MINUTES OF THE
SENATE Committee on Human Resources and Facilities
Seventy-First Session
April 2, 2001
The Senate Committee on Human Resources and Facilitieswas called to order by Chairman Raymond D. Rawson, at 2:05 p.m., on Monday, April 2, 2001, in Room 2135 of the Legislative Building, Carson City, Nevada. The meeting was video conferenced to the Grant Sawyer State 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 Maurice Washington, Vice Chairman
Senator Randolph J. Townsend
Senator Mark Amodei
Senator Bernice Mathews
Senator Michael (Mike) A. Schneider
Senator Valerie Wiener
STAFF MEMBERS PRESENT:
H. Pepper Sturm, Committee Policy Analyst
Cynthia Cook, Committee Secretary
OTHERS PRESENT:
James Carosone, Concerned Citizen
Amanda Goddard, Concerned Citizen
Craig Huntington, Concerned Citizen
Larry Ashley, Professor, University of Nevada, Las Vegas
Frankie Sue Del Papa, Attorney General
Yvonne Sylva, M.P.A., Administrator, Health Division, Department of Human Resources
Michael J. Willden, Administrator, Welfare Division, Department of Human Resources
R. Alexis Miller, Lobbyist, Planned Parenthood of Southern Nevada
Helen A. Foley, Lobbyist, Clark County Health District
Dana Bennett, Lobbyist, Nevada State Medical Association
Connie Foxwell, Concerned Citizen
Janine Hansen, Lobbyist, Nevada Eagle Forum
Lynne Chapman, Lobbyist, Nevada Families Education Foundation
William Lloyd, Concerned Citizen
Nikki Meleskie, Executive Director, Family to Family: Americans for Prostrate Cancer Support
Lew Musgrove, Concerned Citizen
Maureen Brower, Lobbyist, American Cancer Society
Mary C. Walker, Lobbyist, Carson-Tahoe Hospital
Joan Lapham, Director, Carson Ambulatory Surgical Center Incorporated
Steve Smith, Chief Executive Officer, Carson-Tahoe Hospital
Robin Keith, Lobbyist, Nevada Rural Health Project Foundation
Rick C. Bennett, Lobbyist, University of Nevada, Las Vegas
Chairman Rawson:
We will call the meeting to order. We have video to Las Vegas which we are going to lose in an hour. We have two bills of interest to those in Las Vegas, and I understand there is to be testimony on both. I will open hearings on Senate Bill (S. B.) 367 and Senate Concurrent (S.C.R.) Resolution 17.
SENATE BILL 367: Provides for administration of certain activities to reduce rate of pregnancies among unmarried teenage girls in Nevada. (BDR S-26)
SENATE CONCURRENT RESOLUTION 17: Urges Commission on Mental Health and Developmental Services in cooperation with Department of Education, University and Community College System of Nevada and local school districts to take steps necessary to increase public awareness of certain eating disorders. (BDR R-25)
Senator Wiener:
Mr. Chairman and members of the committee, for the record, I am state Senator Valerie Wiener, representing Clark County Senatorial District No. 3. Today I appear before you to urge your support for Senate Bill 367, which provides for the administration of certain activities to reduce the rate of pregnancies among unmarried teenage girls in Nevada.
The idea for this legislation dates back to a health conference I attended, along with Chairman Rawson, in Minneapolis after the last legislative session. One of the important issues emerging from the conference was the crisis in America revolving around teen pregnancies. When I left the conference I vowed to do something about the problem in Nevada.
Before I get into the details of the bill, let me give you some data to underscore how considerable this problem is on a national scale.
According to March 21, 2001, MSNBC report, 39 percent of ninth graders, and 65 percent of twelfth graders have engaged in sex. One in three teens opt for no birth control, and 25 percent of American girls have been pregnant at least once by the age of 20.
Senator Wiener:
On the “up side,” according to the Associated Press (August 9, 2000) teenagers are having babies at the lowest rate in at least 60 years. Nationally this translates into about 50 births per 1000 teenage girls, a reduction by almost half since 1957 (96 births per 1000).
Nevada has fallen from number 1 to number 4 in births for 15 to 19 year olds. We can boast a reduction of 20 percent since 1995. In 1999, the reduction translated to 75 births per 1,000 population for 15-to 19-year-old mothers.
Whatever the reasons for the reduced rate, this decline gives us hope. Certainly, the risks in the 1990s were greater, even life threatening. Young people have attributed their awareness to advertising campaigns and community based and faith-based programs. Even seeing their friends having children has had a chilling effect, sometimes resulting in the teens forgoing sexual activities altogether.
The harsh reality is simple. Nevada has nothing substantial to boast about just because we have dropped from first place, a position we held for nearly a decade, to fourth place.
Senator Wiener:
In fact, Nevada still has to deal with the reality of more than half of our high school students reporting they have had sexual intercourse. One in 15 of our teens has engaged in sexual activity before the age of 13.
We also know those teens who use alcohol or drugs are more likely to find themselves in risky sexual situations. In Nevada more than one in four sexually active students drank alcohol or used drugs before they had sexual intercourse the last time. We are gathered here to do more than listen to numbers. Senate Bill 367 will help reduce the rate of teen pregnancies in our state.
First, as you will note in section 1 of S.B. 367, we create a state partnership to carry out activities throughout the state designed to raise public awareness among unmarried teenage girls in Nevada. The partnership is comprised of the health department administrator and others she appoints, representing education, social work, juvenile justice, law enforcement, family court, health care, and parents.
The partnership will meet not more than six times during each biennium until 2005. They will submit reports to the Legislature.
The health department will be able to accept gifts, grants and donations to help the partnership carry out its duties. This includes monies received pursuant to TANF (Temporary Assistance to Needy Families).
In section 5 of S.B. 367, the duties include promoting efforts to reduce the rate of pregnancies among unmarried teenage girls in Nevada, establishing and promoting the recognition of “Teen Pregnancy Prevention Month,” and developing and carrying out two social marketing campaigns.
Senator Wiener:
To accomplish its duties, the partnership will develop and carry out a program to award grants for the implementation and evaluation of local projects in Nevada.
There shall be one grant to Clark County, one grant to Washoe County, and at least one grant to any other county in the state. Each recipient will be required to submit reports about the use of the money and the effectiveness of the program.
I experienced great relief when I learned about a funding opportunity to expedite the goals in the bill. Legislation provides for an inter-agency agreement between the Health Division and the Welfare Division. The Welfare Division will be able to transfer TANF money to the Health Division to carry out the provisions of S.B. 367 to reduce out-of-wedlock pregnancies in Nevada.
Chairman Rawson:
What are we expecting the costs of this to be?
Senator Wiener:
I worked with Mike Willden from the Welfare Division and Yvonne Sylva from the Health Division on this. I would rather they explain how the funding would take place.
James Carosone, Concerned Citizen:
I am a junior at Palo Verde High School. I wish to share my concerns about teen pregnancies and eating disorders. These problems exist in our society, and especially in my age group. We lack the proper education about them to fully understand their impact unless they touch our lives directly. I have close friends who have acted without thinking things through, or considering the consequences. As a result, girls have become pregnant. The situation has disrupted her life, her boyfriend’s life, and both sets of parents. The baby is born in an atmosphere of disadvantages.
Another issue teens face is eating disorders. Most people who develop these problems do not realize the consequences until they are no longer able to hide it from their parents. The parents find information for the average person is limited, and not knowing how to recognize early signs has proven deadly in some situations. The first step in dealing with and fighting these issues is better education.
Amanda Goddard, Concerned Citizen:
I am a student at Silverado High School and also a representative of the Leadership Las Vegas Youth program. I am in full support of S.B. 367 because I feel teen pregnancy can be attributed to both ignorance and a lack of education. I hope these campaigns reach teens in the largest numbers. With the funding allowed in this bill, a campaign will hopefully make information more available. It reminds me of the recent AIDS awareness campaign, and I believe today’s teens are much more aware of STDs (sexually transmitted diseases) and the risk of those because of that campaign.
Craig Huntington, Concerned Citizen:
I am a student at Valley High School, and a member of the Leadership Las Vegas Youth program. Regarding S.B. 367, I think it is really important we do something about this in Nevada, and especially in Clark County. I see a lot of students who are pregnant, and it affects a lot of people in many different ways. The environment is harder for students to learn in, and makes it harder for those students who are pregnant to be successful in their later careers. I do feel this is an excellent bill, but I would like to see it taken to another level. When children are pregnant in Minnesota, they are immediately sent to an alternative school, and it has reduced the teen pregnancy rate. I think both males and females should be targeted for education, and the consequences of their actions.
Senate Concurrent Resolution 17 is also a good bill. However, I believe one clause should be included. As part of the educational materials, there should be sufficient information to inspire Nevadans to support legislation to include eating disorders as part of the insurance benefits mandated for mental health coverage. Further, it is not the responsibility of our schools and our teachers to inspire students to support legislation, I kind of think it is more important for teachers to inspire students to learn. The bill could be implemented into our health classes and give students a little more information about certain eating disorders.
Larry Ashley, Professor, University of Nevada, Las Vegas:
I teach addiction courses at the university, and I came to speak on behalf of S.C.R. 17. In my classes, I always teach about compulsive behaviors, especially eating disorders. The bill is critical, because a lot of young ladies start going toward what the media tells them they should look like, and do not take into consideration the implications of eating disorders. Also, many young ladies take diet pills, which further complicates the issue. The bill is going to require the development of appropriate materials, which is not something a lot of places are ready to do.
I see teen pregnancy issues constantly, and I have seen teenagers who have had their lives destroyed because they were using drugs and alcohol at the same time they got pregnant. I strongly urge the passage of both these bills.
Ms. Goddard:
I wanted to comment on S.C.R. 17. In addition to my affiliation with the Leadership Las Vegas Youth group, I am also president of the Silverado High School Global Lab, in which we focus on many environmental and social issues. Between 1998 and 2000, we conducted a diet study for teens. I have seen firsthand the detrimental effects of eating disorders. Most were not aware they had a problem, because of the lack of education. They felt alone in their battles. I found a lot of the disorders were not just caused by low self-esteem, but also from outside pressures. We believe education and awareness will help alleviate some of these outside influences and pressures. I think in the education discussed in the bill, it would be proper to include information on how to diet properly.
Chairman Rawson:
Now the Las Vegas testimony is complete, we will hear the bills in order. The hearing now is for S.B. 367.
Frankie Sue Del Papa, Attorney General:
I am a member of the National Campaign to Prevent Teen Pregnancy, which is a nonpartisan group partially funded by the Robert Woods Johnson Foundation. I am here to speak in favor of the bill, and what I would like to do is explain where we are as a state, and where I think we need to go as a state, regarding this very important public policy issue. We held hearings throughout the state, and the result was a plan for action from 1996 to 2000. The plan implemented components for involvement in the following areas: community action, media, state leadership, parental and legislative action. The heart and soul was to establish Community Action Teams (CAT) throughout the state.
Nevada has consistently rated among the top 10 states with the highest teenage pregnancy rates. Among the various populations we have in our state, one of the big concerns is the Hispanic teen pregnancy rate, which is virtually off the scale. Nationally, the 1990s have brought some good news. The teen birth rate has declined by 16 percent from 1991 to 1997, with all states recording a decline in the birthrate for the 15-to 19-year-olds age group. Nevertheless, four out of ten American girls get pregnant at least once before age 20. Clearly teen pregnancy remains a serious problem, and the economic, social and personal cost for teens, their children, and society are great. Helping teens avoid pregnancy cannot be accomplished by any single program or strategy.
There is no one solution, because the causes of teen pregnancy are complicated and overlapping. There needs to be multiple strategies, new partners, and long-term commitment. Parents are important influences on their children’s decisions, and focusing on boys and young men is critical. Senate Bill 367 takes a giant step in right direction. The bill will focus on kids, involve key players, and make it happen in a coordinated manner.
Chairman Rawson:
Why can we not do anything about the problem of older males preying on the younger women? The issue has bothered me every year I have been in the legislature.
Ms. Del Papa:
We have done initiatives in the past with the district attorneys’ associations, trying to create interest in that regard. Often it gets complicated because of consent factors and we need to continually work with it. The teens we met in our focus groups said there is an increasing problem in our high schools with the issue of date rape. We have done public service announcements in the past with a concentration on the date rape issue, trying to let people know it is a crime.
Chairman Rawson:
Why have women not become more outraged about the issue?
Ms. Del Papa:
I think they are becoming more outraged. When we did the initial tour through the state, it was astounding the people who showed up, who are really concerned. At meetings and sessions, Hispanic leaders demanded the state do more to assist in the teen pregnancy issue and education.
Chairman Rawson:
We could go on a long time on this, but again I give notice to the committee and others, I think we should be doing more on this than we have done. At least I am not seeing the results I want to see in the time I have been here.
Yvonne Sylva, M.P.A., Administrator, Health Division, Department of Human Resources:
I am here in support of S.B. 367. The bill will create and formalize activities about teen-age pregnancies in Nevada. It will allow for the expansion among partners to include parents, juvenile justice staff, family court staff, and two discretionary appointments by me, a representative of the faith-based community, and Mike Willden, the administrator of the Welfare Division. The bill increases the opportunity for collaboration and reduces duplication of services in Nevada. In the past 5 years, 35 CAT groups have done voluntary work throughout the state to develop community-based approaches. During the 5 years, teenage pregnancy rates dropped from 63 per 1000 to 46 per 1000, and we have a goal of 35 per 1000. The rate for Hispanics is 127 per 1000 compared to 27 per 1000 in the Caucasian community, and 75 per 1000 in the African American community. These statistics are not acceptable, and we will develop a marketing campaign to target these populations, and also to focus on adult and adolescent males. Successful prevention programs meet the needs of the community. Funding will allow grants to be awarded to conduct at least one local project in Clark County, Washoe County, and any other county in Nevada. The use of TANF funds will result in a partnership between the Health Division and the Welfare Division.
Michael J. Willden, Administrator, Welfare Division, Department of Human Resources:
I am here to provide information on S.B. 367. This bill provides for the administration of certain activities to reduce the rate of pregnancies among unmarried teenage girls in Nevada.
The federal welfare reform law passed in 1996, requires states to establish goals and take action to prevent and reduce the incidences of out-of-wedlock pregnancies, with special emphasis on teenage pregnancies, and to establish numerical goals for reducing the illegitimacy ratio of the state. As a reminder to the committee, there are four goals in TANF.
They are: (1) to provide assistance to needy families so children may be cared for in their own homes or in the homes of relatives; (2) to end the dependence of needy parents on government benefits by promoting job preparation, work, and marriage; (3) to prevent and reduce the incidence of out-of-wedlock pregnancies and (4) to establish annual numerical goals for preventing and reducing the incidence of these pregnancies; and to encourage the formation and maintenance of two-parent families.
As required, Nevada established its numerical goals to prevent and reduce the incidences of pregnancies in the TANF state plan. The plan states the goal is to reduce the pregnancy rate among women ages 15 to 17 by one-third, to no more than 35 per 1000 by the year 2005. It is my understanding the rate, as of 1999, was 45 per 1000. These statistics are tracked and produced by the Health Division.
Although the Welfare Division has some ongoing initiatives in this area, more are needed to meet the 35 per 1000 goal by 2005.
Division social workers have been involved in the Health Division’s community action teams. These teams conduct community assessments of teen pregnancy and identify potential methods for reducing teen pregnancy through abstinence-based programs. The Welfare Division’s interest in the CAT teams stems from our Supporting Teens Achieving Real-life Success (STARS) program, which focuses on the pregnant or parenting teen population to reduce the likelihood of long-term welfare dependency and accelerate their transition to economic independence. A Welfare Division social worker case manages the teen to ensure regular school attendance, support services are obtained, and other needed services such as life skills, money management, problem solving, decision-making, conflict resolution and parenting classes are provided.
The national welfare reform law also requires states to deal with statutory rape. As such, the Welfare Division has contracted for statutory rape education through the Nevada Public Health Foundation for the past 2 years. The first year was development and production of a 2-hour training curriculum, manual, and compressed video. These were designed to reach state and local law enforcement officials, the education system, and relevant counseling services which provide education and training on the problems of statutory rape so teenage pregnancy prevention programs may be expanded in scope to include men. This year’s contract provides technical training and education to local law enforcement personnel including police, prosecutors and judges, education systems, social services, and other relevant counseling services. The project has also extended its efforts out to the general public to increase awareness of the extent of the statutory rape problems. As far as we know, this is the only education piece on this subject in the West Coast.
In closing, I believe the partnerships and their related efforts, as outlined in S.B. 367, will help the state meet goals of TANF. The TANF funding included in The Executive Budget may be used to fund the activities included in the bill.
Chairman Rawson:
The finance committee staff looks at these various goals, and they see good progress in the first two goals, but not the second two. We will try to use this as a vehicle to show the staff there is more to this plan than originally thought, and they might have a different read on it.
Mr. Willden:
We have done research on other states and we will be happy to provide that information. We would be able to fund $1 million for the first year, and $1 million for the second year. We believe this would allow for 8 to 10 demonstration projects, which we believe is appropriate. We are required to address our funds to the entire population of out-of-wedlock births, not just teenagers.
Chairman Rawson:
I am concerned about the reluctance on the part of the district attorneys to prosecute for statutory rape. I would like to see a policy and some enforcement.
R. Alexis Miller, Lobbyist, Planned Parenthood of Southern Nevada:
The national cost of teen pregnancies to the taxpayers is $7 billion per year. Teen mothers are more likely to rely on welfare, and their babies often have low birth weight. Universal education, access to family planning services, and youth development programs are among the solutions, and S.B. 367 could provide these programs.
Helen A. Foley, Lobbyist, Clark County Health District:
The district strongly supports this legislation, and will work with any and all groups to help in any way.
Dana Bennett, Lobbyist, Nevada State Medical Association:
The association wants to go on the record in support of S.B. 367.
Connie Foxwell, Concerned Citizen:
I am a homemaker and mother of seven children. I commend the committee’s intentions in attempting to deal with teenage pregnancies among unmarried girls in Nevada. For the past 5 years I have worked as an unpaid volunteer leading a CAT under the auspices of the Health Division. Our team promotes abstinence only, or chastity education among faith-based and public school students throughout Northern Nevada, in cooperation with the Catholic Diocese of Reno.
We have been unable to attain any funding from the Health Division or the Nevada Public Health Foundation. Many other teams throughout the state who received grants were promoting birth control and abortion. Nationally, the teen birth rate has fallen, and the explanation is increased abstinence, not the use of more and better contraception.
I feel S.B. 367 as presently written has a built-in bias against parental groups and faith-based organizations. The state partnership as constituted in the bill consists of eight members, only one of whom is a parent, and no representative of a faith-based organization.
Chairman Rawson:
Do you have specific amendments?
Ms. Foxwell:
I feel as though the administration of the funds should be shared among various groups, not just the Health Division. I feel there should be more faith-based representation, and more parents should be consulted.
Chairman Rawson:
You understand the partnership could be stacked with nine parents. The way the bill is written, every person could be a parent.
Ms. Foxwell:
If a member is representing a governmental agency, they are going to act with the interest of the agency as their first priority.
Janine Hansen, Lobbyist, Nevada Eagle Forum:
I have concerns about S.B. 367. I feel the premise incorrect, and the focus should be to reduce teen sexual activity, not pregnancy. Nationally, abstinence education has grown. I tell teens, once you become pregnant, the three choices available will last a lifetime. The choices are abortion, adoption, and keep the baby. Instead, we should encourage teens to decide to be responsible. The bill does not focus on sexually transmitted diseases (STDs), and preventing pregnancy does not stop broken hearts and lives. The broader issue of sexual activity must be looked at.
Nationally, there are wonderful programs promoting abstinence, and warning about drinking and drugs. The approach of Planned Parenthood is to promote oral sex as an alternative to intercourse, and this is not positive. We have not been part of CAT teams, because there are strings attached. We raise our own funds. We would encourage the committee to look at alternatives. The partnership seems top heavy with bureaucrats, and could be stacked with those not using an abstinence approach or pushing for the alternative of adoption. There is nothing in the bill about those approaches. We should believe our teens could make the right choices, and have confidence in them, and encourage them.
Chairman Rawson:
The way this bill is written, do you feel it precludes what you are talking about?
Ms. Hansen:
I would say it does not preclude it, but it is very unlikely it would take place. I would like to see some weight in favor of abstinence education. Also, weighted away from the issue of teen pregnancy.
Senator Washington:
In reading through the bill, the attorney general mentioned the formation of a partnership with two alternate people. Would it suffice if one of the alternates was from the faith-based community?
Ms. Hansen:
It would improve the bill. I would encourage you to have more balance in the partnership.
Senator Washington:
I understand there are two sides to the issue in the faith-based community, but having one geared around teenage pregnancy, such as Crisis Pregnancy Center, which offers alternative solutions to pregnancies and STDs, might add balance.
Lynne Chapman, Lobbyist, Nevada Families Education Foundation:
The foundation is working on a project covering a large range of sexual information, and we are trying to get this information into the hands of teens. We are distributing newspapers with information on virginity, abstinence, dating, rape, teen pregnancies, STDs, and abortions. We are providing these newspapers to private schools, home schools, churches, and individuals. We raised all the money needed from private donations.
Chairman Rawson:
Ms. Sylva, can you give assurance there will be a wide spectrum of views looked at and dealt with as this goes forward?
Ms. Sylva:
Absolutely, the division has done a great job in including all parties on this issue because it is so complex. Page 3, of the bill, lines 40 through 45, clearly states any program selected needs to have been proven to be successful in reducing teen pregnancies among unmarried girls. It also is to utilize innovative techniques as the partnership determines are likely to reduce the rate of pregnancies. The reporting requirements will let the legislature know the progress we are making.
Chairman Rawson:
I think it is important to note here we have a federal mandate and a federal mechanism. The problem needs balance, and there is no one specific approach. There has to be a way for all aspects of the community to be represented. We cannot speak to the issue of why a particular CAT team has not received money, because we do not know anything about what their proposals looked like. But we would like you to work with those who may be less sophisticated, so they may be able to put some of their ideas to work.
William Lloyd, Concerned Citizen:
I am a member of the board of the Crisis Pregnancy Center, and I am neutral on the bill. I can say as far as faith-based organizations go, I believe there are issues of mistrust existing between the government and these organizations. I would hope the Health Division would be sensitive to those feelings, and personally, I believe the government can play a role in this problem.
Chairman Rawson:
We will close the hearing on S.B. 367, and open the hearing on S.B. 318.
SENATE BILL 318: Creates task force on prostate cancer. (BDR 40-1045)
Nikki Meleskie, Executive Director, Family to Family: Americans for Prostate Cancer Support:
Governor Kenny Guinn was the first governor in the country to declare September as “Prostate Cancer Awareness Month,” and since then 37 governors have followed suit. Today the Senate and the Assembly declared April 2 as Prostate Cancer Awareness Day.
Prostate cancer is one of the most commonly diagnosed cancer tumor in American men, second only to skin cancer among men. Many patients still suffer from the embarrassment of diagnosis, pain, treatment and premature death. Increased diagnosis of young men under age 35 is frightening. Section 5, of S.B. 318 states the task force may compile research and information concerning prostate cancer, and section 6 states the director of the Department of Human Resources shall provide the personnel, facilities, equipment and supplies required by the task force. These are the most important parts of the bill, and we should not forget the need to increase funding for research. Nevada lacks a urology department for clinical trials. More people die from cancer each year than have died in all the wars in our history.
Lew Musgrove, Concerned Citizen:
I am a survivor of prostate cancer. The urologist who did the surgery requested me to start a prostate cancer survivors group. My own support group in Las Vegas averages 85 to 90 participants per meeting. We receive two to three telephone calls per week from those people who are newly diagnosed, and they are frightened. An interesting fact is, in the past 3 to 4 years, newly diagnosed prostate and breast cancer statistics have been nearly identical in numbers, and so has the death rate. The American Cancer Society has estimated the figures will drop this year, and they credit early detection. Men aged 45 and over, and those aged 35, with a family history of prostate cancer, and African Americans should be tested annually for prostate cancer. Bringing awareness to the men of Nevada for early detection means a better chance of survival.
Senator Washington:
I would like to commend the participants here today, and I urge the committee to strongly support S.B. 318.
Chairman Rawson:
There have been a lot of high-profile reports on breast cancer, and attitudes have changed. Currently there is a change in attitudes towards prostate cancer. Cancer is a bad word, no matter what type, and it affects all in the family. I am a 3-year prostate cancer survivor, and the difference between having something premalignant and malignant is life and death to you. It absolutely can make a difference in the quality of life.
Mr. Musgrove:
There is some general education needed for the medical profession, and they should eliminate the word “normal” from their vocabulary.
Maureen Brower, Lobbyist, American Cancer Society:
The society appreciates the introduction of this bill. We would like to recommend the task force be placed under the health division, who would staff the meetings. We believe there should be a small appropriation for the task force to allow the Health Division to draft the report, and the American Cancer Society would like to be a part of the task force.
Ms. Meleskie:
I have no problem with the American Cancer Society being a part of this. In the past couple of years, we have had some difficulty in encouraging the society to emphasize the screening process. Communication on the Internet shows these concerns are shared across the board.
Chairman Rawson:
Does that concern come out of their channeling resources to higher profile cancers, or is it a difference in philosophy concerning treatment?
Ms. Meleskie:
I think it is all of the above. When you walk into the office of the society, the literature is very slim, and there have been some questions across the nation whether they are going to fully support prostate screening. I think screening is the biggest issue, and the controversy between the American Cancer Society, the scientific community, and the patient community, with the National Cancer Institute in the middle, has been ongoing. I do see some relief from it.
Senator Wiener:
The fact they have come forward and asked to be a part of this is more than symbolic to me. If they want to play a role, there may be an opportunity to bring them in, and a chance to sell them on your ideas.
Ms. Meleskie:
I have no problem with that, and I agree with you. I would like to see their administration involved in this, rather than a representative from the prostate cancer community.
Mr. Musgrove:
I sit on the leadership council for the Southern Nevada American Cancer Society, and serve as the chairman of the prostate cancer committee for the American Cancer Society, so I think we can share involvement.
Chairman Rawson:
Committee, your pleasure on this bill.
SENATOR WASHINGTON MOVED TO DO PASS S.B. 318.
SENATOR AMODEI SECONDED THE MOTION.
THE MOTION CARRIED. (SENATOR TOWNSEND WAS ABSENT FOR THE VOTE.)
*****
Chairman Rawson:
We will now open the hearing on S.B. 406. I will turn the chair over to Vice Chairman Washington for a short time.
SENATE BILL 406: Provides additional exception to prohibition against certain referrals of patients by health care practitioners. (BDR 40-596)
Senator Amodei, Capital Senatorial District:
Senate Bill 406 is a response to requests by constituents in the district. Serving as the vice chairman on the Governor’s task force for public access to health care, we were looking for people to provide quality health care throughout the state. This bill represents an opportunity we think is important to have as a tool when we try to tackle the issue of quality infrastructure resources. The bill is coordinated to comply with “Stark” legislation (antikickback legislation, illegal under federal and state laws). The substance of the bill safeguards the limitations on the authority of the self-referral issue. There is a rural flavor to the measure, and the bill works to provide an option we think is necessary, without coming to the state for additional funding. In underserved areas, it is important to give the opportunity to people involved in the care-giving area, subject to some extensive limitations.
Mary C. Walker, Lobbyist, Carson-Tahoe Hospital:
Nevada is one of the most restrictive states regarding physician ownership. Referrals to ambulatory surgical centers only are currently not limited. Senate Bill 406 expands the law to allow physicians ownership in limited surgical hospitals located in counties with populations under 100,000. We first looked at expanding this in Carson City only, and then we met with the Nevada Rural Hospital Project and the Nevada Hospital Association, and concluded if this is good for Carson City, why not the rural areas also. Nevada rural areas have serious problems attracting and retaining physicians in their communities. This bill will give a mechanism to allow physicians to own a part of the medical services, which will attract new recruits. As a safeguard to the rural hospitals, the physician referrals to the limited surgical hospitals cannot be made unless the local hospital concurs, or the board of county commissioners has determined there would be no substantial adverse financial effect on any other hospital serving the community. We do have a number of checks and balances on lines 10 through 30, of S.B. 406 including assurances the physician discloses ownership interest to the patient.
Joan Lapham, Director, Carson Ambulatory Surgical Center Incorporated:
In Carson City, we have had great success with partnerships between the physicians and the hospital in a variety of venues. We have been successful in providing the availability of medical services in our community. This bill provides the option to further develop these partnerships. We do have a common goal for affordable and quality health care. We believe a surgical hospital could be a very cost-effective setting in which to provide these services in our community. We have been working on consensus for the past 6 months, to relieve apprehensions of any entities in the state who might be affected by this bill. The following support this bill, or are neutral: Carson-Tahoe Hospital, Carson-Tahoe Hospital staff physicians, the Nevada Rural Hospital Project, the Nevada Hospital Association, and the Nevada State Medical Association.
Vice Chairman Washington:
I have received e-mail from a Dr. David Gissen stating some concerns with S.B. 406. Has he conveyed these to you?
Ms. Walker:
We received this just before the meeting.
Vice Chairman Washington:
What type of effect would the suggested amendments have on the bill? He is requesting, in your list of requirements for a physician to be an investor in a surgical hospital, deletion of the word “either” on line 31.
Ms. Walker:
We specifically wrote “either” in order to protect the rural hospitals. When a physicians group comes into an area, we want to make sure they either partner with the hospital or they go to the county commissioners, in order to determine there is not an adverse fiscal effect on the hospital and to provide an option.
Steve Smith, Administrator, Carson-Tahoe Hospital:
I would like to clear up the fact that Dr. Gissen really does support the hospital. This language would have been even more restrictive. Dr. Colgan, who is on the board of Carson Ambulatory Surgery Center Incorporated (CASCI), has stated all of the staff of CASCI supports the bill. Dr. Gissen is on the staff of CASCI. Carson-Tahoe Hospital is the only public hospital in the state that is self-sufficient, with no taxpayer support. The reason is due to the relationship with our medical staff. Currently we have a limited partnership with CASCI. Most of our physicians are on staff at both facilities. In July of this year, the federal government allowed the expansion of ambulatory surgery centers. A patient can stay up to 3 days, instead of 24 hours. The partnership is precluded from this because of state law. We are the only state in the West not allowing this. Without any action on the part of the legislature, any national firm making money from ambulatory surgery could construct a center here in Carson City, and effectively take all of the paying patients out of Carson-Tahoe Hospital. This would leave all of the uninsured patients we now take care of, and reduce our revenue by one-third to one-half.
Robin Keith, Lobbyist, Nevada Rural Health Project Foundation:
We have been working with this group for several months, and we support Senate Bill 406.
Senator Amodei:
By way of wrap up, we have talked about institutional failure in Elko, Ely and Tonopah. This is not a Carson City problem. Participation is welcomed by any group of care providers in the state. Any improvement to rural healthcare is important.
Chairman Rawson:
There was no opposition, and as far as you know, everybody is in agreement. What is the pleasure of the committee?
SENATOR WASHINGTON MOVED TO DO PASS S.B. 406.
SENATOR WIENER SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS TOWNSEND AND SCHNEIDER WERE ABSENT FOR THE VOTE.)
*****
Chairman Rawson:
We will reopen the hearing on S.C.R. 17.
Senator Wiener:
For the record, I am Senator Valerie Wiener, Clark County Senatorial District No. 3. I seek your support for Senate Concurrent Resolution 17, which urges state agencies and school districts to take steps to increase public awareness of certain eating disorders.
Researchers estimate from 55 percent to 90 percent of women experience some level of discomfort with what they see as their physical appearance. The primary reason for these distortions is the direct result of how the media has conditioned us. Body hatred goes deeper than mere appearance. It can create severe self-defeating behaviors, such as those described in S.C.R. 17.
I would like to share my own story with you. While attending law school in 1978, I struggled with my grades. Until that point in my scholastic career, I had been an exceptional student. I could not break into that performance level at law school. During my second year, I joined a “slimnastics” class, and I devised a terrific diet to improve my mental and physical health, I thought.
Within months, I had slimmed down to 85 pounds and dropped eight clothing sizes. I expanded my daily regimen to include diet pills, water pills, vitamin C, and laxative tablets. I had become my own kind of “addict.”
During my months as an anorexic, at age 29, I maintained my studies; but I suffered an upper-body paralysis, and spent a year in a sling suffering from unrelenting pain. I experienced panic every time someone got near me.
The endless pain continued and prevented me from finishing exams. I took a leave of absence 5 weeks before the end of my third year, and I never returned to law school. Today, 15 years since my last “slip,” I am in recovery.
It is this message we, as legislators, can share with those who feel alone and alienated by eating disorders; S.C.R. 17 will help shed light on the issue, and provide hope for the many victims in Nevada who otherwise feel alone with their disorders. I urge your support for S.C.R. 17.
Rick C. Bennett, Lobbyist, University of Nevada, Las Vegas:
I cannot add anything more strongly about the bill than what we have just heard. The university supports this measure.
Helen A. Foley, Lobbyist, Clark County Health District:
We applaud Senator Wiener for bringing forth this legislation, and we support it.
Chairman Rawson:
We will close the hearing on S.C.R. 17, and I will entertain a motion.
SENATOR AMODEI MOVED TO ADOPT S.C.R. 17.
SENATOR MATHEWS SECONDED THE MOTION.
THE MOTION CARRIED. (SENATORS TOWNSEND AND SCHNEIDER WERE ABSENT FOR THE VOTE.)
*****
Chairman Rawson:
What is the pleasure of the committee on S.B. 367?
SENATOR WIENER MOVED TO DO PASS S.B. 367.
SENATOR AMODEI SECONDED THE MOTION.
Senator Mathews:
Mr. Chairman, I am still not clear on how we are going to pay for the prevention.
Chairman Rawson:
Federal TANF money will be used for the prevention, and I can tell you it has been presented to the subcommittee on the budget. There is a mandate, some TANF money be used for teen pregnancy prevention, and it will be used regardless of this bill.
Senator Wiener:
Mr. Willden shared with me that as we receive awards in other arenas of welfare, if we do reduce our teen pregnancy rate we can get up to $2.2 million a year for each year we reduce the rate, so there is a financial reward if we accomplish the reduction of teen pregnancies.
Chairman Rawson:
That does not change some of the concerns people have about this issue. I think we need to express the intent as it was represented to us; there would be a faith-based member on the team, which does not solve all of the concerns, but it does broaden it out.
Senator Washington:
I might state my concern with the bill. I would like one of the two discretionary positions be assigned to the faith-based community.
Chairman Rawson:
It has been discussed, and the committee agrees. Also, I asked Ms. Sylva to represent to us that she would promote a broader look at the programs; in other words, try to encourage some diversity in the programs. We can draft a letter of intent and ask for some specific reports on this.
Senator Wiener:
I would like to remind the committee, reports are required under the bill. Each local project will report to the Health Division to show how they accomplish the goals of the grant, and the Health Division is to report to the legislature.
Chairman Rawson:
In the letter of intent, let us request regular reporting to the interim Legislative Committee on Health Care, which is a standing committee.
Senator Mathews:
The administrator appoints the persons for the partnership as spelled out in section 1, line 8, of S.B. 367. I am concerned sometimes minority groups get lost, and these appointees do not indicate any people of color.
Chairman Rawson:
Let us also express that in our letter of intent. Ms. Sylva said we must get to these communities, because within them is where we have the greatest problem.
Senator Mathews:
It is still difficult to work with this kind of structure. The people who are in charge are the people who will come, and they will not send people who really add voices and faces to this issue.
Senator Washington:
Those down in the trenches working with these problems day-to-day do not get invited, both from the Hispanic and the African American communities.
Chairman Rawson:
When the letter of intent is completed, it will be presented to the committee, and will not go out until the committee is satisfied with the content.
Senator Wiener:
We were looking at targeting the minority communities when putting this bill together, and we came up with the language of “populations with high rates of teen pregnancies” in order to address this without necessarily naming the minority communities.
Senator Mathews:
Social conditions seem to be what often dictates the problem. I think we need to recognize those in low socio-economic positions need to have a say. As I look at the structure of the bill, this is not identified, unless we put it in the intent.
Chairman Rawson:
I have expressed a concern about getting to the issue of older men and younger women. I would like it emphasized in the letter of intent.
Senator Wiener:
We were trying to address the issue in the language of S.B. 367. We did not wish to weight it in any way. I asked everybody involved if there was some way we could describe who we could put on this partnership in order to reach a specific population, and we could not. Someone suggested appointing a person from substance abuse, but doing so might cause people to assume they are all substance abusers. We could not come up with one specific recommendation to address this problem.
Senator Washington:
One other concern I have is STDs, which seems to have slipped through the cracks. There is definitely an increase in the problem, and it needs to be addressed.
Chairman Rawson:
I understand your concern. This issue is about teen pregnancy. Are you asking for an amendment?
Senator Washington:
Yes, I am. I do not know where the language would fall. We could indicate as one part of their tasks, the partnership could look at a plan to reduce STDs, or at least educate tying the two together, so they are not two separate issues.
Chairman Rawson:
I am not sure they should be tied together in this bill.
Senator Wiener:
This bill is a direct product of a federal mandate dealing with out-of-wedlock pregnancies. I would be certainly willing to address our concerns in the letter of intent, without putting it into the bill itself.
Chairman Rawson:
When you link pregnancies and STDs together, the tendency is to get into a protected discussion about sex and condom use. We have not solved the problem if that is the net result.
Senator Washington:
I would probably advocate abstinence, not the use of condoms.
Chairman Rawson:
That is what I am saying. By linking the two, there is a tendency to draw them together.
On the issue of S.B. 367, all those in favor?
THE MOTION CARRIED UNANIMOUSLY.
*****
Chairman Rawson:
The meeting is adjourned at 4:30 p.m.
RESPECTFULLY SUBMITTED:
Cynthia Cook,
Committee Secretary
APPROVED BY:
Senator Raymond D. Rawson, Chairman
DATE: