MINUTES OF THE meeting
of the
ASSEMBLY Committee on Health and Human Services
Seventy-Second Session
March 12, 2003
The Committee on Health and Human Serviceswas called to order at 1:38 p.m., on Wednesday, March 12, 2003. Chairwoman Ellen Koivisto presided in Room 3138 of the Legislative Building, Carson City, Nevada, and, via simultaneous videoconference, in Room 4406 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:
Mrs. Ellen Koivisto, Chairwoman
Ms. Kathy McClain, Vice Chairwoman
Mrs. Sharron Angle
Mr. Joe Hardy
Mr. William Horne
Ms. Sheila Leslie
Mr. Garn Mabey
Ms. Peggy Pierce
Ms. Valerie Weber
Mr. Wendell P. Williams
COMMITTEE MEMBERS ABSENT:
None
GUEST LEGISLATORS PRESENT:
None
STAFF MEMBERS PRESENT:
Marla McDade Williams, Committee Policy Analyst
Terry Horgan, Committee Secretary
OTHERS PRESENT:
Blanca A. Vazquez, Lobby Team, Clark County, Nevada
John Haldeman, Executive Director, Laughlin Family Resource Center
Glady Laughlin, Member, Board of Directors, Laughlin Family Resource Center, and Principal, Bennett Elementary School
Frank A. Hall, Licensed Clinical Social Worker
Chairwoman Koivisto announced that a panel of three people from Laughlin, who had been quite innovative in providing mental health services to the citizens of that community, would make a presentation. She asked Blanca Vazquez from Clark County to introduce the panel.
Assembly Bill 183: Makes appropriation to Clark County for provision of mental health services in Laughlin. (BDR S-1075)
Blanca Vazquez, representing Clark County, introduced the panel from Laughlin who were to present their community’s response to the lack of mental health services available to its residents.
John Haldeman, Executive Director, Laughlin Family Resource Center, thanked the Committee for allowing him to speak on behalf of the community of Laughlin. Mr. Haldeman explained that Family Resource Centers were the result of prior legislation passed to develop community stakeholder bases that worked with the state and helped people navigate the bureaucratic systems and receive services. Laughlin, he continued, had been able to use community-based volunteers as well as industry and business leaders to bring senior citizens’ programs and children’s programs to their community. Mr. Haldeman commented that ten years ago the citizens endeavored to get mental health care but had been unsuccessful using the state rural mental health programs. Proposals to include mental health services to Laughlin in the budget, he added, never made it through any legislative session. As a result, community leaders, the Family Resource Center’s Board of Directors, and the community council had looked for a granting source. The Legacy Foundation made a $37,000 grant that enabled the Family Resource Center to hire a licensed clinical social worker to do counseling in Laughlin for 17 weeks out of the year.
What the panel was asking for, Mr. Haldeman emphasized, was enough money to hire the services of a psychiatrist for Laughlin. A psychiatrist, he noted, would add another dimension to Laughlin’s mental health services, and families
and senior citizens would have access to some mental health care until another way of funding a stand-alone clinic was found.
Assemblywoman Leslie, mentioning she was from northern Nevada and not completely certain where Laughlin was located in Clark County, asked which of the state’s rural mental health clinics was supposed to be serving the Laughlin area.
Mr. Haldeman replied that a few years ago, the state planned to put mental health clinics in Mesquite and Laughlin. Mesquite received a clinic, but Laughlin had not, he noted. Mr. Haldeman added that Laughlin was about a two-hour drive from Las Vegas.
Assemblywoman Leslie opined that Laughlin residents would have to drive to Las Vegas to access state mental health services.
Assemblyman Hardy expressed enthusiasm for Mr. Haldeman’s personal efforts, and those of many other Laughlin citizens, for what they had been able to accomplish. He noted that the road between Laughlin and Las Vegas was “horrendous” and much in need of major repairs. Mr. Hardy acknowledged that there was a growing population in Laughlin that needed access to appropriate mental health.
Glady Laughlin, Member, Board of Directors, Laughlin Family Resource Center, and Principal, Bennett Elementary School, thanked Assemblyman Hardy for recognizing the complexity of accessing family services in Laughlin. Ms. Laughlin mentioned that she had arrived in Laughlin as principal of the elementary school in 1992 and realized that there was no access to mental health services in Laughlin. She emphasized that the situation was dire because there was a corresponding lack of childcare in Laughlin that had led to a corresponding lack of early childhood readiness skills and social skills. Those deficiencies, she explained, affected the schools because stabilized caregivers were better able to provide their children with feelings of comfort and security. Ms. Laughlin emphasized the need for a sustained presence in the mental healthcare arena to instill a level of trust and confidence in the process of receiving mental health care. She added that it seemed as if mental health was not treated the same way that heart attacks or diseases were, but Ms. Laughlin believed the lack of stable families was a cancer having a dramatic impact on Laughlin. As an example, Ms. Laughlin testified that during the past three weeks, children in need of mental health care had battered school employees. She explained that one of the children was on numerous complicated medications requiring a great deal of supervision; however, as the child had grown physiologically, the prescriptions had not been adjusted. Ms. Laughlin indicated that every second or third week, a counseling social worker, brought through the resources of the Legacy Grant, came to Laughlin. Ms. Laughlin pointed out that many of Laughlin’s families did not have cars, so driving to Las Vegas for mental health services was out of the question. Ms. Laughlin also reminded Committee members of the community of Laughlin’s substantial contribution in tax monies to Nevada, and said that they should be able to get “something” back.
Chairwoman Koivisto asked what the population of Laughlin and its surrounding service area was.
Ms. Laughlin replied that Laughlin’s population was 7,076 with an elementary school population of approximately 400 children and a middle and high school population of about 400 also.
Mr. Haldeman pointed out that the figure given for Laughlin’s population of 7,076 was from the federal census. He added that there were another 4,000 to 5,000 senior citizens who lived in the area for about six months during the winter. He also emphasized that there were millions of visitors to Laughlin, and that oftentimes the resort casinos requested mental health resources.
Frank Hall, Licensed Clinical Social Worker, testified that he had been approached by a major rural mental health provider in late 1998 to help with a needs assessment. The company believed there was potential to make money on mental health care in rural America by operating using a sliding fee scale. In January 1999, the company opened a clinic in Laughlin; however, the parent company was bought and sold several times, and abandoned the project. The Legacy Foundation stepped in, and the town put together “a really remarkable plan” that was truly a community effort. They employed Mr. Hall to come treat clients every two or three weeks, the casino industry provided him with a place to stay, the town provided him with a place to see clients, and the Legacy Foundation paid the bill. This was a true example of creative community services, he added.
Chairwoman Koivisto emphasized that the citizens of Laughlin had done a remarkable job on their own with few resources. She pointed out that the appropriation in A.B. 183 was a one-time appropriation from the state General Fund to Clark County for disbursement to the Laughlin Family Resource Center.
Assemblywoman Leslie agreed that need had certainly been demonstrated. She noted that, because A.B. 183 would be going to Ways and Means, the Committee’s vote would be a vote on policy. Noting that the funding was “one-shot,” she inquired what would happen when the funding was used up.
Mr. Haldeman answered that they had a commitment from the Legacy Foundation to have their grant be a companion to the state funds, should the bill pass. He explained that there would then be enough money to create a model over the next two-year period. The model, with a pro forma, could develop the ability to bring additional funding back from the state or other foundations. He stated that the rural mental health clinic looked as though it could service all clients and almost pay for itself and possibly become self-sufficient in a two-year period. The best-case scenario, Mr. Haldeman continued, would be that Laughlin alone could sustain a mental health clinic. A more realistic scenario, he added, would be that the need for funding would be decreased. With a pro forma they could see how much they could expect to bill and what their clients’ financial and insurance situations were. At least after two years, they hoped to have a great model and a great pro forma to bring back to the Legislature and to other grant funding sources.
Mr. Hall explained that currently, social workers in private practice could not “capture” Medicaid funding, but he noted that was “being discussed.” He acknowledged that when the privately owned Laughlin Community Mental Health Center was operating, if it could have captured the Medicaid dollars of the patients he saw who were Medicaid eligible, it would have been of enormous financial help.
Assemblyman Hardy indicated that he had been singularly impressed with the citizens of Laughlin and what they had been able to do within their community. He commented that they were very isolated and almost an island, but it was an island of activism with people very involved and dedicated to their community. He mentioned that a very successful and well-attended health fair had been sponsored by the community, that there was a lot of volunteerism in Laughlin, and that he had a lot of confidence that the citizens of Laughlin would figure out a way to make such a project work. Mr. Hardy believed if the Legislature facilitated Laughlin’s mental health project by enabling them to capture Medicaid funds and providing the one-shot appropriation requested in A.B. 183, it would go a long way towards helping the community.
Assemblywoman Weber, remarking that the people from Laughlin had done an outstanding job, mentioned that the major employer in Laughlin was gaming and inquired whether there were any employee assistance programs available through any of those major employers.
Mr. Hall responded that there were and that most of the properties on the river had good employee insurance. He added that most required an employee contribution. However, he noted that most of the children and senior citizens he treated were unemployed.
ASSEMBLYMAN HARDY MOVED TO DO PASS AND RE-REFER A.B. 183 TO WAYS AND MEANS.
ASSEMBLYWOMAN ANGLE SECONDED THE MOTION.
THE MOTION PASSED UNANIMOUSLY.
Chairwoman Koivisto reiterated that A.B. 183 would go to the Assembly Ways and Means Committee and that the contingent from Laughlin would be notified when their testimony would be needed again. With no further business to come before the Committee, the meeting was adjourned at 2:09 p.m.
Terry Horgan
Committee Secretary
APPROVED BY:
Assemblywoman Ellen Koivisto, Chairwoman
DATE: