MINUTES OF THE
SENATE Committee on Human Resources and Facilities
Seventy-First Session
May 9, 2001
The Senate Committee on Human Resources and Facilitieswas called to order by Chairman Raymond D. Rawson, at 1:46 p.m., on Wednesday, May 9, 2001, in Room 2135 of the Legislative Building, Carson City, Nevada. The meeting was video conferenced to the Grant Sawyer Office Building, Room 4401, Las Vegas, 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 Raymond D. Rawson, Chairman
Senator Randolph J. Townsend
Senator Mark Amodei
Senator Bernice Mathews
Senator Michael Schneider
Senator Valerie Wiener
COMMITTEE MEMBERS ABSENT:
Senator Maurice Washington, Vice Chairman (Excused)
GUEST LEGISLATORS PRESENT:
Assemblyman Dennis Nolan, Clark County Assembly District No. 13
Assemblywoman Barbara E. Buckley, Clark County Assembly District No. 8
Assemblyman David R. Parks, Clark County Assembly District No. 41
Assemblyman Mark A. Manendo, Clark County Assembly District No. 18
STAFF MEMBERS PRESENT:
H. Pepper Sturm, Committee Policy Analyst
Patricia Vardakis, Committee Secretary
OTHERS PRESENT:
Kelly Quinn, Emergency Medical Services Field Representative, Clark County Health District
Jonathan Bernstein, M.D., Children’s Center for Cancer and Blood
Diseases of Las Vegas
David Nelson, M.D., Pediatric Emergency Department, University Medical Center
Meena Volura, M.D., Director, Pediatric Intensive Care Unit, University Medical Center
Lucille Lusk, Lobbyist, Nevada Concerned Citizens
Chris Ferrari, Lobbyist, Regional Emergency Medical Services Authority (REMSA)
Mary Liveratti, Administrator, Aging Services Division, Department of Human Resources
Virginia Cain, President, Silver Haired Legislative Forum
Ruth Mills, Congressional District 1 Representative, National Silver Haired Congress
Thelma M. Clark, Lobbyist
Roger Owens, Concerned Citizen
Marjorie L. Walker, Social Welfare Program Specialist, Division of Child and Family Services, Department of Human Resources
Nancy Angres, Chief Deputy Attorney General, Human Resources Division, Office of the Attorney General
Gerald W. Hardcastle, District Judge, Department D, Family Division, Eighth Judicial District
Kathleen Boutin, Chairman, Nevada Partnership for Homeless Youth
Robert W. Teuton, Chief Deputy District Attorney, Juvenile Division, District Attorney Clark County
Stan Olsen, Lobbyist, Las Vegas Metropolitan Police
Thom Reilly, Professor, School of Social Work, University of Nevada, Las Vegas
Chairman Rawson opened the hearing on Assembly Bill (A.B.) 173, and introduced Assemblyman Dennis Nolan, Clark County Assembly District No. 13.
ASSEMBLY BILL 173: Expands circumstances under which emergency life-resuscitating treatment may be withheld from patient in terminal condition. (BDR 40-437)
Assemblyman Nolan stated A.B. 173 concerns “do-not-resuscitate” (DNR) orders. He told the committee people at the “end stage,” or “terminal phase” of their lives would be able to expire without “heroic,” life-saving efforts.
Assemblyman Nolan explained A.B. 173 addresses three issues. First, he pointed out, the bill closes a loophole in existing legislation regarding whether or not to resuscitate a person against their will enroute to a facility or home. He testified the second provision of A.B. 173 provides for the use of bracelets or other identifying medallions indicating “do-not-resuscitate,” and the method of obtaining such identification. Concluding, Assemblyman Nolan pointed out the third provision would address “no resuscitation” in pediatric cases.
Assemblyman Nolan commented there has been an amendment proposed to A.B. 173, which should be reviewed by the Legal Division of the Legislative Counsel Bureau.
Assemblyman Nolan discussed two suggestions posed by Senator Wiener prior to the meeting. He said the first suggestion is to clarify a “qualified patient,” which means a person who is in a terminal condition, as determined by their physician. He noted the second suggestion is to emphasize understanding the language, “ . . . the minor is of sufficient maturity to understand the nature and effect of withholding life-resuscitating treatment . . . “ He said the simplest explanation is, a parent and child should understand the issue, and the physician must concur, before a DNR order would be issued.
Chairman Rawson questioned whether the parent could reverse the DNR order. Assemblyman Nolan answered in the affirmative. He stated a child could also withdraw a DNR order, depending on whether the child and physician agree, and understand the nature of the DNR order.
Kelly Quinn, Emergency Medical Services Field Representative, Clark County Health District, described the current statutory requirements. He said the patient must be “qualified,” which means being 18 years old with a terminal condition. Mr. Quinn added the patient working with the physician must apply to the health authority to obtain identification that a DNR order is in place. He explained an identification is required to contain the following information: an unique number assigned to the patient, the patient‘s name, date of birth, and the attending physician’s name.
Referring to a document titled “Do-not-resuscitate Identification” (Exhibit C), Mr. Quinn explained it is the same DNR protocol adopted by the Clark County Board of Health for carriers of do-not-resuscitate identification.
Mr. Quinn stated currently, DNR identification does not apply during the transport of a patient from one facility to another, but the language proposed in A.B. 173 will enable the charted DNR orders to be honored. Continuing, he commented on the pediatric issue of DNR orders. Mr. Quinn commented on the present paper form method of DNR identification, and defined the procedure for the use of bracelets and medallions as a second form of identification as included in A.B. 173.
Summarizing, Mr. Quinn pointed out that all the components of A.B. 173, and the current statute are not geared toward human euthanasia, but address empowerment issues.
Chairman Rawson asked whether A.B. 173 contained all necessary language, and addressed the issue to the satisfaction of the Clark County Health District. Mr. Quinn replied the Clark County Health District had no concerns with A.B. 173 or the proposed amendment.
Senator Wiener queried whether there could be a liability or cause of action when a person is resuscitated against their will. Mr. Quinn responded the statute provides any person who administers resuscitation to someone with the “Do-not-resuscitate Identification” form in place is guilty of a misdemeanor.
Jonathan Bernstein, M.D., Children’s Center for Cancer and Blood Diseases of Las Vegas, gave supporting testimony on A.B. 173.
David Nelson, M.D., Pediatric Emergency Department, University Medical Center, testified A.B. 173 would eliminate the unnecessary utilization of emergency services and stress for parents. He explained the decision to procure a DNR order is made after much deliberation by the child’s parents and physician; therefore, when a child is resuscitated against the parent’s wishes, it causes great distress.
Dr. Nelson told the committee the American Academy of Pediatrics is in favor of DNR orders for children, and has issued guidelines to help schools handle this issue.
Chairman Rawson questioned whether a DNR order would be ignored if requested by the parents or child. Dr. Nelson responded every life-saving measure would be administered.
Meena Volura, M.D., Director, Pediatric Intensive Care Unit, University Medical Center, testified in favor of A.B. 173.
Chairman Rawson asked whether MedicAlert is the only source for DNR identification bracelets and medallions. Mr. Quinn replied there were other styles and companies. Senator Mathews reiterated her concern was whether MedicAlert was the only company providing identification materials. Mr. Quinn responded he was not aware of another company providing the same services as MedicAlert. He emphasized the information required by A.B. 173 must be included on the identification materials.
Lucille Lusk, Lobbyist, Nevada Concerned Citizens, voiced support of A.B. 173. She proposed an amendment, (Exhibit D) to A.B. 173, which would keep the parent in the decision-making process.
Chris Ferrari, Lobbyist, Regional Emergency Medical Services Authority (REMSA), voiced support of A.B. 173. Speaking on behalf of REMSA, Mr. Ferrari said A.B. 173 would allow an emergency medical attendant to perform his or her job. He stated presently an emergency medical attendant responding to a call to transport a patient from a nursing home to a hospital would not have the authority to honor a “do-not-resuscitate” order.
Chairman Rawson closed the hearing on A.B. 173 and asked for a motion.
SENATOR AMODEI MOVED TO AMEND AND DO PASS A.B. 173.
SENATOR SCHNEIDER SECONDED THE MOTION.
Senator Wiener pointed out the placement of the amendment should be in section 10, not in section 9, on page 3 of A.B. 173, as indicated by Exhibit D. Chairman Rawson said the committee policy analyst would place the amendment appropriately in A.B. 173.
There being no further discussion on A.B. 173, Chairman Rawson called for a vote.
THE MOTION CARRIED. (SENATOR WASHINGTON WAS ABSENT FOR THE VOTE.)
*****
Chairman Rawson opened the hearing and invited testimony on Assembly Bill 195.
ASSEMBLY BILL 195: Revises provisions relating to Nevada silver haired legislative forum. (BDR 38-534)
Mary Liveratti, Administrator, Aging Services Division, Department of Human Resources, explained the Silver Haired Legislative Forum, which was established by the 1997 Legislature, operates independently and without state funding. She stated the Aging Services Division is the fiscal agent for the Silver Haired Legislative Forum and expenditures are processed through the division.
Ms. Liveratti stated the Assembly amended A.B. 195, but the Governor and the Department of Human Resources support the original version. Chairman Rawson asked for clarification regarding the preference for the original version of A.B. 195. Ms. Liveratti replied the original version of A.B. 195 provided that the Governor appoint the 21 members of the forum. She said Assembly Amendment No. 112 provided for the legislative commission to appoint the 12 members of the forum, which is a significant decrease in the total number of members. Ms. Liveratti noted the members of the forum would be appointed by legislative districts not senatorial districts, and the current member’s term would expire July 1, 2001. She said the legislator representing the district would nominate the member, and the forum would hold four public hearings, in three different parts of the state. Ms. Liveratti added the forum would submit a report with a request for legislative action to the Governor and the legislative commission.
Virginia Cain, President, Silver Haired Legislative Forum, testified the members only had the statute as a guide when the forum was originated. She stressed the forum was limited by a lack of funding. Ms. Cain explained the National Committee of the Preservation of Medicare and Social Security provided financial assistance to forum members many times to hold meetings.
Ms. Cain expressed concern A.B. 195 would limit the number of members of the forum to 12. She pointed out, based on statute, the forum must be comprised of: equal political representation and equal gender balance, in addition to the age requirement.
Ms. Cain stated the amended legislation would have an “umbilical cord” to the Legislative Counsel Bureau, which is supported by state government. She remarked the purpose and goals of the forum are clearly defined as investigating recommendations to the next legislative session.
Ms. Cain stressed the members are volunteers from various professions giving their time, energy, ability, and commitment to help senior citizens in Nevada. She commented after two years many members were discouraged because of the lack of funding.
Ms. Cain emphasized the members of the Silver Haired Legislative Forum should not be expected to pay for travel expenses and meals while on official state business. She voiced support of A.B. 195, but reiterated the concern of only having a 12-member forum.
Senator Wiener asked for a clarification of the funding. Chairman Rawson responded the $5000 is for the Silver Haired Legislative Forum to operate. Senator Wiener expressed support of a 21-member forum, and counterparts in the Senate, to ensure statewide representation.
Chairman Rawson commented he favored nominating a senior representative from his district, and then, having the Governor make the appointment because it created communication with the forum. He acknowledged the lack of funding could cause dissatisfaction with the results of the forum’s work, and said the committee would address the issue in a work session.
Ruth Mills, Congressional District 1 Representative, National Silver Haired Congress, expressed concern the Silver Haired Legislative Forum has not met during the last two years. She spoke in favor of A.B. 195 but encouraged the retention of a 21-member forum in Nevada. Ms. Mills emphasized the importance of having a liaison between the national and state groups.
Thelma M. Clark, Lobbyist, claimed the original language on line 24, page 2 of A.B. 195, would provide better representation of the entire state. She proposed the following language to section 3, page 1, of A.B. 195:
The Legislative Commission is authorized to appoint 12 persons to the Nevada Silver Haired Legislative Forum, and may at anytime appoint 9 additional members to a maximum of 25, including the National Silver Haired Congress.
Ms. Clark questioned whether Nevada Revised Statutes (NRS) 427A.350 was still intact. Chairman Rawson answered in the affirmative. She then suggested the following amendment, “A Nevada Silver Haired Congress person may not be elected to any office.” Ms. Clark explained they can be on the committee, speak at meetings, and vote on issues, but cannot be elected to office. She requested permission for Robert E. Erickson, Research Director, Research Division, Legislative Counsel Bureau, to be a co-signer, along with the elected treasurer, to sign checks.
Concluding her testimony, Ms. Clark opined the language on page 3, lines 17 through 26 does not permit the forum to meet in the Legislature as was past practice. She commented the meetings designated in lines 23 through 26 would depend on the funding available.
Chairman Rawson assured Ms. Clark the Legislature would refine A.B. 195 to make it “workable,” and would be in touch with all parties.
Roger Owens, Concerned Citizen, claimed when the Silver Haired Legislative Forum started there were too many ”chiefs and no Indian braves,” therefore, the forum’s leadership was questioned. He explained because of the efforts of many dedicated individuals the forum improved, and even introduced legislation. Mr. Owens expressed concern with the designation of 12 members for the forum in A.B. 195. He stated a 12-member forum would have to be dedicated, otherwise the meetings would frequently not have a quorum. He emphasized the forum has a valuable service to perform for the state. He affirmed a 21-member forum would be more practical than a 12-member forum. Mr. Owens acknowledged funding was a major concern and problem. He opined public meetings would not accomplish the personal contact with senior citizens that visiting various senior centers had accomplished.
Chairman Rawson closed the hearing on A.B. 195, and noted A.B. 195 would be reported in a work session. He opened the hearing and invited testimony on A.B. 248.
ASSEMBLY BILL 248: Requires adoption of regulations governing provision of certain information to foster or adoptive parents and revises certain provisions governing procedures for protection of children from abuse and neglect. (BDR 38-356)
Marjorie L. Walker, Social Welfare Program Specialist, Division of Child Family Services, Department of Human Resources, stated the provisions outlined in A. B. 248 are technical amendments ensuring continued compliance with the Adoption and Safe Families Act of 1997, thereby preserving federal funding. She emphasized A.B. 248 would allow $16.5 million in federal funding for various programs. Ms. Walker said the funding would affect programs that protect children from harm or abuse. Ms. Walker stressed without the technical revisions contained in A.B. 248 to comply with federal laws and regulations, federal funding could be compromised for child welfare programs.
Ms. Walker indicated the packet of information entitled, “Assembly Bill # 248, 1st Reprint (BDR38-356) Testimony Division of Child and Family Services” (Exhibit E), contains summary provisions, written testimony for each section, a copy of the federal regulations pertaining to the Adoption and Safe Families Act of 1997 (ASFA) a copy of the Child Abuse Prevention and Treatment Act (CAPTA) and a copy of ASSEMBLY BILL 356 OF THE SIXTY-NINTH SESSION for reference.
ASSEMBLY BILL 356 OF THE SIXTY-NINTH SESSION: Revises provisions governing protection of children from abuse or neglect. (BDR 38-783)
Chairman Rawson commented, “if the suspected abuse or neglect was the result of the reasonable exercise of discipline, the agency would take no further action.” He opined the language allowed for corporal punishment. Chairman Rawson questioned whether the standard was being changed.
Nancy Angres, Chief Deputy Attorney General, Human Resources Division, Office of the Attorney General, directed the attention of the committee to line 44, on page 3 of A.B. 248. She stated:
The bill retains the provision regarding corporal punishment, that if the agency determines the alleged abuse or neglect was the result of the reasonable exercise of discipline by a parent . . ., and then what happens. The text that is being repealed . . . is a reconciliation of some sort that they have to do in the statutes of Nevada. They are repealing what is in the Statutes of Nevada, not what is already in NRS (Nevada Revised Statutes.)
Ms. Walker gave an oral presentation of the technical revisions in A.B. 248 found on page 3, of Exhibit E. Chairman Rawson queried whether the changes were only technical in nature, and not policy changes. Ms. Walker replied the changes were technical. Chairman Rawson suggested Senator Wiener and the subcommittee review the technical changes, then report back to the Senate Committee on Human Resources and Facilities.
Gerald W. Hardcastle, District Judge, Department D, Family Division, Eighth Judicial District, stated objection to the proposed technical changes in A.B. 248, and requested to be included in the subcommittee. Chairman Rawson agreed to include Mr. Hardcastle in the subcommittee.
Chairman Rawson opened the hearing on A.B. 264, and introduced Assemblywoman Barbara E. Buckley, Clark County Assembly District No. 8.
ASSEMBLY BILL 264: Authorizes counties to designate certain shelters as approved youth shelters for runaway or homeless youths. (BDR 38-115)
Assemblywoman Buckley testified A.B. 264 would assure homeless teenagers have the ability to be served and not be on the street. She said it is unfortunate current law requires parental consent for referrals to agencies offering food and shelter, and A.B. 264 would eliminate that requirement. Assemblywoman Buckley introduced Kathleen Boutin, Chairman, Nevada Partnership for Homeless Youth.
Ms. Boutin offered to answer any questions the committee has regarding A.B. 264. Senator Wiener requested a clarification of the time element, or the circumstances required to be considered a “homeless youth.”
Robert W. Teuton, Chief Deputy District Attorney, Juvenile Division, District Attorney Clark County, answered A.B. 264 does not address a specific period of time. He said assessment of whether the youth is properly classified as “homeless or runaway,” would depend on the interview conducted with the youth.
Mr. Teuton testified A.B. 264 is “enabling legislation authorizing county commissions, if they choose, to adopt ordinances which would designate approved shelters for homeless youth.” He stated the key provisions can be found on page 3, lines 11 through 23, of A.B. 264. Mr. Teuton stressed the shelters would not just house youths until the age of maturity, but would provide services to enable them to re-enter the community. He explained a major issue addressed in A.B. 264 is the county is required to assure a shelter notifies parents as soon as possible when their child has been taken into the shelter. Also, the shelter must notify local law enforcement agencies, so the child’s name can be removed from any national or state registries for runaway youths.
Chairman Rawson asked for clarification regarding an appropriate shelter for youths. Ms. Boutin reiterated A.B. 264 would make available many shelters who presently fear the liability issue and will not grant admittance. Chairman Rawson questioned whether the shelter would restrict the activities of the youth. Ms. Boutin responded the youth would be privy to the same privileges as any homeless person. Chairman Rawson asked where a youth would be placed after abuse or neglect has been identified. Mr. Teuton answered Child Protective Services would become involved, and the youth could remain in the shelter until the investigation has been completed.
Chairman Rawson questioned whether there would be county funds involved. Ms. Boutin replied no governmental funds have been requested.
Assemblywoman Buckley iterated there is no language in A.B. 264 permiting a shelter to detain a youth. She said the intent is to bring the youth off the street and into a safe environment.
Mr. Hardcastle voiced concern about whether A.B. 264 is a “parent’s rights bill or a child’s rights bill.” He expounded on the necessity to have the “life-lines” such as is provided in A.B. 264 to protect the youth. Mr. Hardcastle stressed it is important not only for the youth, but also for the parent. He stated support of A.B. 264, and urged the committee to support the bill.
Chairman Rawson questioned whether A.B. 264 would facilitate children to leave home. Mr. Hardcastle replied children leave home for emotional reasons and would not weigh the consideration of shelter homes. Mr. Teuton said an initial assessment of the child is required if there is no allegation of abuse or neglect, then the shelter is required to notify the parent. Continuing, he told the committee the language of A.B. 264 has been crafted to enable the shelter to be an active partner in the process of getting the child back home.
Assemblywoman Buckley commented a recent television documentary showed many youths go to areas such as University of Nevada, Las Vegas (UNLV) because they can blend in with other youths.
Senator Wiener said there is a distinction between a “runaway” and “push-out.” She stated the sad event is many of these youths are not “runaways,” they have literally been “pushed-out” of their homes. Senator Wiener emphasized youths are wary of “the system” and of becoming involved, therefore, A.B. 264 would be “reaching out” to give them a helping hand.
Assemblyman David R. Parks, Clark County Assembly District No. 41, stated in his district there are 2 miles of Maryland Parkway in Las Vegas, which attracts a large number of homeless youths. He reiterated the youths try to blend into the area around UNLV.
Assemblyman Mark A. Manendo, Clark County Assembly District No. 18, elucidated on the homeless problem in southern Nevada. He noted the Boulder Highway area in Las Vegas attracts homeless youths. Assemblyman Manendo said the homeless youths are recognizable because of their backpacks, and they travel in groups. He emphasized A.B. 264 was a positive move in the right direction to help the homeless youths.
Stan Olsen, Lobbyist, Las Vegas Metropolitan Police, testified the homeless youth are a drain on the resources of the police department in Las Vegas. He pointed out homeless youths are increasingly involved in prostitution, and drugs. He pointed out they are being used as “mules” to transport and sell narcotics, out of a desperation to survive. Mr. Olsen voiced support of A.B. 264.
Lucille Lusk, Lobbyist, Nevada Concerned Citizens, stated her support of A.B. 264.
At the request of Shaun T. Griffin, Executive Director, Community Chest, Incorporated, the letter in support of A.B. 264 (Exhibit F) was entered into the record.
There being no further testimony on A.B. 264, Chairman Rawson closed the hearing, and asked for a motion.
SENATOR WIENER MOVED TO DO PASS A.B. 264.
SENATOR SCHNEIDER SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS WASHINGTON AND TOWNSEND WERE ABSENT FOR THE VOTE.)
*****
Assemblyman Manendo testified Assembly Joint Resolution (A.J.R.) 13 addresses the social security issue of “notch babies,” those individuals born between 1917 and 1926.
ASSEMBLY JOINT RESOLUTION 13: Urges Congress to eliminate inequities in payment of social security benefits to certain persons. (BDR R-1215)
He explained seniors born during the specified period receive 20 percent less in social security payments than those born before 1917, and after 1926. Assemblyman Manendo said A.J.R. 13 supports correcting the inequity. Chairman Rawson asked the age of the affected seniors. Assemblyman Manendo replied that the senior population affected would be between 75 and 84 years of age. Chairman Rawson questioned the number of seniors affected. Assemblyman Manendo apologized for not knowing the number of seniors affected, but said as the years pass the number decreases. Chairman Rawson asserted it was an issue of fairness.
SENATOR AMODEI MOVED TO DO PASS A.J.R.13.
SENATOR SCHNEIDER SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS WASHINGTON AND TOWNSEND WERE ABSENT FOR THE VOTE.)
*****
Chairman Rawson opened the hearing on Assembly Concurrent Resolution (A.C.R.) 10.
ASSEMBLY CONCURRENT RESOLUTION 10: Urges Department of Human Resources to review federal Foster Care Independence Act of 1999 to determine feasibility of amending state plan for Medicaid to create new Medicaid eligibility group for young adults who have “aged out” of foster care. (BDR R-323)
Thom Reilly, Professor, School of Social Work, University of Nevada, Las Vegas, urged the committee to vote in favor of A.C.R. 10. He said A.C.R. 10 concerns the extension of Medicaid benefits for youths up to 21 years of age, which have left foster care. Mr. Reilly told the committee the Division of Child and Family Services, and the University of Nevada, Las Vegas, examined the results of youths leaving foster care and integrating into society. He stated this is a “throw-away“ population. Mr. Reilly noted one-third of the youth interviewed were homeless, or did not have a place to stay during the past three years. He claimed 40 percent of the youth interviewed made less than $5000 a year, and only 60 percent were employed. Continuing, Mr. Reilly said 55 percent had no type of health care, and over one-third of these youths needed, but could not obtain health care.
Chairman Rawson asked the committee for a motion on A.C.R. 10.
SENATOR AMODEI MOVED TO ADOPT A.C.R. 10.
SENATOR MATHEWS SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS WASHINGTON AND TOWNSEND WERE ABSENT FOR THE VOTE.)
*****
Chairman Rawson adjourned the meeting at 3:36 p.m.
RESPECTFULLY SUBMITTED:
Patricia Vardakis
Committee Secretary
APPROVED BY:
Senator Raymond D. Rawson, Chairman
DATE: