MINUTES OF THE meeting
of the
ASSEMBLY Committee on Commerce and Labor
Seventy-Second Session
April 28, 2003
The Committee on Commerce and Laborwas called to order at 2:28 p.m., on Monday, April 28, 2003. Chairman David Goldwater presided in Room 4100 of the Legislative Building, Carson City, Nevada, and, via simultaneous videoconference, in Room 4401 of the Grant Sawyer State Office Building, Las Vegas, Nevada. Exhibit A is the Agenda. Exhibit B is the Guest List. All exhibits are available and on file at the Research Library of the Legislative Counsel Bureau.
COMMITTEE MEMBERS PRESENT:
Mr. David Goldwater, Chairman
Ms. Barbara Buckley, Vice Chairwoman
Mr. Morse Arberry Jr.
Mr. Bob Beers
Mr. David Brown
Mrs. Dawn Gibbons
Ms. Chris Giunchigliani
Mr. Josh Griffin
Mr. Lynn Hettrick
Mr. Ron Knecht
Ms. Sheila Leslie
Mr. John Oceguera
Mr. David Parks
Mr. Richard Perkins
COMMITTEE MEMBERS ABSENT:
None
GUEST LEGISLATORS PRESENT:
None
STAFF MEMBERS PRESENT:
Vance Hughey, Committee Policy Analyst
Wil Keane, Committee Counsel
Diane Thornton, Senior Research Analyst
Corey Fox, Committee Secretary
OTHERS PRESENT:
David Rosin, State Medical Director, Division of Mental Health and Developmental Services
Dr. Weldon Havens, CEO, Clark County Medical Society, Legal Counsel
Trey Delap, Deputy Executive Director, Board of Osteopathic Medicine
Steven Mack, Chairman, Court Reporter Board, State of Nevada
Dawn Jackson, Executive Director, Court Reporter Board, State of Nevada
Stephanie Koetting, Nevada Court Reporters Association
Chairman Goldwater:
We’ll bring the Committee to order. Note that everyone is present. We don’t have a quorum yet, but I’ll note, for the record, when we do get one. [Opened the hearing on S.B. 133].
Senate Bill 133 (1st Reprint): Authorizes Board of Medical Examiners to issue restricted licenses that allow certain psychiatrists to practice medicine at certain mental health centers. (BDR 54-508)
David Rosin, State Medical Director, Division of Mental Health and Developmental Services:
[Introduced himself and submitted prepared testimony (Exhibit C)]. Good afternoon, Mr. Chairman. I am here this afternoon to testify in support of S.B. 133. This bill was requested by the Division of Mental Health and Developmental Services (MHDS) to enable our Division to maintain an adequate number of treating psychiatrists and to ensure continuity of care of our patients during times of staff shortages and staff turnover.
Locum tenens psychiatrists are physicians who are licensed to practice in many states and earn their livelihood by providing short-term care when they’re needed. They are called on to fill in as need arises. We have used them extensively, here in Nevada, to provide continuity of care for our clients at time when there has been a shortage of psychiatrists. They are used extensively nationally, as well.
Following the last legislative session, NRS Chapter 630 was interpreted by the State Board of Medical Examiners in a way that created some hardship for our Division, creating a barrier to licensure to some of these physicians and thereby creating hardship for us in hiring temporary physicians to fill our needs. The barrier that we experienced was a requirement of taking an examination, which was the SPEC examination. The SPEC examination is a general medical test that measures issues such as medicine, surgery, pediatrics, et cetera. It does include some psychiatric issues, but that is a minor part of the test.
As an aside, I have taken that test. I left practice in 1994, after 24 years of private practice, to lead a medical strike force in Central Africa. When I returned to the States and wanted to practice, and I came here to run the northern Mental Health System and become a State Medical Director, I, in fact, took the SPEC exam. To do that, I bought a textbook of family practice and a textbook of medicine and spent almost three weeks reading two major textbooks. I did pass the examination. I was quite motivated to come; however, locum tenens psychiatrists work in many states that don’t have this requirement. Where they are very well-trained psychiatrically, most of the psychiatrists have had very little recent experience in the general practice of medicine. This SPEC examination tests for medical examination roughly two years following residency training. So, where we had many applicants who were qualified psychiatrists, they did not qualify to get a license in this state because they had not had psychiatric board exams taken in recent years.
S.B. 133 enables qualified, competent psychiatrists to practice psychiatry only with a limited license in our own facilities, under our own direct psychiatric supervision. It does so without forcing them to take a general medical examination, which is outside their area of expertise. Passage of this bill will allow for unbroken patient care at times when we are short of psychiatrists. [S.B. 133 would] take us out of the position we were placed in over the past two years, where we have been trying to provide psychiatric care to growing populations with very limited resources. I’d like to thank you for considering S.B. 133 and I would be happy to answer any questions.
Chairman Goldwater:
Thank you, Dr. Rosin. Keith Lee of the State Board of Medical Examiners has represented to me that the State Board of Medical Examiners has no problem with this bill. Is there anybody who has other questions? I don’t see any. Is there anybody else here who is testifying on this bill? Note for the record a quorum is present. Sir?
Dr. Welden Havens, CEO, Clark County Medical Society, Legal Counsel:
We are here to testify in favor of the bill.
Chairman Goldwater:
Thank you, Dr. Havens. Further testimony? I don’t see any. Now that a quorum is present, I’ll accept a motion.
ASSEMBLYMAN HETTRICK MOVED TO DO PASS S.B. 133.
ASSEMBLYMAN BEERS SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
Chairman Goldwater:
Next on the agenda is S.B. 281.
Senate Bill 281: Revises provisions relating to osteopathic physicians. (BDR 54‑985)
Trey Delap, Deputy Executive Director, Board of Osteopathic Medicine:
Good afternoon, Mr. Chairman, and members of the Committee. There was a handout (Exhibit D) outlining what I am going to say today on S.B. 281. S.B. 281 was originally introduced by Senator Shaffer. It was heard twice in the Committee and, ultimately, passed with a unanimous vote in the Senate on April 11, 2003. S.B. 281 seeks to achieve four objectives.
The first section would provide for a criminal background check of any applicant for the osteopathic physician or osteopathic physician’s assistant. The background check would help the board identify whether or not grounds for disciplinary action exists prior to the issuance of a license. We recently adopted regulations that would provide for any activity that would be grounds for disciplinary action that occurs before the issuance of initial license is grounds for denial of a license. It also provides for us to double-check the truthfulness of an application submitted in connection with license to practice osteopathic medicine or renewal of a license to practice osteopathic medicine. Lying on an application form is itself a felony.
Currently, there are eight states that require background checks. Six states are currently considering adding criminal background checks to their licensing procedures. These checks provide an additional layer of protection to the public from felonious physicians or physicians who would seek to escape criminal or negative history in other states. The Board may issue a provisional license to an otherwise qualified osteopathic physician, pending the return of their background check so we won’t be denying the public the service of a qualified physician waiting for the FBI to come back with their background check, because we are well aware that they have quite a lot of workload at this point.
The second objective is to increase the membership of our Board from five members to seven members. We would like to add an additional physician and an additional public member. The reason for this is that the workload of the Board has steadily been increasing and we are aware of changes that occurred in A.B. 1 of the 18th Special Session, and some pending legislation that is for your consideration at this time, that would require more thorough review of malpractice settlements and other information relating to professional liability. That increase in workload is cumbersome, so we are looking to expand our Board to be more efficient and respond more quickly to these issues.
The next section lightens up our strict confidentiality statute. The way it’s written now, all information, pursuant to an investigation, is held strictly confidential. The problem we’ve been encountering is in working with federal agencies or other regulatory boards in other states in securing investigative information, because we won’t share it with them, so why would they share it with us? Most boards in the United States will share confidential information among boards, so we are seeking to get that kind of language for ourselves, as well.
The final section of the bill corrects what is a de jure exclusion of osteopathic physicians from different chapters of NRS. We were looking through the NRS and there appears to be, over the past several years, an oversight on behalf of the LCB [Legislative Counsel Bureau] when they were drafting bills. They would draft a bill that says a physician is someone licensed pursuant to NRS 630 that only includes allopathic physicians, or M.D.s. Not only does it not include D.O.s [doctors of osteopathic medicine], but D.O.s are exempt from certain responsibilities. This bill would correct all of that language. In drafting this section of our bill, we discussed it with Brenda Erdoes with the LCB, and she recognized that there was an oversight that occurred and recommended that we come before the Legislature to correct the oversight because it was beyond the scope of a reviser’s note. That is, basically, the purpose of S.B. 281, and I would be happy to answer any questions.
Chairman Pro Tempore Hettrick:
Any questions from the Committee? I don’t see any.
Assemblyman Beers:
I’m reading the language in Section 1, and as I read it the first time, which was too hurriedly, it was unclear to me whether or not you are expecting the osteopathic physician to provide his or her fingerprints, or those of the assistant there seeking to register with you. I may just need to read it a couple times, slowly, to get comfortable with the language. Your intent there would be that, currently you have no fingerprints for any osteopathic physicians in the state?
Trey Delap:
That’s correct.
Assemblyman Beers:
Over time, with renewals, new licensees, and the licensing of assistants, you expect to develop a complete set of fingerprints?
Trey Delap:
The intention of the legislation would be for new applicants for licensure.
Assemblyman Beers:
My problem is on page 2, line 2, “Board must submit to the Board a complete set of his fingerprints.” Looking back at the previous sentences, diagramming the grammar, we have the potential for that to be applied to each osteopathic physician’s assistant for whom an application to employ an osteopathic physician’s assistant [is filed] or the actual osteopathic physician licensee. So, it’s not your intent to get any fingerprints off your historical licensees?
Trey Delap:
That was the original intent. It could be interpreted that the renewal of a license is itself an application for a license. The intention was to implement this procedure with new applicants for licensure and not require current licensees to go through this process. That is the intent. I understand your comments that could be interpreted to apply to renewals as well.
Chairman Pro Tempore Hettrick:
Any further questions? Seeing none, anyone here to testify against the bill? Anyone in Las Vegas? We will then close the hearing on S.B. 281 and we will open the hearing on S.B. 350. Go ahead in Las Vegas.
Senate Bill 350: Authorizes dentist who holds a medical degree to identify himself by that degree under certain circumstances. (BDR 54-928)
Dr. Weldon Havens, Clark County Medical Society:
We are here in support of this bill. This bill would allow a dentist who has earned an M.D. degree to use the M.D. degree without fear of being referred for a felony violation, as currently exists in NRS 630.400. There have been two oral surgeons who have earned M.D. degrees who have been referred for felony prosecutions and have ceased using their M.D. degree that they have earned. We are in favor of this legislation, which would allow them to utilize their M.D. when they have earned their M.D. This bill further states that the dentist must clearly identify himself as a practitioner of dentistry. The Clark County Medical Society is in favor of this bill.
Chairman Pro Tempore Hettrick:
Questions from the Committee? Seeing none, is there anyone here to testify against the bill?
Assemblyman Beers:
I’m looking for some language, and perhaps it is elsewhere in NRS, that describes what the accrediting authority is for the schools that the degrees are earned from.
Weldon Havens:
I’m not aware of where in NRS it’s located. Generally, [one has] to be from an AMA-approved school before one is recognized by the Department of Health and Human Services as an equivalent. That includes the Caribbean school, some of the schools in Mexico, some of the schools in Europe, and the schools in England.
Assemblyman Beers:
And, you don’t know if that is elsewhere in NRS 630 or 631?
Weldon Havens:
I do not. I would think it’s in 630. It’s called a fifth pathway, and that may have been closed as an avenue for licensure for M.D. physicians in Nevada last Session, but it is an accepted method in most states of becoming licensed by going to a foreign medical school.
Chairman Pro Tempore Hettrick:
I think Mr. Keane, of our staff, would like to comment.
Wil Keane:
If I understand the question, it’s about where in NRS we provide which medical schools are adequate for the purposes of Chapter 630. If that’s the question, the answer is in NRS 630.160, subsection 2(b), where they list the kinds of schools that would meet the requirement, NRS 630.160 2(b)(2), to be exact.
Vice Chairwoman Buckley:
Any other questions? Seeing none, we’ll move on to our last bill.
Weldon Havens:
May I just add something? This bill would not qualify a dentist with an M.D. degree to apply for a Nevada M.D. licensed under 630. It would just allow that dentist to utilize the letters M.D. and identify himself as a practitioner of dentistry.
Vice Chairwoman Buckley:
Thank you. The Chairman is back. I will turn it over to you.
Chairman Goldwater:
Were there further questions for the testimony on S.B. 350?
ASSEMBLYWOMAN GIUNCHIGLIANI MOVED TO DO PASS S.B. 350.
ASSEMBLYWOMAN BUCKLEY SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
Chairman Goldwater:
[Opened the hearing on S.B. 395].
Senate Bill 395 (1st Reprint): Revises provisions governing court reporters. (BDR 54-548)
Steven Mack, Chairman, Court Reporter Board, State of Nevada:
[Introduced himself] Good afternoon. With me is Dawn Jackson, our Executive Director. We are here to support this bill. There was an amendment made over on the Senate side. It had to do with Section 7, subsection 12. The words “repeatedly failed” were taken out and replaced with simply “failed.” So, the sentence now reads, “Failed without excuse to transcribe stenographic notes of a proceeding and file a transcript of the stenographic notes.” We have no problem with that change because it actually made it clearer. We support the bill.
Chairman Goldwater:
What was the main reason for introducing the bill in the first place?
Steven Mack:
We needed to clarify several issues, including the fact that we could not… If someone violated the statutes, we had three choices: We could suspend their license, we could revoke their license, or we could do nothing. We’ve made some changes that allow us some fining ability so that we don’t have to take such a harsh action in the event that something they did wrong doesn’t warrant it. Other than that, they’re just corrections to the way that we operate. For instance, the executive secretary, she is full-time. We had to add the words “or full-time” in there. If you look through the bill, they were just corrective measures.
Chairman Goldwater:
Question on the court reporters bill? Ms. Giunchigliani, please.
Assemblywoman Giunchigliani:
Thank you. Is $5,000 a standard fine that we charge in other boards? I know it says, “not to exceed,” I’m assuming you are talking some kind of progressive discipline there.
Dawn Jackson, Executive Director, Court Reporter Board, State of Nevada:
Basically, the $5,000 is because it includes court reporters and firms. It’s possible that a firm could have a violation that’s $5,000, or if it’s a violation, maybe the third time, the max is $5,000. Yes, in other boards, that’s exactly how it’s worded in other boards when it comes to fines.
Assemblywoman Giunchigliani:
But your intent would be some kind of progressive discipline, in other words, and also depending on the egregiousness of what they did wrongly.
Steven Mack:
Absolutely.
Assemblywoman Giunchigliani:
And you still could revoke their license? That does not take that away.
Dawn Jackson:
Oh yes.
Assemblywoman Giunchigliani:
In Section 8, it says “on the cover page and certificate page of all proceedings and…” You got rid of everything but business cards. Is that just kind of updating and cleaning up the language? I’m assuming they would all have business cards.
Steven Mack:
Yes. The number is for our purposes, more than anything else.
Chairman Goldwater:
Can you, for my edification… well, not edification, but more curiosity, tell us a violation that has been occurring where you might fine rather to suspend?
Steven Mack:
Untimely filing of the transcripts. We’ve had some situations where a court has requested a court reporter to have the transcripts by a certain period of time and they don’t, so then we have the ability to come back a take a look at it. Under the statutes now, we probably couldn’t do anything, because we would hate to suspend somebody because they were a couple of days late. But, we’ve got a judge on the other line that’s pretty pissed off. So, it puts us in a situation where we can’t do anything.
Dawn Jackson:
And another one, which is more administrative, would be their failure to update their address or change their name. We have judges or attorneys calling in trying to find a court reporter and we can’t find them because they’ve changed their last name and they haven’t let us know. That would just be more of an administrative fine. We don’t want to revoke or suspend a license for that.
Chairman Goldwater:
See, now you have me worried. If you are going to start fining all your members for not changing their address, then you’re going to have a lot of members upset at you and in here with a bill that’s probably four inches thick for board revision.
Dawn Jackson:
Each year when we send the renewals out, out of 450, we get about 10 back that never updated their address. So now they’re going to get suspended for non-renewal because we had no way of contacting them, or if there is a complaint that comes in, we can’t mail a certified letter to them. Right now, it’s about 10 to 15 court reporters out of 450.
Steven Mack:
Just to address that a little bit further, we’re not going to go out looking for these people. It’s usually if something occurs that would cause us to not be able to get a hold of them.
Chairman Goldwater:
That puts my mind at ease a little bit more. I appreciate that. Further questions regarding the court reporters? I don’t see any. Is there anybody here who would like to testify on this bill? Welcome to Commerce and Labor.
Stephanie Koetting, Nevada Court Reporters Association:
[Introduced herself] We are here in support of this bill, as well. Thank you.
Chairman Goldwater:
You don’t think they are going to be mad when they get a fine?
Stephanie Koetting:
I don’t think there are going to be many instances, and they are probably warranted if they are.
Thanks. Further testimony? I’ll close the hearing on S.B. 395.
ASSEMBLYWOMAN BUCKLEY MOVED TO DO PASS S.B. 395.
ASSEMBLYMAN ARBERRY SECONDED THE MOTION.
THE MOTION CARRIED. (Ms. Leslie, Speaker Perkins, and Mr. Hettrick were absent for the vote.)
Commerce and Labor Committee members, there are 50 bills that have been referred to Commerce and you need only look at your calendar to figure out that we have very few hearing days and very many bills. Watch for agendas coming out; they’re going to be longer. If there is anything that is of particular concern, please communicate that to the Chair. [Chairman Goldwater adjourned the meeting at 2:58 p.m.]
RESPECTFULLY SUBMITTED:
Corey Fox
Committee Secretary
APPROVED BY:
Assemblyman David Goldwater, Chairman
DATE: