  We are addressing persons within a licensed salon, meaning in our jurisdictional areas.  According to our current statutes, we license cosmetological establishments, and we certainly inspect those premises for health and safety.  We lost the licensing authority for a demonstrator in retail establishments.  As was mentioned, within a beauty salon establishment, only licensed people can work.

 

Joe Lamarca’s (one of the owners of the Euphoria Salons in Las Vegas) request was to have a person in the salon to simply do makeup.  We discussed the issue of licensed aestheticians being within those facilities, and he mentioned the aestheticians certainly are authorized by their scope of practice to do makeup, but in fact, want to focus in the skin care area, and are not really willing or able to do the makeup because of their busy schedules.  We are concerned about the health and safety of the public, and we sat down with Mr. Lamarca and agreed there would be a short health and safety sanitation class given to these persons. They, in turn, would take a short exam relative to health and safety issues.  We would merely issue them a demonstrator license focused strictly to the salon establishment.

 

What we are seeing as being different, and we are open to suggestions, is the fact that, if we have these individuals schooled and educated in health and safety and subject to inspection as are the rest of the licensees within our salon, we are keeping the consumer aware. If there were any problems with health and safety issues, they would have some contention with us as far as making us aware of any problems.

 

 

 

 

Senator Townsend:

Is the person referenced as a demonstrator of cosmetics an employee of the salon or a separate provider?  Does that person represent the cosmetic company?

 

Assemblywoman Giunchigliani:

I believe they are closer to being employees, but they are simply applying makeup from various companies.

 

Senator Townsend:

Okay.  I just want to make sure we do not have the same people doing the same thing, but with different standards.  I do not know whether the person who works in a department store is employed by the department store on behalf of that company.  However, what it looks like is now we are going to have an examination for a license as a demonstrator of cosmetics who might be doing the same thing that we are exempting just because the person works in a licensed establishment.  I just want to make sure we do not have two different standards.

 

Assemblywoman Giunchigliani:

We may be having two different standards because of the action the Legislature took in 1993.  I think the Legislature made the decision that the cosmetology board had jurisdiction solely over cosmetological establishments.  Therefore, they exempted the demonstrators since they were employees of department stores, and they were applying the makeup at those stores.  I think this, because the State Board of Cosmetology has authority and jurisdiction of these establishments, allows licenses for these individuals in that specific case.

 

Senator Townsend:

There are salons I am familiar with that are usually in larger malls, and seem to be more retail establishments for the sale of products.  In the back they might have two, three, or four chairs at which they take customers on an appointment or walk-in basis, but the vast majority of what they do appears to be retail sales.  They still come under the term cosmetological establishment, as I understand it.  If you have one person in the business doing that, then the business becomes a cosmetological establishment, no matter how big the retail store is.

 

 

Ms. Manna:

You are absolutely correct, and, possibly, I can help to clarify.  For example, there are a number of salons, as you mention, are primarily for retail sales, but have just the one person.  Our law reads that, if there is a licensed cosmetologist or aesthetician providing services, they are required to have what we refer to as a cosmetological establishment license.  As Assemblywoman Giunchigliani indicated, that is the difference we were trying to clarify between a retail counter and a salon.

 

The other issue, of course, is that in the retail establishments, the exemption the Legislature put through for us dictates that a retail store, such as Macy’s or Dillards, is just that, a retail store.  The difference is that our jurisdiction is in a cosmetological establishment, day spa, beauty salon, or whatever the term may be.  We require licenses of all those under our jurisdiction.  We are trying to ensure this demonstrator, who may not be formidably trained at the minimum is aware of the health and safety issues regarding disposable applicators.

 

Another comment would be that this person could possibly be doing a complete makeup, possibly for a type of a wedding service, whereas that would not be done in a normal retail store.

 

Senator Townsend:

The establishment we are speaking of is a rather large business, at least the one I have seen.  What happens if the business only has licensed cosmetologists and aestheticians for the backside of the business and then they sublease to a product person to put out all of these products?  Does that person who might be more like a retail employee then have to have one of these licenses?

 

Ms. Manna:

As Assemblywoman Giunchigliani made reference to, we ask for a floor plan when someone is opening a salon in a retail area.  We do that to make sure we know where our jurisdiction lies.  If you opened a retail store and you decided that you wanted two aestheticians to be able to operate, our regulations allow that there can be two contiguous businesses under one roof.  For example, if it were 1000 square feet, and 400 square feet were the esthetic area and 600 were retail space, we would request our jurisdictional area be somewhat separated, meaning partitioned off in some way.  This way the consumer would be aware which area is a licensed salon, and if there were any health or safety issues we would have jurisdiction over that area.  If it were a separate retail area, we would then be able to say that is simply a retail area over which we have no jurisdiction.

 

Another concern is that we wanted the health and safety issues to be the main concern for the licensing.

 

Senator Townsend:

Is food becoming more prevalent in larger spas, day spa activities?

 

Ms. Manna:

We are seeing, particularly in the last 3 to 5 years, an onset of a lot of different areas in the cosmetological establishments.  Certainly, there was a period of time during which complimentary coffee and juices were offered.  We are seeing a big movement to coffee bars and, in some cases, restaurants.  Our only concern, again, is with health and safety, and that the food area be somewhat separated from where the other services are provided.  In most of the jurisdictions, the various health departments have certain requirements on separation, as well.

 

Senator Townsend closed the hearing on A.B. 551.

 

Senator Townsend opened the hearing on A.B. 302.

 

ASSEMBLY BILL 302:  Makes various changes relating to practice of Oriental             medicine. (BDR 54-1083)

 

Assemblywoman Giunchigliani:

Assembly Bill 302 genesis is that I was asked by the State Board of Oriental Medicine to introduce legislation to begin to open up the process.  Over about the last 3 months, we have been dealing with the issue of making sure we maintain standards, but also making sure other individuals now qualified through other accreditation schools, and so forth, would have access to being licensed within the state.  It is always difficult to move boards into being more open, as you have witnessed with the dental board, but this one has been far more reasonable.

 

We have handed out an amendment (Exhibit C) because the doctors pointed out that we created three tiers, and we really need only two tiers.  For persons from a foreign country, we still want the standard of the licensed, accredited school and a bachelor of arts (B.A.) degree. We are recommending only two tiers to license someone.  We have eliminated all the other types of names, and persons will be licensed as a doctor of Oriental medicine, rather than doctor of acupuncture we used to have in the statute.  There is only one individual, I believe, still in the state who will reapply to become a doctor of Oriental medicine, because that person was titled a doctor of acupuncture.

 

Fees stayed the same.  The amendment deals with page 4, subsection 3.  It parallels subsections 1 and 2.  Additionally, we wanted to include a time period in the bill to grandfather in individuals who already sat for the national exam, so they would not have to take the exam again.

 

I would also point out the State Board of Oriental Medicine will utilize a national exam, rather than doing its own exams.  In addition they will still do a state practical examination.  That is the termination the Legal Division, Legislative Counsel Bureau, used.  I would point out the practical exam means it could be demonstration, or it could be written questions making sure they know a science background.  It could be an oral exam, or any combination thereof, but a practical exam means a state exam.  The State Board of Oriental Medicine will contract with a company to write the questions, because some of the arguments were the tests were not as valid as we would have liked.  We wanted to set aside that debate for the future and make sure it was not done by the Board members, but by an independent party.

 

We have set up a standard that, I think, will allow other individuals to now be able to be licensed as practicing Doctors of Oriental Medicine, rather than being a barrier.  With that said, a new issue has just arisen, even though this issue has been out here for over 3 months, and that is from the drug courts.  While I have a great deal of respect for Judge Jack Lehman, Department 10, (Eighth Judicial District Court, Clark County), it has been found through the drug court there are acupuncturists doing adjunct treatment, and they have not been licensed.  I think they want to bring an amendment in, which I have not seen; they did not give it to me as a sponsor of the legislation.

 

I urge this committee not to accept that amendment, because there is a complaint filed with the State Board of Oriental Medicine by an individual who was referred by the drug court.  I do not want us getting caught up in any kind of legal issues.  I think the State Board of Oriental Medicine can more properly handle that discussion and debate through regulation.

There is nothing in writing that the State Board of Oriental Medicine ever granted any certificate or license to these individuals to practice acupuncture.  So, unfortunately, they brought it to our attention that they have not been licensed and they have been functioning illegally within the state.  A court does not have jurisdiction to grant licenses for a body that is controlled by another board.  I hope that will be dealt with through regulation at a State Board of Oriental Medicine meeting, rather than our trying to put something in statute that permanently codifies something that may change over the years.

 

Dr. Sae E. Lee, Board Member, Nevada State Board of Oriental Medicine:

I am here, today, as a representative and vice president of the State Board of Oriental Medicine to support A.B. 302.  Senators, you know our state established laws regarding oriental medicine in 1973, and we understand the statute has not changed much since then.  As a board member, having heard some complaining, we understand we had to enact significant changes through the licensing requirement.

 

You already heard through your colleague, Assemblywoman Giunchigliani, regarding A.B. 302.  Let me, just briefly, pinpoint what this bill stands for.  The current statute requirements to be a licensed practitioner are 4 years of ordinary school, 6 years of experience practicing oriental medicine, passing a board examination, and, of course, a background check and fingerprints.  The board issues the license of doctor of Oriental medicine and, also, the current statute has the license of doctor of acupuncture, which requires 1 year less education compared to the doctor of Oriental medicine.  Otherwise it is the same requirement.  Also, there is an assistant in acupuncture license for people who have all the requirements accomplished but lack the 6 years experience.       The Board also issues the license of acupuncture assistant.

 

We heard a lot of concern about the 6 years of experience, regarding some qualifications for licensure of native Nevadans who have to go out of state, and things like that.  This bill removes the 6 years of experience, and we recognize the national exam.  Also, of course, we have a State Board of Oriental Medicine exam, in addition to the national exam, such as the practical exam that Assemblywoman Giunchigliani explained to you.  This includes some basic science, clinical questioning and laws.  The most important part of A.B. 302, is the removal of the 6 years of experience requirement that we have had because, in the current time, we only require a 3- to 4-year education requirement.  However, the situation has changed and A.B. 302 requires a bachelor’s degree or 4 years equivalent experience.  So, A.B. 302 does not just remove the 6 years experience requirement.  The reason this new bill is asking those people who even graduate from 4 years of Oriental medicine school to have a bachelor’s degree is to remove the 6 years experience requirement.  Also, we are helping those people who went to Oriental medical school and did not get experience and never had a chance to practice.  So, we give those people a chance to either have 4 years experience or a bachelor’s degree.

 

As a board member and as a doctor of Oriental medicine for 24 years in the state of Nevada, I am very proud that we have a good system here, not just acupuncturist assistants as in some other states.  This bill will maintain those licensees to have a basic principle of college education, as well as a professional school of 4 years of Oriental medical school.

 

Maureen Lamerdin, Concerned Citizen:

I have my masters of science in Oriental medicine.  I am also a diplomat of acupuncture.  I am a very strong supporter for reform of Oriental medicine in Nevada.  This is my home.  This is where my family is, and I would certainly like to come back home.  As it is right now, it is a closed market.  I would like to see it open back up.  The newest amendments of A.B. 302 would establish and maintain that closed market.  If you could go to the green tab in my handout (Exhibit D) , I have laid out the amendments I would like to see changed.  Regarding section 6, the first problem with requiring a bachelor’s degree is there is no bachelor’s degree in Oriental medicine offered in the United States.  That is why the colleges for Oriental medicine have a long master’s program; it is anywhere from 3 to 4 years that you go to school after achieving your 60 undergraduate credits, compared to the normal 1 to 2 years of a master’s degree.

 

That is why there is a longer program.  You cannot go out and get a bachelor’s degree in Oriental medicine.  By having this requirement in the bill, it would exclude over 90 percent of the people graduating from colleges right now.  Someone like myself would have to go back to school for 2 years to get a bachelor’s degree in accounting, or something completely different from what I have just studied for 4 years.

 

Senator Townsend:

Looking at the bill, it speaks to a bachelor’s degree from an accredited college or university in the United States.  That is your first level.  Then it says, “Successfully completed a 4-year program of study, or its equivalent, in Oriental medicine at a school or college of Oriental medicine that is approved by the board.”  Is it my understanding you are saying there are none of those in this country?

 

Ms. Lamerdin:

That has a bachelor’s degree.

 

Senator Townsend:

No, I did not say that.  If you will look at section 6, subsection 1, paragraph (b), “successfully completed a 4-year program of study or its equivalent in Oriental medicine at a school or college of Oriental medicine that is approved by the board.”  Are there any 4-year programs of study or their equivalents in Oriental medicine in this country?

 

Diane Crowne, Concerned Citizen:

I am a nationally certified acupuncturist, and I am representing myself.  There are 46 colleges in the United States graduating acupuncturists and Oriental medicine practitioners.  The national organization, which certifies those individuals, has, over the last 15 or 20 years, certified 13,000 individuals.  Ten thousand of them have been certified in acupuncture.  Three thousand of them have been certified in acupuncture and herbal medicine.  Consequently, the largest portion of people coming out of these colleges in the United States are acupuncturists.  Those programs are 3 years, not 4 years.  The fourth year is considered a specialty of herbal medicine.  Some of these colleges are accredited, and some are not.  I believe the number, 6, has been tossed around in our discussions, which are accredited colleges out of the 46.

 

Senator Townsend:

OK.  I am going to restate my question.

 

Ms. Crowne, Concerned Citizen:

I am sorry.  I missed it completely.

 

Senator Townsend:

If you will look at the bill, section 6, subsection 1, paragraph (b), it says that after you have completed a bachelor’s from a college in the United States, you also must have “successfully completed a 4-year program of study, or its equivalent, in Oriental medicine at a school or college of Oriental medicine that is approved by the board.”  Are there any 4-year programs in the United States, currently, that meet that standard?

 

Ms. Crowne:

Yes, there are.

 

Senator Townsend:

OK.  That is all I wanted.  Is there more than one?

 

Ms. Lamerdin:

I would like to add to that, if I could.  There are 6 out of the 46 schools in the United States that require a bachelor’s degree, but they are not 4-year programs.

 

Senator Townsend:

Okay, you are reading way too much into these questions.  According to this bill, you have to have a bachelor’s degree, period.  Put that aside.  Do not confuse it with anything else.  Now a person has to complete a 4-year program of study, or its equivalent, in Oriental medicine at a school or college of Oriental medicine that is approved by the board.  Are there any 4-year programs of study, or their equivalent, in Oriental medicine, currently, in the United States?

 

Ms. Lamerdin:

Yes, as Ms. Crowne said, there is.  However, the number is an extremely small percentage compared to the 3-year schools.

 

Senator Townsend:

I have heard there is 1, there are 2, and there are 3.  How many 4-year programs are there?

 

Ms. Lamerdin:

I could not give you that exact number.  I am sorry.

 

Senator Townsend:

How many are 3-year programs?

 

Ms. Crowne:

It is an option for students.  All of those colleges present a 3-year program and a 4-year program.

Senator Townsend:

And, “all of those” are how many?

 

Ms. Lamerdin:

Forty-six accredited colleges that are accredited by the accreditation commission for Oriental medicine.

 

Ms. Crowne:

Only 6 are accredited; there are 46 total.

 

Senator Townsend:

Somewhere between 46 and 0, since we do not seem to have an answer to that.

 

Ms. Lamerdin:

When you attend these acupuncture schools, most of them give you an option to complete a criterion of around 2400 hours in 3 years, or you can complete it in 8 years.  This is why the amount of years here is so arbitrary, because a program is about 2400 hours and it goes up from there.

 

Senator Townsend:

So, would it be fair to the sponsor to say, 4 years is X number of hours and how long it takes to complete it is X?

 

Assemblywoman Giunchigliani:

That might be a reasonable approach, and I do have the booklet upstairs in my office from the national accreditation which breaks that out.  The issue of the 4‑year program, or its equivalent, was to recognize that a doctor of Oriental medicine also has the “herbology” training.  That way they have the higher standard.  But the equivalent language was recognizing if a person did not choose to have the herbology specialty, then the State Board of Oriental Medicine could set the lower standard through its equivalency so that person could license those who choose just to be the acupuncturist, but they could still be called a doctor of acupuncture.

 

Senator Townsend:

I am not arguing with the board or these ladies.  I am just trying to understand this.  Now that you have met that, and you have passed this investigation of the background and personal history, then you must pass an examination required by the board, which is 634A.120 of the Nevada Revised Statutes.  Now you have to have been licensed to practice Oriental medicine in another state; lawfully practiced in another state for at least 4 years; passed a background investigation; passed an examination required by chapter 634A of NRS; or you can have a bachelor’s degree.  And, you are going to pull that out.  Is that correct?  Is that your proposed amendment?

 

Assemblywoman Giunchigliani:

Yes, Mr. Chairman, the proposed amendment from the State Board of Oriental Medicine pointed out we needed only 2 standards.  On subsection 2, line 49 on page 3, they are recommending to make it the same standard as we would require for anybody, currently the B.A. degree or its equivalent, who had lawfully practiced Oriental medicine in another state for at least 4 years, and then passes the state exam.  That would allow a person, from a foreign country or not, to have the B.A. standard, because that is the same standard required for the other.  But, then, they wanted to let people in who had been licensed and practiced in another state or foreign country.  So, that is why they recommended, after we passed the bill in the Assembly, to eliminate subsection 3 as duplicative and just make the B.A. degree standard the same for either party.

 

Senator Townsend:

Your concern is on line 42, which Assemblywoman Giunchigliani is saying they can change, based on its equivalent if you did not want the herbology year.  Your concern is that it should not say a 1-year program; there needs to be some agreement on how many hours are going to be part of this program.

 

Ms. Lamerdin:

Correct.

 

Senator Townsend:

Okay.

 

Senator O'Connell:

You have your bachelor’s degree from an accredited college.  It does not talk about an accredited college with the Oriental medicine, and it allows the board to determine if the credentials you have are going to be accepted.  Is there a reason for that?  I ask this question, specifically, because I have received some of those many complaints that have been talked about where people feel they have gone to school in good faith, they have gotten their credentials, and yet, they cannot get past the board.

 

Assemblywoman Giunchigliani:

Absolutely, that is part of the point of why this legislation came forward.  On line 42, page 3 of the bill there is an accreditation standard and the board is going to be adopting those schools accredited nationally, through the national organization.  That is why it is approved by the board; they have to adopt those.  The intent they would accept those accredited schools, and then create the list.  Because that has been the problem, only 3 or 4 of the schools in the United States have been accredited by the board.

 

Senator O'Connell:

Is there a problem with saying, “accredited,” in the bill?

 

Assemblywoman Giunchigliani:

No.  We did choose, though, not to mention the name for the national exam or the accreditation council, because both of those are self-funded organizations that happen to exist now.  At least the Assembly side said, “We really should not be naming a specific group at this time.”  The intent was to make sure it was a nationally recognized test so that if another group came in, or another national exam came in, the board had the flexibility of which one to adopt.  I do not think there would be a problem with adding the term “accredited.”

 

Senator O'Connell:

Okay, just so they could not turn people down if, indeed, they had received their education at an accredited school.

 

Assemblywoman Giunchigliani:

We could probably add that someplace on line 43 or 44, if that would be your wish.

 

Tom R. Skancke, Lobbyist, Nevada Society of Oriental Medical:

If you could go to line 47 on page 3 of A.B. 302, to go back to your previous question, there should be an “or” at the end of that line.  You either do number 1 or number 2; you do not have to do both of those.

 

 

 

Senator Townsend:

And, Assemblywoman Giunchigliani’s point, you only wanted two tiers.  In essence there was only one tier, but it was so high, I am not sure there would have been anybody who would pass it.

 

Assemblywoman Giunchigliani:

And after all these years, I can never remember when a semicolon means “or” or when it means “and.”

 

Scott Young, Committee Policy Analyst:

Actually, Mr. Chairman, in that particular instance, the semicolon at the end of line 47 functions as an “or,” because you have subsection 1 starting on line 39 and subsection 2 on line 48, and then subsection 3 begins on the next page at line 6.  So, in effect, at least by drafting standards, there is an “or” at the end of line 47 on page 3.

 

Senator Townsend:

Since Assemblywoman Giunchigliani is removing subsection 3 and, therefore, the “or” would be dropped, the “or” has to go back.

 

Mr. Young:

Then you would put an “or” back in at the end of line 47.

 

Senator Townsend:

Mr. Skancke, thanks for catching that, because I was trying to figure out who in the world could pass this new standard.

 

Senator O'Connell:

I think one of the ladies in front of you, Mr. Chairman, that is one of her issues that she would have been bringing up.

 

Ms. Lamerdin:

Yes, that is correct.  Thank you for clearing that up.

 

Senator Townsend:

This section, then, would now have an “or” on line 47 at the end of NRS 634A.120.  Then on page 4, you would remove subsection 3,             lines 6 through 14.  Is that your recommendation, Assemblywoman Giunchigliani?

Assemblywoman Giunchigliani:

Yes.  And, then on line 49, add the term as Senator O'Connell said, “has completed an accredited 4-year program of study, or its equivalent, in Oriental medicine,” so, it is the same standard for both.

 

Senator Townsend:

Okay, so, we have it twice.

 

Mr. Young:

Mr. Chairman, if I could ask for clarification, Assemblywoman Giunchigliani referenced line 49.  Could I ask her to give me the page and the line again?

 

Assemblywoman Giunchigliani:

I apologize, Mr. Chairman.  On page 3, we would have to insert on line 49, “successfully complete an accredited 4-year program of study, or its equivalent, in Oriental medicine in a school of Oriental medicine that is approved by the board.”  Then you would not need “(a)” any longer.  They will have lawfully practiced Oriental medicine in another state or foreign country.  We combine the two, because lawfully means licensed.  So, it was redundant to some extent.

 

Senator Townsend:

I was trying to figure out the reason to have both.  So, now the goal is to have two standards.

 

Ms. Lamerdin:

If you could go to the yellow tab in the booklet (Exhibit D) that I passed out, I am trying to show you other boards in Nevada and how they have met their criteria.  This is the chiropractic board of Nevada; they use a process very similar to the acupuncture process of going through school and obtaining a degree to be able to practice.  According to the Chiropractic Physician’s Board of Nevada, people need 60 undergraduate credits prior to attending a chiropractic college, which is about 4 years.  They do not have a bachelor’s degree in chiropractic medicine in the universities, so that is why a person must go to a specialized college.  I just want to point this out to you that the Chiropractic Physician’s Board of Nevada does not require a bachelor’s degree, because there is no bachelor’s degree offered at the university level.  A person must go to a specialized college to get the specialized training for the 4 years.  By having the bachelor’s degree in this bill, it would limit thousands of people graduating from schools today.

Senator Townsend:

I am confused, so please clear this up.  The proposal, which is on line 40, says, “a bachelor’s degree,” period.  It does not say what you have to have it in, or where you have to get it.

 

Ms. Lamerdin:

It says a bachelor’s degree under subsection 1(a), but it also requires under subsection 1, paragraph (b), a 4-year program, or its equivalent, which means 8 years of education.  I point this out to you with the chiropractic, because they have to have 60 undergraduate credits.  Through the acupuncture colleges, a person must also have 60 undergraduate credits and then go through a specialized program of 3 to 4 years.  This is very similar to the chiropractic standard.

 

Senator Townsend:

So, you are asking not to have a bachelor-level degree, but to copy the chiropractic.  Is that what you are saying?

 

Ms. Lamerdin:

I am not, necessarily, saying copy them; I am, basically, saying I think we should look into other boards with similar educational processes.

 

Senator Townsend:

I am not sure you want to, because most of them require a bachelor’s degree.  The vast majority of them, whether or not they are health care, require a 4-year degree.

 

Ms. Lamerdin:

Right, I understand that.  I guess my problem is there is no bachelor’s degree out there for Oriental medicine or acupuncture, and there is no bachelor’s degree out there for studying chiropractic.  So, that is how I related those two.

 

Senator Townsend:

So, what are you saying?

 

Ms. Lamerdin:

I am requesting 60 undergraduate credits, which is the standard for 40 schools out there with acupuncture and Oriental medicine.  If the bachelor’s degree stays in the bill, it will impact over 90 percent of the people graduating from an Oriental medical college today.  They will not be able to come to Nevada and practice.  That is my main concern with the bachelor’s degree.

 

Senator Townsend:

And you think that is a new level of challenge?

 

Ms. Lamerdin:

I think it is very challenging.  If I could bring my life back 4 years and be able to obtain a bachelor’s degree in Oriental medicine, and then go on to a master’s program, I would love to.  Unfortunately, that was not offered to me at the time, and it is still not offered.  In Nevada there are no schools of acupuncture, so I would actually have to leave the state to even study Oriental medicine while going to school for 2 more years for a bachelor’s degree.  So, in essence, I would not be able to practice Oriental medicine, or even study it, for the next 2 years, and then come back to Nevada and be treating patients with no practice for 2 years of Oriental medicine.

 

Senator Townsend:

Please look at the current requirements on page 3, section 6, line 30, subsection 1, not what is proposed, “Has successfully completed a course of study of 4 years in Oriental medicine, or 3 years in acupuncture at any college or school approved by the board which is located in any country, territory, province, state, or has qualifications considered equivalent by the board.”  Subsection 2, “Has practiced Oriental medicine, including acupuncture and herbal medicine for 6 years;” and subsection 3, “Passes the examination of the board.”  Do you meet those current requirements?

 

Ms. Lamerdin:

No, I do not.  I think these amendments have come a long way; however, I can go to 37 other states, right now, and practice Oriental medicine with my credentials.  However, Nevada is my home, and I can tell you there are many others like me who want to come home, and to their families, and cannot because of the current requirements and if the bachelor’s degree was in there, as well.

 

Senator Townsend:

Let me see here on the second section.  If you had to go away, as you are saying everybody does because we do not have a collegiate training level available in Nevada, according to what is being proposed, all you would have to do is get your credential, get licensed in another state, practice for 4 years, pass this background check and then pass the state test.

 

Ms. Lamerdin:

Correct.

 

Senator Townsend:

Have you been practicing for 4 years somewhere else?

 

Ms. Lamerdin:

I have not been practicing.  I graduated just recently, and I interned for 3½ years while I was going through school.  I practiced in a hospital, an oncology clinic, and a nursing clinic.  I have practiced acupuncture and Oriental medicine, but not in another state, licensed.

 

Senator Townsend:

OK.  We are at tab yellow.  Where do you want us to go now?

 

Ms. Lamerdin:

My other issues with this was subsection 1, paragraph (d) with the “or,” but that seems to have been cleared up.  So, that seems to be all.

 

Senator Townsend:

You have three red tabs in your handout.  Are we supposed to be reviewing those?

 

Ms. Lamerdin:

These are most of the amendments to A.B. 302.  Basically, I wanted to point out the amendments with Assemblywoman Giunchigliani’s bill were showing us we could be able to practice in the state without 4 years of experience.  And, when I read the newest amendments, this was not the case, because there was not an “or” in there, I did not read it correctly.  So, I just wanted to bring that to your attention, but it seems as if it has been cleared up.

 

Ms. Crowne:

I am a nationally certified acupuncturist.  I am really gratified by this process.  One of the things that has impressed me is that Assemblywoman Giunchigliani and those proponents on A.B. 302 have made a genuinely fine attempt to meet each of us as our complaints arise.  And they have done that this morning, as in clarifying the matter of “or,” because I, also, am recently graduated, and I do not have that 4 years experience to offer. 

 

So, many of my issues have been taken care of.  Perhaps there is one more small matter that has to do with the 3- or 4-year program of study.  I do appreciate the value of the word “equivalent” in there, and I just wanted to point out that I have an application in process as an assistant acupuncturist, which is a rather confusing status to be in right now; especially, since, at the February 26 meeting of the State Board of Oriental Medicine, not only was my application for an assistant acupuncturist approved, but my school, as well, was approved at that time.  I wanted to point out that it was a 3-year graduate program, not a 4-year graduate program.  So, there is an inconsistency here in the decision of the board to approve my school and my background as a 3-year program, master’s level program, and then in the law to make it mandatory for there to have been a 4-year program.

 

Senator Townsend:

The current law says 4 years in Oriental medicine at any college or school approved by the board, or 3 years in acupuncture at a college or school approved by the board, or as qualifications considered equivalent by the board.  So, the board, obviously, looked at your application and said, “That is equivalent.”

 

Ms. Crowne:

I qualify as an assistant acupuncturist.  What it would take for me is to be assured that the word “equivalent” would include the 3-year program from which I am a graduate.

 

Senator Townsend:

It was testified to that the 3-year program is for Oriental medicine or for acupuncture.  And then there is a 1-year program for herbology.  Is that correct?

 

Ms. Crowne:

That is correct.

 

Senator Townsend:

Well, perhaps we can be clearer on what a 4-year program is, because some people choose to become acupuncturists, but do not choose to do herbology.

Ms. Crowne:

Exactly.  Many more people choose to be acupuncturists, rather than to include herbal medicine.

 

Senator Townsend:

Perhaps, Mr. Skancke and Assemblywoman Giunchigliani, in working with the board, we can clarify what 4 years means, so everybody understands what it is.  If you want an Oriental medicine degree, it is a 4-year degree; if you want an acupuncture degree, it is a 3-year degree; if you want to be a herbologist, whatever that is; et cetera.  We do not, necessarily, like to get this technical because things change.  That is why we usually have regulations of the board.  So, we try to keep some flexibility in our regulations to deal with change.  There may be new things that Oriental medical doctors find that they need in their regulations.  So, we have to have a certain amount of flexibility.  That is why the term “equivalency” has to be there, because there needs to be an accommodation in case somebody comes in and says, “Look at what happened when I was at XYZ College.”  And, they are allowed to accommodate for that.

 

Ms. Crowne:

The direction of this legislation concerns me just a little bit, because it leaves so many acupuncturists such as myself behind.  If we are going to insist all individuals who apply for licenses in the state become doctors, and that is the underlying issue with the 4-year degree with the necessity for herbal training, my concern is the word “doctor” is misleading.  Perhaps it is even deceptive to the public because there is no doctorate program in Oriental medicine in the United States.

 

At our April hearing it was also pointed out that, in foreign countries, the doctorate degree is rare.  A second interesting cultural point is that in China, where I am familiar, the word “daifu” is applied to individuals who work in the healthcare industry, who are in hospitals, and who are held in great esteem and honor in that country.  And, they do not, necessarily, back that term of respect up with a doctoral degree.  They are health care workers who are referred to as doctor.  So, here in Nevada we are one of only 2 states in the union who refer to individuals who practice acupuncture as doctors.

 

The prior tradition in the state was to differentiate between doctors of Oriental medicine and doctors of acupuncture, but it was always “doctors of.”  This is not indicative of the majority of the practitioners in the United States.  There are licensed practitioners in the area of acupuncture and there are licensed practitioners in the area of acupuncture plus herbs.  That is the way it stands in the United States.  So, to me, not wanting to be disrespectful of our pioneers in this field in Nevada, that they should be called “doctors” is highly commendable because in their own countries, that is exactly what they are, and with their current patients that is exactly what they are.

 

But, for people coming out of school now, we are practitioners of acupuncture and Oriental medicine.  We will not draw your blood and make an analysis, or we will not examine your breasts to find out if you have lumps in them.  This is not an appropriate designation for people who place needles and work with the energetics of the body.  So, it is a large issue, and I am saying that it is misleading, if not deceptive to call all of us doctors; but, then again, call me Buddha, if you like, I just want to be able to practice acupuncture.  I am not going to be “hard-nosed” about this designation; I just want it to go on the record that it is misleading to our patients and people who seek acupuncture.

 

Senator O'Connell:

I need to ask Ms. Lamerdin and Ms. Crowne if this testimony was given on the Assembly side, as well?

 

Ms. Crowne:

Yes, I believe so.  At the hearing and the arguments for the opposing bill?  Yes, they were.

 

Senator O'Connell:

Was that the bill as we see it today, not the original bill that your testimony was given on?

 

Ms. Crowne:

I am sorry, I was making reference to A.B. 339, which did not successfully come out of committee in the Assembly.  That was a bill that supported what many of us believed to be the reality in the United States.  To have a separate designation for acupuncturist and a separate designation for acupuncturist licensed with herbs is the reality in most of the states.  There are, I believe, 40 states that license acupuncturists.  Only 2 states prefer to call all practitioners of Oriental medicine doctors.  Those are Florida and Nevada.

 

 

ASSEMBLY BILL 339:  Revises provisions relating to practice of Oriental             medicine. (BDR 54-295)

 

Joan McSweeney, Concerned Citizen:

Senator O'Connell, you are in receipt of many of my e-mails that I sent to you prior to the session beginning with my concern about lowering the artificial barriers that were in place and then maintaining high standards.  I am here on behalf of our daughter who will be graduating from ACTCM (American College of Traditional Chinese Medicine) in San Francisco.  Her college with her master’s program has been referred to on many occasions as the Harvard of Oriental medicine training in the United States.  And, what you have in place right now is a stellar piece of legislation.  There are no artificial barriers in that legislation.  It maintains high standards, and high standards that our state of Nevada could be very proud of.

 

Senator O'Connell:

All right, you are telling us that you do not agree with the dialogue that has gone on for about the last half hour to 45 minutes?

 

Ms. McSweeney:

I do not.  My problem is, we do not have the handout.  If you would like to go through it piece by piece, I would like to answer each one as in support of the bill.

 

Senator O'Connell:

The major concern and questioning has been on section 6, specifically from lines 39 through line 49.

 

Ms. McSweeney:

This is what our initial e-mail to you was about before this legislation started.  We wanted high standards; we wanted to lower the artificial barriers.  It is an option these practitioners decide, prior to education, whether they go for          a 2‑, 3-, or 4-year program.  The high standard is to have the baccalaureate, and that is going to be the wave of the future, as Senator Townsend was mentioning.  Things change, drastically.  As the professionalism is going to be acknowledged, more programs are going to demand that baccalaureate degree before a person is accepted in the master’s program.  So, we have it in place now with A.B. 302.

 

Herman “Herb” Roth, Concerned Citizen:

You have probably received, along with all the committee members, any number of e-mails from my wife, myself, and our daughter Sharon.  In addressing A.B. 302, I am in full support of it in several respects.  The first respect is that they have done away with the most grievous, restrictive article in the present statute, and that is the 6-year requirement.  Our daughter is now an assistant in acupuncture in the state of Nevada.  She has been licensed, as such, but she cannot practice here.  She is in practice as a licensed acupuncturist in California, for approximately 4 years.  She cannot come here as an assistant because, under the present statute, she would have to work for a Doctor of Oriental medicine.

 

There are 17 or 18 doctors of Oriental medicine in the southern Nevada area.  She sent letters to each of them asking for a possible position as an assistant in acupuncture so she could fulfill the 6 years.  She received the courtesy of only 2 replies; both said there is not enough business to warrant hiring her.  She would have to spend an additional couple of years in California as a licensed acupuncturist doing exactly the same things that doctors of Oriental medicine do in Nevada.  The present statute, with the 6-year requirement that, thankfully, has been done away with, would allow any young person to be a waiter, a go‑go dancer, or anything else for 6 years, just pay their $500 every year to continually be licensed as an Assistant in Acupuncture, and pay $3,000 and not be able to practice in Nevada.

 

In addressing one more item, and that would be with Ms. Lamerdin, as I read it and I may be in error, when Ms. Lamerdin takes the test, administered by the State Board of Oriental Medicine, on June 30 and July 1 of this year, should she pass the test, she could then be given the title of “assistant in acupuncture,” same as our daughter, not being able to practice here, of course, but at least be given the title.  Then, according to section 16 of A.B. 302, she would be grandfathered in and automatically become a doctor of Oriental medicine on October 1^st of this year, without having a bachelor’s degree.  Basically, I just want to express my full support for A.B. 302 as written.

 

Mr. Skancke:

We have come a long way on this bill since I became involved in the early part of February.  At that juncture, there were two bills in the Assembly.  A lot of Assemblyman Beers’ requests in his bill, A.B. 339, were wrapped into         A.B. 302.  We have come a long way.  There are probably additional things we need to work on, and we will be more than happy to sit down with these individuals and talk to them about amendments.

 

Shauna Swainston Haipola, Concerned Citizen:

I have one comment on the bill.  Assemblywoman Giunchigliani has already clarified regarding section 15, where the dates are restrictive.  The test has been psychometrically the same since 1983.  So, to narrow the test dates to this small range is a little bit restrictive.  There is also an exhibit that is being handed out to you now (Exhibit E.  Original is on file in the Research Library.) which is a background on acupuncture.  It describes what the bordering states do, and defines what all the national organizations are.  So, it should be your encyclopedia for any questions that should come up.

 

Senator Townsend:

A question I have for Assemblywoman Giunchigliani is whether there was testimony with regard to section 16 on how many people would qualify and who would be granted a new doctorate under this?

 

Assemblywoman Giunchigliani:

Truthfully, no.  I know there is a couple that were qualified as assistant acupuncturists; they would then qualify when it goes into effect as doctors of Oriental medicine.  I believe Dr. Peter Lok, Jr., who is a doctor of acupuncture, would have to apply and then he would be moved to the doctor of Oriental medicine.  I think there are about 4 or 5 individuals that would be affected upon passage of this bill.

 

Senator Townsend:

I am just curious on how many persons that would add.

 

Assemblywoman Giunchigliani:

I do not think there was any testimony on the number.

 

Senator Townsend:

And, I do not know how many people actually use the services of acupuncturists.

 

Assemblywoman Giunchigliani:

There was discussion that Nevada has approximately 1.2 million people now, and we have 17 practicing in southern Nevada and 1 in northern Nevada.  There are 31 that are licensed, but they are not all choosing to practice.  I believe some will come into Nevada, and we wanted to open the door without losing the standards.  Also, part of it is recognizing that this is a changing process in the United States.  The contemporary trend is to look more at the bachelor’s degree and the higher standards, because right now a person can go out of high school at age 18, go into an accredited school of Oriental medicine, and in    2½ to 3 years, graduate and be licensed.

 

There was concern those individuals may not have had the science background and the other areas needed.  That is why we were trying to find the proper balance without losing the standard, but making sure the doctors were opening the door to others to be able to be licensed in the state of Nevada.  I think we are pretty close.

 

Judge Jack Lehman, Department 10, Eighth Judicial District Court, Clark County:

We started the first drug court in Nevada in October of 1992.  We strongly support this legislation.  We think it is very good, and we have no objections to it other than as it affects the drug court.  I want to clear up some things that have been said by Assemblywoman Giunchigliani and Mr. Skancke.

 

We became aware of this bill only 3 days before it was due to be voted upon in the Assembly, otherwise we would have all been up to testify and ask of the Assembly what we are asking of you.  At that time, Assemblywoman Giunchigliani spoke to David Gibson, who is the Deputy Public Defender assigned to the drug court.  Mr. Gibson made her aware we had some problems with this bill, and asked for exclusion for the drug courts.  She said, “Well, it is a little late to be asking to change this thing right now.  I propose to you, just let this thing go through here and then we can deal with this when it gets over to the Senate.”  I think Assemblywoman Giunchigliani would verify that occurred, and Mr. Gibson is here and will verify that occurred.

 

In addition, Mr. Gibson gave Mr. Skancke a copy of our proposed amendment (Exhibit F) 3 days ago.  So, it is not something that has been dropped on everyone at the last minute, but we would have been here sooner had we known about this.  And, let me suggest this, too, the people who work in drug courts are not acupuncturists.  Mr. John Marr (with Clark County and Washoe County Drug courts) is here, and we very carefully went to the Nevada Oriental Medical Association in 1991 to make sure we “crossed all the t’s and dotted all the i’s.”  I admit to you we should have, perhaps, gone to the State Board of Oriental Medicine, but I do not think Mr. Marr was aware of it.  But, we did work very closely with Dr. Lok, and Dr. Lok helped us set this thing up just the way we have it.  He has spoken to us, as recently as yesterday saying, “You know, there is no reason why you cannot continue to function the way you have for 8.5 years.”  That is how long we have been functioning.

 

The people who are certified, auricular needlers, work in drug courts and are very important.  And, I will explain to you why.  You may have gotten the       e-mail that Mr. Marr sent to Senator O'Connell.  He explains how important this one little process is.  We are not asking for any great relief or change for what the acupuncturists are doing.  I met with Dr. Duk Joon Lee, whom I admire enormously and whose son, incidentally, is a deputy district attorney and who has on two occasions sat in as the deputy district attorney in drug court.  As late as Monday, we were trying to get together something that would allow us to continue to function the way we have been.  However, it was awfully late in the game, so we will continue to try and satisfy them, but we do not want to change what we have been doing.

 

Assemblywoman Giunchigliani was concerned that an amendment we proposed would permanently codify something.  I suggested an amendment to Dr. Lee on Monday, and he could not agree to it because he had not yet talked to the other members of the board.  They want to help the drug court.  They want to keep it going; they think it is fine.  But, he said there is going to be a lot of new people coming in here in order to apply for the licenses when this bill passes, as it should.  He said he felt they would be able to meet the needs of the drug court.  He then said, “How many people are you treating a day?”  We pointed out we were treating 150 people a day by putting needles in their ears and this is one protocol out of the vast number of things acupuncturists do.  That is all we do.  And, all of the people that put 5 needles in each addict’s ear at the Choices Unlimited clinic in Las Vegas have been trained by the NADA, National Acupuncture Detoxification Association. 

 

That is a recognized national firm; these are not totally unlicensed or uncertified people.  They are certified.  What we are doing to the addicts that we have been treating very successfully, as you all know, is the equivalent of what a person in a dentist’s office does who has been trained to put cotton swabs in the patient’s mouth.  It is one little procedure.  We are not asking that these people be recognized as acupuncturists.  They are not.  Dr. Lok insisted on a couple of things when all of this got started.

 

I would like to review what I feel is very important.  If we cannot get our amendment in, this bill, in its current form, will take a major component from both the Clark County and Washoe County drug courts.  We have seven drug courts in Las Vegas, in Clark County.  There are three or four in Reno.  Judge Breen can discuss that with you.  The drug court has been providing, both in Reno and Las Vegas, a very specific protocol of auricular needling to all of our participants since 1992.  All of the technicians providing this service have been specifically trained to perform only this procedure, which was established by the National Acupuncture Detoxification Association under the direction of medical doctor Michael Smith, who had been performing this procedure on methadone addicts going back to 1978.  He assisted in setting up the original program, both in the Florida program, which was set up in 1988, and in the Las Vegas program, which was set up in 1992.  He is an acupuncturist in addition to being a psychiatrist and a medical doctor.

 

In 1991 and 1992, several meetings were held with Dr. Lok, Dr. Damon Yang and several members of the Nevada Oriental Medical Association.  These people gave us permission to provide this service as an exemption to the existing law, subject to two conditions.  Number one, we were not to call, or advertise, what we do as acupuncture.  We never have.  And, number two, we needed to hire a licensed acupuncturist selected by the board to work for us part time, and monitor that we did not practice outside the scope of the single protocol.  Since that time, the drug court has called the procedure auricular needling, as agreed by the Nevada Oriental Medical Association, and has employed Dr. Miu-Ying Tong as a part-time acupuncturist.  Dr. Tong was referred to us by Dr. Lok.

 

We have been up front and honest in this relationship for the last 9 years, not only with Dr. Lok, but also, with Dr. Lee who acknowledges they were fully aware of what we have been doing for 8.5 years.

 

A recent independent study that was funded by the United States Justice Department and performed by the Crime and Justice Institute, studied the Clark County Drug Court and specifically measured the efficiency of this protocol that I am talking about, this one little protocol.  We set up two control groups, one that got the auricular needling and one that did not, and they functioned for a year.  Although we do not have the exact figures yet, we have been advised by Dr. John S. Goldkamp (President of the Criminal Justice Research Institute, Tempe University, Philadelphia, Pennsylvania), who headed up the study, that those people who got the auricular needling detoxed nearly 30 percent faster than those who did not get the auricular needling.  Those receiving the auricular needling went 30 percent longer before their first relapse and had more than a 30 percent higher program retention rate than the non-auricular needling track.

 

It seems to me this program helps all the acupuncturists.  Here is one of their little protocols that are making a 30 percent difference in the efficacy of the drug treatment we have been doing for 8.5 years.  Dr. Lee says, “We think that is wonderful that you have come up with these statistics.”  Dr. Lok said the same thing.  So, I think, if anything, we are helping the acupuncturists, and we are not trying to hold out people to be acupuncturists who are not even acupuncturist assistants.  They are doing one small protocol.

 

Senator Townsend:

I do not think there is anybody in this building who does not support the drug court, because you have had a huge success.  Has Mr. Skancke and/or the board’s representative seen this new language?

 

Judge Lehman:

They were handed what we have 3 days ago by David Gibson.

 

Senator Townsend:

Okay.

 

Judge Lehman:

Let me suggest a compromise to having our amendment put in this bill.  Assemblywoman Giunchigliani expressed a concern that it would permanently codify some.  Put a clause in the amendment that would cease to exist in 2 years, a sunset provision.  We want to try to work in the next 2 years to see if we can satisfy the board.  Dr. Lee seems to think we could work that out.  Dr. Lok seems to think we can work that out.  We need some time to do that, doing 150 procedures a day, the number of people Dr. Lee and Dr. Lok felt would be coming in within the next 2 years.

 

If it turns out they cannot service the drug court, or they cannot accept everything as it is being done now, then we are out in the cold for 2 years before we can come before you again.  Whereas, if you just amend the bill to allow us to be excluded for the next 2 years, we will work with the State Board of Oriental Medicine 100 percent for the next 2 years.  I think we can get along fine because they are in favor of us, and we are certainly in favor of them. 

 

However, we need the next 2 years to try and work out with them the specifics of how we can continue to function as we are functioning now.

 

With the seven drug courts we have in Las Vegas, we have right at           1000 people who are being affected at this time who are getting treatments.

 

Mr. Skancke:

There is no question the drug court has done an outstanding job in Clark County where I am from.  And, Judge Lehman has done a phenomenal job with that court.  The concern that certain board members had when this was first presented to them was we were not licensing enough acupuncturists.  Some people, not just the doctors, but also the people who were complaining about not getting licensed were saying, “It looked as though it were competition for them.”  Clearly, that is not the case.  We would like to offer to the committee and to Judge Lehman that, as we have our meetings, we will definitely work with them.  As we move forward with additional amendments, there is no question this issue needs to be addressed.  We will be more than happy to address it.  We will talk with the folks in Las Vegas, as well, who brought this forward to us with their concern.  I think this is a very simple process that we can work through and get it worked out.

 

Dr. Lee and I have just spoken and there is no question that this can be worked out.  Whether it is legislatively or whether it is through a regulation or some type of written understanding, these gentlemen and individuals who practice this technique are more than happy to work with the drug court, because it is a very successful program.

 

Judge Peter I. Breen, Second Judicial District, Washoe County District Court:

Based upon what has been said, I do not think I have to say much except to let the committee know we have exactly the same program with the same care provider that Clark County does.  We do the same thing with two of our three drug courts in Washoe County.  And, one to be added to the cow counties here in the north is going to use Choices Unlimited, as well.  So, whatever happens to Clark County will happen to us, and we have close to 1500 people who would be affected by it over the course of the last 6 years.

Senator O'Connell:

I just want to say that I appreciate, very much, what Mr. Skancke has just put on the record.  Because of the number of people who are affected and the success of the program, it should be a companion to the bill and put into law, with the sunset.  I am just going to have a level of confidence about it, and I think it is certainly going to give these gentlemen a level of confidence.  If they are saying we have the commitment that they would be doing this, then I see no problem with adding this to the bill.  Then we know, for sure, that it is taken care of.

 

Senator Townsend:

Mr. Skancke, I want to make sure your association, as well as the board,  understands our interpretation of (c) of this proposed amendment (Exhibit F), whether we use this language or some other language, “is under the supervision of a doctor of Oriental medicine, licensed pursuant to the provisions of this chapter or a physician licensed pursuant to the provisions of chapter 630 of NRS,” which is the board of medical examiners.  Those persons whom they supervise, if they have a problem, if a client has a problem with that treatment, that licensee is responsible.  Okay.  I want to make sure there is not any misunderstanding about this.

 

Judge Lehman:

I would agree to that, Senator.

 

Senator Townsend:

So, if you hire Dr. Lee to be your part-time supervisor of the people who are providing this very scope of treatment, his license is the one that is responsible to the complainant, if there is one.  Or, if, as an example, some other doctor became your part-time supervisor, it is his license against which the complaint would file.  And, I want to make sure there is no misunderstanding, no matter how we process this, that whoever you hired, and I presume your vendor is this Choices Unlimited group, that whomever the supervisor is, if one of these individuals makes a mistake, then it is the licensee who is going to be dragged in front of the board.  That is the way it works.  That is not anything new. 

 

And, I just want to make sure everyone understands there is a certain level of protection, and if an individual happens to be in front of your courts and says, “Hey, I have a problem with this treatment.”  They do not go back to you, because you are dealing with the legal aspects of their life.  For the medical aspect, or the treatment aspect, there is a licensing board to which they can go. And, that should be made quite clear to whoever is receiving that treatment.

 

Senator O'Connell:

Mr. Chairman, I understand this is the way it has been for the last nine years, so nothing has changed.

 

Senator Townsend:

I agree to that, but I do not think it has been articulated.  The whole point of licensing people is so there is a place to go if somebody has a problem.  And, the individual who is receiving a treatment has to know that the individual who may not be a licensee, but only is a certified person by this National Acupuncture Detoxification Association, that there is a licensee, over which the state has control, that has ultimate responsibility.  All of us who are involved in the issue may know it, but I do not think the average person who comes to your court bothers to take the time to understand that part.  This is a very important element here.

 

Senator Carlton:

This, it is my understanding, is a condition of probation.  Therefore, if there is a problem and a person who is getting this procedure performed on them would decide to pull away from this treatment, how, in the backs of their mind, are they going to be considering how this is going to affect their probation or parole?

 

Judge Lehman:

Thank you.  Senator Carlton, probably 60 or 70 percent of the people are on probation.  The rest of them are not, but under any circumstance if they do not wish to undergo the auricular needling there are other programs in Las Vegas they can participate in without it affecting their probation in any way.

 

Dr. Lee:

I had a chance to meet Judge Lehman and the director of Choices Unlimited.  They have been doing the auricular needling, so called ear acupuncture, and counseling to help the many drug addicts for the past 9 years.  Number one, we respect that the Judge has been helping those people out of drug and alcohol abuse.  I, personally, believe this treatment works wonderfully, as the Judge previously stated.

 

As a licensed practitioner and representative of the State Board of Oriental Medicine, I am not a lawyer or lawmaker, but we feel somewhat uncomfortable with this amendment submitted by the Clark County drug court.  The concerns to our state licensing board on the exemption make us very uncomfortable.  Statutes, I understand, are very clear and loud speaking so everybody can understand, clearly.  But, if you make some exemption, we feel as though some other exemption can occur in the future.  That is what we have been thinking and are concerned about.

 

The second issue is to the solution.  Since we have known about this issue by our board and licensees, Judge Lehman stated to you that not many other licensed doctors are interested in going to their clinic to perform the acupuncture.  However, I, personally, contacted most of the licensees in southern Nevada.  So far, two licensees are very interested in a full-time job, which I think would be a great help.  I have no idea how much they can afford for these two licenses.  That is a different matter.  I am not concerned about that this morning.

 

Judge Lehman and the director of Choices Unlimited mentioned they might not be able to afford these salaries for licensed doctors of Oriental medicine or acupuncturists.  If that is the issue, I have been talking to the other board members and licensees and we need to find a solution.  We are citizens, and we are not working only for money.  We probably contribute our share of time, like once a week or every two weeks, servicing acupuncture procedures.  We can do that, too.  If you give us the power with a board of regulation, we can approach it that way, too.  The question is, "Is it really necessary to have this amendment stapled to our current statute?"  This is, to my viewpoint, or the licensees' viewpoint, not necessary.  And I can promise, as Judge Lehman promised you and us, that this is going to go on.

 

Whatever situation comes, we would love to have this program go on, and we will be working hard to not stop this program.  Another thing is there are many theories of acupuncture.  I do not have time to explain to you how acupuncture works at this moment, but auricular needling is one small part of acupuncture therapy.  Some acupuncturists are only doing hand acupuncture.  They believe all the diseases can be cured by specific body acupuncture and can be cured by only sticking needles in some hands.  Also, we designate other acupuncture therapy in the same way as auricular acupuncture therapy, such as foot acupuncture therapy, which is solely of the feet and can cure all different diseases in our body.

 

If you allow this exemption theory of acupuncture treatments in this particular case, we are concerned that other acupuncturists will come up and say, "Hey, I am helping these peoples’ problem; I am doing only hand acupuncture.  Why not give me an exemption too?”  This is some concern about statutory construction.  Again, I firmly believe we can deal with the matter, wisely, without any confrontation, and we can deal with the regulation, as well.  So, Senators, this amendment is a very big issue at this moment.

 

Judge Breen:

Mr. Chairman, I would just like to say something on that last point.  Most of the activity occurs down in Las Vegas and Clark County.  Most of the acupuncturists are there, and we are about a third the size.  I would be more comfortable with a sunset provision, because I really do not know what we have available in northern Nevada.  And, I really do not know how much it will affect our program if we have to stop it immediately.

 

Senator Townsend:

Let us do this.  There is a whole separate discussion that needs to take place that has nothing to do with this bill, and that is all of the alternative things, including the full breadth of Oriental medicine, including herbology, including acupuncture and its full scope, as well as the many things that homeopathy and osteopathy have to offer the people who come in front of you.  I think we have missed out on many things.  I have seen a huge amount of success in some of these more delicate areas that arrive in your courts.  And, as Judge Breen knows very well, and thanks to his leadership, we are working on patterning after the drug and mental health courts, because many of those individuals arrive in front of you and you are thinking, “What are they doing here; they do not belong here.”  We are trying to figure out that issue.

 

There are so many wonderful things out there available to people, and when they arrive in front of the judiciary, they need to be able to, perhaps, be made aware of some of the wonderful things that are out there.  That is for another debate.  I think professionals, such as the four who sit here in front of us, today, representing the judiciary and representing the profession, can, over the next few days, sit down and have a dialogue that will work for both sides.  Then we will pick this up again next week.

Senator Townsend closed the hearing on A.B. 302.

 

Senator Townsend:

All right, committee, from yesterday there are two bills that could go on the Consent Calendar.  And those are A.B. 384 and A.B. 160.

 

ASSEMBLY BILL 384:  Changes terms used in provisions relating to mobile             home parks to refer to manufactured home parks.  (BDR 10-1010)

 

ASSEMBLY BILL 160:  Revises provisions governing industrial insurance.             (BDR 53-1097)

 

Senator O'Connell moved TO put A.B. 160 and A.B. 384 on the Consent Calendar.

 

Senator Schneider seconded the motion.

 

THE MOTION CARRIED.  (Senator Amodei was absent for the vote.)

 

*****

 

Senator Townsend opened a work session on A.B. 415.

 

ASSEMBLY BILL 415:  Revises provisions relating to pharmacy. (BDR 54-104)

 

Assemblyman John J. Lee:

I have brought these people together, today.  I would ask that they present their amendments, and I think that you will find this is an “amend and do pass.”  Everyone seems to be satisfied.

 

Mary F. Lau, Lobbyist, Retail Association of Nevada:

Mr. Wadhams and Mr. Sande had to be in other committee meetings.  We did have agreements on this.  The amendments would be in section 7 on page 5, line 14, that stays in; and within section 7, subsection 1, paragraph (f), lines 38 and 39 would be deleted.  Subsection 2 would be deleted beginning at line 43 on page 5, continuing on page 6, and deleting subsection 3, lines 8 through 13.  We leave in subsection 4, which is on lines 14 and 15, and delete subsection 5, lines 16 through 37.

Senator Townsend:

I am on page 6.  You are just going to take out subsection 2, so you end at line 7, device?

 

Ms. Lau

They are taking out sections 2 and 3, so it ends at line 13 through the word “reissued.”  Section 4 stays in; however, section 5 is deleted.

 

Assemblyman Lee:

We are in agreement with that.

 

Ron Bingaman, Director of Pharmacy Administration and Compliance,

Safeway, Incorporated:

Industry supports this.  It retains the essence of having the information and it refers some of the enforcement back to the commission for action to ensure these elements are enforced.

 

Senator Carlton:

As far as section 7 goes with eliminating section 1, paragraph (f), can you tell me how section 1, paragraph (e) stands, then?  That concerns only the electronic routing of transactions.  Does that information need to be on the card, or is that just information for the insured?

 

Mr. Bingaman:

Routing information is a specific electronic bin number that identifies the electronic address of where this bill will go.  It is about a 6-digit character.  It is very small, but it is extremely critical to control where the billing ends up, electronically.

 

Senator Carlton:

My question is whether that number is part of the card or just part of the record?

 

Mr. Bingaman:

That will be on the card.  Where it says “international identification number.”  That is commonly referred to in the industry as the bin number.

 

 

 

Senator Carlton:

With the elimination on page 6, or reissuing cards, that was one of the things I had problems with.  In the industry I work in, the membership changes constantly.  And, the issuance of cards can take a whole division just to issue cards, because a lot of people who work in southern Nevada self-pay their insurance because they may not work the required number of hours.  I just wanted to make sure this was not the only way they could get service, because we use a computer system, also.  If that is eliminated, it would eliminate that problem regarding the trades and self-paying your insurance and having to have a card.  Is there anywhere in section 7 that it mandates policies that do not now issue cards will have to start issuing them?

 

Mr. Bingaman:

If you refer back to the portion in subsection 1, it says, “Any agency that issues a single prescription benefit card.”  If they do not currently issue one, this will not cover them.

 

Senator O'Connell moved to Amend and Do Pass A.B. 415 with the amendment presented by Ms. Lau.

 

Senator Schneider seconded the motion.

 

THE MOTION CARRIED.  (Senator Amodei was absent for the vote.)

 

*****

 

Senator Townsend opened the work session on A.B. 491.

 

ASSEMBLY BILL 491:  Authorizes optometrist to collaborate with ophthalmologist under certain conditions. (BDR 54-1280)

 

Senator O'Connell moved TO do pass A.B. 491.

 

Senator Rhoads seconded the motion.

 

 

 

 

The motion carried.  (Senator Amodei was absent for the vote.)

 

*****

 

Senator Townsend reopened the hearing on A.B. 622.

 

ASSEMBLY BILL 622:  Makes various changes to provisions governing practice             of court reporting. (BDR 54-533)

 

Scott Young, Committee Policy Analyst:

Mr. Chairman, while we were discussing other bills, I received a message from Reanie R. Walters, Executive Director, and Steven J. Mack, Chairman, Certified Court Reporters’ Board of Nevada.  They indicated there is an error in the bill on page 5.  At the very top on line 2, it says, “$50.”  Actually, starting at line 1 it reads:  The fee for the original issuance of a license as a court reporting firm is $50.  Then, if you look at lines 3 and 4, you will see that the annual renewal fee is $150.  According to Ms. Walters and Mr. Mack, the $50 should have been $150.  I asked Jan K. Needham, Principal Deputy Legislative Counsel, Legal Division, Legislative Counsel Bureau, if that was just a “typo” and she indicated it was not.  The bill was prepared that way, it went through the Assembly that way; however, she noted, almost universally, the original issuance fee and the renewal fee are the same.  So, it does appear it has unintentionally been stated as $50 instead of $150.

 

Senator O'Connell:

Was that ever questioned on the Assembly side?

 

Scott Young:

Apparently not, although I cannot verify that since I just received the message during this meeting.  I think it was just something nobody noticed until today.

 

Senator Townsend:

Why not do this, committee, so there is no misunderstanding, because this is a serious issue.  We have not touched the fee in, how long, 10 years or something?

 

Scott Young:

I believe it was 1993 when they were last changed.

Senator Townsend:

There is no rush to get this out of here.  Why not contact both of them and find out if they can be here Friday, and we can take it up then.  That way there is no mistake.

 

Senator O'Connell:

Ms. Yates, the lady who testified earlier today on this, did mention the fees.  And, I think, she should be contacted, as well, and made aware of the situation.  So, if there are any problems, she can let us know.

 

Senator Townsend:

Yes.

 

Scott Young:

I know Ms. Yates, and I will talk to her and ask her about this.

 

Senator Townsend reopened the hearing on A.B. 551.

 

ASSEMBLY BILL 551:  Revises provisions relating to practice of cosmetology.             (BDR 54-1133)

 

Senator Townsend:

I tried to establish with Assemblywoman Giunchigliani the issue of a place of business creating two separate standards for doing the same thing.  Ms. Manna did a very articulate job in explaining the issue of her jurisdiction in an establishment.  It is an establishment licensed for cosmetology, and that is a separate license; then that gives her jurisdiction, in essence, over anyone who is licensed as an aesthetician or a cosmetologist practicing under the license of the establishment.

 

Now, the question arose that in many of these larger units in southern Nevada, and we even have one or two here in the north, the retail portion of it is actually larger than the cosmetological establishment.  The question then becomes, if there is an employee of that firm selling retail goods, is that person any different from the person who works at Macy’s or Dillard’s, for example, who under NRS 644.469 is exempt.  Now, under the first exemption, the persons in the front of this establishment do not charge.  They are just showing the customer the various products.  But, under the second exemption, if the retailer does not advertise or provide a cosmetological service, except for makeup and fragrances, then they are covered because they are also the retailer.  And, the retailer in that case does advertise, and he or she provides these other services.

 

So, we have a bit of a misnomer, and I will tell you why.  Neiman Marcus, for example, has all of those demonstration ladies in their cosmetological retail area.  Upstairs, they have a full salon, and that salon is allowed to advertise.  Now, does that scoop in the retail person, and then would this proposal require all of those people on the main floor of Neiman Marcus to get this new license as a demonstrator of cosmetics?  It should not, but, unfortunately, if you read subsection 1, paragraph (d), subparagraph (2) of section 24, and then you read the part about demonstrator of cosmetics, now you have a problem.  And, I am not picking on particular stores; I am just saying this is how problematic it gets.

 

Now, if the person who is selling retail in the front of a Euphoria store, for example, is a licensed cosmetologist or an aesthetician, that person is already licensed under the jurisdiction of the board.  A large establishment might hire a counter person previously employed at Macy’s, Dillard’s, Neiman Marcus, or Saks Fifth Avenue and she is not licensed.  Now, doing the same thing she did at one of those establishments, she has to get this license.  I do not know if that is what you want to do.

 

Senator O'Connell:

That is not what I would want to do.  I think that is ridiculous.

 

Senator Carlton:

I believe this was all geared towards a spa-type atmosphere, not a retail atmosphere.

 

Senator Townsend:

I think Assemblywoman Giunchigliani was trying to accommodate the spa establishments, because the State Board of Cosmetology took jurisdiction over the employees there for selling cosmetics.  The places I have seen are becoming more of an experience, as opposed to just a service establishment.

 

Senator O'Connell:

Probably, in most of those instances, at least the ones that I have been in, they are very young ladies.  They probably are not much above minimum wage, and it is just a part-time job.  But, I sure cannot see the need to have them licensed.  Unless they are demonstrating a product, and can prove that they have training from that, all they are doing is saying these are the lines that we offer.

 

Senator Carlton:

They do in some of the spas in the hotels.

 

Senator O'Connell:

But I would imagine they are then trained by the manufacturer of the products that they are dealing with, so they would fall under the other situation.

 

Senator Townsend:

Under this, they would have to be licensed if they work, and almost all of the large hotels advertise.

 

Senator Carlton:

So, we would be capturing those people, also.

 

Senator Townsend:

The problem with this language is you sweep the whole world in.  You just swept in all the hotels.  Let us go to the second part of it.  Any food or beverages sold for immediate consumption in a cosmetological establishment must be sold in an area sufficiently separated from the area of cosmetology.  Well, I am confused.  I thought food and beverage was what we were supposed to make healthy.  I thought this would be a health department issue as opposed to a board issue.  Are you not more concerned as a restaurateur than you would be as a cosmetological establishment?

 

Senator Carlton:

I believe, Mr. Chairman, there is a certain level at which it is not the prime business, so does not fall under those guidelines of an A, B, or C rating.  Your prime business is cosmetology, but you are going to offer coffee or espresso or a fruit smoothie, et cetera.  They just want to make sure that there is no cross-contamination.

 

Senator Townsend:

I do not have any problem with that.  I guess that is the point; we are not talking about putting in a restaurant, we are talking about a gray area.  I do not have any problem with section 5, but I do have a problem with section 1.

 

Senator Carlton:

Can we qualify this as not a retail establishment, but a spa atmosphere?  Is there a definition of spa someplace that we could use to make this apply?

 

Senator Townsend:

We have been there, and we could not decide.  The problem is, you are still going to sweep in the resorts.

 

Senator Carlton:

They call them spas.

 

Senator Townsend:

That is the problem.  All right, let us talk to Mr. Lamarca.  Is there a consensus just to do section 5 and try to get an arm around what they are trying to accomplish here with Mr. Lamarca.

 

Senator O'Connell:

Yes.

 

Senator Carlton:

It has made it this far.

 

Senator Townsend:

If we can accommodate him without hurting a whole class of people out there and having the hotels in there, et cetera.

 

Senator Carlton:

I know how I feel when so much work has been put in and you really thought you had it together, and then you get someone else’s perspective, with a little more experience, and they see things that you did not see.  I would rather make it work than lose it.

 

Senator Schneider:

I think Mr. Lamarca has one or two of those in hotels now.  He has gone onto The Strip.

 

Senator Townsend:

Okay, what we need to do is make sure he understands the issue of the exemption versus what they are doing, because all of a sudden if he licenses his

people under this new definition, it means the whole state licenses them.  Just as long as he understands that, we can divert the calls to him.

 

There being no further business, the meeting was adjourned at 9:59 a.m.

 

 

RESPECTFULLY SUBMITTED:

 

 

 

Gayle Nadeau,

Committee Secretary

 

 

APPROVED BY:

 

 

 

                       

Senator Randolph J. Townsend, Chairman

 

 

DATE: