MINUTES OF THE
SENATE Committee on Human Resources and Facilities
Seventy-First Session
May 16, 2001
The Senate Committee on Human Resources and Facilitieswas called to order by Chairman Raymond D. Rawson, at 2:15 p.m., on Wednesday, May 16, 2001, in Room 2135 of the Legislative Building, Carson City, Nevada. The meeting was video conferenced to the Grant Sawyer Office Building, Room 4412, 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 Maurice Washington, Vice Chairman
Senator Randolph J. Townsend
Senator Mark Amodei
Senator Michael Schneider
Senator Valerie Wiener
COMMITTEE MEMBERS ABSENT:
Senator Bernice Mathews (Excused)
GUEST LEGISLATORS PRESENT:
Assemblywoman Barbara K. Cegavske, Clark County Assembly District No. 5
Assemblywoman Vivian L. Freeman, Washoe County Assembly District No. 24
STAFF MEMBERS PRESENT:
H. Pepper Sturm, Committee Policy Analyst
Cynthia Cook, Committee Secretary
OTHERS PRESENT:
John Lawton, Concerned Citizen
Doug Bandow, Senior Fellow, Cato Institute
James J. Spinello, Lobbyist, Clark County
David Rosin, M.D., Medical Director, Southern Nevada Adult Mental Health Services, Division of Mental Health and Developmental Service, Department of Human Resources
Janice C. Pine, Lobbyist, Saint Mary’s Health Network
Cynthia Pyzel, Senior Deputy Attorney General, Division of Mental Health and Developmental Services, Office of the Attorney General
Margaret Thompson, Concerned Citizen
Wm. Patterson Cashill, Lobbyist, Nevada Trial Lawyers Association
Leslie Admirand, Deputy District Attorney, Forfeiture Unit, Civil Division, District Attorney’s Office, Washoe County
Kathleen O’Leary, Deputy Public Defender, Washoe County
Chairman Rawson:
We will open the hearing on Assembly Concurrent Resolution (A.C.R.) 2.
ASSEMBLY CONCURRENT RESOLUTION 2: Urges support for Women’s Health Care Platform: Campaign 2000. (BDR R-314)
Assemblywoman Barbara K. Cegavske, Clark County Assembly District No. 5:
As primary sponsor of this piece of legislation, I appreciate the opportunity to present some brief remarks. The resolution urges support for the women’s health care platform, an initiative that highlights the inequities in health care provided to women and men. The initiative concentrates on outlining goals to eliminate current disparities by focusing on care, research, and education. We are all aware there are differences in the health needs between men and women. We know that one in five women have some form of cardio-vascular disease, yet women are less likely to be referred for diagnosis, and less often treated for heart disease than men with the same disease. The goal of providing appropriate and equitable health care to all citizens of Nevada is an important one. Assembly Concurrent Resolution 2 will assist all of us in achieving that goal.
Chairman Rawson:
I would hope this is just a phase in our evolution, and there will be a day when we ask there be no further distinctions because there is adequate health care for everyone. I will accept a motion on this resolution.
SENATOR WIENER MOVED TO ADOPT A.C.R. 2.
SENATOR TOWNSEND SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS AMODEI, SCHNEIDER AND MATHEWS WERE ABSENT FOR THE VOTE.)
*****
Chairman Rawson:
We will open the hearing on Assembly Bill (A.B.) 402.
ASSEMBLY BILL 402: Authorizes adoption of ordinances in certain counties for designation of family cemeteries and authorizes cemetery authorities to order disinterment and removal of human remains. (BDR 40-1192)
Assemblywoman Vivian L. Freeman, Washoe County Assembly District No. 24:
With me today to explain the bill is Mr. John Lawton who owns cemeteries in Reno. He owns the Hillside Cemetery, which is an old cemetery across from the University of Nevada, Reno. Mr. Lawton would like to be able to clean it up and do something with it. There is a neighborhood council in Reno who is concerned about the historical issue with this little cemetery. We have seen through the years the cemetery has been neglected and vandalized. Because of legal issues, nothing has happened. Mr. Lawton has made a commitment to me that if we will pass the bill he will work with the association to get their cooperation on doing what needs to be done. He has spoken with people in the area, and he has offered to “step up to the plate.” I hope you will support his proposal.
Chairman Rawson:
You support all parts of this bill?
Assemblywoman Freeman:
Yes.
John Lawton, Concerned Citizen:
This cemetery was started back in the late 1800s and the record keeping is limited. There is no endowment care fund. It is a blight and there have not been any authorized burials in the Hillside Cemetery for over 10 years. The best suitable use of the property would be for the University of Nevada, Reno, possibly for a dormitory. Working with the neighborhood committee will not be easy. We might contact all the neighbors and let them know what we are doing. This bill is a necessity in order to go forward and clean up this cemetery.
Chairman Rawson:
Is there not a perpetual care fund? This legislation would open it up for any cemetery that is in disrepair or without a fund to be closed and moved. Typically, around the country, how do they deal with this?
Mr. Lawton:
There is no fund. Various parts of the United States work in the same fashion in order to take a piece of property of this size and try to bring it into a condition that the neighborhood can be proud of.
Chairman Rawson:
But your attempt is not necessarily to bring the cemetery up to standard; it is to essentially eliminate the cemetery.
Senator Wiener:
How many grave sites are there?
Mr. Lawton:
In 1973 there was a count of, I believe, 1400 burial sites, in several sections.
Senator Wiener:
What is the major concern of the neighbors?
Mr. Lawton:
Cleaning it up. I do not know if it could ever be cleaned up to a standard of a cemetery, because there is no endowment care fund. The best suitable use for the property would be for the university.
Senator Washington:
I might add for the record that the site is very run down. There are turned over tombstones, and students use it for shortcuts. If this is an attempt to clean it up and repair it, I think it is a worthwhile effort.
Chairman Rawson:
But the attempt here is to remove the cemetery. You are not trying to make this a beautiful cemetery are you?
Mr. Lawton:
I think if there were ways to do it, yes. But I do not see a way at this point of doing that.
Chairman Rawson:
There is a historical significance to this, I assume. How far back do we see families buried there?
Mr. Lawton:
Starting back about 1890.
Chairman Rawson:
So where would these bodies be moved to?
Mr. Lawton:
Across the street. There is another piece of property that is contiguous, between the Pythian Cemetery and the Grand Army Cemetery
Chairman Rawson:
Is there room to move the existing remains?
Mr. Lawton:
There is plenty of room.
Assemblywoman Freeman:
The point that you made about opening this up for other cemeteries, would you like to have further language that would make it clear it is only for this cemetery?
Chairman Rawson:
No. I think it is late in the session for further changes and amendments. There is a suggestion to change the population size from 20,000 to 50,000, and nobody has come forward with a complaint. Who will bear the cost of moving the remains?
Mr. Lawton:
I would. The value of the land justifies this expense.
Chairman Rawson:
We will close the hearing on A.B. 402. What is the pleasure of the committee?
SENATOR WASHINGTON MOVED TO AMEND AND DO PASS A.B. 402.
SENATOR WIENER SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS TOWNSEND AND MATHEWS WERE ABSENT FOR THE VOTE.)
*****
Chairman Rawson:
We have a presentation by the American Legislative Exchange Council on price controls.
Doug Bandow, Senior Fellow, Cato Institute:
The issue I want to talk about today is price controls. The cost of pharmaceuticals has become a major concern. The National Institute for Health Care Management Foundation issued a study stating that last year the cost of drugs increased by 18.8 percent. It is critical when we look at a number like that, to look behind the number. What is significant is, the foundation found the price increase of existing drugs accounted for about one-fifth of the increase. The primary increase was caused by the volume of pharmaceuticals, and the shift to newer drugs. Half of the increase is attributable to a couple of dozen major drugs involving things such as depression, arthritis, cholesterol, and other serious conditions. Americans want better drugs, and they want more of those drugs for conditions that they face.
What does one do to alleviate the cost issues without getting in the way of them? State governments have begun to consider controls over drug prices; others are expanding assistance for the aged and indigent in paying for pharmaceuticals. Looking across different countries and medical systems, price controls tend to discourage development, create shortages, and other unforeseen consequences as companies try to work around them. For example, European companies are more likely to engage in marginal research rather than try to develop major new drugs. But what you cannot do is confiscate that which has not been created. Price controls discourage creation in the future.
I think there is a lot said about development. People want access to the benefits of pharmaceuticals, and they help lower other medical expenses, by avoiding surgeries. Drugs have to pay for themselves, and the failures of research. The successful drugs pay for the entire process of research and development. I would encourage you to review the degree of the problem, target the need, and use an assistance program to meet the needs. Encourage federal officials to reform Medicare to bring pharmaceuticals under the plan, and encourage private alternatives.
Chairman Rawson:
It occurs to me one reason Americans demand drugs is because of intense advertising, which helps to drive the costs. We also see some interesting pricing strategies where some drugs will be over-the-counter in Canada, and prescription in the United States. As you bring several different suppliers into the marketplace, you will see almost identical drugs, and there is not a consistency between the countries. I would be interested in more information on some statements that prices in the United States are not the highest worldwide, and American consumers are not paying more to subsidize foreign consumers. That information would be useful to the committee.
Mr. Bandow:
I will be happy to get some of the underlying documentation.
Chairman Rawson:
Whether there is a crisis or not, there is a growing perception among our seniors that prescriptions are a major part of their health care costs.
Senator Wiener:
It is my understanding drugs that are prescription in the United States versus what is sold over the counter in Mexico or Canada account for the major difference in costs, and that difference is attributable to liability. I also understand substantial sample packages of drugs are distributed to physicians in order to get an interest among patients, particularly the vulnerable senior population.
Chairman Rawson:
This committee is not opposed to profit, but we are concerned about excessive profit, and wish to encourage fair play.
Senator Washington:
I would be interested in data you might have that discusses the pros and cons of who is best suited for the allocation and dispensing of pharmaceuticals to seniors, the states or the drug companies. Also, in dealing with an aging population with an appetite for new drugs to extend youth, how much of that drives the market?
Mr. Bandow:
The issue of the aging population is important for all health care costs. Seniors complain more about prescription costs because Medicare does not cover these out-of-pocket expenses. It is critical to remember pharmaceuticals offer an offset, by keeping somebody out of the hospital you are actually saving money. One of the problems with Medicare is the benefits are not coordinated. Many states have different programs, but they are all fairly new and there is not much data out there. I will find what information I can for you.
Chairman Rawson:
I think what Senator Washington is asking is, are we better off to have private insurance or a state program.
Mr. Bandow:
My inclination would certainly be private insurance.
Chairman Rawson:
I am not sure the American consumer should be bearing the brunt of supplying AIDS (acquired immunodifidiency syndrome) drugs to Africa. Perhaps the taxpayer should pay through foreign aid; that is instead of giving guns and tanks the aid will be used for things such as food and medicine.
The liability absolutely drives these costs, maybe in a way that it does not in other countries.
Senator Washington:
If the drug is approved by the Federal Drug Administration, does that not shield the company from a part of the liability of the product?
Mr. Bandow:
Federal Drug Administration approval is not enough to shield a company. Part of the price differential with Canada and other countries is the liability factor. There are many factors that go into the international comparisons. We have more reliance on generics, which often do not get into the statistics.
Chairman Rawson:
We will open the hearing on A.B. 636.
ASSEMBLY BILL 636: Makes various changes to provisions governing admission of allegedly mentally ill person to mental health facility. (BDR 39-1077)
James J. Spinello, Lobbyist, Clark County:
A number of individuals are brought to the emergency rooms who in fact need mental health assistance. Under state law those persons are first required to have a medical screening examination, to make sure the cause of their apparent mental illness is in fact that, and not a physical problem. This bill would expand the other element of state law, which calls upon law enforcement to transport the individual to a facility where they can have the medical examination. A system for the nonemergency medical transportation of persons whose operation is authorized by the Transportation Services Authority, or an ambulance service that holds a permit would be added. Assembly Bill 636 would also add those qualified to examine the person include a physician’s assistant or an advanced practitioner of nursing. Those are the essential elements of the bill and the intent is to try to help those individuals to more directly and efficiently get to the mental health services they need and also relieve the emergency rooms.
Chairman Rawson:
This is a triage function, not a definitive diagnosis of the individual’s status. I think it lists it here as a screening examination and I am just trying to see if it is truly a screening we are looking at.
Mr. Spinello:
Current law states the allegedly mentally ill person be examined by a licensed physician. I believe they are given a pretty thorough physical to determine if there are any physical problems, but there are probably other professionals who can speak to that.
We would like the bill moved. The amendment being presented here today would add there would still be a physician present.
Chairman Rawson:
Are there any places you are aware of where there would not be a physician on the premises?
Mr. Spinello:
None that I am aware of.
Senator Wiener:
Has the Transportation Services Authority defined this nonemergency medical transportation?
Mr. Spinello:
Yes, Medicar Services (radio dispatched cars to provide transportation to and from medical offices, hospitals, rehabilitation center, and nursing homes) qualifies for that provision.
David Rosin, M.D., Medical Director, Southern Nevada Adult Mental Health Services, Division of Mental Health and Developmental Services, Department of Human Resources:
I am here today to offer an amendment to A.B. 636 by adding, “with on-site supervision by a physician” inserted after “advanced practitioner of nursing.”
The bill in its current form would allow, for the first time, nonphysicians to perform a very critical medical examination. Giving nonphysicians this responsibility is a major change. The Division of Mental Health and Developmental Services cannot support the bill as it is drafted because of inadequate supervision of the nonphysician. This proposed amendment requires the presence of a physician on-site when a nonphysician performs the medical examination to certify medical stability.
Chairman Rawson:
Would you say it is a shortcoming of our system that we are not able to deal with medical conditions within the mental health system?
Dr. Rosin:
I think for us to be able to say we could do otherwise would take major resources to upgrade our system.
Chairman Rawson:
But, is it where we should be headed, to treat the whole person?
Dr. Rosin:
If I had my choice, yes. I was in private practice for 24 years, and I always assumed that responsibility. On the other hand, representing the system, it would take considerable resources and effort to get to that point.
Chairman Rawson:
Physician’s assistants and advanced practitioners of nursing work under protocols. It seems to me they have to have the approval of a physician for those protocols, and they are not ever that far removed from access to a physician.
Dr. rosin:
We have a special situation which requires a special standard. Men and women who suffer from severe mental illness are truly a special population. They are unable to give accurate medical history because of the severity of their mental illness. When they are suicidal, there is little motivation to assist in their own health issues. They usually have neglected their health because of mental illness. This examination may be their first adult contact with a health provider. There are more undiagnosed medical problems than in the general public, and illness when present is more severe due to lack of prior treatment. The severely mentally ill tend to be irrational and emotionally volatile. This limits cooperation with the medical examination. Hallucinations and paranoid delusions often make the examining person “the enemy.” They are not cooperative patients. Drugs and alcohol often complicate the diagnostic picture and make examination harder. If a nonphysician is responsible for the medical evaluation they must have immediate access to a physician consultation.
Several years ago when legislation funded modern psychiatric medications, a commitment was made not to have two standards of care, one for the general public and one for the severely mentally ill. This amendment ensures the continuation of that principle.
Chairman Rawson:
Is the section of this bill you are concerned about specifically the transporting of someone from a facility to a mental health facility?
Dr. Rosin:
It is the examination being done in emergency rooms, prior to transporting to a mental health facility. Assembly Bill 636 might change the location to an urgent care setting, and this protection would not be necessary. I do not know of an urgent care that does not have a physician.
Chairman Rawson:
What is the area you are concerned about?
Dr. Rosin:
I am very concerned about the thrust that came earlier which would allow people in ambulances to make this evaluation in an unsupervised setting.
Chairman Rawson:
Would this bill allow that?
Dr. Rosin:
I believe it does, as written. There is a move to get some of our psychiatric clients out of emergency rooms, and we have no problem with that if we are looking at a regulated facility.
Chairman Rawson:
You are asking for a separate standard of care for the mental health patient than that of the general public.
Dr. Rosin:
We already have a different standard in the law, which requires a physician evaluation before rights are taken away from an individual and they are detained against their will. The general public does not live under those circumstances. We are talking about a decision in a person’s life, where in fact, they will be detained until there is a court hearing
Chairman Rawson:
But this does not have anything to do with that legal hearing.
Dr. Rosin:
If in fact they are found to be physically ill, Nevada Revised Statutes does direct them into a hospital for treatment, prior to admission to a mental health facility.
Janice C. Pine, Lobbyist, Saint Mary’s Health Network:
A coalition of providers from northern Nevada met numerous times over the interim, trying to deal with the issue of expediting the examination process. It was the recommendation of that group of providers that advanced practitioners of nursing and physician’s assistants be allowed to perform the examination. I do not think the coalition would be supportive of the recommendation by Dr. Rosin. It would basically throw up a roadblock, and try to preserve the status quo while we are trying to facilitate the process. It is within the scope of practice of a physician’s assistant and an advanced practitioner of nursing to be able to perform certain duties. If they go beyond those duties, then they are in danger of losing their license. Within the discussions of the coalition there were no discussions about trying to perform examinations in an ambulance, and I think I can represent to you today that is not the intent. The intent is for the examination to be performed in an ethical and professional manner by advanced practitioners of nursing or physician’s assistant, in a facility with the benefits of
equipment and processes these professionals would require in order to keep their licenses.
Chairman Rawson:
You have no reservations about creating a legislative intent here that this is for facilities, not for ambulances?
Ms. Pine:
I do not. I do not believe there are enough of these types of transports in a day that would warrant having a higher-priced professional on board an ambulance.
Senator Wiener:
We are trying to discern which facilities would not have a physician. You are talking about the protocols for the physician’s assistant or an advanced practitioner of nursing, and you just mentioned they would want all the tools of their craft around to do a proper diagnosis. They would be in a facility that has a physician on-site, correct?
Chairman Rawson:
I could see rural facilities where they would not.
Ms. Pine:
It is possible a patient could go to a doctor’s office, and it is also possible somewhere down the road a community could staff a clinic where these patients could be evaluated, under the supervision of physicians. Right now I do not know of any facilities where patients are presently being taken where there are no physicians. There are innovative ways that could be done in the future where there may not be a doctor on the premises.
Cynthia Pyzel, Senior Deputy Attorney General, Division of Mental Health and Developmental Services, Office of the Attorney General:
Part of our concern before the amendment was offered is, it becomes a trap for the unwary under existing federal laws governing the transfer of patients with emergency conditions, which requires physician oversight. We were concerned about the state law expressing a standard that is contrary to federal law, which is going to be controlling.
Margaret Thompson, Concerned Citizen:
As a senior medical student, I would like to express my support of the amendment offered by Dr. Rosin. Under federal law, all patients deserve a full examination by a licensed physician prior to being transported. I think the mentally ill patient should be given equal consideration under the law.
Chairman Rawson:
We are not here trying to change the law generally. The law says people can be examined by other than physicians, and we have made a policy in this state to allow physician-extender personnel (physician’s assistants and advanced nurse practitioners who carry out activities under direct case-by-case supervision of an experienced physician) to perform examinations.
We will close the hearing on A.B. 636, and open the hearing on A.B. 550.
ASSEMBLY BILL 550: Revises provisions governing rights of clients of mental health facilities and patients of health care facilities and revises procedures for detention and civil commitment of mentally ill persons. (BDR 39-1479)
Wm. Patterson Cashill, Lobbyist, Nevada Trial Lawyers Association:
This bill came out of a situation involving a real estate broker in Reno, Mr. George Shoenberger, who in early December of 2000 was involuntarily committed to the West Hills Hospital, and remained involuntarily committed for a period of 71 days. It was not until 41 days into the commitment that any judge made any determination that he should be held involuntarily. During the course of his confinement his treating physician rendered the opinion that he did not meet the criteria for involuntary commitment, yet nothing was done to release him. He was deprived of his right to counsel, and he was involuntarily medicated.
The explicit language of A.B. 550 was generated through the Assembly judiciary committee. A working group was formed that included Ms. Pyzel, Leslie Admirand, of the Washoe County District Attorneys Office, Kathleen O’Leary of the Washoe County Public Defenders Office, and various other people who had an interest in this issue. The bill before you had some Assembly amendments, and we seek further Senate amendments. The proposed amendments have been distributed. The Assembly judiciary committee, because of time restrictions, did not consider these amendments. The bill came to a head during the waning days of the Assembly deadline, and we discussed with others on the committee the need to make certain amendments on the Senate side. It was with the understanding the working group would continue that the Assembly passed the bill. The only vote against the bill at the committee level was by Assemblyman John C. Carpenter, part of Elko County, Assembly District No. 33, , who expressed his reservation that he simply needed more information. His doubt was resolved on the Assembly side, based on my assurance to him that he would have his questions answered by Ms. O’Leary and others.
Chairman Rawson:
We have dealt with a lot of these issues over the years, and I suppose this is everybody’s nightmare that something like this can happen. Has there been some action taken by this individual?
Mr. Cashill:
He does have civil recourse, and there may be criminal avenues as well.
Senator Wiener:
There is a provision in the bill concerning transporting the allegedly mentally ill person, and I am wondering if there is a conflict with testimony heard earlier on A.B. 636.
Ms. Pyzel:
I do not believe there is a conflict. It is a multi-tier process to bring a person in for any emergency evaluation, and for the first tier you have a group of people expert in the observation of mental conditions of individuals to get the process rolling. The process earlier has to do with the second phase of the process.
Senator Wiener:
Looking at the language, I still see there could be a substantial overlap with A.B. 636. This bill states that without a warrant, the allegedly mentally ill person could be transported to a public or private mental health facility or hospital for an emergency admission.
Ms. Pyzel:
As I said, it is a two-step process, and you are talking about the two applications of the screening. I believe it is always difficult when you have bills that cover similar sections of the law, and that is why the Legislative Counsel Bureau helps to conform to legislative intent. This bill also brings into play the ability to take a person into custody without a warrant, and adds a new provision to allow a warrant to be obtained in order to bring a person into custody.
Senator Wiener:
I sense it is our job to understand what we are asking the Legislative Counsel Bureau to clarify.
Mr. Cashill:
At the request of Carlos Brandenberg, Ph.D., Administrator, Division of Mental Health and Developmental Service, Department of Human Resources, we met to address some additional issues. The reference to chapter 433 of Nevada Revised Statutes will be changed to chapter 433A to assure the scope of the bill will not include children, the mentally retarded, or the clients of Lake’s Crossing (Lake’s Crossing Center for the Mentally Disordered Offender).
Leslie Admirand, Deputy District Attorney, Forfeiture Unit, Civil Division, District Attorney’s Office,Washoe County:
The Washoe County District Attorney requests, “subsections 1, 2 and 3” be inserted on page 2, line 7, after NRS 433A.270.
Mr. Cashill:
Additionally, on page 4 we request lines 14 through 25 be deleted, to eliminate the involvement of the district attorney’s office in the preparation of a petition.
One final change, on page 1, line 13, after the word “court” insert “upon judicial review.” This was requested by Ms. Pyzel in order to address the procedure presently in place at state facilities, which involves an administrative-like hearing, where there is medical input provided, in the event involuntary medication is sought to be administered.
Ms. Pyzel:
I believe that language would assist the private-sector facilities in understanding the material they need to bring to the court. What we have done in the state facilities is adopted a three-tiered process with independent review by medical practitioners, so it truly is review of the clinical judgment by peers as to the appropriateness of the intervention and the legitimacy of the claims. We produce the evidence for courts, which consider it among all the factors they need under federal standards. This is basically taking the court review process that is currently done and putting it in statute. The division has many other procedural and substantive due-process steps that we follow to make sure what happened to Mr. Cashill’s client in a private-sector facility does not happen in a state facility.
Dr. Rosin:
I would like to clarify the tiered process. The first tier is the application which can be made by an accredited agent of the department, an officer authorized to make arrests in the state of Nevada, a physician, a psychologist, a marriage and family therapist, a social worker or a registered nurse. The person is evaluated medically, and can then be further detained.
Chairman Rawson:
Essentially, this is speaking to the group of folks who are authorized to make application, so if they are concerned about people harming themselves or others, they can submit an application for emergency admission.
Dr. Rosin:
They can make application, which leads to the transport by ambulance or police.
Kathleen O’Leary, Deputy Public Defender, Public Defender’s Office, Washoe County:
Our office represents any patient subject to a civil commitment hearing. We also represent those patients following commitment who are challenging their medication. This current draft of the bill represents a great deal of collaboration between the parties, and the Washoe County public defender fully supports the bill.
Chairman Rawson :
Is there a general agreement on all of this with the various parties?
Mr. Cashill:
There is broad nearly unanimous consensus on nearly every issue, but it would not be accurate to say there is 100 percent consensus on every issue.
Our agreement to insert the language “upon judicial review” is not meant to tie the hands of the judge. The judge has the full power constitutionally to make whatever determination she or he chooses to make. The court has the power to determine what the least-restrictive method of treatment is, and it is not anybody’s intent at this table to tie the hands of the judge in making that kind of a determination.
Ms. Admirand:
I am here on behalf of the Washoe County district attorney’s office. We are in favor of the proposed amendments to A.B. 550. I wanted to comment on the proposed amendments, which states the Washoe County district attorney’s office wants any amendments to section 9 deleted. It is not to the substance of that section, and the objection should not hold up the bill.
The handout I have provided addresses some of the concerns Mr. Cashill brought up in the case of his client. The deputy district attorney who prosecuted the mental health proceeding with regard to Mr. Shoenberger wanted to have a copy of the court’s order dated January 31, 200l, entered as part of the record (Exhibit C).
Chairman Rawson:
There being no further testimony, and no objections from the state, we will close the hearing on A.B. 550, and I ask the committee for a motion on this bill.
SENATOR WIENER MOVED TO AMEND AND DO PASS A.B. 550.
SENATOR TOWNSEND SECONDED THE MOTION.
THE MOTION CARRIED. (SENATOR MATHEWS WAS ABSENT FOR THE VOTE
*****
H. Pepper Sturm, Committee Policy Analyst:
The first item for the work session is A.B. 195.
ASSEMBLY BILL 195: Revises provisions relating to Nevada silver haired legislative forum. (BDR 38-534)
There were some amendments suggested for the bill. Essentially, the amendments restore the number of members to reflect senatorial districts, with the Senators nominating and the Legislative Commission making the appointment. Also, the amendment provides for staggered appointments and legislator donations to the Silver Haired Legislature.
Senator Wiener:
Would the provision in the bill that allows the forum to accept gifts, grants, and donations not allow for legislator donations?
Chairman Rawson:
What I was trying to do, and this may be unnecessary, was to try to make the statement that if a legislator used campaign funds to donate there should not be ethical questions.
Senator Wiener:
Would the $500 donation from a legislator be a lifetime cap?
Chairman Rawson:
I was thinking per their session, which is every 2 years. Committee, tell me what clarification you wish.
Senator Wiener:
If anybody should have a vested interest in the success of the forum, it should be those of us who are here sitting with a relationship with them. The time frame should be clarified.
Chairman Rawson:
Do you want to specify up to $500 per senior legislature session, up to $1000 per state senator term?
Senator Wiener:
I think it should be per term of a senator, because there are staggered terms for the members of the forum, and there are also dual districts involved.
Chairman Rawson:
How much do you want to limit?
Senator Wiener:
I would say no more than $1000 in one state senatorial term.
Chairman Rawson:
I do not know that we need to be the sole support of the forum. Let us set the limit at $500 for each senator, per senatorial term.
Mr. Sturm:
Section 8 shows the current law, and the proposed amendments. The Silver Haired Legislative Forum is currently required to submit a report “containing topics for possible legislative action.” That has been amended to say a report “containing recommendations for legislative actions.” There is not a fixed number there, if that is something you wish to consider.
Chairman Rawson:
Let us list a number, so we do not go crazy with recommendations. Who would like to suggest a number? We will list it as four primary issues.
SENATOR WIENER MOVED TO AMEND AND DO PASS A.B. 195.
SENATOR AMODEI SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS TOWNSEND, MATHEWS, AND SCHNEIDER WERE ABSENT FOR THE VOTE.)
*****
Mr. Sturm:
The next bill is 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)
All parties came to an agreement in a subcommittee meeting held May 15, 200l, chaired by Senator Wiener.
Chairman Rawson:
There were some who were concerned about any amendments to this bill. Do you feel that in the subcommittee there is now agreement?
Senator Wiener:
The subcommittee especially needed to comply with federal law, so that we would not lose funding. Almost every change is tied to a federal requirement.
SENATOR WIENER MOVED TO AMEND AND DO PASS A.B. 248.
SENATOR AMODEI SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS TOWNSEND AND MATHEWS WERE ABSENT FOR THE VOTE.)
*****
Mr. Sturm:
ASSEMBLY BILL 253: Enacts Uniform Athletes’ Agents Act. (BDR 34-992)
Senator Titus has a proposed amendment, that clarifies the costs incurred from an investigation or hearing of an incident caused by a booster also may be recovered. Additionally, one of the committee members had a series of questions, and a memo is provided with the answers (Exhibit D).
Senator Washington:
Does the amendment say that if the athletic association initiates an investigation they must bear the cost?
Chairman Rawson:
That is correct. What is the pleasure of the committee?
Senator Wiener:
My understanding of the amendment was, if a booster were the reason for an investigation, they would pay for it. Is that clear in the amendment?
Mr. Sturm:
I will check with the Legal Division of the Legislative Counsel Bureau for clarification.
Chairman Rawson:
Other than that, does the committee wish to see this processed?
SENATOR WIENER MOVED TO AMEND AND DO PASS A.B. 253.
SENATOR SCHNEIDER SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS TOWNSEND AND MATHEWS WERE ABSENT FOR THE VOTE.)
*****
Mr. Sturm:
The next bill is A.B. 318. There were no amendments proposed; no opposition was expressed.
ASSEMBLY BILL 318: Provides for development and distribution of certain information relating to high school proficiency examination. (BDR 34-1301)
SENATOR AMODEI MOVED TO DO PASS A.B. 318.
SENATOR WASHINGTON SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS TOWNSEND AND MATHEWS WERE ABSENT FOR THE VOTE.
*****
Mr. Sturm:
The next bill is A.B. 444, and includes amendments proposed by Assemblywoman Freeman to address broker responsibility for certain notices. These are included along with a Conflict Notice (need to change references to Bureau of Alcohol and Drug Abuse to Health Division and health board).
ASSEMBLY BILL 444: Makes various changes regarding preservation of neighborhoods. (BDR 40-906)
SENATOR WASHINGTON MOVED TO AMEND AND DO PASS A.B. 444,
SENATOR AMODEI SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS TOWNSEND AND MATHEWS WERE ABSENT FOR THE VOTE.)
*****
Mr. Sturm:
The next bill is A.B. 488.
ASSEMBLY BILL 488: Revises provisions relating to transportation by fire-fighting agencies of sick or injured persons to medical facilities. (BDR 40-181)
The only proposed amendment was for the deletion of “without limitation” on page 2, line 3. Due to concerns of the committee, the committee may wish to consider a letter of intent to clarify that the county would be acting to provide such services only in the event of an emergency situation.
Chairman Rawson:
We have a letter from Clark County Commissioner Dario Herrera stating it is not the intention of the county to do this unless there was an emergency. He said he wants to assure us that it is not the county’s intent to compete with providers, but if they should go out of business, the county would need to be able to respond.
Senator Wiener:
For the record, in the hearing Mr. Spinello voiced several times what an emergency situation would be. We see that the two ambulance providers do have contracts that expire at the same time, and the city is now allowed to provide service and charge a fee, whereas the county is not allowed to charge a fee. The county does have one of the largest populations in the state. I do not want to see the private industry be pushed out.
Chairman Rawson:
In our letter of intent, we can express our concerns about this, and then suggest if there is an interim study on the issue of public versus private competition, that this issue be included in the study.
SENATOR SCHNEIDER MOVED TO DO PASS A.B. 488 WITH A LETTER OF INTENT.
SENATOR WASHINGTON SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS TOWNSEND AND MATHEWS WERE ABSENT FOR THE VOTE.)
*****
Mr. Sturm:
Our next bill is A.B. 499.
ASSEMBLY BILL 499: Revises provisions governing policy for renovation or reconstruction of schools and authorizes use of money from fund for capital projects for continuation of pilot program for replacement of schools in certain school district. (BDR 34-861)
An amendment was suggested that reduces the number of schools from eight to five. The committee might also wish to review the amount authorized for such actions.
Chairman Rawson:
I think it is necessary to process this. Something has been started that took on a life of its own, and I am not sure it has been done responsibly. If this were to be replicated in all of these schools, it would be a disaster, and I am thinking if we pass this, I would like an accounting of the money that has been used to this point. I specifically want to know the costs for consultants, projects, and trips, everything that is involved. It could be reported to the interim committee on education, since they will have an interest in pursuing this. I just do not want to lose track of this. I think we have gone from what was essentially a $12.5 million project to an $18 million project. It may be a wonderful school, but I do not think we can afford it everywhere and I do not think we want to duplicate this.
Senator Wiener:
As I recall, the architectural costs were something like 7 to 8 percent of the total cost, which is pretty substantial. I also heard a disclaimer that each project must be designed to be site specific. Several years ago I attended the groundbreaking ceremonies of several schools, and every single school had a different architect; I do not think that is appropriate.
Chairman Rawson:
I would accept a motion on this, but we need to follow it with a request for a thorough accounting.
Senator Washington:
Does this need to be re-referred to Senate finance committee?
Chairman Rawson:
The fiscal note says no.
Senator Washington:
May I offer proposed amendments that went into Senate Bill 292? Basically they are just technical amendments for the operation and maintenance of charter schools.
SENATE BILL 292: Revises provisions governing education. (BDR 34-382)
Chairman Rawson:
My sense of what has happened in this session is that there have been a number of bills that have been confused and tied up, but there are some essential elements that need to pass this session.
Senator Washington:
I would like to offer these as friendly amendments. They are not controversial, they are just technical adjustments that charter schools need.
Chairman Rawson:
Does the committee have any concerns?
Senator Wiener:
I am not trying to put up a roadblock, but in fairness, I think we should check with the sponsor of the bill.
Chairman Rawson:
I suspect anyone would say at this point in the session they do not want any amendments because it slows things down. However, this does go back to the Assembly for consideration so I do not mind trying to get this through. I am willing to entertain it because of the lateness of the session, but we may or may not be able to defend this. I think A.B. 499 needs to happen or there will be some people in trouble.
SENATOR WASHINGTON MOVED TO AMEND AND DO PASS A.B. 499.
SENATOR AMODEI SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS TOWNSEND AND MATHEWS WERE ABSENT FOR THE VOTE.)
*****
Mr. Sturm:
ASSEMBLY BILL 659: Revises provisions pertaining to contents of policies adopted by certain larger school districts concerning reconstruction, renovation or replacement of older buildings. (BDR 34-872)
No amendments were proposed and no opposition was expressed.
Chairman Rawson:
It seems innocuous. It is asking for them to develop a procedure, to take it out of the political realm in the future.
SENATOR WIENER MOVED TO DO PASS A.B. 659.
SENATOR AMODEI SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS TOWNSEND AND MATHEWS WERE ABSENT FOR THE VOTE.)
*****
Chairman Rawson:
We will adjourn this meeting at 4:35 p.m.
Cynthia Cook,
Committee Secretary
APPROVED BY:
Senator Raymond D. Rawson, Chairman
DATE: